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HomeMy WebLinkAboutLITTLE BEAR BLK 1 LT 1Little Bear Block 1 Lot 1 #014-061-18 r"1€ A PA I A—.- X, F€:"` F-1 L__ I T alit' �_A F G==H �'A A._ : � �.e_rA IF-=`_ A==S DEP A* RTMENT' HEALTH FIND EC•dVIROtdt1Et•d'xH[ r=:ciTF.C:"T"l:Otd ; 5l.d_;I E. TUDOR RD.. i-it"dCi"jORAGE, fit::. _•�4507 i 'T - PERMIT NO. 6-3: 02 APPLICANTEC- F:ICd_P��F ='2-1, 0 WELL.SLE:Y COURT LOCATION BABY BEAR PLACE LEGAL L:1 P.1 LITTLE BEAR `-,�T_: LOT' SIZE 8400.� SQUARE FEET' MINIMUM DISTANCE BETWEEN H WELL FIND ANY ON—SITE SEWAGE. DISPOSAL SYSTEM, I 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LJ:'{G ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT GCI?'HIC",I OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE: TO IC•d_::URE. f-''F:OPER INSTALLATION. I CERTIFY THAT 1.: I AN FAMILIAR WITH THE REQUIREMENT`_ FOR ON—',ITE SE["[ERRS FIN DI. ELLS, AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL. INSTALL THE SYSTEM IN AC:C:ORDAtdCE WITH THE: CODES. SIGNED: .L APPLICANT ED RINNER ISSUED BY. ,.kid- .V—� '—CJs _6� �. ��— __C>ATE C =_/ 4 -.4 Ili 771 Fal P P P E-4 w Ili 771 Fal P P P E-4 E-4 .11 01 lz m Ili 771 P P P E-4 E-4 E4 w 14 Prd E4 E-4 E4 1-4 E4 E-4 rC O zq Ili 771 Development Services Department 0 Building Safety Division On -Sire Water & Wastewater program 4700 Bragcw Street p.0. Box 156650 Mark Eegich Anchoroae, AK 59519-6650 Mayor w mpno^n /nncn• w I907 -j343-7904 Pump Installation Log Well Drilling Permit Number: SW_ . . Date of Issue: _ Parcel en n um er:_ Legal Description Property ner Name &� pAddress: Lt IG �ea✓ P tJI*.r SdoCIC t` G 7q 'F 9�so?.. R- Pump Installation Date: _ Z _ Q pump Intake Depth Below Top of Well Casing:S-`(feet Pump Manufacturer's Name: /n�'r5 Pump Model: AJ.5� C Pump Size �2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: ✓14A4; -- 1N5 o Pitless Adapter Installer. /4j/A Well Disinfected Upon Completion^ R Yes C3No CS 0d V^,� �n �er% Method of Disinfection: Comments: Pump Installer Name: �uJ i� -5 — Atdy k Jam-. Attention: The pump irsaller shall provide a pump installation log to the DSD within 30 days of pump installation. Time Time Time Time CXLek�t- lic, _ APPLI( .NT FILLS OUT UPPER HA, )NLY Praoerty Owner -J _ "" _ _ _ : ,�i -_ .�. - Phone Mailing Address % l '" rF '=✓ Zip Code Inspector Buyer�'-`- T/n Jl= -•..7� �) 0. �JJ A S' - Address ` Zip Code Lending Institution Phone AVTess ° - Zip Code & Fahy' . & Agent -,1 , t- ''`"' ' "" Phone Address,_< i c.-,•� L . >.'r�-=._ , ...:- �i - - -- -' - Zip Code ',`G } _! : dl DATE�� Legal Description -,:. i / .: — '-.� .: 4-1=���-``-"rte - Street Locafi Date Sewer Installed Well To Absorption Area Well Log Received Type of Residence Well to Tank �ngle Family ❑ Multiple Family No. of Bedrooms" ❑ Other Water Supply individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. " ❑ Community For wells drilled prior to that date, nfYa wkpth (attach log if available). ElPublic Utility - Sewer Disposal�- 2/ J ElIndividual Year Individual Install d: public Utility - When Connected to Pu til .