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Home My WebLink AboutHOLLOWBROOK BLK 1 LT 16041 DA .... ~ECEIVED INSPECTION APPOINTMENTS TIME '~ TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ' MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ~EPT OF H~At DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO , ' . ' .... ~,~ 825 L Street - Anchorage, Alaska 99501 ENVIrONMENtAL ENVIRONMENTAL SANITATION DIVISION ~EC ~t 1981 Telephone 264-4720 ~~1 ~~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW DIRECTIONS: Complete a~li parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE ~~ PHONE 2. BUYER MAILING ADDRESS 3. ~ENDING INSTITUTION I PHONE MAILING ADDRESS 4. REA~TOR/AGE~T ~ PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION / 6. TYPE OF RESIDENCE N[~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well 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 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: NUMBER OFBEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL' DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER Septic/Holding Tank Absorption Area ISewer Line Nearest Lot Line 5. COMMENTS [~PPROVEDFOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED Municipality of Anchorage MEMORANDUM DATE: TO; January 11, 1982 Laura Crow, Fifth Floor FROM: Sewer and Water Program SUBJECT: Request for Refund - Account ~ 2460 Please make arrangements for the following refund. It was not necessary for this office to make a physical inspection of the property. The sewer and water facilities are both public utilities. Thank you. Receipt ~ 165186 Sewer and Water Other $25.00 Deborah Grube Post Office Box 17-439 Big Lake, Alaska 99687 Laura J. Ward Senior Office Assistant attachments ~~ . ':-~UNICIPALITY OF ANCHORAGE ~, (/~.~--~ DEPARTME~i JF HEALTH AND. ENVIRONMENTA. PROTECTION li~'~---Jl' , '(~ 825 L Street, Anchorage-, Alas.~a 99501 . x~k~~// ~ ~ ~ 264 - 472 0 ~x~, ~N~$$~' , Date Rece~g N~ember 1, 1977 Time ~: , . ~2: Time ~ ,%~D~ 93: Time _ __ . Date [~.~XT7 ~'h~A.~% Date ~-h.q-~[,¥~/ o~at% -- ,-- . R~Q~ ~OR ~OV~ O~ I~DIVID~ S~ ~D ~R ~CI~I~p~, Wagner Mailing Address: Post Office Box 4-2090 99501 Phone: 274-1521 2. Property Owner: Fleet Truman Mailing Address: 659 East 7th Avenue 99502 Phone: 344-2984 3. Legal Description: Lot 16 Block 1 Hollowbrook Subdivision 4: Single Family Residence: ( Multiple'Family Residence: Number of Bedrooms: Number of Bedrooms: Three 5. Well System: Individual well ( ) qommunity/Public System ~ Permit ~ Depth of Well Well Log on File ( 6. Sewage Disposal System: On-site System ( ) Public Utility Permit 9 Installed Installer Septic Tank Size Absorption Area Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ---, Municipality of Anchorage DEPARTI%. ~T OF HEALTH & ENVIRONMENTAL POUCH 6-650 ANCHORAGE, ALASKA 99502 279,2511 REOUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES " , :~ 1. TYPE OF LOAN I 2. ASSESSORS PARCEL, NUMBER : i: '' f-I VA [] F.H.A. ~ CONV []I '~ ~ 3. LENDING INSTITUTION 4. REALTOR OR AGENT ;~: ¥~ First National Bank of Anchorage Ward Realty ~, P.O. Box 4-2090 ~ : ~Mile 7, Old Seward Hwy. Anchorage, Alaska 99509 Anchorage, Ak, 99502 ~' Florence Wegner ',~i ~,~'i:: 274-1521 ~"F~Ginny Ward ?i ~'> 344-5995 5. SELLER 6. BUYER , ~' 1 Lewis %~,i~: Fleet Tr~nan Ear ~J;~i~ ~'~;;~, 659 E. 76th 3928 E. 88th Anchorage, Ak 99502 Anchorage, Ak 99507 ~ 344-2984 277-3591 (wife) 7. LEGAL DESCRIPTION 8. LOCATION/STREET ADDRESS Lot 16, Block 1, Hollowbrook Subdivision 659 E. 76th, Anchorage, Ak 99502 9. TYPE OF DWELLING 10. WATER SUPPLY 11. SEWAGE DISPOSAL SYSTEM [~SINGLE FAMILY RESIDENCE '~ BDRMS [] PUBLIC UTILITY J~] PUBLIC UTILITY [] MuLTI-FAMILY RESIDENCE BDRMS ~ PRIVATE ON;SITE~Sha-~ec~ wlt~ [] ON-SITE n~cj-hbor i~g properties YEAR INSTALLED INSTRUCTIONS TO REQUESTOR I. Complete Items 1 