HomeMy WebLinkAboutALPINE VILLAGE BLK 5 LT 12014
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Development Services Department
Building Safety Division
"r On -Site Water & Wastewater Program,a
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4700 Elmore Poad
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P.O. Box 196650
Mark Begich Anchorage, AK 99507
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Mayor www.muni.org/onsite
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(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: CTSI132.2.1
Legal DescriptionProperty Owner Name & Address:
40-%k /��
13s 12 �5l� 8`C.
Pump Installation Date: / Q
Pump Intake Depth Below Top of Well Casing: 9 Z feet
Pump. Manufacturer's Name: 17-e def
11
Pump Model: S0C2
��5l7
Pump Size Yf, hp
Pitless Adapter Burial Depth: t feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? 2 Yes ❑ No
Method of Disinfection:
ell- Peed
Comments:
Pump Installer Name:
8517,
ANCHORAGE WELL & PUMP SERV.
330 EAST 76TH AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
GAAB-HD-I
GR ER ANCHORAGE AREA BOROI.
DI:r.~FITMEBIT OF ENVIFIONMEBITAL 0.UALI',,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ,...~?77Z/,,(' u4~.,.) PHONE__~'~~.~'~'
ADDRESS
LEGAL DESCRIPTION/7*`//2 ~'/',/~-~ ~//'~' ~4//~f'Z~
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
NUMBER OF /
MATERIAL ("1~ to" ~,~'~"~' COMPARTMENTS
'd/'~¢~"~(?~'i~") '~"¢~"~- ~' ~ ~::-'--~ LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS__ / OUTSIDE DIAMETER
LINING MATERIAl ti'l~2'f./~.'J~z'-~/L~''' [~'i~'~ll'*"~'. ) ·
NEAREST LOT LINE''"~'./~ ~
OR WIDTH__J'~
DISTANCE FROM WELL .,'/~"'~ ~_Z~..,/~.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH /~ , DEPTH
, BUILDING FOUNDATION~
'~-- C'-'~ ,SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINE~..~..~'""'~
ABSORPTIONF~EA
DEPTH.. TOP OF TILE TO FINISH GRADE
, NEAREST LOT LINE
TRENCH WIDTH
FOUNDATION
DISTANCE BETW--~NES
SQ, FT. LENGTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH'
OF LINES ,
IN.~L EFFECIIVE
IN. ABOVE TILE__
WELL:
LOT LINE
DISTANCES:
f~:'Zo,~...
.~ DISTANCE FROM
BUILDING FOUNDATION.__ '"'"
SEPTIC ~/ SEEPAGE , ~'
TYP E~"~';'~ DEPTH
NEAREST ~
SEWER LINE
DIAGRAM OF SYSTEM
WATER
SAMPLE
CESSPOOL
, NEAREST
OTHER
, SOURCES~
,/
G.A.A.B.
MUNICIPALITY OF ANCHORAGE MUNICIPALITY O~F ANCHORAGE
~~ DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION DEPT. OF ilEALTH &
825 L Street Anchorage, Alaska 99501 ENVIRONMENTAL Pi:<)'iLCTION //~
ENVIRONMENTAL ENGINEERING DIVISION NOV ! /' 1978
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWL~~JI~IIL~D
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTY OWNER PHONE
Bob/Brenda Whitney 344- 8343
MAILING ADDRESS
7517 Bern 99507 863-8287/w
i PROPERTY RESIDENT (If different from above) PHONE
2, BUYER PHON~
John Barlow/Reta Kennedy 278-9748
MAILING ADDRESS
2007 East 3rd Avenue 99501
3. LENDING INSTITUTION I PHONE
State of Alaska Veteran's Administration1274-7555
MAI LING ADDRESS
907 West Northern Lights Boulevard 99503
1
4. REALTOR/AGENT PHONE
Bette Sherry % Area Realtors, Inc. 278-2525
MAILING ADDRESS
3300 C Street 99503
5. LEGAL DESCRIPTION
Lot 12 Block 5 Alpine Village Subdivision
STREET LOCATION
7517 Bern
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
;:~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
* 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,)
**If individual/on-site, give installation date 1971
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 'rIME
DATE DATE DATE
I NSPECTO R I NSP ECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
L-] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] IN DI VI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [~ Holding Tank
Size: 1~)(2~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SQILS RATING
MANUFACTURER
MATERIAL
Absorption Area to nearest Lot Line
Septic/Holding Tank IAbsorption Area
ISewer Line
INearest Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
DATE ] BY (Tit~)e)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection..j
t 825 [ Stree-~-~! Anchora e,, Alaska 99501 ~ 2~0(~ ~,~-~a,,, ext. 224, 225
Reques~ for App~ov~l of Individual Se~eP and ~ateP Fac~l~8~es
Property Owner: ~:),{ ~, ~L~ I~ ~'C~a.~_
Mailing Address: ~)5~lfl i~4xC) ~cIS~ (/Phone: ~'~
2. Name of Buyer:
Mailing Address:
Mailing Address:
Be
Mailing Address: '~ '~'VO0 '~'0" ~exfJJ.~
Legal Description:
Street Location:
e
Single Family Residence:
Multiple Family Residence:
(X) Number of Bedrooms: ~.~
( ) Number of Bedrooms:
Water supply: *Individual Well
If Individual Well, well depth
Publ i c/Communi ty System
If Community System, name of system
()
Sewage Disposal System: On-site System
If on-site System, date of installation:
(X<) Public System
()
*NOTE:
A well log is required on ALL wells drilled since 6/75.
REALTORS'
