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HomeMy WebLinkAboutNEWLAND BLK M LT 5 F'ERMI T NO: [:,RTE ISSUED: " _ 'rTE] 84050'1 b-~ELL PEF-:~--1 "r T RPPL ICRNT: R[:,DRESS: ClaNTRCT FHCNE: DOROTHY F STRPLES 844? VERNON STREET RNCNORRGE, RK ~D5t5 ~44-0~47 RPPLIC:flNT: DOROTHY F ff~flPLEz, ~/ I'-']'_-TUED B,'" ~..~.~ ~ [.',RTE L~GRL DESCRIP: SUBDI',' '- ~ I-,ION: NENLRND LOT: 5 BLOCK: M ' - SECTION: 7 TONNSHIP: 12N RRN.~E: ]:H LOT SIZE: e]0C4~]' ' (S~.FT. ~- ' I CERTIFV THRT: ' 1. I ~.1. FRMILI~R HITH THE REOUIREMENTS FOR ON'SITE SENERS RNa, NELLS RS SET FORTH E:'~' THE MUNICIF'RLITk' OF RNCHORRGE (~lOfl) BND THE STflIE OF RkRZ~Kp. 2. I NILE INSTRLL THE Sk'STEM IN RCCORDRNCE'HIT~ RLL MOB CODE~ fiND REGU*~TIONS. HND IN C, Cf~LIHNLE WITH THE DESIGN CRITERIR OF THIS PERMIT. 2~. I NILL' RDHERE TO RLL MOil RND STfiTE OF RLflSKB REQUIREMENTS FOR THE '- [.Iz, THNuE:, FROM RNV E~iISTING NELL, HRSTEWRTER DisPOSRL SVSTEH OR PUBLIC SENERRGE S'~'STEt,'t ON THIS OR RNk' R[:,JRCENT ER NERRB'~' LOT. WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys  ATION OF ~ELL (Pleos~omplete. e.e.e.e.e.e.e.e.~elther la, lb or lc.) STANCE AN ' D DIRECTIO~ FROM RO~D INTERSECTIONS Section Street Address and Area of Well Location 2. WELL LOG Feet Selow Material Type Top Bottom MUNICIPALITY OF D~PT. Drilling Permit No, A, D. L. No, s~l/ wig Meridian OWNER OF WELL: WELL DEPTH; (final) 1 5. DATE OF COMPLETION ..~ ~2 ~'__ ft. ':,2" ~ / <'./ -- ,:... E] ~able fool E] Rotary ~] Oriven F~Dug ~ Auger ~dette~ ~.ore* ~ Other: 7. USE: ~ Domestic ~] Public Supply [] Industry ~] Irrigation [] Recharge [] Commericel [] Te~f Well [] Other; __ 8. CASING: ]Threaded [] Welded to/'-,' '~/ ft. Depth Weight '' ..~: lbs./ft. fo ft. Depth Stickup __ ft 9. FINISH OF WELL: ,; Type: ''~Vi ~- ,~ ,.~'i;:t ; --. Diameter: Slot/M~sh SIze:~ Length: Set between ft. and ft. lO, STATIC WATER LEVEL: '; __ tr. ~.'/,..:/: EquiPment used: II. PUMPING LEVEL below Iond surface and YIELD ~ ,:!~, .~ ft. after ' __hrs. pumplng~',",:'.'~ g.p.m. ~ff- after ~hrs. pumping g.p.m. 12.GROUTING Well Grouted: [] Yes [] No Material: [] Neat Cement [] Other: Length of Drop Pipe ft. capocily ,~ Subm. [] del [] Centrifical [] Other _ o E]F []C 16. WATER WELl.. CONTRACTOR'S CERTIFICATION: 15. Water Temperature This we.,I.J...y~.!~..?!!!..e.>d..~ug~.~.~j,u~j._~ i:~;.ip~, a~od .his re~'~rt i'~ J~e ~o he bas 9f kno , / * ?? '( . ¢"~"'~'~ ._. ~Conlract License Number O2-ww~ (Il/si) Authorized Represen?dtive Copy Distribution; WHITE-State BAGS, PINK-Driller, CANARY-Customer FROM SIGNED Y (50 selsl 4PAT1 SIGNED OA,E 5 /~2/ //_~..~-~,.~ - . ': 'UNICIPALITY OF ANCHORAGE ~},~]~f~, /~-~ ~,~.~'*~1/ DEPARTM'EN¥~-'¢F HEALTH AND. ENVIRONMENTA'~.?ROTECTION .,{~y// ~. . ~, A%25 L Street. Anchoraae. Alaska 99501 Insp P~att Insp ~, f /' REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Spokane Mortgage Company Mailing Address: 3201 C Street, Suite Phone: 277-0543 Property Owner: Mailing Address: Ronald C. Hartley 8447 Vernon Phone: 3. Legal Description: Lot 5 Block M Newland Subdivision 4: Single Family Residence: (z) Number of Bedrooms: Multiple. Family Residence: ( ) Number of Bedrooms: Three Well System: Permit # Construction Individual Well (~ Community/Public System ( ) Depth of Well Well Log on File ( ) Bacterial Analysis e Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System ( ) Public Utility kx) Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area P~age Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block M Newland Subdivision Letter Attached: ( ) Affadavit Attached: Date: Department Worksheet: o ; ' ~-~¢I'UNICIPALITY 0 ', F ANCHORAGE ~, Department of Health and ~nvzronmental Prote¢~.i.on: 825 L Street, ~chorage, Alaska 264-4720 :eq~es~ ~o~ ~o~a~ o~ ~na~v~a~aZ Sewe~ and ~ake~ ~ac~l~t~es Property Owner: ~9~ ~ O, left Mailing Address: gCd~ V~ ~0~ Phone: Name of Buyer: Mailing Address: Phone:~~ Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: (,,, ~, Phone: Phone: Dg~t OQ&~-~ Legal Description: Street Location: Single Family Residence: (~f~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: o Water SupPly: * Individual Well (~'~Public/Community System ( ) If Individual Well, well depth ~'rF$;~[23£~ ~jJ~l~J;~ if conununity System, name of system Sewage Disposal System: *~n-site System ( ) Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 L .......... _1 L. ........ J LJ Abbott Loop Area Reference Map-P11 134 146 ~ 156 -'~ :~ 162 135 148 © 1976 JH SIGNED '1 DATE Redi~orm ® SIGNED SEND PARTS 1 AND 3 WITH CARBON INTACT 4S 469 Po ¥ Pak 50 e s 4P469 PART 3 WILL BE RETURNED WITH REPLY DATE D.'~/,RTMENT OF HEALTH AND WEL. IE DIVISION OF PUBLIC HEALTH "~/ BACTERIOLOGICAL WATER ANALYSIS OFFICE PUBLIC E~] SEMI-PUI3LIC [~ NAME fNDIVIDUAL [] REPORT RESULTS TO ADDRESS CITY ADDRESS, OF SOURCE l[] Records in this office indicate this WATER SUPPLY to be of: Salisfaclory [] Questionable ~] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: [] Satisfactory [] Questionable [] Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. __1. Notify consumers water ~s polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." SAMPLE COLLECTED BY am DATE COLLECTED TIME COLLECTED - --pm Sample Collecled Prom (~ Bilchen Tap [] Bathroom Tap [~ Basement Tap J [] O,her (Lis,),~___ ~"'~e '~ . . Well- [] Dug [] Driven [] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other Dug Well or Cistern Construction: Walls - [] Wood [] Concrete [] Metal [] Tile [] Concret. Top - [] Wood [] Cor:.crele [] Metal [] Open Top LOCATION: [~ In Basemenl [] Basement Ogset [~] Under House [] In Yard [] Olher MATERIAL: Building Sewer - []IronCast [] Wood [] Tile [] Fibre [] AsbeslOScemenl __ GENERAL: Does Water Become Muddy or Dscoored? [] Yes [] No When? Diameter of We . Depth Fee~, Well Casing Material Diameler Depth Length of Waler Deplh Drop Pipe Fram Botlom Feet, PUMP LOCATION: [] In Well []J~asementOffsef In [] In Bosernenf [] Roomln Utility On Top [] Of Well [] Olher PURPOSE OF EXAMINATION: Illness Suspected? [] Yes J~ No New Source of Supply? [] Yes [] No Repo rs fo Syslem9 [] Yes [] No 2. Increase chlorlnatlon sufficiently to meet recommended residual standards. Delermlne source of contamination and take action necessary lo maintain a safe water supply at all times. 3. Check chlorinatinn and other mechanical equipment. Make certain it is functioning properly. 4. If after checking equipment a disinfecting residual is not obtained, please wire this office for emergency assistance or advisory services. S. This is a surface water source and subject to polluHon by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cistern. __7. Relocate your welt to a safe location in relationship to your sewage disposal system. [] see enclosure __.8. Sample too long in transit; sample should not be over 48 hours old at examination lo indicate reliable results, please send new sample. [] Baffle Broken in transib please send new sample. ,9. Contact your nearest [] Local Health Department or [] Alaska Division of Public Healih, sanitation office for bulletins, consultation and assistance. SANITARIAN'S REMARKS Signature. READ INSTRUCTIONS Dale Received 0 N Lactose Broth 24 hours 48 hours REVERSE SIDE Brilliant Green 24 hours BE FO RE 48 hours EMB COLLECTING SAMPLE Lactose Broth, 24 hrs. Coliform Density MF results ? r; BACTERIOLOGICAL WATER ANALYSIS RECORD om .Time Received_ pm_ Lob. No AGAR 48 hrs. 1.0cc J 0.1cc t (Most probable No. per IOOcc.) am Reported by .' Thls analysis indicates Coliform Organisms to be: Absent ®L J Present AFFADAVIT I, hereby, state that the well serving my property, Lot 5 Block M Newland Subdivision, is a cased drilled well which is located in the crawl space of the residence on the property.