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HomeMy WebLinkAboutKRAMP BLK 3 LT 7 M-W DRILLING, Inc. P.O. Box 10-378 * 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG (,( . J ,.,ur; ... ~ Use of Well ~)o~,m~;t.; ~': Well Owner Location (address of: Township, Range, Section, if known; or distance main road Size of casing. ~',~' Depth of Hole Static water level .,',~z~ ft. (abave) Screen ( ); Perforated ( .i.'2 f feet Cased to 't 2 ¥, !; feet (below) land surface. Finish of well (check one) ). Describe screen or perforation Non ~. Well pumping test at !.'~ gallons per (herin.) of drawdown from static level. Date of completion ~)ecmni,,-'.:~ "-) ~, !91)3 (minute) for 'i hours with WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 .TO. "'- Ca~ing ~;~ :~.cl~.~l.~ :; .TO. 3 Fill '~ .TO.__('; 0 .TO. t 0 .TO. 3 3 5 .TO. '/ 7L .TO. 94 9/: .TO. J ! 0 _TO _TO .TO _TO _TO .TO TO open end ( ,.'iXX ); :i:ti.t y (~z~ve& (::ray Certificate No's. 814 & 973 ~;:! ],t'? Iiax.'dp~!, 3--CONTRACTOR Department '~ Health and Environmente' ~rotection 825~ Street, Anchorage, AK. ,~01 * * * HANDWRITTEN PERMIT * * ~ WELL ~~~T Location: Legal Description: ~, 7 8]~ % Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: Phone Number: Seepage Bed: Lot Size: Holding Tank: Soil Rating(sq.ft/br) ~[~ The Required Size of the Soil Absorption System Is: DEPTH ~)//~ LENfSTH /V'f~F- GRAVEL DEPTH /L//~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a 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 outfall pipe and the bottom of the excavation(in feet). * * REQUIRED' SEPTIC(HOLDING) TANK SiZE = ¢3/~;' GALLONS * * ermit applicant has the responsibility to inform this department during the nstallation inspections of any wells adjacent to this property and the number f residences tha~ the well will serve. ~' * * 7~0(2) INSPECTIONS ARE REgUIRED * ackfilling of any system without final inspection and approval by this department ill be subject 'to prosecution. [inimum distance between a well and any on-site sewage disposal system is 100 feet or a private well or 150 to 200 feet from a public well depending upon the type ~f public .well. Minimum distance from a private well to a private sewer line .s 25 feet and to a community sewer line is 75 feet. Well logs are required .nd must be returned, to this department within 30 days of the well completion. ~ther requirements may apply. Specifications and construction diagrams are vailable to insure pzoper installation. * * * PERMIT EXPIRES I}ECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install t. he system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled' to include more that 3 bedrooms. -:-- - . .... 2~ ' Issued by: Date: ~¢/~, ~ ~ ' ~i;'~g~_h ~ima~sio_n ±~ '~-he, l~ngt~(in feet) of the t%e~oh or drai~field~ ~:: ~ ~ REQUt~ED SEPTIt:(HO~IN~)' TANK 8~ZE ~ ~/~ GALLONS ~,~.'~pp~i~ant ~ ~h~ ~.~pon~b~l~ty ~o ~nfo~ thi~ department '~ * * PERMIT [XPIR~S DECf~mER 2>1~ i 9 ~ 3 ! GENERAL INFORMATION Complete legal description 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. Lot.~7.; Bloc~.3~.Kramp Subdiv~io~ 11930 Northern Raven · Property owner _, . . Mailing address '~:" ", Lending agency Mailing address Location (site address or directions) Cindy Krogman 11930 Northern Raven Anchoraq.e, Anchora,qe~ AK . Day phone AK 99516 Day phone. 345-5825 Agent' Day phone _ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,~ '~_ TYPE OF WATER SUPPLY: Individual well xxx Community well Public water 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 Holding tank Community on-site .... Public sewer X×X NOTE: If community wastewater system, provide written confirmation from State ADEC .... ., .;: ' attesting to the legality and Status of system. 72-025 (Rev. 1/911 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/or wastewater dis posal 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 Municipalit~ 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 Phone ~/¢¢--Z.~'¢ ¢ Eagle, I~lv~'~_~_.~" a 99. .- Address Engineer's sig nature . Date DHHS SIGNATURE Approved for ,5 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 abovu 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 federa an.d state requirements. Em ployees of DHHSdonot Conduct inspections or analyze data before a certificate is issued..The Municipality of Anchorage is not responsible for e~rors or omissions in the professional engineer's work.. 72-025 (Rev. 1/91) Back MOA 1121 Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ '7 _~* ,~' A, Well Data Well type / Log presen (~N) Total depth Sanita~ sea~) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed /~/~/L~ ~ Driller Cased to /'2 '-/, (_~ ¢-~/ Casing height Wires properly protected (~/~) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION Septic/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL TO: g.p.m.rrl ; On adjacent lots /~//4. ; On adjacent lots /'~ Public sewer manhole/clea~eut Sewer service line ';~' Petroleum tank /C/© ~/V A'~/)¢/c~ ~ Coliform ~2 Nitrate O¢ / O Other bacteria ' S & S ENGINEERING Date of sample: ~/~/¢ ~ Collected by: !1~4 E-~'~ m~er L~op Road Eagle River, Alasl(a 99577 B. SEPTIC/HOLDING TANK DATA Date installed Tank size Co~~-~ Cleanouts (Y/N) Foundation cleanout (Y/N) // D~ression (Y/N) High water alarm (Y/N) ~m tested (Y/N) Date of pumping ~ Pumper SEPARATION DISTANCES FRO~OLDING TANK TO: Well(s) on lot /~ On adjacent lots Foundation To prope~yAt~ Absorption field Water main/se~ice line Sudace water/drainage 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/~~ Vent (Y/N) "Pump on" level at ~ "Pump off" Level at High water alarm level ~ Cycles tested Meets MOA ~) SEP~I'~N DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorptioq area Width Date of adequacY test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM AB Well on lot ...-'On adjacent lots To building foundation On adjace~ Iot~'~ Su~,~ater (./~rtain drain Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) Results (pass/fail) .~After test If yes, give date System type ¢/ Total depth ~// De~/N) .,..-~ Tor Bedrooms Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parkinCvehicle storage area E. ENGINEER'S CERTIFICATION I ceA'fy that I have checked, verified, or conformed to afl MOA and HAA guidelines in effecto/~ith¢'d~of this inspection. Signature ~ ...... /~..Z ~~ Engineer's Name 17;3~4~~o~ Date Eagle Eiver~j(a // HAAFee$ ~)~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3~93)' Back zTL Commercial Testing & Engineering Co, Environmental Laboratory Services ~.,~r~.~',~,a~,,e',~r,,~'~',~,a,~.e,~,~,,e~'~ LABORATORY ANALYSIS REPORT Client Name S & S ENOINEEIEflqG WOld4 Order 77198 Ordered By RIS Prh~tad Date 04/08/94 ,:~} I0;31 tffs, Project Na,ne Collected Date 04/04/94 (~ 16:20 ~s, Project~ Received Date 04/05/94 (i~ 09:30 bJs. PW8~ UA Technical Director S'I'.I:;I'.HJ.';N C., EDE ............................................................................................. fimnp/e Remm'k.s: ROI.1TLNE SAMPLE COLLECTED BY: SS QC Allowable Ext. Anal Parameter l}.esttlt~: Qmd Un[ts Method limits Date Date * See Special tnstructi OhS Abovc ** Sea Sample Rem~ks Above U = Und~t ected, Rep ort cd v 'al t~c is th e p tactical qua~,.t [ fi catio n 1 i m i t. D = ,'qeco n da~7 dilution. UA= UJiavailable NA ~ Not Al~al. yzcd 15633 El Street, Anchorage, AK 996181-1600 -- Tek (907) 5~2-2343 Fax: (~07} 561-5301 MUNICIPALITY OF ANCHOP&GE DIVISION OF ENVIRONMENTAL HEALI~:i DEPARTMENT OF HEALTH AND ENREII~ONMENTAL PRfMfEClqON APPLICATION b7DR HEALTH AUTHORITY APPROVAL CER<FIFICATE 1o C~r~ral Information Ap.Dlication Date (a) Legal L~scripticn (include lot, block, subdivision, section, township, range) Lo~tion (ad.ess o~ directions) Applicants ~e ss~Z~~_~ 2- (c) Applicant is (che~ o~) ~nding Institution ~; O~r~uil~r ~; Buyer ~ ; O~er (d) I~nding Institution %%lephop~ Address (e) Ileal Estate Co. & Agent Adck, ess Te le phone 2. _Type. __of Residenoe Single-Family Numce~ of Bedrooms 3. Water S__uj~.~.lj~ Mult i-Fmnily ~ Other (describe) Individual k%ll~~ C~unity ~ Public ~I Note: If c~nmunity ~11 system, must have written confirmation from the State Depa~tn~nt of Environmental Conservation attesting to the legality and status. Is the ~11 adequate fo~ the number of hedrcxnns specified in this HAA (Y/N) %( .S¢ wa~gsa.l' Onsite ~ Public~ Community ~ Holding Tank ~ Is the wastewater disDosal system adequate fcr the p~nbez, of bcdro~rms (Y/N) [Page 1 of 2] 2-15~84 5. Engir~erinq Firm Providir~~ns, 2%sts, Eata and Information I certify that I have checked, verified, or conformed to all LVDA HAA Q~id~lir~,~s ir effect on the date of ti%is insrx~,ction. ( ENGINEER SEAL) Terms of Ccndit:ional Approval The Municipality of Ar:cho~age L!3partnent cf }-~alth and Environment-hi Prctecticn dc not guarantee the continued satisfactory p~rfoznm~nc~ of t~e water supply, e~:d/cr t~- wastewater disposal system. This approval indicates that¢ as of the validation d~~ shown, aLwove, based on the data and information furnished by an engireer registere~ the State of Alaska, the w-ater supply and wastewater disposal system is safe and ~ tioo, al for the number of bedroca%s and type of stm'ucU~,e indicated. ( [~-tEP SEAL) 7. Mail the NAA to the follc~ing address: KB2/dS/s [Page 2 off 2] 2-15- 84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well C].assification ~ If A, B, c~ C, D.E.C. Approved(Y/N) Well Log Ih~esent (Y/N) ~/ Date Completed %%~ ~ ~% · Yieid~~ Total ~p~_ ~ 0_% ~ Card to ~%~ ~x __ ~pth of G~outing ~)/~) ~. ~.~' Static Water ~1 ~,~ ~[,.~ .. ~ ~t A~0~A3~~ Casing ~ight ~ Gr~nd 1~"+ Sanit~y ~al on ~sing (Y/~) TO ~ptic/Holding Ta~ ~ ~t ~ ; ~ Adjoining E:tL~A. ' To ~a~est Edge of ~so~ption Field on ~t ~/~ , ; ~ Adjoining Lots~~. ...... . . .,.. . ..... ~ ~'~ ,. . . ~te Installed Si~ No. of C~nts Standpi~s (Y~) Ai~-tight Caps ~ Foundation Cleanout ~p~ession o~ Tank J~) Date ~st P~d Pt~ing~intenan~ Con~act ~ File (Y~) ; for Holding Ta~ High-Wate~ Ala~ (~ ~a~y Holdi~ Tank ~it (Y~) ~p~ation Distan~s ~ ~ptic~olding Tank: To Water-Supply ~11__ To ~]ildinq F~ndati~ To ~o~rty Li~ To Dis~sal Field To ~ter Main/Se~vi~ Li~ To S~e~, Pond, ~e, ~ ~jor ~aina~ Course Conments [Page 1 of 2] MUI,,!ICIPAIJI'¥ O~ ANCI IOt~AGI:~ DEPT, OF IIE-AI_¥1a & ENVtllOIqMEI','TAL PEO'I ECIION 2=!5~84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Alzea Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent !Y/N) Date of Last Adequacy Test Separation Distance f~cmAbsorption Field: To ktate~-Supply Well To Building Foundation To Wate~Main/Service Line To P~operty Line To Existing or Abandoned System cz% ; On Adjoining Lots To CUtbank(if present) To Stream/Pond/Lake/o~ Major D~ainage Course To D~iveway, Pa~king A~ea, or Vehicle Sto~age A~ea Ccn~ents Date Installed Size in Gallons "Pump On" Level at High Wate~ Alarm Level at Tested fop Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) .Pumping Cycles du~ing Adequacy Test. Meets MOA C~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checke.~ verified, o~ confc~med to all MOA HAA Guidelines in effect on the date O~ thi~, ~2~pect/fo~. -~ --- KB1/d5/s ~ ~ ~ ~~5 - 8 4