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HomeMy WebLinkAboutWOODLAND PARK LTS 12C & 13CLo-F' IZc " , MUNICIPALITY ~' ~O ~ MUNICIPALITY OF ANCHORAGE DEPT. OF j~':ALTH DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONJ~ENI',",L ~~ 8~5 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION FEB 2 Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATERAND SEWER FAGILITIES DIRECTIONS: Complete ail parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE George J. & Peggy J. Gallagher 337-2073 MAILING ADDRESS PROPERTY RESIDENT (if different from above) PHONE Edmund & Gerladine M. Walter 2, BUYER Ed~nd & Geraldine M. Walter MAILING ADDRESS 3310 Doris Street, Anchorage, Alaska 99503 3, LENDING INSTITUTION PHONE SECLTRITY PACIFIC ~©i~R"GAGE ODRPORATION~,,.%.~O., ~p 12,),~,,.~m~. 276=1933 MAILING ADDRESS 1011 East Tudor Road sulte 190, ANchorage, Alaska 99507 4. REALTOR/AGENT Jim Suddeth Taylor Realty MAILING ADDRESS 2409 C Street, Anchorage, Alaska 99503 PHONE 243-8284 5. LEGAL DESCRIPTION Lots 12C & 13C, WOODLAND PARK S/D SIREEI LOCAIION 3310 Doris Street, Anchorage, Alaska 6. TYPE OF RESIDENCE [] SINGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY  '~¢~ NUMBER OF BEDROOMS ~a~' ~[] One [] /~ l, -- [~g~[] Two [] Five ',Z~'C~,~ / ~'~/~1~" ,~, [] Three [] Six Other ~'~ * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY If individual/on-site, give installation date If system is over two (2} years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY TIME DATE DATE RECEIVED INSPECTION APPOINTMENTS "' TIME TIME DATE DATE INSPECTOR INSPECI'OR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY []] MULTIPLE FAMILY WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified. 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE E~ PUBLIC UTILITY Connection Verified E~Septic Tank or []Holding Tank Size: I f Tank is homenlade give dimensions: [] ONE ~ THREE []] FIVE [] OTHER 4. DISTANCES WELL TO: [] TWO [] FOUR [] SIX PERMIT NUMBER DEP'FI( OF kNELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSFALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank Absorption Area ISewer Line Line L Absorption Area to neares~ Lot Line 5. COMMENTS [~APPROVED FOR I~_ .... BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 3/78) CLa!~_._~.~I__ & 9EOLOalC&L LABORATORIE~ OF ALA~K~ INC. P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. Ddnking Water Analysis Report for Total Coliform Bacteda TELEPHONE (BO7) 279-4014 TO BE COMPLETED BY WATER SUPPLIER Public Water~yst~n Name M~lllng Address ~'~ -~ City ' ~ State Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no, [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION I 4 Zip Code Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADBRESS~. Date Received Time Received CITY Analytical Method: [] Fermentation Tube ,~Membrane Filter Lab Ref. No. Result* Analy~..~ I F-I-I READ INSTRUOTIONS BEFORE COLLECTING SAM PLE Form No. 18-310 (3-78) ANALYSIS RECORD 06-3.220 (b) BACTERIO LOG ICAL WATER Rev. 1978 Date Collected Source Mem~3rane Filter: Olrect Count lOml Tubes Positive/Total lorn[ Portions Collform/3. OOml Collform/lOOrnl ~ ~;' ' De?rtment of Environmental Quelftv Tudor }~oad, Anchora.~e, Alaska 99507 ~79-86~0 Date Received ~- Time of Inspection /d .~ Date of Insoectton ~-./~.