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Home My WebLink AboutKWIK LOG BLK 3 LT 6 DEPA/~TMENT OF NATURAL P~ESOURCES DIVISION OF GEOLOGICAL AND GEOPRYSICAL SURVEYS LOCATION OF WELL 1' DIRECTIONS: ~' '~EAS~RING POINT: [] top of casing []ground surface []other: ~OREHOLE 4)ATA: . Depth ~aterial t~rpe and color I Froml To / SECTION QTRS ~ '~WNSHIP "" I DN WELL OWNER: WELL DEPTH: I Depth of hole:. / /~ ft I Depth of ca~ing: ,,//9_ftI STATIC WATER LEVEL:__ ~..~ 4ETHOD OF DRILLING: Dcable tool MERIDIAN ])ATE OF COMPLETION ft. Da re, ,~.--~ ~ ~c/~ D air rotary D other: USE OF WELL: Ddomestic ~]irrigation ~m°nit°r []public supply []other: CASING: Stick-up_///~_ft. Diam: WELL INTAKE: [] open end [] perforated Depths of openings: to ~screened ~open hole ft SCREEN TYPE: Diam: J.n Slot/Mesh Size: Length:____ft Set Between and __ft GRAVEL PACK TYPE: Volume used: Depth to top: CONTRACTOR INFORMATION: // ~ent------a~ ire --- Date GROUT TYPE: Volume: Depth: from ft to __ft Duration PU}tPING LEVEL AND YIELD: ~ ~'ft after V hrs pumping PUMP INTAFd~ DEPTH: ft Date Pump Installed -- -., Horsepower:__ WATER CHEMISTRY SAMPLE TAKEN? []yes []no Wall disinfected upon completion'? ~y~:~ ~no PLEASE MAIL WHITE COPY OF LOG WITHIN 4~ DAYS TO: DGGS PO BOX 77-2116 EAGLE RIVER, AK. 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930367 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:BJURSTROM MARILYN J OWNER ADDRESS:P.O. BOX 1703 KENAI, AK 99611 DATE ISSUED: 9/15/93 EXPIRATION DATE: 9/15/94 PARCEL ID:01304345 LEGAL DESCRIPTION: KWIK LOG BLK 3 LT 6 LOT SIZE: 11136 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: DATE: DATE: '- "- C,N iliE .... .~,, M Anchorage Reco:'ding Precinct, Alaska, and that the improw~.ments situated thereon are within the I)rope~y lines and do n~t overlap or encroach on the property lying adjacent [hereto, that no improvement~ on prop- erty lying adjacent thereto enc:'oach on tl:e premises m ([uestion and ti:at ~here are no :'oadways, transmission hnes o; ollner visible easements on ~4 property except as indica;ed hereon. Dated at Anchorage, Alaska ~ED WA~TKA & >.SSOCIATES Engineer~ and Surveyor~ hereby certify ii, at I have sur','e2vd ;~.:a foiiowing zi.~9 T- .'. -q.-' ~' , d / ,::' ~,.~ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received _February 25, 1977 Time of Inspection.~-~-~ ~ Da~e of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Alaska National Bank of the North % Claudia Jones Mailing Address: Pouch 7-010 99510 Phone: 278-4581 2. Property ,Owner:; Knute ~and Sylvia Melsom Phone: 349-2108 (h) .' ' '27'2-1461 (Mrs~. Mailing Address: 730 Eas~t 72nd Avenue 3. Legal Description: Lot 6 Block 3' kwik Log Subdivision 4. Location: 730 East 72nd Avenue Single Family No. of bedrooms 3 5. Type of facility to be inspected 6. Well Data: A. Type Community C. Construction Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: B. Depth D. Bacterial Analysis Public Utility B. Installer 1. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Absorption area E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line , Sewer Lines ._, EQ-034 (1/74) Page 1 of two pages iP~Ei~."~ 'GREATER AHCiiORAGE ARE/, BOROUGH DEPLOi I{/,l~. ' ~ 330 C St., Anchorage, Alaska 99503 - 274-~561 [~ ~°T[c~I°M3 Department of Envlronmer, tal Qual~t~VlRONM~qP'~L P',<O'~CTION FEB J= 1977 2 5 1977 RECEIVED ~,,~v~UAL SEWER &WATER FACILITIES I. Type of Inspection: ' CMRO VA 2. Property Owner: I<nute & $¥1vla MeZsom Mail ing Address: 730 g. 72nd Ave. FHA Name of Buyer: Hailing Address: _._D_~a y_ Phone CO ~,~ V ~.. 272-1461 (wk. 349-2108 (home)[' Juan & Shirley__~. Dominguez 2326 Cordova ~15 276-2131 (wk hers. .... ~_ Phone 277-6920 (home) Name of Lending Institution: Alaska National Bank Mailing Address: Pouch 7-010 Anchorage, Ak. 995/0 Name o'f Realtor or Agent: N/A Phone 278-4581 Mai ling Address: Phone Legal Description: Locai. i on: Lot 6 Block 3 Kwifl/~_jL_gg $._u_b_divis__ion 730 E. 72nd Ave. Anchorage., Al_a_sk_a___ 99502 Type Water Supply Type of Supply: If Individual, If Individual, of Facility to be inspected: ~or.