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Home My WebLink AboutPOTTER POINTE LT 4Potter Point Lot 4 #020-091-88 Municipality of Anchorage al Department of Health and Human Services 825 V Street P.O. Box 196650 Anchorage. Alaska 99519-6650 Rick Mystrom http Monro ei anchcrege aK us Mayor Permit Number: #SW 010192 Date of Issue: 6-15-01 Parcel Identification Number: 020-091-88 Date Started: 7-3-01 Date Completed: 7-3-01 Is well located at approved permit location? ® Yes ❑ No Legal Description: T Potter Point Lot 4 Property Owner Name & Address: Hagen Investment LLC PO Box 240186 Anchorage, Ak 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 Bedrock 2 87 Diameter: 6 inches Depth: 20 feet Liner Type: H2O 67 87 Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 11 feet Pumping level: 87 feet after 2 hours pumping 20 gpm Recovery Rate: 20 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 it 8 Volume: 1 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: Clodne 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 rouwr nr thn ,unll .lr;llw *hell nrnvvl.+ a wall Inn In th. rinm of Wl alth JE 4L.m*n Cnrvira* within AA clave of rmm�lnlinn 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 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SWO10192 Legal Description: POTTER POINTE LOT 4 Date Issued: Jun 15, 2001 Expiration Date: Jun 15, 2002 Parcel ID: 020-091-88 Design Engineer: 0000 None Required Site Address: NHN SAGE COURT Owner Name: HAGEN INVESTMENT LLC Lot Size: 27061 SQ. 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: //r/ Date: Date: 4 — /S"— 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. Permit Number SWO/O/92 Property Day phone 209L -90E) Mailing address (1) too. AX��L ewZ- Mai+irtg address (2) N141-1 Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 0 % 61 Acre S2.Ft. Number of Bedrooms 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 ❑ tion Is correct. I further certify that this application is being made for a in accordance with applicable Municipal Codes. (Signature of property ow fer of authorized agent) Permit Fees: o e Waiver Fees: Date of Payment: 0 1Date of Payment: Receipt Number: y 3 S Receipt Number: (Rev. 12/00) r n a yr a n Municipality of Anchorage - �'� �C • '� Development Services Department �� G ° . Building Safety Division yss,. On -Site Water and Wastewater Program 4700 Bragaw Street "' P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL _ FOR A SINGLE FAMILY DWELLING 9�_(ss�� Parcel I.D. 020-091-88 COSA #_ i7 O / / 1. GENERAL INFORMATION Expiration Date: Complete legal description Lot L Potter Pointe Subdivision Location (site address) 4161 Sage Circle. Anchorage AK naafi Current Property owners) _Jack MacArthur Day phone Mailing address 6i Sage Cir le Anchorage, AK 16 Lending agency Day phone Mailing address Real Estate Agent _Jodi Moses/Prudential JW Relo Dept Day phone 242-1117 Mailing Address 8oi Centernoint DriveSte. zoo Anchorage, AK qq 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 ® Individual On-site Individual Water Storage ❑ Individual Holding Tank Community Class Well ❑ Community On-site El Public Water System ❑ Public Sewer El 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 sample results. (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 y that r this investigation, es application, based on procedures outlined in the Certificate of On -Site Systems Approval 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 Pannone Engineering Services LLC Phone 272-8218 Address P O Box 102954 Anchorage AK ggS10 Engineer's Printed Name Steven R Pannone P.E. Date /0(7 wl f� �� Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the systei These conditions are outside the control of the evaluator of this system All systems eventually fail s satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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 other person or party is not authorized nor will confer any legal right whatsoever. 