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Home My WebLink AboutRINNER RANCH ESTATES LT 8000 Well Location W.W.D. Water Well Drilling Phone 349-3809 Anchorage, AK. Date Phone -' ~ -' / Size Casing * Depth of Hole ,//'?) ' ~:>" Cased to Static Water Level '?' ? "~' feet Well Test ./'?~ Gal per Minute for Date of Completion .' ' f~ '~ " :,"' ' feet / ' '" Hours WELL LOG ,, ; · , ,: . ,,--,¢ .) *~. -'/ ." ,.. ., . : ,.,, ~ .... 'L,:¢ '2 ,' E" (' ¢. /',. AUTHORIZATION TO DRILL I hereby authorize W.W.D. Drilling to proceed with the above work· Payment shall be made in the following manner: Rig up Minimum (50% of anticipated depth). .feet. @ per foot Balance due upon completion. In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional sum of Ten percent (10%) of the original contract price as attorney's fees, plus costs, for legal proceedings. Name Date Address DATE RECEIVED ~ INspECTION APPOINTMENTS TiME: TIME TIME DATE DATE DATE NSP ECTOR I NSPECTO~% I NSPECTO& MUNICIPALITY OF ANCHORAGE MUNIC?~LITY OF DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT ON 825 L Street - Anchora0e, Alaska 99501 ENVIR~.Fdv'~£ x i,\L I ;,OTECflON ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 DIRECTIONS: Complete all parts ca page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. ,~ERTY ~OWNER,~ __ '/ PHONE MAILING ,~ D D R E~S P~OPERT'?RES~l~EN'C(If'different from above) -' ' PHONE 2, BUYER PHONE MAILING ADDRESS.' , ''; -' ' MAILING, AD. DRESS MAILING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [~ Three [] Six [] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. 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 DISPOSAL 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 ISewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line '5. COMMENTS i~'-~-APPROV E D FOR S BEDROOMS [-~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79) CHEMICAL & GL LOGICAL LABORATORIES i,~ ALASKA, INC. ' TELEPHONE (907)-279,40~14 ~,NCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street ..... Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE Time Collected NO. LOCATION 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 Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref, No. Result* Analyst I ~ .. I *No ofc~)lomes/1OOml or No of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD ed L.ab. NO, 3resumptlva 10mi 10mi 10mi 10mi 10mi 1,0ml 0..[mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours Multiple Tube Report= Verification: LTB Broth 24 hours: Broth 48 hours~ 10mi Tubes Positive/Total 10mi Portloni Collforrn/100ml BGB Collforrn/lOOml CHEMICAL & GL.~LOGICAL LABORATORIES ,~£ ALASKA, INC. ' TE LE~pHON E'(907).279,4014 ANCHORAGE INDUSTRIAL CENTER ' Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D, NO. Water System Name Phone No. Mailing Address City State Mo. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO, 1 2 3 4 5 LOCATION Ttme Collected Collected By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 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 Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst L J *No ofcolomes/10Oml or No. of Positive portions 0S-1220 (b) Rev, 3.978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collect e~ Source Confirmatory 24 Hours 48 Hours .... , .... EMB Broth 24 hours: Multiple Tube Report~ Membrane Filter: Direct Count Verification= LTB Final Membrane Filter ReSults Reported By Broth 48 hotJirS~ 10mi Tubes Positive/Total 1Omi Portions Collform/lO0ml BGB Date Collform/lOOml