HomeMy WebLinkAboutASPEN HIGHLANDS #3 BLK 3 LT 9Mayc~r
,xnchor~g~, ,~K 995!9-66~0
Pump Installation Log
Well Dzff]Ur ~ Permit ~fumber:
Data of issae:
?~mP TnstalIati°n D ~te: ~/l~/((.~
p~,mp !atak~ De, pth Below Top of~e~ Cas~:/~ ~ feet
Size ~//f hp
Pifles-~ ,=kdapter BuriM Depth:
feet
December 29, 1978
~780734
Jerome Augdahl
Post Office Box 10711
Anchorage, Alaska 99511
Subject: Lot 9 Block 3 Aspen Highlands Subdivision
A permit issued by this department for well and/or
sewer system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be
sent to this department to document the installation
date.
If there are any further questions, please contact
this office at 264-4720.
Sincerely,
Les N. Buchholz. R.S.
Senior Environmental Specialist
LNB/ljw
enc: copy of permit
F~F::'F:'L. IC:FINT .)'fEF;.:E[hlE~ Ffl]GDFIHI .... I:::'[) E:C[::':; :l]Eq::':L:t.
L. CJCI::I'T' I Ol",l ['11E:'OF?. ii: :E;"t"
L.E[iff::IL. L. 9 E:',L..K ]ii: FI'.i~;F'EN H :[ GI"'II....I::~NE:'~ii; :i!!;/D I..E "l" :::]; :[
1.tFt;:.:;iHI]M I'.,II...IHE:EI:;?. OF BEE:,F.:O01',i::i:: ::: 4
!;: '] ! L. RFI"I" :[ NG ,:: :ii!h:;:! I:= 'l" ,-." E: l:;?. ::,: 'J..L:
'THtE Fi:E:f..%J :[ RED ':':='; I ;:='"'.E: JIF 'T'HE F2;O I t... FIP'E.;ORt::"T'I ON ?'r'STE1.q ].' :~!i:
THE:': LE'NC'iTH D I HEN'J31 ON ]: ~!; THE: LE!:NG'TH ,:: 3: N F:E:E'I" ::, OF' "rile TREN(.]H O1'.:?. [::,.[;i:i:::l t I',!F' I E:L..E:,.
THE DEF'TH OF: FI TREI'.,IC':H OF.'. PIT I'/::; THE E:,I':'3TF:II'~C:E BETHEEI'.,I THE:.: SURF:'FIC:E OF::' "f" !...l l:~i:
C:iF.:CH..IND FINE:, "rile E:OT'T'OH (.:If:' THE E',:.::C:t::i',,,'FITIOI'.,I ,:: 1'I'.,1
"I"HERE:: Z'.:J; I'.~O :3ET HI[)TH [::'(::iF.: "r'I;?.EI'.~CHEE;.
"f'HE GF::F-I'v'EI.... E:, [.:.': F' T FI :[.'.E; 'T'HE FI I I'..I ]: HUM DEF'TH CiF' Ci[?.FI',,,'EL.. BE'T'HEEI'.,t THE:: OUTI:::'FII..I .... F:'].'F'E
I:::IND THE BOTTOM f)F:' THE E,':.'.:E:FIVf:IT:[Ed'.,I ,::I Iq FLEET).
...... I .......... l"'¢ . . .
I:::'EFi:M :li"F FIF'I:::'L I CF:INT HI::1:!.:.; THE': k[:=,l JN=, I [:, ]. L.. I "f'C~ ~. NF'OFi:h'I 'T'H I E; E:,EI::'Fll;::THEN'T' f", I:;'. I t'~'iii 'T'HE
]:Iq:i'?f"I::tLLFIT I L" N I NE;F'EC:T I ONEi', OF:' I=lN"r' [.t[.:'Jl...l...J!; FIE:'..TI=IC:ENT "l"O TH :f. ~; Pt;i:OF'EF?.T'¢ FIN[) 'T'I"'tE
NI...tPIE]:EF.: Cfi:' [~:E':_~II]:'ENCE~!; THFfT THE HELL HIL..L. :.::~,E:]?.'v'E.
E:f::IC:I'::]::: I I...L I f-,ll:.:.i I]F I::II",I~T' ""' ''" ......
