HomeMy WebLinkAboutUS SURVEY 3042 LT 88B T10N R2E SEC 19
40298
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
Alaska Hydrologic Survey
WATER WELL LOG Revised 08/18/2016
Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______
City/Borough Subdivision Block Lot Property Owner Name & Address
Well location: Latitude Longitude
Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4
BOREHOLE DATA: (from ground surface)
Suggest T.M. Hanna’s hydrogeologic classification system*
https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD
Depth
From To
Drilling method: Air rotary, Cable tool, Other
Well use: Public supply, Domestic, Reinjection, Hydrofracking
Commercial, Observation/Monitoring, Test/Exploratory, Cooling,
Irrigation/Agriculture, Grounding, Recharge/Aquifer Storage,
Heating, Geothermal Exploration, Other
Fluids used:
Depth of hole: __________ ft Casing stickup: ___________ft
Casing type: __________ Casing thickness: _________ inches
Casing diameter: _________ inches Casing depth: __________ ft
Liner type: _________ Depth: _____ ft Diameter: _____inches
Note:
Well intake opening type: Open end, Open hole, Other
Screen type: _________, Screen mesh size: ____________
Screen start: ________ ft, Screen stop:________ ft, Perforated Yes No
Perforation description: Perf from: ________ ft, Perf
to: _______ft, Perf from: ________ ft, Perf to: ________ ft
Gravel packed Yes No Gravel start: ______ ft , Gravel stop:______ ft
Note:
Static water (from top of casing): _______ ft on____/____/_____ Artesian well
Pumping level & yield: ______ feet after _____ hours at _____ gpm
Method of testing:__________________________________________
Development method:______________ Duration: ____________
Recovery rate: _________ gpm
Grout type: _________________ Volume __________________
Depth: From ___________________ft, To ___________________ft
Final pump intake depth: __________ ft Model: _______________
Pump size: _____________ hp Brand name: __________________
Include description or sketch of well location (include road names,
buildings, etc.):
Was well disinfected upon completion? Yes No
Method of disinfection:
Was water quality tested? Yes No
Water quality parameters tested:
Well driller name: ..................................................................................
Company name: ...................................................................................
Mailing address: ....................................................................................
City: __________________________ State: AK Zip: ___________
Phone number: (________) ________- ______
Driller’s signature:
Date: ______/______/_________
Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require
that a copy of this well log be submitted to the Development Services Department/City
within 30 days of well completion.
City Permit Number: _____________________________
Date of Issue: _____/____/_________
Parcel Identification Number: ______-_______-________
*Guide for Using the Hydrogeologic Classification System for Logging
Water Well Boreholes by Thomas M. Hanna NGWA Press
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
copy of the well log be submitted to the Department of Natural
Resources within 45 days of well completion. Well logs may
be submitted using the online well log reporting system
available at:
https://dnr.alaska.gov/welts/
OR email electronic well logs to
dnr.water.reports@alaska.gov
North
17
1
PO BOX 110378
WAYNE WESTBERG
GUSTAVE HANSON , AK
M-W DRILLING INC
33.0
41.0
70.0
002E
0.0
3.0
8.0
907
40
80.741.0
33.0
8.0
3.0
6
n
80.0
70.0
5
19
1978
n
SANDY WATER GRAVEL
SANDY GRAVEL
LOOSE GRAVEL
WET GRAVEL
SILTY GRAVEL
CASING STICKUP
80
40298
345 4000
Municipality of Anchorage
2
n
ANCHORAGE
n
99511
1040
S 010N
Parcel I.D. #
1,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address.
Agent
Address
Day phone ~-~c~l
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: · ~ ~"
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/~1) Front MOA~21
5. STATEI~¥1ENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investig~tion of 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 verifythat 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 Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
6. DHHS SIGNATURE ... ,/
I/"/ Approw.~d for ~'/'-~/0 bedrooms. '
Disapproved.
__ Conditional approval for I~edl:ooms, with,th"e following stipulations:
Additional comments
The Municipality of Anchorage 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 rsgistered 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 federal and state requirements. Em ployees 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.
Municipality of Anchorage SEP 0
DEPARTMENT OF HEALTH & HUMAN SERVICE~JNIClPA~.ITY OF
Environmental Services Division ~NVI£ONMENTALSERVIGES
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
Health Authority Approval Checklist
Legal Description: L.o '~ ~ ~ ~) ~,_C> ~D ~ Z~
Parcel I.D.:
A. WELL DATA
Well type '~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
~ ~,~'/ Cased to
FROM WELL LOG
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
~ '~7_.- Casing height (above ground)
//
Wires properly protected (Y/N) 7
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform
/
Date of. sample:
Nitrate
~),-7 ~;~/l/~/~ Other bacteria ~
Collected by: ~", -.~
B. SEPTIC/HOLDING TANK DATA
installed Tank size /Number of Compartments Cleanouts (Y/N)__
Date
/
Foundation cleanout (y/N) ~ Depr~ion (Y/N) High water alarm (Y/N)
/
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
/
Date installed Soil rating (g.p.d/fF or fF/bdrm) System type
Length Width _ __ Gra7 thickness below pipe Total depth
/
Effe~t~s~rp:°~e~:ea -- -- M°~te°sl ~sT'~:;~i~nt (Y/N) Depression over field (Y/N)_
Dat q a y __ __ s~ts (Pas ' ) For. __ __
Fluid depth in absorption field before test (in.~/ Immediately after gal water added (in.):.
Fluid depth __ (ins) Minutes late7 Absorption rate = q.p.d.
Peroxide treatment (past 12 months) (Y/N~ If yes, give date
bedrooms
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (WN)
High water a!ar~n level at*
Cycles tested
· e in gallons
"Pu
,.-/ *Datum
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /'~/,~,
Absorption fiekt on lot
Public sewer main
Sewer/septic .,;ervice line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout ~/~:~
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDINGTNK ON LOTTO:
Foundation Property line / Absorption fie d.
/
line Surface wate/r~rainage Wells on adjacent lots
Water
main/service
/
SEPARATION E)ISTANCE FROM ABSORPT/~N FIELD ON LOT TO:
Property line _ Buildi~'foundation __ __ _ Water main/service line
Sc~rfrtaa~ ~vl:ti~r / Drivv~l~sY:~a~i;~gc~n~hl,;i; storage area
ENGINEER'S CERTIFICATION / _-~ :,
I certify that I have determined thru field inspections and review of Municipal record~i~h~t ~h~ a~b've ~YSt~ms are
in conforrnanc~ with MOA HAA guidelines in effect on this date.
Date
HAA Fee $__
Date of Payment ....
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
T. SPURKLAND P.E.
WEST 15TH. AVENUE SUITE 203
ANCHORAGE, ALASKA 99502-3904
(907) 279-3916
Fax (907)-276-6013
RESIDENTIAL WELL INSPECTION
LEGAL:
OWNER:
LOCATION:
Lot 88B USS 3043
Gustave Hanson
Girdwood
TYPE OF WELL: Private, Single Family
WELL LOG AVAILABLE: Yes
INSTALLATION REQUIREMENTS MET: Yes
WAIVERS GRANTED: None Required
WELL YIELD FROM WELL LOG: 10 Gallons per Minute
WELL YIELD FROM TEST: 10.55 Gallons per Minute
DATE OF INSPECTION: August 29, 1999
TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an
acoustic probe. At the beginning of the test water level was found at 73 feet below top of casing. At a pumping rate
of 10.5 gallons per minute the water level stabilized at 7-5 feet. A total orS00 gallons was pumped in a time period
orS0 minutes. Thc well recovered to 53 feet immediately.
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on
August 29, 1999
E.Coli 0. Other Bacteria 0 Total Nitrate-N 0.791mg/l.
Max. allowable TotalNitrate-N 10mg/l.
10 Colonies of Bacteria Allowed
TEST RESULTS: This well meets the requirements of the Municipality of Anchorage.
THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE
THANFOUR HOURS
The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceeds this
requirement. The assessment of the 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 factom that may impact the aquifer feeding the well.
SEP'02'99 14:t3 FROM-CTE ENVIRON~IENTAL
,.~T~: r:T&~ ~nv,~onmen,al Se~ic~s ,nc_
T-557 P.02/02 F-748
CT&E Ref,$
Client Name
Proj~
Clienl Sample ID
Matr~
Ordered By
PWSID
9~4590001
Tobbea Spuf~and
Lo~ 88B, VSS 3042
.Lo~ 88]8, VSS 30ne2
Drinking Wamr
S~ple Remarks:
Client PO# P~e-Pa~d Colis/NO3
Printed Date/Time 09/02/99 13:56
Collocted Date/Time 08/29/99 [4:00
R~eefve41 ])ate/Time 08/30/99 08:55
Technical Director: Stephen C. Ede
Released By
units
0.500 ~/L EPA 3fl0,{}
10 max 09/05/~> 0B/30/¢7~ SCL
SEP-03-1999 F'RI 09:28 rift L~NTEOH/SL~Nff F~× NO, 5616626 P, 0!
88A
2
LOT 8!':
S~SO
GRAVEL
DRIVE
HOUS
/
~-NS TRUC TION SURVEYORS~PLANNEES-ENOINEERS
440 WEST BENSON BLVO, ~ !O~ ([ox) 58i¢6626