Loading...
HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 8 LT 16 MUNICIPALITY OF ANCHORAGE DE rMENT OF HEALTH AND HUMAN SEW ~ Environmental HeaLth Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ONoSITE SEWAGE DISPOSAL SYSTE:M AND/OR WELL INSPECTION REPORT TANKS FROM WELL LOT LINE FOUNDATION DISTANCES SEPTIC ABSORPTION TANK FIELD Io 9_ I I,~, WELL 'AS-BUILT DIAGRAM ~Show Iocahon of well sephc system property hnes, Ioundat~on, driveway, water bodl0s, otc j I~ SEPTIC [] HOLDING TYPE OF SYSTEM TRENCH ~ BED ~ W, DRAIN ~ OTHER ~ '~,'/FT ~ FT absorption area [ D~stanyo between hnes ! ?O SO F'rl_ , WELLS PRIVATE OTHER (Identify) FT REMARKS: Health Depadment Approval: ' ~'~ ~' ' ' ' ~- ~ ,~ ' MUNICIPALITY OF ANCHORAGE ~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'FECTION  ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264.-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~EGAL DESCRIPTION NO. OF BEDROOMS ~ 11 Well ) Absorption area "~weUing ~/~ PERMIT N~ ~ S--/ ~p~ Manufacturer ~~1~o M~ N°'°fc°mpartments ~__ ~ H Liq. , ~2 n~ InsiJe length ~ Width Liquid depth /~0 IF HOMEMADE: Well Dwelling PERMI-F NO. ~ _ ~ Manufacturer Materia~ Liquid capacity in gallons ~ Well Foundatio'~ Nearest lot Hn~ PERMIT NO. ~-- Z ~ ~ I Ne. of lines ~ Lengttl of each~line/ Total length~f~nes Trench width~ ~ inct~es Distance between line ~-- -- ~'otal effective absorption area_./ / " ~ ~ ~ Top of tile to finish grade~ ~ I Material beneath tile~ / i~ . ~--O~--' ' ~ Length Width Depth PERMIT NO. ¢ Total effective absorption area ~ ~ Type of crib Crib diameter Crib depth ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: Class ~epth Driller Distance to ~ot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: , OTHER PIPE MATERIALS ~/~-. SOILTESTRATING /~ 3~ REMARKS ~ - FEFdlI 1 1',10. ,' ::3~3E~5"19 ':, - FF'LZ ~,HNI L. 0 C I"::'1 ]" I 0 N LEGRI,_ DEF'RI:,?THENT" HEFIL.TH FIND ENVIF.'3f',IME'1',ITF ':~'::'::i '":STREET., FINCHOF.:FIGE., FIk:. 2,.'-~ 4-472Ei .=,, E:T. It-,. I E.' IF~4: IF::" J'OHI',I HENSLE'¢ F:: I [:,13E",,' I EN r:,R I VE: F'E E~.~X ::LO-.2::L57 995':1d,. E;:.~ EMI E.=. I, :'L6 B '=' ' ......¢' %,.'"D ,-, MT. PFIRI..'. I...O'f' :E; I ZE "t'YPE CF '_:O'[L FIEr~;')RF'TI3N S;'¢'.~;TEH ]:15' F-F..EN~.H -, ? '::;F~]:.I RFI'I"ING ,":1o F"f',.'"E:R::,= :[.65 HF4%:I:I"'IUH I't.II1E, ER LqF' E~EDROOH:E; = .:,I,.;.E OF THE: E;OIL PE,=,LF.'.f'I ION ::,~:,f'E. II THE REE.:!IJIRED ' ...... ' .... "- q ' "'"" II ..... "" ""~" *, "~ .... t..Z.:, F" IL.-" E:.IF" ~ 1~ 1t ............. THE: L. E1'.,IGTH [:,IHENE;ION I.'E;, THE LE1',IGI'H ,::IN FEET::, OF THE TRENCH OR [.',RRiNFIEL.[:,. THE [:,EPTH LqF R TRENCH OR PI]' IE, THE [:,IE;TFt1'qCE BETI.,.IEEN THE SURFRCE OF THE GROUND RND THE BOTTOH OF THE" ENE:RvR'rlON (I1'.,I FEET::,. ...... FREI,t ...HE_. THERE IE..: 1'.40 E;IE]" HIDTH Fr'~F,.' ' .... '=' .~.n ~.~ E:E'f'FIEE1"4 THE OUTFFtL. L F'IPE THE GRFI',,,'EL. [)EF'TH I2~ I'HE HtNIHUM [:,EF'TH OF F''~''' ..... f:lNI) TFIE BOTTOf'I OF THE EXCFIVRTIOI",I ':: IN FEET>. tF;~?. E:: "]~::-" ILII :E FE-" EE: E:. :~:27 E F" '"IF' ~ C: 'T' F~ lf..,,~ Ifc.' ¢-_=...; % ~ E: == Dr.. ~-'E~ ~Z~ HZ.-Z~ ~'~ F:::~ IL._ L.. ~:.:~ ~'..,,ll E:E;; F'ERH I"t" RPPL I C:lahlT HR:E; THE REE;PONS l B I L I T'¢ 1'O .T. NFORM TH I'.5 [:,EPflRI"MENT [:,UR :I:I",IG ]"HE INSTFIL. LFITII.3N INE;PECTIONS OF FIN"? kIEL. L2; R[.',J'F~CENT TI3 THIS F'ROPERT'-r' FIND THE NUMBER OF F..:EE;I['.,ENCE'..E; THFFF THE NELL 14IL. L SERVE. ............. '1- lt...JI (:n ( ;t. ::, 3[ If'-4~ :5 F' E:Z C: 1- :E ,LZ~ If'4.72; fl F: E: fi". ~.'Z ul.:..~ It_Il % Fi;." EE:.: IE:: ............... E~RCKF]:I.J...ING OF FIN'¢ S¥$'f'EH 14ITHOLIT F'INFtL IN'.SPECTIOI'.4 RN[:, FIPF'RO',,,'FtL. E,"¢ TH]:$ [:,EPRRTMENT MILL BE E,.UBJ'ECT '1"0 PROSECUTION. MI1',IIHUH [:,Z2;TRNCE BETFIEEN I::~ P-!ELL F¢.4[:, FINh.' ON-SITE E;EI,.IFtGE [:,ISPOL-7, FIL S¥'.F.';TEH :1J3E~ F'EE:T FOR Ft PF..'I',/FITE NELL OR Z5¢:'~ TO 2E~r3 FEET FF'.OH FI F'UBL. ZC 14ELL B, EF'EN[:,ING UF'ON THE ]"'¢F'E OF PUBLIC: 14ELL. M:rNIHUH E:,:[::,l--NL.E FF'.H FI F I.IVFITE 14ELL TLq FI F'F.:I',,,'FITE :,EhlEF. LINE :f.S ':"~ FEET _ ' ', I '"' ':;:' ',' :172; '~': Ft L..Hf't. NI [~ _EHER LI:NE 771 FEET. ~ .... .. ,,:. OTHER REQLIZF:EME1",ITt5 HFI'¢ Fff:'F'L'¢. 'SF'EE:[FZCRTIONS RI"4E:, L-:ONE;TI~.:. ::T]"3N E. IHbF. NH_ FfF. tE R',,,'FIILflBLE TO ]'NE;URE PROPER INSTFIL. LFITTOI'4. I ..EF:.T I F 'r THFIT ,. -,:." fL' I FIH FAf,IILIFIR I.,.IITH THE F::EE.!UIREHENTS FOR Cl~ .... ['TE E;EI.4ERS laN[:, I.,.IEI_L$ [aS; LE;ET F'F~RTH E:"r' I-HE Hr J1'.41 C I PRL. I 1"'¢ elf FI1'.,ICHE F'RGE. · ,--, ,c- :', FICCORDFtt',ICE 141 TH THE COB, ES. ;2: I I.,.IILL ]:1'.4E;TFILL THE =,-r_,TE..H I1'.4 ENLFIF. aEI' EN I IF "rilE :3' I UN[::,ER'.E;TFIN[:, THFIT THE ON-...E;ITIE :E;,ENEF.: =,.r..:,FEfl f'IR'¢ F.'E;~ IRE , .... '1": .... RE:iE;IDENC:E I::~ RFMOE:,ELE[:' TA INCLU[:'E HORE THRN 2-": BEDR FIF'F'L :1: F:FtNT ..'rFfl4N HENSL. E'¢ B r' [' FITE C~ _ I q - C~-3 V4. Et I S E;I·.IE[:, - .................................................................................... [',EF'F~R"I-I'1ENT ~ .... HE~~L'i'}'l Fff'~[" EN',/IF:I:INt'I[:.NTFtL r>n'F_lTE(::'i [CIN E','sJ5 '::TF'EE'I, RHCHEff;iF~(:iE., ~-;:i. '-'" I- I E l_ b FI ~-.! f::' ¢_-~ k-,l --- ::_-~ :]ET' Iq '--5 [~ 1 · IFC [~: F' ~FZ F-: I"1 I: T ,: ::' % q' © :'F'L~,::nUT ~ t) ~; m r'F'E OF ?3IL FIE',$OF:F'TICIN ?T"2~FEF'I I:5 TF~ ~ Fm ~:..::~f'l~.lf'l HUHE:EF OF' E:EE:,F:Eu'3P15 = ~ 5OI L F:t~ f [ FIG '"EEO FT."E:R::' = ~ ~ ~ 4E F:EOIJtF'EE:' t:E.[ZE OF THE SOft .FiE:SOF'F'TION '"""-' '-' ['~ / THE LENGTH [:,IHEN%IOH !% lff.lE t_EHGTH (IH FEET) OF' THE Ti;TENIi:H rjr DF'IqIHF'~EL_[' 3F'Ol~f B, FIN[::, THE E:OTTOH Cfi: l'!4E E> .-IvHT~Cff.i (:~N FEET", -. -,,- ~: [kH._ff'l DEPTH FiF GRFIk,'EL E',ETNEEH Tile nLIrFt3L! ]HE _~RH,,EL DEe"IH THE NiH - - f:ffff) THE E;O'f-['Ot'~ Eft: THE E:.:C~3',~F~T[Oti ,' IH FEET',. 