5. DSD SIGNATURE �,, Approved for q bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �, Original Certificate Date: _10-31-09 Municipality of Anchorage ' Development Services Department j Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _Lot & Potter Pointe SID Parcel ID:_220-oy2.88 A WELL DATA Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 2oo2 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth _Zft. Cased to 20 ft. Casing height (above ground) 2. in. FROM WELL LOG AT INSPECTION Date of test 71;12002 Static water level ss ft. Well production 1.20 g.p,m WATER SAMPLE RESULTS: Colifonn-�/ colonies/100 mL Arsenic: B. S TIC/HOLDING TANK DATA Tank Type teriai Tank size Foundation cleanout(YIN) _ Date of pumping C. ABSORPTION FIELD DATA Date installed Length : ft. &.2 g.p.m. -7 Nitrate O mg/L Other bacteria �—colonies/100 mL Date of sample: zh & 20/27/08 Collected by: Laura Pannone Date installed Number of Fompartments _ Cleanouts (Y/N) Soil Width overtank(Y/N) _ High water alarm (Y/N) System type ft. Gravel below pipe . ft. Total depth ft. Eff. absorption area _f? Monitorin be Depression over field Date of adequacy test Results (Pass/Fail) r _ bedrooms Fluid depth In absorption field before test_ in. Water added_ gal. New depth_ in. Elapsed Time:—min. Final fluid depth _ in. Absorption rate Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date ... D. LIFT STATION Date installed izejtrmyiions 'Pump on' level at_ in.'Pu evelat_In. Datum Cy etested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfift station on lot NIA Absorption field on lot NIA Public sewer main ioo+ Sewer /septic service line —2s+ Manhole/Access (Y/N) High water alarm level at In. Meets alarm & circuit requirements? On adjacent lots moo+ On adjacent lots zoo+ Public sewer manhole/cleanout —1oo+ Holding tank —&oo+ Animal containment areas zoo+ Manure/animal excrete storage areas moo+ SEP TION DISTANCES FROT SEPTICIHOLDING TANK ON LOT TO: Building found atio Property line Absorption field Water main Water service line Surface water Wells on adjacent lots —t=�— SEPARATION DISTANCE FROM ABSORPTIO D ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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 Steven R Pannone P.E. Date to l �4 ih4i COSA Fee $ 1430 Date of Payment ZR Receipt Number 107501 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Is storage ,en R. Panni r:o. CE 8149 u SCS Refa 1085837001 Client Name Pannone Eng. Srv. Project Name/N 4361 Sage Ct Printed Date/Time 10/302008 13:58 Client Sample ID Lot 4, Potter Pointc Collected Date/Time 10272008 10:00 Matrix Drinking Water Received Date/Time 10272008 10:40 Technical Director Stephen C. Edc PWSID 0 Sample Remarks: Paramctcr Results PQL Units Prep hfethod Method Analysis Container ID Limits Date Date ]nit Waters Department Total Nitratc/Nitrite-N 0.705 0.100 mpJL SM20 4500NO3-F Q (<10) 1028/08 1DZ Microbiolocy Laboratory Colony Count 0 Total Coliform 0 col/100mL SM20 9222Q A (I) 1027/08 DLC Fecal Coliform col/IOOmL SM2092226 A (q) 1027/08 DLC 0 coVI00mL SM209222B A (<I) 1027/08 DLC j4t1VV l�) AV040 Municipality of Anchorage • Development Services Department �•'` ""'3r�, Building Safety Division: On -Site Water and Wastewater Program ° 4700 Bragaw Street 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 Parcell.D. 0*—6y-92 COSA+f_ X80119 Expiration Date: — O I 1. GENERAL INFORMATION Complete legal description Lot 4 Potter Pointe Subdivision Location (site address) 4361 Sage Circle, Anchorage AK 99516 Current Property owner(s) Jack MacArthur Day phone Mailing address Lending agency 4361 Sage Circle, Anchorage AK 99516 Day phone Mailing address Real Estate Agent Shari Boyd/Prudential-JW Day phone 762-5849 Mailing Address sboyd@alaska.net Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ED Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 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 sample results. (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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102954 Anchorage AK 99510 Engineer's Printed Name Steven R Pannone, P.E. Date 2/16/08 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with htOA DSD Guidelines & Regulations. Ile reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. 