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HomeMy WebLinkAboutALASKA CEDAR LT 4Lot 4 075-092-79 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?  Yes  No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Well Log Permit Number: #__________ Date of Issue: ________ Parcel Identification Number: __________________ Date Started: _________ Date Completed: _________ Is well located at approved permit location? Yes No Legal Description:_________________________________________________________________________ Property Owner Name & Address: _______________________________________ _______________________________________ _______________________________________ Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Method of Drilling air rotary cable tool Casing type: _________ Wall Thickness: inches Diameter: inches Depth: feet Liner Type: _________ Diameter: inches Depth: feet Casing stickup above ground: feet Static water level (from ground level): feet Pumping level: feet after hours pumping gpm Recovery Rate: gpm Method of Testing: _________ Well Intake Opening Type: Open End Open Hole Screened Start feet Stopped feet Perforations Start feet Stopped feet Grout Type: _________ Volume: _________ Depth: _________ Start feet Stopped feet Well Disinfected Upon Completion? Yes No Method of Disinfection: Comments: Well Driller: _____________________________ Company: _____________________________ Mailing Address: _____________________________ Water Sample Results: Arsenic: _________ ug/L Nitrates: _________ mg/L Total Coliform Bacteria:_________ colonies/100mL Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP251003 Work Type: Well Initial Tax Code Number: 07509279000 Site Legal Address: ALASKA CEDAR LT 4 GA913 Site Mailing Address: Owner: CAREY KYNDALL LEIGH & CLYDE RA Design Engineer: This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 1 /21 /2025 1 /21 /2026 11005 © Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 6 '� -5,-, ) 1 '4 i l Issued By: CA//,1 Date: _ Date: z t l 2oZ� 2 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 0 � 5, 0 9 1 � Property owner(s) Clyde and Kyndall Carey Day phone 907 830 5024 Mailing address 1352 M street Anchorage Alaska 99501 Site address TBD Legal description Alaska Cedar Subdivision Lot 4 Number of Bedrooms 2 Engineering Firm Andrew P Adams PE Building Permit Number TBD Not Applicable ❑ APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field ❑ Initial FX] Septic Tank ❑ Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Well F1 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment: Permit No. C) C) Waiver Fees: Date of Payment: Waiver No. Distance: Well Location marked meets all seperationrequirements.