'F'i'I[]' Fff:'F'L~FFNT Fff~S THE ¢:ESF'OIt'¢[B~L[T'¢ TO [/-iFCff;:i'l TH]:5 C:,[ZF'R~'-F'IEII~ [:,IJ~'[NG F~IE 4E:I-FtLt R'I'ION [)i'_~?E(::Tit')fi~; OF tkN'.~' NELt.~: F~D~aC:EHT TO TH[~: F'F'C~F'EF:'I'r' F!flC' 'rile II'I[~:EF' OF F'E'S][)ENCE~: THR'f [HE HELL HILL bE.I, ,,E. ¢3FF'IL.L. IHG OF ""~" c'"-'~C"l N[THCII..I'F Fit. IFiL_ [H'2F'ECTIIqH Rfi[" Fff:'F'F:O'v'RL E:'T' iH[Et :F'RF'Tr, IEf~T H[[.L E:E '~II[?,..fECT TCI .-,,,-rcN [ N[PII_IP1 [,I%Ti~HCE E:ETHEEH ~q HELL qNE', F~NV OH-'SITE %EZ[,IFI~(:. f.:,[%F'OE:~RL :.~:,,~' '0~ THE T'r'[:'[; OF F'LIE:t_[(" I,IE! N[f,lur,1 D[~.TFIH[TE f:F:FiH F~ F'[;:[',,,'I~TE I.IEt.L -['0 Ft F'[;:I',.,'I~TE '3IF;NEFf !. [fie ['21 .~'q FEET' L[ tFu3'B F~F'E F'EC!~,Ii4:E¢:, Rf'4[:' f'l:l'ST E:E [;'ETUF'NEE:' ~t-~ 7'!~E C'Ef:':~ r'iEflT HI'FHIIi :?F~ F FF:T [F'r' I F~P1 F~!'I[[_IF!F! NITH 1'HE F%(~!UJR%HEHT::: FORt O~I-EiITE ~"[H E','T' THE I'll IN i C I F'FiI_ J Th' OF '-" "-"c'H I N FICCO~iE"Fff'~C:E I l,I]t..l_ [N~.TFtl_L THE :,Tz, [, - '-'""'r~r~ I'IR'¢ F'~:3 IIF'[- ENLIqF:C~[~HEHT If: ft.lE f UfI[,EF"~.I'k~H[" THF~r fttE OH-SITE :5E[,If~[;' :,~:,~' -- :FtDENC. E [¢, F'EPIOE:,ELED TO [NCL.UE,E ,I:rPE THRf~ :¢ E'EDF:oor'!~; E'RFORMED FOR: ,EGAL DFSCRIPTION: ( ONTRAI TINO EN ]NEERS & ASSOII' 212 E. INTE~-~TIONAL AIRPORT ROAD ANCF~FGE, AL~SKAJ99502 ~ ~ __ DATE PERFORMED; SOILS LOG PERCOLATION TEST SLOPE SITE PLAN Jokelo NO. 19f~5.E ENCOUNTERED7 ~'~(~ O P E iF YES, AT WHAT DEPTH? Gross Net Depth to . Net Reading Data Time Time Water ' Drop q-tq- ~c 'o 3.0 30 '1 PERCOLATION RATE / 0 (minutes/inch) TESTRUN EETWEEN ~ FTAND q,V=. FT BOX ]~]~9~ STAR ~OUTE A ANCIIORAGE, ALASKA SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT The RATE OF ;;~o00 Per FOOT. Ill:ko y. om~ ~t~,ge~j. ,344~719.'; PROPERTY OWNER L, OCAT[ON OF WELL SITE DRILLER W~LI. LOG: 0 .......... 22' $'~F 58 ......... 92' 3'~ .bo~.~ 745-.~'179~ Co,~.t o~ ~;J~l,tir~9: i/79,00 ,~ 180 ~.e~e.'t: o3420°00 Co,o;L o.fi N~Z SeoZ: ~,22o50 COST INCLUDES ALL LABOR AND MATERIAL ~OR COMPLETION OF SAID DRILLING. $3442o50 WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF DATE. THANK YOU VERY MUCl4. BERNIE CLAUS OF rAMPArt DrILl/lNg WORKS o~:~ 2(~&, 1980 "~-~' / `j , fiErVlCE CHARGEOF 1V~% PEr MONTH WILL BE ASFIES~eD ON PAST D~~~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section_township, rangeA Location (address or directions) ' ' " Applicant Name Telephone:Home Business Applicant Address Applicant is (check one): Lending Institution []; Owner/builder/~; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Telephone TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY IndividuaIWell~ Community[] Public[] / Note: If community well system, must have written confirmation from the State Department o! Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL , Onsite~' Public [] Community [] Holding Tank [] ' ' / Note: If community well system, must have written confirmation !rom the State Department of Environmental Conservation attesting to the legality and status. "~' ' 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDINg. ,NSPECTIONS, TESTS, FILE SEARCH, DA,.-, AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and a~dequate 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. ~ Engineer's Seal DHEP APPR~OVA~_. ~ ~ .,~.,/~ ~ Approved for "~~ bedrooms by~'~'~'V~ ~"'~'~--¢'''Lq.-~. Date ~;r~V~con d~al Approva~iSappr°ve~ C°nditi°nal ~ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICiPAI3TY OF AN~L~ AUTHORITY APPROVAL (HAA) DEPT, OF HEALTH ~ ENVIRONMENTAL PRO'[EC'r~NECKLIST - FEBRUARY 1984 264-4720 t~]~,~' 2 21986 Legal Desci;iption; Lo"ri&. "~J~, ~:~ R£CEIVED Well Classification Well Log Present (Y/N) Total Depth ./_,~/ Cased to Static Water Level ,/ Casing Height Above Ground ~/_~ Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ~' ] ~ ' To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed 10/&.f~/~' f..~. Yield .,'g/ Depth of Grouting ~ O~d.~ Pump Set At ,~ '/~'o~l,/, Sanitary Seal on Casing (Y/N) _ ~/ Depression Around Wellhead (Y/N) ~ ~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer ~, 0 ~ ~' To Nearest Sewer Service Line on ;Date SEPTIC/HOLDING TANK DATA ~ Date Installed Or.;/"' 1~:~ Size l~ No. of Compartments T'~ 0 Standpipes (Y/N) ~ t.~[~' Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well J ~ To Property Line · ~ To Water Main/Service Line ~ / C~ Course Foundation Cleanout (Y/N) Date Last Pumped'~' 'for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 'Fo Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,~ Square Feet of Absorption Area Depression over Field (Y/N) ~ Results of Last Adequacy Test 74 ..¢,..~ Separation Distance from Absorption Field: To Water-Supply Well ~ ./ ~' To Building Foundation _~.~ Type of System Design Length of Field ~.~ Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified.,4~r conformed to all MOA and HAA guidelines in effect on the date Signed ~.-~ Date ~"~ ~ /¢~ ofthisinspection. Company MOA No. Receipt No. ~.,-~dt,~ ~ ~ ~%~'~'*~"0~ ~'~- Amount: $ ~¢' ~ //*: 4~ >~ ~;;~, Engineer's Seal 72-026 (11 ~84) ~- ~'1~~ CONSUL FING ENGINEER -~03 W 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 7EL£PHONE:(907) 279 3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: LOT 16 BLOCK 8, MOUNTAIN PARK E ~ ' ~STArE 13047 RIDGEVIEW DRIVE --~ - · ..1~,, ..... ,. TIIOMAS CRAWFORD :" ON SITE WELL ":'- EROM MUNICIPAL RECORDS: 'i. '. ..,. TANK: GREER STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 310 SO. FT. SOIL RATING: 165 INSTALLATION DATE: OCTOBER 1980 OCTOBER 23, 1985. ANCNORAGE CESSPOOL PUMPING OCTOBER 22, 1985 SYSTEM WAS INSPECTED ON OCTOBER 22, 1985. TANK WAS FOUND TO BE BURRIED FIVE FEET BELOW GROUND. SUMP AT END OF TRENCH WAS PLUGGED WITH SOIL BELOW THE CONNECTION TO THE DRAIN PIPE, TOTAL DEPTH OF SUMP AND THE WATER DEPTH IN THE TRENCH COULD THEREFORE NOT BE DETERMINED. THE INSTA- LLATION PERMIT ISSUED 9-19-1980 SPECIFIED 50 FEET OF TREN H. INSTALi, ATION WAS INSPECTED BY MUNI INSPECTORS ON OCTOBER ~ NDT~,E 1980 A · TIlE RESULTING INSPECTION REPORT SHOWS THAT A 31 FOOT LONG TRENCN WAS INSTALLED, NOT 50 FEET AS SPECIFIED. THE MUNI APPROVED THE INSTALLATION AS SUFFICIENT FOR A THREE BEDROOH DWELLING. TEST RESULT: THIS SYSTEM DOES NOT MEET THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE FOR A THREE BEDROOM RESIDENCE. THE INSTALLATION IS ONLY SUFFICIENT FOR A TWO BEDROOM HOUSE. IN ORDER TO OBTAIN A THREE BEDROOM RATING, TNE TRENCH MUST BE EXTEN- DED BY 19 FEET. THE COST OF THIS WILL BE LESS THAN $ 3000.00· The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE. ALASKA 99501 TELEPHONE:(907) 279 39t6 RESIDENTIAL WELL INSPECTION LEGAL: LOT 16, BLOCK 8, MOUNTAIN PARK ESTATE LOCATION: 13047 RIGDEVIEW OWNER: THOMAS CRAWFORD TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABI, E: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: PUMP YIELD: [)ATE OF INSPECTION: 5 GALLONS PER MINUTE, ESTIMATED 6.5 GPM WITH 2 FEET OF DRAWDOWN OCTOBER 22, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED FOR 80 MINUTES. THE STATIC WATER LEVEL WAS FOUND TO BE 161 FEET BELOW TOP OF CASING. AFTER 80 MINUTES OF PUMPING THE WATER LEVEL WAS 163 FEET. THE WATER LEVEL RECOVERED TO ].61 FEET WITHIN THREE MINUTES AFTER PUMP SHUT OFF. THE WELL DEPTH IS 181 }PEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA OCTOBER 22, 1985. TEST WAS NEGATIVE. TEST RESULT: ON THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes Jn land use and other factors that may impact the conditions of the aquifer feeding the well. m ~ATE RECEIVED · INSPECTION APPOINTMENTS , ~'- ........... ", , ¥1ME TIME TIME ::)ATE DATE DATE I NSPECTOR~,x) · INSPECTOR I NSP ECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITy OF ANCHORAGE T C DEPT OF H~t~Llll & DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO E ~O , NMENTAL ;:'[~OTECTION  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE,~~I.~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing· PHONE 1. PROPE~X OWNER MAILING ADDRESS ~--~ ~ ~ ~ ' ~/~' PHONE PROPERTY RESIDENT (If d~e~t~~' ab°ve) 2, BUYER ~AILING ADDRESS MAILING ADDRESS "~. LEGAL DESCRIPTION S'FREET LOCATION ~/ T"PEO"RES'"ENCE ,,,UM,EROP,"EDROOMS [] One [] Four [] ~ SINGLE FAMILY [~] Two [] Five [] MULTIPLE FAMILY [~/Three [] Six 7. WATEB S~PPLY ~' iNDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled · since June 1975. For wells drilled prior to that date, give well depth (attach 10g if available.) 8. SEWAGE DISPOSAL SYSTEM ~) I N DIVi DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE F-ipUBLIC UTILITY Connection Verified [~]Septic Tank or []Holding Tank Size:_/~(()(~ If Tank is homemad~ give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED Io INSTALLER SOl LS RATING MANUFACTURER ~._~, MATERIAL Septic/Holding Tank IAbsorption Area ISewer Line J Nearest Lot Line DATE [] APPROVED FOR ~' BEDROOMS C~:~r~-(~NDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)