71e content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE __jZ Approved for L+ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist Septic System Advisory X 79-c� �- l - D 8 Well Flow Advisory Nitrate Advisory Municipality of Anchorage e Development Services Department \ Building Safety Division 1 _ On -Site Water & Wastewater Program ' • "' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 4 Potter Pointe 5/D Parcel ID: 02 0— d q—g A. WELL DATA Well type P I If A, B, or C provide PWSID N Date completed 7/3/2001 Sanitary seal (Y/N) Y Total depth 87 ! ft. Cased to 20 ft. FROM WELL LOG Date of test 7/3/2001 Static water level 11 ft. Well production 20 9. p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0.244 mg/L Arsenic: 0 ugt B. StPTIC/HOLDING TANK DATA Tank Tvo Material Tank size \ gal. Foundation cleanout Date of pumping C. ABSORPTION FIELD DATA Date installed Length Total depth _ ft. Date of adequacy test Well Log (Y/N) Wires property protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION . 2/7/zoos 31 $. 4.1 g.p.m. Other bacteria 0 colonies/100 mL Date of sample: 217/2008 Collected by. Laura Pannone i Number of Compartments Date Installed Cleanouts(Y/N) Depression over tank (Y/N) _ High water alarm (Y/N) Pumper Soil rating (g.p.aA�orfeibdrm) ft. Width Eff. absorption area fe Results (Pass/Fall) System type ft. Gravel below pipe tube— Depression over field For _ bedrooms Fluid depth in absorption field before test _ In. Water added_ Elapsed Time: min. Final fluid depth in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ Absorption ft. New depth_ in. If yes, give ... D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off' level at _ High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 7 ' Absorption field on lot�'1A Public sewer main Sewer /septic service line 7-S On adjacent lots / Oc On adjacent lots / re) ' - Public sewer manhole/cleanout 1004 - Holding OD` - Holding tank S� Animal containment areas /6,0 T Manure/animal excrete storage areas /GOA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells Property line Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Wates in Water Service line Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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 Steven R. Pannone, P.E. Date COSA Fee $ 1f %U Date of Payment L/ Receipt Number d cJD (Rev. 11105) Driveway, parking/vehicle storage Waiver Fee $ Date of Payment Receipt Number U No. CE 8149 0 SGg SCS ReLN 1080519001 Client Tame Pannone Eng. Srv. Project Tame/N Lot 4 Potter Pt Client Sample ID Lot 4 Potter Pt Matrix Drinking Water P%N'SID 0 Sample Remarks: All Dateslrimes are Alaska Standard Time Printed Date/1'ime 02/15/2008 12:49 Collected Date?ime 02/07/2008 12:20 Received Daterrime 02/07/2008 12:45 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results P0L Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) Waters Department Total Nitrate/Nitritc-N 0.244 0.100 mg/L SM20 4500NO3-F E (<I0) Microbiology Laboratory Colony Count 0 col/IOOmL SM20 9222D A (<200) Total Coliform 0 col/IOOmL SM209222B A (<I) Fecal Coliform 0 col/IOOmL SM2092220 A (<I) 02/13/08 02/14/08 Mll 02/12/08 LCP 02/07/08 DLC 02/07/08 DLC 02/07/08 DLC Municipality of Anchorage -. Development Services Department \�Building Safety Division On -Site Water and Wastewater Program S. �„ 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPR JV FOR A SINGLE FAMILY DWELLING� Parcel I.D. 020-091-88 HAA # ; fr AQ�� Expiration Date: 3 0 — O -2- 1. 1. GENERAL INFORMATION Complete legal description 4; Lot 4 Potter Point Subdivision Location: (site address or directions) 4361 Sage Circle Current Property owner(s) Hagen Investment, LLCIHagen Homes Day phone 229.8400 Mailing address P 0 Box 240186 Anchorage, AK 99524 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 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 21 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 seal affixed hereto and as of the validation date shown below, I 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 1129102 .