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Home My WebLink AboutWENTWORTH BLK 3 LT 26 ;fi-- ^ ilm5E5ErH \>#Jq"< ARcrrc Punap & WeI-t. lr.Ic. Jim Sullivan, CPI PO Box 770197 Eagle River, AK99577 (907) 688-2510 (907) 243-2282 iim@arcticpump.com Well Decommissioning Log Legal Address: Subdivision:wentworth Block: 3 Lot: 26 T: R Section Lot: On-site Water & Wastewater Program certified confactor performing the well decommissioning: Name: Jim Sullivan Company: Arctic Pump & Well,Inc WellDecommissioningDate 8-14-17 MethodofDecommissioning: AMC 15.55.060L1 a.f] b.f] c.E Location: Use the space below to provide a drawing of the properfy showing the following items: r Norlh Arrow o Decommissioned well r Other water wells on the property o Two separate swing tie distances for each well shown on the drawing Note: the swing tie distances shall be measured from either pennanent sffuctures or the property corners. N b 43 Arctic Pump & Well, Page I of I Inc. GREATER AI~NOP~AGE AREA BOROUG~i,~ ~, Anchorage, Almska 99507 279-8686 REqUEsT FOR APPROV~L' OF 3. 4. 5. INDIVIDUAL SH~HR & WATER FACILITIHS FOR "' Address ~ - ,, Phone A. ~e B. Depth Sewage Dtsoosal System.-- >~ - A. Installed B. Installer C. Septic Tank: 1, Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Field: Total Length of Lines Distances: A. Well To~ Septic Tank , Absorption Area , Sewer Lines , Nearest Lot Line · Other Contamination Bo Foundation to Septic Tank "~ Ab'~orptton Area C. Absorption Area to Nearest Lot Line ~'-~ " , ~-'Individual Sewer & Water Faefl~'-"es Request for Approval Page T~o ~ ~" ~. 3% ~q~ ~~ , , ~ App~val Valid for One Year From Date SSgned G-cea~er guchorage Area Borough, Do¢~r[men~ of Environmental ~ual.i~7 DIAGRAM OF SYSTEM ~ certify that the information contained in this request for approval to be a true and accurate represehtatten of the subjec~ sewer and water fact!~tiea located at: Signed Date July 13, 1973 T,,~ First ,~a~onat T)ank of Anchorage, P.O. ))ox Anchorage, Alaska 99510 · p c,m~r~. Weng,.~orth StbMVlslon, ,.doc Lot 26 Dear ..ir. U~nn your request, the sewer and wnter ~ecflltfes serving the subject lot Were Inspected by 'chis department on July l(), 1973. The follow,tn9 ~as noted: SO~'$OP 1. Tm. sewage ~s d~sposed of vt~ ~ubl~c 3. The well is located ap,,roximately elght feet ~outh of the dwellinf~ amd twentY-five feet north of ~.e south lot tine. For the wel~ to meet state ~nd Greate~ Anchorage Area [~orough codes, the casino must be raised 18 inches above the existing ground ~eyel ~ and sealed with a s~n~arY ca~. The ~lt ~hen must be ¢111ed w~th ~ impervtou~ soil. The dwelling ma~ also be connected %o the ava~la,~e public wager. This de~artment wi11 give tem~)ora~y approval on the gub~iect ~ell pending %i~e escrow of funds needed for either of the above im- prov~en~s. These tmprov~ents mutt be made by August 30, 1973. ]f you have any questions concerning this matter, ~]eage contact me at 274-4561, extension 135. Sincerely, Tim Rumfelt~ R.S. Sanitarian I lb cc: John Bell FHa, FORM NO. 2573 U,S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Budget Bureau No, 63-R0296 PART I..--~TO BE COMPLETED BY HUD/FHA Insuring Office gnchorage~ Alaska The First National Bank of/\Anchorage WATER SUPPLY BY: [] Public System 1 ~-~Ves [~No [] Commu0ity System SEWAGE DISPOSAL BY: [~ Public System [] Commu0ity System FHA Case No. Mortgagor or Slpot~sorl John R. and Har¥ Lou Bell 3311 E. 43rd Avenue, Anchorage, Alaska Subdivision: Lot No* Wentworth Subdivision, Blk. 3 26 [] New Installation Individugl [-] Individual [] Yes [] NO SYSTEM DESIGNED FOR Bedrooms Garbage Disposal 2 [] Yes [] No. PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH ~llllllJ II