HomeMy WebLinkAboutBRUCE Lot 10File ~),~ 4-1
Roy ~. Sierke~
Aueho~ef.. Alaoh 0lt0~t
Lot 10o B~dee Subdt~
well 18 ~ elude to the eesopool which ~os fh,~
pFopex~,
old .ewe~ syotem mumbo ~ in. The new oewer system mus~ be
Ins~eated end .ppre~ed
~h2be~ C. PI'lit, It,S,
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
0
Mailing Address:
Property Owner:
Mailing Address:
First National Bank of Anchorage
Post Office Box 720, 99510
Roy, E. Siefker
2119 West Dimond Blvd.
Phone:
Phone:
344-7884
Legal Description:
Lot 10 Bruce Subdivision
Location:
2119 West Dimond Blvd.
5. Type of facility to be inspected
6. Well Data: Individual
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On-site system
A. Installed Prior to '68 B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
e
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
300'
, Absorption area
, Other contamination
Absorption area
, Sewer Lines
No. of bedrooms
3
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEAL'IH &
ENVIRONMENTAL F'F,.O rECTION
1976
RE_CE!rED,
1. Type of Inspection: CMRO
2. Property Owner: /r-~
Mailing Address:
3. Name of Buyer:
Mailing Address:
Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description: ,~
Location: ~/,/
VA FHA CONV.
,/)/,4,,4 c~/~ _/) Day Phone: '~'~ '~ ~;~ ~'
Day Phone:
Phone:
Phone:
o
Type of Facility to be Inspected:
Water Supply
Type of Supply:
No. Bdrms. ~
Public Utility
Individual
If Individual, number of dwellings presently served
If Individual, depth of well ~' ~?~ '
Sewage Disposal System
Type of System:
If Individual, date of installation
Public Utility
Individual (on-site)
72-003(3/76)
Page 2,of two pages - Re( st for Approval of Individual S ar & Water Facilities
Legal Description
Comments
Approved
Disapproved I~.. ~-~_·/~-~~Date- ~/~(~
Approval~Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)