HomeMy WebLinkAboutGIRDWOOD ORIGINAL TOWNSITE BLK 2 LT 5
Rick Mystrom,
Mayor
Mt cipality of A chorage
Department of Health and Human Services
825 'L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 3, 1997
Cindy L Nielsen
PO Box 565
Girdwood, Alask
99587 0565
Subject: Lot 5 Block 2 Girdwood Original Townsite
Permit #sw960333, PID #075-152-05
The subject permit, issued October 3, 1996 by this office for a
single family well and/or on-site wastewater system, has
expired as of October 3, 1997.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
On-site Services
eric: Copy of Permit
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE
1 OF
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW960333
DESIGN ENGINEER:~O~BE~-SPURi[LA~[D,---P--.~---
OWNER NAME:NIELSEN CINDY L
OWNER ADDRESS:BOX 565
GIRDWOOD, AK. 99587
DATE ISSUED:10/03/96
EXPIRATION DATE:10/03/97
PARCEL ID:07515205
LEGAL DESCRIPTION:
GIRDWOOD ORIGINAL TOWNSITE BLK
2 LT 5
LOT SIZE: 6000 (SQ. FT.)
NUMBER OF BEDROOMS: 1 THIS PERMIT: 1
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENSURE A 100 FT. HORIZONTAL SEPARATION BETWEEN WELL
~D A~ ~OU~C~. O~ ~O~I~IO~.
~UB~T W~,~. LO~ ~ITHI~ ~0 D~ ~ ~.~,~, O0~P~.~.~O~.
DATE: /0/~ /~
,~VIRONMENTAL .SERVICES DIVISIOk
NOV 1 9 1997
RECEIVED
LOCATION OF WELL (Please complete either lo, lb or lc.)
~orougb s ubdi,ieio. L o,~ ~l
Ic.JIDISTANC/ AND DIRECTION FROM ROAD INTERSECTIONS
2. WELL LOG
Moterial Type
WATER WELL CONTRACTOR'S CERTIFICATION:
Top BOttom
WATER WELL RECORD
STATE OF ALASR~
DEPARTMENT OF NATURAL RESOURES
Division of Geological 8~ Geophysical Surveys
Ori,ling Permit NO.
A.D.L. No.
WELL DEPTH: (final 5 DATE OF COMPLETION
qO ,,. ~o - ~ - q~
6. ~Coblo tool ~lory ~ Drive~ [Z] DUg
7. USE: ~ome$lic [] Public Supply [] I,dustry
[] Irrigollon [] Recharge [] Commerical
[] Toot Well [] Olher:
8. CASING: [] Threaded
diem. ~ i.. ,o ft. Dop,b weigbt
dial. in. to ft. Depth Stickup fi.
FINISH OF WELL:
Set between ft. and
Back fillinq Grovel pock
fl.
STATIC WATER LEVEL: (~'~ ff.
JO.
[]Above or E] Below land surfaco ,-T~,~Ore
Equipment used:
Il. PUMPING LEVEL below land surface end YIELD
__ft, after __.hrs. pumping g.p.m.
-- ft. offer __hrs. pumping g.p.m.
I;LGROUTING Well Grouted: J~)s [] No
Material: [] Neat Cement [] Other:
15. PUMP: (if ovoilable) HP
Length of Drop Pipe ft. capacity
14. REMARKS:
- ~-~ .~, _' .~.i.ll~q 5a_~ '
-.~-., .~. ~d_~ _.~._., ~ ,~, qq~b
Form O~-WWR (11/81) Copy [)JSlriOuho¢: WHITE- Slele DGGS PlNK-Oriller, CANARY-CusIo~er
15. water Temperature __o [] F [] C