HomeMy WebLinkAboutKRAMP BLK 1 LT 7~*~
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WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of GeologicDI A Geophysicol Surveys
LOCATION OF WELL (Pleose complele either lo, lb or lc.)
Sorougb S,bdi,,,,o. Lo, B,oc
~JoIsTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address end Areo of Well Locallon
2. WELL LOG
Material Type
Top
Feet Below
Surface
Drilling Permit No.
A.D.L. NO.
Soclion No. Townehip Nj~] Renge
MUNCCiPALiTY-~c-ANC~
~OF HE^LTH
ENVIRONMENTAL PROTI
16, WATER WELL CONTRACTOR'S CERTiFiCATION:
OWNER OF WELL:
Address:
~RAGF
:TION.
WELL DEPTH: (final)
I ,::'. % n.
E[~ Meridian
5. DATE OF COMPLETIO~
6. ,,~.COble 1001 ~]Rol~ry [] Driven L~J Dug
E] Auger E]Jetled [~ Bored [-'~ Other:
8. CASING: [] Throaded [] Welded 1'*~
diam. r:[~[ [n · to /'~,3 ft. Oeplh weight ~ / lbs./ft.
9. FINISH OF WELL:
Slol/Mesh Size; Lenglh:
Sol between fl. and
ft.
This well was drilled under my ju~isdJclion and this report is Irue to lhe best et my knowledge and belief;
Registered Business Name Conlrocf License Number
~;~:~I~t)Z:~Wn ill/Oil Copy OiSJ~ibulio~: WHITE-Stole OGGS, PINK-Driller, CANARY-Customer
PUMPING LEVEL below lend surface and YIELD
ft. offer hrs. pumping g,p.m.
I~,GROUTING Well Grouted: [] YO~ [] No
Material: [] Neo! Com.nt []Other:
13. PUMP: (if available) HP
Longlh of Drop Pipe fl. copocily g.p.m.
~ Sabra. [] Jet [~ Cenlrifical [] Other
I4.REMARKS:
Water Temperalure .___o [] F [] C
STATIC WATER LEVEL: /',.~ ft, ."~'/__~)~i'i
[] Above or [-~-Below land ~urfoco Dote
Equipment used: ~L-i~?!?(- ;Ji'r;'~
L.?' Eikl., i':::F?.I~IMF'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section,,township, range)
Location (address or directions)
(b) Property Owner /~ ~1 C_ /~¢,z~-~¢,~4 Telephone: Home Business
(c)
Mailing Address
Lending Institution /~r.//. /C~c,r~,,/-c.. /_~//..
Mailing Address
(d) Real Estate Company and Agent )t--~o~7.~¢,,_~~ ~A~¢p...-~.~-¥ / ~._.¢--I //'>
Address _~o ,,G ~ ~ , ~C ~.
/
Telephone ~ ~ - ~/¢ ~ ~
(e) Mail the HAA to the followinq address: or: Check here ~if hold for pick up.
List contact person and day phone number below.
5 & S-ENGiNEERiNG
17034 Ea.qle River Loop Ron~ ~ ~
Eagle River, Alaska 995~
TYPE OF RESIDENCE
Single-Family ~/'
Number of Bedrooms _
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.
Page 1 of 2 72-025 fRev 8/86~ Front
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WELL DATA
Well Classification
Well Log Present~'.~/N)
Total Depth _ /~-%,~ '
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit(~/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST .:FEBRUARY 1984
264-4720
Legal Description:
If A, B. C. D.E.C. Approved (Y/N)
Date Completed ~7/_ '~ -,,_~7_~ Yield
Depth of Grouting
Pump Set At I,
Sanitary Seal on Casing
Depression Around Wellhead (Y,~
Cased to ! ~-,~
To Nearest Edge Of Absorption Field on Lot __
To Nearest Public Sewer Line t~'L:~ / .~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
Cleanout/Manhole _
Water Sample Collected by .~ ¢ -~ ~-¢'~f-~¢/'/'~-'~-"~/"//-~ ; Date
Water Sample Test Results
Comments ~i/l~~ ~"~-o ~-*' '~,~,~4 ,--"'~ 5'"/~'/~ ~ .,' --~
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed '~ Size No, of Compartments
St~tp.~(Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression"ov~.~k (Y/N) .... Date Last Pumped
Pumping/Maintenanc~tract on File (Y/N) ' for /
Holding Tank High-Water Alarm~-~/N)---~%._._~ Temporar~zJ4otd~ Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank: -~~
To Water-Supply Well
To Property Line // To ~n-~j-~datlon
To Disposal Field''-~--
To Water Main/Servi~i~ nl~'e To Stream, Pond, Lake~, r-~.or Drainage
C o u r..se...~ ~' .....
Page 1 of 2
7P-~P6f11/841
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata -'-~
Type of System Design
d Length of Field _- ---- .......
t Depth of Fieldj ~JJ ,-~ ....
Gravel Bed Thickness J
Square Feet of Absorption Are'a-.. Stand~gip sesesesesesesesesese~resent (Y/N)
Depression over Field (Y/N) ~"~,~~D'D'D'D'~t oeoeoeoe~Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Fled ~/ ~-~
To Water-Supply Well ~-- Ix) Pro-pe~.~ne
To Building Foundation ,-/"" g or Abandoned System on
Lot / ;On Adjoining Lot '"-T~
To Cutbank (if present) ~
To Water M~Line
To St.~mCPond/Lake/or Major Drainage Course
~,g-4D'riveway, P. ~rking ~Area, or Vehicle Stora~ge Area
Comments '-~ (_~,~,/,../~."r.~%~,'1'~ / ~ ~,~,~ c. .5,~co~_/'~ ,
D. 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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed $ & $ ENGINEERING Date ,~'~-~///,.~ ,/..,~ 7
17034 Eagle Riv~ L~p Road No. 2~ ~2~ ~ p ~
C°mpa~gJe River, Alaska ~9577 MOA No.
ReceiptNo, /~ ¢/ ~ O ~
Date of Payment , ~//~/~
/
Amount: $ / ~ ¢~
Page 2 of 2
72-026 (11/84)
CHEMICAL _&.GEOLOGICAL LA~BOR~A_T:O. RIE___.~S OF.~__ALASKA, INC. '°Y"~
ANALYSIS REPORT BY SAMPLE
Client PO~I : VERBAL Req ~I:
Client Smpl ID: LOT '? KRAMP S/l}, 5-5-87 1445 HRS
Sample Rec'd : MAY 5 87
Ordered By
REPORTS ADDRESS #1
S & S ENGINEERING
Work OrderNo. : 359
Client Account : SNSENGP
Bate Report Printed: MAY 12 87 @ 15:33
Released By : ~
REPORTS ABDRESS 02
17034 EAGLE RIVER LOOP RD., #204
EAGLE RIVER, AK. 99577
Special BY JPM
Instruct:
Chemlab Ref ~: 6131 Lab Smpl ID: 1 Matrix; Water
Allowable
ParameterTested Result/Units Method Limits
NITRATE-N ND (0.1~) mo/ 10
TOTAL COLIFORM c col/100ml
Sample L7 KRAMP, HOSE BIB, 5-5-87, 1440 HRS BY JPM
Remarks:
2 Tests Performed * See Special InstructionsAbove
ND= None Detected ** See S,ampl e Remarks Above
NA= Not Anal yzed LT=Less Than, GT=Groater Than