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HomeMy WebLinkAboutSILVER CREST BLK 2 LT 2S'i l Cr s-r Jul 22 19 11:45a Maetc 8e�rch Mayor A7,ohcrage Well & Pump Sar +072430742 C)eveIOP teem Services bepartment Suildina Safety Division h --Sime Water 4 Wastewater ProgravA 4700 Elmore Road P.O. Box 196650 Anchorage-, AK 99507 (9471 $43-7909 PUmp Installation L® 'WellDrillin,; Permit Number: SW Parcel IdeWifacation ?'erurpber: 0� 1- 3 3 Legal Description Crest t -Z Pump Installmtion ➢ate; els PHinp Intake Depth Be;iorv'a.rp of tiII Casing,� +.- feet PumF 1'413r"'facturer"s i`;:j_rtr;: Pump Model: -2- Pulap Size Al lip Pitlesss Adapter Burial Depth, Ji- feet Pitless Adapter 1 Ias iliacfurex°s Name: 60-e�, pidess Adapter Instaider: Well f}isinfeeted Upon ornplet4oni' es r j NoMethod. of Disinfecr- Comments. 1'�44 ¢ 6. PUMP l:Zsr_aller Name, Date a i"ssise: Propert)- Owner 18ltie h g; 0 r c v T- _4ttenticn:711e pump irslallet shall provide 2,PUMP iiista;iatior 1, g o to D5D lv:thin')0 days ofpizxrp i tallat;c�<. 13 S A t C T Y Mt) NICIPALiTY OF ANC[[ONAG)~ He .h and ~nvironmental Proka ion Pourth Floor West 825 ~l, Street Anchorage ~ A].aska 9950]. 264-4720 SFPTIC iANK: U ~, !) t t I,i(';ltt IN%~[)L WI[)I il . LlOtJlll) I)[iP/'H _ I I()[Jt() CAt~'ACI I'/' /,-,~,'~0 GAl LONS ]I[_E il)N,\lf'q FIE. L[): I.EN{; i I t .... ()!(PTH ........................ ~ ........... (]( PItt . I)lSJ i\NCJ' I:'R()M: WI{t.I ............... ] 0'1 /',!. I:Ff ECTIVt{ ass: ............ Deplrh: ~ell Distance To: Lot ::]dg: Sower ]',ine: '[po Mater:Lals: .... ~__~ ............. of Bedrooms: .~ (elilark s: ....... li2.1i lii !Pl Ii! I:::IF:'F'L.. 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M :l: I",l I MI...IM [:, I :i!i;'I"F:II',IE:IZ E:E:TI.'.ItEE:N I=1 I,.IFELI .. 1::fl"41~:, t:::11~'4",'' Oiq-'S I TIE %Et.,It::IGE D I ::J..l;::JI;!!l I::'Ii!]ET I=O1::;: I:::1 F:'F;i:IVI=ITE!: t.'.IE[.J.. OF.". ;:i:EIt;g i::'IEIET FOF;i: I::1 F'UE',L. IC I.'.IIEL.t .... t,.IiEL. L. I...O(3:~i; F:II:;;:IE ];~:IEQU:I:I:'~'.E]:) f:li".J[::' ]"'il.J:E;T E:l:i: f;i:tiii:"l'i...J{:;i:l",tl!i:[::, T(] "{']'"llE OT'I. IEi:;;: I:;.'.t;~X;!U I I:;~'.EMtiEI',ITS MR'¢ I:::IPPL2'r'. '.~I:;:'EX;: t I:::' I E:I:::IT I CIi'.4:~i; FIN[:, COI",I%TRUC':T I:::I'v'I:::IIL. I::IE:L..E: 'J'O IN:ii;IJRE; I:::'I:;:OF'E!:R Well Owner Location DRILLING, DRILLING LOG .Use of Well (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole Static water level '!~ ft. (above) Screen ( ); Perforated ( Describe screen or perforation Well pumping test at i0 gallons per of drawdown from static level. Date of completion .( © / 'i/, / '/7 0') feet (below) land surface. ). Cased to i ;~? feet Finish of well (check one) open end ( i:: ); (minute) for i. hours with '} [i!,:]j:. fi. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness i : t~,,~' 'i ~ ~,: _TO _TO TO ~' _TO TO / ' _TO TO TO TO TO TO __TO TO. TO 2 -- STATE DEPARTMEN 825 #l: Time 1:30 p.m. Date 4-7-78 Friday MUNICIPALITY OF ANC~IORAGE OF HEALTlt AND ENVIRONMENT, ,F-.¢fECI'ION L Street, Anchorage. Alaska 99501 264-4720 Date Received: April 5, 1978 #2: Time ~3: Ti. me Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 4-2090 99509 Phone: 274-1521 Property Owner: Robert/Patricia Milby Mailing Address: 3408 Woodland Park Drive 99503 Phone: 272-2805 _ 274-8611/555 3. Legal Description: Lot 2 Block 2 Silver Crest Subdivision 2nd lot in on the left on Grover Street, off of Homestead Trail 4: SJ.ngle Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit ~ Construction IndivJ.dual well (x) Con, unity/Public System ( ) Depth of Well .109' Well Log on File (x) Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed ___L977_ .. Installer Manufacturer Soils Rate .//~ Material Septic Tank Size 1~-~') Absorption Area Distances: Well to Septic Tank ~d~ to Sewer Line Nearest Lot line to Absorption Area /~--[) Absorption Area to Nearest Lot Line PageTwo Department of Health and Environmental Protection Request for Approval of Individual Sewer and Waker Facilities Legal Description: Lot 2 Block 2 Silver Crest Subdivision CoKfffl~II t S: Letter Attached: ) Disapproved: Date: Department Worksheet: . MUNICIPALITY OF ANCHORAGE \0,'~ ~~'' Department of Health and Env].ronmental Protection Alaska 99501 2 6 4 - 4 7 2 0 ' uest for A roval of Individual Sewer and Water Facilities Property Owner: Mailing Address: Mailing Address: Lending Institution: Mailing Address: ~2~/ o o Realtor/Agent: /UO~'~' Mailing Address: Legal Description: S~reek Location: Single Family Residence: Multiple Family Residence: Phone: Number of Bedrooms: ( ) Number of Bedrooms: Water Supply:~ *Individual Well (~ Public/C'ommunity System ( ) If Individual Well, well depth /o~. . If Coum~unity 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. ** 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 06-1220(a) Rev. 1973 DATE ALAS DEPARTMENT OF HEALTH AND SOCIAL SE ~,ES DIVISION OF PUBLIC HEALTH Lab No. INDIVIDUAL AND SEMI.PUBLIC BACTERIOLOGICAL WATER ANALYSIS oF.cE INDIVIDUAL [] NAME SEMI-PUBLIC [] CHLORINE RESIDUAL PPM . REPORT RESULTS TO ADDRESS CITY ADDRESS OF SOURCE ZIP CODE , Analys(s shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at examination fo [ndJcate reliable results. Please send new sample. [] Bollle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS :AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY - DATE COLLECTED TiME COLLECTED Sample Collected From [~] Kitchen Tap [~ Bathroom Tap [] Olher (List) [] Basement Tap Well-- [] Dug [] Driven [] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other Dug Well or Cistern Construct[on: Walls--J~ Wood [] Concrete [] Metal Top -- [] Wood [] Concrete [] Metal LOCATION: [] In Basement [] Basement Offsel Iqln Yard [] Other - Building Sewer Septic TanL Feet, DISTANCE TO: or Other Drainage Pipe .Feet. Tile Seepage Cess- Field -- Peet. Pti .... Feet. Pool .... Feet. Privy .__.Feet. Other Possible Sources of Contamination MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] Fibre [] Asbeslos Cement [] Plastic Joint Material - Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? [] Tile Brick or [] Open Top [] Concrele [] Under House Diameler of Well Deplh Feet. Well Casing Material Diameter . Depth - Length of Water Depth From Bottom Feet. Drop Pipe Offset in In Utility PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspecled? [] Yes [] No New Source of Supply? [] Yes [~ No Repairs to System? [] Yes [] No Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE o6-J~2o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 Lactose Brolh 10cc 1Otc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours 48 Hours Brilllant Green 24 Hours 48 Hours EMB AGAR Lactose Broth, 24 hfs, 4B hrs. Groin's stain . Coliform Density (Most probable No. per MF Resulls Reported by ': '''/= This analysis indicales Coliform Organisms lo be: Absent Present