HomeMy WebLinkAboutCHUGIAK GARDENS TR A .GI
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Development Services Department
Buildina Safety Division
On -Site Water , Y/astewcter Proyr_m�
4700 Grogow Street
n -
- ' oo:< 790050
MarkBegich Anchor.^_ge, AK 99519-6650 LLJF
Mayor w�,�u;.miminrg/unsi;r
(907; 343-7904 -
Pump Installation Log
Well Drillin5 Permit Number: SW_ Date of Issue:
Parcel Identification Number:
Legal Description
Ci v (� �a v e l� S
Property Owner Name & Address:
GCCIK �eva�s
T
Apt
3l
Pump Installation Dates 5:-. 4Ll
Pump Intake Depth Below Top of Well Casing: 1)0 feet
Pump Manufacturer's Name: RED SQCK<
Pump Model: I W C31 \ 1`1- S ILI
Pump Size l hp
Pitless Adapter Burial Depth: /O feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:/
Well Disinfected Upon Completion:'es ❑ No
Method of Disinfection: L&LVY141.
Comments: ST O -l -I C y I '
ti
Anchorage PUMP & Vdeli Service
Pump Installer Name: 330 East 76ftAvenue
Anchorage, Alaska 99513
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of punp installation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE I
MAI LING ADDRESS
LEGAL D ESCR I PTI('~RP"~
NO, OF BEDROOMS
·
] Well ~,bsorPtion area Dwelling PERMIT NO.
D,STANCE TO: I
I'
~ Manufacturer ~ Mater,at No. of com~.~ments
Liq~i~pacity in gallons Inside length Width Liquid depth
.,~ /~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
· ~Z -
O Z <[ Manufacturer Material Liquid capacity' in gallons
. Well Foundation Nearest lot line PERMIT NO.
IOO
DISTANCE
TO:
~ u~ ~O No, of lines Length of~ I~ne Total length of lines Trench width Distance between lines
~. uJ ~,~"1 inches
~. Top of tile to finish grade Material beneath tile Total ef~t?e absorption area
Q inches
Length Width Depth PERMIT NO.
uJ
<[ I- Type of crib Crib diameter Crib depth Total effective absorption area
'" Well Building foundation Nearest lot line
u~ DISTANCE TO:
.j Class Depth Driller Distance to lot line PERMIT NO.
'" Building foundation ! Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER ~
REMARKS
.-., ,
A P P~E~. DATE LEGAL
72-013 (Rev, 3/78)
[:,E:F'FIF. t'T'P1ENT ,::iF:' HL::FtI_.'FH FIN['.:, E'N',,,'I F.:OhlI'"IE']'.4TFiL.. F'F.:F'Ff'[.E' 1':TI ]: t",1
,_,':"":'"~ .. '" L '" STREET., FINCHORFIGE., FII':::.
2
F'EF:H ]: T N 3 ,' ';:" '. .:.~ 0 ..'2 'L:3 ',
t::IF'F'L Z CFINT
I... O C I::J 1" Z O N
L E::GFIL.
.:r nSL::F'H FI.
5FINT I
G E'N [::,E L'T' E. R.
'FI:;~: FI L":FII G:I:FIK EiRF~:[::,EN
LOT 51 Z'E ..L :,o..L4...L :~i;C.!LtF:IR[!-: F:'EE;T
'T"T'F'E I:)F ::'~i;I,'.)tL I'I[,....,LIF,:.E rIol'.4 E,'.?:STEr,'I ];~.:;' TF.:ENCH
HFt::.::II"'IIJH N LI FI E: [:Z F:: Eft:' E:EE:,F. tOOPI~?; = Z-':
SF~ I I_ RFIT I NG ,' :'5(.~ FT,.."E:F.: ::, =
'T'HE F,.':EI:.:!U ]: F.:E[> ~!; I ZE OF THE '..:.,O I L. FIEV.'SEff;.:F','f' t Or.,I L-~;'T"_.:";TEI 1 1:5 ·
[ii'::: F' 'T" IH == '::~ L. E; if-,t ,3 T' t'-'! ='"-= -:~: :::L ~ ......... ' IF:ti '-,,,' [::, ' ....'
THE LENG'FH [::, ]: r'IE:N'_:., I ON I :;.-:; THE L.F"NGTH ,' I N F:'EE:'T ::, OF THE TF4:ENC:H OF.: [.. F:.P I NF' I E:I....I":,.
THE E:,EPTH OF R TF.:ENC:H OF.': F'IT ];:E: THE E:,I:E;T'FINCE: E~E:TI.4EEr-,I THE 'L::;LIF;:FFIC:E CF THE.'.
GROLIND FIN[::, THE: BOTTOP1 OF' ~rHE E.:...:..:R,, F~'FION ,' :1:1'.4 FEET>.
THEF.:E I :E; NO :.-_-5E1" [41 [::,TH F:OF:t 'T'F..:EIqCHL::S.
THE EiRFI',/E:L DEF'TH :['::~., THE HI I'.,IIHUH [>EF'TH OF." 1.3F.:FI',/EL E;ET'P.IEE:I'-4 THE OLITi:::FILI.~. PIPE
RIqD THE E:OTTOH OF THE EXC:FI',,,'F1TIOt'.~ ,' ]:N FEEl"',
~:~:E,'.:...:., ~....I :It: IFC E E:, :E:; EE F:' -'r' I. C'.:: -1F' FII Ir-,! F=:.: "_::7:; Z ,=-L:." E: == ::11... ~31 E.._~ ~.Z::~ C.3i F~ L. IL..... ,':7:, ~"..,~ .".:":!L.';
F'EFF..:H]:T tdFFI....I_.HI"41 HFt:::'; THE [E_-,F_I'J:,IE:IL:[T'T' TO II'.tFOF. ff,1 TI-I:[~; F.:,EF'I::IF;'.THEI'-JT [::,UF;~:ING T'HE:
].' I',,I'::;I"FILLFI'T' I ON I 1'.,I:SPEC:T' :[ 13f.,l':-~; OF FII",I'T' I-,.IELLL~; FIE:,...TFtF:ENT' T'O TH ]: :5 r:: r; "F,~:",''' -~'
· ,' _ r r:.r~, , F~P',I[::' THE:
I'.~UH[:3EF:: OF' F:tE'_::.;I[::,ENC[.:::~5 THFIT THE I.,.IEL. L P~II..J.. '.'SE:F.'?,,,'E.
E:FIC:KF ILl..., I NG (:iF:' FIf,I'T''::, ...... .:, l EH [,4ITHOUT F INFIL IN:SF'EC:TION laND h' F..'F'"FI' "F.'... v HL E'"r'., "FH I'.;'~:;
D[-::F'FIRT'HENT 1.4 :[ L.L E:E'." .... , T .....
.:,IJE.,. E ... [ T .3 F'f4' - '5[.:' Z. T '[ ON.
HINIf"tUH DI:'5'T'FINC;E E:ETI.4EEN R 1.4ELL RN[> RN'.r' ON-.SITE SEI.,.IRGE [:,I:!~;F'OSF~L.. :5"r':.E;'T'E':P1
fl.E~e~ FEET FOR R F'RIVR'T'E [,.IELL..'
:L50 TO 2¢3E1 F'[.:.':ET FF.':OH FI PUE:LIC P~EL.L. DEF'ENDING LIPON THE T'¢PE OF PLIB[...IC I.'.tEL.[ ....
OTHER REI:.~LI]:F.':EHENT$ r'IR'T' RF'F'L'T'. ':7, F'EC:IFICFITIONS RN[> CONSTF.':UCTION [:,IRGRFIH:"3 FIRE
R',,,'R :[ LFIE:LE TO I NSL.IF.:E F'F.'.OF'EF.: I NSTRL. L. RTI ON.
:[ CEF:':TI F'"r' 'T'HFtT
::L.: I FIH F'F:IPIIL. IFIR HITH THE: F;::EQUIF,:EMENT$ FOR O1'.4.-..%I'['E ::.!; E [,.I E F:: E; FIN[::, NEL. L.$ F¢:?:; SET
F:'Cff;~:TH B'T' THE HUN I C I Pla[. I T'¢ OF' F:INCHI.'.'.'IF.'.FIGE.
;2:: I [4 ]: L.L. I N'Z~;TFiL. L. THE :-.';¥E,'f'EI'"I I N I::IC:C:I.')F.:DFiI'.4CE I.,.I I TH THE: COE:,E.'-.:~;.
::!~:: I IJNDEF::$TFtI"~[':, THFIT THE OI'.,I.....SITE SENL:.R '"_:;'T'[STEH HR'T' F:':EC!UIF4:E EI"~LFIF::EiEHENT :IF' THE
F:E?::;IDENCE': ]:'F.., F;.".EHI.3D['ZLE:[:, 'FO :[I'.4C:[,LI[:.',E P1OF.:E THFII'.,I 2[: E:E[:,F.:OOH$.
PERMIT NO.
r-lLl~ I C I PAL I TY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
25i0 E. TUDOR RD., ANCHORAGE, AK. 9~507
276-2221 ~
WELL.- PERM 'r -r
( 761.~0 )
APPLICANT
LOCATION
LEGAL
PLEASANT VIEW DR
TRACT R CHUGIRK GARDENS
GENERAL DELIVERY E.R.
LOT SIZE
iG8000 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PERM I t YAL I D FOR ONE YEAR FROM ISSUE
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
S I GNED: ......
RPPLI CANT WILLIAM,, W~TMRN
/
/
/
O & E ENG,,,,IEERING & DEVELOt .vlENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for: Name:
Mailing Address:
Legal Description: ~"~_,~/~ ~ 7-'
Tel. No. ~'~ - 7217
Depth (feet)
Soil Characteristics
6__
7__
8__
~9
13
~P
PLOT PLAN
PERC. TEST
15__
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
No L.--" If yes, what depth
Drain Field,
Performed by:
Date:
( 1 H~ALTH DEPA?.TMENT CASE
327 EAGLE STREET - ---. ~-
ANCHORAGE, ALASKA' 99501
This F~ R.~po~'ts a: Soils ~u~ - · -rarco~a~on 'rest . ' - -
Fea~ Soil Characteristics' ' " Location
/
'-
Proposed 'Ins-tal~o'n:~eepage Pi% Dp~in Field
Dep:th Of Inlet ~apth. To Bot~o~ Of Pit Or. T~enc~ ....... ~" '
COMHENTS~ = -"' -.
Oepth of ~il _.~..,z~;z_.ft. Casing: depth .__~r~ ft. diam. _.~tn.
Static water-'level ~ ft. [above, bel~ew~ land surface. Oate _~_.~7~
F'~sh of ~ei1~ (ooen-end, screen, perf~ce~d, open~ole, other) , ~
~;ell yi~l~ tested by (pump~bailing, air) at ___~ 9al/min.
fo~ ............. hours w~th ~ft. of drawdo~ fr~ static level.
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECIION~
MAY 26
RECEIVED
Depth belo~.~ land
surface ~n [eet
Gi¥~ description of strata penetrated (size of maL~.r~al, color, hardness
drilling, and water content)
to
to
to
to
to
to
to
to
to
to
BIT AND corehEaD RECORD MUD RECORD TIME RECORD DRILL STEM RECORD
RUN NO. WEIGHT DRILLING ~IZE D. P.
SI2E VISC. CORING SIZE COLL.
~AKE WTR. LOSS-C.C, OTHER JTS. D. P, FT
SERIAL NO. FILTER CAKE REPAIRS KELLY DOWN FT
DEPTH IN PH. TRIP COLLARS FT
HOURS RUN MTL. ADDED ( REMARKS) TOTAL FT
REMARKS:
FROM TO FORMATION ROTARY WEIGHT PUMP
NAME HRS.
SPEED ON BIT PRES,
7-0
SLOP~ TEST ACCIDENT:--
~,' ~. . -.. ........ :~ -
_.~ ......... ·~, : ..:-';.~-..,_:~:~ ____ ~.~ _ ~ ....
BIT AND COREHEAD REC°RD Jj MUD RECORD TIME RECORD DRILL STEM RECORD
WAKE W~R. LOSS-C.C. OTHER JTS. D, P. PT
~ERIAL NO. FILTER CAKE REPAIRS KELLY DOWN FT
ffOUR:5 RUN MTL. ADDED [ REMARKS) TO'IAL FT
from TO
SLOP TEST
ACCIDENT:--
(GIVE NAME)
FORMATION
WEIGHT
OH BIT
NAME HRS.
RUN NO.
SiZE
BIT AND COREHEAD RECORD
MUD RECORD
WEIGHT
WTR. LOSS-C.C,
FILTER CAKE
TIME RECORD,
DRILLING
CORING
OTH ER
DRILL STEN
SIZE COLL,
KELLY DOWN
, COCLARS
RE.CORD
FT.
FT.
PH. FT.