- ~3 REQ'!EST FOP A?oROVAL OF INDIVIDUAL SE¢~HR & WA/~.R FACILITIES FOP i. Approval Requested By: Number of Bedrooms: Phone: 6. Wel] Data: 7e A. Twe B. Depth C. Conetruction~7~ ,-- D. ~acteria] Analysis Sewage Disgosal System: /~'~ ./~f~z~J~/~ A. Installed ~. Installer C. Septic Tank: ]. Size 2. Mamffacturer D. Seepage Pit: !. Size 2. Material E. Disposal Fie}d: 8. Distances: Total Length of Lines A. Well To: Seotic Tank . Absorption Area · Sewer Lines , Nearest Lot line B. Foundation to Sentic Tank Other Contamination osor~tion Area O. Absorption Area to Nearest lot Line Sewer & Water Facilities ~eque~t for Approval of Individual Page Two 9. Comments~ Approval Valid for One Year From ~gned Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTE~ I certify that the information contained in this request for approval to be a true and accurate representation of the sub~ect sewer and water facilities located at: Signed Date DATE DEP~""'TMENT OF HEALTH AND SOCIAL SF~qlCES DIVISION OF PUBLIC HEALTH ~ BACTERIOLOGICAL WATER ANALYSIS MATERIAL: Build/rig Bewer- [] hon [] Wood GBNE~AL: D~es W~er Become Muddy or PU~ ~A~ON: ~ In.WeB [] THe [] ~ib~e [] Cement [] ~e~t [~ Raom [~ Yes.. ' [] 'No OFF/CE G, Bnp~ove ¥ou~ [] spdng [] dug well [] driven well ~ ~1~ ~eB ~ c~tem 9. ~ntact y0~ n~ ~ ~ Heath ~e~t or ~ ~ka SANITARIAN'S R~MA~KS ' READ INSTRUCTIONS,, ON REVERSE SIDE BEFORE COLLECTING SAMPLE 08-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD GREATER ANCHORAG~ AREA BOROUGH Department of Environmental Quality dot Road, Anchorage, Alaska 99507 279-8686 Date Received Time of Inspection Date of InsDectlon REQUEST FOR APPROVAL OF INDIVIDUAl, SEWER & WATER FACILITIES FOR 5. Type of F~c~li%y to be Number of Bedrooms: 6. Well Data~ ........ C. Construction 7. Sewage Disoosal System: Depth D. Bacterial Analysis A. Installed B. Installer C. Septic Tank: 1, Size' 2. Manufacturer D. 'Seepage Pit: 1. Size 2. Materiel 5. Disposal Field: Total Length of Lines Distances: A. Well ToG Septic Tank · Nearest Lot Line Foundation to Septic.Tank , Absorption Area Sewer Lines Other Contamination Ab'§ orpti on Area Absorption Area to Nearest Lot Line Req~Jest for Approval of Ir(~zidual Sewer & Water Facilities~ Page Two 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 ~epresentation of the subject sewer and water facilities located at: Signed, Date 06-1220 (a) DATE DATE COkLECTED [] Other (I~l) STATE OF ALASKA DEP/"~TMENT OF HEALTH AHD SOCIAL S~'"4iCES DIVISION OF PUBLIC HEALTH BACTERiOLOGiCAL WATER ANAL¥SgS [] Bosement T~r~ READ, INSTRUCTIONS. ON REVERSE SIDE. OFFIC~ SErOR~, COLLECTING. SAMPLE, ~f on ,~,tidacto~" ~r '!~ueafionable" status ~ ~ ~ve 9. ~nta~ ~ourn~st ' ' ~ ~Heglth~mentor ~ ~ka SANITARIAN'$ REMARKS 06-1220 (b) BAC'~IERIOLOGICAL WATER ANALYSIS RECORD GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received ~////73 Time of Inspection Date of Ine ectton REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Prooertv ~ner: ~/ ~~ ~m~ay ~, Location: ~/~ ~<~j ~. 5, Type of Facili~yt to be Inspected: ~~ Number of Bedrooms: 6. Well Data: ~/~/~ A. Type B. Depth C. Construction D. Bacterial Analysis Sewage Disoosal System: ~.c~//~j A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Field: Total Length of Lines Distances: A. Well To: Septic Tank · Nearest Lot Line Foundation to Septic.Tank , Absorption Area Absorption Area to Nearest Lot ~ine · Other Contamination Ab§orption Area Sewer Lines Request for Approval of In6 dual Sewer & Wet.er Facilities Page Two 9. Comments: ApprovaJ Valid for One Year From Date<~4-~ned Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be e true and accurate representation of the sub.iect sewer and water facilities located at: .. Signed Date ~,,'!? ,'_ :;tree'::. 3 ii t~, Ted Fi,el.ds 331fl Boris St. CAHOUS~g~, Penney Mall 27'7-9581 1443 Northern Lts. 279-6541 106 Muldoon 337-1533 Spenard Area Reference Map-P7 ~J 33 74 86 75