HomeMy WebLinkAboutKNIK HEIGHTS BLK E LT 9Aug 19 22 07:15p Anchorage Well & Pump Ser
9072430742 p.1
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: 017 371 27
Legal Description Block Lot Property Owner Name & Address:
PERRY RONALD G & JULIE J
KINK HEIGHTS E 9 101 E 9TH AVE #9B
ANCHORAGE, AL 99501
Pump Installation Date: 08 _ 18 _ 2022
Pump Intake Depth Below Top of Well Casing: 312 feet
Pump Manufacturer's Name: FRANKLIN ELECTRIC
Purim Model: 7FRI P4 -2W230
Pump Size: 1.00 hp
Pitless Adapter Burial Depth: 12
I Pitless Adapter Manufacturer's Name:
I Pitless Adapter Installer:
feet
MARTINSON
IWell Disinfected Upon Completion? )� Yes ❑ No
Method of Disinfection: PELLETS
Comments:
Pump Installer Name:
ANCHORAGE WELL & PUMP SERVICE
Company: 7640 KING STREET
ANCHORAGE, AK 99518
Mailing Address: _ 907-243-0740
City: State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telepl~one 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME r) ~ 'IF'HONE
- [] UPGRADE
~-E- G A L DESCRIPTION
~ DISTANOE~O:' ] Well. iOOU ~ Abs~)ptionarea Z ' Dwelling ~ t PERMITNO.~ ¢Og(¢
~ ~ Manufacturer
Materi~
of compartm~
~ < ~~ No.
Liq, ca))~it~n~allons I nside~ Width ' '
-- /~ (~ IF HOMEMADE: .-
O Z < M~acturer ~ ~
-- ~ Well Foundation ~ot Near~s~f~t'[[ne , ~RMITNO. '
~ DISTANCE TO: '~- [OO "~- ~0 '~ ~O~ ~ (
~u -- ~ ' Total length of lines Trench width Distance between line~
%,m~ No. oflines~,~ Lengthofeach~e~ ~ ~ ~nches
I ~ ~ Top of tile to finish grade Material beneath tile ' T~t%[ effe~u~ d~ area
-- ~ ~ ~ '7~ inches
Length Width Depth PERMIT NO.
~ ' ~t_ i~ '~ ~ea
DISTANCE TO:
~M CI a~4~ Depth Dr~Jler D stance to~_lot~oline PERMIT NO. ~~
~ DISTANCE TO: Building foundation~o ~ Sewer line ~ ~ Septic tank [00~ A~sorption area(s)
OTHER
PIPE MA~IALS
_ ,-
SOIL TEST RATING
REMARKS l ~ ~)~ ~3~ (
~ [~'~
-APPROVED~ ~~ DATE LEGAL
FIF'PL. I CI::INT
L. EGF~I
:ST EF:'IqEiq S"/VERSON
LE"r'[)EI',! RE:' OF'F
L. 5~ [.':",L..K E KIqIK HT'.5
::".51;.:R E:O';.,: :'L58::L E:
L. OT :S i
T"r'F'E (]F' ':'!!;el :1: L,. f:IE:E;ORE:"I' 3: ON S"r'tS'IFEP] :[ 5: 'f'RENCH
SOIL RFI]"].'N(ii [::SI~:! I::' T,," [~] F.] :) ..... L1.1~10
THE RE:.C!U I RE[::, S :[ 2% OF TIqE: Si]i I L FIB::SOI~:PT i ON S'¢:E;TE]"I I S:
'f'I-IE L. ENGTIq I::,IHEN'.:SiOI'.,I I5; ]'IdE LEhIGTH (IN F'EET) i])F THE TREI'.,IC:Iq OR [:,RFI:I:I'4FIEI...[::,.
THE [:,EI::'TIq I]F I:1 TF.:EI'.,IC:H OR F'I"f' I:!!; T,LIE [)]:.:'.STFtNC'E E~ETI.,.IEEi'.,I THE SIJI~'.F'FqC:E OF THE
GROUN[:, FIN[)THE E[OT"FOM OF THIS E;:.,',E:I::I',,,'F:ITION ,::IN FEET).
'['HIERE I:S NO '.:.SEET .L,.IIDTH 1:::OI;.: 'T'REIq(::HES.
"['HE: GF..'R'v'EL. [)EPTH 3: ~::; THE M :t: i'.,I I MIJM [:,EPTI.q OF GRI":I'v'EL E[E'I"I.,.IEE:I'.,t THE OUTFF:It..I... F:' :[ PE
FIN[) THE: BCITTOM OF THE IE',:.:',CR'v'FIT I OIq ,'.: I N FEET ).
