HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 7CC^ pB
COT
"lC
ia, cK.
2833 £a~t T2nd Avenue
D/.ILY DRILLING LOG
PEHN JERSEY DRILLING CO.
Anchorage, ,%lask:t 99502
D£PTII OF WELL.
STATIC I EVEL OF W.~TER F~.'
DRAW DOWN ~ ...............................................................................
G.l[$. PER I[~ .................
KIND OF C:~S1NG '
~? 7¢, :'--. -. . , FROM ............... FT. TO ........................ FT ................................
FROM ......................... FT. TO ............. '-. * ~..~/...,Tr:'~, ~-. ~
~: - '"'"~: 7~' o ~.-I .............. ~T. TO .................... FT... . ....
FROM ~ FT TO ~.r. ~(*I". 'l ~ ' C"- ~
.~5 .................... FROM ............... FT. TO .................. FT .........
FROM FT. TO ~'e ~ ' ~ . a.*, '~ ~'-~C" ':
r *. .~ '. .................................... FHO.M ................. FT. TO ....................... ~T. .
FRO.H......~..~ .......'T '' ;q::~ ';" '- ' ' ................
~. .....FT. 0 .......................... FT .......-.. - '.r~'," ·
FROM ...................... FT. TO ........................ FT ..................................
FROM ........................ FT. TO....: ..................... FT ......... i:i~'..t.~.:_'. ................
I~RO.~, ........................ FT. TO ...................... FT ......................................
~ao.M ........................ FT. TO ......................... FT ....................................
FHOM ......................... FT. 'TO .......................... FT ........................................
FHOM ......................... FT. ~0 ......................... FT .........................................
FROM .......................... FT. TO FT
.',I l S CL. INFORMATION:
FRO.~ ! .............. ~1'. TO ................... FT ..................................
FP. OM ................. FT. TO ................ FT ..............................
FR01I .....................FT.. TO ........................ FT ....
FROM .................. FT. TO ......................FT .................................
FROM . FT. TO ......................FT ..........
FROM ....................... FT. TO FT
FROM .......................... FT TO FT
no
DRILLER'S I.~,.-.ry, '£!n. ~. Nancy
NAME ...................................................................................................
LOAN APPROVAL INSPECTIONS
~Expose and mark stand-pipes and ~ells.~
Dra~ ~ property for t~spectors use.
ENVIRONMENTAL ENGINEERING DIVISION JAN 2 ~ 1~0
Telephone 2~1-4720
REQUEST FOR ~PROVAL OF INDIVIDUAL WATER ~D SE~IL~
MUNICIPALITY OF ANCHORAGE MUNICIPAU~Y OF, ^NCHORAG~E,1 _
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF ! !.ALTH & I1[~ c~'
~25 L ~ · Aedm~, Al~k~ 99501 ~'IRONMENT,~L F ~,OTECTION ~
DIRBCTtON~: Con~)lete a4l parts on p~ge t, I~ mquel~ will not be p~eeeelld, M~I~M) (10) ~ for
PROPERTY OWNER I PHONE
DAHL HOt~S. INC. [ 344-7514
MAILING ADDRESS
2&27 ~T 86'1'1{ g'I'~['T ANCHORAGE. ~ 99507
N~ ~O~
BUYER PHONE
MAILING
LENDING I~TiT~ION
PHONE
MAILING ADORE~
~ R~LTO~AGENT ] PHONE
VTT.T.TA..T, ~nnn~'
MAILING ADOR E~
LEGAL DESCRIPTION
LOT 7C BLOCK 2 CAHPBELL HIEGHTS SUBDIVISION
STREET LOCATION
ONI~ HALF MILE EAST OF LAKE OTIS ON 68TH STREET (NORTH SIDE OP IU)AD)
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One I--I Four [] Other
[~ SINGLE FAMILY [~ Two r--I Five
I-'l MULTIPLE FAMILY r-I Three r-I Six
7. WATER SUPPLY
~ INDIVIDUAL*
r-'l COMMUNITY
I--] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[] ' PUBLIC UTILITY
x
* A'UI'ACH WELL LOG. A well log is required for ail wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
724)10(3/78)
TIME
DATE
INSPECTOR
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
TIME
DATE
INSPECTOR
DATE RECEIVED
TIME
DATE
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3, SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
r-'l PUBLIC UTI LITY
Connection Verified
[]Septic Tank or I-'l Holding Tank
Size:. If Tank is homemad,
give dimemions:
NUMBE~ OF BEDRO01~
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [:] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL '
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED . .
INSTALLER
SOILS RATING-
TYPEOFTANK MANUFACTURER
MATERIAL
S~otlc/Holding Tank
TOTAL ABSORPTION AREA
4, DISTANCES
WELLTO:
Line
COMMENTS
~'~PPROVED F(~"'~t""'~E D R OO M S
[] CONDIT!ONAL A~PROVAL (letter must ~/~pany certificate)
[:~ DISAJ~PROVEO ' .~/~.-- //.J-"~/~ '
/
LEGAL DEECfltPTION
72-010 (Rev. 3/78)
January 25, 1980
Dab1 ~omes, Inc.
2427 East ~6th Street
Anchorage, Alaska 99507
Subject: Lot ~D Block 2 C~pbell Heights Subdivision
Approval for your individual sewer and watcr facilities
can not be granted until the following £t~s have been
completed:
A water s~nple taken from the property. At the
time of inspection the water was not turned on to
obtaine~water s~ple.
top of the well casLng sealed with a sanitary
seal so that it is water tight.
Pleaee notify this department for a re-inspection when
the noted descrepancies have been corrected. If there
are any further questions, please contact'this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist