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HomeMy WebLinkAboutANDERSON MILLER Lot 11 & 12 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. ' :-2 ~- · P~OpertY Owner: -_Jay>_~R-._;_M~'e~vil-l-'e - ' ' -phone: _-.---'.':/Mailing Adaress~_35_0-0,1_i. OWa., 995Q3~ - ~, , '. , ' , - ,. - ,.. :-'- ' 3,-_ .Legal -Descr. fption: Lot_l:!a~a =.1._2 .-An.__derson Miller smbaiVision -~' i.. _ _' . . , "3~0O-:-i~wa- DriVe ........ ' ..... ?._ -i4:-_ s~ngle Family; Re.ei:.aenoe: =- .;(X) - . amber of sedrooms= Four .~: '~.- - ~-~Mu-ltEple Family-Residence; ( ) Number of Bearooms;. '-: - :--~5'. -We'll System:-'-in 1 well (x) cOmmunity/Public system ~--'- ~. ~ermit-~ - - -~'- ~' De~th of.Well ~6°' ~e~l-ao~°n .'-' /: : - -" _ ' - -- ~ ' ' - - ~- - -~ _ - Cons~c~on - ::. - Bac~e~ial 'AnalYsis . :6-'.' Sewage DisPosal System: .O~.Site-System ( ) Public ~Utility ~-- ~- ] permit.9 '. . ~ ._, -. _;.-ins~l_ied_ installe~ . .'- ~ -' ~ _ : Septic .Tank. Size' __- - - . Manufacturer - - -'-- - -.:' .Absorption Area - - ? Soils Rate - Material ' '- 7. / Distances: Well-to Septic Tank- _ to-AbsOrption Area .-_: _.-l_: to:Nea~es~ Lo.t.-LSne_~-: -' __-- - _ _' -. - . _ - _ . -- . -.. __. __.-._ . ~ - _- ._:~_..-~. _ _ _-~ . _- - ...- MUNICIPALITY OF ANCHORAGE ~..~ Department of Health and Environmental Protection ' ~ //'~ld~"~ ~ S~,,~chorage, Alaska 99501 ~'~quest for Approval~al Sewer and Water Facilities 1. Property Owner: ~ /~~a~ Mailing Address: 2. Name of Buyer: ~~C~-~ ~. ~4(5~3~ Mailing Address: Lending Institution: '~~r-~._~' ~_-~)_rr ~(3~6(~,; Mailing Address: t~O0 ~~O~r ~6.~~. Phone: 4. Realtor/Agent: Mailing Address: Phone: w Legal Description: Street Location: 6. Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well X) Public/Community System ( ) If Individual Well, well depth /~ ~3 ~'.;~ If Community System, name of system Sewage Disposal System: On-site System ( ) If On-site System, date of installation: Public System *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77