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HomeMy WebLinkAboutSPERSTAD BLK G LT 3©10 0~ ©~© I &o'l'- l =l< ',~ Oct_19.2022 09:05 AM Anchorage Well & Pump Service Inc 9072430742 #1651 P 1/ 1 MUNICIPALITY OF ANCHORAGE Development Services Department � � Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue - Parcel Identification Number; 010 346 03 Legal Description Block Lot Property Owner Name & Address: SHORT SARAH p GPERGTADDBA ECHO PROPERTIB5 G 3 5405 NORTH STAR ST ANCHORAGE AK 99598 I Pump Installation Date: 10 - 18 - 2022 Pump Intake Depth Below Top of Well Casing: 100 Pump Manufacturer's Name: A.Y. MODONALD Pump Model: 2405OV2A IPump Size: .50 hp Pitless Adapter Burial Depth: N/A feet Pitless Adapter Manufacturer's Name: NSA Pitless Adapter Installer: IWell Disinfected Upon Completion: V Yes ❑ No Method of Disinfection: PELLETS I Comments: Pump Installer Name: Company: Mailing Address: Feet ANCHORAGE WELL &. PUMP SERVICE 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to Oxy -sate within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE 3F HEALTH AND ENVIRONMENTA L Street, Anchorage. Alaska 264-4720 Date Received: PROTECTION 99501 November 1, 1977 I~2: Time ~3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner: Terry D. Stimson Mailing Address: 1610 E Street 99501 Phone: 272-6094 3. Legal Description: Lot 3 Block G Sperstad Subdivision 5405 North Star 4: Single Family Residence: (x) Number of Bedroo~s: Two Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual well (x) Cormmunity/Public System ( ) Permit ~ Depth of Well Well Log on File ( ) Construction~/~/~D. /~j"~' Bacterial Analysis ~~,~.~. 6. Sewage Disposal System: On-site System ( ) Public Utilit~ Permit # Septic Tank Size Absorption Area Installed Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 3 Block G Sperstad Subdivision Comments: Affadavit Attached Letter Attached: ( Disapproved: Date: Date: Department Worksheet: MUNICIPALi~I"Y OF ANCHORAG[ ,; ~) ~)epartment of Health and ]~nvJ.~onment. al Protection '/~'~'7~225'~{'5~ 805_ iL Street, Anchorage, Alaska 995~0I,"', '' · ..... l~equesL for Approval of Individual Sewer alld Naher Faoi. l.i'hJ, es Lending Insti'b_utien: Hailing Address: Phone: Sii~glo Family Residence: (~ Number of Bedrooms: H./~] ~ip]e Family Residence: ( ) Number of ]3edrooms Water Supply: Individual. Well ~, .iub'l..Lc/Con~'nun~ty System ( ) If Individual Wo].]., we].l dept. h If Community System, name of system Sewatle Disposal System: *{)n-s.ilze System~ ( ) Public Sys6em (~ If On-s~te Ss~stem, date of! installation: *NOTF.: A well log ;ts required oil AiL,L~ wells dri. lled since 6/75. ** I£ on-site sewer system is oveF two(2) years o].d, an adequacs~ tes[~ is required by this department. A l!ee of $2!}.00 m~st accompany each request before processing can be JniLiated. 3/77 06-1220(a) Rev. 197~ DATE NAME ADDRESS ALAS DEPARTMENT OF HEALTH AND SOCIAL SE( ES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS INDIVIDUAL [] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ZIP CODE ADDRESS ~OF SOURCE COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED" , TIME COLLECTED : : ~ ?: i : Sample CoJJecled From [] Kitchen Top [] BathroDm Tap [] Basement Tap [] Other (List) Well- [] Dug [] Driven [] Drilled SOURCE~ [] Spring [] Cistern [] Other Dug Well or C[stern Construction: Walls--[] Wood [] Concrele [] Metal Top -- [] Wood [] Concrete [] Metal LOCATION: [] In Basement [] Basement Offset []In Yard [] Other Building Sewer DISTANCE TO: or Other Drainage Pipe__ _Feel, THe Seepage Cess- Field- Feet. Pit Feet. Pool Olher Possible Sources of Contaminallon MATERIAL: Building Sewer- [] Cast Iron [] Wood [] THe GENERAL: Does Waler Become Muddy or Discolored? When? [] Bored [] Tile Brick or [] Open Top [] Concrele [] Under House Septic Tan~ Feet. Feet. Privy · .F~el. []Fibre [] Asbestos Cemenl [] Yes [] No Lab No. OFFICE Analysis shows this Water SAMPLE to be: [] Satisfaclory [] Unsatisfactory [] Questionable [] Sample too long [n transit; sample should not be over 48 hours old at examination to indicate rel[able results. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS Diameter of Well Depth Well Casing Material Diameter . Depth Length of Water Deplh Drop Pipe From Bollom Offset in PUMP LOCATION: [] In Well [] Basemenl [] In Basemenl On Top [] Of Well [] Olher Feet. [] Room PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of Supply? [] Yes [] No Repairs to System? READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] No [] Yes [] No S[gnature--~ E6,1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Bev. 1973 Dote Recelved ]r'ltr~) ? ~1~ j Time Recelved '[' -pmam Lab. No, : Laclose Broth h, 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0c¢ 24 Hours 48 Hours ' ' Brilliant Green 24 Hours 48 Hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs. Gram's statn Coliform Density . (Most probable No. per 100cc) MF Resulls This analysis indicates Coliform Organlsms 1o be: Absent Present /~'Q'~k~ , ~ ,~CIPALITY OF ANCHORAG~ //C~~ .ID]~Jl/~'IME, 4/~:~EALTH AND ENVIRONMEN _ PROTECTION ~[~ff.~)~ ~ ~' n~' Lnl~t-¥eet, Anchoracje, Alask. a-99501 Date 5~7 Tues Date &-~7 /~] Date REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILIT.IES 1. Lending Institution Request: A.H.F.C. - V.A. Mailing Address: 2013 East 3rd Avenue 99501 Phone: 274-4621 2o Property Owner: Terry Stimson Mailing Address: 5405 North Star Street 99503 Phone: 272-6094 3. Legal Description: Lot 3 Block G Sperstad Subdivision 540~ ~%~ Star St~ 4: Single Family Residence: (x) Number of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit Con s Individual Well (x) Conm~unihy/Public System ( ) Depth of Well Well Log on File Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System ( ) Public Utility (x) Instal]_ed Installer Manufacturer Soils Rate Material DJ. stances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorphion Area to Nearest Lot Line Page Two Departmenu of Hea].th and Environmental Prohechion Request for Approval of Individual Sewer and Water Facilihies Legal Description: Lot 3 Block G Sperstad Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( Date Date MUNICIPALITY OF ANCltORAG. 1' q 825 L Street, Anchorage, Alaska 99501 ~ 279-2511, ext. 224, 225 for Approval of Individual Sewer and Water Facilities Mailing Address Mailing Address: _ ~ 13___~_ ~= .~.a~ Phone: Mailing Address: .... _.~ff _~ ~__ hone: Legal Description: Street Location: Single Family Residence: Multiple Fami].y Residence Number of Bedrooms: Number of Bedrooms: Water Supply: * Individual Well ~.,(') If Individual We].]., well depth If Community System, name of system Sewage Disposal System: On-site System If On-site System, date of installation: Publ ic/Con~munity System ( ) ( ) Public System *NOTE: 3/77 A well log is required on ALL wells drilled since 6/75. Municipalityof Anchorage June 2, 1977 POUCH 6~650 ANCHORAGE, ALASKA 99502 (907) 279-2511 GEORGE M. SULLIVAN, MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL (825 "L" Street) A.H.F.C. - V.A. 2013 East 3rd Avenue Anchorage, Alaska 99501 Subject: Lot 3 Block G Sperstad Subdivision The well casing must be extended above the crawl space ground level. Since the crawl space is connected to living quarters in the basement the casing extension is all that would be required. If there are any further questions, please contact this office at 279-2511, extension 224 or 225. Sincerely, Sanitarian ~F ~ LNB/ljh cc: Terry Stimson 5405 North Star Street 99502