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HomeMy WebLinkAboutUS SURVEY 3044 LT 41C ~-'VV DRILLING, Inc. P.O. BOX 10-378 * 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner TL,~'r~c', ~BZL~ _UseofWe]l Location (address of: Township, Range, Section, if known; or distance main road Lot 41 C US Sm~vey ~304A Size of casing 6" Depth of Hole Static water level 40 ft. Screen ( ); Perforated ( Describe screen or perforation_ None Well pumping test at__.~gallons per (h'~ of drawdown from static level. 50 feet Cased to 49.55 feet (below) land surface. Finish of well (check one) ). open end ( , ); (minute) for 1 _hours with i00;,~ Date of completion_ I.kiy 24, 1984 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO_ 2 CasirLg sticleam TO. 3S m~ .TO. 50 .TO. .TO .TO _ TO_ .TO. .TO. .TO. _ __TO_ .... .TO .......... _ _TO_ Olive Gray C%av Gray silty tlardpan w/cobbles Brown silty Gravel -- danp iN'WIViK ~; er t ~J'i ecl Contractor Certificate No's. 814 & 973 3 -- CONTRACTOR PERH T 1- i'.l i: [:,FtT[~ IS~;LIE[:,: ]:,EF'FIF;:THENI' OF HEFILTH FIND Ei',i',,,'IRONI',tENTFIL F'ROTECI"ION 825 L '_:;TREE:T, Flt'.,ICHORRGE., FIR 264-4720 FIF'PL.. I E:Ffi'..Ff': FI [:, [:, R E S L--.,: CONTRCI" F'H EJi",IE P'IIE:HFIEL R. TUHE'¢ F'O BOF,: 4'_:i,:J_ . G 1[ RIi:.,FfE~QB,., FI~::: :99!587 L. EGRL [. b..:.,L.~. I, LOT .:, _. ,':.E . L. OT LOCF!-I'I E~F,I: SUBD!',/tSION: US SURVEY :~:~:044. LOT: SECTIOI',I: 8,-":1.7' TOI,INSHIP: ::LON RFINGE: 2E ::L2~:::!..7 (S6!. FT. OR FIE:RES) G I RD!.qOE~D E:LF,S,k:: NR ! CERT I F'?' i. ! FIH FF!HIL. IFtR WITFI ']-HE: RE~;!L.IIF:EMENT:E; FOE: ON-SITE SEI-,.IERq RND IqELLS FIS SET F'ORTH D"? ]'FIE HUNiCIF'FILIT'¢ ElF FII'.~E:HORF!GE (I"IOFI) FIND THE STFITE OF FILRSKR. ..2'. i 1.4ILL IhtSTRLL. THE Sh-'STEH iN RCCORDFINCE FIITH FILL P10FI CO[)E::S FIND REGULR:rIoNs, F:¢.,tD ZN COHPL. ZRNE:E I.,!):T'H THE DESZGIq C:RI'FEF::IFI OF THIS F'ERH]:T. Z !.,.i![LL R[)FIEF'.E TO F~LL. i'qOR FIN© i:,TRTE OF FIL. RS';k:FI REL.:!LIIREHENTS FOR THE SET BFICI< DiSTRi',tCES FROH FIf'.,W E',:.::ISTING !.,.IE:LL.., !-,IR'..:..TEI-,IFITER [:,ISF'OSFIL S'¢STEf'I OR PUBLIC '_:;EI.,.!EF:FIGE S'¢?TEPi Oh! THIS OR R['.,l'¢ :.IDJFDENT OR qEFtRB'?' LO]". S I GNE[:, :'~F'F'L I C:RN-r: ISS _ F-E:, E, r h'IIE:FIFIEL H. I- ~.~ B, RTE [:'FITE MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name A~C~/~fc '%~¥ Telephone - Home ~8)~%siness Applicants Address ?,C' ~ ~ ~ t G /~0'~d~o£~ ~Ft< ')? ~-~?~ (c) Applicant is (check one) Lending Institution ~ ; Owner/builder ~ Buyer ~; Other ~q (explain); (d) Lending Institution ~ ~_~l~ ~<~f~ ~?~CO~ ~,~l~'~ Telephone (e) Real Estate Co. & Agent__~ Address Telephone (f) Mail the HAA to the following address: T~pe of Residence Single-Family,( Number of Bedrooms Multi-Family Other (describe) 3. Water Supp1Z 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 states. 