HomeMy WebLinkAboutSWISS AIRE LT 4
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MUNICIPALITY.OF ~NCHORAGF
' 'DEPARTMENT~F HEALTH AND'ENVIRONMENIAL~-~)ROTEC¥ION
825 L Street, ~]ch6rage, Alaska 99501
279-25ll, ext. ~224' 225
Date Received: March 17, 1977
Inspection: Time 2nd Inspection: Time
Date ~- J~7 ~. Date
Inspecto= nspector
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
]Lending Institution Request: Lomas & Nettlet0n Company
Mailing Address: 4449 Business Park Blvd.
Phone: 274-7661
2. Property Owner: David Droege Phone: ~/~--'~
Mailing Address~ Contact buyer: Dennis Cullington, 349-5416
3~ Legal Descriphion: Lot 4 Swiss Aire Subdivision
4. Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
4
o
Well Data: Type Community Depth Well Log Filed ( )
Sewage Disposal System: On-site system ( ) Public Utility (X)
Permit ~ Installed Instal ' ' ~ ~' ~'~'
Septic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
Distances: Well to Septic Tank
to Sewer Lines Nearest Lot Line
Absorption Area to Nearest Lot Line
to Absorption Area
' ~ Department of Health and Environmental Protection'
Request £or Approval of Individual Sewer and Water Pacilities
Legal Description: Lot 4 Swiss Aire Subdivision
Comments:
Affadavit Attached: ) Letter Attached: ( )
Approved:~
Disapproved:
Date:
Date:
Department worksheet:
1. Type o~nspecti~n: CMRO VA x~ FHA
2. Property Owner~ ~'~_ ~ ~ '( (_~.0,.
CONV
Mailing Address:
3. Name of Buyer: b~/A ~'~\ ,~,~
4. Name of Lending Institutio,:
Mailing Address: H~fi
5. Name of Realtor or Agent:
Mailing Address: Phone:
Legal Description: ~_([~'J[ R ~' ~'~ '~'~ ~j~ k~-~-' ~ / ~
Location: ~j~ qO SL~-}'\,~ ~)/~. ~
7. Type of Facility to be Inspected:
8. Water Supply
No. Bdrms. q
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well~
Sewage Disposal System
Type of System: Public Utility
Individual
Individual (on-site)
If Individual, date of installation
72-003(3/76)
06.1220(or Rev. 1973
AL,,~ .,A DEPARTMENT OF HEALTH AND SOCIAL
DIVISION OF PUBLIC HEALTH
NDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOG I CAL'FWATER
Lob No
A N A L Y S I S O~,CE r~.;::>:-..
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDU:AL/SUPPLY
D~ometer of Well
WeN Casing
Length of
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
Lactose Broth I Otc 1 Oct I Ouc 1 Otc I 0c¢ 1.0~c I .Otc
]6 1220 lb ~ACTERIOLOGICAL WATER ANALYSIS RECORD
~.J~ GREATER ANCHORAGE AREA BOROUGH
FROM: DEPARTMENT ~ ~_~...~ SUBJECT:~ ~_ ~
INITIATED BY: ~ _.~.~.~ ~_~' .1~" l ~.~ d ~ DATE OF MEMO
DATE ANSWER
TO: DEPARTMENT: ~/.~ REQUESTED
RECEIVER:
REQUESTED ACTION SCHEDULE
~r',R INFORMATION ONLY ~%? PREPARE BACK-UP INFORMATION
FOR IMMEDIATE ACTION CALL ME BEFORE YOU ANSWER
~ NEED YOUR RECOMMENDATION
FOR YOUR CONSIDERATION
OTHER
NUISANCE CO~PLAINT FORM
Street Address:
Phone No~, ~ ~- LAT~ 7..,~ ,B°x No,
-Name of Person Against Whom Complaint is Made: ~
Owner of Property Where Nuisance Exists: ~---~:~.~'~ff ..... ~?;;~7~-fi~-7~-/ff~-~r~- ~
Owner's Address: Phone No.
Location of Complaint: ,~' ~ ~/ ~mzPl~: /~/.~ ~ ?~
Street Address:
Person Receiving Complaint; Q, ~
I certify that such statement of facts is true to the best of my belief and know-
ledge. I request that the foregoing matter be investigated and that appropriate
action thereafter be taken. I am willing to testify to the facts stated in the
foregoing complaint in court if necessary.
Complainant
REPORT OF ACTIOI~' TAKEN
Invest igato~: .A -- ' ....
)ate Investigated: , I 7
ction Taken.'.
3E COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT:
Comp_lslnant ' s Name
Street Address:
MUIS,ANCE COMPLAINT FORM
Phone No. ~/~/~ BOX No.
-Name of Person Afainst Whom Complaint is Made:
Owner of Property Where Nuisance Exists:
Owner's Address:
Location of Complaint:
Street Address:
Person Receiving Complaint
Phone NO.
I certify that such statement of facts is true to the best of my belief and know-
ledge, I request that the foregoing matter be investigated and that appropriate
action thereafter be taken. I am willing to testify to the facts stated in the
foregoing complaint in court if necessary.
Complainant
Invest igatoP:
)ate Investigated:
ction Taken;
REPORT OF ACTIOI~' TAKEN
COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT: