HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 8 LT 3
~T~T~/ ' 'v'~
O~-Sfi'a '¢¢~tar & V,/~staw~?ar
P.O. g~x 196650
Anchor~a, AK 995 !9-6650
(907) 243-7904
Pump Installation Log
VCeI1 Dr411Lag Permit Number:
Date of Issue:
Parcel IdentXficafion N~mber:__
Pump Intake D~pth Below Top of WeE CasMg:
Pump ~an~acmr~r's Name: ~
p~p Sae ~ hp
pifless Adapter BmdM Dep~: ~ feet
Pittess Adapter Xanafacmrar's Name:
P~_t~ess Adapter Installer: /L~ Jq
Attention: The pump installer shah provide a pump instmttmtion log to the DSD witkin 30 isys of pump
LOCATION OF WELL
~/~ . ~_ -z ~?
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
SOROUGH
I
SECT[ON QTP~ SECTION TOW~ISHrP RANGE
E~N LqE
DS
WELL OWNER: 4/~k.~C~\ ~-.~(~(._~v(~ ~'~
MERIDIAN
LOCATION/SKETCH:
DEPTHS MEASURED FROM:~[[casing top r-lground surface
BOREHOLE DAT,A: . ,
Material Type and Color
-: Depth
From To
']~'l~lclpallty of A~
Dept. Health & Hum
DATE OF COMPLErION
Depth of hole: /CZ- ft
Depth of casing: /O,~_,, _ft / / '~// / ~
DEPTH,TO STATIC WATER LEVEL:
'Zt//'f ft below .[~ top of casing [] ground surface
Date: / / //'/ / ~G
METHOD OF DRILLING: [~,air rotary [] cable tool
[] other
USE OF WELL: ~].domestic [] irrigation [] monitor
E] public supply [] other
CASING STICK-UP:. ,~-, ft. Diam: , __~,?n, to~__ ft
Casing type: .~'2-~:~/x]---'"'~'-~/~,,~f
WELL INTAKE OPENING TYPE: [] open end ~J~screened
[] perforated [] open hole
Depths of openings: ~.~? to 6.,.,.~__ ft
SCREEN TYPE: ~',~' Diam: ~;~ in.
Slot/Mesh Size: .~,'~'
GRAVEL PACK TYPE:
Volume used: "Elepth to too;
GROUT TYPE: j Vo ume: /
Depth: from
DEVEI.OPMENT METHOD:
Duration:
PUMPING LEVEL AND YIELD:
ft after hrs pumping.
gpm
PUMP INTAKE DEPTH: __ ft Horsepower:
WELL DISINFECTED UPON COMPLETION7 .~t YES [] NO
CONTRACTOR INFOr~MATION:
Regis?red B~iness Nam~'~ ......
~nature of Authorized~resentative Date
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF MINING & WATER MGMT
3601 C St, suite 800
Anchorage, Ak 99503-5935
Ph(907)762-2538,Fax(907)562-1384
PAGE i OF i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950407
DESIGN ENGINEER:
OWNER NAME:MORGENTHALER BOYD & KATHRYN
OWNER ADDRESS:il80 SHORE DR.
ANCHORAGE, AK. 99515
DATE ISSUED: 1/02/96
EXPIRATION DATE: 1/02/97
PARCEL ID:01920108
LEGAL DESCRIPTION:
SKYWAY PARK ESTATES BLK
8 LT 3
LOT SIZE: 67500 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM Ol~L~
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 (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY: ~h~
DATE:
DATE:
RECEIVE[)
BOYD & KATHRYN MORGENTHALER JAN X 199
1180 SHORE DRIVE
,. Municipality ol Anch,ora¢le
ANCHORAGE, ALASKA 99515 uept, Health a Human SerVices
Mr. Jim Williams
Municipality of Anchorage
On Site Services Department
Suite 502, 825 L Street
Anchorage, Alaska
Januaw 1,1995
HAND CARRIED
Re: Residential Well at 1180 Shore Drive, Anchorage
Skyway Park Estates Subdivision Block 8, Lot 3
Subj: Request for Permit to Drill New Well
Dear Jim:
Happy New Year! This may be your first urgent request of 1996!
Please issue a permit for drilling a new residential well as referenced above.
This request is submitted with some urgency. Our old well pump failed suddenly
yesterday, on December 31. The only pump available on such short notice was
installed, but it pumps the well dry in just seven minutes. Our system is now only
marginally operable, and we run the risk of burning out the new pump motor if the water
is left running too long.
When we discussed this last November, I noted that we had been experiencing a water
shortage for several years. The existing well (installed in 1979 or 1980) produced
approximately 3 gpm in 1991. Currently, the well is producing approximately 1.5 gpm.
This drop off in production rate is apparently due to the build up of silt at the bottom of
the casing. The well is not screened or perforated. The probability of successfully
restoring of this old well is not worth the economic risk.
Attached please find a copy of our as-built site plan and the Sewer location plan from
AWWU, as we discussed previously by phone. Review of the drawings will show that
there are no sources of contamination within 100 feet, discounting the building waste
service line. The lot to the east (Block 8, Lot 2) is undeveloped. The AWWU sewer
main in Shore [}rive is 130 feet North of the proposed new well and 98 feet North of the
existing well. There are no fuel storage tanks on either Lot 3 or Lot 2.
With your approval to drill the new well, Alpine Drilling will begin on January 2 or Jan 3,
1995. Otherwise, we will be forced to wait a month to get back in the Driller's schedule.
Your assistance will be very much appreciated. 'f'hanks for you help.
Sincerely,
'RECEIVED
JAN 2 X'199~
MunicCpahty of Anchorage
Dept. Health & Human 8ervi~e
O
Indicate North
RECEIVED
dAN ~ X 199~
,.(~t Heall;h & H~Jman Ser~;~e,e.
DRILLING, INC.
I~UNICIPALITY OF ANCHORAGE
DEPT. C)F I]SALTH &
ENVIRONMENTAL t,hO [ECTION
Well Owner__
DRILLING LOG
JUN 5/979
Location (address of: Township, Range, Section, if l~nown; or distance main road
Size of casing. (~" Depth of Hole_
Static water level o ft. :(,~b'6~'~)
Screen ( ); Perforated (
Describe screen or perforation
Well pumping test at /; gallons per
of drawdown from static level.
Date of completion 5/21./79
6.1. feet Cased to (i0~ 6 feet
(below) land surface. Finish of well (check one)
).
.,:,~i~,~
(minute) for ]- hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
('1 TO " "1' ,'ktt
' TO
3 TO_
~ TO
~;!~
TO
TO_
.TO_
.TO_
.TO
.TO_
.TO_
.TO_
.TO_
.TO.
open end ( ,::': );
3--CONTRACTOR
FII':'F::'L I C:J'::II",I'F
l ,OCFIT I Oi",l
I... Ei:C:iI':IL.
I'"IIN]ii'd!JH [)I~.:-:;TFII'.,ICE: E:':E;TIqI~:E!:N FI FIE:L[. FIN[) FII",I'T' Ol",l--!-i;I"f'E ~?:;E~HI':I[31=.
::1.O0 F'EEiT f=OF'. FI I::'R:I:VFI'I"I'~ 14E:L.I..~ CJI:'?.
::1.750 TO ~:~00 F'E:E:T F'F?.OI'"[ FI F'L.II_:~I....:I:C I,.ll~:I...!.. [)E:F'I'~-:I",II)]'I',IG IJF:'Oi'.,[ THE: T"?PK OF: F'UDL]:C
I.'JE~I..L.. IJ3L:i:ii: I::II:~'.E~ RD.,:!IJ:I:F?.E:~I::, F'II",I[) I'"IU:S'F E~Ei RE:TLli:~:I".IlSE:, TO TI.iT:: DIi~':I='F:IF?.THEI",H' P.I:(T'H:I:N
i::lI.:: TH[i:: I,IELL C:CiHF'I..E~'F:I:Cli",I.
I:YTI"II::R I:i?.E:[i:!LI:!:Rlii:HEI'.,IT::S HFI"r' FIF:'F'L.."r'. :SI:::'E:C:IF']:I:::FFF:I:ON:!:i; F:II",IE:, C:ON!~:TI:;?.t.ICTiON [:) ]: F]EiI,?.FIM':'~ FIRE:
FIVf:I:fL.F:IF?I..E~ TO ):MS:LIR. E: F:'F~'.OF:'E:I'~'. II',ISTKIL.L.F:FI~IOI",I.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR NEALTH 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)
(b)
(c)
Location (address or directions)
Applicant Name ./'/~."' ~ _/-,~.~ .~'~';~' Telephone: Home
Applicant Address //~O ,~/)/1~ z
Applicant is (check one): Lending Institution ~; Owner/~; Buyer []; Other ~ (explain);
Business
(d) I~ending Institution ,"F¢,~-,'',~'5~' ,"~,,'¢~--~/* ~ Telephone
Address ~/ ~ ~y~
(e) Real Estate Company and Agent ~ ~¢~ ,~~
Address _~o~ ~/~/~ ~ ~¢~%~~
Telephone ~ ~
(f) Mail the HAA to the following address:
2. 'rYPE OF RESIDENCE
Single-Family.~ Multi-Family ['] Other
Number of Bedrooms ~
WATER SDPPLY
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.
4. SEWAGE DISPOSAL
D Public~L Community ['] Holding Tank []
Onsite
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11~84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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.
N a m e o f Fi r m -~,~/~'~/../.~' ..~/'.,~'x~ ~.E- _Telephone
Address ~/ //~
Date ~/-Z ~ - ~
DHEP APPROVAL
Approved,or C )bedroomsb 7
Approved /'"~"~' Disapproved Conditional
Terms of Conditional Approval
Date
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)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORAGE
DI~PT. OF HEALTH &
ENVIRONMENTAl- PROTECTION
RECEIVED
Legal DescrJptlon: ~"'~'~' ~'~ '~ ""~'/-'~/ ~
WELL DATA
Wel Classification J~'-~.'¢-/
Wel Log Present (Y/N) _
Total Depth ~/ ~ased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit [Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Depth of Grouting -/~'.,~'~
Pump Set At __ ¢-',,4¢,.~¢,¢*c,~-7
Sanitary Seal on Casing (Y/N) ,~
Depression Around Wellhead (Y/N) _ ~/
On Adjoining Lots /.L.,,,,~
_: On Adjoining Lots '~',,"/,,~
To Nearest Edge of Abso at,on Field on Lot
To Nearest Public Sewer Line ./o,~ ~' To Nearest Public Sewer
Cleanout/Manhole .,./,~,~. ¢' To Nearest Sewer Service Line on Lot
Water Sample Collected by ./'~/~? ._~:2:~"~¢'~'~ ; Date '""/-- ¢'-~'
Water Sample Test Results _ ~/'"~' '-~'~"¢r¢'/
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) Air-t ght Caps (Y/N) _
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water.-Supp~y Well
To Property Line
To Water Main/Service Line
Course
Size No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
: for
Temporary Holding Tank Permit [Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond Lake. or Major Drainage
Comments
Page ' of 2
72-02601/84)
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
Separation Distance from Absorption Field:
To Water-Supply Well
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
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
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 haJv~ checkeCcverified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~.,.~ ~ Date ./,¢,/'¢~ ~',~'- ~¢'4¢'
Company ."~/Z--//' ~'- /~-~¢'¢~J -~2'~ ~'~'~ ~'
,,'~" MOA No.
Receipt NO. 2d~/ ~:~¢:~//
Date of Payment /~,/J/~
Amount:$ ~,~'-. ~
Page 2 of 2
72-026 (11/84)
BEVAN ENGINEERING
Approved Well & Septic Engineers
I'~lclve. mbe!r' :~!5~ J. 986
P.O. Box 112852
Anchorage, AK 99511
MUNICIPALiTy OF ANCHORAGE
D,F--.,P,T, Of: FlEA T
I F. CEIVED
(907) 522-1383
(907) 258-0584
Re :: M!'~u-'t'.y Plt.u"ll<e'bt:, Health Au'EhcH.'it:y Appr'cJval (HAA) Applicat:LcJrl
L.o'k 3 Blk [-] Skyway F:'ark Efr[:a'kl~il
t:tar-iod .]:r'om Novaml:~er' 1.7 'bo ]qc~ventbar" 2A~ :1.9136 N~:~ F}~r-.foF'dla~d r-eib, teat'ch,
gaf. i onE~ ar'ici v~a]. 1 flo~ te~ting pur'~L.larrk 'ko He!a].'kh
We. per".Eor'mecl a well .Flow 'kee;t and foLInd 'khe wel 1 [:~r'oduc:'~ion to I:}a~ 4.5 gal Ions
t:ook a wa'kqr' sampl a 'For Col i.For'm anal y!~i~; and 'khe ra!~ul'k!~i ware I'lt~.>F~ative.
To our' knowledge all o.F 'bhe in.Fc)r'ma'i:ion reques'bed on t. he I.-IAA Cl'ieck].:i.~r[: arid
App]:i.c:a'kictn haiti I:n~E:~n a!~i~ffiblad. WE} ar"a !!iLibmit'~:[gg 'kh:Ls data 'bO yi::lLI '{:of your"
r'ev:i, ew,, F:'].~as~e c(:m'l:ac:'k L.~ i'F w~, c:an pr'c~vida any additic)nal
Si n cl:~.r'e I y ,~
Hugh R~ Br~¥an F:',,E~
c:c: Hat"ky F:'i mql<a'kE
EIA 2~fEI-'w
~) MUNICIPALITY OF ANCHORAGE DEPI' OF l,':"!' .&
DEPARTMENT OF HEALTH & .
ENVIRONMENTAL PROTECTIONIRONMEN1AL PF;O'£bCTION
82E L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION filer 1 ~1979
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE I
· rv~ ~h~| I~i~[.r N ~0 r ANCHO[tAGE
DIRECTIONS: Complete all parts on page 1. incomplete requests will not be processed. Please allow ten {10) days for processing.
~-. PROPERTY OWNER
~AI LINE ADDRESS
JPHONE
PHONE
PROPERTY RESIDENT (if different from above)
PNONE
~'BUYER
~-AI LIN G ADDRESS
PHONE
3, LENDING INSTITUTION
JPHONE
MAILING ADDRESS
~.. REALTOR/AGENT
MAILING ADDRESS
m
~' LEGAL DESCRIPTION
~TREET LOCATION
6~' TYPE OF RI=.SIDENCE
[~'~,- SI NG LE FAMILY
~ MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
r~ Two [] Five
~i~.- Three Six
[]
E_- Other
7. WATER SUPPLY
I
NDIVIDUAL'
COMMUNITY
I-- PUBLIC UTI LI'f'Y
S. SEWAGE DISPOSAL SYSTEM
[-- INDIVIDUAL/ON-SITE*'
'~ PUBLIC UTILITY
ATTACH WELL LOG, A well log is required for al wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
'*If individual/on-site, give installation date
If system is over ~wo (2) years old an adequac'y test is required
hy this Depgrtment.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
'~.010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTO R INSPECTOR
DIRECTIONS:
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 SYSTEN] PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
I~]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~/~APPROV ED FOR ~ .BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev, 3/78)