4. Sewage Disposal Onsite~ Public~ Community~ Holding Tank~ Note: If community well system, must have v~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspection{, 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 regula- tions in effect on the date of this inspection. Name of Firm /~/~7c~ ~v,w~,~.l ~,.:/ro! ~,"~5 /~ Telephone ~%~ ~-~O Address /~ ~'~ ~3 /~a~ /~ ~~3~-°I ~ Date (ENGINEER SEAL) DHEP Approval Approved for bedrooms Approved ~/~ Disapproved Terms of Conditional Approval Conditional CAUTION THE [,fONICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 H~fES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® '~"~ MUNICIPALITY OF ANCHORAGI~' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (BAA) CHECKLIST - FEBRUARY 1984 Well Log P~esent (Y/N) ~ Total Depth ~o Cased to Static Water Level q ~7) Casing Height Above Ground Electz~ical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot b3 A To Nearest Edge of Absorption Field on Lot SEP ! 0 t984 RECEIVED If A, B, c~ C, DoEoC. Approved(Y/N) Date Completed i%~ 'Lq/~ql~c~id g Gp~v~ Sanit~y ~al on Casing (Y~) ~ ~ession ~ound ~llhead (Y~) ~ To Nearest Public Sewer Line Cle a ncu t/Maf4a~tl~ .~ Water Sample Collected By I>~ Water Sample Test Results Con,Tents To Nearest Public Hewer Nearest Sewe~ Service Line on LOt ; Date ~ .. ~ ~,~L ; On Adjoining Lots /dk ; On Adjoining Lots B. SEPTIC/}IOIJDING TANK DATA ~tments 'of alled Size No~ Standpipe-~/N) Air-tight Caps (Y/N) ~1~dation Cleanout (Y/N) Depression ove~'~nk~(Y/N) Date Last P~"~__ ~ Pumping/Maintenance Con~H~ile ~/ ; for Holding Tank High-Wate_~ ~a_~m (.~.~ Tempo~ak~; Holding Tat%k Rermit (Y/N) Sepa~_ation Distances ~l~'~'Ioldi~ TO Water-Supply ~ To Buil~d_ation TO P~ope~ty L/~ To Disposal Fiel~.~ To Wat/c~in/Se~vice Line To Stream, Pond, Lake~-Major D~ainage Conments [Page 1 of 21 2-15-84 Ce FIELD DATA Sol Date Width of Field lng in Absorption St=ata Type of System Length of Field__ Depth of Field Gravel Bed Thic Square Feet o~ Absorption Depression ove= Field (Y/N) Date of Last P~esent (Y/N) Test Results of Last Adequacy Test Separation Distance f~omAbsorption To kEster-Supply Well To Building Foundation Lot To Wate~ Main/Service Line To Stream/Pond/Lake/c~ Major To D~iveway, Parking A~ea, o~ Con~nts ; On Adjoir Line Existin~doned System on Lots To Chtbamk(if present~ Course ~ Sto~age A~ea ~ De Size in Gallons "Pump On" Level at High Wate~ Alarm Level at Tested fo~ Electrical Codes(Y/N) Comments Dimensions Manhole/Access (Y/N) '~'~mp~Off" Level at Pumping Cycles du~ing Ade~s MOA / ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformsd to all MOA on the date of this inspection. Company /~ ~-~ /4 ~ KB1/d5/s [Page 2 of 2] MOA No. ~ o~ 2-15-84