HomeMy WebLinkAboutEAGLE RIVER HEIGHTS Block 3 Lot 10B108
(fir tft�e� Urtttlng :vNNgLITY OF ANCHORAGE
by DEPT. OF HEALTH &
ENVIRONMENTAL F�.OTECTION
DOC Co. aba
SULLIVAN WATER WELLS APR 2 8 1981
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 RECEIVED
�T
OWNER OF LAND [ /A_ Jt O Ll I < NA.t e?S DEPTH OF WELL 16 o I
ADDRESS -7,) D F /P H TSSTATIC LEVEL OF WATER FT. I U
LEGAL DESCRIPTION L 1128 /Tl t 7 DRAW DOWN FT. /,Of
Or
DATE -Started /6 IPI Ended 311C / GALS. PER HR -7,20
PERMIT NUMBER ? KIND OF CASING T 6
KIND OF FORMATION:
From "7 Ft. to Ft. O 0E</30"e00 E22 From Ft. to Ft.
From —) Ft. to Ft.,
4,r�d! �`/
From
Ft. to
Ft.
From If' Ft. to n�Ft.
1Al2/7 / P ✓tc G-(,vf rom
Ft. to
Ft.
From Ft. to Ft.
/77 I X F_ XJ
From'
Ft. to
Ft
From 4 Ft,to7 `� Ft.
/C'ti` r srg^'O
From
Ft. to
Ft
From Ft. to .E Ft.
�G Nt7' �PFa£ c
From
Ft. to
Ft.
From Ff� Ft. to�Ft.
r
-Tr t HT lklo JO
From
Ft. to
Ft.
From Ft. to Ft.
C /?a✓F C wF i
From
Ft. to
Ft.
From f7 ,}_Ft. to / �t Ft.
e4,0?':' Lee 9 vE'G
From
Ft. to
Ft.
From1'q F Ft. to AGO Ft.
SAti4 ^0IJ471L
From
Ft. to
Ft.
From Ft. to Ft.
�IOD� rn .r �4L k/R r
From
Ft. to
Ft.
From Ft. to Ft.
Pel f d r ✓B< K
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft. From Ft. to Ft
MISCL. INFORMATION:
DRILLERS NAME
MLjfJ I (_ I jF,L- I T'r' OF FiirJGH4Fct�GE
DEPAP.TMENTs HEALTH AND ENVIRONMENTAL ~'.OTECTION
t 825 '� STREET, ANCHORAGE, AK. 95c,01
264-4720
WELL F"EF:ZM I T
PERMIT NO. ( 810043 )
APPLICANT DAVID RICHARD
LOCATION CHAIN OF ROCK ST. ER
LEGAL LOT 10B BLOCK 3 E. R.
705 MULDOON RD #186
338-3082
HTS S/D LOT SIZE 25947 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXF` I RES~ D>ECEME3ER :3:1.+ :lL 4.9`3'-
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES.
SIGNED
APPLICANT DAVID RICHARD
ISSUED BY
V4. 0
a
T'3L.tf�i I � I Pt'1L I TY ri� FiTtCf-itaRt��3E
OEF�rMENT LIF HEALTH AM ENVIRONMENTAL PROTECTION
823 'L' STRE'EL, A� W X501
264-4728
FF3stttr N0. S aft43
nPPLICIVNT tkWLD RICHFM M MULD" RD *I -v6
U X,'nT I ON cm I N OF ROCK sr. ER
LEGAL LOT 100 BLOCK 3 E_ R_ HIS S'D LOT SIZE 25447 5011M FEET
t4IttUUM OI PMEE BETMEN A WELL ANO AW ON-SITE SEbME DISF,068L 5'YSTEM IS
200 FEET FOR A PRIVATE HELL OR £59 TO 20A FEET FROM A PUBLIC WELL DIEMIDING
UPON THE TYPE Cr PUBLIC WELL.
tjLNItFjM ()ISTAME FROM A PRIVATE HELL TO A PRIVATE SE14ER LIKE IS 25 FEET AM
TO R i7wpJNITY SE[4eP. uw- IS n FEET.
