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Home My WebLink AboutUS SURVEY 3043 LT 70D P.O. Box 10-378 o 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 D~ILLING LOG Well Ownez. JOSEI?H LUSIU~kA Use ofYVeil Domestic Location (address of: Township, tIange~ Section, if known; or distance raain road Lot 70 Block 5-~ USS # 3043 Size of casing. 6'_' ..... Depth of Hole_..~82 feet Cased to__80.8 feet otat]ee ' v/ater leveb..._'~t____ft. (a]c~v~ (below) land surface. Finish of well (check one) Screen ( ); Perforated ( ). Describe screen or perforatiozL~-e Well pumping ~est aL._2.~_.gallons per ~ of drawdown from static level. Date of completion__~z~_L~3__ open end ( xxx ); (minute) for 1 .... hours witlL__JI)_QX___. W~:~L LOG Depth in feat from ground surface Give details of formations penetrated, size of material, color and hardness .... _0__.'tO 2 ___2__TO .... ~L__ .... 4__TO ....... ?___ ____f/_ .2'0 ..... ii_._ .... _ Lo___.37o ..... _6..2._ __ 62___TO. '70 __2_0__.TO. 75 ..... Z_a___TO ..... 82 ..... ......... 'PO ......... ' ........ TO .......... TO __ __,_9 a_~..j Z.L~_i a__Y e Y g_r_az_e_]_- MUNICIPALITY OF ANCHORAGE "~ OF ..... F:NVIRONMENTAL PROTECTION ,FEB 2 0 1987 RECEIVED ___C_l.a_y_aZ. gravel ~_~_~oos_e._. c,,~al .amp~ __Hard__dr~Kravel Gravel ~_ da~ ~'," ~{I ~L3~;it a rJkear_in/g_ .gzta~, e 1 ,_2,lar.~z_b~a 2iin. D~Jia ~z] .jzI_WWA Certified Contractor 1 -- CUSTOMER /'--"~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~ O~'-'~ _ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date //'~/~:~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions)_// _. ~ Applicant~me /~~~ Te~phone:Home ~ Business ~-~/~V Applicant Addres; ~ ~O CJ. ~~ .~/~ ~ / ¢¢~ ~ Applicant is (check one): Lending institution ~; Owner/builder ~; Buyer ~; Othe~ (explain); /~ (d) Lending Institution ~5/~...? Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: : '.': TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY individual Well~'~ Community [] Public [] Note: if community" well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Publicx Community [] Holding T~nk [] Note: If community/'well system, must have written confirmation from the State Department of EnvironmentaJ Conservation attesting to the legality and status. 72-025 111/84) Page 1 of 2 5.. ENGINEERING FIRM PROVIDIF~'~%NSPECTIONS, TESTS, FILE SEARCH, DI:'-"~AND INF.ORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investig'ation of this Health Authority Approval 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 Municipal and State codes, ordinances, and regulations in effect on the date of this insp.~ection~ Name of Firm ~~ ~~ Telephone Address ~ CJ. ~, ~_~'~-c--~--~ -~..~'J~°'~4~'~'(~l'~ Date DHEP APPROVAL Approved for Approved. Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipa[ity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent profess[onat engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their [ending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 eng'neer s work. Page 2 of 2 72-025 (11/84) WELL DATA Static Water Level 3¢ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Well Classification '~. ~/~ i )//Ri,/~ (.-- If A, B, C,, D.E.C. Approved (Y/N) Well Log Present (Y/N) '~ Date Completed ,/t'/~ ¢' Z/ /~' ~.~ ,Yield Total Depth ~Z...' Cased to c~¢2,- Depth of Grouting Pump Set At Sanitary Sbal on Casing (Y/[~¢ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ,,/Vo/,¢',~ ; On Adjoining Lots /~ 7,~.,¢~..~ To Nearest Edge of Absorption Field on Lot /~"'/~)~'¢~'; On Adjoining Lots ./"~¢)/1¢'~2 To Nearest Public Sewer Line ~'.