- _ ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time CXLek�t- lic, _ Date Date Date Date Inspector Inspector Inspector Inspector �) 0. �JJ A S' - ` Field Notes: APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE�� B ' Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank CI FIVICAL & GE LOGICAL LABORATORIES ALASKA, INC TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street w+� -eORAroR1°e Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: _ A alysis shows this Water SAMPLE to be: I.D. NO. Satisfactory t� '�=�-;��%�j:� k/��'v'�i�'t/Yl���%'ldl _ ❑ U t' f t r Water System Name '�- / Phone No. Mailing Address City t;. £ �, 1 -State B: a_ A Zip -Code" - SAMPLE DATE: C ® F ``I Mo. Day Year SAMPLE -TYPE: 0 Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. no. t ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION �,J Collected By > � C 3 4 5 READ INSTRUCTIONS mCCAMC COLLECTING SAMPLE nsa is IF ❑ Sample too long in transit; 'sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date'Recelved ,Time Received t Analytical Method: ❑Fermentation Tube /' r©. Membrane Filter Lab Ref. No. Result' Analyst I I � I I m r �m L I m .No. of colonies/ 100 ml. or No. of Positive portions. S 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a.m. Date Received Time Received p.m. Lab. No. Presumptive loml I loml I loml I loml I loml I 1.0ml O.iml Multiple Tube Report: Membrane Filter: Direct Verification: Final Membr Reported By Broth 24 hours: Broth 48 hours: 10ml Tubes Positive/Total lOmi Portions Count Collform/loom) READ INSTRUCTIONS mCCAMC COLLECTING SAMPLE nsa is IF ❑ Sample too long in transit; 'sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date'Recelved ,Time Received t Analytical Method: ❑Fermentation Tube /' r©. Membrane Filter Lab Ref. No. Result' Analyst I I � I I m r �m L I m .No. of colonies/ 100 ml. or No. of Positive portions. S 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a.m. Date Received Time Received p.m. Lab. No. Presumptive loml I loml I loml I loml I loml I 1.0ml O.iml Multiple Tube Report: Membrane Filter: Direct Verification: Final Membr Reported By Broth 24 hours: Broth 48 hours: 10ml Tubes Positive/Total lOmi Portions Count Collform/loom) MUNICIPALITY OF ANCHORAGE'S DEPARTMEN OF HEALTH AND ENVIRONMENTS. PROTECTI 825 L Street, AnchoraaR, Alaska 9950 264-4 U l Dat ceived: October 27, 41: Time 11; 0 a.m. v 10- 8-77 Friday Date Insp Wi 1's 0 Time ) #3: Time Cl) °,00h Date �,- Mat, Date Insy�% c/ y `� Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: United Bank Alaska Mailing Address: 645 G Street, 99501 2. Property Owner: Lawrence J. Sebring Mailing Address: 6741 Baby Bear Drive Phone: 276-1911 Phone: 3. Legal Description: Lot 1 Block 1 Little Bear Subdivision rancri sytie ouse on tfte as you turn 4: Single Family Residence: (x) Number of Bedrooms: Thre Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (X) Community/Public System ( ) Permit # Depth of Well 2 , Well Log on File Construction Bacterial Analysis 6. Sewage Disposal System: On-site System ( ) Permit # Installed Septic Tank Size Absorption Area Public Utility (4 Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 1 Block 1 Little Bear Subdivision Comments: max-vN—L 6 131�7� Affadavit Attached: ( ) Letter Attached: ( ) Approved:_CZ� Date: Disapproved: Date: Department Worksheet: I MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & � Nic1NICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION //. I Coll).f; �', DEPARTMENT OF HEALTH AND ENVIRONtv1ENTA!