HomeMy WebLinkAboutALDERWOOD BLK 1 LT 14
PERMIT NO.
[:,EF'RRTFIENT~ HEALTH 8N[:, ENVIRONMENTRL~O'T'ECTION
825 STREET., ANCHORAGE., AK, 9. ~1
264-4?20
I.WELL PER£'I I T'
( 820~0 >
APPLICANT
LOCATION
LEGAL
ROBERT VRUGHN
SAND LAKE
LTl4 Bi F",LDERWOOD
S~R BM i¢84 D RNCH
LOT SIZE
345-0~??
15000 SQLIRRE FEET
MINIMUM DISTANCE BETWEEN R NELL RNE:, ANY ON-SITE SEWAGE DISPOSAL SYSTEM I~
100 FEET FOR 8 PRIVATE WELL F ,
JR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRI',,/RTE SEWER LINE IS 25 FEET AND
TO 8 COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED, AND MUST BE RETURNED TO THE [:,EPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION
F"EF~:r-1 I T E×F' I RE_'i;, DE,~-::..E_'FIE:ER _---{.~.~L..
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN RC:CORDANCE WITH THE CODES.
V4. 0
Date Drilled:
~ELL LOG
Static Water Level 76)
Draw Down
feet
feet
Gallons Per Minute
Total Feet of Casin~
I
Type Material Drilled~
0 feet to
,
/C to
~0' to
/ /
~0 to /0o
i
/o0 to / ~3
MUNICIPALITY OF ANCHORAGE
[""~T Cc !JE'LT'-I t
::, i"_' ? 1 5 I982
RECEIVED
Hefty Drilling
S.R.A. Box 1553 H
Anchorage ,Alaska
995o?'
'APPLIC' NT FILLS OUT UPPER HA~--ONLY
Pror .x' O~ner _~- /(.~ ).:~ .~ (~_~/ // ~.~ ,_..~/~ ./_~ Phone
.¢-, .? .,.- .-r F
Buyer
Address ~ /I .~-, f~ I--7' P
' ~ ..... ' ~' Phone
Lending Institution
Address ,_~_ _-~,_~3~..~ j &.~.[.~/.~.- ,~'3 "~'-F,~--- p~. /1.//~ Zip Code
Realty Co. & Agent Phone
Address Zip Code
Legal Description
Type of Residence
. Single Family
Multiple Family No. of Bedrooms
[] Other
Water Supply
,, Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal
[] Individual Year Individual Installed:
When Connected to Public Utility:
Public Utility
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
MUJ~ ICIPALITY OF ANCHORAGE
Field Notes:
~,~, 1 o 1982
RECEI_V_FD
( ~S ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CO. NOITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)
~CHEMICAL & GI-LOGICAL LABORATORIES ,r ,ALASKA' INC.~
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria ~
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water S~stem Name
I.D. NO.
~ Phone No.
Mailing Address
City
SAMPLE DATE:
Mo. Day
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
State
Year
Zip Code
[] Treated Water
[] Untreated Water
SAMPLE
NO.
,
3
4
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
,r~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
~/Membrane Filter
Lab Ref. No. Result* Analyst
I r-J-I
i r-T-i
I I--I-I
I
*No of colonies/lO0 mi. or No. of Positive portions.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 {b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Data Collected Source
Data Recalvecl Time Recalve(I __ p.m.I.ab. No.
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hour~:
Multiple Tuba Report: 10mi Tubes Po~tlve/Total 10mi Portlon~
Membrane Filter: DIr~t Count Collform/100ml
Verification: LTB BGB
Final Membrana Filter ReSults " Collform/i00ml
Raborted By · Data
TlmeT ~ ,,~- .~ a.m.