HomeMy WebLinkAboutUS SURVEY 3201 LT 19 T10N R1W SEC 9
LOCATION
'~ ~ WATER WELL LOG
FOSS DRILLING
1336 Ingra Street
Anchorage, Alaska 99501
FEET OF DRAWDOWN.
REMARKS
DATE COMPLETED
PUMP TO, BE SET AT ~
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~1: Time
Date
Insp
~-",.MUNICIPALITY OF ANCHORAG?'~'~
,DEPARTME~F OF HEALTH AND ENVIRONMEN~,~L
825 L Street, Anchorage, Alaska
264-4720
PROTECTION
99501
2:30 p.m. #2: Time
3-31-78 Friday Date
Pratt Insp
Date Received: March 24, 1978
#3: Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1, Lending Institution Request: Alaska Teamster's Federal Credit Union
Mailing Address: 1200 Airport Heights Road #430 Phone:
2. Property Owner: Ronald F. Brandt
Mailing Address: Box 8590 Bird Creek 99540
Phone: 653-8523
3. Legal Description: T10N R1W Section 9 Lot 19 USS 3201
Single Family Residence: (d) Number of Bedrooms: Two
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x) Community/Public System ( )
Depth of Well 86' Well Log on File
Bacterial Analysis
( )
Sewage Disposal System:
Permit #
Septic Tank size
Absorption Area
On-site
Installed
System (x) Public Utility (
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
Affadavit Attached: ( )
Approved:
Disapproved:
Letter Attached: ( )
Date:
Department Worksheet:
' ~ ~ i MUNICIPALITY OF ANCHORAGE
~ ~ ~ Department of Health and Environmental Protection
~%~/ 825 L Street, Anchorage, Alaska 99501
- ' ~quest for Approval of Individual Sewer and W. ate, r Facilities
1. Property Owner: ~,~ ?
Mailing Address: -_~.3( ~O ~/~-~,~..~?,_Phone..'
Name of Buyer:
Mailing Address:
Phone:
Lending Institution:
Mailing Address:
Phone:
o
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location: Z
Single Family Residence:.
Multiple Family Residence: ( ) Number of Bedrooms:
Phone:
7. Water Supply:_ *Individual Well~"~) Public/Community System ( )
If Individual Well, well depth/F/bo~ ~ z
If Community System, name of system
8. Sewage Disposal System: ~n-site System"~) Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
0&-1220(a) Rev. 1973
DATE
ALAS,~__ .DEPARTMENT OF HEALTH AND SOCIAL SEh.,.~ES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI.PUBLIC
BACTERIOLOGICAL :'WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL
ADDRESS
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
CITY \ ._ = " ZIP CODE
ADDRESS
Analysis shows lh~s Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Quesl~onable
[] Sample too long in transil; sample should not be over 48
hours old al examination to indicate tellable results. Please
send new sample.
[] Bottle broken in transit, olease send mew sample·
' ~ SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY I ' ~ · :'; !
GENERAL: Does Water Become Muddy or Discolored?
When?
[] Yes [] No
Diameter of Well Depth Feet.
Well Casing
Material Diameter Depth
Length of Water Depth
Drop Pipe Fram 8olJom Feet·
Offset in In UIiBty
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING .,SAMPLE
06-1220 b BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0c¢
24 Hours :
Brilliant Green ~
24 Hours '~
--48 Hours
EMB AGAR
Lactose Broth, 24 hrs. ~ 48 hrs.__ Gram's stain
CoEform Density (Most probable No. per 100cc)
MF Results ·
This analysis indicates Coliform Organisms to be~ ~" Absent