HomeMy WebLinkAboutELLEN COURT LT 7
WATER WELL RECORD
S~[A'TE OF ALASKA
DEPARTMENT OF NAYURAL RESOURES
Division' of Geological 8~ Geophysical Surveys
Anch. E1Jen Ct. 7 __o~_of__of __ sO wO
1 DISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL:
Mr. Jerald Henke
$~reet Address and Area of Well Location
S.rfo~e, 60' f', 7 -- 19 -- 69
soft, brn. sand w/ layers of.clay 0I 32 6. ~Cab~. ,oo~ ~.o,..v
grey clay 32 44 ~ Auger ~ O,'f,d -
grey hard pan 44 59 7. us~:~oom.,.~ O
brn. sand & gravel w/ water 59 60 O ~.~.,,o. ~ .?..~;.
~ Till Will ~ Other:
8, CASING: ~ Threaded ~ Welde~
~..: _~en~-- bottom
,o. sr~,c w~[. taws: 17' .. ? /19/69
~ Above or ~ Below {ond lurfece
dart valve bailer
Municipality ~ m, ~n Se~c~ t ,~.oaou~,,o w.,, o,o.,.o:
15. PUMP~ (If available) HP
~ Sabra. ~ Jet ~ Cen,rlflcol ~ O,her
Developed ~ 4GPH w/ baS,er,
~umped w/ rSg for 2 hrs.; cleared.
Left w/ 1~ plug.
15. Woter lemperolure __o ~ F~ U
Dotten Drilling Co. AA512
~.. .... : ~37. Hart~el! Road
............
Dotten Drilling Co.
8537 Hartzell Road Anchorage, Alaska 99507 907-344-1514
Mr. Jerry Henke
bm.: 345-4705 wk.: 762-7672
jobsite: Lot 7 Ellen Court Subd.
PUMP TEST
well depth: 60'1TM2
static level: 26'
pump intake: 56'
Date: 4/29/95
Begin:
10:25 A.M.
11:20
11:50
12:20 P.M.
12:45
1:00
1:30
2:00
2:25
initiate pumping @ 4.2 CPM (H20 ~eter= 8280)
pumping rate @ 4.2 GPM; pumping level @ 54:
steady @ 4.2 GPM
4.2 CPM; w/5A'4" pumping level.
4.2 steady.
4.2 GPM
4~2 GPM w/ pumping level of 54'6",
4.2 steady.
End pumping. (H2O metier = 9288)
Total Pumping Time: 4 hrs. Total Gallons Pumped: 1008
Remarks: 1.) Initial pumping stirred up some fine sand. Cleared fairly well w/ slight
residual remaining ~ end of pumping° 2.) Well was .chlorinated w/ H?H pellets
upcn completion of pumping.
Signed:
Earl Dotten
* All measurements from TOC.
Parcel I.D. #
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
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address.
Agent N,/I.
Address
~7'~ rrv /;ten I.c~ Day phone
N, A. Day phone
'76'~- 7d7~
Day phone
J
Unless otherwise requested, HAA will be held for pickup.
NUMBEROF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well ~
Community well
NOTE:
Public water
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
NOTE:
Public sewer ~
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 {Rev. 1191) Fror~l MOA #21
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
Address
Engineer's signature
Phone
Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments Note: The well for this property meets existinq
State and Municipal Codes. There are nitrates present. It is
cor~inued suitability. Nitrate concentration is 5.22 mg/1. EPA
By: ~ ~ Date
The Municipality of Anchorage Depa~ment of Health and Human Se~ices (DHHS) issues Health Authority
Approval Ce~ificates based only upon the representations given in paragraph 5 above by an independent
professional engin~r registered in the State of Alaska. The DHHS does this as a cou ~esy to purchasers of homes
and their lending institutions in order to satis~ ce~ain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a ce~iftcate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineers work.
72~25 (Rev, 1/91) Back MOA #21
Legal Description:
A. WELL DATA
Well type Pm ~,oc
Log present (Y/N)
Total depth
Sauitaty seal (Y/N).
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ~{~~~0%~.,~
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4
Health Authority Approval Checklist
t~lLe,o do~,r~' .C lt~ ParcelI.D.:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 7
Cased to ~6' ' Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production ¥.P
WATER SAMPLE RESULTS:
Coliform 0 Cot /leo
Date of sample: ¥ / I 9 ! 9 ~'
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size
Foundation cleanout
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed
Length Width
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth (ins.) Minutes later:
Peroxide treatment (past 12 months)
FROM W~LL LOG AT INSPECTION
1'7 ' ~ '
Number of Compartments Cleanouts (Y/N) ,
Depression (Y/N)
Ptanper
Soil rating (g.p.d./ft: or fl:/bdrm)
High water alarm (Y/N)
System typ~
Gravel thickness below pipe
Monitoring Tube present(YfN)
Results (Pass/Fail)
Immediately after
Absorption rate =
Total depth
Depression over field (Y/N)
For bedrooms
__gal. water added (in.):
g.p.d.
yes,.~v~e date~
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Size in gallons
"Pump on" level at*
*Datum
Public sewer main
Sewer/septic service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
"Pump off' level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~/,
Building foundation Property line Absorption field
Water main/service line Surface water/drainage Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIBLD ONLOT TO: tJ. ~.
Building foundation Property Line Water main/service line
Surface water Driveway, parking/vehicle storage area
Curtain drain Wells on adjacent lots
I certify that I have determined thrufield Inspections and review of Municipal reco~*T~,*tr/~e aboge ~e~e
in conformance with MOA I-LdA guidelines in effect on this date. ~'
Date ~t-[~r,'/ ~4 199~
HAA Fee $
Date of Payment
Receipt Number ~~
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
04×25?96 14:34 CT~E ESI ANCHORAGE ~ 90734513SS NO.O?? Q02
CT&E Environmental Services Inc.
Laboratory Division
Laboratory Analysis Report
CT&E Ref.#
Client Sample ID
~,[atrLx
96135t.11320
L7, ELLENT COURT S/DJ 1~81-01
DNn}dng Water
PWSID 0
Samp[¢ Remarks:
Collected Date 04/19196
Technical Direc:or: Stephen C. Ed~
Released By_22, ~ ..... ~
Nttrfte-N 0.10""'-'--'~ U o:lO0
~ethod ~ttowabte Prep Anatys;s
Limits 0ate Date
EPA 353.2 0&119/96
EPA ~5~,E 0~/19/96
u · undetected
GT · Greater than
D * Secondary DiLution
200 W Potter Drive, Anchorage. AK 99518-1605 -- Tel: (907) ~62-2343 Fax: (907) 561-5301
3180 Pager Road, Fairbanks, AK 99709-5471 ~ Tel: (907) 474-8656 ~ax: (907} 474-9685
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