HomeMy WebLinkAboutHANSEN SAND LAKE LT 17
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program q
4700 Elmore Road E r
P.O. Box 196650
Mark Begich Anchorage, AK 99507
Mayor www.muni.org/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: 0912-' I S� • Lj
Legal Description / Propty O�yner�me�Addre/ss:
fk 0 � S'�1 S ow�-e1 � G3���t �' ���,,,,,6C I✓� f tet' .
K— t �G� o yl/'`—
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: (00 feet
Pump Manufacturer's Name:Pd
C�
Pump Model: l &g
Pump Size _6A hp
Pitless Adapter Burial Depth: N0 feet
Pitless Adapter Manufacturer's Name: Ai/A
Pitless Adapter Installer: A*
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection //&/(3
Comments:
Pump Installer Name: ANCHORAGE WELL & PUMP SERV.
330 EAST 76HAVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
FHA' Form'No. 2218
(R~,vised June 1951)
New installation.
Existing installation.
FEDERAL HOUSING ADMINISTRATION
REPORT OF INSPECTION
INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
To B~ Headed, in by FHA Offke
NATIONAL BANK OF ALASKA
Form approved.
Budget Bureau No. 63--1~297.4.
..... ~._0__._-4!0_ M.7_0 .....................
(Serial number)
(Insuring office) (Mortgagee) (Mortgagor or sponsor)
Proper~;y address _____TI~___Q.T._.~7_~ HANS SE~ SU]~ ..............................................................................
N It __RAG_.~ AT a.q~a
.................................. ..&.'_OHO ............................................................................ --, ...........................................
(Oity) (County) (~ate)
Water supply by: [] Public system. [] Community system. [] Individual system on site.
Part I-a.mFOR USE OF INSPECTING OFFICIAL
(Fill in below information applicable to subject installation)
INSTInlcTIONS: If new installation, inspect for compliance with approved exhibits and record any observed information not
shown on, or which varies from, the approved exhibits. If existing installation, furnish as much of ~he information as may be
available. :
PRIMARY TREATMENT consists of ~ Septic tank. ~ Cesspool
Septic Tank: . ~ ,:~
Distance from well,__i.~ffd__ feet. Material, ~-,':~' ....... ~, 4~,~,_,_~_~::~ ......... ::.:.~ X~.~ ~_k:~f&_:f_~:~.~lL:~-.. Number of compartmen~ ..... ~ ......
Total liquid capacity, ............... J-J]-~ .................gallons. Capacity inlet compartment, _ ................ :: .................. gallons.
Inside length, ....... ': ....... feet. Inside width, feel Liquid depth, ...... ~::__.. feet.
Cesspool:
Distance from: Well, ............. fee~; foundation, ............... feet; nearest lot Hue at ~ front, ~ side, ~ rear, ............... feet.
Inside diameter, .......... feet. Depth, .......... feet. Liquid capacity, ............ gallons. Lining material .........................
SECONDARY TREATMENT consists of ~ Distribution box and ~ Tile disposal field. ;~ Seepage pits. Other ........................... Tile Disposal Field:
Distance from: Well, ............ feet; foundation, ............ ~eet; nearest Io~ line at ;~ fron~, ~ side, ~ rear, ............... feet.
Total length of tile lines, ..................... ieee. ~umber of lines, ..................... Distance between lines, ................... feet.
Total effective absorption area in bottom of trenches, _ .......................... square feet. Trench width, _ .................... inches.
Length of each line, ....................................... feet. Depth, top of tile to finish grade, ....................................... inches.
Type of filter materiah ~ Gravel. ~ Broken stone.' '~ Cinders. Other .............................. k ......................... ~ ......... : .....
Depth 0f filter material beneath tile, ........................ inches. Depth of filter material over tile, .............................. inches.
Seepage Pits: . ~ t ~' ~ ~: ...... ~___ .~
N~ber of pits _~z__ Ou~ide d~ame~r, ~'_::.~::~ feet. Depth; feet. Lining material ............ ~ ............... : ........
Distance from: Well, / 2;~ fee~; foundation .... : .........gee~; neares~ lot line at ~ frone,~ ~ide, ~ rear, ____/~5~--;~:- feet.
If Ex,sting Inatallabon~ gi{e all the iollow~g ~di~donal info~a~ion available:
Distance to nearest: Public sewer, ........ ~: ..... feet. Community system, ........ :~: .... feet. . l
· ~ Approximate direction of surface drainage of lot, ................ ::: ................. Approximate slope, _.-~]4.[ .... feet per 100 feet.
