HomeMy WebLinkAboutSHRYOCK LT 4�,,
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Development Services Department
Building Safety Division
GE $4i
' On-Site Water & Wastewater Program
4700 Elmore Road �=
P.O. Box 196650
Mark Begieh Anchorage, AK 99507 $ "
Mayor www.muni.or /og nsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description Pro ertFocKy Owner Name & Addres
f3dl�C 14ILSa"
L4-
l( 916'jz
Pump Installation Date: 4/2e//_5_
Pump Intake Depth Below Top of Well Casing./C14 feet
Pump Manufacturer's Name: AY
Pump Model: 2 36,75 V
Pump Size 3/4 hp
Pitless Adapter Burial Depth: /0 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: twor
Well Disinfected Upon Completion? KYes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
/v7gF4
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological & Geophysicof Surveys
Drilling Permit No.
LOCATION OF WELL (Pieaee complete either lo, ib or Ic.) A.D.L. No.
lo. BoroLS14
A pa
Subdivision
pe%
Lot
!
Bloek
11
1
ib. I/agi.re.
Section No. Township N0
3
Runge E0
WO
Moridlon
ic. DISTANCE AND DIRECTION FROM ROAQ INTERSECTIONS .
3. OWNER OF WELL:
LOCATION OF WELL
(Piece$ complete either lo, ib or Ic.)
7'i�`
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological & Geophysicol Surveys
Drilling Permit No.
A. D.L. No. - ---
01,
lo. or)ough/ S%u,�!gddiiviiss/ion Lot Bock lb. 1/egtrs. Section No. Township No Range E0 Moridlan
Cu S ` O at_of�of_ So Wo
Ic,r
. DISTANCE AND DIRECTION ,FROM ROAD INTERSECTIONS 3. OWNER OF WELL: tJTT[vF %�T 1.1
�t
Address:
Street Address and Area of Well Location
2. WELL LOG, Feet Below
Surfaco
4. WELL DEPTH: (final)
6. DATE OF COMPLETION
Material Type Top Bottom
ft'
_
f3 {Ej Q
g, 0 Cable tool Rotary 0 Driven 0 Dug
❑ Auger Q Jetted Q Bored 0 Other:
Q �Ci
7. U8E: fA Domestic 0 Public Supply O Industry
0 Irrigation 0 Recharge 0 Commerical
D Test Well Q other:
B. CAS!06; D Threaded 0 Welded
dial". Yj in. to- ft, Dopth Weight 1�lbs./ft,
dlcm.' In, to ft. Depth Stickup ft.
9. FINISH OF WELL:
Type: Diameter:
SIot/Moih Size: Length:
Set• betwoon ft, and ft.
Backfilling Grovel pock
10. STATIC WATER LEVEL: ft.
Q Above 'or Q Below land surface Dote
Equipment used:
I I. PUMPING LEVEL below land surface and YIELD
ft. atter hrs, pumping g.p.m.
It. after fire, pumping O.P.M.
12.GROUTING Wolf Grouted: Q Yes Q No
Material: (-] Neat Cement O Other:
'
13, PUMP: (if available) HP
Length of Drop Pip* it. capacity g.p.m.
O Subm. Jet O Contrificol 0 other
14. REMARKS:
16. WATER WELL CONTRACTORS CERTIFICATION:
M. Water Temperature 0 �
F C
This w l was drilled u or my jurisdiction and this report is true to the best of my knowledge and belief;
AA X9'16 o
gistered Wisiness N e Contract License blunybor J /
Address:
Signed: Date:
Authorized RepAsentative
Form 02-WWR (11/81) Copy Distribution: WHITE - State DOGS, PINK -Driller, CANARY- Customer
I
MA I ER ANCHORAGE AREA BORuJGH
F
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME li ie �� f� iVf"� ING ADDRESS ��� d%� HONE ,,L/'
LOCATION
SEPTIC TANK:
LEGAL DESCRIPTION
DISTANCE�/ 7 l NUMBER OF
FROM WELL �� MANUFACTURER4�`G3iU •S�/ MATERIALCOMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH_ LIQUID CAPACITY45 6 GALLONS.
P�a E=P I -T
NUMBER OF PITS DIAMETER OR WIDTH /LENGTH�3 DEPTH _
LINING MATERIAL
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
_ CRIB SIZE: DIAMETER —DEPTH-- DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE �Ul ABSORPTION AREA (WALL AREA)SQ. FT.