~ / To Nearest Public Sewer Cleanout/~;:h;.~;; ~'~ / To Nearest Sewer Service Line on Lot ~ / Water Sample Collected by ~t,/o~L ~._~-o.~ !.J~ I,.~. ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed __ ~.Size No. of Compartments Standpipes (Y/N) '~r-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped __- Pumping/Maintenance Contract on File (~ _ ~; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septle/Holding Tank: To Water-Supply Well ~ Building Foundation __ To Property Line __ _ Ti~posal Field -- To Water Main/Service Line ~ To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Stra~_ Type of System Design Date Installed X Length of Field ___ Width of Field '~ Depth of Field __ __ ~ Gravel Bed Thickness ____ Square Feet of Absorption Area ~ Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ Separation Distance from Absorption Field: ~ To Water-Supply Well '~o Property Line __ To Building Foundation ~ To Existing or Abandoned System on Lot ~ ;On Adjoining~ts __ _ To Water Main/Service Line __ To Cutbai~f present) _ To Stream/Pond/Lake/or Major Drainage Course ~ To Driveway, Parking Area, or Vehicle Storage Area ~ Comments ~ D. LIFT STATION Date installed "~ Dimensions Size in Gallons ~ Manhole/Access (Y/N) . ,,, "Pump On" Level at '~ Pump Off Level at High Water Alarm Level at ~ Vent (Y/N) . Tested for ~,% Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, veJ:ifieCCor conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sig ne~/~/~,z/'~L"~~-,,-~ate'"['~ /~ /~/ .//"'~/~_;~ ~1, Company~~~. MOANo.~' 0 / /oo/ ReceiptN°' - //W~. Date of Payment Amount: $ ' ¢ 00~ ~ Seal Page 2 of 2 72 026 (lW84) unicip litYof Anchorage P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES February 18, 1987 Wayne Henderson Peninsula Engineering 440 West Benson Blvd., Suite 206 Anchorage, Alaska 99503 Subject: Lot 70D U.S.S. #3042, T10N, R2E, Section 18 Waiver Request WR87-001 Dear Mr. Henderson: Your request for a waiver of the 100 foot separation required between the sewer cleanout and the well serving the subject lot has been granted. This distance has been waived to 89 feet in this case. An analysis of site conditions indicates that it is very unlikely that the well could be contaminated as a result of the sewer cleanout's proximity to the well. Sincerely, Stephen S. Morris civil Engineer On-site Services TO · PENINSULA ENGINEE .~JG 440 WEST BENSO'N BLVD., SUITE 206 ANCHORAGE, ALASKA 99503 (907) 561-5107 GENTLEMEN: WE ARE SENDING YOU [] Shop drawings [] Copy of letter ~¢'Attached [] Under via separate cover [] Prints [] Plans [] Change order [] [] Samples .the following items: [] Specifications COPIES DATE NO. DESCRIPTION / //7/~'7 / ,/'/~ ~r ~ THESE ARE TRANSMITrED as checked below: [] For approval [] For your use [] As requested [] For review and comment [] FOR BIDS DUE [] Approved as submitted [] Approved as noted [3 Returned for corrections [] 19 [] Resubmit [] Submit [] Return__ copies for approval copies for distribution corrected prints [] PRINTS RETURNED AFTER LOAN TO US REMAR COPY TO. SIGNED: SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown and de ~n ~ encroachments exist other than noted. ! PLEASE NOTE: It is the contract LEGEND: SET FOUND wa..: 'ENGINE·RS · PLANNERS · SURVEYORS -or's responsibility to check top 5/8" REBAR · O of foundation In relation to HUB & TACK tm ~ ORN- 440WESTBENSON BLVD. finish grade and building set- MONUMENT ~ backs In relation to lot lines AL-CAP ~ (~ CHKD'; ANCHORAGE, ALASKA 99503 562-5291 and easements. PK NAIL X LEGAL DESCRIPTION: ~RON PIPE (~ GELD: ,, SGMED 177