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Home My WebLink AboutCAMPBELL HEIGHTS BLK 5 LT 20B Well Log For ...................... ~ ................................................................... : ..................................... m~ ~o=~d ......... f.L:.L:..~d .......... ; ............................................................. ~ o~ ~a...[ ...... ~.gf ............. ' .................................... : .................................... Size of c~s~g..~ ........ ~.' .............. ~ ........................................... , ............................. Distance to water.....~..ff. ........ . Dist~ce to water while p~pmg ............ ~ ....................................... at rate of ................................................ 'gallons per hour. ] Formation ~ ~UN~Cl ................ ?"T C~ I.I:AtT! t. £lqVI2 :J '1:7.'.; D [-7^ I FE6 '~ from { to 14-/- Driller DELTA DRILLING COMPANY SRA BOX 394 e ANCHORAG£. ALASKA 99507 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~(~ -~ -- "~ "'"(..-~-J OF ON-SITE SEWER AND WATER FACILITY 264~4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (inc!ude lot. block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~.~-(~'~. ~- / / Telephone: Home ..~-'~- ?c ,1G Mailing Address U/S/ ~ ~ ./. /,~,. (c) Lendinglnstitution ! ~.{4~.r~,/J I.y~,cL~ Telephone ( ' Mailing Address (d) Real Estate Company and Agent Address J Telephone J (e) Mail the HAA to the f~llowino address: or: Check here,J~, if hold for pick up. List contact person and day phone number below. Business TYPE OF RESIDENCE Single-Family/~i Number of Bedrooms WATER SUPPLY Individual Well~' Community I-I Public Note: If community well eye!em, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL/.! Onsitel'l ./Public~. Communityrl Holding Tankl-I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page I of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, 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 bedroom~ 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 syster~ is in compliance with all Municipal and State codes, ordinances, and regulations in effect on Name of Firm "'-~"-'~-'~ elephone ,~-.7 Address Date DHHS APPROVAL Approved for ~bedrooms by Approved--~'~ -. I Disapproved Terms of Conditional Approval /JX~ Date Conditional Engineer's Seal CAUTION The Municipality of Ancho, rsge Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above 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 fed?al and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) k4UNiOP^t. ITY OF ANCHO,"C~I=ALTH AUTHORITY APPROVAL (HAA) ' ENVI~'ONM[NT~'L$££VICESDIVI$1ONcHECKMST FEBRUARY1984 i ' / REC, EIVED WELL DATA I Well Classification ,~--- 264-4720 Legal Description: I! A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth ~'f/~ J Cased tO ~-~ Static Water Level I I Casing Height Above {~round Electrical Wiring in Cogduit saparafion Distances Item Well: TO Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on LOt To Nearest Public Sawer L ne CleanouVManhol~ 7.. Water Sample Collected by Water Sample Test Results ~ Comments Date Completed ! ~ ' I' ~3'! Yield Depth of Grouting Pump Sat At Sanitary saal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots h///~/ IV/~, ; On Adjoining Lots To Nearest Public sawer TO Nearest sawer Service Line on Lot ; Pete 'A/ r SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank'(Y/N) Size No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarn~ (Y/N) Saparation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Sarvice Line Course I ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 ~ 72-026(11/84) ABSORPTION FIELD DATA ~J Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (WN) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) 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 orr' 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,~r conformed to all MOnA and HAA guide~e..s in effect on the date of this inspection. Signed '~'~ Date ~ ~.~.~. it C(~3,~ · '' / MOA No. ~ ' Company Receipt No. Date of Payment Amount: $ '/ .. -,,.' ~ · - 'o, Engineer's Seal ~ .~-... ...... ,~ .~. · ~.~,~ (~, '' '~' ~ '.'--~ t~"~ 203 W 15th AVE "C" SUITE 203 ANCHORAGE. ALASKA 99501 TELEPHONE: (907! 279.3916 LEGAL: '~OCATION= OWNER=- · TYPE OF..WELL · .WELL LOG AVAILABLE: ~UNICIPALITy OF , RESIDENTIAL WELL INSPECTION " RECEIVED Lot 20B, Campbell Heights Subdivision 4151 E. 66th. Avenue ~%-~ John Rall Single Family,'Residential INSTALLATIONiREQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 20 Gallons per M2nute PUMP YIELD FROM TEST: 6 Gallons per Minute ' DATE OF INSPECTION:. .January 12, 1988 TEST PROCEDURE: Well was pumped at a constant rate'while the drawdown waslmonitored with an acoustic probe. At the beginning of the'test water level was found at 13 feet below top of casing. At a pumping rate of 6 gallons per minute the water level did not drop below 24 feet.'A total"of 350 gallons were pumped. The · well recovery rate was not monitored since the distance to the water level Was less than'the minimum readable distance for the probe. I TEST FOR E.COLI AND TOTAL NITROGEN:· Water was tested for E.Coli and total nitrates on January 14, 1988. E.Coli 0. Total Nitrates 0.17mg/1. Max. allowable Total Nitrates 10mg/1. TES? RESULTS= This well meets the requirements of the Municipality of Anchorage. THIS WELL WILLIPROD6CE.MORE THAN ~'GALLONS PER MINUTE FOR MORE THAN FOUR HOURS:~ . .! . . · · .:":'~' .. The Municipal requirement for well flow is 150 gallons of water · per bedroom per day. This'well. exceed 'this requirement. The assessment of Ithe condition of the well applies, only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. 6RID No. TAX .CODE I r' MUNICIPALITY OF ANCHORAGE -- SEWER UTILITY Nome ~cl, 5~'/ (~ LOtr~A~NO. c Residential ~ Comme~i~l ~ ZndustHol ~ No. of unlls~ ' ~- ~ , Size L Main Tap ri On Property [~ Permll NO. L~ I c~,:5"/r~ /-'~/.4~ Type Drawing No. Size Main ~ Type ~ / ~ Depth ot ConneCt In~lolion ~ Cleonouts / _Type C / Comments- ASSESSMENTS: L.I.D. No. Private Dev. No. Subd. Agreement Sewer Agreement ri No._ RT, E. ri Roll T- DYE TEST Negotive ~ ~,S.A, ~ Dote M.H, No, Billing C~cle i~[~ Positive ri Page No, '1 Tested By- ,_'. t__Comments- ndicate NC, rlh LiJ MUNICIPALITY OF ANCHO.~AGE RECEIVED .4 ~ 6 I I Time ,, j Time ,e I Date I Dete Date Inspector I Inspector Inspector Comments .~/ Conditional Approval Date Sew~lnstall~ I Po~lt No. ~ptlc Tank Size ~ Holding Tank Size ~lls Rating Well To Absorption Area Well L~ Receiv~ Well to Tank ~ APPLICANT FILLS OUT LOWER HALF ONLY Prope~yOwner ~ ~~r I~ ~ ~one Address Lending Institution ~ q/~ ~ C i ( ' ~ ~ ~< Phone Address Strut L~atlon Type of Reslaence ; ~Single Family [ 0 Multiple Family No. of Bedr~ms ~ Other Wat~Suppty ~lndivldual ~ A~ACH WELL LOG. A well log Is requlr~ for all wells drlll~ since June ~ ~mmunity ~ 1975. For wells drilled prior to that date, give well depth (attach ~g If available.} ~ Public Utit~t~ Sewage Disposal ~ Individual Year Individual Installed: ~Public Utility When ~nnected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. February 18, 1982 C&E Enterprises P.O. Box 10-911 Anchorage, AK 99511 SubJect~ Lot 20 B, Block 5, Campbell Heights To %~om It M~y Concern~ Approval for the individual sewer and water facilities cannot be granted u~til the following items have been completed~ · The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. · The water analysis report needs to be submitted to this office fro~ the Chem Lab, 5633 B Street, for our review. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist