HomeMy WebLinkAboutWICKLUND LT 24Bl
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a. Bacterial
b. Detemgent ....
Well data:
a, Type~.
b. Depth__
Casin~ Size
Distance from well to closest existing or proposed:
Sewer llne
Septic tank
Seepage Area~.
Cesspool'
Property Line
Other sources of possible contamination, i,e.~ creeks~ lakes,
houses, barn~ drainage ditch~ etc.
Sewage disposal system.
a. Age of system__
b. Septic tank capacity in gallons
c. Name of septic tank manufacturer
1, If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1, Distance to propemty line.., to house foundation
Percolation. Test ~esults
f. Percolation Test performed by
Use the reverse side of this form to show diagram. Diagram should include
%he following information: p~operty lines~.well location, house locations
~6ptic tank location, disposal area location~ location of percolation test,
and direction of ground slope~
9. The 1T~formation on this form is true and correct to the best of my knowledge.
SSgnature of Applicant
Date Signed
TO BE FILLED OUT BY HEALTH DEPART-~ENT PERSONNEL
[---~'7~e above described sanitary facilities are hereby approved, subject to the
.......... ~611owing conditions:
Conditions:
[~he above described sanitary f ' '
acll~tles are dis~!pproved for the followine
reasons:
Appmoval is valid for one year following the date of approval.
CPJ: cw
NUISANCE COMPLAINT FORM
' co~¢)3~in~nr's Name:
..... ~ .Descplptlon~~i~/~ ~_ . of Complaint_
Owner of Property Where Nuisance Exists.~ '
~,/
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 appropmiate
action thereafter be taken, I am willing to testify to the facts stated in the
foregoing complaint in court if n~cessary.
Complainant
REPORT OF ACTION
Inves~ ig~at or ~
Action Taken:
DATE COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT:
NUISANCE COMPLAINT FORM
lComp_lalnant' s Name:
Phone No~. ~~,~BOx NO.
"~Descr~pt~on of Complaint:
Name of Person Against Whom Complaint is Made:_
Owner of Property Nhere Nuisance Exists:
Owner's Addme~s:
Phone No.
...... __Street ^ddress:
I certify that such statement of facts is true to the best of my belief and know-
ledge. I mequest that the f · .
Omegomng matter be mnvestigated and that appropriate
action thereafter be taken, I am willing to testify to the facts stated in the
foregoing complaint in ¢ou~t if naceseary.
C mpla~nant
__REPORT OF ACTION TAKEN
Action Taken: ~ f~ ~ /7
DATE COMPLAINANT WAS CALLED REGARDI~Q DISPOSITION OF COMPLAINT:
Ur. Arnold Fry
4532; ~i,mr 3t:roet
tho o',,ncr. ,/~ ii~vo~ti,.:i'(:i(~a ',,y cur ,_C~ alt;~cnt
BY:
JhL:rn
MUISANC~ COMPLAINT FORM
Name of Person Against Whom Complaint is Made:
Owner of Property Where Nuisance Exists: ~
Owner's Address: -2
. Phone No.
Person Receiving Complain. :~~ , , ~te:
I cemtify that such statemen~ of facts is true to the best of my belief and know-
ledge, I request that the fomegoing matter be investigated and that appropriate
action thereafter be taken, I am willing to ~estify to the facts stated in the
foregoing complaint in cou~t
Complainant
REPORT OF ACTION TAKEN
Date Investigated:
Action Taken:
DATE COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT:
Richard Gay
4511 Piper Street
Anchorage, Alaska
Lo~ ~4B Wtckllaid Subdtvisl~ - Mandatory sewer connection.
June 1. 197§. .
Les Buchbolz, R.S.,
Sanitarian
LB/~o
Certified ~o, 740409
SENDER: Be surge fo follow instructlons on other side
PLEASE FURNiSH'SERVICE(S) INDICATED By CHECKED BLOCK(S) ~
~ Show to whom,*date and address r-~ ~Y '-Y' '1;o
~' where delivered ' ~ ~4~ ]~
,,' ' RECEIPT ~ ~ j" :'~
Gay/Buchho)z ~,.~ ~- '~ /: 3
~.T,.~ .0. ~ ~ ~... / ~~ -.
/~U~U~ ~0 ~ SI~URE OF A~ESSE~S A~EN, I~ ~ ~
Owner:
GREATER ANCHORAG- kREA BOROUGH
D YE ~-ES T
Ma/ling Address:
User / Tenant:
Properly Address:~
Subdivisio '
I?."
DYE TEST: [] Pos/#ve
[] Negative
ADDITIONAL INFORMATION;
Off/ce: , ~: 'i' ~ /
Field:
Administered By:
pW-062 (7-74)