Soil is: ~ Loam. ffi Sandy loam. ~ Clay. :~ Sandy clay. ~ Coarse sand or g~avel. ~ Hardpan. ~ Rock. O~her .....................
Number of bathr5o~s, ............ Is there a basement? ~ Yes. ,~ No. Basement drains to ... ....... ~&:..lz-~-~2-.,:~z- .................
Fixtures in basement: :~ Laundry tray. ~ Toilet. ~ Bathtub. ~ Shower. ~ None. ~ Floor ~ain. ~ Sump pump.
Laundry ~vaste disposal: Direct to .~ Seepage pit. Other .................. Through sump pit to: :~ Septic t~nk. ~ Seepage pits.
Is footing drain prodded? ~ Yes. ~ No. DrMns to: '~ Su~ace. ~ D~ well. ~ Sump in basement. Other_ ....................
Dom~srouis or areaway drain to: .~ Su~ace ~scharge.. ~ Dzy well. Other ..................................................................
Depth of house sewer below fi~sh grade at foundation, _ ....... ~::_. ~eet.
Inspection made by: ~ State. ~ ~ty. ~ Local H~alth Authority.
Da~e of insrec~ion ..... :-~Z4::- .... ~ la2-~' ........................................ :--~
.... ~ (Title) :' ..-
Part I-b.--See reverse mdc
Part IL--FOR USE OF THE HEALTH DEPARTMENT OFFICIAL REVIEWING REPORT
Eased on the information repro'ted hereon and other available information, it is the opinion of the ~ State C] Comity [] Local
Department of Health that this system with proper maintenance:
~ can be expected to function satisfactorily, and is [] cannot be expected to function satisfactorily.
not likely to create an insanitary condition.
Remarks: .............................................................. : ...... :?,,~,-~::,;----? ..... ~------~ ........... ~ ....... ~-'" '>}-'--'~_
'
Par[ Ill.--FOR USE ~F FHA OFFICE ~
· 0 THE OHIEF UNDEBI~I~: ~ ~' ~'~
Z ha~e ~eviewea ~he fore~oin~ and She pe~i~en~ ~HA O'ompliance ~nspec~ion ~epor[, and recommend tha~ the individ~al
sewa~e-Sisposal system be considered ~ acceptable .~ not acceptable.
~em~ks: ................................................................................................................................................
Date ............. : ..................... ,19 .....
FH/ ~'orm/~o. 2217 Budget Bureau No. 63-R29~.3.
Cievi~d Dec. 1948)
~ FEDERAL HOUSING ADMINISTRATION
REPORT OF INSPECTION
INDIVIDUAL WATER-SUPPLY SYSTEM
To Be,Heoded in by FHA Office
[] New installation.
[] Existing installation.
6~41057_70 ................
(Serial number)
, National Bank of Alaska
..... Anchorage__Alaska ........ ~ ..... in Anchor,age ...................... RE~IOLI~S, Igm~__A. ...........
(Insuring office) (Mortgagee/ (Mortgagor or sponsor)
Property address __Tract~_lT.__Manzer~_Tmnd Lake__~ub. ...................................................................
.................... ~ ....... ~nchorage ............................................................ Alamka .....................
(City} (County) (S~ate)
Total number: Living units .... 1 .... Bedrooms ___~___ Baths 2-~__ _ Basement: [~ Yes [] No.
Sewage disposal by: [] Public se~er. [] Community system. [] Individual system on site.
Part I-a.--FOR USE OF INSPECTING OFFICIAL
(Fill in below information gpplicable to subject installation)
INSTRUCTIONS: If new installation, inspect for compliance with approved exhibits and record any observed information not
showh on, or which Varies from, the approved exhibits. If existing installation, furnish as much of the information as may be
available.
Distance to nearest public water main, ~ feet. Size of main, _~_ inches.
Individual wells [~ are [] are not customary in neighborhood.
Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water __,~--~----
Properties in neighborhood ~ are ~ are not being d~veloped with both individual water-supply and selvage-disposal sys~ms.
Lot size: __~_~ ...... feet wide, ~_~_~ ....... feet deep. Dwelling set back from front property line ...... [~- .... feet.
Individual water supply from: ~ Drilled well. ~ Driven well. ~ Dug well. ~ Bored well.
