HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 3 LT 14A2-1AOnsite File
Eagle River Heights
Block 3
Lot 14A2-1A
#050-271-68
NOV-7-2006 11:07 FROt1:EAGLE RIVER 694-7701 70:3437997 P:2r2
c1Certitieb
�rr tag
by
SULLIVAN KWATERPWELLS
p.O. BOX 67o272.
OWNEROFLAND:
ADDRESS:FP
_LEGALDESCRIPTION: �, 0 �f1 �'l�-
DATE:�/ _PERMIT NUMBER: a? pIssue LL- i -TAX IDENTIFICATION NU1-- ��Is well located at approvn? drYes 0 NoMethod of Drilling: Q41ftool
Depth of well: IS
Casing Type S; -P,7:1- Wall Thickness; cT ��� inches
Diameter_ Inches, depth
a 1 feet
Liner Type: u '�J'^
Casing Stickup Above Ground: feet
Static Water Level: %r ? feet
Recover Rate: Z" gpm
Method of Testing: .
Well Intake Opening Type: a6%n end 0 open hole
U Screened; Slart feet Stopped feet
WFerforatlon3 Start feet -Slopped feet
�9e) 1 r
Grout Type: �'^:+�,`"' r rolume
Depth: from r� feet, to feet
Well Disinfected Upon Completion?es 0 No
Method of Disinfection: CAL
Comments:
Driller's Namer
ATTENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Nov 07, 2005
Expiration Date: Nov 07, 2006
Permit Number: SWO50419 Parcel ID: 050-271-67
Legal Description: EAGLE RIVER HEIGHTS SID BLOCK 3 LOT 14 A2-1
Design Engineer: 0000 None Required
Owner Name: VERNON MOELLER
Owner Address: 10312 CHAIN OF ROCK
EAGLE RIVER. A 99519 -
Site Address: 10312 CHAIN OF ROCK
Lot Size: 28647 SQ. FT.
Total Bedrooms: 1 Permit Bedrooms: 1
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( IBAAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IT IS
THE BURDEN OF THE PROPERTY OWNER TO DETERMINE ANY EXISTING WASTEWATER PERMITS EFFECT
THE LOCATION OF THE WELL. IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE
WATER AND WASTEWATER PROGRAM AT 907-343-7904.
Received
By Date: �l S
Issued B )r, Date: It
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C>Q 47Y-67 Permit Number SW
Propert,.
Mailing
III �.� �� iii
/ /_ F
,ode
Site address / Zip Code
L.
Legal description (Lot, Block & Sub'd.) /07-1440-/ c .
Legal description (Section, Township & Range)
Lot Size o(g Co�i�. Acre q.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
�� �J Waiver Fees:
Sewer Only
❑
Well Only
Receipt Number:
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
TherapyEpDL,
❑
I certjfy that the ve in rmation is correct. I further certify that this application is being made for a
Si le Fami Ilin n �s i accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
�� �J Waiver Fees:
Date of Payment:
l0 dSJ Date of Payment:
Receipt Number.lod�,e,(�_
Receipt Number:
(Rev. 09/04)
10
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