YJCLL LOaS ARE LCoUtAE0 lam? "raT BE REP.MiED TO TW OEPRfCrMENT WITHM sA OfI'PS
�¢ THE WELL rl�TMPL
OMER REDNJIREMENIS MAY APPLY. SPECIFICATIONS AND CON'STRUCTtON otsotAtis ARE
AYAtL1*-'LC TO INSURE MIPER INSTALLArto'L
f}�Ri`T i T !=:•LP I f�1=5 tat=CENSER 31. �..��1. ,
I CERTIFY THAT
£: I RM FAIL IL I SR WITH TW REOV I RE MEN TS FOR ON -SUE TE SS -PERS AND WELLS Ali ser
FORTH 8Y THE MMICIPAL[TY OF A► OE
2: [ BILL INSTALL THE SYSTEM IN FiXlJR0f0X WITH THE CODES.
SIGTIED:--'---�-- ----- --------
APPL CANT OAYID RICHARD
Y4. $;
Y
X
> rll� r44�
MAILING ADDRESS
I5. LEGAL DESCRIPTIONrv� I
G4/- /O-Q_Z!7- c�//c ven �✓� J
/,.. 0 Y CfTOL.S'
S. TYPE OF RESIDENCE
❑ One ❑ Four ❑ Other
.( SINGLE FAMILY ❑ Two ❑ Five
❑ MULTIPLE FAMILY Three ❑ Six
7. WATER SUPPLY
�i 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 UTILITY depth (attach log if available.)
[NOTE:THEIN
EWAGE DISPOSAL SYSTEM
❑ INDIVIDUAL/ON-SITEYEAR ON-SITE SYSTEM WAS INSTALLED.
PUBLIC UTILITY
SPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEDL
72.010 (Rev. 6/79)Id" )
c-e�
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTO�
R
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT, OF 11EALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTtiIRONMENTAL f:.OTECTION
\1 825 L Street • Anchorage, Aloka 99501
JUL 1 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 R Er I V E
APPROVAL OF INDIVIDUAL WATER AND SEWER F]�CiLIT1E�
REQUEST FOR
DIRECTIONS: Complete all Darts on page 1. Incomplete requasn will not be processed. Please allow ten (10) days for processing.
PHONE s
1. PROPERTY OWNER �3P•'�''��--••
,u+ tid•
MAI LINj •ArDORE55 Idol
/� � L>
HONE
PROPERTY RESIDENT lit different from above)
N
2. BUYER 4-
MAILING ADDRESS
PHONE
3. LENDING INSTITUTION
MAILING ADDRESS
PHONE
q. REALTOR/AGENT
a Al L
MAILING ADDRESS
I5. LEGAL DESCRIPTIONrv� I
G4/- /O-Q_Z!7- c�//c ven �✓� J
/,.. 0 Y CfTOL.S'
S. TYPE OF RESIDENCE
❑ One ❑ Four ❑ Other
.( SINGLE FAMILY ❑ Two ❑ Five
❑ MULTIPLE FAMILY Three ❑ Six
7. WATER SUPPLY
�i 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 UTILITY depth (attach log if available.)
[NOTE:THEIN
EWAGE DISPOSAL SYSTEM
❑ INDIVIDUAL/ON-SITEYEAR ON-SITE SYSTEM WAS INSTALLED.
PUBLIC UTILITY
SPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEDL
72.010 (Rev. 6/79)Id" )
c-e�
720/0 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLEFAMILY
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
UMBER
❑ INDIVIDUAL
F WELL
❑ COMMUNITY
TDATE
❑ PUBLIC UTILITY
ILLED
Connection Verified
EIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
DATE INsrgLLED
Connection Verified
❑Septic Tank or ❑Holding Tank
INSTALLER
:.If Tank is homemade
SOILS RATING
s:
MANUFACTURER
,SizeSize:
PTION AREA
MATERIAL$
Septic/Ho...ng Tank Absorpton Area Sewer Line Nearest Lot Line
WELLT0:to
nearest Lot Line
5. COMMENTS
PPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL
(letter must accomp y cert ficate)
❑ DISAPPROVED
BY '
?—/ s
720/0 (Rev. 6/79)