Distance of well from:
Building foundation, _:~-~- .................... feet; nearest lot line at ~ front, ~ side, ~ rear ....... ~'~ .................... feet,
cast iron sewer ................. feet; tile sewer .................. feet; septic tank, __~_~--- feet; disposal field .................. ~e~
seepage pit, ]~ ...... feet; cesspool ................... feet; other sources of possible ~tlon ..... $--~ ........ feet.
Well construction: ~
Approximate depth te pumping leve~ of water in wel~, ~: - feet. Approximate yield, .~_-~--- gallons per minute.
Sealed watertight te depth of _[__~ feet.
Exterior space around casing sealed with: ~ Cement grout. ~ Puddled clay. ~ Ordinary backfill.
~Vell cover: ~ Concrete. ~ Wood. ~ Metal. Openings in well cover watertight: ~ Yes. ~ No.
Pump: ~ Shallow well ~ Deep well. Len~h of drop pipe, ~-- feet. Pump capacity, ~ gallons per minute.
Located in: ~ Basement. ~ Pump room off basement. ~ Pump house above ground. ~ Pump: pit.
Pump room properly drained: ~ Yes. ~ No. Pump moun~ing watertight: ~Yes. D No.
Has bacteriological examination of water been made? ~ Yes. ~ No. If answer is "yes," give date ................ ,19~
Quality of wa~er ~ is ~ is not sa~isfactery gor human consumption.
Insgalla~ion ~ does ~ does not comply wi~h approved exhibits, if any.
Inspection made bg: ~ State. ~ County. ~ Local Health Aughority.
Part I-b.--Se~ reverse side ~.
Part IL--FOR USE OF THE HEALTH DEPA'RTMENT OFFICIAL REVIEWING REPORT
Based on the infm~ation reported hereon and other available information, i~ is the opinion of the ~ State ~ County ~ Local
Department of Health thag this system ~ is ~is not satisfactory as a domestic water supply for ghe subject properly.
Remarks; ............................................................................................................................... : ..........................
AprXJ. &O~ 19 >~5 ,I ' - -' .......... ~h
Date ...................................... --~;tOYr~r-Ei-l~e~ri~- 3~[a~ka l~op~. Of Ileal
To TH~. CHIEF UNOERWRIT~R: Part IlL--FOR USE OF F. H. A. OFFICE
I have reviewed the foregoing and the pertinent FHA Compli~[nce I~spection Report, and recommend that the individual water-
supply system be considered [] acceptable [] not acceptable.
Remarks: ................................................................... ~ .........~'- ................................................................... '
Date .............................. , 19 ....
Report of Inspectimt
Amos Je Alter, Chief
Sec%ion of Sanitation & .f6ngineerfng
Mr. Phillip B. Kreitz~ Sanitarian I
11 April 1958
SE F}tA Forms 2217 & 2218
RiSYNOLDS~ %,Sm. A.
Tract 17, Hansen Sand Lake Subd.
~[nchorage
Serial No. Se-60-005770
Enclosed please f~nd subject FHA forms 2217 & 2218.
The sub-surface disposal system and the private water supply systems
meeb the mAnimum re¢~uirements of the Alaska Department of Health. The
disposal system was ortgiually inspected and approved by Mr. Warren Powell
in November 1957. ~ vmter sample taken ? ~pril 1958 wss satisfactory.
It is recommended that this system be approved.
PE[:sb
~"' ~4m : I~b. No. 6536
INDIVIDUAL WATER SUPPLY
ALASKA DI~PARTiV[ENT OF HEALTH
Sect/on o£ Sanitation and Engineering
ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS
Your recent request for an analysis of a sample
from the Individual Private Water Supply
serving Tl~act 17, }Ian~en was
Sand Lake Subd.
received ~'7-~ and
examination has been completed.
Records in this office indicate this Individual Private Water Supply to be of / sfactory
sanitary status. :~,S a
Analysis shows this SAMPLE to be tisfactory Questionable
If an "Unsatisfactory"
Mr. Wm. A. Reynolds
Star Route A, Box?2~
Spenard, Alaska
Southeentral Regional
Questionable
Unsatisfactory.
Unsatisfactory
or ~'Questionable" stares is indicated above, you should take immediate action as recommended below.
1. Boil or chemically treat your water supply to protect your family from water-borne diseases as outlined in en-
closed leaflet, "Drink It Pure."