PIEF;;:M Z T IqI::'PL. I I:::f:'ll'.,l"l" Iqf::l'.:5 'THE RES;F'ONS :[ E: I I.. ): '['"r' TO :[ I'.,1[:'(:1[-;::i"1 TH :[ 2i; [:,EPFtI:~'.TMEi",IT [)I JR i J"41:!i THE
I I",t%TFIL. L.I::IT I ON I I",I'.'SF'ECT ): Of',!5; OF FIN"r' l.,IE:[..l...~; FIDJFICEI",IT TO ]'H ]: S F:'ROF'EI;i~T"r' FII',ID THE
NL.livtSEP:~ O1:: F}.!:SS';II}Et",ICE':'i:; THFIT THE !.dELL I*I.'[LI... S'iEI';.'.',,,'E.
T' IL,,-II C::fl ,:: ;;='2~i: ::,, 3.' Ih41 .!:£E; F::" ~EE C: -IF ]E C::~ fr'-4 ."E.?, ~::::111i::;~i". E'E F;~L" [t:.E: C:::! LI :E [;E: IIFZ 115: ............................
BF:ICI<]-:'II....LING OF RN'.r' S"¢SI"EH H:I:THOIJT FINI::tL I I',ISi:'EC:TION I:IND I::IF'PF.:O',/F:tt... f3'¢ THIS
[:,E]:::'FII:;..:TI"IENT !.,.I i LL. ['.31E SUBJECT TO PROSECUT I ON.
i'd I I'.,I .'1: ML.IM C, :[ :.STI:':INCE I~i:E'FI,]IEEI",I F:I 14E'.'LL. l::llq[) f:IN'T' CIIq.'-qS I 'FE SFZP.II::I(3E: 13, ]: SF:'OSf:tL 5;'T'5;'T'EM I S
:I..I-7.HZ~ F:EET FOI-;i'. f::l PI:;:'. ]] ',,,'FITE HELL..; OR
::l..SEI Tf.3 200 FEET FROM I::1 t:::'UE:LIC HEL. L E:,EPEI'.,IE:,Ii",IG UPON THE T"r'PE
I.'.IIELL L.O(3'.:5 I:::IRE RE(;!LIiRE[) FIiqE:, f"llJkST E~,E RETIJI:;i'.i'.,tEE:, -I"O THE [:,EPI:::II:;i:TMEIqT HITHII",I ]:O E:,F:I"r':S
O1':' THE HELL C:OMPLI}:TI
O"f'HEF;: REO. LII REMENT'.S i'"tR"r' l'ql::'PL"r'. SPEC: I I::' I CRT I OI",IL=; FIN[:' CCdq:E;TRUCT I ON D I FIGRFIH!~; F:IRE
FI'v'FI I I...FIE',LE TO I N?.;IJl;.:E PROF:'ER ]: f'.I'.:.:;TFILL. I::tT ]: Oi",l.
:1: I][:::f'i'.'T']:l::'~'r' THt:::I'T'
::L: I FIt'"I F:FIMiLII::II::~: P.I:[TH THE I:-.":EQUIF;'.EMEi",IT'.."S I:'CIR Ol'.~-sI"rE :SE!.,.IERS I:::iN[)I.,.!ELI...% FrS; SET
FORTH IB'.r' 'THE MLll,41 C ~ Pf.:tL I T'.r' OF F:INCHOF.:I::IGE.
2: I t.4]:I...L iIqSTFIL. L 'I"HE: S'-r'STEM :[i'.,t F:II]:COR[:,flNCE:. I.qITH THE E:O[:.',ES.
]:: I UI',t[:,ERSTf::IND THF:FF THE ON-SITI!E SEI.,.I[:;R S'T':STEM Mi:::l"r' REC.!UIF.:E ENL. I:::IRGEMENT IF "I'I"'IIE
F.':E:i;I[:,ENCE ]:S REMO[:,ELE[:, 'TO INCLU[:,E HORE THl:'tiq 4 BE':DROOM'.:~;.
D/SOtLS LOG
MUNICIPALITY ()F ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [J PERCOt_ATION
Pouch 6-{;50, A,~chorago, Alaska 99502 276-222!
SOILS LOG - PL:RCOLATION TEST
PEI;H-Oi~M E D FOH;
DATE PERFORMED:
SLOPE SiTE~LtAN ........
14
~5
16
17
18
19
20
.5 ;', ~} o5/
WAS GIqOUND WATER
E NCOLJNTE F:EI)?
IF YES, AT WIIAT
DEPl'lt?
S
L
P ~. CL. ~//
E
Net
1 line
{)top
P[H~COLATION FIATE
(minutes/inch}
1ES'I HUN BETWEEN FT AND
.................... ,, .......................................... 7 7~-'=/ ~'
FT
[)Is
72 008
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
Parcel I.D.# _t~") ~ '~ - ."~"~ \ '- _--~'~ NAA#
1. GENERAL INFORMATION
Complete legal description
Lot 9~ Block E~ Knik Heiqhts
Location (site address or directions) 4301 Leyden, Anchorage, Alaska 99516
Property owner Sherry Syverson Day phone 345-5042
Mailing address 4301 Leyden, Anchorage, Alaska 99516
Lending agency
Mailing address
Day phone
Agent Mary Rea rdon
Address Personal Servi ce Real ty
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 ",4
TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
Day phone 274-6142
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 X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State AD£C
attesting to the legality and status of system.
72-025 (Rev. t/91) Front MOA #21
5, 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/orwastewaterdisposal system is safe, functionaland 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 Gi I fi I lan Engineering, Inc.
Address 255 E. Fi reweed LaneI Anchorages AK
Engineer's signature /~~~~
/ Robert E. Gi/filian, P.E.
Phone 277-2021
99503
Date
DHHS SIGNATURE
X' Approved for /r~-zx-,"Z(~)bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date ~- O- ~-~
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 federal 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 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type Private
Lot 9~ Block E, Knik Heights ParcelI.D.
If A, B, or C, attach ADEC letter. ADEC water system number Date completed /~ q ~'/;) Driller
Casedto Unknow~ ' a 'a 1~ in above gn~nd
- .Ca~ln~ height , · _
properly protected (Y/N) Y ~ ~ r ~ ~/¢.5~
FROM WELL LOG AT INSPECTION ~ ~
7/22/93
198 ft.
3
Unknow~
; On adjacent lots
; On adjacent lots
g.p.m.
Log present (Y/N) N
Total depth Over 300 ftc
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
Y
Unknowa
Unkn ov,~q
Unknowa
Unkn ow:q
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 100 + f t.
Absorption field on lot 1 00 + f t o
Public sewer main NA
Sewer service line 25 + f t.
100 + ft.
Public sewer manhole/cleanout
NA
Petroleum tank 25 + f t,
WATER SAMPLE RESULTS:
Coliform Absent
Date of sample: 7/22/93
Nitrate 0.6 rrg/I
Collected by:
Other bacteria
Kent Sheets
B. SEPTIC/HOLDING TANK DATA
Date installed 11/78
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date of pumping
Tank size 1250 gal . Compartments 2
Foundation cleanout (Y/N) Y Depression (Y/N)
Alarm tested (Y/N) N
Pumper ~,¢~,_¢z ~ c~ ~,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 00 + f t. On adjacent lots
To property line 25 + f t. Absorption field
Surface water/drainage None
100 + ft. Foundation 35 ft.
40 f t. Water main/service line 50 + f t.
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed 11/78
Length 34 f t. Width
Total absorption area 408 f t.
Date of adequacy test 7/22/93
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N) N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 100 + fl·
To building foundation 45 f t.
On adjacent lots 100 + f t.
Sudace water None
Curtain drain None
Soil rating (GPD/F¢)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
.Cycles tested
Surface water
3 f t. Gravel thickness
Cleanout present (Y/N) Y
Results (pass/fail) Pass
44½ inches
i00 s.f/B.R. System type Trench
6 ft. Total depth 13 ft.
Depression over field (Y/N) N
for 4 Bedrooms
After test 48 inches
If yes, give date
25+ ft.
None
50 + ft,
70 ft.
the date of this inspection,
On adjacent lots 100 + f t. Property line
To existing or abandoned system on lot
Cutbank None Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICA'rlON
I certify that I have checked, verified, or conformed to all MOA and HAA
Refer to attached 2-day well flow test.
Engineer's Name Robert E./Gi Ifilian, P.E.
Date
HAA Fee $ ~-~ E-%
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3t93)* Back
Gilfilian Engineering, Inc.
1800 E. Parks Hwy., Suite D-100
Wasilla, Alaska 99654
ADEQUACY TEST FORM
Location: Lot 9, Block E, Knik Heights
Date: 7/21/93
Inspector: Kent Sheets
Septic Tauk Size: 1250 gallons
Type of S.A.S: Trench
Project No: 93083
No. of Bedrooms: 4
No. of Bathrooms: 3
Cale. Peak Load*: 300
Cale. Peak Time*: 33.3
Calc. Peak Flow Rate: 9
Meas. Ave. Flow Rate: 3 gpm
DAY 1
1420 4 - 491/2'' I/2" 44~A'' 21/2'' Ran water into
1440 4 80 50" 47" S.L.C.O.
