HomeMy WebLinkAboutMURRAY BLK A LT 15Murray
Block A
Lo1' 15
#014-041
IV1-~V DRILLING, Inc.
P. O. Box 4-1224 - 1310C International Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Gereld Protzmen Use of Well
Location (address of: Township, Range, Section, if known; or distance main roa~
Dom
nl~, [~ ~, *,urray Subdivision
Size of casing 6 Depth of Hole 73 feet Cased to 7} feet
Static water level 45' ft. (dl~e~ i~below) land surface. Finish of well (check one) open end (
Screen ( ); Perforated ~( '
None
Describe screen or perfora on ~ ~ '~ "'
Well pumping test at ~ gallon ~e~ ~li6(lr) (minute) for 1 hours with 19'
of drawdown from'static i~V~l'~ ,i~ !;'"' ii !:
Date of completiop ~.o ~.~ ?~ . :';:;
~,i ,~;:,i~: ~ ! WELL LOG
Depth in feet from t~,; ~' ~ ', ~' '
groun~ surface Give details ~f formations penetrated, size of material, color ~nd hardne.~
,-.'~ravel Fill
'i ,,r .! '~
'~ ;Clay
.... 0rav,llV cl.v
' k'~y~e ~.
);
ft.
TO.
.TO.
.TO
.TO
3--CONTRACTOR
DEPARTMENT HERL. TH AND ENYIRONMENTAL. ~:OI"EE:T~ON
82~i '"L" STREET¢ ANCHOR¢~t~E, At(. S~D50:1.
264-4728
4493:
LOT
FEET
MINIMUM DIS'I'F~NCE BE'FHEIEN A HELL FIND FIN'¢ ON-SITE SliB4FIdlE D!SPOSHL S'¢S]'EM I:~i;
:1,00 FEET FOR FI PRtVRTE HEL.L OR &DO TO 20~3 FEET FROM t~ PUBLIC HELL DEPENDING
UPON THE "FYPE OF PUBLIC NEL, L. '
MINIMU[I DISTANCE FROII R PRIVRTE 14EL, L 'f'O R F'RIVWI'E 2~EHER LINE IS 25 FEET RND
TO R COblMUNIT¥ SEHER LINR IS 75 FEET.
HELL, L.08S RRE RE~;IUIRED RND MU2]T BE RETURNEr) TO THE DEP~RTf,IENT HITHIN ]~O bR9¢
OF THE HELL. COMPt. ETION.
OTNER RE(':~UIREMENTS f, lRV ¢~PF'L.¥. SPECIFICBTIONS t~ND CONSTRUCTION D;(RSRRMS RRE
F~VR II-~BLE TO INSURE PROPER I N',~TRLL, FtT I ON.
I CERTIF'V THRT
:1,: I Fir1 F-"FIMiI. IRR HITH THE REQUIREMENT:5 FOR ON-*SITE ~,;.;EI,,.IER~; F~ND HEL. LL5 FIS SET
FORTH B"r' ]"HE i'4tJNICIPI::ILIT'¢ OF' RNCHORRGE.
2: I HILL INSTFIt. L THIE S'¢STEfl IN RCC. ORDRNCE HITH THE CODE:~;.
.',,R.' I EINED:
,r::IF'PL, IC:f~N]" :STEVE COOPER
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
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
Parcel I.D.., 0'14-04'1-33
1.
GENERAL INFORMATION
Complete legal description ~r Lot l$,'Block A Murray SID
Location (site address or directions) 6522 Rosewood
Current Property owner(s) Sharon -Nm'to~
Expiration Date: ~0~.
Day phone .23S-7939
Mailing address
Lending agency
Mailing address
.6522 Rosewood StreeL, Anch~ AK 99518
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: .3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTE~NATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site
[] Public Sewer []
The Municipality of Anchorage Department cf Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required
for the transfer of title (except between spouses) on properties served by a single family on-site wastewater
disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of
Health Authority Approval are valid for 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 less than 30 days old. 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 emissions in the professional engineer's work.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as cf the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval
application 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Phone 272-8218
Name of Firm Pannone Enq. Svc.
Address P.O. Box i02954, Anch~ AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date.
En neers Comments In conducting an adequacy tcsL I attempt to provide a [borough, conscic~dous ~' ' v i fthcsvstmninaccordanc~,,ithMOADHHSGudeines&Reg~lations. Th¢
~and aration d~s~anocs racasurcd to rcadilv identifiable features. Thc operational hf¢ of all wells and
tc~t, scp ' "
~ uc ~.. stems depend on fl~c local sod condiuon, gm .. - ..... a~
~thc water usage of thc family being sen'~ by Ibc ~.~tem. l'hes~ ~ndiuons am outsmc mc control m ~.....~
thc ~ aluamr or this r.'srem Ail ~tetns m.~mallv fail and satisfactory test ~sulls do not g~aram~
?ES can therefore not provide any warranty for futu.m performanc~ nor g,v¢ any a~-u..r~.? of how I~g mf
~..s em ~II continue to meet ~h¢ opera tional n:quiremems of thc ADEC or MOA DHtI~.. . ln¢ coment o~
mis rt is for fl~e sole ben¢fit or the o,,~er listed abov¢. Any rehancc upon or use of ~s re~ort bY. ~
~cpo n or any is not authorized nor will it con£~
6. DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
bedrooms, with the following stipulat~ns:
Conditional approval for
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date: z~//7/0~-
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Reissue Date:,
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
HEALTH AUTHORITY APPrOVaL CHECKLIST
Legal Description:
A. WELL DATA
Well type PRIVATE
Date completed 2/22/1975
Total depth 75 ft
Lot 15. Block A Murray S/D
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi
Date of sample: 1/3/2002
B. SEPTIC/HOLDING TANK DATA
If A, B, or C provide PWSID # ~
Sanitary seal ..Y.E.S
Cased to 40+ ft
FROM WELL LOG
2/22/1976
45
$ gp.m
Nitrate · ~- mg/I
Collected by: LRP
Tank Type/Material AVA
Date installed Tank size
Cleanouts.__ Foundatio~ cleanout ~
Date of pumping ' , Pumper
ABSORPTION FIELD DATA
Co
Date installed'
Length --ft
Total depth ft
· Date of adequacy test
Parcel I.D.: 014-041-33
Well Log Y
Wires properly protected YES
Casing height (above ground) 36 in.
AT INSPECTION
113/2002
24 ft
4.1 g.p.m
Other bacteria
Arsenic.
gal
Depression over tank
Soil rating (g.p.d./ft2 or ft=/bdrm) AVA
Monitoring tube
Water added
in
Width ' ft
Effective absorption area fl2
Results (Pass/Fail)
Fluid depth in absorption field before test ~ in
Elapsed Time: min Final fluid depth
Any rejuvenation treatment (past 12 mo.) (YIN & type)
(Rev. 11/99)
Number of Compartments '
High water alarm __
System type AVA
Gravel below pipe ' ft
Depression over field --
For bedrooms
gal. New depth
Absorption rate >= ~
If yes, give date
colonies/100 mi
in,
gp.d.
D. LIFT STATION
Date installed
'Pump on' level at
Datum
Size in gallons NIA
in'Pump off level at
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCEs FROM WELL ON LOT TO:
Septic tankJliff station on lot N/~
Absorption field on lot N/A
Public sewer main 100+
Sewer/septic service line 50
in
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation N/A
Water main
Drainage
Properly line __
Water service line
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line N/A
Water Service line
Curtain drain
F. COMMENTS
Building foundation
Surface water
Wells on adjacent lots
Well only on lot. Served by AWWIJ Sewer System
G. ENGINEER'S CERTIFICATION
I certify that I have determined through fie/d inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone. P.E.
Date 1-7-02
Absorption field
Surface water
Water main
Driveway, panking/vehicle sto~age
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
~075515~01 T-E10 P.OI/02
J~l-Og-O~ II'O?A,V FR~AE ENVII~N?AL $~/
,~ CT&E Envlron~e~tai Sorvtcms lnG.
Smml:l~ ~m~tcs:
TQL U~.~ Medio4
A~ow~le ~p Anal)sis
Lim~ Dt~e D~ Init
0.00'750 0.00200
0.100 U 0.200 m~,/L ..~A. 300.0 (<10) 01/05/02 SCL
Total Coliform 0 col/100n'.L SMI~19222B (~1) 01/03;02 K.AP
SCALE
1"=.30'
Lot 16
0.~,' rncro~.,. N §9'53'16" E
~50.00' x
PROPOSED I ~o~
CTs.)
I Lot 15
L .... .J
150.00'
CONG.
Lot 14
NOTE VARIOUS FENCE ENCROACHMENTS.
GARAGE
THIS AS-BUILT SHALL NOT BE USED FOR ANY
PURPOSE OTHER THAN FINANCING REOUIREMENTS.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
SHOWN HEREON BE USED FOR CONSTRUCTION OR
FOR ESTABLISHING BOUNDARY OR FENCE LINES.
AS-BUILT ONLY
NO POINTS SET THIS SURVEY
I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING
DESCRIBED PROPERTY:
LOT 15, BLOCK A, MURRAY SUBD.
ANCHORAGE RECORDING PRECINCT, ALASKA, AND THAT THE
IMPROVEMENTS SITUATED THEREON ARE W1THIN THE PROPERTY
UNES AND DO NOT OVERLAP OR ENCROACH ON THE PROPERTIES
LYING ADJACENT THERETO, THAT NO IMPROVEMENTS ON PROPERTY
LYING ADJACENT THERETO ENCROACH ON THE PREMISES 1N
QUESTION AND THAT THERE ARE NO ROADWAYS, TRANSMISSION
UNES OR OTHER VlSlBI.~ EASEMENTS ON SAID PROPERTY EXCEPT
AS INDICATED HEREON. z~-
DATED THIS /~ DAY OF ""~4J~' , 1995
ALAN J. ROOKUS
REGISTERED LAND SURVEYOR
205 E. DIMOND BL~. t 54B
ANCHORAGE, AK 99515