HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 17
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number:
Legal Description Property Owner Name & Address
Eagle River Heights Block 2 Lot 17 Josh & Kateland Plumb
Pump Installation Date:
3-14-19
Pump Intake Depth Below Top of Well Casing:
90 feet
Pump manufacturer’s Name:
F&W
Pump Model:
4F07P05305S
Pump Size:
1/2 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
UNKNOWN
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: UNKNOWN
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
APPLI("'~NT FILLS OUT UPPER HAI""*~)NLY
Multiple
Water Supply ~
~mm~lty For wells ~tll~ prior to thM date, give well depth (attach t~ If available).
~ Public Utllily
NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time
Inspector Inspector Inspector Inspirer
Field Notes:
~ ~6'~ ~ ~0,~ MAY05]983..
~ APPROVED ~DROOMS ~ ,~NDITIONSOFAPPROVAL "Dapt. of Yeal:h &
Environmental Prol~on"
) DISAP~OVED
~lls Rating Date ~wer Inslalled Well To ~soiptlon Area Well L~ R~etv~
~ We~l to Tank ~pllc T~k Size
DATE,RECEIVED
INSPECTION APPOINTMENTS
TIME · TIME TIME
INSPECTOR INSPECT INSPECTO~.-~
MUNICIPALITY OF ANCHORAGE /~UNIClPALITY CF AHOIORASE
D£PT C
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~ION
825 L Strut - Anchora~, AI~A~ ~1 ENVIrONMENtAL
) ENVIRONMENTALSANITATIONDIVISION DEC ~ 1980
Tefe~one ~7~
o.'.m.
DIRECTIONS: Complete all parts o~t page ~. Incomplate r~um~ will not ~ pr~, Please allow ten (~0) days fo~ pr~essing,
'1. PROPERTY OWNER ] PHONE
MAILING ADDRESS
PHONE
2. BUYER
MAILING ADDRESS
3. LENDING I~TITUTIO~ I PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT. [ PHONE
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPEOF RESIDENCE NUMBER OF~BEDROOMS
~ One ~ Four
~ SINGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~u~l~ ~ Three~. D Six
I-1 Other
WATER SUPPLY
[~ INDIVIDUAL*
[~] COMMUNITY
I--1 PUBLIC UTILITY
* 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.)
SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
.YEAR ON*SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY I-'1 ONE [] THREE [] FIVE ;-I OTHER
r--I MULTIPLE FAMILY [] TWO I-'1 FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUSMCUTILITY
Connection Verif[ed LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
I---I INDIVIDUAL/oN -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[--ISeptic Tank or I-'lHold[ng Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
5. COMMENTS
[~APPROVED FOR ,."'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)~
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561'
Date Received 3/21/74
Time of Inspection 11:00 am
Date of Inspection 4/18/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
Lomas and Nettletnn
3)~0 C St. Anchcra? 9q~O~
Phone: 274-7661
Clarence La May
Phone: 694.~1Bq
p.o. Box 935 £agl~
Lot 17, Rlnrk ~; rag!e River ~K ~e!ght:
4. Location: ~orlbou Street
5. Type of facility to be inspected
6. Well Data:
A. Type .'
C. Construction
7. Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field: Total
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
Duplex No. of bedrooms 6
B. Depth
D. Bacterial Analysis
PUBLIC SEWER
B. Installer
Size 2. Manufacturer
Absorption Area 2. Material
length of lines
, Absorption area
Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page~2 of two pages - Re~..Jst for Approval of Individual ~_.,¢r & Water Facilities
Legal Description
Comments
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)