WELL:
,, 5 401
TYPE � CONSTRUCTION IJf�Piii _ DEPTH
BUILDING l'+� NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:-_ A
E' 6
INSTALLED BY:
PIPE MATERIAL:t4G�6t–
LOT SLOPE:
REMARKS:
Form No. EQ -031
NEAREST SEPTIC
SEWER LINE_ TANK_
REMARK
DIAGRAM OF SYSTEM
DISTANCE FROM:
SEEPAGE
SYSTEM _
OIL
a••l 11 PA I ®:::= I I=n ■-) L_ .IL. -U 9-,Y rZ) F' F-11•4 Irl K -A � f'71 i� ter
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
33 -WI C ,_ L...I... ANCHORAGE, ALASKA 99`11025
274-4561
PEIR.M I T hai=l. ;
BARBARA FERGUSON SRA BO:-,,.' 4019B
LOCATION W I LDR I E N DRIVE CiFF NI IGGET" LANE
LEGAL. L4 ���__.�„�C�,4 , 1,Gcrav�_
LOT .IME -.::100.
} 1.1.206
TYPE OF SOIL ABSORPTION SYSTEM... P I T
NUMBE''R OF BEDF-1,00VIS 4 SOIL RATI NG, . SGPT; BR 845
THE REQUIRED SIZE OF THE: ^_=,COIL_ ABSORPTION SYSTEM ' S : DE♦"= TF'1=' 1.:1 LENGTH=
J.4, 166666F -366F.37
THE. MINIMUM C-EPT'H OF GRAVEL BETWEEN THE OUTFALL F'IF'E ANN) THE EXCAVATION BOTTOM
IS E FT
THERE 1.:i NO SET WIDTH FOR TRE:1,40HES. FOR DRAINFIELD'c•, THE WIDTH 15 '' FT
THE DEPTH OF TRENCH H OR PIT is THE: C:1..3TANCE BETWEEN THE; GROUND SURFACE APIC, `FHE-.
BO'T'TOM OF' THE EXCAVATION.
THE LENGTH DIMENSION 15 THE LENGTH CSF EACH SIDE FOR A SEEPAGE PIT OR THE
LENGTH CIF THE TRENCH: OR DRA1h,IFIELD.
THE REQUIRED SEPTIC TANK 'SIZE IS _L250 GALLONS
BACKFILLING OF Aha',' 'r'` `fE:P1 WITHOUT FINAL INSPECTT.OPI BY THIS DEPARTMENT WILL
BE SUBJECT TO PROSECUTION.
r
MINIMUM DIST'ANC:E FROM WELL. TO ANY SEPTIC TANK/PACKAGE PLANT OR SOIL. ABSORPTION
.SYSTEM IS, 1.00 f '1" FOR H FE'1'ti'ATE WELL AND 200F'T' FORA PUBLIC WELL..
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
I C:E:F;T I F',•' THAT I All FAMILIAR WITH THE REQ U I REteIF.N"FS FOR ON ---SITE `,EWERS ANC- WELLS
AS SET FORTH BY THE: MUNICIPALITY OF ANCHORAGE AND WILL INSTALL 1N ACl. ORDAN E
WITH THE: CODE.
ISSUED D BY,Ty.. . . . . . . . .7.... GATE.. . ./^ (� e7
/ � ^
2.49 EAST 51ST AVENUE P.O. SOX 0087 ANCHORAGE, ALASKA 99503
October 27, 1975
Mrs. Barbara Ferguson
SRA Box 4019-=B
Anchorage, Alaska 99507
F:\1HuaYI(3
JU`FAU
TELEPHONE 907-279.0483 • TELEX 090.35419
R & M No. 562146
RE: Test Hole and Soil Log Report for Sanitary System
Lot 4, Shyrock Subdivision
Dear Mrs. Ferguson:
we are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This inves-
tigation was performed in accordance with your request of October 21,
1975, and those procedures outlined in a letter dated July 15, 1975, by
Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of
Environmental Quality.
A single test hole was put down within the Lot 4 area for the purpose of
defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with a tractor -mounted backhoe and
the test hole was extended to a total depth of 14.5 feet below ground
surface. The final log prepared for the test hole has been included in
Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Roon1
Vice President
JWR/WED/ja
Encl.
xc: GAAB
No scale
TH-1
10 -24 -
ORGANICS
SILT, TRACE SAND (ML)
SAND, SOME SILT (SM)
�z,2 --------------
o.
p. SANDY GRAVEL TRACE SILT
TRACE COBBLES (GW)
T11-1
NO WATER TABLE
Log represents location of
test hole Lot 4 Skyrock
Subdivision
R Consultants Inc.
