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Home My WebLink AboutMOUNTAIN TERRACE ESTATES #2 LT 10 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 020 121 14 MOUNTAIN TERRACE ESTATES #2 10 FREDSTON JILL A 50% & FESLER DOUGLAS S 50% 9140 BREWSTERS DR ANCHORAGE, AK 99516-6928 06 07 2023 125 BERKELEY L7P4CMGS .50 10 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 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 PHONE ~UPGRADE NAME MAI LING ADD~{~SS LEGAZ R'PT'OY6' LOCATION / I Well ~ . ~ Absorption area Dwelling ~ ~ I Manufacturer ~ ~ ~ Lq capacty riga OhS nsdelength,_.~ · '[~ F HOMEMADE: ~welling~ ~ ~ ~ Manufacturer ~ Material a I I Well kt~ Foundation / Nearest lot line ~ ~ I DISTANCE TO: I [ ~ ~ No. of lines Length of e~hJ~ ~al length of lines Trench width Top of tile to finis~ ~ Material beneath the Length ( Type of crib//~- ~" DISTANCE TO: Class DISTANCE TO: Width Depth De.th ~,_ ¢ ~ OTHER PIPE MATERIALS SOl L TEST R~,TIN~G INSTALLEB REMARKS \~'~/APPROVED ' Building foundation Sewer line DATE NO. OF BEDROOMS PERMIT NO. No. of co~,~tments Liquid O ept h,~///~_ PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between fines inches Total effective absorption area inches PERMIT NO. Total effective absorption area ~;~,.¢ ¢,~/ ~ / Nearest lot lige Distance to lot line Septic tank PERMIT NO. Absorption area(s) LEGAL J.)E:F'"!?'i '1"El .":::' ]: F:'E~ ;EK:jIT'TEihl (F::IT'.) (:':;F;:F:~:VEL. BE:F:'TH (F:T,) '!"C)TF:fi,_ DE:F::'TH (i::'"l".) GFi:F::~VE:L. t;.,I :]: );)'TH (F'T :, ) E}R:?,/'EL. LENGTH .(F::T:: ) {SF:;:F:':VE~L..VCil...LJl'"lliii; (CLI ~ Y:(:)S ,, T:qlxll. C S ;I: ZE ((3F.'d.,~S) E:',E) ! L. I::;:{Y'F ;[ NE3 (:~C'!. F:'T ~ ,-"BF;'. DEFT, OF HEALTH & qRONMENTAL PROTECTION ~uNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION RECEIVED LEGAL DESCRIPTION 6 ; tJ}5 O 11 12 SOILS LOG - PERCOLATION TEST SLOPE SOILS LOG PERCOLATI(~N TEST -.~ SITE PLAN / / / I 20 COMMENTS_ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE I ' minutes/inch) TEST RUN BF-.,TWEEN~ ~t tt~ FT AND -~''''' ~) PERFORMED BY: CERTIFIED BY: 2-00~ (6!79} ALASKA r'-"!ROnmE nTAL £OnTROL SE~RL"]eS, II'lC. J~nclin~erinq f~ J~nuir~Jm~ntal $luOi~ PERCOLATION TEST DATA SHEET ADDRESS zip CODE LEGAL LOCATION TOTAL DEPTH 'OF HOLE ZONE TESTED L READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) DATUM FINAL PERCOLATION RATE.. .~/' PERFORMED B~' .J//),) (min/in) 12oo LU~s133d Auenu,~. ~u,,,',,~. An[h~q~. Alasko 995o3 · (~o7) 276-1361 BIG DIPPER DRILLING 7529 E. 6th Avenue · June 27, 1985 Jill Fredstan 723 W. 5th #6 Anchorage, Alaska 99501 Dear Jill: The following information is your copy of the well log for the property located at Unit 2 Block 10 Mt. Terrace Est. This should be retained as your perminate record of improvements to your property. Wq~LLLOG 0 to 6 Soil 6 10 Silty Sand, Gravel 10 120 Shale, Lime Stone, Silica 15 GALLONS PER MINUTE STATIC WATER LEVEL 29 FEET STATEMENT 120 Feet drilled @ $19.00 per foot 40 foot by 8" Cement seal & labor Total Anchorage, Alaska 99504 · (907) 333-6435 = $2280.00 $320.00 $262.00 $2862.00 Thank you for specifying BIG DIPPER DRILLING for your water well needs. Sincerely, C.R. Kron Owner Licensed · Bonded · Insured 4O · . 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 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) " (b) ~p~licant Name F~Ot~ Telephone, Home ~-ZZ~ Business (6) .Applicant is (check one~:'Ebnding Institution g; Owner/builder; Buyer B Other ~ (explain); (d) LencJing Institutio~ Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well)~ Community [] Public[] ".: ? Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL . : . , Onsite)~ Public [] Community [] Holding Tank [] ~ Note: If community well system, must have Written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIh~ INSPECTIONS, TESTS, FILE SEARCH, DA iA 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 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 ~/ Telephone Address Date X~~ / Approved for ~/C~.~_.]'/.~ Approved ,~( Terms of Conditional Approval 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 Mb-NtCiPALITY OF AI~¢HOI~,A~JNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST' FEBRUARY 1984 t- Et3 l 9 19B6' 2e4-472o RECEIVED WELL DATA Legal Description: 7"/1 ,,v' Well Classification ,~'/'~/¢~"' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed (~/~ 7'/,~'~' Yield Total Depth /~ Cased to ¢~ Depth of Grouting Static Water Level ~ ' Pump Set At ' ' - Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/F-J:¢~4~ Tank on Lot /, ~ ' Sanitary Seal on Casing (Y/N) }/ Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots ~> /~ ~ To Nearest Edge of Absorption Field on Lot /~,,~ / ¢' To Nearest Public Sewer Line . To Nearest Public Sewer Cleanout/Manhole ,4///~ To Nearest Sewer Service Line on Lot Water Sample Collected by /-.), ,~)g / .~'~'~'~,/ /~£. ; Date ~-//Z/~'~' Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ¢¢¢'5'~ Size /~'~-~::~ No. of Compartments Standpipes (Y/N) ~/' Air-tight Caps (Y/N) '~/ FOun'dation Cleanout (Y/N) Depression over Tank (Y/N) /V/ Date Last Pumped 'Pumping/Maintenance Contract on File (Y/N) /(/,/'~ ; for Holding Tank High-Water Alarm (Y/N) /V//~ Temporary Holding Tank Permit (Y/N) /U,/~ Separation Distances from Septic/Holding Tank: TO Water-Supply Well , /~..~ / ¢ To Property Line ~ To Water Main/Service Line ) ~"~ / Course To Building Foundation '¢~, ~ / To Disposal Field ,¢ / ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7,/~'~" Width of Field / '?" Square Feet of Absorption Area ::~'¢¢ Depression over Field (Y/N) /'~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Length of Field ,-~ Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Type of System Design To Building Foundation Lot /~/,,~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Y To Property Line ~"?/ To Existing or Abandoned System on ; On Adjoining Lots ¢~"~'¢": ;> /00 r To Cutbank (if present) ,4//./I D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at . Tested for Electrical Codes (Y/~'~'~'- Comments/......-.'''/ Dimensions ~ Manho~N) Off" Level at j..~P~ump Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .A/~ ~ ~,/~,'~ Date '~'//~//~'/-~ ~' / Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF ..... : !. [ ~ .... .~ ..... .~ :~ · -