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APPLIC-IT FILLS OUT UPPER HAL7 NLY
Property Owner
Ll
Phone
Mailing Address
Zip Code
sj
Buyer
Address
Zip Code
Lending Institution
'o Nc- iV- %' b"
Phone
Address
ZipCode
-lk03
=l1�66 '"('
Realty Co. & Agent%
Phone
Address
J/ Zi p Code I/
A A
Legal Description
'
Street Location
-/7
Type of Residence
0,'8jngle Family
El Multiple Family
No. of Bedrooms
El Other
Water Supply
0-Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
El Community
For wells drilled prior to that date, give well depth (attach log
if available).
0 Public Utility
Sewer Disposal
El I dividual
Year Individual Installed:
-Public Utility
When Connected to Public Utility:
El Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
APPROVED BEDROOMS
IT
CONDIT
NSPFAPP:RO
DISAPPROVED
APPR L*
CO! VA—L
_�DITIONAL
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72-023 (3182)
GREATER ANCHORAGE AR EA BOROUGH
Department of'Environmental Quality
��3330
JAW
"C Street Anchorage, 06ska-99503
Date Received
j!,
Time ..of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
'INDIVIDUALSEWER .&,WATER -FACILITIES
FOR
Conv.
1.
Approval requested
by: First National Bank of Anchorage % Jackie Barrett
Mailing Address:
Post Office Box 4-2090' Phone: 274-1521
2.
Property Owner:
Douglas Dickinson Phone: 892-6398
Mailing Address:
2607 Arctic Boulevard
3.
Legal Description:
Lot 5 Block G Fyfe Subdivision
4.
Location:
1828 East 57th Avenue
5.
Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data: Individual
A. Type Drilled B. Depth
C. Construction — Approved D. Bacterial Analysis
7. Sewage Disposal System: Public Utility
A. Installed
C. Septic Tank:
D. Seepage Pit:
B. Installer
1. Size 2. Manufacturer
1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
2. Material
A. Well to: Septic tank Absorption area
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74),
Satisfactory
Sewer Lines
Page
ALASKA bUIROI MenTAL COnTROL S660S, InC.
Engineerinq & Enuironmental Studies
February 20, 1984
Department of Health &
Environmental Protection
825 L Street
Anchorage, Alaska 99501
Attn: Robbie Robinson
Dear Robbie:
On February 16, 1984, I inspected the well located on Lot 5, Block
G, Fyfe Subdivision. At that time a water sample was taken and the
results are attached.
The house is connected to public sewer. The well has a sanitary
seal and the wires are encased in conduit. The casing stands 1.5'
above the ground surface. The ground is graded away from the well.
Sincerely,
Jim Green
Geotechnical Engineer
JG/caj
Approved By:
,1 El '190adLOC
a
L
tyFg •s `y ��" enei9aaeoo�ec9psv o9on
o Ley C. Reid, Jr.
t� c'�1J1/o�a No. 2251 E L°�cy
1200 West 33rd Auenue. Suite B • Anchoraqe. Alaska 99503 • (907) 561-5040
��;a�,crezaet a,r
U Y
LO JAilUP4y
(i71'C
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
March 31, 1976
C)
Time of Inspection 1 30/p.m.
Date of Inspection April 6, 1976
REQUEST FOR APPROVAL OF Tuesd�y — Les
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: First National Bank of Anchorage o Jackie k X nL±4-
Mailing Address: Southcenter Branch PO Box 4-2090
2. Property Owner: Douglas Dickinson
Mailing Address: 2607 Arctic Boulevard, Anchorage
Phone: 279-4'a81 aIu/ -ISZJ
Phone: 892-6398
3.
Legal Description:
Lot 5
Block G Fyfe Subdivision
4.
Location: 1828
East
57th Avenue
5. Type of facility to be inspected Single Family No. of bedrooms 3
R1
7.
Well Data: Individual
A. Type iu B. Depth
C. Construction D. Bacterial Analysis
i
Sewage Disposal System: a� �,+o,�� m
A. Installed B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
y4 *ocxoa.cJ +r
Y
�A9jrF� JMNAa`J
MUNICIPALITY OF ANCHORAGE
GREATER ANCHORAGE AREA BOROUGH KEPT, OF HEV,LTH ca
Department of Environmental Qual i ty ENVIRONMENTAL NC)T;CTION
3330 "C11 St., Anchorage, Alaska 99503 - 274-4561
l.A MAR ' 1976
INDIVIDUAL SSEWER &T FOR PWATTERLFACILITIES OF � YE D
1. Type of Inspection: CMRO VA FHA C0NU XXXXX
2. Property Owner: Douglas Dickinson
Mailing Address: 2607 Artic Blvd., Anch. Day Phone 892-6398--Palmer
3. Name of Buyer: Nicholas & Patricia Migliaccio
Mailing Address: 3917 Carleton Av.-Apt.3 Day Phone 272-1076
4. Name of Lending Institution: L 65 Nojibna) Bank 61 Ayi Y tee,
Mailing Address: 3 0 3 Csk Phone
5. Name of Realtor or Agent: Ken Calhoon -- Dynamic Realty
Mailing Address: Phone 279-7611
Name of Realtor William Schlegel --- Totem Realty, Inc.
Mailing Address: 516 East Fireweed Lane Phone: 272-0571
6. Legal Description: Lot 5, Block G Fyfe Subdivision
Location: 1828 East Fifthv-seventh (57th) Avenue
7. Type of Facility to be inspected:
8. Water Supply ----- Well
Type of Supply: Public Utility
d•Ywnw¢�t/ . w • • • 11
Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System -----Septic System
Type.of System: Public Utility Individual (on -site'
If Individual, date of installation
NOTE: Please mail results to the bank first,the other addresses
second.
EQ-037 (1/74)
Page 2 of two pages - Rel. . for Approval of Individual ` & Water Facilities
Legal Description
Comments
Approved
Lot 5 Block G Fyfe Subdivision
Disapproved
Date
ApprovaL4alid 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)
4�4 .nCHOi AGf apfi
G
u �
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
�G�PfD „UW-' 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 6, 1976
Time of Inspection 10:00 a.m.
Date of Inspection February 6, 1976
REQUEST FOR APPROVAL OF Les
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by: Totem Realty o Esther Bumgardner
Mailing Address: 516 East Fireweed Lane
2. Property Owner:
Mailing Address:
3. Legal Description: Lot 5 Block G F_yfe Subdivison
4. Location: 57th Avenue off of Petersburg
Phone:
Phone:
272-0571
5. Type of facility to be inspected No. of bedrooms
6. Well Data:
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank Absorption area
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
, Sewer Lines ,
EQ-034 (1/74)
Page 1 of two pages
Page 2 of two pages - RE ,st for Approval of Individual er & Water Facilities
Legal Description Lot 5 Block G Pyfe Subdivision
Comments
Approved;
Disapproved
Date
Appro°vV/ Valid for one year from date signed
Greater Anchorage —Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
1 l.er L I I y Lrld L Wit. I III Uf'Illd L I UII UUH Ld I rleU III Lfl 1 S r'UUUeS L I Ur' dppr-uvd I LU Ue d Lrue dr1U
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)