HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 1 LT 13
by
A & I, DRILLING COMPANY
BOXO7, EAGLE RIVER, ALASKAO9577 ® TELEPHONE 694-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION /' / 15
DATE - Started / /'(~
PERMIT NUMBER '/:(, (, :) J
Ended
DEPTH OF WELL (', / /
STATIC LEVEL OF WATER FT,
DRAW DOWN FT. _
GALS. PER HR
KIND OF CASINO
KIND OF FORMATION:
From
From ; '~ Ft. to ~ ,~h Ft
From / t' Ft. to'-:),.~ Ft.
From
From
From Ft. to_~Ft
From Ft. to Ft.
From Ft. to~Ft
From Ft. to~Ft
From Ft. to.~Ft
From Ft. to.~Ft
From~Ft, to Ft
From~Ft. to Ft
From Ft. to~Ft
From~Ft. to__Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to__Ft,
From Ft. to __Ft,
From Ft. to____ Ft,
From Ft. to___Ft.
From __Ft. to__Ft,
From Ft. to__Ft,
Fronl Ft. to Ft.
From Ft. to Ft.
From __ Ft. to Ft.
From Ft. to Ft.
From__.Ft. to___Ft.
From__.Ft. to___Ft.
From. .Ft. to__Ft.
From Ft. to_ Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
M1SCL INFORMATION:
,./, ~ /'1~ ', ,,./...:', ',~7 i ,/?": ~
DRILLER'S NAME
. ~ DATE RECEIVED
INSPECTION APPOINTMENTS
TIME ~., . ." TIME TIME
CT INSPECT~II INSPECTOR
D~PT.
,.
MUNICIPALITY OF ANCHORAGE ENVIRONME~.~TAL
i ,' C'TECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825LStreot-Anchorage, Alaska 99001 APR 9 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES
DIREOTION8: Complete all parts on ~1. Incomplete requesls will not be processed. Please allow ten (10) days for processing.
MAIL~'~ ~ ' ~ ~ ~ ~ '
PROPERTY RESIDENT(If different from above} PHONE
2, BUYER ~ i PHONE
MAILING ADDRESS
3. LE~OING INSTITUTIOn, ,~G~?~,. ~ PHONE
MXlLING A~DR~
STREET LOCATION
6. TYPE OF RESIDENCE
~SI~GLE FAMILY
[] MULTIPL[-' FAMILY
7. WAT E R .S U?..P-L'Y""' ~'
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
Tw ~ [] Four
o E] Five
[] Three [] Six
[] Other
V~/* ATTACH WELL I_OG. 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.)
8. SEWAGE ~8'A-[.'SYSTEM [~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE,FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[~] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[~Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
1
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~'~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ,~
72-010 (Rev. 6/79)
REID ENVIRONMENTAL ENGINEERING
SRA BOX 1584R
ANCHORAGE, ALASKA 99507
(907) 344-1205
MUNICIPALITY OF ANCHORAGF
DFPT. OF ;:"L~;i &
FNVIRONM~i~i,: ,, - ~ECTION
~:~R;:'~ E:0X 93:i. 0