2. Improve your spring--See bulletin HSE-6-2
3. Improve your cistern--See bulletin HSE-6-3
4. Improve your dug well- See bulletin HSE-6-4
5. Improve your driven well--See bulletin HSE-6-5
6. Improve your drilled well-- See bulletin HSE-6-6
7. Relocate your well to a safe location in relationship to your sewage disposal system--See bulletin HSE-15
8. Bottle broken in transit, please send new sample.
9. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results.
Please send new sample.
10. Contact your nearest [] Local Heakh Department or [] Alaska Health Department, Sanitation office for
bulletins, consultation, and assistance.
I1. This is a surface water source and subject to pollution by man and animals. An approved water supply source
should be developed.
SANITAKIAN'S REMARKS
ADH--HSE~6-FI (e)
.j
This Form Most Be Filled
Out Completely.
INDIVIDUAL WATER SUPPLY
ALASKA DEPARTMENT OF HI~:~LT~
Section of Sanitation and ~n~ineering
Request for Bacteriological Analysis
Please Look on Reverse o~[
Sheet for Sample Collection
Instructions.
(Name of person~I!ecting sample)''(Date) (Time)
Water sample collected from [~ Kitchen tap; [] Bathroom tap; [] Basement tap;
[] Other (list) ....................................................................................................................................
(Mr.) ~ ~- ~- ~/3& A
.il,-epor,, ...... ............................ .....
tO (~;~') / (Box NO. or street address) (City)
Please place an "X" in the box before items which bast describe your water supply:
SOURCE: Well -- [] Dug, [] Driven, ~] Drilled, [] Bored [] Spring, [] Cistern, [] Other (list) ..............................................................................................................
[] Creek, [] River, [] Lake, [] Pond .................................................................................................................
DUG WELL
OR CISTERN CONSTRUCTION: Walls- [] Wood, [] Concrete, [] Metal, [] Tile, [] Brick or Concrete Block
Top -- [] Wood, [] Concrete, [] Metal, [] Open Top
LOCATION: [] In basement, [] Basement offset, [] 'Under iaouse, [~ In yard
Other ...................................................................................................................................................................................
DISTANCE TO: Building sewer or other drainage pipe .............. feet, Septic tank/.~....'~..U:feet, Tile field ..............
feet, Seepage pit ../..f.,i...~'.::feet, Casspool .............. feet, Privy ..............feet. Other possible sources
of contamination (list) ..............................................................................................................................................
tVIATERIAL: Building sewer -- ~] Cast,~ ~ir°n' [] Wood, [] Tile, [] Fibre pipe, [] Asbestos cement
Joint material -- Type ....... .'.~:a..~.~:!-,:.( .............................. : ............................................................................................
GENERAL INFORMATION: Does water become muddy or discolored? [] yes, [] no
When ? .......................................................................................................................................................
Diameter of well ........ ~...~f. ..................................... depth ...../....~..~.~.'. ........................................ feet
Well casing material ..... ~~[ ........... diameter......~.....f./. ...... depth....~f.....'J...~./:i ..............
Length of drop pipe_ ./...ffU..-~_...-Y.. ........................................................................................................
Water depth from bottom........4.:.~ ................................... ~ .......................................................... feet
Pump location: [] In well, [-j Offset in basement, [] In basement
[] In utility room, [] On top of well
[] Other (llst) ........................................................................................................
Co you suspect illness from this supply? [] yes, .~ no
.i;temarks: .........................................................................................................................................................................................................
PLEASE DRAW A SKETCH IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW LOCATION OF HOUSE, WATER
SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES
;3E'I~VEEN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILfI'ifiLS.
SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY THE ALASKA DEPARTMENT OF ItEaI, TH
,d~.~;~,£ TH £)lST,ffl(~:j'
Federal ~-.~ous~g A~ration
Po~t Office B~x 723
Anchorage,
SE M~A Form~ 221'7 & 2218
T~'ac~ 17, H~en S~ L~te Subd.
Auchorage
mentioned property,
Tt~ w~e~ ~upply ~ ~ew~ge dispo~ sy~ ~et with the
minimum re~irements of the ~la~ Depart~t of Health ~t with
manner and net cx~te an insanitary c,ndition.
This ~n~tallation is approved by the Depm~nt.
If ~ ~a~y be ef further a~sistance rsga~L~ this prol~rty
~lease feel free to contact us.
Am~S J. Alter, Chief
Section of 8~uitation & Engmneeriu~
FOB:rgl
Encl~ 2 1~o~ 2217 & 22D~
G~tD - ~*~ Ereitz ~
Anchorage Regional OffiCe