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HomeMy WebLinkAboutKWIK LOG BLK 3 LT 22BKwik Log Block Lot 22B #013-043-54 WELL LOG RECEIVED APR I 5 1994 Manicipality o4 Anchorag. e Dept. Health & Human Services Date Drilled: Static Water Level Draw Down N/A April 4, 1994 18 feet feet Ken Baptiste Gallons Per Minute ' 30 + Total Feet of Casi.ng 1i8' Type Material Drilled: 0 feet to 2 ft. Ove_rburden 2 ft. 30 ft. 35 ft. 45 ft. 60 ft. to 30 ft. Clay to 35 ft. Rock w/clay to 45 ft. Gravel w/H20 7R Fi, · 90 ft. 100 ft. to 60 ft. Rock w/clay to 75 rock w/l_ittle UZ0____ to 78 Silt_sL.~and to 90 ft. Rock w/cia_ff. to 100 ft. wet rock w/_clDy to 105 ft. Gravel /H20, some clay 105 ft. to 110 ft; Gravel w/H2~ 110 ft. to 118 ft. Clean gravel w/ H20 HEFTY DRILLING 3540 AKULA DRIVE ANCHORAGE, AK 99516 (907) 345-0593 PAGE 1 OF 1 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:SW940035 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:BAPTISTE KENNETH R & OWNER ADDRESS:621 E 73RD AVE ANCHORAGE AK 99518 DATE ISSUED: 2/22/94 EXPIRATION DATE: 2/22/95 PARCEL ID:01304354 LEGAL DESCRIPTION: KWIK LOG BLK 3 LT 22B LOT SIZE: 9144 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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 RECEIVED BY: ISSUED BY: DATE: DATE: As Built /" Anchorage, Alaska ~: ?'~ -~/'/~/& /-~-? ~ 4-' No 'Corners Set This Date Book No. Page Ne, I hereby certify that I have ~urveyed the following described property, L~t 22~ Block ~ , ,' '.,'. 5)/?,D, Anchore{~ recording Precinct, Alaska, end that tl~e improvementt situated thereon are within tile property lines and do not overlap or encroach on the proper~y lying adjacent thereto, ~het no Improvement~ on properW lying adjacent thereto encroac~ on the premilel in question and that there ere no ro~dwayl, transmis~ion lines or other visible easements on ~aid properW except, e! Indicated hereon, Indicate North z il >-- © © c~ o_ o ~- Municipality of Anchorage Development Services Department Building Safety Division · On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lo Location (site address or directions) Current Property owner(s) t H Mailing address Expiration Date: Day phone Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: · Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: [~/ Individual On-site ~  Individual Holding tank Community On-site [~ [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval am required for the transfer of title (except between spouses) for properties served by a single-~mily on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid fcr 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to cna year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of struc~re indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and fi.om my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State ccdes, ordinances, and regulations in effect at the time of installation. Name of Firm l'""'O ~ ~ ~'. gVU ?'V,.te. v~. Address ~ ~ ~, ~ Engineer's Printed Name ' t J 0~,~ ~ v' DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for ("'~ bedrooms. Phone bedrooms, with the follow~ng stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. cLanchorage, ak. us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descdptfon: A. WEll DATA Date com;leted Total depth tt ~ ft. Date of test Static water level Well production If A, B, or C provide PWSID # Santtar~ seal (Y/N) Casedte tt/~ ft. FROM WELL LOG "~O g.p.m. Parcel iD: O1.~ -' Oq~l" 5~'I Well Log (Y/N) y Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION q7 ~t g.p.m. WATER SAMPLE RESULTS: Coliform ~/-~.. colonies/100 mi. Arsenic: mgo/I. B. SEPTIC/HOLDING TANK DATA of.mplo: Other bacteria Collected by: ~ colonies/100 mi. Tank Type/Material Tank size gal. Date installed Cleanoute Foundation cteanout (Y/N) (Y/N) High water alarm Date of pumping C. ABSORPTION FIELD DATA Date installed Soil Length ft. Total de~th ~ ft. Eft. ft2 Date of adeduac~ Results (Pass/Fail) Fluid test in. below pipe ff. Depression over flelc~ For bedrooms New depth in. Elapsed 'lqme: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. UFT STATION ~ ' ' Data insTiled Size in gallorls Ma/~e/Access (Y/N) 'Pump on level at in. 'Pump off' level at in. /~lgh water alarm level at in. Datum ~ __ Cycles tasted ~ w / Meets alan~ & circuit requirements? E. SEPARATION DISTANCES Absorption field on lot ~ ~ ~ / On adjacent lots." _ Public sewer main ~ JO D' / Public sewer manhole/cleanout Sewer/septic service line ~ '~' / '" Holding tank SEPARATION DISTANCES FROM S~TIC/HOLDING TANK ON LOT TO: / Building foundation ./ Property line__. Absorption . . Water main / Water service line .... Surfa~ .. Wells on adjacent lots / SEPARATION DISTAI~E FROM ABSORPTION FIELD ON LOT / Property line / Building foundation _ . ~/~tar ma!n __ .. Watar Bewice I/jKe . Surface watar ~ Driveway, pan~ingNehicle storage / Curtain d~if_ ' .Wells on adjacent lots F. COM NTB · ~.~ ~ENTS .';'',: . ".- G. ENGINEER'S CERTIFICATION ~T ~..;,"'.,. .~.~ · ::~:. '%, .,.~ . I certify that I have determined through field inspections and ;:i" ":'~'~~-'-" :' ~''~ ........ review of Municipal records that the above systems am in ,~, , orme.ce MOA o.date. Data ~o- ~-~--U~ "' HAA Fee $ Date of Payment Receipt Number (~ev. ~2/o~) Waiver Fee $ Data of Payment Receipt Number ,JUN-2S-OZ 04:27~ FROIJ-CT&E EN¥1RONIEIiTAL SRV · ~,~t~___ CT&E Environmental Servlcea Inc. T-419 P.02/02 CT&E Ref. #: Client Name: Project Name: Client Samp!e ID; Malrix: pWSID Sample Remarks: 1023728001 Tobben Spurkla,'l~ P.E. Kwick Log Lot 22b, BIk 3 Kwlck Log Lot 22b, B:k 3 Drinking Water Chert! PO#: nla Printed Date/Time: 06/25/02 15:30 Collected Date/Time: 06/24102 14:20 Received Date/Time: 06,'24/02 14:30 Technical Director:. Step~,e~ Ede Pa,"ameter Nitrate Total Coliform (MF) 0.200U 0 PQL Unite 0.200 mg~- cai/100 mi Ai[owai=le Prep Method Limits Date Date Init EPA 300 10.~ 06/24/02 JDT SM9222B C(~/24/02 KAP . . · ~ ~.~~. "~ ....~-,.~',~ ..'~. · Jl ~ ~ ~mibilill O~ Iht owner lo ~ctcmltnc thc :, ASBUiLT ANCHO~GE ~CO~G DIS~ ~ HUB AND TACK · P~D BY: DOWLING & ASSOC~TE$ , 1426 Hyder Street : .. "~ ' Aneho~ge, Alaska 99501 ~VISION8 DATE . BY DA~: BY: ~ SCALE: WO~ O~ER: FIELD BOOK: GMD NO.: ' ~'~ ~ ,'- , D/~'I>E RECEIVED ' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DA'T~_~ ~ ~.,' INSPECTOR ~NSPECTOR INSPEC~,~R MUNICIPALITY OF ANCHORAGE~~ OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 ENVIRONMEi ~i,"-.L i ,...:i ~CT ON ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~ DIRECTIONS'. Complete aH parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, P~OPERTVOWNER , ~ PHONE I MA~G ADbR~S PROPERTY RESIDENT (If different from above)- ' ' PHONE 2. BUYER / ' MAILING ADDRES~ 3. LENDING INSTITUTION , /~/ ] PHONE I MAILtNG ADDRESS MAI LIN~Abb~E~S ,- , ~ -, / STREET LOCATION 6. TYPE OF RESIDENCE X SINGLE FAMILY [] MULTIPLE FAMILY 7, WATER SUPPLY [] INDIVIDUAL* ,~ COMMUNITY PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Other [] Two [] F ire ~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. 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 -' PERMIT NUMBER ' ' ' 3. SEWAGE DISPOSAL SYSTEM ~ I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified z~ ~-)-.l,~ ~_ 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 ' ' Septic/Holdin9 Tank IAbsorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to noarest Lot Line 5. COMMENTS ~ APPROVED FOR r~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79)