HomeMy WebLinkAboutVALETSKAYA TR AI
Development Services Department
Building Safety Division
® On -Site Water & Wastewater Program
4SI'l
4700 Elmore RoadP.O. Box 196650Mark Begich Anchorage, AK 99507
Mayor www.muni.orolonsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number: •(q(.6-5—
Legal Description
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Property,Owner Name & Address:
13A I l -EX 7k_ 4i /_ve COLAXT
4/235 MCCc.�_AnJ PLAc.r
Pump Installation Date: 3lid
Pump Intake Depth Below Top of Well Casing: Meet
Pump, Manufacturer's Name:
Pump Model:
Pump Size Z hp
Pitless Adapter Burial Depth: Nfeet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? es ❑ No
Method of Disinfection:
Comments:
ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: 330 EAST 76TH AVENUE
ANCHORAGE, AK 99518
AWPS.COM
PHONE: 907-243-0740 -
Attention:
The pump installer shall pr@VW0Apump installation log to the DSD within 30 days of pump installation.
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GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
i Date Received VIA
l " ! Time of Inspection / 3 r>
Date of Inspection - G
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
Phone:
,s
2. Property Owner:, S f `` , Phone:
Mailing Address: a S
3. Legal Description:
j J
4. Location:
5. Type of facility to be inspected No. of bedrooms
6. Well Data ti nt ..�L e� ✓-e�`_�'-_�`-_`
A. Type 1. B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:, f
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
r
Page.,2 of -two pages - Req,. --.t for Approval of Individual S ..:r & Water Facilities
Legal Description
Comments
Approved
Disapproved
Date���
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
i
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 and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental (duality
f 3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received <
Time of Inspection���� _--
i
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEINER & 'MATER FACILITIES
1. Approval Requested By:
Address:-� CJ �� Phone:
2. Prooerty Owner: Phone:
3. Legal Description:
4. Location:
5
Type of Facility to be Inspected:
Number of Bedrooms:_ -
6. Well Data:
A. Type j /• �� — B.
C. Construction _ D.
7. Sewage Disoosal System:
A. Installed
Depth_
9acterial Analysis
B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Size --y 2. Material
Disposal Field: Total Length of Lines
8. Distances:
A. Well To: Septic TankAbsorption Area— —9 Sewer Lines
9
Nearest Lot Line , Other Contamination
B. Foundation to Septic Tank , Absorption Area
C. Absorption Area to Nearest Lot Line
Sewer & water
Request for Ap�proval Of
9, Comments' J7
DlsapprOyed
Apnrove I- a
Date
1CL,for one Year FrohiNte Signed
Approval V31 n'yrenta I �Qua litY
Greater Anchor 1 age Area jf�oj-Oughp Depaxrtment of Enviro
DIAGRAM OF SYSTEM
-------------- —
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AW
GREATER ANtt46,
DEPT, Of tqVk 141VE ARE
0AMENITL
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:
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4ZSigned �6z Date – 1; T-2 -