to 11 above 3. Send to address above 5. Response will be returned to lending 2. Remove the carbon 4. Please allow 10 days for processing institution DATE RECEIVED DATE OF INSPECTION TIME OF INSPECTION INSPECTOR TYPE DEPTH YEAR DRILLER PERMIT REFERENCE -~ FT. ~ CONSTRUCTION BACTERIAL ANALYSIS LAB REFERENCE NO. YEAR INSTALLED INSTALLER TANK SIZE MANUFACTURER ~ DIMENSIONS CRIB CONSTRUCTION ~- [] PIT >- ~ TOTAL LINE LENGTH TRENCH DEPTH GRAVEL DEPTH ~- [] DISPOSAL ~u FIELD ~ FT. FT. FT. TOTAL ABSORPTION AREA PERMIT REFERENCE SQ. FT. SEPTIC TANK $ORPTION AREA SEWER LINES LOT LINES OTHER ~ WELL TO: ~- SEPTIC TANK ABSORPTION AREA WELL LOT LINE ~_ ABSORPTION ~ FOUNDATION TO SYSTEM TO: [] APPROVED [] CONDITIONAL APPROVAL [] DISAPPROVED .[] UNABLE TO INSPECT DATE INSPECTOR DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and watar facilities and these facilities are operating satisfactorily. DATE SIGNATURE Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 16 Block 1 Hollowbrook Subdivision Comments: ~/.~ --~~ // Af fadavit Attached Approved :~~~j~ Disapproved: Letter Attached: ( ) Date: Department Worksheet: 06-1220fa) ~ev. 1973 DATE ALASi:DEPARTMENT OF HEALTH AND SOCIAL SERV.~.,~ES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER AN'ALYSlS Lab No. OFFICE NDIVIDUAL [] NAME ADDRESS CITY SEMI-PUBLIC [~]~L CHLORINE RESIDUAl PPM REPORT RESULTS TO ZIP CODE ADDRESS OF SOURCE Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Questionable [] Sample too long in trans[t; sample should not be over 48 hours old at examination to indlcate reliable results. Please send new sample. [] Bottle' broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED - TIME COLLECTED Sample Collected From ~l~tchbn Tap [] Bathroom Tap [] Basemen Tap [] Other (List) Well- E Dug ~ Driven -- Drilled ~ Bored SOURCE: [] Spring [] Cistern [] Other_ Dug Well or Cistern Construction: Walls--J~ Wood [] Concrete [] Metal [] Tile Brick or Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete LOCATION: [] In Basement [] Basement Offset [] Under House []In Yard [] Othe~ -- Bu~ldJng Sewer Septic DISTANCE TO: or Other Dralnage Pipe Feet. Tank Feet. Tile Seepage Cess- Field Feet. Pit------Feet. Pool- Feet. Privy Feet. Other Possible Sources of Contamination MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] Fibre [] Asbestos Cement ~-- Plastic Joint Material - Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No Diameter of Well Depth Well Casing Materlal Diameter Depth Length of Water Depth Drop Pipe From Bottom Offset in PUMP LOCATION: []'in Well [] Basement [] In Basement On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Iness Suspected? In Utility [] Room New Source of Supply? [] Yes E Yes [] No [] No Re~alrs to System? [] Yes []No Signature 06-I220 (b BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 ~?'~. j:,'i~.,.:? "~" °~"~' ~ab. No. : Date Received _ Time Received Lactose Broth 10cc 10cc 10cc 10cc 10c¢ 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 DensHy __ IMost probable No. per 100cc) 'MF Results READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Reported by Absent Present This analysis indicates Coliform Organisms to be: November 9, 1977 First National Bank of Anchorage MortgaqeLoan Section Post Office Box 4-2090 Anchorage, Alaska 99509 Attention: Flc=ence Wagner Subject: Lot 16 Block 1 H°llowbrook Su~ivision Fleet T~uan ~operty The well serving the subject property is in a well pit which must be upgraded. The upgrade cor~ist of exten~ing the well casing above surrounding ground surface and filling the pit with impervious so~l. The storage tank must be relocated in a well house or one of the residences se~e~. If there are any f~rther questions, please contact this office at 264-4720. Sincerely, Les N. Buchhol=, Sanitarian cc: Fleet Truman 659 East 7th Avenue 99501