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Home My WebLink AboutT13N R4W SEC 25 N2N2NE4SE4 PTN (2)T13N R4W Section 25 N2 N2 NE4 SE4 PTN #010-113-19 Development Services Department 0 Building Safety Division On -.Sete W&er & Wastewater Procram 4700 BraBaw Street P.O. Box 196650 -/ MarkSesich Anchorage. AK 99519-6650 Mayor.w muni ark/�n<it� 1907}343-7904 Pump Installation Log Well Drilling Permit Number: SW_ . Date of Issue: 4&j $ Legal Description 7 i 3 9 ti w sem. s Property Owner Name & Address: Pvt to LoPcz- l OJACVn fl0 A Pump Installation Date: pump Intake Depth Below Top of Well Casing: 70 feet Pump Manufacturer's Name: R«.ICI,(�,c L<<-- ' Pump Model: C_ N l UJj Pump Size � hp Pitless Adapter Burial Depth: V feet /J Pitless Adapter Manufacturer's Name: ilii (C/ /Y Pitless Adapter Installer. &t Well Disinfected Upon Completion". R'Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: S�Wev� �J \ c.�CT 50 YL AW +wy,. Attention: The pump installer shall provide a pimp installation log to the DSD within 30 days of pump installation. Pa rr 17 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 1� C VLN C-5. ENVIRONMENTAL ENGINEERING DIVISION OF BEDROOMS Telephone 264-4720 ❑ One ❑ Four ❑ Other REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FA ILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) da for processing. 1. PROPERTYOWNER ` F CSSz- PHONE MAILING ADDRESS �ojSI vJ4L-45fdif f �� PROPERTY RESIDENT (If diffe�ent from abo e ..mob - 2. BUYER - PH NE MAILING - DD ESS kZ 3. LENDI GINS ITUTIO 1,D A6 L, ^lT ALT®►J PHONE MAI LINGA RES �1►-I v ?key, Gia K 9 3 4. REAL70� E� 1GCa� 'C PZHON.E7, O�^� � eft. ( 1 MAILINGADDRES V�/f 5W 5. LEGAL DESCRIPTION�� 1*d T STREET LOCATION I D 10 vJ�N \ i R,Ig c 1� C VLN C-5. 6. 'TYPE OF RESIDENCENUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FA IL ❑ Two ❑ Five ❑ MULTIPLE FAMILY Q" Three ❑ Six 7. WATER SU PLV IK INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well PUBLIC UTI LITY depth (attach log if available.) _❑ 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **II individual/on-site, give installation date__. If system is over two (2) years old an adequacy test is required (' PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER =PHONE '� 4ClkRci�,p ��•ByJf.L,I-.. Z'�9� l'��2_ MAILING ADDRESS C) I o VtlL-6 V� I,'Pf — k\fy- • _ PROPERTY RESIDENT (If different from above) PHONE 2. BUYER p R_ �l�tJ�,4A F615IJR0 55t5Tt.R PHONE MAILING ADDI3ESS `Q r� r iy _ , AYIt ?9?95;C>--r3'?95;C>--r3'3. fM\ rl�/V^ O LENDING INSTITUTION A PHONE ILI MAILING ADDRESS �Hqg k 1AU'J 1: y'� ' 9957(' 4. REALTOR/AGENT �. PHONE _ Z -'? - 0 MAILING ADDRESS M1_ I �'— r �� • 919-2s: 5. LEGAL DESCRIPTION (>-f��-p�� STREET LOCATION 1 v ►ia �nl t Ia��s�t2� �� 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS E ❑, One ❑ Four El Other SINGLE FAMILY Ci Two ❑ Five ❑ MULTIPLE= FAMILY ❑ Three ❑ Six 7. WATERS PPLY Y INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date_ / If system is over two (2) years old an adequacy test is required C� PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) PLUMBING O&HE A'r ING 7/14/73 2910 Eide Street Anchorage, Alaska 99503 Phone: 274-6576 LICENSED AND BONDED To Whom It May Concern: Inspection requested on well 7/12/78 by Mr. Rowell at 1010 Wilshire Dr., Anchorage, Ak. (Formerly 36th Place) Findings: No protection for electrical lines. Inspection requested 7/13/78. Findings: All code violations corrected. Comments: Well is in proper working order as of this date, 7/13/780 and meets all applicable codes. Keith Winkle R & S PLUMBING & HEATING THIS SIDE FOR OFFICIAL USE ONL TE INSPECTION APPOINTMENTS 4. DISTANCES I Septic/Homing WELL T0: Absorotion Area to nearest Lot Line 5. COMMENTS APPROVED FOR -- = BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED L DESCRIPTION 72-010 (Rev. 3/78) ❑ OTHER NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE --- --� ❑ ONE ❑ THREE C] FIVE SINGLE FAMILY _ ❑ FOUR El SIX ❑ MULTIPLE FAMILY Lel TWO PERMIT NUMBER s 2. WATER SUPPLY LSA INDIVIDUAL _ DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified.___ LOG RECEIVED 3. SEWAGE DISPOSAL. SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATE INSTALLED E415`661_IC 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. DISTANCES I Septic/Homing WELL T0: Absorotion Area to nearest Lot Line 5. COMMENTS APPROVED FOR -- = BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED L DESCRIPTION 72-010 (Rev. 3/78) ❑ OTHER