HomeMy WebLinkAboutTAFEL LT 7A2 (2)TION I 2E SEC
19
Lot 7A
#075-132-61
W
' I�Olif M+1pM �
ET
i
a
G'
Ilk
'714 's'
h
t
W&A "5
4
UNDER No ]FtMb *A* A9 -81I I It USED FOR CION OR FDR RTAU1N0 WJNVARY OR FENCE UNES. j
INC .•'tr I vCM TAKESS INC I "M iRMSAGAON ONLY #A* AM= FNA"C L UPXM Tf ONLY FOR VE COSI OF IME SURYCY.
OWMCES PRLNAL OVER •SCAT. M REPRODUCTION MAY CAUSE MOSS IN MM
LP:
sauRN v $U YtY n? Sl'M80i„5 !
NMI pl AshB�1..T SET RESAR ' NP DRAq 1, " �:::" A5P►IALT
w s xs-aue.T o FOUND W" �►-.o--a wow sr:: CDHCRMp.m e
- LY ... ASn' .; l011N11.. ,w.4CrOb1llAfit op ASSUM QN �t--N--M METAL "Wee WOOD
N it
ti�'•1HF ESP . .T'' ��-MLY-THOM IMPPOq\1lI�� E TS ABOVE CRQVMD AND NU. 0
CONSIRUC ON, TO FY Pi��O �I T FR -VOEt1�C DL N43UYW MUMAMSo-MVEWAYS.
TO FINSHED AND AND Ta pETTdRtd}TE CTD...ARE SHCOM IN 1HOM APPROXIMATE LOCATOR, ON6Y. SNOW
SNOT APPEAR TH$ REQCRQED i .lBD1%M*N PLA;t . .aAt.L QISTANM'S ARE ACCO D URN't BEWa ruesEEN 1w LOCAL
WI i
su!m C ,� repave by
.�, 0'�`�+►y Robert E. Johns Jr. & Assoc.
;.°• ►N'"e'�'' � �„� —0 �P."•" Professional Land Surveyor's
M» r i �r N +wa w wires '"`' ' 544 E 12 AVE
. raw,wsw a 1:24::r
w r.r r ANCNCRAM MAM SUM
•r.•••. w..M •.na �• •th .. X111 40 t Roo, tat &F: RW. Plot no No.
F4tlNDA110N Ai-lIItE.T '•�
•wtf 40ft %A i Sr'a bees.• hv. tliadtee! b1R
9mx%JtE A6-Y4gLT
� N Mt Yl !�i p/1/1 M i� N•
r •d trwrYr w +Mies Mrw
own d/ IIMM
41Ar, f1 sy� JM 29,2004 24226
..s•`•
IGfq# ..•« US SURVEY 10.3042 LOT 7 A
��' GIMMO0 :ALL TRACT GROUP
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196550 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0751326100001 HAA#_ N ():jq 9-
1. GENERAL INFORMATION
Expiration Date: JA — 7 — Q L�
Complete legal description USS 3042• LOT 7A, TION P_ZE c6C Iq
Location (site address or directions)-HOTTENTOT MINE ROAD * GIRDWOOD AK. 99587
Current Property owner(s) DAVID QUINN
Day phone (907) 783-2845
Mailing address P.O. BOX 61 * GIRDWOOD AK. 99587
Lending agency
Day phone X
Mailing address
Real Estate Agent GEORGE MCCOY w/ PRUDENTIAL JACK WHITE Day phone 783-2937
Mailing address 3201 "C" STREET SUITE 200 * ANCHORAGE, AK. 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
2
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date bf issue for properties served by a private or Class C well and may
be reissued with new watersamples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
TYPE OF WASTEWATER DISPOSAL:
aIndividual
On-site
❑
Individual Holding tank
[]
O
Community On-siteEj
Public Sewer
Ej
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date bf issue for properties served by a private or Class C well and may
be reissued with new watersamples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certift my
ied by my seal affixed hereto and as of the validation date showroval Guidelines fon below, I verify r this application,
investigation, based on procedures outlined in the Health Authority App
shows that the on-site water supply and/or wastewater disposal system ise ry safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation andinsMunicipal inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will if confer any legal right whatsoever.
5. DSD SIGNATURE
_t,/' Approved for bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
By:
(Rev. 12101)
Phone 337-6179
Date z L&o
bedrooms, with the fllowing stipulations:
Manitenance Agreements
Supplemental Engineer's Reort
Other
o:
w���M:
-rnnlnT�C ,`C�
PROGRAM
NT
�f ��//IIIn•1-�1A��V�
Original Certificate Date: 1 —
la -e1
rtment
x
o • _d. a .T
ww. . - . M';:Asar Manhole/Ac
OAS A `Size in gallons______.---
m IT� l— F µ
High water alarm level at
„ Pump off' —
drat �---,„Wells
n.
Meets alarm & circuit requirements?
Cycles tested---
VCES FROM WELL b1N LOTTO
U V
Water main
Surface water
--Driveway, parkinglvehicle storage
31 records that the above systems are in
MOA HAA guidelines in effect on this date.
......,.....
=Warve�"Fee $� .. „
4'•.W� MmN+'X uvN':X'MN M.YW 'Hw SX M. %'HSGMT' '^n
2/U"/ Defe of Payment
Receipt Numbet
on adjacent lots
drat �---,„Wells
o Or
A
.m � a
�4
31 records that the above systems are in
MOA HAA guidelines in effect on this date.
......,.....
=Warve�"Fee $� .. „
4'•.W� MmN+'X uvN':X'MN M.YW 'Hw SX M. %'HSGMT' '^n
2/U"/ Defe of Payment
Receipt Numbet
SGS Ref.#
1044606001
Client Name
Gamess Engineering Group, Ltd.
Project Name/#
Client Sample ID
USS 3042 Lot 7A
USS 3042 Lot 7A
Matrix
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time
08/02/2004 18:11
Collected Date/Time
07/29/2004 10:35
Received Date/Time
07/29/2004 12:35
Technical Director
_ SttPhenje. Ede
Parameter Results V
PQL Units Method Container ID Allowable Prep Analysis
Limits Date Date Init
Waters Department
Nitrate -N 0.308
0.100 mg/L EPA300.0 B (<=I0) 07/29/04 JIB
Microbiology Laboratory
Total Coliform 0
001/100mL SM20922213 A (<=I)
07/29/04 DKC
?14
SGS/CT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM IW .
'SPRIVATE WATER SYSTEM
❑ Sera Results ❑ Saw Imdee'
4 1 •/1
T
ZIPCOJI
SAMPLE COLLECTION:
hr..ran ,-01'.� r W..IaY.'bMa..,p:
DaM: ®''i 2 9 6 St
rs.M. Day YW
Tune: A&A
.y�_I _A&AM
Locatlon: LLiS z._ L4T- iA
Transported
to Lab By. _Same as collector
R!�. Sand Resuka
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tel: 907.562-2343
Fax: 907-561-5301
Lab Ref No
104�61610,61'-I/4
X11111111
�eM
Routine ❑ Treated Water
❑ Repeat Sample ❑ Untreated Water
(refer to lab no.
❑ Special Purpose -
'O BE COMPLETED BY LABORATORY san.w,.
SampleReceiving,
e_ ivino,
Date: _� -1 r'/ —,c ❑Sample over 3o touts lid:Time: �� �.2n. Rasutts may be uae0ale b ❑ RUSH SAMPLE
Temp: „� ❑ /g Hoa walla
Delivery Method; L For Rei Phone #:
Received BY:_ L- J FBx
Comments:
.......................... ......... .....
-----_
BacteriolocicalWate
erAnalvslsRecortl
�
"•""
•••°•.....................................
MR"UG (PIA) RESULTS:
.
p
Analysis Beaanr "(1 y`^7 / -I i G=
Total CdNam:
=E]E
Analyst
.
E. co&
Analyboal Method.
Santo Ctent
MEMBRANE FILTER RESULTS:
0Dkea
Count
�On1°5I10a^L
PhonLM O Faxed []
Membrane Filter
Data/rme:
❑Verification:
MMO-MUG(P/A)
s
rrc.rs..LTB:
{BGe
-
may;
Satisfactory
EC
❑ .
Unsatisfactory
'.sported By; "`'%'j. ,
s;p,ann
DateMme: S 2-�,�:;,
y z,
TN*e•raatw.».w.ro co..a
oe . oarra..r,h
uua10:23AP9
TY ONLY
SCAUNC. R6PR000CDON MAY CF14 N W THE COST THE SURVEY.
Y TYPE SCALE.
�Garness En�ineerioo Group,
Ltd
,5
_ REBAR ..-._..nn7 pSpHAt7
'WOOD FENCE CONCRETE
DDA ASSUMED ELEV,
i£ BUILDER OWNER PRIOK TO
MerAL FENCE
NOTE: wboo DECK +
I
ONLY INOSE IMPROVEMENTS ABOVE OROUN
SEPTC b AND VISIBLE PILL Bf i
OMN' FENCES. LIN
ETO-,
COVENANTS OR R
E RECOItOED S 901 ESTRICTONS
y S Oy,pLAT.
ARE SNOVM 1 7NEI,, APPROOXIMATE L `CA7IOwS. L DRIVE'NAYS, i
ii;
MAY PREVaNT SOME�NPROVEIAENTS FROM
ONLY- SNOW
Aj},
BEINOASE
O157ANCE5 ARE RECORD UNLE fR AND LOCATED.
� �MERW SE NOTED.
OF 4
..............1. •�•�
a y
Robert E Pfe Orel b
Jr.
P .Johns, & Assoc.
0�
rofessiOnal Lad SUrveyOrs
:rB42
.Y yl T} ♦
1- 12 AVE t
- ANOIORAOE. ALAS(A &4501 n
52v1e:
R.rc, lot SF.
97
F
6?ems\
Od
UNDER NO CIRC
7NE SURVEYOR TAKES RI
tOT yly1—
RX MpATId( AS -&JILT
R AL S mmm A5•;glyi
nor&GN.--A am.T...
D
� STRUCTURE AS�BUAT
�w^� M .v w.t •I w.
ti N.aw4wWr rlmw Nb
4`�ti�\„/^cip'
i •- F
q•/
4
• fib.- [ ` �' ! It• i
iBILIfY FDRW . A� JLT BE USED' FOR CCNSTRUCTION OR OR
THE INITAIL DL 7RANSACC. ONLY AND ASSUMES F7NANOAL UABI GARY OR FENCE UNFS.
DISTANCES PREVAIL DYER AL UA
TY ONLY
SCAUNC. R6PR000CDON MAY CF14 N W THE COST THE SURVEY.
Y TYPE SCALE.
R.EY • • • lOPpO(Apjly
SYMBOLS
SEf'REBAR `O11"° �—�^--- L--�-,�
0 FOUND ORNNACE
,5
_ REBAR ..-._..nn7 pSpHAt7
'WOOD FENCE CONCRETE
DDA ASSUMED ELEV,
i£ BUILDER OWNER PRIOK TO
MerAL FENCE
NOTE: wboo DECK +
IN CRAD
COpNECTION3 ANp TO pEIFTiMINE
ITs,BGII 8A GRADE RELATNE
ITS
ONLY INOSE IMPROVEMENTS ABOVE OROUN
SEPTC b AND VISIBLE PILL Bf i
OMN' FENCES. LIN
ETO-,
COVENANTS OR R
E RECOItOED S 901 ESTRICTONS
y S Oy,pLAT.
ARE SNOVM 1 7NEI,, APPROOXIMATE L `CA7IOwS. L DRIVE'NAYS, i
ii;
MAY PREVaNT SOME�NPROVEIAENTS FROM
ONLY- SNOW
Aj},
BEINOASE
O157ANCE5 ARE RECORD UNLE fR AND LOCATED.
� �MERW SE NOTED.
OF 4
..............1. •�•�
a y
Robert E Pfe Orel b
Jr.
P .Johns, & Assoc.
0�
rofessiOnal Lad SUrveyOrs
:rB42
.Y yl T} ♦
1- 12 AVE t
- ANOIORAOE. ALAS(A &4501 n
52v1e:
R.rc, lot SF.
b7
LTS SUrY',Y YO - 3042, 'LOT 7--A —
GIM)""00f) Sbi,Ai.7 TrW-.T GROLP
I,. J v
LU
I— w I "'' v co
N n c Q
ob
N W
U. NN]
NR ' 1 �,,, O J •
N 1u, Q a W CV
(J)(Y- to
05 F -
(Z 133HS 33S)
r,
W
O LN3110H
• a2� , 3 N I W 1 ---� �o Q
,- W _
.. 9 O co
? ..
Q O
NN•OJ
w N
M
m
v- .. -.-:O I I rJ w N
1� O o d
J N N I
N y
LU
J 11 k.
�vr
L
LLOj
f= tp
00 00
M
ul
O � O F
crLIL Ir
1 s
^ua cu• CUU4 y:[QHj':9 udYfiASS EfiolflAeY108 ',iYuUp, Ltd, c
Jo.9524 P. 2
GAR -NESS ENGINEERING GROUP, Ltd
CONSULTANTS & GENaRAL CONTRACTORS
August 20, 2004
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Dox 196650,
Anchorage, AK 99519-6650
(907) 343-7904
Re: Well Pit for Private Well Located on USS 3042, Lot 7A in Girdwood
This letter is in reference to the well pit containing the well, controls, and pressure tank
the house on USS 3042, hot 7A in Girdwood. The well is in a five Foot deep pit. The pit is linserving
ed
with lumber and Styrofoam insulation. There is a 4" daylight drain located a few inches below
the top of the casing, The MOA recently directed that this pit should be abandoned and the well
raise to code. We wish to appeal this decision. Records indicate the house on this property was
built in 1945 and has an aging foundation. Work required to raise the well and abandon the pit
could compromise the nearby foundation. The property has value due to its location; in all
likelihood, the house will be tom down by the new owners and the well will be upgraded at that
time. There is currently no space within the current home to relocate the well controls and
Pressure tank. The owner, Dave Quinn, has submitted the following statement:
"1 am in the process
department that my welof selling my propetty in Girdwood and have been informed by your
I is not in compliance with your on-site adequacy certificate (OSAC). The
issue at hand is the well casing needs to be extended.
"I Would like to point out that the house was built in 1945 and the `°" pit welp, was installed
decades age. The existing pit well has a daylight drain and provides proper drainage. ,-he well
has a sanitary seal which has never been compromised. Thus, at present, the well has not
endangered the users with health issues.
"It should be noted that the if the casing is extended, it would endanger the integrity of the well
system, The well is located within 3 feet of the foundation. At present, the system is located in a
small house housing containing the controls and pressure tank. If the casing is extended then
some excavation would be necessary_ This could endanger the house because of the poor
condition of the foundation and the proximity of the well to the deteriorating foundation_
"In summary, the house will be torn down once the realty exchange is made and the present well
3701 Fast Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179. Fax: (907) 338-3246 s Website: www.gamesseAginftnng.com
nua.[u. ZUU4 9:25Ah9 Garness EnineerinK Group, Ltd.
No.9524 P. 3
will be brought to standards, Thus the coneems over the extension of the casing at this point
may not be neecssssaxy at this time until a new building is placed on the property_,
From an engineering standpoint, I concur with Mr. Quinn and would recommend that the
Municipality reconsider their request to have the owner raise this particular well at this time.
Please contact me at 337-6179 if you have any questions.
M.S.
Ph: 9
3701 337-617617901--ax:udor Road, Suite 101 • Anchorage Alaska 99507
(. 07 (907) 338-3246 r Website; garncsscngineering,cgrn
Sep. 7. 2004 9:02AM, Garness Engineering Group, Ltd.
USS 3042 Lot 7A — Dave Quinn, owner
Well raised to Muni Code
September 7, 2004
NO.0096 P, 2/2
August 3, 2004
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, AK 99519-6650
(907) 343-7904
VEEMN(i
& GENERAL CONTRI
Re: Supplement to iIAA Form for Private Well Located on USS 3042, Lot 7A in Girdwood
This letter is in reference to unusual conditions found during the HAA well flow test performed on July
29, 2004. The well was found to be installed in a five foot deep pit. The pit is lined with lumber and
Styrofoam insulation. There is a 4" daylight drain located a few inches below the top of the casing. (See
attached photos) This well complies with current MOA regulations regarding well pits.
When a line probe was introduced through the 1/4" plug in the old style sanitary seal, it encountered a
blockage at 52' of depth. There was no water on the probe when it was removed from the well casing
although the well produced 313 gallons in 58 minutes, for an average flow rate of 5.4 gpm. The owner
reports having no problems with shortages. The owner also said that he had work done on the well and
the pump is set at 68'.
Records indicate the house on this property was built in 1945. A search for the well log was
unproductive. Well logs were found for USS 3042; Lots 5 and 10, which are close to this property and
situated at a similar elevation fronting Alyeska Highway (see attached). The static well levels for the two
nearby properties are 50' and 6P respectively. We have reason
exists in this well. to believe that similar static water levels
Please contact John Goerner at 337-6179 if you have any questions.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
ww ^� M -W DRILLING, Inc
K..+. Box 4.1224 • 1310C International Air rt
(907) 274-4611 koad
•� ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Harold Dill
Use of Well Dom
Location (address of: Township, Range, Section, if )mown; or distance main road
- - Lot 5 U.S. 'Surua" v)do 12---
Size
.____.
Size of casing 6" Dee of Hi
Static water level 50 ' ft, (6*
Screen ( ); Perforated
Describe screen orPerforat�t.i�on,z
Well Pumping test at- LQ__galloiis
of drawdown from static level
Date of completion tor,
�( t
A
ueptn in feet from
ground surface <
O-TO--Z-
2
TO 22 TO 10
--I_0_TO__IA_
_1.4�T0___32_
- 34 _T0___d5 _,
TO •7t
TO
TO
TO
TO
71 feet Cased to 71 soot
",g
lxlow) land surface. Finish of well (check one) open end ( x )
r, ii?'..
( tf n
9 (minute) for--2---hours with 1 QW -0 f
�A
iCS
R
i I WELL LOG
size of material, color
TO //GU�rc2� e V i
--TO 1��'�^,95. Cea;.�l,d Cur:trvOor
P.oa. bl, & L`73 9J
TO ,
TO Gb
TO
a
b
4i -
HEM DRILLING
1.
3540 AKULA DRIVE
ARCHORAGE, AK 99510
(907) 345-0593 •I
LOCATION OF WELL tPlodtc complete either to, Ib or fc.)
subdivision Lot Blocka. Borough
c.DISTANCE
e 41 rt.
OIS TA NCE ANO DIRECTION FROM ROAD fNT ER SEC TIONS
trs Surv� �jpy� L i
� /u -NW
Street Add rata and Area of Wall Location
2. WELL LOG
WATER WELL RECORD
STATE OFALASRA
DEPARTMENT OF NATURAL RESOURES
Division of GoolOgfool 0 GoophysiCol Surveys
Drilling Permit No. S rj boot O
A.O.L. No.
section No. TownahipNo Range -E❑ Me,ldlan
dp WC)
J. OWNER OF WELL•
Addran06 AJC�aq 74f
Ii. PUMPING LEVEL belor land surfoao and YIELD
fl. of-r—hq. pumping�
ft. after Are. pumping
12 -GROUTING Well Glovled:
— Yoe
MalerlcU C] Hoot Cement 0 Ol Aar.
Is. PUMP, ill avaltabte) HP
Length of Drop PIP. 11, co Pacil
Y
--� 0 Subm. [3def O Crofrifltal Other
14.REMARKSt
IB, WATER WELL CONTRACTOR'S CERTIFICATION: O
15. Water Tampere", a p ❑
TAie ell at drilled oder m ' C
f Y Iv rlctlic Ilan nnU Inis repvrf is Nne ro lne Lest of my knowledge ge and belief;
' No iatwed Bvt'ne t Name ---
i UCenee Ndmber
golNlo _ ----
Aull+orl i� L
out.:
Fa.m 02-WWR Of/91)
_— Copy Disv:uution: WHITE•S,ulo 0GG5. P:NX •grill v, CANARY•Curlemar r
Feet
Surface
Be_
4• WELL DEPTH: Ifinal) S, DATE OF COMPLETION
4r It• AIT Ck,,W,
8oflom
V
/Ue.
OCoble fool KJRalery ❑Driven Doug
(]
❑Augat i0dafdd• 0811ed 0Other:
7.USE: �j Domeelic. Q Public 9Yppiy [] Induwy
A
QD
Q Irrigation O Recharge Commerical
Q Ta et well 0 Other:
O..
a
B. CASING: S _
// - Q.Thr�pd.d !ED Welded
_ ......
alom.�N In. to_ 11. Depth Weight
diam.� In. 1* --11. Depth Slicko0 11,
9. FINISH OF WELL:
1
Typa: DILn Dn 1 Olameler:
JSol
Slot/Math Site; Length:
between ft. and /1.
Beckfllitng � Gravel oek
—"`
to. STATIC WATER LEVEL: 6/ it. s
C]Above or Beier land tartan Date
L.
Edulpment uIll
Ii. PUMPING LEVEL belor land surfoao and YIELD
fl. of-r—hq. pumping�
ft. after Are. pumping
12 -GROUTING Well Glovled:
— Yoe
MalerlcU C] Hoot Cement 0 Ol Aar.
Is. PUMP, ill avaltabte) HP
Length of Drop PIP. 11, co Pacil
Y
--� 0 Subm. [3def O Crofrifltal Other
14.REMARKSt
IB, WATER WELL CONTRACTOR'S CERTIFICATION: O
15. Water Tampere", a p ❑
TAie ell at drilled oder m ' C
f Y Iv rlctlic Ilan nnU Inis repvrf is Nne ro lne Lest of my knowledge ge and belief;
' No iatwed Bvt'ne t Name ---
i UCenee Ndmber
golNlo _ ----
Aull+orl i� L
out.:
Fa.m 02-WWR Of/91)
_— Copy Disv:uution: WHITE•S,ulo 0GG5. P:NX •grill v, CANARY•Curlemar r
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program `
4700 South Bragaw St. S R E i q
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Oe vae cs
Legal description: US Survey 3042. lot 7A TI ON R2E Sec 19
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on _
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted. _
❑ Topographic information missing or inadequate. _
❑ Incomplete; missing _
❑ Incomplete; missing —
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted. _
❑ Well log required. —
❑ Omission in narrative. _
❑ Insufficient fill over tank or field._
® Other. Well pits are prohibited
Name of reviewer: Jeff Poet
Date: 8/17/2004
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK