HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 3 LT 17B ,f~jWATER WELL RECORD
STATE OF ALASKA
OEPARTMENT OF NATURAL RESOURES
Division of Geologicol P, Geophysicol Surveys
io.?l Boro.h Subdlvlllon~'/~' Lot 81ock
..~-~.~/, ~l ,~.,,,.. ,.,,.n.o. To.ri..,.o ..0. ~o"'""'
WELL LOG Feet Below 4. WELL OEPTH: (final) ~. DATE OF COMPLETION
~"""" ~/ ,,. ~ - = ~ - ~ ~..
r"?T r IJ~T'~ P OAbOve or _~ Below lend outface DOte
AU~ 1 8 198~ ,,. ~u....~ ,~v~ b.,.. ,.., ...,.....,
MOIOHII: ~ NIQ9 Cement 00fhlr:
15. Water Tlmperal~r~----~-~ g ~ C
PERMIT NO. (
RPPLICRNT CiE ENT. INC
LOCRTION
LEGRL LI?B B~ CRMPBELL HTS
¥
PO BOX 10-931
LOT SIZE
87~ SOURRE FEET
MINIMUM DISTRNCE BETHEEN R HELL RND RNY ON-SITE SEHRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE HELL OR 3.50 TO 200 FEET FROM R PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL
MINIHUrl DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RND
TO R COMMUNITY SEHER LINE IS 75 FEET.
HELL LOGS RRE REQUIRED RND HUST BE RETURNED TO THE DEPRRTMEHT HITHI[~ ~0 DRYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS HRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER IHSTRLLRTION.
PERI'"I I T EXP I RE--C; BEr2~EI"IBER 2--:1.. -1982
I CERTIFY THRT
1: I RM FRMILIRR HITH THE REQUIREMENTS FOR ON-SITE SEHERS RND HELLS RS SET
FORTH BY THE HLINICIPRLITY OF RNCHORRGE.
2: I HILL INSTRLL THE SYSTEM IN RCCORBRNCE HITH THE CODES.
S I GNED: ....
RPPLICRNT C&E ENT. INC
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;I ti.]LL...II,I~Ttqi.',. 11-5-. yT,':-,I£H llq .HJ:C'C?.DIIf~L'.E {.ll~ll file ~-:OC~('.'-~.
FIF"'~'L-]C'RI'.r{' ~'.~F. FI.II'. if/.: .
..,-/_.- ~-, - ~-
....... ................ , .....
..: ~ ..-:._:,.. :::._._:.. ......... : ~,~.~J: · . r Division of Enwmnmental Services. :-: ,.-~ ..
,. .. ..... : ..... On-Site Ser~tces Sec o - .- .
X'196650 ~:h~ia'ge;A ~
': .................... P O Bo ':;'An a~[ka'~ 99519-6650 ...... -"J~'
.:.:,:~ .,. . ....... _-.: . ,:; ..: AUTHORITY :-~..:: .... ...............
- - ' ...... APPROVAL FOR A SINGLE FAMILY DWELLING
.- ................. -~ ~'~.-,; ;! Parce ID #'~::3\t-~--C'3"~'~1-'" -~,-~ .......................................................... '-- -'".' '.- ': · HAA# ~C~,~-~,~-~c~ ' ' .... ! ......
- .'~.- ~'--~i: -' '(~EI~ERA[.'INFO RMATION ..................
~::..:~x:,'~-~,.:-Locatl~n ts~teaddress ordlrections)- (3'"51 ,.._A. -~,,. ~, ....
..... ' ......... [,l~r0oertv owner ~ ~--~-~ ~*~& ~)~c~ 0 i ..
,~ ..,- :.: .,... .;....~,~.~,.......-~....:~:',,~.,~, .~ .~, :...- ....... .:.._..-:!: ,, ..-.~.,; : :,~...,~, :::--.~: :..-
% '-~--.' -' .... ',.~nd~na aaen~ · ~ ~,~ ~e~ Day phone
,; '~'~;. .'..~;%-~ -%,~?.-,~;~., .-~-~,~.,-,~.?,....,~ .,.. .... ~ -:.~ ?,.~C. .,:~ ~-.. .-~.: ~; ..... .;'..~.~r~...~, ~.~;.~;c~
~ ~": Unle~ othe~se ~uest~; H~ will be held for pickup.~ ~ ~ ?, ~,, ..... -., :--~.. ~.~,.~, ~- ~ .....
!}~.'~2:~ ~0T~?lf ~'~i~ll ~ste~;:P~o~ide Wri~en'confi~ation from State ADEC a~est-:~
,. ~'r'.,~., 4, ,*.~PE OF WASTEWATER DISPOSA~ -.-.- , .:- ..... :' "' .... ~,", '*.~ ~'-'~,'.~'~¢c ;-.
......... ~..~ ........... ~ ............ ~ ......... ,. - .... x,~ ...... ~ .... ..,~t,~ ~;~ . -
.... - ~ ...... NOTE: .'- If commum~ wastewater system,provide wr/~en confi~at~on from State ADEG.:. , .......~.?
- · .-.. · ~ a~estina to the leaali~and status ofs~tem..- .: -. · ..~, ,....,::~...... -..- .... .. -,.. ~. ·
~.-.. .... ::_:;.'"~:- . ....
........... 5 ..... STATEMENT OF INSPECTION BY. ENGINEER .~ ...... ,~... ............................ : ......
.... ..*'. As ce~fl~ by my seal affixed hereto and as of the validation date shown below, I veri~ that my
investigation of this Health Authori~ Approval applimtion shows that the on-site water supply :n.;..~.~
and/or wastewater dispo~l system is ~fe, functional and ad~uate f~r the numar of b~rooms
and ~pe of structure indi~t~ herein I fu~her veri~ that bas~ on the info~ation ob~in~ from
the Municipali~ of Anchorage files and from my investigation and ins~tion, the onqite water .- .....
.. supply and/or wastewater dis~l s~tem Is in compliance with all Municipal and State codes, ~" ........
ordinances and r~ulations in eff~t on the date bf this ins~ion ' '
- Name 0f Fi~ - ~ ~¢~ ..... Phone ; ' '-~-"
-' : '' ' ~:" ., ' r .., ,' ~ ~t ' .... ~-:' ~)~.~ ~'~.
............--[~;; , .......... ~~ ~:~ ~~ ~"~ ~ ..
. Engm~esmgnature _ .-~ _ .- Date
. . . . ·~ ~ . ~--~.~__ ~-'_' ..~ ~:..'.~...~:
,-.~-, "; · · .~" ' '~F ~ · '~-,1:~;-~-=.~ ~--'..~;:, ..'.'",'~-~''
, ....... .... ,; ,-.- ..,- . , .' . ..... .,
6. -.,. D~S SIGNA~RE ........................................ I~:~~ ,',~-'-' ~'*..~'~':~,~"~ '~ '
·. .-'.By ........ Date :::,.'... -
. L'~_~ , .~. - ',',,,'. ........ - -. -..- ~ . · . · _ ........
..... .~ ~e M~m~ h~ of ~ge De~nt of Halth ~nd Human ~1~ (DHHS) I~u~ H~I~
:' - :' -. ~Approval__ .~ -- ~~fl~t~ only u~n ~ ~pr~n~hons g~n In ~mg~ph 5 a~ve by'an
~ '. and ~i~hdin~ ~fions in ~er m ~fls~ ~n~l and ~te ~uim~. ~ploy~ of DHHS do not ,':~ '.
~nslble for e~o~ or omi~o~ in ~ p~f~i~l, engin~(s wo~..,: ..., -,., ,~ ....?. ~, ..... . . :~ -~.. ~ .- -.,, =~, .... .
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICF-oSen
1995
Environmental Services Division
oF..r
825"L" Street, Room 502 · Anchorage, Alaska 99501· (90~t~.~i1~[~ of Anchorage~
Dept. Health & Human Service"'~"-"-~'
Health Authority Approval Checklist
Legal Description: I e,~. 17 R. ~'t ~,C.~'~. ~ Parcel I.D.:
A. WELL DATA Ce,,.,.p~c\\ ~A~[ej~ars c~,..~,d:,,D, le,,,.
Well t)pe q:),. l ,.,e.-L,e IfA. B. or C. attach ADEC letter. ADEC water system number
Date completed $/'~ q f ~'9..
