HomeMy WebLinkAboutTract A
Development Services Department
Building Safety Division
aG t f1 �
On -Site Water & Wastewater Program
' 4700 Elmore Road
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: I a&
Parcel Identification Number:
Legal Description
�l(7�0�L� �nd�5/�fir►a�
Prop e Owner Name & Addre s:
2 �� 64— 4-a61 q
AWdo. 91<„ ?qS"f r
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: (/0
feet
Pump Manufacturer's Name: tINI,-Je,�
Pump Model: 6rs - 3 00
Pump Size 7-0 hp
Pitless Adapter Burial Depth: feet
Pitless Adapter Manufacturer's Name: VP
Pitless Adapter Installer: h(u
Well Disinfected Upon Completion?Yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name:
'Aw6i`_+a;. ANCHORAGE WELL & PUMP SERV.
330 EAST 76TH AVENUE
.,r 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.
GREA.,:R ANCHORAGE AREA BORL.,_ GH
Department of Environmental Quality
3330 C Street
Anclnorage, Alaska 99503
........... ~NsPECTION REPORT ON'SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE / ~,~OW6~;;~-~ NUMBER OF
FROIVl WEI_L *~¢..~L~_0 MANUFACTURLR . _ MAI'ERIAi _ _COMPARTMENTS ~
INSIDE LENGTH ___ ~ INSIDE WIDTH ~-- _ LIQUID DEPTH ~ LIQUID CAPACITY/~GALLONS.
DISTANCE FROM WELL~' F' / TOTAL LENGTH~ /
FOUNDATION ~ NE;,RES1 LOT LINE. ~/ _ _OF LINES
, /
NUMBER OF LINES ~__~ DISTANCE BETWEEN LINES 7 __TRENCH WIDTH ~IN. TOTAL EFFECTIVE
/, DEPTH GF FIL~LR
DEPTH: TOP OF TILE TO FINIS~I GRADE ~ MAiERIAL BENEAT~I TILE ~'~_IN. ABOVE TILE . ~'" ~ IN.
BUILDING NEAREST NEAREST / SEPTIC_ ~ /SEEPAGE ( ,~.
~OUmD.T~O. _ ~OT ~E .... S~V','~R ~/~_ _, T*,.~¢~_ ~, SYSTEM ~¢
CESSPOOL ...... OTHER SOURCES --.
APPROVED ~ DISAPPROVED ..... RE,MARKS
SEWER LINE DEPTH:
Form EQ-032
ALASI'::[FI A1:3i3 fE:EI3Ft T E~
T_OC:FI~ J: ON ' ';;':~l'-Jl:) _~:. C~ ~/~
LEGRL 'T'F.:FICT FI Ftl._A'=qKA :[I'..I[;,US ~=';I.JE:I)
LOT SIZE
I'"r'F'E OF S':O ~. L FIE:SORtF'T Z ON SYS'f'EH... T'REt",ICH
~' E:,EF:'FIE:'T'HEI'-,H" I:~ HEFIL'fH AI'.,I[::, EI'.,I',,,"r F::Ot'.,Ir,'IEI'.,ITAL [ 3'TECI'T ON ~ _./¥~_
NLIr,IBEF.: OF E:E[:,f4tOOH'.:J, 4 SO]:L F.:FITTI'.,IG :.::;QF-f',.."E:I~:
THE F.:EL.';!U :[ REE:, % ]: Z'E OF THE SO Z L. FIE:SOF.:F'T :[ O1'.4
F' ]: F' E- FIIq [:, 'T' HE E X C~Br O T'T' O H
1'HE 1''II:NJ;HUH E:,EF'TH OF:' GF.:A'v'EL E:ETHEEI'.,t THE: OUTFFILL
THEF.'.E :[ "+.'; I'-,IO :SE"I" N I DTH F'()~: TF4:EI'.,ICHES::;. F'OF4: E:,D'.R I NF 1: EL. DS, 1-HE H I E:,I"H I S.:; :].':F"T'.
THE DEF'Tf4 OF TI:,::EI'.,ICH OF.: F'T-f' ZL=i; 'T'HE D.'[L:.';'T'ANCE E:EI"HEEN 'file GF.:OUNE:, S-';URFACE FINE:, THE
BOTTOH OF' ']"HE EXC:A'v'FI-f'TON.
THE LENGTH [.':, :[ HENS T OI'.4 :[:5 'THE L. ENG'fH OF EAE:H 2;TE:,E F'OR A :~EEF'AGE F':[.I" OF..' 'THE
LENGTH OF THE: TF.:ENE:H, OF.: E:,RA ]: NF ]; EL.[::'.
THE REI::.:!I...t :[ F4:E[.:, ::.::;EF'T ]: C: TRNI'::: ?_; ]: ZE: ]: E; :1.2:5E1 GAL. LEq'-,IS
BACI':::F :[ LI.... ]: NE'i OF' RNY :.:.';YS:.;TEH H ]: THOU']' F' ]: NAL T NSF'E:C'f'T ON BY TH T S E:,EF'AF.:Tr"IENT H Z LL
E:E SLIB.J'EC'f 'T'O F'F.:OSECt..Fr];ON.
H T I'.,I T HUH D :[ STFINCE F'ROH HELL_ TO FINY SEF:'T :[ C TRNI-:::,.."F:'FIC:I--':.'AGE PLAN'T OF.: E;O ] L FIBSOF.:F'T :[ ON
SYSTEH ]:S :1..OC~ F=T F'OF4: Ft F'I(::['v'Ft"rE:HELL. AN[) 280 Fl" FOF.: Fl F'UBL:[C: NELL.
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FILE; SETFOF.:TH E!:'-r' THE HUI",I :[ E: ]J F:'FIL. ]. 'fY (:jif FIN E: H: F.'FIr3E' FIND [,.I :[ LL :[ I'.,fSTRLL ]: N FIC:E:EtF.':E:,FINC:E
H,TH THE: E:E~,E. ."~.~.,t...~
~O3 EAST SIXTH AV~iNUE
WATER LEVEL W D .L"~ c/ '2,'.
_ DATE_ /~ ~ ~.: STATION ,
" " AD.~ DRILL TIME ST., ..FN. GR. COVE~
J /
" " 24h'[__ CASING SIZE TECH ~:~
PIEZOMETER YES NO DRILL USED ,':., 5' . DRILLER .':'
~,03 1~^ST $1XTll AVI3qUE
ANCHORAGE. ALASK^ ~Ol
" " AD _-----. DRILL TIME ST. ~FN.~GR.
" " 24 h',~ CASING ~ _
ELEV .
?..t:.} _ PIEZOMETER YES NO DRILL USED ,~.. C' :.;' ........
~03 FAST 51XTII AVENU£
.~NCHOI'i^GI~, AL.ASK^ ~ol
~/ ,,
WATER LEVEL WD~ DATE.___J '~ :?,,5" /~ STAT/ON .
" " AD_ __ DRILL TIME ~ FN._GR. COt~El?
" " 24h'[ .... CASING SIZE, TECH :i
PIEZO,~,ET~R YES FIO DRILL USED [Z~. ..... ~ ~/ DRILLER
= 7-' ,,.~:'--"---7- ~~-' ~,?.'----~,, z-----::~ --/ ~:~,/ ~.~,. /
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I
CLIENT ', ~'~ ~ ~ ~
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oLE
£LEV
FROST ......
I~O3 £AST SIXTH AV~-:t',IU[~
ANCI-IOIrlAGE, AL/~,S,I(A ~,~Ol
WATF'R LEVEL WD/f;~''' DATE_ /-?~,~' STATION
" " AD ~ DRILL TIME ~ ,, FN,~GR. COVEI?~.~
" " 24h'r_ _ _ CASING~SIZE. , TECH
PIEZOMETER YES NO DRtLL USED. .: DRILLER
Well Owner.
Location
(address of:
[VI-W DRILLING, Inc.
P.O. Box4-1224 · 1310C International Airport Road
(907) 274-461 ]
ANCHORAGE, ALASKA 99509
DRILLING LOG
MUNICIPALITY OF ANCHORAGE .,~
DEPT. OF HEALTH g,
ENVJRONMENIAI,. PROTfClION '
]dAY 20 '
RECEIVED.
Use of Well
Township, Range, Section, if known; or distance main road
Size of casing.
Static water level
Screen ( ·
Describe screen or perforation
Well pumping test at 77<i gallons per (~r)
of drawdown from static level.
.Depth of Hole :~'~ feet Cased to feet
ft. (~bi~V4y (below) land surface. Finish of well (check one)
Perforated ( ).
open end (
(minute) for : hours with
Date of completion :: :,-' '~. ~7,~
WELL LOG
);
ft.
Depth in feet from
ground surface
Give details of formations penetrated, size of material, color and hardness
.TO_
TO.
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TO
TO
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TO
__ .TO
TO
_.TO.
TO.
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2 -- STATE
i".'ti_,lt'-41 :E ,2: ][ F"RIL__ :[ "I'"'T" C'F" FII'qI~Z:HE'F.:FI'3E
DEPRRTMENT _iF HERL. TH RN[:, ENVIRf]NHENTRL PROTECT'ION
] ~:":~:F~ C '.:_:TF.'".EET., FINE:HE F.'RGE., FIL. FISKR
L.J El L_ L .... F' E I~" I'-1 "If' -['
PERM 11T NE ,' '~:~ E~3(:J ',
IRLF:ISKR FtGE'iREL-~FJ'TE, p I'-I EI~I',:.:: ~: ":'"::'°l-' q~..~[1L'L
~..OCFI]" I I"11'.,I ?:' ~1'-,1[:, ';:. C ~.;"1"
I_EGFIL RLAGCCi I N[:,U'_:;
I_L-I"[' E; I ZE jLO::LZ~948 SL'.:!FT
- "' '--' '" '" I~' --"-I-1 ' -
MINIHUH [:,ISTRNCE FROM WELL Tf] RN'¢ '_:;EP]"IC THI"4k.,-'FHL. KH-~E F'LRNT OR SOIL HB_-,_RPTTUN
'.5'¢S]'E1"~ IS :tE.~O FT F'OR R F'RI',,,'RTEHELL RNE:' 2'OR FT FFR' R FLIBLI_. WELL
1.4E]LL. L. OG2;~; MUL:.;'T' BE RETL.IRNEE:' TO THE [:,EPRRTI'IENT HITHTN 3:8 [:'R¥S F'IF THE HELL
C O M F'I_ E T I 3 N.
SPEC I F I r':RT ! ONS RN[:' CONSTRUCTZ ON E:'Z RGRRMS RRE R',,"RILRBLE TO INSURE PROPER
]: N ~-.'; T R L I.... R T I O N.
Z C:EF.'.'rIF'¢ THRT I FIM FFIMIL:[RR HTTH 'THE RE6!UTREMENT'=; FLF.. ON-SITE SEWERS FtN[:, WELLS
FIS '.'SETF'~. ,B'T' THE MUNIC!PRLZ'T"¢ OF RNE:HF~RRGE RND H!LL INL=,TRLL !N RCCORDRI'-4C:E
14]:TH TH~ ~[:E.
'5; I G N E [) ..................
I'.SSUEI]:' E: .... [:'RTE]. /'"7..~..//.-'.~::~
ALASKA TESTLAB
4040 "B" STREET ' ANCHORAGE, ALASKA 99,.503 ' PHONE: 907-279-2581
06-1220(a) Rev. 1973
DATE
ALA? DEPARTMENT OF HEALTH AND SOCIAL SE IES
DIVISION OF PUBLIC HEALTH Lab No.
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS OFF,CE
iNDIVIDUAL []
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
NAME
ADDRESS
CITY
ZIP CODE
ADDRESS
OF SOURCE
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsat]sfactory
[] Questionable
[] 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 send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
Sample Collected From [] Kitchen Tap [] Bathroom Tap
[] Other (List)
Well- [] Dug [] Driven [] Drilled
SOURCE: [] Spring [] Cistern [] Other
Dug Well or Cistern Construction:
Walls--J~ Wood [] Concrete [] Metal
Top -- ~ Wood [] Concrete [] Metal
LOCATION:
~ In Basement [] Basement Offset
[~]ln Yard [] Other
Building Sewer
DISTANCE TO: or Other Drainage Pipe
Tile Seepage Cess-
Field Feet. Pit_ Feet. Pool __-
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- ~ Cast Iron [] Wood [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
When?
Diameter of Well
Well Casing
Material Diameter
Length of
Drop Pipe
Offset in
PUMP LOCATION: [] In Well [] Basement
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes
READ INSTRUCTIONS
ON
[] Basement Tap
REVERSE SIDE
[] Bored
[] Tile Brick or
[] Open Top r~ Concrete
[] Under House
Septic
Feet. Tank
Feet. Privy. __
[] Fibre [] Asbestos
Cement
Feet,
Feet.
[] Yes [] No
BEFORE
COLLECTING SAMPLE
Depth Feet.
Depth
Water Depth
From Bottom Feet.
In Utility
[] In Basement ~ Room
[] Yes [] No
[] No Repairs to System? [] Yes [] No Signature
06 1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Re,.'. 1973
am
Date Received Time Received pm Lab. No.
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc
24 Hours
48 Hours
Brilliant Green
24 Hours
48 Hours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs.__ Gram's stain
Coliform Density (Most probable No. per 100cc)
MF Results
Reported by
This analysis indicates Coliform Organisms to be:
Date
Absent
Present
D]RF::CT~ONS FOR COLLECTING SAMPLES OF :-VATER FOR BACTERIOLOGICAL ~XA'~NATi'ON
Rec~d CarefuJly and FoJ~ow Instructions Exactly
Bear ~n mind thc~t wc~ter ar~a[ys~s dea~s with ma~eri~ s present in very minute quantities. The least care-
lessness in collecting and handling may give rise to :'esults which are mis~eading.
Samples are ~ccepted at the regional Jaborc~torie~ i~ the early part of the week (MondawWednesday)
urdess there is an emergency or prior arrangements have been made. Arrangements should be made to
have the water samples reach the laboratory as qu~'kJy as possible and within 48 hours after colJectiom
After 48 hours, the significance of the bacteriological analysis is impaired.
Jn collecting samples from TAPS or PUMPS proceed as follows:
(a) Thoroughly flush tap or pur~p by aJ[owir~g ;,rater to run freely for five minutes.
(b) Shut off water a~d flame the out[et with torch or burning paper. The flame should not be
merely passed over the outlet but shou!d be applied until fixture shows indication of being
hot, Flame should be directed against inside edge.
(c) Open fixture so that a small stream flows.
(d) Remove bottle from mailing tube. Hold bottle by the lower half in one hand and with the other
remove the screw cap with the fingers, leaving fall protecting cover in place. Fill the bottle to
the shouider. Replace cap with foil cover, screwing firmly into place but do not apply pres-
sure which will split cap.
(e) Pack bottle carefully in mailing tube enclosing this completed information sheet.
DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD
HYDRANTS, DRINKING FOUNTAINS OR SIMILAR OUTLETS
WHICH ARE DIFFICULT TO DISINFECT PROPERLY.
STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM:
Depk of Heofth& Social
Sout[~eastern Regional Sanffadan
Juneau, Aiaska 99801
Dept~ of Hec~lth & Social Services
SouthcentraJ Regional Scmitadan
338 Denall Street, MacKay ~ldg.
Anchorage, AIaska 995~]
Dept. of Health & Social Services
Northern Reglonal Sanitc~r~an
604 Barnette Street
F~[rbanks, Alaska 9970i
Or D~strk~ Offices in Fc~irbanks, J~ec~u, ~etchikan, Kodbk, ~,[ome, t';Jmer, So~dot~ and VaJdez. Cm~sult bcal telephone directory for