:, .: I E. 1.1 H I TH[IL.IT t::: I NFIL Z I'.,r.:.5F'ECT I OIq FtI'.,t[:, F:tF'F'F:' ]'v'F::tL Ei:"r' 'T'H I :'};
[:,EI::'F:IFi:TME~I'-4T H ]: LL E:E ':::1 E': ]'E :] "1" 'TCJ F'I:;.':O~3E:.'C:LI"f' :[ ON.
M I I'.,t :[ I"IUPI [':, :[ :i!i;"l"F:ll'.,IOE E:E:TI4EEN I:;:I HEL. L I:=I1',1[::, RN'¢ CH'-,I '-" :'.::; I TE :iL.:F.:l-ql:lL]iEi: D I ':':.:;F:'O:ii.:,l:::lL. :E;'.,.':iii;TE1.'t :1: :"..];
:.t.t:j.:ll~) F::'EE'T' F::[ID: FI F'F.'.].",/f=r'FE I.,.IE::L.L.; OR
::L!!:.!~EI TO ;.:J:EiHZ~ F'EET FROFt I:::t I='I.JBL]:C !.,.IEI.].. [:,EF'END:[I'.4Ei I...IF'ON THf..!.:: 'T".¢F'IE (.".IF.- PUE!:L:[C: HEI...L~.
I")TH[.:.:I:;.: I:;?.E[.:!U t F.:E]"IE]'.,I'f'L:!; 1.'lFl"r' FIF::'F'L.'¢. :?.~;F'E:C: :[ F'I C:FIT I ON:!.:.; I::1t',1[:, C:ON::3Tf~'.L.IC:T :!: ON D I FICiI:;i:f:::ff"I:!3 F:II=.".E':
F:I',,,'I=t I LI:::tE:L.E 'l"(] I 1'.4 :i:] I] F?. E". PF.:OF'EF.: I NSTF~L..L. laTI ON.
! C:E:I:~'.T I F:'"r' 'T'HI:::I'T'
:1..: I F:tM FFtFIIL..IFIR HITH THE F?.E6!I...IIF.'.EMENT::~; F'OF.: ON'"-E;]:TF=: :ii;EHEFi'.:=J; FII',IE:,
F:'OF;?.TH E'i["r' THt'}: I"1LI1"4 ;[ C ]: F::'FIL. ! T"r' OF F:II"4CHOi:;.:I::IG[::.
;;i!:: I I.,.I ]: 1...L I I",IE;'T'FIL. L. THE ':'!!;'¢:~5TI:?."]'t I N F~ C L]: Eff?. E:' FI N C: E:: P.I I TH Tt'"ItE E:O[.':,E:F];.
::ii:: :1'. UN[)['ii;f~'.:~;'T'I:::II",II.".:, TF'IFIT THE [)N"""Jii;IT[E ~;I:'EHEF.: :.::7'r'~.:;TE']'"t l"1t"::l"r' I:;..'E:(;!LII[?.E Et"4L.I:::IF::GEMEtqT ]:F:' THE':
Fi: E E; I I]' E 1",1 C: E I ~i; F.: E I"10 [:' E L.. E E:' T O ~ I I",1 C: L. U E:' E i''tO F.: E "1" H I=~ I",1 ,'.t- E:: E E:' I:;.: O O I"1
I=1 i:::' F' I..¢ C: FI t",1T 3 E F.: Clfl E ~ 't~] E:' F:I H L.
GRE ,ER ANCHORAGE AREA BOR,,JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~ ___ MAIL. lNG ADDRESS /~ok' /'d2~' 'Tg~ PHONE
LOCATION ~~Z~ ~ LEGAL DESCRIPTION__ ~ ~ ~ ~~~~
SEPTIC TANK:
DISTANCE
FROM WELL /'¢~'J '1~- MANUFACTURER MATERIAL
INSIDE LENGTH ~' INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITYzl¢l''~) GALLONS.
TILE DRAIN FIELD:
/
DISTANCE FROM WELL. J~:~'Tg FOUNDATION
NUMBER OF LINESJ DIS~ANC
ABSORPTION AREA ____ 7~'~ ~ 7q'
DEPTH:
E BETWEEN LINES
NEAREST LOT LINE
TRENCH WIDTH__
TOTAL LENGTH~/~¢ /
OF LINES
IN. TOTAL EFFECTIVE
TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
/ DEPTH OF FILTER
~ MATERIAL BENEATH TILE
IN. ABOVE TILE
IN.
WELL:
TYPE ~"
CONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING NEAREST
FOUNDATION___ LOT LINE
NEAREST SEPTIC /
SEWER LINE , TANK __
SEEPAGE
SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED_
DISAPPROVED
REMARKS
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:_ ¢ /
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
Form EQ-O32
J'ENOt',IE FIL.tI3C, PIHL
I'1 ]: [:, O 14: l '_"~;'i"
L"¢. B2: N'.'-SF'EN H:[GHL. FINr:,s
LOT 2; I ZE
FEET
~ r t I:::. t)l- ::(;O 1 L HE,=,UR.E, I ! ON :=, T.=, i Erl I 2; · 'T'f4:ENCH
FiFIJ:.::Ii'"tur'I r-dl_ll',lE:El~: OF E:EDR:OOMC; = 24
'E,O I L F.'.AT I I'.,IG ,:: SL:..! F"I",/E:F.: ', =
'l'Hb: Nb:L::¢.J 1 14:EL:, :5 1 ZE OF THE .Sf"~ I L ¢iB":.;OF,'PT I ON S'¢"5'T'EM .'1; S ·
'IHE LENGTH DIMENSION :IS THE LENGTH (IN FEET) OF THE TRENCH OR F:,RAiI'.4F:iEL. D.
"IHE DE.P'i'H OF FI TF.:ENCH OR Pl"l' IS ]"HE [:,ISTFINCE BETWEE:N THE SURF'RC:E OF 'THE:
L314:OUND FII'4[:, ]'HE BO'f']"Ol"l OF' 'THE EXCFIVFITION ,.'.IN FEE'I").
]'HERE.: I~; 1'40 SET P~ID'i"H FOR TRENCHES.
tHE 1314'.PtVEL DEPTH I'::; THE MINIr,IUM [:,EPTH OF' GRAVEL BE'f'NEEN THE OU'IF'ALL F']:F'E
FIND ']HE BEr't'"l'OM OF THE EXCf':IVFITION (IN FEET).
E:t"IL:I-:::H']'.L. LZt",tf3 OF RN"r' S'.r'STEr'I WI'T'HOIJT FINAL II'.,I_-,FEL. T ION AND HFPRUvHL E:"r' TF'II'.-.,
L::,E:F't:4P::'i'I"tbN'I W ILL BE SL.IB.JECT TO PROSECUT I ON.
t',*t.LN.[i','ILII"t DI:~,tFINCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL_ SYSTEM
:LE~:~ FEE't' FON: A PRIVATE L4EL. L OF..' 2~:-"~1:.:~ FEET FOR A PUE,'LIC WELL.
WELL LUGS ARE REg!LIIF.:E[.:, FIN[) HUST BE RE'I"UR'.NED TO THE DEPARTMENT' W:[THIN
OF 'THE NELL COr,IPLE;"f']:ON.
':.:,PELii:iFIL:A'i']CONS PINE:, E:ONSTI~:UC"i-ION DIAGF4'.AI"I'=; FIF.:E AYAILABLE TO IN'_:;Ut~".E PI~:OPEF?
]: I'.l~,"t ALL. H"I 1 UN.
]: L:EF.: I' IF"r' "I'IHF;I'I'
i.' i i;tr,'l FAI',IIL];FII;;'. L,.II'TH 'I"HE R:E6!LIIREMENTS FuR. ON-SITE :,EWER._-. AND WEI...L.S AS '_'-.'i;ET
i.-LIN"I'H bJiT' THE J"IUN I I"': I F'PIL. I T"r' ElF HNE. HURPI.~E.
2: i WILL. tr.,I.:,IFILL THE cg'¢':-;TE'H IN RC:C:ORDANCE t.4ITH THE CO[:,ES.
3: I UN[)EF4:S'T'AI'.,ID THAT THE UN-.:,I I E :,EI~EI~'. S"r'STEM I"1A"¢ F,'Eg!IJIF.':E EI'-,ILARtl3EHENT IF' THE
P::E~;;il)ENCE I2; F4tEr,lODEL. E[) TO I~4CLUDE I',1ORE "f'HAN Z~ BEDF.:Cu:ff,IS.
Depth j ,,.
~_. ~, ~__.~z~,~~ .....
~_- /~/~~ ~ z~
Nas 9~ound ~ater encountered?
_.~_~. ......... If yes, at wi~at depU~?
Well Log
Location..~,. ~. 7...,.~...~.... ~ ..... .~....~_,'~.......~/.".~.~ ~.~....~.. ...........................................
iDepth of .well ........... ,.~..~.., .... .~.~i~ ...................
Distance to water while pumpin~ .... ......~.,..~...~?~....:~ ................ ~t r~te
Formatxon
[ from [ to'
Driller
DELTA DRILLING COMPANY
SRA BOX 394 B
ANCHORAGE. ALASKA 99507
J
DATE RECEIVED
INSPECTION APPOI NTM ENTS
DATE o
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPT. OF I:~ALTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~qEONMENL.~L
826 L Street - Ancho~a~, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION M~ ~ ]980
Telephone 264-4720
DI ~TlOffiS: ~ompl~to all ~art~ on ~a~ ~. Inoompl~t~ r~qu~t~ ~ill not b~ ~roo~d. ~l~a~e allo~ ten {~ O} dags for
M~I kl~
PROPERTY RESIDENT (If different from above) PHONE
MAILING ADDRESS
3. LENDING INSTITUTION PHONE
M~lkl~G
MAI LING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
~. TYP'E OF RESIDENCE
NUMBER OF~BEDROOMS
~' SINGLE FAMILY [] One [] Four
[] Two [] Five
[] MULTIPLE FAMILY p4~ Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A welt log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR, OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTI LITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: ~ If Tank is homemade
give dimensions:
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
Septic/Holdi ng Tan k
Absorption Area
ISewer Line
INearest Lot Line
5. COMMENTS
DATE
[~' APPROVED FOR ~L~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
ANCHORAGE CESSPOOL PUMPING
Star Route A, Box 144
ANCHORAGE, ALASKA 99502
Phone 344-2632 or 344-2453
All claims end returned goods MUST be
2 4 0 0 accompanied by this bill, ~a~kG.~u
SERIES 609
]/~k CHEMICAL & GEt.?OGICAL LABORATORIES (,. ALASKA, INC.
~- ' TELEPHOSE 1~07~-270.4014 ANCHORAGE ~SDUSTR,^, CE~TE~
/~~ ' 274-3364 5633 B St re et
~/~.o ...... · ~ Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Water System Nam@ ,
Mailing Address
Phone No.
City
State
Zip Code
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab reft no.
[] Special Purpose
) [] Treated Water
[] Untreated Water
SAMPLE
NO.
I
= I
I
4 I
LOCATION
t
J
I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
.-{~ Membrane Filter
Lab Ret. No.
I
Result*
I
I FTq
I
Analyst
*No, of co onies/100 m or No. of Positive portions
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date C ollectN Source
a.m.
Lab. No.
Presumptive 1Omi 1Omi 1Omi 1Omi lOml 1.0mi 0,1mi
24 Hours
48 H'ours ,
ConfirmS, tory
24 Hours
48 Hours
EMB Broth 24 hours:
Multiple Tuba Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
Broth 48 hours:
10mi Tubes Positive/Total 10mi Portions
Collform/100ml
BGB
· Date
Collform/lOOml
Time; a.m.
p.m.
- -- MUNtC I PALITY OF 'ANCHORAGF
DEPARTMi OF HEALTH AND ENVIRONME~
825 L Streetv Anchorage, Alaska
99501
#1: Time 2:30 ~m~ #2: Time . ~3: Time
Date 8-26-77 Friday Date ...... Date
Insp
Insp Pratt Insp
-REQUEST FOR APPROVAL OF INDiVIDUAL sEWER AND WATER FACILITIES
1 Lending InstitutiOn Request. National Bank of Alaska- % Shirley Jones
2
Mailing Address: Post Office Box 3-3859 99509 Phone: 279-2506/,~
2. Property Owner: Jerome/Roger Aug ahl _ Phone:
Mailing Address: Post Office Box 10070 Klatt Station 99502
3. Legal Description: Lot.9 Block 3_ Aspen Highlands_ Subdivision. ,,~3 ..- _
4: Single Family Residence: (x) Number of Bedrooms: Three
Multiple Family Residence. ( ) Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System { )
Permit # Depth of Well Well Log on File ( )
Construction ..... Bacterial Analysis
6. Sewage Disposal System: On-site System (x) Public Utility ( )- .~.
Permit # _ Installed 1~76 Installer
Septic Tank Size Manufacturer
Absorption Area Soils Rate Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line .......... Nearest Lot line Absorption
to Nearest Lot Line
Page Two
· Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 9 Block 3 AspgD Hiqh%and,.Subdivision 93
Comments:
Affadavit Attached: { ) Letter Attached:
Department Worksheet:
06-1220(a) Rev, 1973
DATE
ALA IEPARTMENT OF HEALTH AND SOCIAL S: ES
DIVISION OF PUBLIC HEALTH Lob No.
INDIVIDUAL AND SEMI*PUBLIC
BACTERIOLOGICAL WATER ANALYSIS oF.cE
INDIVIDUAL []
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
NAME
ADDRESS
CITY
ZIP CODE
ADDRESS
OF SOURCE
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
A~alysis shows this Water SAMPLE to be:
E~' Satisfactory
[] Unsatisfactory
[] Questionable
[] Sample too long in transit; sample should not be over 48
hours old'at examination to indicate relTable results. Please
send new sample.
[] Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
DATE COLLECTED TIME COLLECTED
Sample Collected From [] Kitchen Tap [] Bathroom Tap
[] Other (List)
[] Basement Tap
Well- [] Dug [] Driven [] Drilled
SOURCE: [] Spring [] Cistern [] Other_
Dug Well or Cistern Construction:
Walls--[~ Wood ~ Concrete ~ Metal
Top -- [::] Wood ~ Concrete .~~ Metal
LOCATION:
[] In Basement [] Basement Offset
[lin Yard [] Other
Building Sewer
DISTANCE TO: or Other Drainage Pipe
Tile Seepage
Field Feet. Pit
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- [] Cast Iron
[] Plastic Joint Material - Type
[] Bored
[Tile Brick or
Open Top [] Con:crete
[] Under House'
Septic
Feet. Tank
Cess-
Feet· Pool Feet. Privy
[] Wood [] Tile [] Fibre [] Asbestos
Cement
GENERAL: Does Water Become Muddy or Discolored?
Feet.
Feet.
[] Yes [] No
When?
Diameter of W~ll
Well Casing
Material Diameter
Length of
Drop Pipe
Offset in
PUMP LOCATION: [] I~ Well [] Basement
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes
Depth Feet.
Depth
Water Depth
From Bottom Feet.
In Utility
[] In Basement ITM Room
[] Yes [] No
[] No Repairs to System? [] Yes [] No Signature __
READ INSTRUCTIONS
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-122o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973 ·
Date Received -/ / :~ ~.' ~" - i Time Received ~pm:LLab. No.
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc
24 Hours
48 Hours .... ~ .... ~ ...... ~ '~ ' ' ~
Brilliant Green
24 Hours
48 Hours
EMB AGAR
Lactose Broth, 24 hrs, 48 hrs, Gram's stain
Coliform Density (Most probable No. per 100cc)
'MF Results
iF ; ! , _ a.m,
Reported by - - ~ -' ~ ~- Date ~' ~ , ~ ~ ;- ; p,m,
This analysis indicates Coliform Organisms to be: ~J~d~se~t. ~?
Present
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
7.333 ...... L, Anchorage, ~ - ~
825 "L" street 279 251.!
825R~:~UI~S~F~)R APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: JEROME AUGDARL & ROGER AUGDAHL
FHA CONV
X
Mailing Address: P.O. BOX 10070 KLATT STATION
ANCHORAGE, ALASKA 99502
Name of Buyer: REFINANCE
Day Phone 344-2003
Mailing Address:
4. Name of Lending Institution: NATIONAL BANK OF ALASKA
Mailing Address: P.O. BOX 3-3859 ANCH. ~ AK. 99501
ATTENTION: SHIRLEY A. JONES
5. Name of Realtor or Agent: N/A
Mailing Address:
Day Phone
Phone 279-2506 EX#21
Phone
Legal Description: LOT NINE (9), BLOCK THREE (3), OF ASPEN HIGHLANDS SUBDIVISION, UNIT. #3
Location: 000 MIDERI DRIVE ANCHORAGE~ ALASKA 99502
Type of Facility to be inspected: SINGLE FAMILY
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
No. Bdrms.
Individual X
3
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
X
If Individual, date of installation rD e~+'. 1976
EQ-037 (I/74)