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Home My WebLink AboutT15N R1W SEC 18 LT 104 W2 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address T15N R1W Sec 18 Lot 104 W2 Greg Stevenson 19412 Adrian Drive Chugiak, AK 99567 Pump Installation Date: 4-14-20 Pump Intake Depth Below Top of Well Casing: 58 feet Pump manufacturer’s Name: F&W Pump Model: 4F07P05301S Pump Size: 1/2 hp Pitless Adapter Burial Depth: 4 feet Pitless Adapter Installer: Unknown Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Unknown TOTAL DEPTH OF WELL: 62’ STATIC: 33’ Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILINGADDREss o? LEGAL DESCRSCRJPTION ~ Manufaaturar Inside length Width DISTANCE TO: HOMEMADE: Well Manufacturer Materla] DISTANCE TO: /*~ No. of lines Top of tile to finish grade Length Width [~NEW ~GRADE No. of compartments~_ -iquid depth PERMIT NO. Liquid capacity in gallons eath tile inches inches PERMIT NO. ~ Distance between linesN/~ Total e f fec~ ?~,a~ea PERMIT NO. Type of crib Crib diameter Well DISTANCE TO: DISTANCE TO: ib depth Total effective absorption area foundation Nearest lot line Driller Sewer Jine Distance to lot llne Septic tank OTHER PIPE MATERIALS SOIL TEST 7 R~,TING INSTALLER ~ t~ REMARKS DATE ~ev. 3/78) MUNICIPALITY OF ANCHORAGE Department i Health and Environments ~rotection 825 ~ Street, Anchorage, AK. ~9501 264-4720 . ~ * * * HANDWRITTEN PERMIT * * * ermit~ ~ ,. i ~~OR ON-SITE SEWER PERMIT~ ~)~/~3 / / Applicant: ~ ~.-3 ~// ~'~ C Mailing AddresS5 ..... Ldt ~ ~ ,,, T~e of Soil ~sorption System Is: Trench: ~' Drainfield: Seepage Bed: Holding Tank:~ The Required Size of the Soil ~sorption System Is: DEPTH ~ ' LENGTH ~' ~ GRAVEL DEPTH ~ / WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minim~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~ ~ REQUIRED SEPTIC(HO~DINS) TANK SIZE = GA~LONS Pe~it applicant has the responsibility to inform ~his depar%ment during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ~ ~ ~ TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department: will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co,unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. ~ "~ PERMIT EXPIRES DECEMBER I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Mun~ipality of ~chorage. (2) I will~tall the~stem ~n accordance with codes. (3) I un~rs~d th~/~he~n-slte sewer system may require enlargement if th~res~e~e~eled to include more that 3 bedrooms. SWP/024 (1/81) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 -- ~]~ ~,'1"'-C'~ ¢--~ 13 14- 15- 16- 17- 18- 19- 20 - ~t~OF:~'~& ~ ~ COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? (]ross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /~ (~utes/inch, TEST RUN BETWEEN ~ ft AND 5 ~ FT LIFT EXCAVATION ROBERT A. SHAFER WORK STATION CIVIL ENGINEER 694-29"/9 -- METAL CAP GROUND VARIABLE CHAIN. OR NYLON 2" T04" COUPL TO' ~___ BED SILICONE CAULKING 4 BOX I "CONDUIT LAMP ~ PUMP -POWER CORD VARIABLE 8 DRAIN HOLE-- 2~ PVC PIPE' SUMP PUMP 6 METAL PLATE-- ~:' HEAT LAMP.FOR WINTER USE, SRB 196X EAGLE RIVER, ALASKA CORD ~ILLCONE CAULKING ~I PVC PIPE FROM' SEPTIC TANK FILLET WELD ALL AROUND MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o.~ ~ Parcel I.D. # ~_¢~-~- i'-"),'~L- -L~::~_ HAA# GENERAL INFORMATION Complete legal description LoT' 104-j Location (site address or directions) Property owner Mailing address Lending agency Mailing address /"/ Agent /'4 Address ,A,/ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '"/"~J 0 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1191) Front MOA #21 o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~K-'4 Address '~4 '7 ! Engineer's signature DHHS SIGNATURE X Approved fo r -~r/urJ bedrooms. Disapproved. bedrooms, with the following stipulations: Conditional approval for By: Additional Comments //.,Oz.L~ ~ M ~ '~ ,~.~,.,~._ ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federat and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rew1/91) Back MOA#21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: P~.~,~ ) ~-..c-Ttc~,,J I~ Parcel I.D. O ~ / - A. WELL DATA Well type ~I2.t,V~c-~E= Log present (Y/N) If A, B, or C, attach ADEC letter. Total depth Sanitary seal (Y/N) ADEC water system number Date comp/le.ted U,,~ V-A3o~?J Driller ~asedto TM [/Hi~"J0~/',~ '~ ~Casing height_ ~'"/" / / ~./ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG Ur~ ~-.~ ova M g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot t ~-c3 ; On adjacent lots Public sewer mai~ ~/~ ~ ~ublic~er manhole/cleanout ~ ~./~ ... / ~- WATER SAMPLE RESULTS: Coliform ~ Nitrate B. SEPTIC/HOLDING TANK DATA Date installed ~:~/, 6/D2 Tank size Cleanouts (Y/N) ",/cA ~ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping Com. £artments -'/- W O Depression (Y/N) /~ O Alarm tested (Y/N) Pumper 610--,% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IO ~' (~ On adjacent lots :> To property line /°~'/ Absorption field Surface water/drainage k3o~,/~.. C){~.~JP-~/I~-.,~ -- 72 026 (Rev 7/91) Front CONTINUED ON BACK PAGE Length ¢ ~ I Width Total absorption area _ Size in gallons'"'~ Manhole/Access (Y/N) Vent (Y/N) ~on" level at at High water alarm level "---..% ~..---~ Cycles tested __ sM::~RMAOT'IA~T STAT I O''''''~ ~ On adj~acent lots ~ter D. ABSORPTION FIELD DATA I ii ~.~Coil rating ~ -"6 Gravel thickness Cystem type / /2_.~__.d~ Total depth <~"'/'~' FI'z (~ Cleanouts present (Y/N) '"~-'~ Date of adequacy test for -T'x/q O If yes, give date Depression over field (Y/N) Results (pass/fail) ~/3¢ % <~ Peroxide treatment (past 12 months) (Y/N) 3 SEPARATION DISTA~N(~ FROM ABSORPTION FIELD TO: S~_.~ eov~ Well on lot ~ ~.0 On adjacent lots · { 0~/ c'T'~ Property line To building foundation ~ ~ ~ ~ To existing or abandoned system on lot On adjacent lots >>/0 Cutbank ~[~ Water main/service line Surface water ~5~o~ o~ ~u~a Driveway, parking/vehicle storage area Curtain drain t. ENGINEER'S CERTIFICATION 3 · P ~ P~; ~ ~I~D~ I certify that I have checked, ~rffied, or conformed to all MOA and HAA guidelines in effec/on ate of this inspection. Signatur ~S&Engineers Na~ /~v A' bedrooms HAA Fee $ /7 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/01) Back MOA 21 Alaska Water & Wastewater Services "Preserving the Last Frontier" /~OMpANY: ,~UBJECI': AMESSAG~: FAX #5~8-~246 NUMBER OF PAGES: (Including Cover) ad.r/ 8471 BroOkridge Drive ,, Anchorage, Alaska 99504 · Telephone: (907) 337-6179 Alaska Water & Wastewater Services "Preserving the Last Frontier" Aoril 10, i99g Nunioibality of Anchorage Depar~men~ of Health acc Human Services Division of Environmental Services On-Site Services Section m.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Health Authority Approval for Lot 104, West One-Half, T15N, RiW, Section 18 To whom it may concern: Commenss regarding ~he subjeos HAA 8re as follows; 1. Well Adequacy: The well was tested for adequacy by bumping 6.92 gpm for a total of 65 minutes (450 gallons)_ There was a drawdown aT 2 feeu at the end of this oeriod. Yhe well recovered oomblete]y in less than 50 minutes. indicating tmat the well is more than adeduase for a 2 bedroom house ($00 gpd). 2. Septic System Adequacy: The sebtio system adequacy was performed concurrently with the well test. Water was introduced into sump as a rate of 6.92 gpm for a total 65 minuses (450 gallons)_ The liquid leve] in the trench the beginning of the test was 5'-8'_ After introducing the water the liqdid level rose 8 inches, for a total depth of Fifteen hours later I measured the liauid depth in she ~rencn and found it ~o Be 2'-11", indicating that the total 450 gallons had been adsorbed Based upon this dasa the septic system was deemed so be adequase for a 2 bedroom nouse (gOO gpd). 177e ¢'~'et~oh has a grave2 dem~'h oF 5 ¢'he u;v;~er' 2 '?e8~' o? Sh£s de~t'h, oonsequet?g'jy, £ ~ is Telephone - Fax 338-$246 · 8471 Brookridge Drive · Anchorage, Alaska 99504 sept'~c sys~'em (o~garet't'e t~ut't's, sat~ tary napkins, mist' objects,), and t'he amount' of Wat'er being c'ont'i~ual bas~s, Cons~quer~tly, t'he result's of t'h~s adequac,y t'est are only vaifd for the specff~c day of 3. Separation Distances to Adjacent Wells and Septic Systems: Because of the large lot sizes, I only verified the separation distances ~o be greater than 100 feed. 4. Well Log Does Not Exist. Can't Verify Depth of Well Casing: According to the homeowners, the well was installed several years before they bought the property in 1970, consequently, they did not have a copy o¢ the well log_ There is qo well log on 'File at DHHS_ In order to verify the depth to which the well is cased, I attempted to draw the well down below 40 feet so that I could make a visual examination; however, I was unable to draw the deotll belch 57 feet (from the coo of the well casing)_ By looking down the well with a flash light I ~as able to see well casing as fa- as the light would travel (I couldn't see ~o the water ],eve]). In addition, I could hear' ~o water trickling into the well under drawdown conditions. This technique would identify "surface" water migrating through the well casing Perforations (if they were present) above the static water level. Based upon this limited investigation, it appears that the well is cased to at least 57 feet; however', placing a camera down the well would ce the only way so orovide oositive verification of the casing deoth. 5. Well is Located in Crawl Space: The original 5 oearoom rouse ourned down in 1989, and a new 2 becroo~ ~as 3uilc to replace it. The qew house was built directly over the weii (see attached as-built survey)_ Conseouentiy, if the Well needs to ~e deepened in the future, it Will De necessary to out holes in the roof and floors to accomodate drilling equiomen~ ('there is only about 4 feet of clearance). Furthermore, when the pump needs ~o ce replaced, it will present a chalIenge to the homeowner/repairman, The ~ires =o the well pump are not in a protective (metal or PVC) conduit, hOWever, the well is in a location where the wires can not ce damaged. The exposed sewer lines ~n the crawl space are only 6 feet (horizontal distance) from the well, out the buried sewer lines are about 15 feet from the well_ A creak in the exposed sewer lines could Cohtaminate the ground around the well, and eventually the wa~er, if t~e creak wens undetected for any length of time, I will om out of town until Aoril 26th, so if you questions please leave a message at 5~7-6119 and I Dack to you ASAP. have any wii] get JAG/jag Breesel.WPS APPL~ NT FILLS OUT UPPER HA ONLY /-I Property Owne (~ t{ 1~ f'~ ~..~,SL ~ ~ (~- ~ ~ ~ Phone Buyer Address Zip Code Address Zip Code Realty Co. & Agent Phone Address Zip Code Typo of Residence [] Multiple Family C] Other NO. of Bedrooms Water pply [] Community [] Public Utility Sewer Disposal L~ Public Utility [] Holding Tank ATTACH WELL LOG. A well log is required for all wells drilled since June 1~75. For wells drilled prior to that date, give well depth (attach log If available). Year indlvlduallnstal~ed: /ff~,~' ~,., /d~..,(~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQLIEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time T,mel, _ Inspector Insp~tor Insp~tor Insp~tor Field Notes: j " ( ) DISAPPROVED ~ ~ ~ - ~ Soils Rating Cate ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 {3/~)