_ PROTECTION OCT 2 7 1977 825 L Street, Anchora7e, Alaska 99501 224 2.25 279-2511, PRO F RZCC 141407 REQUEST FOR APPROVAL Qt= INDIVIDUAL SEINER and WATER FACILITIES 1. Type of Inspection: VA_ FHA_ _CONY XX 2. Property Owner: Lawrence J Sebring Mailing Address: 6741 Baby Bear Drive Day Phone: 3. Name of Buyer: Ronald W & Carolyn A Janzen — 0 Mailing Address: 1710 Norene St Name of Lending Institution:_ United Bank Alaska Mailing Address: 645 'G' Street _ 5. Name of Realtor or Agent: Mailing Address Doug Holmes, Jr. Day Phone: 333-6571 Phone: 276-1911 Phor;e 6-1222 6. Legal Description: Lot 1 Bl k I T; rti P Rear S/D — Location: Anchorage, AK ---- -- 7. Type of Facility to be Inspected: Single Family Dwelling —No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility Individual X% if Individual, number of dwellings presently served — If Individual, depth of well - ---- —--------- -- 9. Sewage Disposal System Type of System: Public Utility %X Individual (on-site) ---- If Individual, date of installation — — 72003(3/76) a eJC�L vh J 06 1220(a) Rev. 1973 DATE ALAS DEPARTMENT OF HEALTH AND SOCIAL SERVI DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOG I CAL WATER ANALYSIS INDIVIDUAL g SEMI-PUBLIC r-1 CHLORINERESIDUAL PPM - REPORT REPORT RESULTS TO NAME ADDRESS� �! )7 CITY irk} ZIP CODE.-- ADDRESS OF SOURCE I, COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY kd v rtd DATECOLLECTED t--� i�TIME COLLECTED FAY. Sample Collected From ❑ Kitchen Top ❑ Bathroom Top . ❑ Basement Tap Other (List) Well — El Dug ❑ Driven C1 Drilled ❑ Bored SOURCE: ❑ Spring ❑ Cistern ❑ Other Dug Well or Cistern Construction: Walls— ❑ Wood ❑ Concrete ❑ Metal ❑ TileBrick or Top — E3Wood C]Concrete E-1metalEl Open Top ❑ Concrete LOCATION: ❑ In Basement ❑ Basement Offset ❑ Under House ❑ In Yard ❑ Other Buildin Sewer g Septic DISTANCE TO: or Other Drainage Pipe Feet. Tank_Feet. Tile Seepage Cess- Feet. Field Feet. Pit Feet. Pool Feet. Privy Other Possible Sources of Contamination Asbestos MATERIAL: Building Sewer - ❑ Cast Iron ❑ Wood ❑ Tile [:1 Fibre E] Cement ❑ Plastic Joint Material - Type GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When? Diameter of Well Depth Feet. Well Casing De th Material Diameter P Length of Water Depth Feet. Drop Pipe Offset in From Bottom In Utility PUMP LOCATION: 0 In Well 13 Basement ❑ In Basement C1 Room r Lab No. 4 �` „v ` ' OFFICE Analysis shows this Water SAMPLE to be: Ej Satisfactory -satisfactory ❑ Questionable ❑ Sample too long in transit; sample should not be over 48 hours old of examination to indicate reliable results. Please send new sample. ❑ Bottle broken in transit, please send new sample. JON {p�S�ANITARIAN'S REMARKS 06-1220ta1 - Rev. 1973. ' - ALA, DEPARTMENT OF HEALTH AND SOCIAL SEK. -.)I DIVISION OF PUBLIC HEALTH `°b"° INDIVIDUAL AND SEMI-PUBLIC -'DATE 4 RA(-TERI.O--.LO.G-I CAL -WATER A-NALYSIS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATECOLLECTED - 3 TIME COLLECTED = 1 Sample Collected From ❑ KtcBen Tap! ❑ Bathroom Tap - ❑. Basement Top Other (List) Well — E) Dug ❑ Drfven❑ Dnlled ❑ Bored SOURCE: ❑ Spring-... ❑ Cistern ❑ Other Dug Well or Cistern Construction: '--�- Wells— ❑ Wood E] Concrete - ❑ Metal El Tile Brick or Top ❑ Wood ❑ Concrete ❑ Metol ❑ Open Top ❑ Concrete LOCATION: ❑ In Basement `❑ Basement Offset ❑Under House ❑ In Yard ❑ Other .Building Sewer Septic - DISTANCE TO: or Ofher Drainage Pipe Feet. Tonk Feet. Tile Seepage Cess. - Field Feet. Pit Feet. -Pool- Feet. Privy ,Feet- - Other Possible - SourcesofContamination -- MATERIAL: Building Sewer - ❑ Cost Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos Cement ❑ Plastic - Joint Material - Type GENERAL: Does Water Become Muddy or Discolored? ❑- Yes ❑ No When? Diameter of Well Depth feet. Well Casing Material Diameter Depth Length of Water Depth _ Drop Pipe Offset in From Bottom In Utility Feet. PUMP LOCATION: ❑. In WeII ❑ Basement ❑ In Basement - ❑ Room On Top 11 Other ❑ Oth OFFICE Analysis shows this Water SAMPLE to be: El satisfactory r7�4, ,iUnsatisfactory E3 'Questionable - ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. 0 Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS _ n er I _ Of We - i i PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes - ❑ No - t New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes No Signature Oe 1220 ml BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 - I — I ,-„ am READ INSTRUCTIONS I Date ON REVERSE SIDE BEFORE COLLECTING SAMPLE Time Received Lactose Broth 1 Occ 1 Occ 1 Occ 10cc 1 Occ 1 .Occ 1 .Occ 24 Hours 48 Hours �•_- "--" Brilliant Green 24 Hours.. .-.- ,1 48 Hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs. - Gram's stain Coliform Density (Most probable No. per IODcc) MF Results - . in Date '�'�i/��_.p: rn. Reported by r' f7- T ' This analysis indicates Coliform OrganismsIto be: Absent ' _-"PresentT— 06 1220m) Rev. 1-973 DATE AL .,.A DEPARTMENT OF HEALTH AND SOCIAL SEI,,. rdS DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC RACTERIOLOG I CAL WATER ANALYSIS INDIVIDUAL '❑� SEMI PUBLIC ❑ CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME COMPLETE THIS SECTION ONLY IF WATER -IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED!—_. ` TIME COLLECTED - So mple Collected From `�❑%Kitchen Tap ❑.-Bathroom Tap ❑ Basement Tap ❑ Other (iist) Well — El Dug ❑ Driven ❑ Drilled ❑ Bored SOURCE: ❑ Spring ❑ Cistern ❑ Other Dug Well or Cistern Construction, Walls— ❑ Wood ❑ Concrete ❑ Metal ❑ TileBrick or Top — ❑ Wood _ ❑ Connate ❑ Metol ❑ Open Top ❑l Concrete LOCATION: ❑ In Basement ❑ Basement Offset El Under House__ ❑ In Yard ❑ Other Building Sewer Septic DISTANCE TO: - of Other Drainage Pipe Feet. Tank "Feet. Tile Seepage Cess Field Feet. Pit _Feet- Pool Feet. Privy -Feet. Other Possible Sources of Contamination -- MATERIAL: Building Sewer - ❑ Cost Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos Cement ❑ Plastic Joint Material Type GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When?_._.__ - Diameter of Well - - Depth Feet. Well Casing Material Diameter Depth Length of Water Depth Drop Pipe From Bottom Feet. Offset in In Utility PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement ❑ Room _ On Top ❑ Of Weil ❑ Other PURPOSE OF EXAMINATION: Illness Suspected? ❑Yes ❑ No ' New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature READ INSTRUCTIONS ON REVERSE SIDE Lab No. __ _ OFFICE Analysis shows this Water SAMPLE to be: ❑' Sptisfactory ( ❑ Unsatisfactory ❑ Questionable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. ❑ Bottle broken in transit, please send new sample. i i SAN ITARIAN'SREMARKS 06 1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 - / m jj Date Received ��--r—� ? Time Received / , �pia'Tab. Lactose Broth 1 Occ l Occ I Occ 1 Occ I Occ 1.Occ 1.Occ 24 Hours -' 48 Hours --' —`-— Brilliant Green - - 24 Hours' 48 Hours - - EMB' BEFORE.- Lactose Broth, 24 hrs. `Z'Coliform Density_ ME Results hrs. slain probable No. per 100cc, COLLECTING SAMPLE /5 // Date //�/7�'% /1 P:m: Reported by This analysis indicates Coliform Organisms to be:NAbsent