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HomeMy WebLinkAboutMANN BLK 5 LT 2Certified Drilling Log P DOC CO dba 0 BILL 8. COLE ��►ULLIVAN WATER WELLS CP.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Husein Azzam ADDRESS: 16101 Saint James St. Anchorage, AK 99516 Bore Hole Data Depth From To LEGAL DESCRIPTION Mann Block 5 Lot 2 DATE: 5-19-23 0 2 PERMIT NUMBER: OSP231099 DATE OF ISSUE: 5-12-23 TAX IDENTIFICATION NUMBER 02048102000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 600' Casing Type: Steel . Wall thickness .250 inches Diameter: 6 inches, depth 64 feet Liner type 540' of 4.5" PVC Static Water Level: 60 feet Recovery Rate 1.5 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ❑ open end ®open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 Ibs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 4 24 24 29 29 j 39 39 49 49 55 55 97 97 184 184 240 240 508 508 600 Casing Stickup Overburden/Topsoil Silty Sand & Gravel Tight Wet Silty Sand & Gravel Tight Silty Sand & Gravel Hardpan Weathered Bedrock Bedrock Gray Bedrock Dark Gray Bedrock Gray 22 GPH Bedrock Dark Gray Soft Bedrock Gray Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. Pump Installation Log Well Drilling Permit Number: Date of Issue: - - Parcel Identification Number: 020 _ 481 _ 02 Legal Description Block Lot Property Owner Name & Address: AZZAM HUSSEIN & HAIKHAL RAIDA MANN 5 2 16101 ST JAMES ST ANCHORAGE, AK 99516 4937 Pump Installation Date: 09 _ 07 - 2023 Pump Intake Depth Below Top of Well Casing: 575 feet Pump Manufacturer's Name: GOULDS/A.Y. MCDONALD Pump Model: 12S23 / SM0413 2HP230V Pump Size: 2.0 hp Pitless Adapter Burial Depth: 15 feet Pitless Adapter Manufacturer's Name: MARTINSON Pitless Adapter Installer: Well Disinfected Upon Completion? ❑ Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: Company: ANCHORAGE WELL & PUMP SERVICE Mailing Address: 7640 KING STREET' City: AN C H O RAG E State: AK Zip: 99518 Attention: The pump installer shall provide a pump installation log to On -site within 30 days of pump installation. SGS Ref.# 1236017001 Client Name Residential Testing - Cash Account Printed Date/Time 11/01/2023 14:13 Project Name/# Husein Azzam Collected Daterrime 10/25/2023 11' ' Client Sample ID Horne Received Date/Time 10/25/2023 14:.: Matrix Drinking Water Technical Director Stephen -.Ed; Sample Remarks: Allowable Prep Analysis ~ Parameter Results LOQ Units Method Container ID Limits Date Date I., it Metals by ICP/MS Arsenic I0.9 x 5.00 ug/L, EP200.8 B (<10) 10/27/Z l0f`8.`3 HGS Waters Department Total Nitrate/Nitrite-N 6.64 0.200 mg/L SM21450ONO3-F C (<10) 10/2(%;2. ; EBH Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 10/2 5 2 h!.A Total Coliform Negative 1 100mL SM21 9223B A 1 25/1 , Kjj Page 2 of 5 n T a00 xi v`ii C�1 W m W w 2 Y Q i W N W O ¢ Z O Y < O v 2 2 N Z W Q I, Z Q p O1 19 Nov_30.2022 11:44 AM Anchorage Well & Pump Service Inc 9072430742 #3803 P 1/ 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 dumber: Parcel Identification Number: 020_48102 Date of Issue• - Legal Description Block Lot Property Owner Name & Address: AZZAM HUSSEIN & HAIKHAL RAIDA MANN 5 2 16101 ST JAMES ST ANCHORAGE, AK 99516 4937 Pump Installation Date: 11 - 14 - 2022 Pump Intake Depth Below Tap of Well Casing: Pump Manufacturer's Mame: XYLEM Pump Model: 5OC311 ...B 1 Pump Size: .50 by 155 feet Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: MARTIN DN Pitless Adapter Installer: Well Disinfected Upon Completion? X)(cs Q No Method of Disinfection: PELLETS Comments: Pump Installer Name, Company: Mailing Address: City: ANCHORAGE WELL & PUMP SERVICE 7640 ICING STREET ANCHORAGE, AK 99518 907-243-0740 State: Zin: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation, MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP231099 Work Type: Well Upgrade Tax Code Number: 02048102000 Site Legal Address: MANN BLK 5 LT 2 G:3237 Site Mailing Address: 16101 SAINT JAMES ST, Anchorage Owner: AZZAM HUSEIN & Design Engineer: This permit is for the construction of: Effective Date Expiration Date: Q Ei t) elm rtine nt Lot Size in Sq Ft: Total Bedrooms: 5/12/2023 5/11/2024 45000 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: In order to close out this water well permit the following items will need to be submitted: • well log • pump install log • water sample results; nitrate, bacteria, arsenic • well decommissioning log or justification that the existing well remains connected to the house plumbing Received By: Date: 5 . L. Issued By: L Date: 4 MUNMPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020 -• Lifit -o Z - 00c Property owner(s) f f USS i h :A Z2 1•n /R -a-% J A-2Z2_e_ ^ Day phone (9y723G(o 6716- Mailing address 596-16 Site address S a_vm_-c_ Legal description (Sub'd., Block & Lot) 131 cnc 14 - L 6 - t Q- IV\/41v A,/ Legal description (Township, Range & Section) Lot Size y5 oGc' Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption. Field F-1 Initial❑ Single Family (SF) . (w/wo AD U) Septic Tank ❑ Upgrade ® Duplex (p) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 9 Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature (If propdrty owner or authorized agent) Permit/Rush Fees: Z Waiver Fees: Date of Payment: 2023 Date of Payment: Receipt Number: Permit No. Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterWorms\Client FormsTermit Application.doc C%4 C) on ol cri 0 0 z P p 1-4 H �D m I 4-) - — - — - — - — - — - - *IT'S S21wvf'ss 1/0 id 4j -� v SIA 0 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: --~ ~V%f ~0 Z'~I PID Number: Address: p~ U~ ~~~ Wastewater System: U New ~pgrade i lOl ABSORPTION FIELD LEGAL DESCRI PTI O N ~o~, Rating: Tota~ Depth from ~iginal grade: O - 8 GPD/Sq. Ft. 5'/ -- Lot: ~ Block: ~ Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe ] I Section: . -- -- Fill added above original grade: Gravel length: Number of lines: I Distance belden lines: WELL: U New ~ Upgrade Grave, width: [ ~ Ft. 5 ~¢ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorptio~rea: Pipe material~ Ft. Ft. 0~¢ SQ. Ft. Driller: Date Drilled: Static Water Level:Ft. Installer:~ ~ ~ ~ Date installed:, Yield: m Pump Set at: I Casing Height Above Ground: ~.M .t. .~. TANK SEPARATION DISTANCES a Septic ~ Holding ~.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A W~hOr~ ~ %~ff~ Web J ~ /~ ~Z~ / ~¢~/ Number of Companments: S~ace LIFT STATION Water ~e~ L~; I ' Size ~g~: Manufacture[: ~ Foundation ~ ' ~ ~ 3" 4 /~/ ~ ~ ~ ~ "Pump on" level at: "Pump off" level at: High water al~m at: Drain ~¢~ N ~''~ Pump Make & Model Electrical Inspectiqns ,edor~ed by:, Remarks: J~ ~ ~O~¢~~~ .~~~ BENCH MARK Location and Description: 2nd I[~ l~- ?¢ 1~ 6~'~%/~ Department of Health and Human Se~ices approval Reviewed and approved by: Date: 72-.013 (Rev. 9/91) MOA 25 PERMIT NO. SW990221 AS BUILT SEPTIC PLAN /  ~ / ~00 Gal. STEP Tank ~,m 12 ft. × 30 ft. Interm_ttent ,, ~ ~- Bottomless Sand Filter k JAMES SIZEMORE & ASSOCIATES CIVIL ENGINEERS & SURVEYORS / / STCO1 28.4 STCOI 12.0 t, i I STCO2 34.8 1 ~-'~ STCO2 20.0 NFV5 34.6 CO1 37.1 SFV1 38.1 '. * ""' ..... ~ *-- " ~..'i,~. % %..[~.~,,.~,,,,.~,~ .... JAMES SIZEMORE & ASSOCIATES CIVIL ENGINEERS & SURVEYORS FROM TO DIST. A STCO1 28.4 B STCOI 12.0 A STCO2 34.8 B STCO2 20.0 A NFV5 34.6 B NFV5 29.8 A CO1 37.1 B C01 30.5 A SFV1 41.9 B SFV1 38.1 Permit No.---~ ~ (~' ?<~ ~'-'~--'/ Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: CAL 72-013 A (Rev. 9/91 ) MOA 25 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~9-6650 ¢07) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 27, 1999 Expiration Date: Jul 26, 2000 Permit Number: SW990221 Legal Description: MANN BLK 5 LT 2 Design Engineer: 0027 James Sizemore & Associates Owner Name: David Belanger Owner Address: 16101 SAINT JAMES STREET ANCHORAGE , AK 99516-4937 Parcel ID: 020-051-08 Site Address: 016101 ST JAMES ST Lot Size: 45000 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field [] SepticTank [] Holding Tank E~ Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: 7-"2. 