HomeMy WebLinkAboutBROWNS RESUB (PLAT P-472) LT 3 T13N R3W SEC 13O0
I
Development Services Department
Building Safety Division
® On -Site Water & Wastewater Program *AE
4700 Elmore Road
P.O. Box 196650MarkBegich Anchorage, AK 99507
Mayor www.muni.ory/ansite
_. (907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description Property,Owner Name & Address:_
�Q 157
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: 439,feet
Pump Manufacturer's Name:p
Pump Model: 50C 30/ �5-5 I t
Pump Size f� hp
Pitless Adapter Burial Depth: VA 0 feet
Pitless Adapter Manufacturer's Name: A/4
Pitless Adapter Installer: K/k
Well Disinfected Upon Completion?es ❑ No
Method of Disinfection: LLZ PoP.
Comments:
�/ � ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: / U� i'9 330 EAST 76TH AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall pr is a pump installation log to the DSD within 30 days of pump installation.
APPLIC NT FILLS OUT UPPER HA[ ,ONLY
Property Owner /,~./~, ~/' .~.~'/~/~//~/~--' .~ .~//~\'~..-~ t~ Phone
Address zL/~ Zip Code
'-' ~ , Phone
Lending Institution /~;.~: , L~:.>~ ~')'7' ?
~ -, ~hono
Address //'() ~ : Zip Code
Legal Descript~n Z ,=' /' ~ /~ ' ~
Street Locati~ / .-f ~ ~ ~-( (~ ~)~r) ~ ) ~-
Type of Resl~nce
~ Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to Ihat date, give well depth (attach log if available).
~ Public Utility
~ Individual
c Utility:
Public ~ility ~ e I ~: ~
~' Holding Tank :, ~ :,~ ,,/ ~ ,, , [~ ~ .,;~
NOTE: THE INSPECTION FEE MUST AC~EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time ~)'
Date Date Date Date
Inspector Inspector Inspector Inspector
Fiold N°tte~O/~'' MUI,,IICICALIT¥ O~ ANCHORAGE
R[CEIVED
( ~ APPROVED BEDROOMS ~} 'CONDiTiONS OF APPROVAL
(I ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (311~.)
,Jovei,~be r 10,
V(~.teran's Ad~linis'Cration
Lua. i'~ Gu~ran'Cy Office
q~S "u" Stree'~ ~uite
Ancilorage, ~'laska 99501
SUBJECT:
Water an~J sewer facilities servin~ lot 3, block 15,
~roN'n Subdivision, 201 0Klahoi,~a Street.
0ear Sirs:
The subject ciwelling accoreing to our files is now serv:e by
public sewer. Tile ~ell seal nas been repaired and the washin(j
~,~aci~in~ urains have been plugged in the well aouse, l'i~erefore,
Chis Department gives final approval un the subject facilities.
tf you have ~ny questions regaruin~l the above matter, I;lease
do nec i)esiCate to con'cact this office.
Sincerely,
Ti~, Rul,~fal t
Sani tari an
cc: Alaska Sta:e Bank
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage· Alaska 99507 279-8686
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WA/HR FACILITIES
FOR
Addres~: Phone
5. Type of
Number of Bedrooms:
A. Type B. Depth ,, ,
C. Construction ~'~--~ D. Bacterial Analysis
Sewage Disposal Svstem: ~-/~-~-<-~ -~'~-~%-~
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. We].l To:
Septic Tank
, Nearest Lot Line
Foundation to Septic,Tank
, Absorption Area
Absorption Area to Nearest Lot Line
· Other Contamination
Ab'~orptt on Area
· Sewer Lines
®
Rec~Je£,t for Approval of Ir
Page Two
g. Comments=
'/idual Sewer & Water Facilities
Date
Appr va] Valid for One Year From Date Signed
Greater Anchorage Area Borough, DeFmrtment of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located at:
Signed
Date
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up, VI it-, iioc -;.o its consLructiGn cmu th+_
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' ii s Dt,,,)drtioQiit catinut ',,,,ivL, mppr( val o t �_ Ji Lt � . L i 1 i
un C- al I vif., miuve I }ilprovey.%ents have Lteen iJ;�wL; ,ind a r c is p C.-, c t i un
of the saiie has uccxr, _.
Tiii, Rui(JiA
i slily i;u r i a n
cc: Alaska State Bank
F reema n I s C ) ii s r 1, t.- t i u r,
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
~00 Tudor Road, Anchorage, Alaska ggSO? 27g-8686
Time o~ ~.~to., ~.'~ ~~
RPQUEST FOR APPROVAL OF
INDIVIDUAl. SEWER & WATFR FACILITIES
FOR
- ..'. _ .
Prooerty Owner: _Phone
Legal Description
Type of Facility [o be Inspected. '~ ~
Number of Bedrooms=
6. Well Data:
a
A. Type , . B. 'Depth, , ,
C. Construction
D. Bacterial Analysis
Sewage Disoosal System:
A. Installed .8. Installer
C. Septic Tank= 1. Size 2. Uanufacturer .............
D. Seepage Pit: 1. Size ,. 2. Uatertal ...... ._ ..
E. Disposal Field:
Total Length of Lines
8. Distances:
A. Well To: Septic Tank
, Nearest Lot Line
, Absorption Area
, Sewer Lines
, Other Contamination
B. Foundation to Septic Tank
"'~, Absorption Area
C. Absorption Area to Nearest Lot Line ...... ·
R~est for Approval of ~ndividual Sewer & Water Faoilitles
Page Two
g. Comments:
Aporoved
Disapproved Date
Approval Valid for One Year From Date Stgned
Grea~er Anchorage Area Borough, De~rtment of Hnvironmental Quality
DIAGRAM OF SYSTE~
~ certify that the information contained in this request for approval to be a true
and accurate re~r,sentation of the subject sewer and water facilities located at:
Signed Date
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, .Anchorage, Alaska 991507 2'79-9696
Date Received ���0 -"7Q
Time of Tnsnection-2-.13
0
Date of Tns nect;i ons _ �0 _/
1. Approval Requested
2.
3.
4.
5.
6.
7
REQuEs'r FOR APr-ROVAL OF
TNDTVIDUAI. SESJER & WATER FACILITIES
F O'7
Address: � . • L P tone :27 7
Pronerty Owner: Phone:
Legal Description:
Location:_ %3 ,e3tjJ S 13
Tvpe of Facility to be Irspected: � (�
Number of Bedrooms:
Well. Data:
A. Type B. Depth F
C. Construction D. Bacterial Analysis
m„
Sewage Disnosal System:
A Installed 8. Installer
C. Septic Tank: 1. Size— 2. Manufacturer
D. Seepage Pit: l.. Size 2. Material
E. Disposal Field: Total. Length of Lines -
8. Distances:
l'
A. Well To: Septic Tank - -----2 Absorption Area Sewer Lines
Nearest Lot Linea 0 Other Contamination
B. Foundation to Septic Tank , Absorption Area
C. Absorption Area to Nearest Lot Line
Request for Approval of T iidual Newer & 'Nater Facilitie
_°a-ge Two
9; )mments :
Aonroved Dis3r. proved Date
�� 7
Approval Valid for One Yaar F=t -nm rate a -Yned
Greater Anchorage Area Forounh, Department f Envz.ront*ental Quality
I)TAG-TRIAM OF SYSTEM" -
Al
1
I certify that the information contained in this request for approval to he a true
and accurate representation of the subiect sewer and water facilities located at:
Signed Date
Al.ka State
Box
~ho~ ~ Al~ka
gOSIO
Atl~mtton: ~. Peto~san
Subject: S~R CONNECTI~/B~'S ~DIVISI~, LOT 3, BLOCK 15
Thts ts to eo~ttfy th~ the lot tn questton Is eonnected to ~ arolMtde
sewer system, ~nd that the sewer 11nas have been acoapted for oporat!on
and matntenaneo by the Greater Anchorage Area Boflmgh,
If you have any further questtans regarding thls matter, ploue
AREA
D. 9ardner
CuStomer Servt~e Supervtso~
ce: Oonald Fr, m~m
· ~ATER ~,NO-IOR.~.GE ,~REA BOROUGH
1.1E,~LTH DEP.~R~ENT
$27 E,~LE STREET
ANCHORAGE, ALASKA 99S01
279-2511
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND ~ATER FACILITIES
FOR
e
Approval Requested By ~.,,<~
Phone 33~
Property Owner
Phone
Legal Description~zf~-~, /~-~-~,,~_~z-~',z~'.~.
Type o£ Facility to be Inspected ~....,~-~ STREET:._~z'
Number of Bedrooms
S. Well Data:
A. Type
B. Depth
C. Size
D. Construction
E. Bacterial Analysis
6, Sewage Disposal System:
mJ
Septic Tank (If homemade, show diagram on back)
1. Size , ~~ /,~9~,~
2. Age ' ' '
3. P4anufacturer
4. Installer
.Approval Request flor Sewag ~ Water Facilities
Page Two
0
Seepage Pit
1. Size .... ;.~f~.'/d, ,
2. Lining ~_.~:~,~ , ,.
C ...... Disposal Field
1. Number of Lines ./~ .....
2. Total Length,,. /~,//.~
Required Measurements
/
A. Well to Septic Tank ~ ......
B... Well to Seepage Pit j/,~, / .
C. Well to Sewer Line ~
D. Well to Property Line
E. Well to Other Possible Contamination
F. Foundation to Septic Tank
G. Foundation to Seepage Pit
H. Seepage Pit to Property Line ~-
8. COI~IENTS:
APPROVE/~ /~ ~'-~/~~ '',
DISAPPROVED:
APPRO LID FOR ONE YEAR FRO~.-I DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT
EDll70
REQUEST FOR APPROVAL OF
INdiVIDUAL SEWAGE AND WATER FACILITI~S ~g~~'
(Fill out in T~iplicate) ~ ~/ ..... '
person ~equestin~ approval Ma~ Po~le~ ,
.......... k ..............
property~ owner ,, ,Dcn~d Frse~_ _~Y-,~C ....... , ~. ....
