HomeMy WebLinkAboutLAKEHURST BLK 7 LT 11B
PERMIT NO.
APPLICANT NORMAN BURGESS
LOCATION JEWELL TERRACE
LEGAL 4~ B ? LAKEHURST
2:404 RI Z:HMOND 99504
LOT SIZE ±8006 SQUARE FEET'
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE HELL~ OR
i50 TO 200 FEET FROM'R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL,
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 PR'CS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS RRE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THRT
l: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS AS SET
FORTH B'¢ THE MUNICIPALITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN ACCORDANC:E HITN THE CODES.
MuniCipality
of
Anchorage
POUC,, 6-650
ANCHORAGE, ALASKA 99502
(907) 279-2511
GEORGE
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(825 "L" Street)
December 29, 1978
#780454
Norman Burgess
3404 Richmond
Anchorage, Alaska 99504
Subject: ~ Block 7 Lakehurst Subdivision
A permit issued by this department for well and/or
sewer system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be
sent to this department to document the installation
date.
If there are any further questions, please contact
this office at 264-4720.
Sincerely,
Senior Environmental S~alist
LNB/ljw
enc: copy of permi~
M-W DRILLING, INC.
MUNICIPALITY OF ANCHORAGE
DEPT. OF H:fALTH &
ENViRONMeNTAL pF~O fEcTION
Well Owner
DRILLING LOG
/kR 9 g79
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing·
Static water level
Screen (
.Depth of Hole 6,[~] feet Cased to. ~'(~]- .feet
(}9 ft. (ab'6'~) :(below) land surface. Finish of well (cheek one) open end (
)' Perforated
Describe S~e~g::9r perforatzon
Well pumping test at '/
of drawdown from staQe
Date of completion ~ /
(minute) for ii~ hours with
Depth in feet from
ground surface
'"' .TO. .... 3
Give details of formations penetrated, size of material, color and hardness
..... .TO.
.:?4 .TO.
:, ., TO
3- CONTRACTOR
M-W DRILLING, INC.
DRILLING LOG
Well Owner /:':i~ >~: ..~'.~ ~!;' ,:~ ~, Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing_ Depth of Hole
Static water leve] ft. (above)
Screen ( ); Perforated (
feet Cased to feet
(below) land surface. Finish of well (check one) open end (
).
Describe screen or perforation
Well pumping test at gallons per (hour)
of drawdown from static level.
Date of completion
(minute) for hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
);
ft.
TO
TO
__TO
TO
TO
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSPECTO~ INSPECTOR I NSP ECTOR
MUNICIPALITY OF AN~HORAGg
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska
99501
ENVIRONMENTAL SANITATION DIVISION 00~tt" 1979
Telephone 264-4720
D~P~/~/~h
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing.
1. PROPEBT~ OWNER j ~ , PHONE
PROPERTY RESIDENT (If different from above) PHONE
PHONE
3'. ~EBDIN~ NST~UTION - PHONE
MAILING ADDRESS
4. REALTOR/AGENT PHONE
~, ~,~ ~ss 1~
STREET LOCATION
6. TYPE OF RESIDENCE
[~MIu 6 L E FAMILY
LTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two []~-'~Five
[] Three [] Six
[] Other
7. WATER SUPELY
~NDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* 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 Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~BLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) jill_
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 Verifie~I LOG RECEIVED
3. SEWA(~E 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. DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area 1sewer Line INearest L°t Line
Absorption Area to nearest Lot Line
5, COMMENTS
[J~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~ .
DATE BY
~ PO BOX4-1276 ......... :'*SKA ~ ~9BUSINE~PARKBLVD.
D~nking Water Analysis Repo~ for Total Col~orm Ba~eHa
TO BE:COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM:
I.D. NO.
· Public Water System r~
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. LOCATION
4 I
Time Collected
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310 (3-78)
TELEPHONE
(907) 279-4014
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
Date Received
CITY
Time Received /
Analyti'cal Method:
[] Fermentation Tube
~,~,,Membrane Filter
Lab Ref. No. Result* Analyst
117 - I
] I-]-I
I
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
Date Collected Source
Confirmatory
24 HOURS
EMB Broth 24 hours:
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Fiiter~J~its ~ ~_~.'~
Report. By L~;z~~J
~/2~ ~
Broth 48 hours:
10mi Tubes Positive/Total Z0ml Portions