~,,u~~l- No. Bdrms. 3 single family dwelling Public Utility Individual number of dwellings presently served depth of welt Seivage Disposal' System Type ,of S~stem: Public Utility If Individuat~ date of installation Claudia Jonas Mortgage Loan Secretary Alaska National Bank X (community) ~ Individual on-site) Page 2 of two pages - Re~ zst for Approval of Individual S...~er & Water Facilities Legal Description Lot 6 Block 3 Kwik Log Subdivision Comments Approved Disapproved Date~'--~Q_~9~77 Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~~~ x~.~_~_~.~ ~_~c~]~ Time of Inspe~ti~n~ '~?~.~ ~ ~' ~ ~ REQUEST FOR APPROVAL OF ~~~ ~ INDIVIDUAL SEWER~r~RWATER FACILITIES Mailing Address: ~-~ ~/m ~ ~-~ Phone: ~~//~ / 3. Legal Description: ~ ~_._~~ ~/~: 5. Type of facility to be inspected No. of bedrooms 6. Well Data: A. Type .~-.~-~-~y~ ~ B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: ~_~/~]~_~x ~-~.~ A. Installed B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 2. Manufacturer 2. Material Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area , Sewer Lines , C. Absorption area to nearest lot line EQ-O34 (1/74) Page 1 of two pages Page 2 of two pages - Req..~,st for Approval of Individual S~wer & Water Facilities Legal Description Comments 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) REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) ~/2~~'~~ '~.ame of person requesting approval ._ ~ _~ ~ ~[am.: ~i property~owner Wa~e-~ ~.n~lysis: b. Detem~ent data: b, Depth ' c. Casing Size d. Distance from well to closest existing or proposed: 1. Sewe~ line 2. Septic tank 3. Seepage Area [~. Cesspool' 5. Property Line~__. 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, draJnage ditch, etc. Sewage disposal system. a. Age of system b. Septic tank capacity in ga].:lon~ .~~ c. Name of septic tank 1. If "home made" show d,a,,am on reverse ,i~of~his fo,m d.' Disposal field om seepa~.e pit size and type 1. Distance to property line to house foundation ~., PercoJatjon. Test pesu.Lts f. Percolal:ion Test performed by Use the reverse .side of this form 'to show diagram. Diagram should include ~,he following! information: ppoperty lines~ .well location, house location, ~;'~? ~ c tank iocatJ on, disposal area location, location of percolation test, ahd dJr.ection of Fround slope. 9, The ~-f',,'..n+ion on this form is true an(] correct to the best of my knowledge. Sivn~:ture of Ap~ Date SiFned :'0 BE FILE~ED OU'P BY HEALTH DEPARTqENT PERSOh~HE[, The above described sanitary facilities are hereby approved subject to the rollow].n? con~Ji~'ions: Conditions: .~~ The above described sanitary facilities are dis~pproved fop the following Pea S on S · /}, ~ /7 Ap~rov~l is va]id ~o~ o~e year Eollo~i~F. the ~ate CPJ:cw Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA × FHA CONV Property Owner; Gerald L. & Judy E. Yeiter Mailing Address: 2. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: Pouch 7010 5. Name of Realtor or Agent: Mailing Address: 730 E. 72nd Day Phone 344-7126 (Home). Knute F. & Sylvia J. Melsom 4110 DeBarr Rd. Sp 22D Day Phone 333-7628 (Home) Anchorage, Ak. Alaska National Bank Anch. Ak. 99510 Phone 277-5511 None Phone Lot 6, Block 3, Kwik Log Subd. 730 E. 72nd 6. Legal Description: Location: 7. Type of Facility to be inspected: Water 8. Water Supply (~_~_~,__~_~]~] Type of Supply: Public Utilify Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal'System Type .of S~stem: Public Utility x Individual If Individual, date of installation No. Bdrms. 3 8 on-site) //lq, Anoho~a~e~ A~La~ka 9~03 dtvLoLon ~rae Grea~eF An~horaso Area Bo~ovSh Health Department ~,UppXy ~ervt_~ ~he ~ubja~: ~eeL~ce. Nedical