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Home My WebLink AboutT13N R3W SEC 13 Lot 4A of 64LoT LoT MUNICIPALITY OF ANCHORAG ~ ~ ~ , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTJOI~j~N~L~©NMENTAL FR©¥-L~TION 825 L Street - A.c~orage. ~las~a ~501 ~~~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE I~lo& & #e.~i.e 3a:~m 333-d7/8 MAILING ADDRESS PROPERTY RESIDENT (If different from above) 2fi2 YxZendg~ 5t 2. BUYER ?fSO/ MAI LING A DDR ESS 3. LENDING INSTITUTION 3fie Lo~ & N~on ~o~ MAILING ADDRESS ~447 B~ P~ Bo~ev~ 4. REALTOR/AGENT PHONE PHONE 333-67/8 PHONE 27~-766/ PHONE MAILING ADDRESS Bo~, 33~7 dncfioxa~e dLadm, ~7501 5. LEGAL DESCRIPTION 2~ 3xiendI~t 5t dncfio~se dL~, 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS One ~ Four ~ Other~ ~ SINGLE FAMILY X Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six 7. WATER SUPPLY J~ INDIVIDUAL* * 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 UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** X/~J/~ PUBLIC UTILITY **If individual/o'n-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS; 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size; If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwE LL TO: Septic/HoldingTank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line ' A"PROVE POR 2 .EDROOMS E~/.f CONDITIONAL APPROVAL (le~er must accompan¥.cc~Ctific, a/.~..~2_ DATE LEGAL DESCRIPTION 72-010(Rev. 3/78) P.O. BOX 4-1275 ANCHORAGE, ALASKA 9¢J509 4849 BUSINESS PAR~( BLVD. TELEPHONE (9O7) 279-4014 D~inkin§ Water Analysis Report for Total Coliform Bacter;a TO BE COi~PLETED BY WATER SUPPLIER I.D. NO. Public Water System N~me ' ' Mailing Addres3 City State Zip Code. Mo. Day Y~ar SA~tPLE TYPE: ) [] Treated Water [] Untreated Water [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE Time NO. LOCATION Collected 3I I Collected By TO BE CONtPLETED BY LABORATORY LABORATORY: NAME CITY Date Received Time Received Analytical Method: [] Fermentation Tube ,_~.,Membrane Fitter .Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310(3-78) 06-1220 (b) Rev. 1978 BACTERIOLOGICALWATER ANALYSIS RECORB Date Collected - Source October 31, 1977 ~r~. Molt:Tatum 8201 Duben Avenue ?~chorage, Alaska 99504 Subject: Lot 4A of Lot 64 Section 13 T13N R3W Before this department can approve your request for individual water system approval, the following items need to be completed. The well is presently in a pit and the well casing is below gro~%d level. This well casing needs to be raised at least twelve(12) inches above ground level and the pit must be filled with impervious type soul, so that water cannot stand aro~O the well casing. If sufficient f~nds are escrowed to cover the cost of this well upgade and the well is upgraded by the next construction season, th~ this department will give approval of the above subject property's water supply. If there are any further questions, please con~ct this office at 2~4-4720. Sincerely, Cory Willis~ R.S. Sanitarian Lomas and Nettleton Company 4449 Business Park Boulevard Billiken Realty % Opal Maggard 8125 Dub~n 99504 99503 ~1: Time Date Insp ;~-~]UNICIPALITY OF ANCHORAGE,~--~ DEPARTMEN',_ 3F HEALTH AND ENVIRONMENTA ~PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: October 26, 1977 2:00 p.m. ~2: Time #3: Time 10-28-77 Friday Date Date Willis Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Lomas and Nettleton Company Mailing Address: 4449 Business Park Boulevard Phone: 274-7661 Property Owner: Moir Tatum Mailing Address: 8201 Duben Avenue 99504 Phone: 333-6718 Legal Description: Lot 4A of Lot 64 Section 13 T13N R3W Single Family Residence: ~x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: ?wo Well System: Permit ~ Construction Individual well (~ Community/Public System ( ) Depth of Well 65' Well Log on File Bacterial Analysis ( ) Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-site System ( ) Public utility Installed Installer Manufacturer Soils Rate Material (x) Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line · , ',MUNICIPALITY OF ANCHORAGE ~~ Department of Health and Environmental Protection 1~4~.~J/) 264-4720 ' "i:i;,'t';'/.:' ~(eques~ Eo~ App~ova2 o~ ~nd~v~dua~ Sewe~ and WaLe~ 1. Property Owner: Mailing Addres~;.~ ~~. ~ Phone: Name of Buyer: Mailing Address:~--~~ Phone: Lending In st it u t ion :~~J~ ~-~_ ~ ~ Mailing Address: ~? _~~~~ _ Phone: ~'7{ Mailing Address: ~/~-r ~,~ Phone, Street Location: 6 Single Family Residence: (~) Number of Bedrooms: ~ _ Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well (~) Public/Conununity System If Individual Well, well depth If Community System, name of system ( ) Sewage Disposal System: *~n-site System ( ) Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled s~nce 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each reques.t before processing can be initiated. 3/77 ~a~e,Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4A of Lot 64 Section 13 T13N R3W Comments: ~'~1~ ~k/~'~._~ (--'~ ~) ~ Affadavit Attached: ( ) Letter Attached: Approved: Date: Disapproved: ~~ ~_~, Date: Department Worksheet: