HomeMy WebLinkAboutANGELA HEIGHTS LT 5
PERMIT NO.
DEPRRT~ENT OF HERLTH RND ENVZRONMENTRL PROTECTION
25~0 E. 'TUDOR RD., RNCHORRGE~ RK. ~5507
276-222i
L4ELL PERf"I IT
76276 )
APPLICRNT
LOC:RTION
LEGRL
JOHN JAMES _
C:HIE:k:ALOON ST
L5 ANGELA HOTS
P 0 BOX 7~3
LOT SIZE
688-2450
i1000 SQUARE FEET
MINIHUM DISTRNCE BETWEEN A WELL RND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR A PRIVRTE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS ARE RVAILABLE TO INSURE PROPER
INSTALLATION.
F"EF~:i"-I :[ T '..."RL I E:, F'~2F-: ONE '"r'ERR FI~."OF"I I _~.__=;I_IE
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL WITH THE CODES.
S I GNED:
APP'. .~T,:,~/
A & L DRILLING COMPANY
~OX97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588
OWNER OF LAND k~]O P/P~,d 'J,c~JT//:~,.J'"
ADDRESS
LEGAL DESCRIPTION
DATE-Started ~///~/7~; Ended ~ ,}-/~'~
PERMIT NUMBER
DEPTH OF WELL / 4 ~t~
STATIC LEVEL OF WATER FT. / 0 ~
DRAW DOWN FT. / ~
GALS. PER HR /dO0
KIND OF CASING d~ o o
KIND
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OF FORMATION:
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c~ Ft. to?_?~Ft.
~ Et. to ~ Ft.
c~O Ft. to~-] Ft.
~'/ Et. to ~'~4~" Ft.
~ Ft. to ~;~;' Ft
,~7,~¢ Ft. to JO! Ft.
/O[ Ft. to /30 Ft.
/30 Et. to //~c~ Ft.
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MISCL. INFORMATION:
~gle River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received December 8, 1976
Time of Inspection
Date of Inspection
REQUEST¥~iFiOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
12-~76 Thursday
J~en~edy
Conv.
l. Approval requested by: Elmendorf Credit Union
Mailing Address:
Phone:
2. Property Owner: John E. & Virgina K. James
Phone: 688-2430
Mailing Address: Post Office Box 733 Eagle River 99577
3. Legal Description: Lot 5 Angela Heights Subdivision
4. Location:
Chickaloon Street off of Eagle River Road
5. Type of facility to be inspected
6. Well Data:
A. Type IndividUal
C. Construction
7. Sewage Disposal System:
A. Installed
C. Septic Tank: 1..
D.'Seepage Pit:
E. Disposal Field:
8. Distances:
A. Well to: Septic tank
Nearest lot line
Single Family
B. Depth
No. of bedrooms
D. Bacterial Analysis
Public Utility
B. Installer
Size 2. Manufacturer
1. Absorption Area
Total length of lines
2. Material
, Absorption area
, Other contamination
3
B. Foundation to septic tank
C. Absorption area to nearest lot line
142'
., Absorption area
, Sewer Lines
-LQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO .VA
2. Property Owner: "~/-1 ,'/--')/'~ ~Z" ,d.~'~ J ~//~/~/F/~ ~-/
' ~t .
MailingAddress:Z"~:)X J J,
<-~ -
3. Name of Buyer: ~-D'/'~_..v') ~ C;/ ~"/~/l/'Y) ~
CONV ,/
FHA
Day Phone: L/~ ~ ~-. ~ ZT/~ ~
Mailing Address:.
4. Name of Lending Institution:
Day Phone:
Mailing Address: Phone:
Name of Realtor or Agent: ~ P~ i [~ ~ ~ ~--~ ~. [ /t (ii _
!
Mailing Address: L'~(~[~ ~i ~ ~1~ Phone:
Type of Facility to be Inspected: ~] I-~ ~//~ '~-;C~-~'I;/L/
~ /
/
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well //
!
NO. Bdrms. -.~
Individual
Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
If Individual, date of installation
72-003(3/76)
Page 2 of two pages - Re ~st for Approval of Individual ~er & Water Facilities
Legal Description Lot 5 Angela Heights Subdivision
Comments
Approved ~ ~ Disapproved Date
Approval~Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
06~1';'2~('a) 'Rev~ 197:3
'J DAT~
DEPARTMENT OF HEALTH AND SOCIAL S~,~/~CES ~
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI-PUBLIC
B'ACTERIOLOGICAL' WATER ANALYSIS
~ JJ INDIVIDUAL ~ SEMI-PUBLI~ [] CHLORINERESIDUAL PPM
~JJ:: :-:-~ ( '~REPORT RESULTS TO '
ou.
COMPLETE~.~ .~//x~'~~ ~HIS SECTION
ONLY IF WATER IS/.~/N INDJVIDUAL SUPPLY
Sample Collect~ ~ro4 ' ~hen Tap ~ Bathroom Tap ~ Basement__Tap
~ Other (List) ,
Well- a Dug ~ Driven ~ Drilled ~ Bored
SOURCE: ~ Spring ~ Cistern ~ Other
D~g Well or Cistern Construction:
~Walls- ~ Wood ~ Concrete ~ Metal ~ Tile Brick
<~'Top ~ ~ Wo~ ~ Concrete ~Metal ~ Open Top
L~ION, ~, ~ -
~ ,~.. ~ .1~ Basement ,,~ ~ ~,ment ~fsot ~ Under House
~'~ -'' .,'S~. BuJldln~Se~r ..... ~- Septic
~E'~TO: or Other Drainage Pipe Feet. Tank ~eet.
~ Tile Seepage Cess-
Field F~t. Pit ~ Feet. Pool -- Feet. Privy, Feet.
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- ~ Cast I~ ~ W~d ~ Tile ~ Fibre ~ Asbestos
%.. Cement
~ Plastic Joint Material - Type ~ .
'GENERAL: Does Water Become Muddy or blscolored? ~ Yes
When?
Diameter of Well Depth F~et.
Well Casing
MateNal Diameter Depth
Length of . Water Depth
D~p Pipe From Bottom
Off~et in In Utility
PUMP LOCATION: ~ In Well ~ Basement ~ In Basement
On Top
~ Of Well ~ Other
PURPOSE OF EX~INATION: Illness Suspected? ~ Yes ~ No
New Source of Supply? ~ Yes ~ No Repairs to System? ~ Yes ~ No
~' READ INSTRUCTIONS
, ~. ::~.+~%:_.~.-- _~- .-.~
~, REVERSE SIDE :
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev, 1973
Lab No.
Signature
OFFICE
,,~ Analysls shows thls Water 'SAMPLE to be:
[] Satisfp~tory '~'
[] Unsatisfactory
[] l~uestlonable :: ~
[] Sample too~0ng in transit;
· sample should not be over~
-ho~urs old at examination to indlcate tellable results.
s~nd new sample.
[] Bottle broken in transit, please send new sample.
SANITARIAN/S REMARKS
EMB ~ . AGAR
Lactose Broth, 24 hrs. I 48 hrs.
ColifOrm Density
MF Results ~L..~
Reported by
~ ~. Present
(Most probable No. per 100cc)
~actose Broth lOcc lOcc 10cc
24 Hours "
Brill ia~ree n
'" 24 Hours
48~ Hours
Date Received ~'~-/'~'~ ~/ -,~(~ Time Received ~____~ab. No.
BACtI~RIOLOGICAL WATER ANALYSIS RECORD