ANCHORAGE FAIREJANICS ALASKA JUNEAU
oA'rE 10-27-75 SCALE P=21 I owN By TIED
12273
0.0'
0.5'
2.0'
',1
14.5' T.D.
BARBARA FERGUSON PROPERTY
Log of Test Hole
Anchorage, Alaska
CHKO BY WEDJ PROJ. No.562146 I OWG NO.
MUNICIPALITY OF ANCHORAGE (7
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALI
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include I t, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name b/ ?/ Li�rn�'JC Telephone: Home 3�s� S �3 Business
Applicant Address � 'fie. 1¢Ri6l 1147e �pgy/t.
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
9
(d) Lending Institution 114t Telephone
Address /
(e) Real Estate Company and Agent
Address
Telephone 35`9 - x(08/
(f) Mail the Hto he following /address:
TYPE OF RESIDENCE
Single -Family Multi -Family ❑
Number of Bedrooms
Other
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(1v84
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm f Telephone
Address
Date
6. DHEP APPROVAL 7
Approved for -3 bedrooms by � � � Date / 9 —9/ —4
Approved X Disapproved
Terms of Conditional Approval
Conditional
c�he�
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOi-q
AAUi IC;Ii N.t(` vi" 1•'.'Ci. H,IAUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
ri-
264-4720
Go% #1 �J..dee
Legal Description:
/2-.<1 SCJ sJ'3
A. WELL DATA
Well Classification If A, B, C, D.E.C. Approved (Y/N) 1V
Well Log Presen (Y N) _ Date Completed -MW Y' Id T
Total Depth � Cased to Z 1.L Depth of Grouting -
r
Static Water Level //U Pump Set At
Casing Height Above Ground —
Electrical Wiring in Conduit)
Separation Distances from Well:
ie
U
Sanitary Seal on Casing6N)
Depression Around Wellhead (ye?)
To Septic/Holding Tank on Lot /tTo ; On Adjoining Lots f� 'y-
r r
To Nearest Edge of Absorption Field on Lot /0� ; On Adjoining Lots %� �
To Nearest Public Sewer Line �/� To Nearest Public Sewer r
Cleanout/Manhole _ ���1 To Nearest Sewer Service Line on Lot L� t
Water Sample Collected by 1*5-e-.5 2F7� ; Date =31'-8'/
Water Sample Test Results �i��/SFI�C �a.E`/ Q - # IT RATES Nu e uG I vr7 H
Comments
SEPTIC/HOLDING TANK DATA
Date Installed 5_ - °ted 'J4' Size 1Z� No. of Compartments _ Z
Standpipesg)N) Air -tight Caps6N) Foundation Cleanou�ti� N)
Depression over Tank (Ye Date Last Pumped �'�`f "�l7 �3'lmc'S
Pumping/Maintenance Contract on File (Y/N) ;for Al A"
Holding Tank High -Water Alarm (Y/N) i✓ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well f� r To Building FoundationD
� r
To Property Line /4 To Disposal Field 8 _
r
To Water Main/Service Line %B fi To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
Gel 51eiC,<
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design 7?4'"`W
Date Installed 5--1-9-76 Length of Field _ lr_e
.-
Width of Field
Depth of Field
i
,% Gravel Bed Thickness � �
Square Feet of Absorption Area 3T0 Standpipes Present�N)
Depression over Field (Y( Date of Last Adequacy Test cr-ew --5��
Results of Last Adequacy TestvA'��
Separation Distance from Absorption Field:
To Water -Supply Well /� t
To Building Foundation
Lot
To Water Main/Service Line /a g
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) _
Comments
e
To Property Line
To Existing or Abandoned System on
On Adjoining Lots
To Cutbank (if present)
Dimensions
Manhole/Access (Y/N)
— "Pump Off' Level at
Vent (Y/N)'
** Check Permitted Bedroom Rating Against HAA Request **
ng Cycles during Adequacy Test. Meets MOA
I certify that I have nhPr.lroA „Ptifforl r f .� A.- -.� ..,, . _
LU aI 9: m af��AA guidelines in effect on the date of this inspection.
Signed �r `'- Date
Company MOA No. e7-0,7-1'
Receipt No. 2-0 U l- OO ( L --
Date
Date of Payment / zS &-2
Amount: $ __ /U Q
Page 2 of 2
72-026 (11/84)
Conducted by J 0
Owner D I A kd f
Well Location I
Well Information:
Pump Information
Pump On:
Sheet of
Date:
WATERWELL • TEST PUMP REPORT
cess
Ttl. Depth -Depth of Casing Screen From
Casing Size _ _�_ Screen Dlam Screen Slot
Remarks
Intake DepthZ90 Pump Size
Static Water Level / / D Av. Discharge
Time i/; V �" MI Date 2A Pump Off:
To
Air Line Depth
GPM, Max. Drawdown
Time y%oc.)Date
TIME
WATER PIEZO.
LEVEL TUBE
FLOW
GPM REMARKS
TIME
WATER PIEZO- I
LEVEL TUBE
FLOW
GPM REMARKS
41,1
5
� /
50
V. I
3
o
z
C�
a
-u
v
,v
---
APPLIC RN1" FILLS®U1" UPPER HAf - ONLY
Property Owner --/
"" - -- - -- ---
I )c�'Y',�I -'1 h, �_ � u u 1�/a rte% --
Mailing Address
--
�./ Phone
}e 1
t\J 1 r ,.,✓i 1_ Zip Code J L
Buyer
—
Address
GI
rIns:or
Zip Code
Lending Institution—
b — --
,� ':.� / i Y1✓ ( � f (i �1 � G.'l
Address
_ Phone
n ✓� ,.1 ,%t i
_.. �.-
Field Notes: �eSZ�.,. T
�e
�� Zip Code �1
Realty Co. & Agent
— —
. Phone
Address
---
A\ r �i oc _1C. ? Zip Code
Legal Description
(, _ -
Street Location
c'A
%----—
Type of Residence
S Single Family
APPROVED
_JI BEDROOMS
❑ Multiple Family
❑ Other
Y No. of Bedrooms
Water Supply
'CONDITIONS OF APPROVAL
-------- —
' Individual
❑ Community
ATl'ACH WELL LOG. A well to g is required for all wells drilled since June 1975.
❑ Public Utility
For wells drilled prior to that date, give well depth (allach log if available).
Sewer Disposal
-- --- __
.0 Individual
❑ Public Utility
Year Individual Installed:
❑ Holding Tank
When C
Connected to Public
BY. --a
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
----1�
Time
t
Date
[Inspector
Date
—__-
Inspector
—
GI
rIns:or
Inspector
Field Notes: �eSZ�.,. T
�e
DEPT. OF HEALTH
� C IC L - ��
0,
I
��pp �E,�N�V1I NMENTAL PROTECTION
AUG
c'A
RECEIVED
,(
APPROVED
_JI BEDROOMS
----
'CONDITIONS OF APPROVAL
___
( )DISAPPROVED
( ) CONDITION LAPP OVAL
�.�Q✓
DA"rE
----
BY. --a
Soils Rating Date Sewer Installed
fj —
��'�
Well To Absorption Area (E�CX' —
Well Log Received
�eptic
_ •-'Z�'— %�c.
72023(3182)
Well to Tank ('F7 U
---
Tank
—
Size ('`T
fl ")[l , I
011 Box 2 2 On,
ll ).1 w; W IMI d, Skywo; Sul-Wivil"joll
1111junylij J, jr)IT k1ICY inri ivij un 1 Soulor alld whor Moil h Ilias calwicn-
LUAD QQ fcQjXMjjjqf ibnov", hovc iwoyi
le�f6he LOpM ix" W11106 in) thaL
wCO,o): t-J.rjli-,
i;Xpo.sed cQuArca
il in `3 to 110) TWA. Acad TIAM ill MCA W -ion
ol: ille ow"licir"110%, uf Palchoray) vockvi and IMISt jq! cN"ajj>!Ci
The Sco-Sic Onk [Alopc(I
(No Pa r lam, n
1)?1*1001c"M jM)L. it .41,111 Me
imMud illrwro;Jaric it's; navo booll it Men) are aany
Ocwilllc��, ;i1lowNiollo, p0wou will Win ViAno t 260-1720. -
i. 114--1_ l: c.1, v I
, -, c
Ln 1113 / c j /V 2
i
ARCTIC
INC.
��
m�
September 2, 1983 AEI# 83-013-25
Diane Crowne
SR Box 220 K
Anchorage, Alaska 99516
SEPTIC SYSTEM ADEQUACY TEST
LEGAL: Lot 4, Shyrock Subdivision
OWNER: Diane Crowne
HOUSE TYPE: 3 -bedroom, 1 1/2 Story, Single Family
WATER: On-site Well
SEPTIC
SYSTEM: From MOA Records:
Tank: Plastic, 1250 gallon, 2 compartment
Absorption
System: Deep'i..Trench
Absorption
Area: 340 ft.z
Approval
Date: May 28, 1976
TEST DATE: September 1, 1983
PROCEDURE: The test was started at 1:00 p.m. Water from a tank truck was dumped
into the trench standpipe in 100 gallon increments with liquid
rise in the trench measured after each increment.
After 800 gallons had been added, no rise in the liquid level had
taken place. At that time, addition of water was halted and the
septic tank was pumped.
Absorption monitoring was not necessary, due to no change in
water level.
Diane Crowne
Adequacy Test
83-013-25
-2-
RESULTS: 450 gallons of absorption per day is necessary
home to meet Municipal standards. If a system
times that amount without any appreciable rise
level, it automatically passes the absorption t
tested showed no rise in the water level after
water was added. The system passes the test by
Municipality of Anchorage requirements.
for a 3 -bedroom
can accept 1 1/2
in the water
est. The system
800 gallons of
meeting
°V pn pBOOo
Sidn E CI rk
u
�tl ROFE
MUNICIPALITY OF ANCHORAGE
DEPARTME. OF HEALTH AND E_NVIRONMEW PROTECTION
£325 L Street, Anchorage, Alasi.a 99501
' r 279-2511, ext. 224 or 225
Date Received: June 13, 1.977
{{
1: Time r _l P.�J'LP- dk 2 : T-ime — #3 : Time
Datefin- / j_I� p�� Date �;----- Date
I n s p �. �--.- --^._ I n s p --.—
REQUEST:' FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
% Mary Ann Dodge
1. Lending Institul_:i_on Request: First National Bank of Anchorage
Mailing Address: Post Office Box 720 99510_ Phone: 276-66300/562N
2. Property Owner: Peter P./Barbara E. Ferguson Phone: 3441206
Mailing Address: Star Route A Box 4019B 99507
3.
Lega.7_ Description: Lot 4 Shyrock-Subdivision
4: Single Family Residence: (x>� Number of Bedrooms: _4
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: individual- Well (x� Cosnmun.ity/Public System ( )
Permit It Depth of Well Wel]_ Log on File ( }
Construction Bacterial_ Analysis
6. Sewage Disposal System: On-site System 6cy) Public Utility ( )
Permit # Installed Installer
Septic Tank Size Manufacturer
Absorption Aroa soils Rate Materi.al
7. Di:;tances: Well to Septic Tank to Abso.T.ption Area
to Sewer. Line Nearest. Lot line Absorption Area
to Nearest Lot: Line
Page TWO
Department of Health and Environmental Protection
Request for Approval. of Individual Sower and Water Facilities
Legal- Description. Lot 4 Shyrock Subdivision
Comments:
P.1'fadavi_1_. Attached: ) Lel:l_er !Attached: ( )
Approved: _— — Date:
Disapproved: Date:
Department Wor_kslieet_:
7
IN
V
Legal Description: Lot 4 Shryrock S/n
Location: _N RN Wild; n prime Anchorage, 99507
Type of Facility to be inspected:
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
No. Bdrms. 4
Individual Wel
Type of System: Public Utility Individual (on-site) Septic
If Individual, date of installation
Mary Ann Dodge, Real Estate
1 �'�• 1 ' �(�� .
1� 1
EQ -037 (1/74) 6/1177
��1 J� ,,-tom 1 �, 'V
(
�'
�.
fi "
�-
PW t. I
-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 — 274-4561
�i
-,w.
REQUEST FOR APPROVAL OF
M�
e-�
INDIVIDUAL SEWER and WATER FACILITIES --'
{
1.
Type of Inspection:
CMRO VA
FHA CONV X
2.
Property Owner:
FERGUSON, Peter E. & Barbara E
Mailing Address:
SRA 4019B Anchorage
Day Phone 344-1206
3.
Name of Buyer:
HOOD, Frederick R., III andro- ime,
Diane E.
Mailing Address:
4020 Baxter Anchorage
Day Phone 276-63oo x562
4.
Name of Lending Institution:
- Fiat National Bank of A_ nc-horigp
Mailing Address:
P. 0. Box 720 An horage, Ak.
Phone 276-63OOx572
5.
Name of Realtor or Agent: Dynamic Realty — Val da Drake
Mailing Address:
501 W Northern Tights Blvd Anchorl?Jpne
279-7611
7
IN
V
Legal Description: Lot 4 Shryrock S/n
Location: _N RN Wild; n prime Anchorage, 99507
Type of Facility to be inspected:
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
No. Bdrms. 4
Individual Wel
Type of System: Public Utility Individual (on-site) Septic
If Individual, date of installation
Mary Ann Dodge, Real Estate
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EQ -037 (1/74) 6/1177
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