,~,~ b.dr~ms in house d~lex ·
Watez, Anals~$is:
a. Bact~,ia 1.
b. Detergent "'
data:
a. '17[,~, d~411~~ .... ·
b. Depth .... ~20 ft
c. Casin~ Size
d. Distance from well to closelt existing or proposed: ~
1. Sewer line '
,. 3. Seepage A~ea
5. Property Line
6. Other sources of Possible contamination, i.e.~ creeks, lakes,
houses, barn, raznage ditch, etc.
d "
?. Se'waKe disposal system·
a. Age of system ....
(z) 3,000
b. Septic tank capacity in gallons.~_ (1) 1.000 , .
c. Name of septic tank manufactures
1. If "home made" show diagmam on reverse Side of this form,
d.' Disposal field om seepaKe pit size and type. ~~~ .......
1, Distance to propex~ty, line
to house foundation
· e, Percolatio~ T~st ~.~suLts
f, Percolation Test performed by. .~ ........ ,
'"~,- Use the reverse ,side of this form to show diagram. Diagram should include'
· '~-~he foilowing ~nformatlon: p.noperty lines; .well location~ house location,
~4',~:~c tank location, ,disposal area locatlon,~ location of ~rcola,tion test,
a~,~ d~rection of ground slope. , ,
9. The i'~-r?~,,~,n:t~m .on this form is true and correct to the best of my knowledge.
'~'i~:n a% ure "6f " .....
Applzcant Date Si~ned
\
m~O_ BE FILLED OUT BY HEALTH DEPART[.!ENT PE,[SON,N,EL
?he above described sanitary facilities are hereby approved, subject to the
............ '-~6'l!owing con~";-'~'ions: .
Conditions: . .,/~..W,t'
The above described sanitary aczlzties are disapproved for the following
f · .
reasons:
ApproVal ~s valid for one year following the date of approval.
CPJ:cw
.~.' C) x.,C; ~" ' ~
f ~ ~. ~/'~' INDI IDUAL SEWAGE ,D WATER FACILITIES
~ ~ ' ~ ~ (Fill out in T~iplicate)
5
b. Detergent
Well data:
1.
2.
3.
4.
5.
Distance from well to closest existinE Or propose~:
Sewer
Seepage Area
cesspool-_ I10'..
Property Line
6. Other sources of Possible contamination~ i.e., creeks, lakes,
houses, barn, drainage ditch, etc., ................ ,
Sewage disposal system.
b. Septic tank capaciZy in gallon~, M ~ ,
c. Name of septic tank manufactu~T .....
1. If "home made" show diaEPam on ~evePse side of this fo~m.
d.' Disposal field oP seepage pit size and
1. Distance to proper~cy line
to house foundation
Pex'co] a? ionx Te'st ~emults
f. Percolation Test pemformed by
Use the reverse .side of this form to show diafram, DiaFram should include
~he foJlowing information: tS.~ope~ty lines; .well location, house location,
~v~c tank location, disposal area location, location of percolation test,
a~d direction of ground slope,
9. The l~'~fo~.-,r~ion on this form is tmue and comrec% to the best of my knowledge.
~ i~"tume of ApPliCant ' ga~ sifned
T._O_BE FILLED OUT BY HEALTH DEPART~,~ENT PERSONNEL
~ "£h~ above described sanitary facilities are hereby ~pproved, subje~ct to the
.......... ~6'llowing conditions ~ ..........
The above descmibed sanitary facilities are disappmoved for the following
reasons:
Approval is valid for one year following the date of approval.
CPJ: cw
INDIVIDUAL SEWAGE AND ~ATER FACILITIES
(Fill out in Triplicate)
.
.
a. Type_ _ i
b. Depth .
c. Casing Size
d. Distance from well to closest existing or proposed:
1. Sewer line .
2. Septic tank
3. Seepage Area
4, Cesspool'
5. Property Line
Other sources of $ossible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc. .
7. Sewage disposal system.
a. Age of system _
b. Septic tank capacity in gallons_
c. Name of Septic tank manufactu~.r
If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
Distance to property line
to house foundation .
~, Percolatiork Te'st
f. Percolation Test performed by
Use the reverse ,side of this form to show diagram. Diagram should include
'%he foil,owing info~mation: p~operty lines; ,well location, house location,
~'~.,-~ {c tank location, disposal area location, location of percolation test,
aud, direction of ground slope,
The ~,n~t~n~,a~on on ~his form is true and correct to the best of my knowledge.
S'Ign~ture '6'f APplicant .... .6.~te Signed
T~q BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
~6~ll°wingThe above con~onsdescribed sanitaPy: facilities are hereby approved, ,.,s,,ubje,,c,t, to, the
Ondlt lOLs:
The above described sanitary facilities are disapproved for the following
reasons:
Approval is valid for one year following the dare of approval.
· CPJ: cw