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HomeMy WebLinkAboutPOTTER POINTE LT 2Potter Point Lot 2 #020-091-86 OM 'Alpine Drilling FAX N0. :907 345 0202 Jun.04 2012 08:17AM P1 Alpine Drilling & Enterprises Well Log Permit Number: #SW010416 Date of Issue: 10-3-01 Date Started: 5-28-12 Date Completed: 5-30-12 Legal Description: Potter Point Lt 2 Property Owner Name & Address: George C. Cowie 4321 Sage Circle Anchorage, Alaska Parcel Identification Number: Is well located at approved permit location? x Yes ❑ . No 99516 Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: Existing well 0 227 Wall Thickness: _ inches Diameter: — inches Depth: _ feet bedrock 227 427 Liner Type: _ Diameter: inches Depth: _ feet Casing stickup above ground: feet Static water level (from ground level): LLfeet Pumping level: 427 feet after 24 hours pumping 1 gpm Recovery Rate: 1 gpm Method of Testing: air lift Well Intake Opening Type: ❑ Open End x Open Hole ❑ Screened Start feet Stopped _ feet ❑ Perforations Start _ feet Stopped feet Grout Type: _. Volume: De h: Start feet ed feet Pump: Intake Depth feet — ------Pump-size hp-Drand Name_ --- Well Disinfected Upon Completion? x Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 ,%"e Municipality of Anchorage Department of Health and Human Services Aumil 825'L' Street VIEW P.O. Box 196650 Anchorage, Alaska 99519-6650 Kck Mystrom http7A%ww.ci.anchorage ak.us Mayor Permit Number: #SW 010416 Date of Issue: 10-3-01 Parcel Identification Number: 020-091-86 Date Started: 11-1-01 Date Completed: 11-2-01 Is well located at approved permit location? ® Yes ❑ No Legal Description: Potter Point Lt 2 Property Owner Name & Address: Hagen Investment LLC P. O. Box 240186 Anchorage, Alaska 99524 Borehole Data: Depth (ft) Method of Drilling ® air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: steel stick-up 0 2 Wall Thickness: .025 inches Organics& silt 2 10 Diameter: 6 inches Depth: 17 feet Bedrock 10 227 Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 12 feet Pumping level: 227 feet after 2 hours pumping 5 gpm Recovery Rate: 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: I br Depth: Start 0 feet Stopped ± feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Clorine Tablets Comments: Well Driller: Alpine Drilling & Enterprises P O Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property nomnr nr thn wnll Arillnr shall nrnviiln a woll Inn in tho 11.m nr Llnohh R, Ltuman Cnnrinnc within rn nava of rmm�l..tinn MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Oct 03, 2001 Expiration Date: Oct 03, 2002 Permit Number: SWO10416 Parcel ID: 020-091-86 Legal Description: POTTER POINTE LT 2 Design Engineer: 0000 None Required Site Address: Owner Name: Hagen Investment LLC Lot Size: 20077 SO. FT. Owner Address: PO Box 240186 Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99524 - This permit is for the construction of., ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank Privy �✓ Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 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: Date: —3 _O 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 SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. >y0ZO-0'I ?6-006 Permit NumberSWO/04/( Property ownersWLr► LlG Day phone 4ar/—e56Z) Mailing address (1) A-110. Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size o� D27 Acres(D W& Number of Bedrooms T THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify tha a above in mation is correct. I further certify that this application is being made for a Single F if w II' d is in accordance with applicable Municipal Codes. (Signature of prope owr or uthorized agent) P ' F n ell -)c"> WAivPr FBrs' ermit % ees. Date of Payment: D� Date of Payment: Receipt Number: /n&72 Receipt Number: (Rev. 12/00) Municipality of Anchorage • '� Development Services Department 441m Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street _� z1 P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-091-86 COSA# 0501a l(g3 1. GENERAL INFORMATION Expiration Date: 1— 2 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address POTTER POINTE S/D• LOT 2 4321 SAGE CIRCLE * ANCHORAGE, AK * 99516 GEORGE COWIE Day phone 223-6875 4321 SAGE CIRCLE * ANCHORAGE, AK * 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 samples. (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 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ) 2 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA 000��00 4 o! A DSD Guidelines & Regulations. The reported results described the performance of the •'' S�QO system under the conditions encountered at the time of the test, and separation DOP -..'j distances measured to readily identifiable features. The operational life of all wells and C—) septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test ... . • • • • • •: • • • y results do not guarantee future performance of the system, nor do they guarantee that OOnP of r A. Gar ess: there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the v4 s, '•, CE -7 .•'\00 04re^. �I y- •'scop ,(� operational requirements of the ADEC or MOA DSD. The content of this report is for benefit the listed Any this report by any 0 of essioc°o X000400000 the sole of owner above. reliance upon or use of otherperson or party is not authorized, nor will it confer any legal right whatsoever. `OF tAAL.j .os. ,v-4 5. DSD SIGNATURE V Approved for ' t bedrooms.ff ON-SITE Disapproved. WATER AND So WASTEWATER Conditional approval for bedrooms, with the following stipulations: i� PROGRAM '/��' 4�lSE�»�5 Attachments: COSA Checklist V Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: //�i�l� (, - Original Certificate Date: % 2 (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division - On -Site Water & Wastewater Program 4700DnaQmmStreet P.O.Box 190O50 Anchorage, /\R99519'0050 vmw*.muniorO/onsito (9V7)343'7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST Legal Description: POTrER POINTE S/D; LOT 2 Parcel ID: 020-091-86 A. WELL DATA *DEEPENED VN5/2n/2V12."BEDROCK AT10'.***PERALPINE DRILLING ENTERPRISES. Well type PRIVATE_ |fA,B,orCprovide PVVS|O# N/A Well Log (Y/N) YES 11/2/2001 Date completed Sanitary seal (Y/N) Y[3 Wires properly protected (YYN) YES Total depth 427 ft. Conedto **17 ft. Casing height (above ground) 24+in. FROM WELL LOG Date of test 11/2/2001 Static water level 12 � Well production g -p -on- VVATERSAaPLEREGULTS: Coliform ---{}_--cn|oniau/1OOml. Arsenic: --1V{>-ug}L B. SEPTIC/HOLDING TANK DATA System type Gravel below pipe -----------_ft. — Depnesoionoverfie/d Nitrate _ND_mA�. Collected by: GEG Ltd. TonkTvoo/��c8erio| Date installed --- ',---�_- Tankuizu___---'gai Number ofCompartments ----- Date nfpumping ---_------- C. ABSORPTION FIELD DATA Date installed Length Total depth Bt Datoofodequunytnot - ---_ � Fluid duPkhinobnor�I�)�e|dbefore test ___� Monitoring tube Soil rating (g Width ft Rauu|to(Pusu/Foi|) T11'------' Z Elapsed Ti : —min. � Final rejuvenation treatment (past 12 mo.) (Y/N & type) fluid depth _-_ AT INSPECTION ***13 . *** —9 -P.M. -----' Fnr___bed moma Water added__mal. New depth__in. l. Absorption rate >= g.p4 |fyes, give date ____------' D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons "Pump off' Manhole/Access water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/AI On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout *100' Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption Water main Wells on adjacent lots Water service line Surface water SEPARATION DISTANCE FROM ABSORPTION FI Property line . Water service Cuitain drain F. COMMENTS Surface water Wells on adjacent lots *100' FROM EDGE OF WELL TO EDGE OF MANHOLE. G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date G ItF/('+- COSA Fee $ qqU' `v Date of Payment 40/5-//a Receipt Number 0D9&;26 (Rev. 11/05) TO: Water PUBLIC SEWER Driveway, parking/vehicle storage Waiver Fee $ Date of Payment Receipt Number 31-11-06 10:03 FROM-Pudential Jack White Eagle River 9076896499 T-593 P.002/002 F-780 97-104 POTTER POINTE SUBDIVISION LOT 2 20,077 S.F. Mwa O+M1 S 8905649"E 20' T. & I- ESMT. ---- ----------------------------- 1 \ J \ QOe 4tl ild \\ P {n \ W LA EXISGNO WELL 1'.DiLDING �X �g �m GRAVEL DRIVE / COO 1 11=T°>[lA it 7C� — — — — — — — 5� sNOw sTaRace Esus J _ ~ —�.y6 OQ \ S B8052'55"E 76,20' Ro50' FINAL SMUCTURE AS -QUILT OASTALDI LAND SURVEYING JEFF A. OASTALD4 RLS, 4726 WEST &M AVENUE ANCHORAAIE, ALASKA 90602 PHONE 248--5454 GRID DATE 3336 1/10/2002 F.9. JDB LA0. 01-97 PP2 SAGE CIRCLE HEREBY CERTIFY THAT I HAVE SURVEYED THE ROPERIY DEPICTED ABOVE AND THAT NO NCROACHIAMS EXIST EXCEPT AS INDICATED. 'I$ THE RESPONSIBILITY OF THE OWNER TO ETERMINE THE EXISTENCE OF ANY EASEMENTS, 'OVENANIS OR RB5RRICNDNS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT, iNDER NO CIROUMSTANCES SHOULD ANY DATA IERWN BE USED FOR CONSTRUCTION OR FOR STABUSHING BOUNDARY OR FENCE LANES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE;: NO CORNERS SET THIS DATE. �OF A4 #* S qs �. asm ... * y .Nlhry A• 0a�lalm a Ji 4 1.9-000 f. �A S� reg C.�r Municipality of Anchorage '•Y r �'.1n•�( Development Services Department ,.. Building Safety Division ` On -Site Water 8 Wastewater Program 4700 South r age. SL kr� OP.O. Box 196650 Anchorage, AK 99519-6650 '� www.ci.anchora e.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Oz _ I �A� COSA# 1. GENERAL INFORMATION Expiration Date: 0� Complete legal description POTTER POINTE S/D: LOT 2, Location (site address or directions) 4321 SAGE CIRCLE " ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOISES do SONIA MEDINE Day phone OUT OF TOWN 4321 SAGE CIRCLE • ANCHORAGE. AK 99516 Day phone KATHLEEN TONN w/ PRUDENTIAL ER Day phone 907-244-6844 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of Onsite Systems 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 samples. (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 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 onsite 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. CARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identiriable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson orparty Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for _ bedrooms. Disapproved. Conditional approval for Attachments:. COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory L�� 337-6179 Date23 G>;' bedrooms, with the fllowing stipulations: Arsenic Advisory Manitenance Agreements Supplemental Engineer's Reort Other ON-SITE WASTEWATER By: „ / &/ Original Certificate Date: — —06 (R". /7.01) Municipality of Anchorage • Development Services Department Budding Safety Division On -She Water 6 Wastewater Program 47W South Bragaw St. P.O. Box 196650 Anchorage, AK 09519.6650 www.d.anchorage.ak.us (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: POTTER POINTE S/D: LOT 2, Parcel ID: 02 O -© q I - g r0 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Date completed 11 /2/2001 Sanitary seal (Y/N) YES Total depth 227 ft. Cased to 17 ft. FROM WELL LOG Date of test 11/2/2001 Static water level 12 ft. Well production 5 g.p.m. Well Log (Y/N) YES Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 1/12/2006 35 ft. .45+ — 9 -p.m - WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 0. 1 mgJL. Other bacteria 0 colonies100 ml. Arsenic: lZff A. Date of sample: 1/12/2006 Collected by: GEG Ltd. B. SEPTIC/HOLDINGTANK DATA PUBLIC SEWER Tank Type/Material Date Installed _ Tank size gal. Number of Compartments,e-anouts (Y/N) Foundation cleanout (Y/N) C. ABSORPTION FIELD DATA over tank (Y/N) _ High water alarm (Y/N) Pumper Date insta0ed Soil rating OEPr ft%drm) _ System type Length ft. Width ;ft. Gravel pipe ft. Totaldepthft. Eff. absorption area_ fe MondorDepression over field— Date ew Date of adequacy test Res ss/Fail) For bedrooms Fluid depth in absorption field befo _ in. Water added — gal. New depth _in. Elapsed Time: Final fluid depth _ in. Absorption rate >= g.p.d. enation treatment (past 12 mo.) (Y/N b type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alar & circuit requirements?, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot NSA On adjacent lots 100'+ Absorption Heid on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 't 00'+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manureianimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property Water main Surface water PUBLIC SEWER SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water in Water service line Surma Driveway, parkinglvehicle storage Wells on adjacent lots F. COMMENTS • AREA COVERED WITH SNOW, LOCATION OF MANHOLE BASED ON MOA DOCUMENTATION OF SEWER MAIN, G. ENGINEER'S CERTIFICATION v!ur I certify that 1 have determined through field inspections and r"I•Apl Ip N ••7• review of Municipal records that the above systems are in . • •. •" • "' ..."'"" . ""... conformance with MOA COSA guidelines in effect on this date. sy A. mess: Engineers Printed Name JEFFREY X GARNESS 79 3 .tee Z3%Sc?+�'�e• Date t'ZZ�O% ep�oresaw^d COSA Fee S 3 Date of Payment /' ' n 6 Receipt Number 7 S'7 (Rev. 12v01) Waiver Fee E Date of Payment Receipt Number Municipality of Anchorage ,.._ • Development Services Department Building Safety Division ' - On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 060023 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 2 of Potter Pointe subdivision, the well's productivity was determined to be 0.45 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. S rri A-0 t*v 37� x. :2z -'. - lvJ. 1 11Z: - I : 'elk, 00, V m4 m4 . )9 p nTv P!T11 p I y-1 m4 r 0 0 EF iA 1 9V N co ;i 70 z '-7-7-7 OD. Cn All IYSTROM SGS Ret# 1060214001 Client'Name Garness Engineering Group, Ltd. Project Name/# Potter Pointe SD Lot 2 Client Sample ID Potter Pointe SD Lot 2 Matrix Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time PrintedDateflime 01/20/2006 17:45 Collected DateMme 01/12/2006 13:45 Received Date/time 01/12/2006 14:08 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitrate -N 0.100 U 0.100 Metals by ICP/MS Arsenic 5.00 U 5.00 Microbiology Laboratory Total Coliform 0 mg/L EPA 353.2 D (<=10) ug/L EP200.8 C cot/IOOmL SM2092226 A (<=1) 01/13/06 1C 01/16/06 0120/06 SCL 01/12/06 TLF O. M m NL4 N LLJ r F— 00 Z —3c; �� N //1 L co 6 W Vit: 9K W LAJ 0 N I ' i 1 I I I I 1 I I I I I I I i i 1 I I I 1 I I I I I I I I, J m m LLI D J O�O E z a o e w NN r- Z�E� 02 N O fJ� S2WX- _ {{N�0PCZ) �- ?<W Ia.O NN C�ii F ppqq O V OF C:jBLcr U U O Z N _rim cr m li WZ W Mme_ oiEBLd L) W"K�F W Zo 0J-�z�z MW0oyg5 ZSU O 1.- 0 U5 CL0 IML O N F— Z N 5n o a J�Coll —C� Mo 0 m U L Z n I �d 0= en o Uif� ma Q GSC4o . ,.. . s •• Q Air J LL -;i t� d .: ♦ m ; ; s �; Quo • O�O E z a o e w NN r- Z�E� 02 N O fJ� S2WX- _ {{N�0PCZ) �- ?<W Ia.O NN C�ii F ppqq O V OF C:jBLcr U U O Z N _rim cr m li WZ W Mme_ oiEBLd L) W"K�F W Zo 0J-�z�z MW0oyg5 ZSU O 1.- 0 U5 CL0 IML O N F— Z N 5n o a J�Coll —C� Mo 0 m U L Z n I �d 0= en o Uif� ma Q GSC4o -\ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-091.86 HAA #_ _ 11,,q C7 ZO /0 a Expiration Date: :7-10 — 02- 1. 2 1. GENERAL INFORMATION Complete legal description Lot 2, Potter Point Subdivision Location (site address or directions) Sage Circle Current Property owner(s) Hagen Investments, LLCIHagen Homes Day phone 229-8400 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 240186 Anchorage, AK 99524 Unless otherwise requested, HAA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Four(4) Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ ❑ Individual Holding tank ❑ ❑ Community 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below,.l 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. 1 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 4/9/2002 -'�•OF �o • •....qCNGT E ����, �'STAfAP 5. DSD SIGNATURE ✓ Approved for !4= bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: WASTEWATER Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: /j �J• �� Original Certificate Date: 14 — / O — D � JRO .,wo) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal DascrOon: _ Lot 2. Potter Point $ubdNislion Parcel ID:_ 020-091.80 A. WELL DATA Well type Private If A. B, or C provide PWSID # Date completed 1] 200 Sanitary seal (Y/N) Y Total depth _ft. Cased to 17 ft. FROM WELL LOG Date of test 1Uaf2001 Static water level 12 ft. Well production S 9— p.m-WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires property Protected (Y/N) Y Casing height (above ground) >24 in. AT INSPECTION ft. g.p.m. Coliform –9—cotonkWI00 mi. Nitrate J_ mg.A. Other bacteria 0 colonies/100 ml. Date of sample: 402002 Collected by: Arrow Pump and Well B. SEPTIC/HOLDING TANK DATA Tank Type/Material Municipal Sewer System Date installed Tank size gal. Number of Compartments _ Cleanouts (Y/N) Foundation deanout (YIN) _ Depression over tank (Y/N) _ High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Sod rating (g.p.dN or ft Axdrm) _ System type Length ft. Width ft. Gravel below pipe ft. Total depth _ ft. Eff. absorption area ft2 Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fall) For bedrooms Fluid depth In absorption field before test _ in. Elapsed Time: _min. Final fluid depth _ in Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) _ Water added_ gal. Absorption rate >= New depth_ in. If yes, give date g.p.d. D. LIFT STATION Date installed 'Pump on" level at —in. Datum Size in gallons 'Pump otr level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ManhdelAccess (Y/N) _ High water alarm level at Meets alarm ti circuit requirements? Septic tankAift station on lot WA On adjacent lots >1011' Absorption held on lot WA On adjacent lots MW Public sewer main >TV Public sewer manhole/deanoul MW Sewer /septic service line >2S Holding tank WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation Water main Property line _ Absorption field Water service line Surface water Welts on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation Water main Surface water Wells on adjacent lots I car* that 1 have detemdned through field inspecthns and review of Municipal records that the above systems are in cordbrmance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E Anderson, P.E. Date 41912002 HAA Fee $ 375 Date of Payment r ! Z Receipt Number $ D 6 = Driveway, parkingNehide storage Waiver Fee $ Date of Payment Receipt Number M APR -10-02 07:42ALI FRO"TLE ENVIRONLOTAL SRV J& 9075615301 T-443 P.01/01 F-473• CUE Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 9951a Tel: (907) 562-2343 Fai (907) 561-5301 CTBE Ref. #. 1021770 Client Name: Aarow pump & Well Client PO# Project Name: n/a Printed Date/Time: Client Sample ID: 4321 Sage Circle Z P Collected Date/Time: Matra: r �yQ O� J� Drinking Water Received DaterTime: Technical Director. Pwsm n/a 04/10/02 07:34 04/08/02 09.00 04/08/02 09:20 Stephen Ede - mcula Total Coliform (MF) 0 c011100 ml SM9222B Nitrate 0'44 0.2 mgtt. EPA 300 Allowable Prep Analysis 100