0" 1"
1505 4 180 50" 48"
0" 0"
1535 2 240 50" 48"
0" 0"
1610 1.3 285.5 50" 48
Turn Water Off
1645 2 --
....... -~/2" -1"
1710 2 335.5 49~A" 47"
Stop Flow
DAY 2
0925 6.3 -- 491/2'' 38"
0" 8"
0950 6.3 157.5 491/2'' 46 ....
1015 3.5 245 491/2'. 48 ....
0"
1030 2.3 279.5 491/2'. 48"
End Flow
* Peak Load = 75 gallons x (# of bedrooms)
** Peak Time = 25 minutes x (# of bedrooms + # bathrooms)
ADEQ-2.FRM
Gilfilian Engineering, Inc,
1800 E. Parks Hwy., Suite D-100
Wasilla, Alaska 99654
WELL FLOW TEST DATA SHEET
From: Well Log
Probing Measurements
ADEC Records
Well Depth: Over 300 ft.
Static Level: 188' 9" ®
Physical / Sanitary Features:
Sanitary Seal __ / Cap
Casing Above Ground Surface:
Pump Wire in Conduit
Surface Drainage Away from Well:
Good v' Poor
1 2"
Well Pump Specs:
Water Supply Line:
Size:
Drop Pipe:
Size:
Depth to Pitless Adapter:
Storage / Pressure Tanks:
Type:
Type:
Time Time Interval Pumping Cumin. Static Comments
Minutes Rate (gpm) Gal. Level
DAY 2
0925 -- 6,3 -- 188' 9"
0945 20 5.3 126 206' 1"
1005 20 3.5 196 209'
1025 20 2.3 242 200' 5"
1050 25 2 292 201' 8½"
Minutes Average = Gallons Asl
215 TOTALS 2.9 612
Time Time Interval Static /~ r Comments
Minutes Level
LOCATION: Lot 9, Block E, Knik Heights
CLIENT: SherrySyverson
PROJECT NO: 93083
DATE: 7/22/93
BY: Kent Sheets
WELLFLOW,GEI
MAT-SU TEST LAB, INC.
Soils - Concrete - Water
Field and Laboratory Testing Services
1800 East Parks Highway, Suite D-100, Wasilla, Alaska 99654
Phone (907) 376-3005 Fax (907) 373-5686
CLIENT: Gilfilian Engineering, Inc.
ADDRESS: 255 E. Fireweed, //102
Anchora.qe, AK 99503
PHONE // 277-2021
ACCOUNT #: 001
TEST(s): Nitrate
DATE: 7/27/93
COST OF TEST(s):
TAX:
TOTAL:
PAYMENT: CHECK #
REFERENCE NO:
$22.00
N/A
$22.00
CASH
393092
LEGAL/PROJECT NAME: Lot 9, Block E, Knik Heights
PRIVATE: / PUBLIC (LIST STATE ID NO.):
DATE RECEIVED:_7/22/93 TIME RECEIVED: 1500
DATE SAMPLED:_7/22/93 TIME SAMPLED: 1000
GEI//93083
SAMPLED BY GEl/KS
Analysis Performed:
Level Detected
NiCL
Nitrate 0.6 mg/I 10 mg/I
mg/I = milligrams per liter
ND = none detected
MCL = maximum contaminant level
NOTE: This analysis was performed by: Mat-Su Test Lab, Inc.
If you have any questions concerning the above results, please call me at 376-3005.
.!
7/27/93
Date
..... ' ~ --MAT-'SU'TEST:LAB
' ' Soils - Concrete - Water
Field and Laboratory Testing Services
~800 E. Parks Highway, Suite D-100, Wasilla, Alaska 99654 · . Phone, 907) 3.76-300§ Fax (907) 373:5686 _.
DRINKING WATER ANALYSIS FOR TOTAL COLIFORM BAC',TERi~
APPLICANT I~'FORMATION
Name.:---~ ~
Mailing Ad~res~: ¢~/" ~¢z~q,~-
Sample Information
Legal Bescription~of ..Prope. rty
Date Collected 7/~ f~ '~, Time Collected:
Sample Type: ZRoutine
PWSlD No:
Collected
Repeat Sample ~ ~Treated ~Untreated
Fecal
REFER TO BACK SIDE FOR INSTRUCTIONS