MTL. ADDED tREMaRKS) TOTAL FT.
REMARKS
PRINTED IN U,$.A. APPROVED
TOOL
PUSHER
NUMBER OF BEDROOM8 .
I--I_ ONE [] THREE [] FIVE [] OTHER
I-'t= TWO ' [] FOUR [] ' SIX : '
. ~,~.-r,o~w.,~ _ ~_".
LOG RECEIVED-~ - ~-
~LLED .
Tank
) BEDROOMS
C
ADHW- LAB - 2W
DATE
STATE ON ALASKA
D' \RTMENT OF HEALTH AND WEt ~E
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL_WATER ANALYSIS
Lab. No.
OFFICE
PUBLIC J---1 SEMI-PUBLIC J---] INDIVIDUAL J~] OTHER
REPORT RESULTS TO
NAME
ADDRESS
CITY
ADD RESS
OF SOURCE
Re~c~ords in this office indicate thls WATER SUPPLY to be of:
[] Satisfactory [] Questionable [] Unsatisfactory Sanitary Status.
Analysis shows this Water SAMPLE to be:
[~-Salisfactory [] Questionable [] Unsatisfactory.
If an "Unsatisfactory" or "Questionable" status is indicated above
you should take immedlate action as recommended below.
1. Notify consumers water is polluted. Boll or chemically
treat this water as outlined in the enclosed leaflet
"Drink It Pure."
SAMPLE COLLECTED BY
am.
DATE COLLECTED TIME COLLECTED ' pm
Sample Collected From [] Kitchen Tap E Bathroom Tap [] Baseme~'T-d~
[] Other
Well- --I Dug [] Driven I~ Drilled [] Bored
SOURCE: [] Spring [] Cistern [] Other
Dug Well or Cistern Construction:
Brick or
Wells - [] Wood [] Concrete [] Metal [] Tile [] Concret~
Top ' [] Wood [] Concrete [] Metal [] Open Top
LOCATION: [] In Basement [] Basement Offset [] Under H~use
[] In Yard ~'~ Other
Bu Iding Sewer Septic
DISTANCE TO: or Other Dra nage Pipe Feet. Tank
Tile Seepage ~.~ess-
Field Feet. Pit Feet. '~ool Feet. Privy
Other Possible
Sources of Contamination
MATERIAL: Building Sewer - [] Cast [] Wood [] Tile [] Fibre
Iron
~] Plastic Joint Material -- Type
GENERAL: Does Water Become FAuddy or Discolored? [] Yes [] No
Fqet.
Feet.
[] Asbestos
Cemeni -
When?
Diameter of Well Deptl~ Feet.
Well Casing
Material Diameter .Deplh ~
Length of Water Depth
Drop Pipe From Bottom Feet.
In Utility
PUMP LOCATION: [] In Well [] Offset In [] In Basement [] Room
Basement
On Top
[] of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No
New Source of Supply? [] Yes [] No Repairs to System? [] Yes [] No
2. Increase chlorination sufficiently to meet recommended residual standards.
Determine source of contamination and take action necessary to maintain
a safe water supply at oil times.
3. Check chlorinatinn and other mechanical equipment. Make certain it is
functioning properly.
4. If after checking equipment a disinfecting* residual is not obtained, please
wire this office for emergency assistance or advisory services
5. This is a surface water source and subject to pollution by map and animals.
An approved water supply source should be developed,
6. Improve your [] spring [] dug well [] driven well
'"' [] drilled well [] cistern.
__7. Relocate your well to a safe location in relationship to your sewage
disposal system. [-] see enclosure
8. Sample too long in transit; sample should not be over 48 hours old at
examination to indicate reliable results, please send new sample.
[] Bottle Broken in transit, please senna new sample.
9. Contact your nearest [] Local Health Department or [] Alaska
Division of Public Health, sanitation office for bulletins, consultation and
assistance.
SANITARIAN'S REMARKS
Signature :.-. _
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Received Time Received ~m Lab. r~o.
48 hours . .. ---p .... ~ ~ -. - ,
Brilliant Green
24 hours
48 hours ,.~. ~ .-~'
EMB
Lactose Broth, 24 hrs.
Colitorm Density
MF results
Reported by ~I,~ ~"~ "'"'-'
This analysis indicates Co,~orm Organisms to
48 hrs..
AGAR
Gram's stain
I~ost probable No.. per 100cc/,
be:
(' Absent