HomeMy WebLinkAboutOLMSTEAD Lot 1
Legal Description Property Owner Name & Address:
) ERR Y _\.Tv 15
1:;2,0 q C_1,00J� �
ME- & r �,'o o a 2 <.? * S-0 -:s
Pump Installation Date:`7113// 'W
Pump Intake Depth Below Top of Well Casing: /,q Yfeet
Pump Manufacturer's Name: AY
Pump Model: A\jj in S -0,r-1112 V I
Pump Size hp
Pitless Adapter Burial Depth: 1 0 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: A_}A
Well Disinfected Upon Completion? Yes F-1 No
Method of Disinfection:
Comments:
IPump Installer Name:
0"�
ANCHORAGE WELL &PUMP SERV.
330 EAST 76THAVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark Begich
Anchorage, AK 99507 S A F E T Y
Mayor
www.murii.org/otisite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number:
SW Date of Issue:
Parcel Identification Number:
010 - f 12 - � 3
Legal Description Property Owner Name & Address:
) ERR Y _\.Tv 15
1:;2,0 q C_1,00J� �
ME- & r �,'o o a 2 <.? * S-0 -:s
Pump Installation Date:`7113// 'W
Pump Intake Depth Below Top of Well Casing: /,q Yfeet
Pump Manufacturer's Name: AY
Pump Model: A\jj in S -0,r-1112 V I
Pump Size hp
Pitless Adapter Burial Depth: 1 0 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: A_}A
Well Disinfected Upon Completion? Yes F-1 No
Method of Disinfection:
Comments:
IPump Installer Name:
0"�
ANCHORAGE WELL &PUMP SERV.
330 EAST 76THAVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
TIME
DATE
INSPECTOR
--~/-, _RECEIVED '
NSPECTION APPOINTMENTS
~'r~- 'IME '
DATE DATE
NSPECTOR NSPECTOFt
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH& ENVIRONMENTALPROTECl'IONDEPT' OF HEALTH &
825 L Street - Anchorage, Alaska 99501 [!NVIRONMEN~AL mtorECTION
ENVIRONMENTAL SANITATION DIVISION /~,!.J(~ ~_ ~ 19G1
Telephone 264-472.0
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not I)e processed. Please allow ten (10) Days for processing.
LPHONE
1, PRQ.EI:.RTY OWNER
PROPERTY RESIDENT (If different from above)
.HON E
BUYER
PHONE
5. LEGAL DE,~CRIPTION
6. TYPEOF RESIDENCE
~,~ SINGLE FAMILY
[] MUL_TIPLE FAMILY
7. WATI-'fl SUPPLY
INDIVIDUAL'~
COMMUNITY
PUBLIC UTILITY
s u
L] One E] Four '~ ', [~ Other
[] Two C~ Five /)
UJ Th~'~ [] S~x ~
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975, For wells drilled prior to that date, give wel
der)th (attach log if available, I
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
YEAR OK.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
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2, WATER SUPPLY
[] INDIVIDUAL
COMMUNITY
PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or E~] Holding Tank
Size: If Tank is homemade
give dimensions:
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Septic/Holding Tank
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
Absorption Area
Sewer Line
[] OTHER
INearest Lot Line
5, COMMENTS
--/~APPROVED FOR ~BEDROOMS
~ CONDITIONAL APPROVA~iletter must accompany certificate)
[] DISAPPROVED
DATE
ALASKA, INC.
CHEMICAL & GE~.~,OGICAL LABORATORIES ~_ ~
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM, I--Jl I I I I
I.D~ NO.
Water System Name Phone No.
Mailing Address
Zip Code
City
SAMPLE DATE:
MO,
Day
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no,
[3 Special Purpose
State
Year
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1 L
4 I
I
LOCATION
'rime Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] 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
Ana!ytlcal Method:
[] Fermentation Tube
[] Membrane Filter
Lab Reft No.
Result* Analyst
* No ol ¢olonm$/100 mi or NO of Positive portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYsiS RECORD
Date Collected Source
Oats ReCeived .Time Received 3,rn. Lab. No.
>rssumptlvs lOml lOml ].Omi lOml 1Omi 1.Om('[ O,lml
24 Hours
48 Hours
;o~flrmatory
24 Hours
46 Hour..~~ ~
EMB Broth 24 hours:
Multiple Tube Report=
Mambrai3s Filter= Direct Count
Verification: LTB
Final Membrane Filter Results__
Reported By
Broth 48 hours:__
10mi Tubes Positive/Total 10mi Portions
Collform/100ml
BGB
Collform/lOO~nl
Date
p.m,
/\NCflORAGE, ALASKA 99501
(90/) 264 411i
August 13, 1981
Graham Mower
3801 Mc Cain Road
Anchorage, Alaska
99503
Subject: Portion of Lot 10lmstead Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the fo]lowing items have been
completed:
(2)
The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for
our review.
The well sea[L needs to be t.[ghtened to that it is
water tight. This will need to be re]nspected upon
complet ion.
If there are any further questions, please call this office
at 264.-4720.
SinceFely,
Robert C. :Pratt, R.S.
Associate Specialist
RCP/ljw
cc: National Bank of Alaska
Pouch 7-025 99510
Chuck Lastufka
% Dall Realty
700 West 41 Avenue
99503