HomeMy WebLinkAboutRUSS HARMON LT 125BRuss Harmon
Lot 125B
#O51 - 144- 56
by
SULLIVAN WATER WELLS
P,O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-2750
OWNER OF LAND: /~,,ISS ~/'~4~/1 ~
ADDRESS:
LEGAL DESCRIPTION: J~tJ~ ~ ~
DATE: ~/~/~0 ~
PERMIT NUMBER:~(O ~ ~ Date of Issue ~ -~
T~IDENTIFICATION NUMBER: ~-
Is well I~aled at approv~ pe~it location? ~ Yes ~ No
;.J cable tool
Wall Thickness *
inches, depth
Method of Drilling: ~ rotary
'Depth of well: ,,~o O
Casing Type Y, 7'E
Diameter
Liner Type: ,~.) 3 ~-~
Casing Stickup Above Ground:
Static Water Level:
BORE HOLE DATA
DEPTH
/5-
Recover Rate: q ~
Method of Testing: /~1/'2.
Well Intake Opening Type: CI open end e-.~pen hole
~ Screened; Start feet Stopped
',P oratiens Start StoppeU
Grout Type: O~''~Ta '~ C'C£ Volume
Depth: from ~ feet, to c,~ 0
Well Disinfeeted Upon Completion? ~ees ~1 No
Method of Disinfection: ~ ~z -', ~t~.-./~
inches
feet
feet /3' 7 .,~ ~, o
feet ~ ,~"/'I
feet
feet
feet
Comments:
Driller's Name
A'I-rENTION: It is tt~ responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Con--alien.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(007) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Jul 23, 2002
Expiration Date: Jul 23, 2003
Permit Number: SW020241
Legal Description: RUSS HARMON LT 125B
Design Engineer: 0000 None Required
Owner Name: Russ Harmon
Owner Address: PO Box 670854
Chugiak, AK 99567-
Parcel ID: 051-144-56
Site Address: 021734 KAREN AVE
Lot Size: 32078 SQ. FT.
Total Bedrooms: 0 Permit Bedrooms: 0
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastawater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day,
B. Covered, sealed, and heated to prevent freezing.
Date: '7--'~. ~ ~ (.~'~--..
Date:
Municipality of Anchorage
Development Services Department
Budding Safely Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(9O7) 343-79O4
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLI'NG
Parcel I.D. _ O5'1 - /~ '-~'(~
Property owner(s)
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.) ~,-~1'-
Legal description (Section, Township & Range)
Lot Size ~-,.O¢:)'7~ Acras~.
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Permit Number_SWOZ(~, 4 1
Day phone
Number of Bedrooms
[] Well Only
[] Water Storage
[] Jacuzzi []
[] Water Softening Unit []
I cedify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date o! Payment:
Receipt Number: