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Home My WebLink AboutFARMER LT 4 '~UNICIPALITY OF ANCHORAGE DEPARTIqEN1 dF HEALTH AND ENVIRONMENTAL. PROTECTION 825 L .... " April 13, 1978 #1: Time ~i]~ P~ Time Date LI-I~-~ ~ Date Insp P~a~, Insp Street, Anchorao~. Alaska 99501 264-4720 Date Received: #2: Time #3: Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Lomas and Nettleton Company Mailing Address: 4449 Business Park Boulevard Phone: 274-7~61 2. Property Owner: David H. Poland 5335 East 22nd Avenue 99504 Mailing Address: Phone: 333-8907 3. Legal Description: Lot 4, 5 and 6_~a_~rmer.__S~,u, bdivisiond.q~~;m 4: Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Permit # Construction 6. Sewage Disposal System: Permit # Septic Tank Size Absorption Area Individual well (xk Depth of Well Community/Public System ( ) Well Log on File ( ) Bacterial Analysis On-site System ( ) ??? Public Utility ( ) Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line ~o Nearest Lot Line to Absorption Area Absorption Area ,4UNICIPALITY OF ANCHORAGE Department of Healt~__~ Environmental Protection 825 L Street, AnChorage, AlasKa 99501 264-4720 quest for Approval of Individual Sewer and Water Facilities Property Owner: Mailing Address: David H. Poland 5335 E. 22nd. Avenue Phone: 333-8907 Name of Buyer: Mailing Address: Refinance Phone: Lending Institution: The Lomas & Nettlet0n Company Mailing Address: 4449 Business Park Blvd. Phone: 274-7661 t Realtor/Agent: Mailing Address: Legal Description: Street Location: none Phone: Lots 4, 5, & 6 Farmer Subdivision 5335 E. 22nd. Avenue, Anchorage, AK 99504 Single Family Residence: (X) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well ~ ) If Individual Well, well depth If Community System, name of system Public/Community System ( ) Sewage Disposal System: *~n-site System ( ) Public System ( ) If On-site System, date of installation: *NOTE: 3/77 A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. ~UN~C~LITY OF ANCHORAG2 · reques r~ ~sslng A fee of $25 00 must accompany each can be initiated. APR I 3 1978 RECEIVED '~UNICIPALITY OF ANCHORAGE DEPARTIqEN1 dF HEALTH AND ENVIRONMENTAL. PROTECTION 825 L .... " April 13, 1978 #1: Time ~i]~ P~ Time Date LI-I~-~ ~ Date Insp P~a~, Insp Street, Anchorao~. Alaska 99501 264-4720 Date Received: #2: Time #3: Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Lomas and Nettleton Company Mailing Address: 4449 Business Park Boulevard Phone: 274-7~61 2. Property Owner: David H. Poland 5335 East 22nd Avenue 99504 Mailing Address: Phone: 333-8907 3. Legal Description: Lot 4, 5 and 6_~a_~rmer.__S~,u, bdivisiond.q~~;m 4: Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Permit # Construction 6. Sewage Disposal System: Permit # Septic Tank Size Absorption Area Individual well (xk Depth of Well Community/Public System ( ) Well Log on File ( ) Bacterial Analysis On-site System ( ) ??? Public Utility ( ) Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line ~o Nearest Lot Line to Absorption Area Absorption Area ,4UNICIPALITY OF ANCHORAGE Department of Healt~__~ Environmental Protection 825 L Street, AnChorage, AlasKa 99501 264-4720 quest for Approval of Individual Sewer and Water Facilities Property Owner: Mailing Address: David H. Poland 5335 E. 22nd. Avenue Phone: 333-8907 Name of Buyer: Mailing Address: Refinance Phone: Lending Institution: The Lomas & Nettlet0n Company Mailing Address: 4449 Business Park Blvd. Phone: 274-7661 t Realtor/Agent: Mailing Address: Legal Description: Street Location: none Phone: Lots 4, 5, & 6 Farmer Subdivision 5335 E. 22nd. Avenue, Anchorage, AK 99504 Single Family Residence: (X) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well ~ ) If Individual Well, well depth If Community System, name of system Public/Community System ( ) Sewage Disposal System: *~n-site System ( ) Public System ( ) If On-site System, date of installation: *NOTE: 3/77 A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. ~UN~C~LITY OF ANCHORAG2 · reques r~ ~sslng A fee of $25 00 must accompany each can be initiated. APR I 3 1978 RECEIVED 1813038 Q31~IIU30 1104 ~ _ . - _ - ! (-~elsod snld) 1813038 Q31~IIU30 1104 ~ _ . - _ - ! (-~elsod snld) Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBL,C WATER SYSTEM= I I I I I I I I.D. NO. Public Water System Name Mailing Address City State Mo. Day Year Zip Code SAMPLE TYPE: E] Routine [] Check Sample (for routine sample with lab ref. no, ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION ~ l 2 [ I 4[ I ' I 5 I Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADDRESS CITY Date Received Time Received Analytical Method: [] Fermentation Tube [I Membrane Filter Lab Ref. No. Result* Analyst I I III * No. of colonies 1100 mi. or NO. of Positive portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected_ Source Date Received Time Received ...... p,m, Lab. No. _pLes2mp~tlve~ ........ lOml ~ ~_ 10mi_ !Omi lOml ..... ~._Oml 1.O~mi_ _0.1m~ 24 Hours 48 Hours Confirmatory EMI3 ........ Broth 24 hours: ....... Bret 1 48 hoLlrS _ Multiple Tube Report: ......... 1Omi Tubes Positive/Total 1Omi Portions Membrane Filter: Direct Count ...... Collforrn/loOrnl Verification: LTB ....... BGB .......... Final Membrane Filter Results .............. Collform/lOOml Reported By ......... Date ..... Time: __ a.m, May 9, 1978 David Poland 5335 ~ast 21nd Avenue Anchorage, Alaska 99504 Subject: Lot 4, 5, 6 Fa~iaer Subdivision A second inspection of the well on the subject property was ~erfo~med on May 9, 1978. The inspection revealed that the well construction is approved by this department. If there are any further questions, please contact this office at 264-4720. Sincer~ly, Robert C. Pratt, Sanitarian RCP/lJh The Lomas & Nettleton Company 4449 Business Park Blvd. Anchorage, Alaska 99503 Telephone: (907) £74-7661 April 14, 1978 Mr. Pratt Department of Health and Environmental Protection 825 L. Street Anchorage, AK 99501 RE: Inspection of Individual Well David H. Poland 5335 E. 22nd. Ave., Anchorage,AK Dear Mr Pratt, The request for approval of the individual water facility for the above was mailed to you on April ll, 1978, this property is being processed for a Refinance. Thank you for your attention to this matter. The Lomas & Nettleton Company N. Casey - Loan Processor