� OF t c..0F..q .<Qt., A WC—HAI. L ANDERSON S. DSD SIGNATURE "4381 •' �` J i V Approved for bedrooms. cbQfO PeorrssV"�';O� J ,n`LB99a�� 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: %. <<.C/ Original Certificate Date: (Fay. 12/00) Municipality of Anchorage V ; • Development Services Department ; Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6850 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 4. potter point Subdivision Parcel ID: 020.091.88 A. WELL DATA Well type Private If A. B, or C provide PWSID # _ Well Log (YIN) Y Date completed 7C.i12001 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth Cased to 20 ft. Casing height (above ground) >24 in. FROM WELL LOG AT INSPECTION Date of test 7412001 Static water level 11 ft. fL Well production 20 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate _.L mg./l. Other bacteria 0 colonies/100 ml. Date of sample: 1128@002 Collected by: A Hargis B. SEPTICIHOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (YIN) _, Depression over tank (Y/N) _ Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.lfe or ftp/bdrm) Length ft. Width ft. Date installed Cleanouts (YIN) High water alarm (Y/N) Total depth ft. Eff. absorption area fe Monitoring tube System type Gravel below pipe ft. Depression over field Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test _ In. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA Absorption field on lot NIA Public sewer main >100' Manhole/Access (Y/N) High water alarm level at in. Meets alarm t1 circuit requirements? On adjacent lots NIA On adjacent lots NIA Public sewer manhole/cleanout >100' Sewer /septic service line >25, Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Wells on adjacent lots ' Absorption field Water service line Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Curtain drain F. COMMENTS Surface water Wells on adjacent lots Driveway, parking/vehide storage G. ENGINEER'S CERTIFICATION 1 70 certify that I have determined through field inspections acrd o * . 49TU r,;,; +- d, review of Municipal records that the above systems are in r a conformance with MOA HAA guidelines in effect on this date.01, L•.i Engineer's Printed Name Mlchael E. Anderson, P.E. v Date 10102 `C�06tieeSS�ce�O��. HAA Fee $ o Waiver Fee $ Date of Payment O Date of Payment Receipt Number. y J�� si Receipt Number (Rev. 12!00) . JAN -29-02 03:41PM FROM-CTiE ENVIRONIENTAL SRV ■ G CTBE Environmental Services Inc. %■._ t� ire arrrrrrrrrrrrrrrrrr CUE M.10 1020499001 Client Nome Anderson Engineering Project NameN Potter PointS/D Client So nple 1D Potter Point SID; Lot 4 Motrl: Drinking Water Ordered fly (<1) PWSID 0 9075615301 T-952 P.01/01 F-289 Client PON Printed Date rime Collected Dste/rime Received Date/time Technical Director Released By A 01@912002 15:41 01/28/2002 15:10 0128/2002 15:30 Stephen C. Ede Sample R. marks: Allowable Prep Analysis Perimeter Results PQL Units Method Limits Date ' Date Init !!&lura _Daeart:ma= Nitrate -N 0.200 U 0200 mg/L EPA 300.0 (<10) 01/28/02 IDT micro iology L&boretory Total Coliform 0 col/100mL SM199222D (<1) 01/28/02 KAP Received Time Jan -29. 3:43PM HRGEN INV. TEL:19075690035 �. Jan 29'02 POTTER POINTE LOT 4 27.061 S.F. E� witom Orr K.W T SAGE CIRCLE 1 I 1 10' L 0: E S' SNOW STORAGE Mr. / 4C PAMC i 70.3- WELL • 0 FINAL STRUCTURE K -BUTT BUILDING DETAIL SCAM 1•.20' Q U T I NmwGD1m'7wAT 1 WIYE %VAw= THE LAID SURKYNC PA 'T Dow= AGOVE ANO TWIT No E 0CROACWwflf DOST cwm AE O IMCCAM. ASlu" RLS. rt K THE OtSAOIaW" OPTHEOATO T SM AKNUE DODWIIE THE DOSTZMXOFANTEA30"M , AIASNA 00602 COTS OR AQTRICrad lIOCN DO NOT KAS-19U 2b -M4 APPEAR ON THE REOORDEO SUmor MN pW. UNDER NO CIRCUMSTANCE/ SHOULD ANT DATA DATE HEREON tic UlCD FOR CCMl11 UMM 011 POA 1/0/2002 E7TAKANNo DOIA1OW OR FDR•CUMEL 400 NO. ANCHORAGE RECOMM DISTTOCT. ALAW M. NOTCI NO Co11NER/ !ST THIS DATE. Received Time Jan -29. 10:42AM 10:27 No.001 P.02 I Oc rr � ' �' � � •i � :. �.: •� QUO. .. . SAGE CIRCLE 10' T. do E ESMT. 5' SNOW STORAGE ESMT. 97-104 POTTER POINTE LOT 4 27.061 S.F. KA d