7-?7 :--t:!ol~ ' -- - ....... ============================================================= ..... :-..-.-~--t 1 I ~,,- ~,: .... -" L :~~5 ~;~"~ ~'~~ - . ~ ~ . PROBABLE IMPACTS TO ADJACENT PROPERTIES A) WELLS The proposed wastewater disposal system is designed in accordance with current Municipal Wastewater Disposal Regulations. The proposed deep trench absorption field and the septic tank are greater than 100 feet from the well on this lot, and adjacent lots. This deep trench leach field is a replacement for a deep trench that has been successfully operating for 20 years and therefore, there should be no adverse impacts on wells from this system Since the proposed system is greater than 100 ft. from wells on adjacent lots, it should not preclude replacement systems on these lots. The lots to the west, across St. James Street are served by public water and sewer. The lots adjoining this lot to the East are 300 ft. deep and have adequate space to keep a well 100 ft. from the system proposed on this lot. B) WASTEWATER SYSTEMS The system is designed in accordance with current Municipal Regulations, and construction will comply with current regulations. There should be no adverse impact of adjacent disposal systems. C) RESERVED SPACE/SURFACE AND SUBSURFACE There is adequate space on the lot for a replacement disposal system, and still maintain the protective radiuses around wells. Wells on surrounding lots are deep enough also to provide protection. D) DRAINAGE The topography on this lot and the surrounding lots is mostly level. The area disturbed during construction of the system will be graded to prevent ponding of water. ~Rep].ace existing ST w:ith steel 1250 gal ST /Existinq CO/MT ~ ......~// Ex:is~ lng Deep Trench leach [ield ~/-~ 5' x 75' wide trench (4 ' effecLJve replacement leach [ield LOT 2, BLOCK 5, MANN PROPOSED SEPTIC SYSTEM SITE PLAN SUBD. UPGRADE ,TAMR.q ~qTZRMORV, && A.q.qOCTATES CIVI~0 ENGINEERS SURVEYORS TEL. 7-345-1572 FAX-345-9669 DWN. BY JF$ CHKD. BY JS SCALE: ]" = 60' [)AT E: July 7, 1999 LOT 3 LOT 2 LOT 1 LOT 6 UNDEVELOPED LOT 7 UNDEVELOPED LOT 8 UNDEVELOPED JAMES SIZEMORE & ASSOCIATES LOT 2, BLOCK 5, MANN SUBD. PROPOSED SEPTIC SYSTEM UPGRADE WELL LOCATION PLAN SCALE: ] IN. = 100 FT. Drawn By: DATE: JULY 7~ 1999 Chkd. By: GRID: 3237 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 L_. ?_ L-~ ,~ /~] (--~"/~7~/~/6/~7(T°wnship' Range, Section: SLOPE ;i2o c c .f- Depth to Water A~[/ ~'~ T~Y Monitoring? ~ ~f WAS GROUND WATER ENCOUNTERED7 /~v/O $~e?~ I~-, S*' s L IF YES, AT WHAT O P E Reading Date Gross Net Depth to Net Time Time Water Drop l=i ~l ~"37:~ ' E_~i _ SITE PLAN 72-008 (Rev. 4/85) /' PERCOLATION RATE I~lL! 6 (minutes/inch)PERC HOLE DIAMETER ~1 TEST RUN B: WEEN (~',O F/T/~ND 6' & FT ,,i .... ' . CERTIFY THAT THIS TEST WAS PERFORMED IN COMMENTS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. WASTEWATER DISPOSAL SYSTEM LOT 2, BLOCK 5, MANN SUBDIVISION 1.0 GENERAL 1.1 The scope of this project consists of installation ora 1250 gallon Septic Tank and a wide trench absorption field, 75 feet long, by 8.5 ft. deep, with an effective depth of 4 ft. 1.2 Construction shall be in accordance with: the approved site plan and design drawings and specifications, Municipality of Anchorage permit with any special provisions or conditions. Deviations from the approved design drawings shall be coordinated and approved by the engineer conducting the inspections. 1.3 All construction procedures and material used to construct the system shall comply with Municipal and State Regulations. 1.4 The homeowner shall be responsible for finish grading and seeding disturbed areas after the system is constructed and soil is compacted and mounded over the absorption trench and the Septic Tank. 2.0 SEPTIC TANK 2.1 The 1250 gallon septic tank shall have two compartments and shall comply with Municipality of Anchorage requirements. The tank shall include two 4" diameter cleanouts for pumping access. 2.2 The septic tank shall be set level and shall be bedded as necessary to prevent settling or shifting of the tank. The tank shall be set as high as possible, connecting to the 4" sewer drain from the house. 2.3 All pipe connections to the septic tank shall be made with waterproof mechanical couplings. A cleanout shall be installed upstream of the tank within 5 ft. of the house foundation. A double cleanout shall be installed downstream, within 10 feet of the septic tank. The first cleanout shall clean toward the drainfield, and the second shall clean toward the septic tank. 3.0 SUBSURFACE DISPOSAL FIELD 3.1 The subsurface disposal field shall consist of a 5' wide trench, 75 feet long, and 5' wide, approximately 8.5 feet deep, with 4.0 feet of sewer rock beneath the perforated pipe (the effective depth of the trench). 3.2 A total of 4.5 ft. of sewer rock shall be placed after trench excavation. Four feet of rock shall be beneath the perforated drain pipe in the trench. A minimum of 2 inches of sewer rock shall be placed over the perforated pipe. The trench will be built in a 't' shape as shown on the plans. 3.3 Sewer rock shall be 0~5 - 2.5" screened gravel with less than 3 % passing the #200 sieve. 3.4 Cleanout pipes and monitor tubes shall be 4" diameter and installed as shown of the plan. The portion of the monitor tube extending through the sewer 3.5 rock shall be perforated. All monitor tubes and cleanout pipes shall have waterproof caps conforming to Municipality of Anchorage Specifications. Filter fabric shall be placed over the sewer rock, and a minimum of 3 foot of backfill shall cover the rock. If the contour of the existing ground prevents 3 feet of cover, rigid insulation shall be placed wherever the cover is less than 3 feet. 4.0 ENGINEERING INSPECTIONS 4.1 A minimum of four engineering inspections will be required during construction of the system. One after the septic tank is set prior to backfill, one after excavation of the trench prior to placement of sewer rock, one after placement of sewer rock and all distribution piping, cleanouts and monitoring tubes are in place. The final inspection shall be after the filter fabric is placed , the trench backfilled and the final grading is complete. 4.2 The contractor shall coordinate with the engineer at least 24 hours prior to start of construction. o ( ( ' ����X ��I ���1 T � ��F� ��� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 850064 DATE ISSUED: 03/14/85 APPLICANT: RICHARD C. BUTTON ADDRESS:' 200 W. 34TH. AVE. ANCHORAGE, AK 99503 CONTACT PHONE: 561-4386 LEGAL DESCRIP: SUBDIVISION: MANN LOT: 2 BLOCK: 5 SECTION: 3 TOWNSHIP: 1}N RANGE: 3W LOT SIZE: 45000 (SQ.FT. OR ACRES) I certi{v that: 1. I am familiar with the requirements for on -site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes arnd regulations and in compliance with -the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the sot back distances fm any existingwellwastewater disposal system or public sewadjacent or nearby lot. SIGNED DATE: �> �------- -------- ---7-- ---- APPLICANT:I � ISSUED BY DATE: -\ ` 9 c WATER WELL RECORD STATE OF ALASK_ A DEPARTMENT OF. NATURAL RESOURES Division of Geological. a Geophysical Surveys . Drilling Permit`No LOCATION OF WELL' (Please complete either la, Ib or Ic.) A. D. L: No la. Borough Subdivision Lot Block_ -. Ib 1/4gtra. Section No. Township N ❑ Range-_''` E j .._t1I.j` ct-or_ot s❑ w❑ [�,eridian Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3: OWNER OF WELL:',-.. Ric:iax'�I.'BL� ten _I Address: Street Address and Area of Well Location. . 2. WELL LOG Feet Below Surface Surface 4. WELL DEPTH: (final) - DATE OF COMPLETION"' Material Type Top Bottom 154 it .r .20 ..—'. CS -. eat (� g; : ❑Cable too(; - ❑Rotary .. Driven Dug r *iP?t :•j 7 il�!)�•'c P ?. a :'E2i '. h 1�i ❑ Auger - ❑Jetted ❑ Bored ❑ Other Pei 4.raaVE3 wi t-I d 10t -0i cz4Pr 14 11 7. USE: ❑ Domestic `- ❑ Public Supply : ❑ Industry'. ' Cementer' ` eraye* 111, `hard i)an ' 17 47 irrigation" Recharge ❑Commerical Lcasz, - Crac: tired bedbxk . 47 52 Test Well • ❑ Other: I3�'�irOC'r? L54 8. CASING Threaded ❑^ Welded tJater 1n ircctured rocks �5 3.`j�+ diam. ,fit in. to EVI ' ft. Depth Weight �.7 Ibs.�ft. diam: in. to ., ft. Depth Stickup ft. > 9. FINISH OF WELL:.,s Type: 0T?f313 i'r t) Diameter. - fill Slot/Mesh" Slze `.:'' Length:'., Set between ft and - ft := :. Backfillin9 Gravel pock 10 STATIC WATER LEVEL - . Date ❑ Above or. :. ❑ Below land "surface Equipment .used PL�.�.�1V�-�c�Ier-': - 11 PUMPING LEVEL below land surface and YIELD ;. - 1t. .after '� hrs. pumping ''- .fq.p m --77777 - it: after hre." pumpmq' q.p.m.' 12.GROUTING Well Grouted Yes. 0 No - Material •❑ Neot Cement', � Other - "- 13. PUMP ': (if avalloble) -:;HP N Length of Drop Pipe ft capacity ;.' - _. g p M. w ❑S Jet .,�C �0 ubm.` entnfical them r 0 14. REMARKS:, z Bailed n for ;l i�our.. gP• 1 of 'I. "draiAgw Gp:;.ft. - - _i. 16 WATER WELL CONTRACTORS CERTIFICATION s 15 . Water Temperature. o: ❑ F ❑ C; _ This well was drilled under my jurisdiction and this report is true to the best of m• knowledge and belief, - Y DO71 rV DRILLING CO. , LA0512' - t _ Registered Business Name Contract License Number•_::'. AdAreaa. = U37 IJARTZFL.Lt $O�,D. Afi3�'IIt1T?r1GL. A1.��SI:A 99501 Signed. _ l 1 ,-, ; 'Dote. 1 _85 j �--" Authorizea� Representative Form 02-WWR (II/81) Copy Distribution. WHITE- State DGGS, PINK -Driller, CANARY - Customer DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 STREET, ANCHORAGE, AK. 91 ` , hon-o'oo /LJ 0 4'14 E" L_L- 6=1 K E> 143—So I -T E=n "Em E=n !A! K FKI K E=n & PI 1 7- PERM/T NO. ( 790610 APPLICANT DHVE BELHNGER 5700 OLD SW HNY LOCATION LORETTH ST LEGAL L2 B5 MHNN SUB DIY LOT SIZE TYPE OF SOIL HESORBTION SYSTEM IS: TRENCH I , ' 0 Sal. k-)- &V 38750 SQURRE ET MHXIMUMNUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �KF=,Kk-up= �71 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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 MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). IFT? E=7 Ell Lj 1 EE:r E -.: F=1 -7- 1 F� �1=0 R%k it! !E; 1 171 E=7= ����� ���L_���� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILUSERYE. I QJ Im K FEE (1. _T - ]TE C:o ��tLrl 1 F�,? REE� --- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT NILL BE SUBJECT TO PROSECUTI01-t ~ MINIMUM DISTANCE BETWEEN H WELL HND ANY ON -SITE SEWAGE DISPOSAL SYSTEM IS 108 FEET FOR H PRIVATE WELLn OR 150-TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED FINE) MUST BE RETURNED TO THE DEPARTMENT WITHIN 70 DRY' OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. to* ���1 _T- 1EE 1-19"1, K K0 K 1-1 F, EE-E �� ���� I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPHLITY OF HNCHORHOE. 2: I WILL TySTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTRND THHT THE ON -SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE I� REMODELED TO INCLUDE MORE THAN ] BEDROOMS. ` SIGNED:__ ^�-� Y]�2 _______________ ISSUED B details of formations penetrated, size of material, color and hardness Location (address of: Township, Range, Section, if known; or distance main road Size of casing— Depth of Hole feet Cased to feet Static water level ft. (ab6ve) (below) land surface. Finish of well (check one) open end X'- - Screen Perforated Describe screen or perforation Well pumping test at gallons per (h6iik) (minute) for hours with of drawdown from static level. Date of completion WELL LOG Depth in feet from ground surface TO TO_-� TO ------------- - - -TO TO TO TO MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephono 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOCATION -- . ' ' ' Wall · I DISTANCE TO' I Z/~/~ ~ Absorption area I-- Z I Manufacturer..'"') I~ .. v IDISTANCE TO' IWell Dwelling · ~Z I' I ~ ~ ~ Manufacturer ~1 I Well . ~, ~ (J. , Foundation d? I DISTANCE TO: I ~'~/~----~ ~ /(~--'~ I Nc. of,ne, ¢ I en th4fe h,ne Toreador,ne, ~)I-- Top of tile to finish grade /~-~ Material beneath tile I.u I Length Width Depth ~' I~ -~~ Crib depth ~u~ ~" DISTANCE TO: Well ku I Building foundation ~ IClass Depth Driller ~ DISTANCE TO: Building foundation Sewer line _~ONE .,, ~]EW NO. OFBEDROOMS PERMIT NO- o~m. anis liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot I~r~ / Trench ,~:1~, inches PERM"r NO~c:/~/~ Distance bet~..~. To,a, area PERMIT NO: Total effective absorption area Nearest lot line Distance to lot line J~_ERMIT NO, Septic tank I Absorption area(s) OTHER P I P/~ A.T E R I A L8..~. I NSTA L L~ REMARKS 2-1yr'3 (Rev. 3/78) CT' DATE LEGAL ~. 10 11 12 13 14 15 16 17 18 19 20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-6§0, Anchora0a, Ala-q;a 99502 ~76-222l SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMEE): LEGAL DESCRIPTION: .................... Z .............. ~ ........... ~ ......... Z ''. SLOPE SI'FI: PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S 0 Net Drop IRoading Date Gross Not Depth to Time 'rime Water PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ..... FT AND FT COMMENTS 72-008 (7/76) DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTN & ENVIRONMENTAL PROTEOTI~pT, OF 825 L Street - Anchorage, Alaska 99501 ENVIRONMEN I'AL ENVIRONMENTAL SANITATION DIVISION AUG 8 1980 Telephone 264-4720 ..o. ST .o.A...OVA. AT.. A.. DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ PHONE MAILING ADDRES~ PROPERTY RESIDENT (If¢different from above) PRONE 2. BUYER PHONE MAILING ADDRESS 4, BEABTO~/AGENT I PHONE I MAILIN6 ADD~E88 5, LEGAL DESCRIPTION 6. TYPE OF RESIDENCE [~SI ~G LE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Other [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SU/EPLY E~' INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED, [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [~] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER []Septic Tank or [] Holdin§ Tank Size: /~)c.~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ..~.~./~:~_~y.,.~ 4, DISTANCESwELL TO: Septic/Holding_f~/{~ ~.~Tank Absorptions(/Dc/.hArea Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS I~PPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accom~ certificate) [] DISAPPROVED 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES �, Div(s(on of Environmental Services On=Site Services Section P.O Box 196650' Anchorage, Alaska ' 99519-6650 =' - _ 343-4744 - .. ) ^ f CERTIFICATE OF HEALTH_ AUTHORITY APPROVAL FOR`ASINGLE FAMILY DWELLING` Parcel I D. # C Zd 60 HAA # `l05 ` I 1 GENERAL INFORMATION:,..,,c t Complete legal description Location (site address or directions) / C `0� 5/�l �11T -.JA %C STD" Property owner �r �r'S- �C�� �P�i��'!l'' Day phone — SSzZ Mailing address Lending agency. Day phone Mailing address Agent 4, Day phone 72-025(Rev.1/91) Front MOA#21 72-M5 OW.1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUMCIf'M 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90/�r'd3=4T4` `' Health Authority Approval Checklist Legal Description: 2- 13L5 Ad .&&/J 471,E 13 t-2 Parcel I.D.: C2-C;— A. WELL DATA Well type 12Ct Q J f� If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed-- F� Total depth I f:; - Cased to 6� Casing height (above ground) Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG (23 2-0 �� /r WATER SAMPLE RESULTS: 6 Wires properly protected (Y/N) Z_ AT INSPECTION �--2`� g.p.m. 3 142 g.p.m. Coliform D Nitrate (0 , S JV /7 "G Other bacteria C) Date of sample: I / r 2- Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ' - G C Tank size Number of Compartments 2-Cleanouts (Y/N) Y Foundation cleanout (Y/N) \� Depression (Y/N) High water alarm (Y/N) (I �v � i,c.4 ��T Date of Pumping umper C. ABSORPTION FIELD DATA _ Date installed j%- lo, if-"f 2 , Voil rating (g.p.d./ft2 or ft2/bdrm) System type Length } Width 2- Gravel thickness below pipe Z� Z Total depth Effective absorption area �o� Monitoring Tube present (Y/N)_�/ Depression over field (Y/N) /\ l /-ie�w c,2 r22 Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): _ Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION t I c Date installed l�l e V < 1 l l C Size in gallons Manhole/Access (Y/N) "Pump on" level at* `��"Pump off" level at* r( High water alarm level at* Cycles tested E. SEPARATION DISTANCES M *Datum© f-F, T'>%C,_ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot l Z ©/ On adjacent lots _�> / CIO / Absorption field on lot l On adjacent lots 1 C6/ Public sewer main Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AJIX Foundation l Property line V7L Absorption field--,--) r Water main/service line Iq -0 Surface water/drainage tv �'i' Wells on adjacent lots> SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 0 ; Building foundation l Water main/service line 55 Surface water Driveway, parking/vehicle storage area l ) � 6,4 Curtain drain / I 00 Wells on adjacent lots-�� / n C% F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal records that-tha aka"ve. systefiis,'are in conformance with MOA HAAquideh a in effect on this date. Signaturer I Engineer's Name (f� ,J G Date HAA Fee $ 3 " , 0--E) Date of Payment d / 5 /11 Receipt Number �5 3X3 l a 1 Waiver Fee $ 67) Date of Payment /I/1_r147 9 Receipt Number 5,3 ,K J Q/00 72-026 (Rev. 3/96)* James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 345-1572 NOV 19 1999 MUTT C_'PalltY Ot Anchora Dept. Health & Human e ervjces Nov. 19, 1999 MUNICIPALITY OF ANCHORAGE Health & Human Services Department On -Site Services Section PO Box 196650 825 L Street Anchorage, Alaska 99519 SUBJECT: Lot Line Waiver Request. Lot 2, Block 5 Mann Subdivision Gentlemen: The 12' x 30' Intermittent Bottomless Sand Filter constructed as an Up -grade for a failed deep trench leach field was constructed 0.5 ft. from the Lot line. There was not suitable soil on the lot in locations that could maintain the lot line separation of 10 ft. and the required well separation distance. Granting of this waiver should not prevent the owner of the Lot 1 immediately to the South from upgrading his septic system Thank you for your attention to this matter. If additional information is required, please call. Sincerely yo rs James F. Sizemore P. E, MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -site Services Section Waiver Review Worksheet WR# WR990092 PID# 020-051-08 HA# HA990571 Permit # Date Received: 11-19-99 Legal Description: Mann Subdivision, Lot 2 Block 5 Engineer: James Sizemore & Associates 6410 Switzerland Dr., Anchorage AK 99516 Applicant: Mr & Mrs. -nave Belanger Waiver Requested: A request for a 5 foot distance between lea _hfield and tat- line. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec # : 05383 Amount: $ $1 1 5.00 Date Paid: 1 1 _ 1 q_qq municie-paiLtuy of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.anchorage.ak.us November 23, 1999 James F. Sizemore 6410 Switzerland Drive Anchorage, AK 99516 Subject: Waiver Request for Mann Block 5 Lot 2 Waiver Request #WR990092 Parcel ID #020-051-08 Health Authority #HA990571 Dear Mr. Sizemore: Your request for a waiver of the required 10 feet horizontal separation from the on -site wastewater disposal system to property line has been approved. The approved separation distance is 0.5 feet. This waiver approval applies to the existing on -site wastewater disposal system to property line separation only. Any future upgrade to the on -site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears, E.I.T. Civil Engineer On -Site Water Quality Program