HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 4C4C
Well Log
Date completed ..... ~.r..~.-. ~ .................................................
Depth of well ........... ~.~ .................................................. ~ ....................................
Size of casing ......... ................................................................. :~ .................................
Distance to water..~?.. ..... ~.~..~..~....../...7...~.~ ..............................................
Distance to water while numnin~ ' ! ,~' ' ' ~*- rate
................. .~..~...~... ................. ~allons per.hour. (~d'~'~4~)
of
~orrnation from I to
cc~ y
I~.<-
I
Driller
DELTA DRILLING COMPANY
SRA BOX ~94 B
ANCHORAGE, ALASKA SgS07
LOCATION
~UNICIPR~'IT~' 'OF Rr~CHoRRGE
DEPRRTMENT~C%HERLTHANDENVIRONMENTAL~:~TECTION
, 825 '; .,'STREET~ ANCHORAGE, AK.
264-4?20
t~ELL PERMIT
( 800486 )
8521 SOLAR DRIVE
~44-0746
LOT SIZE 8505 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS
lO0 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
HINIHUH DISTANCE FROH A PRIVATE WELL TO R PRIVATE SEWER LIthE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAY~
OF THE WELL COMPLETION.
OTHER REQUIREHENT~ MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIRGRRHS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I t EXP I RES DECEMBER -~-~
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
S I GNED: ........................................ -
APPLICANT RONRLD E. RIVAREL .
ISSUED BY--- E .....
V4. 0
0
;'1
[ CERi'[FY THI1T
APPLIC'~,NT FILLS OUT UPPER HAr~ ONLY ,
lngle Family
~ Other
Water Supply
~ Public Utility
~wer Disposal
Holding Tank
NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time
Data
Inspector
Time
Time
Date
In spect o(.~
1982
RECEIVED
~?APPROVED BEDROOMS
( /..~ DISA PFROVE D
'CONDITIONS OF APPROVAL
Soils Rating Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Ta~k Size
DA~ RECEIVED
,~' INSPECTION APPOINTMENTS r.
~UNICIPALIIY OF
MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH &
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IRO~NTAL
825 L Strut - Anchor~, Al~e ~1
~ --~ ENVIRONMENTALSANITATIONDIVISlON tt0V 5 1980
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW i~I~S '
PROPERTY RESIDENT (If different from abo~) / ~ PHONE
4. REALTOR/AGENT ~ PHONE
MAILING ADDRES~
STREETLOCAT z e
6. TYPE OF flE~rDENC~'
SINGLE FAMILY
MULTIPLE FAMILY
WATE S P~LY
7. r~ INDIVIDUAL*
/[~ COMMUNITY
[] PUBLIC UTI LITY
NUMBER OF~SEDROOMS
One I--'1 Four [-'1 Other
Two [] Five
~ Three [] Six
· 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 log if available.}
8. SEWAGE DISPOSAL SYSTEM
I--I INDIVIDUAL/ON-SITE'* YEAR ON-SITE SYSTEM WAS INSTALLED.
PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010 (Rev, 6/79)
THIS SIDE FOR OFFICIAL USE ONLY · . . ~
1. TYPE OF RESIDENCE NUMRER OF BEDROOMS
I-1 SINGLE FAMILY I--I ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
I--1 COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]SepticTank or r-IHoldingTank
Size: If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL -
4. DISTANCESwELL TO: ~eptic/Holding TankIIAbs°r'Pti°n Area ISewerl Line I Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS ' ~, '
' ' PPROVED FOR 2 BEDhOOMS
[] CONDITIONAL APPROVAL {l~tter must accompany certificate)
DATE BY
'il-lq'. .-
72.010 (Rev. 6/79)