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Home My WebLink AboutPOTTER POINTE LT 3Potter Pointe Lot 3 #020-091-87 Municipality of Anchorage Page 1 of 3 Development Services Department OnSrte Water and Wastewater Program 4700 South Bragaw Street P.O. Boz 196650 Anchorage, AK 99519-6650 www.cianchorageak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO40158 PID Number. 020-091.87 R.ns Ha en Investments LLC Wastewater System: New .Gd.ea P.O. Box 240186 Anchors a AK 99524 ABSORPTION FIELD 242-0 838 Falrgoan. Municipal Sewer System LEGAL DESCRIPTION Sd Raoq Tai DeNN hon tiger pad GPD/Fe FI 81a La SWowenn Deptbpp.harmhonwvr prM Geral dem sort pp., 3 Potter Pointe FI. FL TowWrp Reqs. FAadded as n. oq'� grade a Lanph Ft. FI. Well: New .wY endo tMe blrraen Ines iL Ft DWN� 1pnraN.Ae, Ck TaW DepM1 Caws W. atwrpban ars. ipa er Private 166 113 FF Osler', D" Dneed suite Was Lw . AI ine Drilling &W04 29 Ft Y.Rarpsal« 2.5 Cm q At Gpurd >2 TANK Cl+M n. FI SEPARATION DISTANCES ® septic []Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ubloplWate From Tank Field station Tank sewer Line well NIA WA NIA NIA >25e suirec.wala WA WA WA WA LIFT STATION — NONE ON LOT WA WA WA WA D„ FouWlvl WA WA WA WA w " b ti it, D~Dr.n None Noted saZ by R� BENCH MARK Wall s on municipal Smer System. Ft Engineers Stamp •��wwwgq .� of ees Inspections performed by: Dates: 1"} 449 h Department of Health and Human Services approval !� V1111 HL E..NDCR$pN f" Reviewed and approved by: ml0 � Date: � ��,..w••''�`�:� _f1�lr..e� ��A�'`�. •• at« rawi oapw �S��a��•,. 0 z m A 9 m 1 0 Pb o s Z a Cl) o� A �W N to m its ;co p ; I < i to 1 O 1 gg 1 � R i 1 f/f 111 C mco q K K 1 v ^ Z = I D ssrI 1 O In d�md y0 G`C f m n 00 Iri, 1 1 X mom c� s 4 *,pvo m D@ I fi • CD Cn = n m m C g m °' o g I R1 1 1 I 1 1 1 �1 g61 1 I it ��1 •P I pp1 _____ �__ ��,��5;\�%�..°�`.. 10 _ a `iF /i o .. / _ oto D y [� O a d / op 41 �: s /� K.:t 10 i i .C��--L. (0 N v Municipality of Anchorage Department of Health and Human Services Aim 825'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mystrom http,Nwww a anchorage A us Mayor Permit Number: #SW 040158 Date of Issue: 5-28-04 Date Started: 5-28-04 Date Completed: 6-02-04 Legal Description: Potter Point Lot 3 Property Owner Name & Address: Hagen Inv. PO Box 240186 Anchorage. Alaska Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Stick up gravelly silt bedrock 0 2 2 9 9 166 Parcel Identification Number: 020-091-87 Is well located at approved permit location? ® Yes ❑ No 99524 Method of Drilling ® air rotary ❑ cable tool Casing type: steel Wall Thickness: .250 inches Diameter: 6 inches Depth: 13 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 29 feet Pumping level: 166 feet after 2 hours pumping 2_5 gpm Recovery Rate: 2_5 gpm Method of Testing: airlift Well Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite # 8 Volume: ! bg Depth: Start 0 feet Stopped 2 feet Pump: Intake Depth feet Pump size ho Brand Name 11 Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property o%Nner within 30 days of completion and the property ..........,. a i �u...r .a .... moi. .....n r. ..., �... .r.• .,., a r•..... n. _ •... ..•.. •. in a._.. .r... .,..•.. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Permit Number: SW040158 Legal Description: Potter P6f6_t6 ..Lot 3 7 Design Engineer: 0854 zzzzzz Owner Name: Hagen Inv. Owner Address: P.O. Box 240186 Anch , A 99524 - ON-SITE WATER SUPPLY PERMIT Initial Date Issued: May 28, 2004 Expiration Date: May 28, 2005 Parcel ID: 020-091-87 Site Address: 4341 Sage Circle Lot Size: 25190 SO. FT. Total Bedrooms: 0 Permit Bedrooms: 0 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: / Date: i Date: �— g Municipality of Anchorage • Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us . . (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. MQ-Cr//—g7-000Permit Number SW Property owner(s'ALgt,3 J—,/V I '466�ta �8 Mailing address (1) A/0. Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Z07-0t4772:0-4VAJ72!_ Legal description (Section, Township & Range) Lot Size Acre q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only X Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ nation is correct. I further certify that this application is being made for a Is in accordance with applicable Munigtpal Cc)des. 5 (Signature of �roperty caner authorized agent) Permit Fees: Waiver Fees: Date of Payment: 0 y Date of Payment: Receipt Number: % 3 Receipt Number: (Rev. 12/00) i:i NYSTROM c1r), Un rAl, NYSTROM • �� .fGE• •t ; Municipality of Anchor . � ' On-Site Water and Wastewater Progra • MAY 11 2017 (907) 343-7904 E*Y 12. Certificate of On-Site Systems Appro 6 8 L Parcel I.D. 020-091-87 Expiration Date: / S~ 17 1. GENERAL INFORMATION: Complete legal description Potter Pointe; Lot 3 Location (site address) 4341 Sage Circle Current Property owner(s) Brenda&David Avery Day phone 301-7111 Mailing address Real Estate Agent Stephanie Richardson Day phone 529-1844 2. TYPE OF DWELLING: Single Family (w/wo ADU) E Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received b Date: 51/64- COSA to be released to th engineer,unless otherwise requested by the engineer, COSA Fee $ 6It - Waiver Fee $ Date of Payment S l I l 1 c 1 Date of Payment Receipt Number Cecott41 Receipt Number COSA# OSG 11 !l 1 J Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group,Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: QOQ�oopp� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OFA � in accordance with the guidelines and regulations established by the Municipality of Anchorage and � ..•...•. •.,.. c rn industry practices. The reported results describe the condition of the system/s on the date/s of the Qoo,�P. • �V evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 4g H .._� nn encroachments may exist that were not identified during the evaluation. The operational life of all wells ' . '�Flu and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and 4VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,andVA are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 0 J = r-, A. Car essi system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of Qn � 0 the well or septic system. GEG makes no representation whether an alternative well or septic system VQ s ''• -<PP can be installed on the property in the event either of the current systems tail to perform adequately in �f�, ,fi .. the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4�Paprales st°^°ate perform the evaluation. Reliance upon the information provided in this report by any other person or 'OOP' party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for I bedrooms System #2 Approved for bedrooms �QP�,�� J A/VC,Sa Disapproved ON-SITE Conditional approval for bedrooms, with the follywing t.l io`diD s` WASTEWATER c PROGRAM _s. . � f Bye_ Original Certificate Date: 5 - 13 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: ` r COSA Checklist K Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue shee[10.10-12.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Potter Pointe; Lot 3 Parcel ID: 020-091-87 A. WELL DATA Well type Private If A. B. or C provide PWSID# N/A Well Log (YIN) Yes Date completed 6/2/2004 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes Total depth 166 ft. Cased to 13 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 6/2/2004 5/10/2017 Static water level 29 ft, 65.1 ft. Well production 2.5 g.p.m. 1.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG. Ltd. Arsenic: ND<5 ug./L. Date of sample: 5/3/2017 B. SEPTIC/HOLDING TANK DATA AWWU Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm i _ Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d_/ft4or ft'/bdr System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption - -a ft? Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absor. .n field before test in. Water added gal. New depth in. Elapsed T •- -: min. Final fluid depth in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at . wa er alarm level at in. 9- Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AWWU Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE I : I OT TO: Property line Bu' • - . oundation Water main Water service line Surface water Driveway, parking/vehicle storage drain Wells on adjacent lots F. COMMENTS I 0�60. O.. G. ENGINEER'S CERTIFICATION ' of 4 L °00 (r444:' _ • • • 9s�4p0I certify that I have determined through field inspections and T *Opreview of Municipal records that the above systems are in • '• Dconformance with MOA COSA guidelines in effect on this j1date. - � � Garn ss.•' jEngineer's Printed Na e JEFFREY A. GARNESS — �p•,cPO Date c1 tr/9- k,., •PaP‘1.�, ,1 .`��p rofessioY' z ' %DO0000a� #AECC844 Pev 11/051 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program ., .�. 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519650 www.ci.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _20-091-87 HAA# nu* � Expiration Date: _ _7-,6_-09_ 1. GENERAL INFORMATION Complete legal description Lot 3 Potter Pointe Subdivision Location (site address or directions) 4341 Sage Circle ciasiL - Current Property owner(s) Hagen Investments, LLC Day phone 2420830 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 240186 Anchorage AK 99524 'Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank 1:1Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water .supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Anderson Engineering • Phone . 522.7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 3/31/2005 S. DSD SIGNATURE Approved for �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:� Z�_ (it/, / &wx� Original Certificate Date: (Re,. Vi00) Municipality of Anchorage . ` •�, • �• Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St P.O. Box 196850 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST '1 Legal Description: ° �"'_. '"'•°iA""'Isbn Parcel ID: 020-09147 1 A. WELL DATA Well type Pr e�q If A, B, or C pie PWSIO # _ Well Log (Y/N) Y G Date completed Sanitary seal (YM) Y Wires property protected (YIN) Y Total depth JR -It. Cased to _11 -ft. Casing height (above ground) 24 n. E: FROM WELL LOG AT INSPECTION I' Date of test 'So" it Static I' Static water level 29 R 'I Well production 2.5 9.p -m. 9 -p.m - WATER SAMPLE RESULTS: Coliform _Q_,coloniesl100 ml. Nitrate mg./l. Other bacteria 0 colonies/100 ml. Date of sample: 313AW5 Collected by: uce B. SEP"WHOLDING TANK DATA Tank TypelMaterial Dale installed Tank size gal. Number of Compartments _ Cleanouts (YIN) I' Foundation deanout (YIN) _ Depression over tank (YIN) _ High water alarm (YIN) Date of pumping Pumper C. ABSORPTION FIELD DATA r Date installed Soil rating (g.p.d.te or felbdrm) _ System type Length it Width ft Gravel below pipe ft. Total depth _ fL Eft. absorption area ftp Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fall) For _bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. I Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g•p•d• Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. UFT STATION Date installed 'Pump on level at _ in. Datum Size in gallons 'Pump off` level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ iR station on lot WA Absorption field on lot WA Public sewer main >7S Sewer /septic service line >2S Manhole/Access (Y/N) High water alarm level Meets alarm & circuit requirements? On adjacent lots >IW On adjacent lots >1W Public sewer manhole/cleanout MW Holding tank WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Wells on adjacent lots Water service line Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service fine Surface water Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots I certify that I have determined through field inspections and review of Municipal records that the above systems are in oonfamance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E Anderson. P.E. Data 3131=5 Driveway, parkirghtehide storage HAA Fee $ 677 Waiver Fee $ Data of Payment �� I 05 Date of Payment Receipt Number ,551 1/. Receipt Number (Rev. 77ralr) 4 in. G7 m 0 X 0 r m N W 2 9 m -v �1 40�°'°••''• ' ''•T9 100 �4,v• :rx N ;p/ s ♦� mss'• . i 's . •� a . �}or N W 2 9 m I 1 m o x2NTa D 36. z C) m 919C) I. o cn to j — (No w N O m y A N D rq oo 0 Zca 0 mMP o z .�'' cic�ca ��m�� z ;a� N = n 01 f C�)1 n fry O_ fA 0 0 zo .0. rri m 4 M -i N N N ...1 CC o= m D fn V) m0 (nm O C n, z 00 z c � o �gS�vo m N 0 r �r 2 cu 5 0 I I I I 33.1' M 0 m -v 0 0Zto N � CO i 0 Z i i I I 1 m o x2NTa D 36. z C) m 919C) I. o cn to j — (No w N O m y A N D rq oo 0 Zca 0 mMP o z .�'' cic�ca ��m�� z ;a� N = n 01 f C�)1 n fry O_ fA 0 0 zo .0. rri m 4 M -i N N N ...1 CC o= m D fn V) m0 (nm O C n, z 00 z c � o �gS�vo m N 0 r �r 2 cu 5 0 I I I I 33.1' M 0 m -v 0 0Zto N � CO 0 Z