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HomeMy WebLinkAboutFYFE BLK I LT 1\ � � � \ - : { . � z « � / 2« � « :© \ \�� �� ^ \� %�� «\\� y f f \~ � -\ � {: � � � . - - ^ � _ /�� , <.\ �y � s 22 � % � \y\d � \ , : � `� y�. ?± . . y ; � % f . >� ~ � ® « % � ^\ y \ \�� © > : � � ` \�� \�� ��\ J \ - - Dri _ag Co. it � c ..�h { 1 USGS No. Driller j/�. � n t /I ,� /� /t tt � Area Well Owner 'c i" Y(. C - l� Chi F of Use of Yti'sll_ c-,a e-- — Location (acdress of; Township, Range, & Section, if known; or distance from main road: Size of Casing _Depth of Hole !J/(o � � - feet. Cased to )k I A i feet. Static water levelfeet ( )(below) land surface. Finish of well (check one) Open end O; Screen ( ); Perforated ( ). Describe screen or perforations We11 pump g test at 1( gallons per ,(% ) (minute) for hours with.. feet of drardown from static level. Remarks Depth in feet from ground surface r 0 to f �' • to t0 to f / 7,/ to 0 � ' to 59 . D , to �7&_ u, toto , 13 .n to /--7 'F 7 I to (M to ( / to to to to MELL LOG Give details of formations penetrated, size of material, color, and hardness. APPLI( ',NT FILLS OUT UPPER HA( " ONLY Prop4, -y Owner r; fff _ r Phone Mailing Address f*,; !� ,. F i Zip Code Buyer Address :. ..'_ �' . - '� ll/ Zip Code Lending Institution Phone Address Zip Code :537_rj - Realty Co. & Agent f A Phone Address :sj !iP` /`'s�2.-'.� xs j �f� Zip Codef Legal Description 9 ,f Street Location y` eF.`� `„� f r 'is SV r Type of Residence Single Family ❑, Multiple Family No. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal ❑ Individual �'�L Year Individual Installed: Public Utility ,l �5 When Connected to Public Utility: It Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. OW Time Time Time Time Date Date Date Date CZ�� Inspector Inspector Inspector Inspecto 1 �� ri1�1`VS Field Notes: /V MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH £: ENVIRONMENTAL PROTECTION S � � 2 198" EC (�) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL _ - ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE Z BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received fyZ Septic Tank Size Well to Tank 72-023 (3/82( ar ZA P-Tt DEPT. G- ^ALV! MUNICIPALITY OF ANCHORAGE ENVIROt,6:,,-,'IT,,.- , ;-• -CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 A :: `,V ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 E� REQUEST FOR APPROVAL OF INDIVIDUAL WATER ARID SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE rl/IC r/u"% • MAI LING/ADDRESS — (/ / ar'f� PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILINGADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑' Four ❑ Other SINGLE FAMILY / \ � Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY DIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 CERTIFICATE 0 INSPECTION SEWER AND WATER FACILITIES 1. PROPERTY OWNER Clarence.W. Lacke MAILING ADDRESS 1890 East 58th Avenue 2. LEGAL DESCRIPTION Lot 1 Block I Fyfe Subdivision 3. TYPE DWELLING XZIK. SINGLE FAMILY RESIDENCE 0 OTHER (Describe) M MULTIPLE FAMILY RESIDENCE 4. WATER SUPPLY 92<xINDIVIDUAL O COMMUNITY/PUBLIC 5. SEWAGE DISPOSAL 0 -INDIVIDUAL/ON-SITE Rg< PUB LICUTILITY ". O HOLDING TANK (Maintenance Required) K�c APPROVED FOR two BEDROOMS O CONDITIONAL APPROVAL (See Attached)K DISAPPROVED DATE BY (TITLE) April 6, 1979 0.��(