Total depth 7(-, .g'ee.$ Cased to 7K ge:eA- Casing height (above ground) ~ .~ ~Ce~.
Sanita~seal(Y/N~ tee~
Wires properly protected (Y/N) ~,=~
Date of test
Static water level
FROM WELL LOG
AT INSPECTION
.-ge;
Well production 7
WATER SAMPLE RESULTS:
Coliform
Date of sample:
g.p.m. E;, ~, g.p.m.
Nitrate
C~. t (5 ~ / L. Other bacteria ~-'
Collected by: .3~-.e~ ~.
B. SEIrflC/IIOLDING TANK DATA
Date installed
ABSORPTION FIELD DATA
Date installed I'4/,~,
Length. Width
Effective absorption area
Date of adequacy test
Tank size
Depression
Pumper
Numbes of Compartments Cleanouts (Y/N').
High water alarm
Soil rating (g.p.d./fl: or ft:/bdrm)
Grav~ below pipe
Tubc present(y/N)
/ Results {Pass/Fail)
System type
Total depth
Depression over field (Y/N) __
For bedrooms
Fluid depth, in abso~tio~eldf~before/test (in. ); _ Immediately, after gal water added (i
Fluid depth ' '~:~ ~':': ~ ' ' .... .' "' =
~ Minutes later: .... '~ On.)' Absorptmn rate g.p.d.
p .xide~'~ ~
ero. ' treatment (past 12 months) (Y/N) If yes. give date
D. LIFF STATION '.
Date inslallcd }4/,fi, ~-----Size in gallons
Manhole/Access (Y/lq) on" level at*
High water alarm~ *Datum
Cycles~
'Pump off' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding lank on lot
Absorption field on lot
Public sewer main ~
Sewer/septic sen, ice line
; On adjacent lots N/6
; On adjacent lots k~//x.
Public sewer manhole/cleanout
Lilt station Iq/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Iq//~ ~ Absorption field
Water mai~g~qtli3'~ Surface water/drainage Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface v,,ater
Curtain ~t~~
F. ENGINEER'S CERTIFICATION
..,.-Wal'~'~in/se trice linc
Drk'cway, parking/vehicle slamgc area
Wells on adjacent lots
I certify that I have determined thrufield inspections and review of Municipal records~. _thk~_ .'e~stems are
in conformance with MOA IL-IA guidelines in effect on this date. ~ ~ 0 F ~ t'~'~ ~ ·
/'7
-. ( / ,,Q v
~,lgnature \/..'~..,Ox vt, _.O~.A~. , , ,~..
Date of Payment Oi _ ~. o~ .~ Date of Payment
Receipt Number 4.- C~ I.'3 %0/ Receipt Number
/
Rev. 8/95 OSS: haa.~vk.doc
Sky Laboratory
Soils and Materials Testing, Geotechnical and Environmental Engineering
RESIDENTIAL WELL FLOW TEST REPORT
LEGAL: Lot 17B, Block 3, Campbell Heights Subdivision
LOCATION: 4031 East 67th Avenue, Anchorage, Alaska 99507
OWNER/CLIENT: Daniel and Janice Boots
RESIDENCE: 3 bedroom, single family
TYPE OF WELL: Private
WELL LOG AVAILABLE: Yes - Attached
WELL PRODUCTION RATE: 5.6 GPM for 4 hours
DATE OF TEST: August 22, 1995
COLIFORM/NITRATE WATER QUALITY SAMPLE TAKEN: Yes
WATER TEST RESULTS: Satisfactory - Reports attached
TESTPROCEDURE
The four hour well test was conducted on August 22, 1995 by Mr. James A. Smith, P.E.,
Principal Engineer. The well was pumped at a steady flow rate of 5.6 GPM for a total of
2,340 gallons, Total water level drawdown from a static water level of 35 feet was 16 feet
after one hour of pumping. At this point the water surface level in the well was static at 52.5
feet below the top of the well casing.
TEST RESULTS
The well flow rate meets the basic requirements of the Municipality of Anchorage for a three
bedroom single family residence as of the day the system was tested. It also meets the FHA
3 GPM for 4 hours requirement.
The assessment of the condition of this well applies only to the conditions as of this date.
The flow rate of any well may change due to subsurface conditions that may not be observed
from the surface, changes in land use and other factors that may impact the conditions of the
aquifer supplying the well.
The test data and investigation of existing conditions is provided to our client for submittal to
the Municipal Health Department for their review and approval. Any concerns with this test
report should be discussed with the testing engineer.
BOOTS.WEL
August 25, 1995
P.O. Box 670371, Chugiak, Alaska 99567
Phone/Fwc (907) 688-0344
CT&Z Ref.#
Matrix
Client Sample
CT&E Environmental Services Inc.
Laboratory Division '~fJJJJJJJJJ~l~f~fJJJJ~r
,s.~,~=-~ Laboratory Analysis Report
~ATER
Technical Director
STEPHEN C. EDE
Sample Re~arks: SAMPLE COLLE~-i'2D BY~ JAMES A. SMITH.
See Special Instructions Above UA - Unavailable
See Sample Remarks Above NA - Not Analyzed
Undetected, Reported value is the practical quantification liml=. LT - Lese Than
Seconda~ dLlution. GT - Greater Than
200 W. Potter Drive. Anchorage. AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907} 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA
From Welt
WELL FLOW TEST DATA SHEET
Log~ From Probing Meaaurements~
~ell Depth: 7~ ~
Static Level: ~ ~c=~
Yield: 7 q~
~hyslcal/S~itary Festures:
Sanitary Seal/Cap []
Casing'Above Ground Surface: 1.5 f~
Pump wire In Conduit []
Surface Dralna§e Away From Well:
Good [] PoorD
Well Pump Specs:
Water Supply Line:
Size: Type:.
Drop Pipe:
Size: Type:,
Depth To Pitless Adapter:,
Storage/Pressure Tanks:,
TIME TIME INTERVAL PUMPING CUHH. STATIC C0HHENTS
MINUTES RATE GAL. LEVEL
HIES AVE= GAL ~sl
RECOVERY
TIME TIME INTERVAL STATIC ~ r COMMENTS
MINUTES LEVEL
SKY LABORATORY
P.O. BOX 670371
CHUGIAK, ALASKA 99577
LOCATION: JOB NO:
CLIENT DATE:
From Well
WELL FLOW TEST DATA SHEET
Log [] From Probing Measurements~
Well Depth:,
Static Level:
Yield:
physical/Sanitary Features:
Sanitary Seal/Cap ~
Casing' Above Cround Surface: %,5
Pump wire In Conduit []
Surface Drainage Away From Well:
Cood Poor[]
Well Pump Specs:
Water Supply Line:
Size: Type:.
Drop Pipe:
Size: Type:.
Depth To Pitless Adapter:.
Storage/Pressure Tanks:.
TIME TIME INTEHVAL PUMPINC CUSS. STATIC COMMENTS
MINUTES HATE GAL. LEVEL
MINS AVE- CAL ~s 1
RECOVERY
TIME TIME I~TERVAL STATIC ~ r COMMENTS
HINUTES LEVEL
SKY LABORATORY
P.O. BOX 67037!
CHUO~AK, ALASKA 995?7
LOCATION: JOB NO:
CLIENT ' DATE:
BY:
.. APPLIC"'N, T FILLS OUT UPPER,HAL~"':ONLY ''
Address Zip ~e
~ Public Utility
~ Indlvld~l Year IndivUual InstallS:
~ Holding Tank
- -NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time ,---'" Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANGHOI~AGE
~,,.'v''[~ ENVIF, ;~ ~.',~t ;;A. I ,:O E"_'Ti: ,~1
AUG ! 8
RECEIVED
(~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPP~OVED
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size