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HomeMy WebLinkAboutBENTZEN Block 4 Lot 3 ~~ ~'~/1~v-~ \ MUNICIPALITY OF ANCHORAGE, ' .. ~ ~ ~ D~R.TME~.'~' OF HEALTH AND EN¥IRONMEN~' 'L ~PROTECTION ~ ~l L . %~' ) 825 L Street, Anchorage, A~a. a 99501 .~ ~ Date Received: May 24, 1977 ~me 9: 00 a.m. 92: T~e 93: Time Date 5-25-77 Wed. Date ~ Da%e ~Insp Dixson Insp ' Insp Mailing Address: 4709 Malibu ' 4: Single Family Residence: ~ ) emily ooms Multiple F Residence: ( ) Number of Bedr : 5~' Well Syst idual Well ~) Community/Public System ( ) Permit ~ i~, Depth of Well 99' well Log on Construction/ ~/~-~~ Bacterial Analysis · 6. Sewage Disposal System: 'On-Site System ( ) Public- Utility Permit # /~ 2,.2~ s' Septic Tank Size p · 'Absorption Area 7. Distances: Well to Septic Tank to Absorption' Area~//~ MUNICIPALITY MUNICIPALITY OF ANCHORAGE ~_PTi O! DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION F.,NVI; 3i. 825 L Street, Anchorage, Alaska 9950]_ 279-2511, ext. 224, 225 ,.~- REQUESI FO8 APPROVAL OF 1. Type of Inspection: VA_ 2. Property Owner:_ Sam P,,& LaDonna Sauer __ FHA CONV. XX Mailing Address: 4709 Mali6u, Anch. 99503 3. Name of Buyer: August W Engel & Margritt Engel.. Mailing Address:_ AMU, Wes le_y__Dr_~_!_V_¢_.,_ Anch. 99504 4. Name of Lending Institution: First National Bank of Anchorage Mailing Address: P.0.Box 4-2090 , Anch. 99509 Phone: 5. Name of Realtor or Agent: None Day Phone: 279 8954 Day Phone:_ 279 1246 274 1521 Mailing Address:. Legal Description:_ Location: Lot 3, Block 4~ Bentzen #3 4709 Malibu, Anchorage, Phone: __ Alaska. 99503 7. Type of Facility to be Inspected:___ SFD 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well g. Sewage Disposal System Type of System: Public Utility If Individual, date of installation ,.No. Bdrms ..... 3 .... Individual Individual (on-site) We would appreciate your earliest attention to this request, home loan pending. Thank you. 72-003(3/76) Una M. Bennett, Loan processor. FirSt ' ':'- '~ ~.~.o National,Bank of A rage k.~ ~,_ Center_~ ~ ~uest for Approval of Individual Sewer and Water MUNICIPALITY OF ANCHORAGe_ Department of Health and Environmental Prote~'i~ 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 Mailing Address Phone: ~2F~F~,. 2. Name of Buyer: Mailing Address Phone: Lending Institution: Mailing Address: 3~ ~ ,¢ ~ "5'7/, ""~L~c~'~''~'~'~ Phone: 4. Realtor/Agent: Mailing Address: Phone: Legal Description: Street Location: Single Family Residence: Multiple Family Residence: (~-~ Number of Bedrooms: ( ) Number of Bedrooms: Water Supply: * Individual Well (~'~Public/Community System If Individual Well, well depth _~~, If Community System, name of system ( ) Sewage Disposal System: On-site System ( ) If On-site System, date of installation: Public System *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 -~age Two . _ .~ · · .~ Department of. Health and Environmen%al Protection Comments: ........ · ................. Affadavit Attached: "(i ) Approved: Disapproved: Letter Attached Date .. ~7or ~, //// ?q21 - Z2 -I0 85 V Spenard Area Reference Map-P7 ¢~7 o¢ ~,a~, 'Rev. ~973 ~ -'~ k .,KA DEPARTMENT OF !JEALTH AND SOCIAL S~...~ICES BACTERIOLOGICA WATER ANALYSIS ] COMPLETE~IS SECTION, . .. i ONLY IF WATER IS AN IND~'U~SUPPLY 'DATE COLLECTED ~'~/.~ .~ / ~ ~ TIME COLLECTED ~' 'F ~ Z/~:[ ' Sample Colleded ~rom ~Kitchen Top ~ B~throom Top ~ Bosem~h~ Top [] Other (List) Wel [] Dug [] Driven [] Driited SOURCE [] Sar(r; [] Cistern ' [] Other Dug Well or Cistern Cc qstruchon Wails- [] Wood [] Concrete 'J'-J Meta Top -- [] Wood I-'l Concrete [] Metal' LOCATION: [] m Basement ~[] Basement Offsef [] in Yard [] Other · ' Building Sewer DISTANCE TO: or Other Drainage Piae Tile Seepage Field Feet. Pit ' Other Possible Sources of Contaminalior- MATERIAL: Building Sewer - [] Cast ran [] Wood [] Tile [] Plastic Joint Materia - Type , GENERAL: Does Water Become Muddy or Discolored? Feet. Cess- Feet Poo When? Diameter of We Depm . Well Casing Material Diameter , Length of Water De Droo Pipe From Bottom Offset m PUMP LOCATION: [] In Well [] Basement On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Susoected? New Source of Supply? [] Yes [] No 'Bored ~"~ [] Tile Brick or [] Open Top © Con~:rete [] Under House Septic Tank ~ Feet. :eet. Privy Feet. [] Fibre [] Asbestos Cement [] Yes J~l No Feet. Depm Feet In Utility [] fn Basement [] Room READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lab No. OFFICE Analvs~s shows this Water SAMPLE 1o be: Satisfactory []Unsatisfactory []Questionable [] Samole too ~ong in transit; sample should not be over 48 hours old at examinatior 1o ~nalcate reliable results. Please send new samale [] Bottle broken mtrans r, please sena new samole · SANITARIAN'S REMARKS [] Yes [] No/ ~' ;~ Repairs to System? [] Yes . [] No Signalure ~ ~...,,'~'-~.,- - -~' 06-1220 lb) Rev. 1973 BACTERIOLOGICAL WATER ANALYSIS RECORD Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours ./, 48 Hours Brilliant Green 24 Hours 48 Hours '~ , EMB AGAR Lactose Brotk 24 hrs. ~, .., 48 hrs. Groin's stain Coliform Densit,~ (Most probable No. ~er 100cd MF Results ' This ano ysis indicates Coliform Organisms lo be: ,,...--A'b-sYqi'~) r~t. 1