IIIII IJlllll J IIII IIIIIII ,,,,,,,, ,,,,,,,~, ,,,,,,,,Jill 4;llll; '""'"" '"'""'"' ,,,,,,, Illl,,,,,,I, Ii~l/ JJllllllll Illlllll Ilil I I I1 I-~Hflt~ I II',lll I i,,ll,,,I , t fttt ! '"'""'"' - I II III I1 I II I '"iii[ iii III - '"'"'"'"" ,,,, ,,, II1,,,,,,,,, ii,,,, ,,~,,,,,,,~,,1~ i', III"" IIII - [ ,,,,'"'"" IIllll[I I Il[ I Jlllllll IIII [] State [] County~-'L~ocal Department of Health thatthis individual water-supply system It is the opinio~he ~] is L~"i-s not satisfactory as a domestic water supply for the subject property. It is the opinion of thej ~ State [] County ~ocaI Department of Health that this individual sewage-disposal system Ca r oper maintenance: n be expected to function satisfactorily, and [~ Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE ~~ 'l / NOTE: The health authority should complete t~ appropriate opnlon statement above and affix dar% signature and title in the spaces provided. Use of the above grid for Health Department Inspector*s sketch as well as use of the back of this form is at the opinion of the hea Jth authority, 'PART II1.~ FOR USE OF FIELD OFFICE TO THE CHIEF UNDERWRITER, OR ASSISTANT DIRECTOR SINGLE FAMILY MORTGAGE INSURANCE BRANCH: I have reviewed the foregoing and the pertinent Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable ~ Not Acceptable Sewage disposal be considered ~ Acceptable [] Not Acceptable. DATE SIGNATURE ]CHIEF ARCHITECTURAL SECTION []DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL FHA FORM NO. 2573. INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Kev. 11/71 REPORT OF INSPECTION - INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of []Septic tank. []Cesspool. Septic Tank~ Distance from well~ Total liquid capacity~ Inside length, gallons. Capacity inlet compartment, feet. Inside width, feet. Liquid depth, feet* Distance from well, feet; foundation, -- feet; nearest lot line at [] front, [] side, [] rear, __ Inside diameter, feet. Depth, __ feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from well, feet; foundation, feet; nearest lot line at [] front~ [] slde~ [] rear~ feet. Total length of tile lh~es, feet. Number of lines, . Distance between lines, feet. Type of filter mater;ah [] Gravel. [] Broken stone. Other Distance from well, feet; building foundation feet; nearest lot line at [] front, [] side, [] rear, feet. Inspection made by: []State. []County. [] Local Health Authority. Inspected by (Title) Date of inspoctinn , 19 REPORT OF INSPECTION - INDIVIDUAL WATER-SUPPLY SYSTEM Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of ~vells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size: __ feet wide, feet deep. Dwelling set back from front property llne, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building foundation, feet; nearest lot line at []front, [] side, []rear, seepage pit, feet; cesspool, Well construction= Approximate depth to pumping level of water itl well, Sealed watertight to depth of feet, feet; septic tank, feet; disposal field, feet; other sources of possible pollution, feet. Type of casing, .Depth of casing,' feet. Approximate yield, gallons per minute. Exterior space around casing sealed with; [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Woad. [] Metal. Openings in well cover watertight; [] Yes.. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [~ Basement. [] Pumpromn off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No, Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is ~*yes~'~ give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [~ State. [] County. [] Local Health Authority. gallons per minute. , 19__ Date of inspection , 19 __ Inspected by (Title) feet; feet; feet. GP 0 921,999