HomeMy WebLinkAboutPOTTER POINTE LT 1Pott¢ Point
Lot I
#020-091-85
Municipality of Ancho.rage
Department of Health and Human Services
825 'L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom http://vwnv.cl.anc borage.ak.us
Mayor
Permit Number:. #SW 010233 Date of Issue: 6-11-01
Date S~arted: 7-30-01 Date Completed: 7-31-01
Legal DeseHp'tion: Potter Point Lot I
Property Owner Name & Address:
Borchole Data:
Soil Type, Thickness & Water Smata
stick-up
otTanics and silt
silty gravel
silt
gravelly silt
bedrock
Parcel Identification Number:
Is well located at approved permit location? [] Ye~ [] No
Hagen Investment LLC
PO Box 240186
Anchorage, Ak 99524
Depth (ft)
From To
0 2
2 3
3 9
9 23
23 28
28 467
Method of Drilling [] air rotary [] cable tool
Casing type: steel
Wall Thickness: .025 inches
Diameter: 6 inches Depth: 37 feet
Liner Type:
Diameter: inches Depth:
Casing stickup above ground: _2 fcct
feet
Static water level (~om ground levcO: 25 feet
Pumping level: 467 feet after
24 hours pumping .25 gpm
Recovery Rate: ~25 gpm
Method of Testing: air lift
Well Intake Opening Type:
[~] Open End [] O~n Hole
[] Screened Start feet Stopped
[] Perforations Start feet Stopped
Grout Type: ]~entonite # 8 Volume: I bg
Depth: Stun 0 feet Stopped _+ feet
Pump: Intake Depth ~ feet
Pump size hp Brand Name
Well Disinfected Upon Completion? [] Yes [] No
Method of Disinfection: C/or/no Tablets
Comments:
Well Driller:
Alpine Drilling & Enterpr/ses
P 0 Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completlon and the property
MUNICIPALITY OF ANCHORAGE
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: Jul 11, 2001
Expiration Date: Jul 11, 2002
Permit Number: SW010233
Legal Description': POTTER POINTE LT 1
Design Engineer: 0000 None Required
Owner Name: Hagen Investmont LLC
Owner Address: PO Box 240186
Anchorage, AK 99524-
Parcel ID: 020-091-85
Site Address:
Lot Size: 20000 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
Ail construction must be in accordance with:
1. The attached approved design.
2..NI 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 pdor 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: ~
Date: 7 -/,~-0/
Municipality of Anchorage
Development Services Department
Budding 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 SEWEPJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Pa rcel I.D. ~:~O - ~::x~/--o~"'-- DO E)
Permit Number SW OI 0
Property owner(s)
Mailing address (1).
Mailing address (2)
Zip Code
Legaldescription(Lot, Block&Sub'd.) ~---~7-/ ,~/-~F-~ ~-----~,~
Legal description (Section, Township & Range). ~'~'X'"'
Lot Size ~0/~00 , Acres/~) 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 [] ,
I certify ~ov~ i~nation is correct. I further certify that this application is being made for a
Singl~g~and~s in accordance with applicable Municipal Codes.
(Signature of property owner ~a~u orized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
Municipality o.f Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw SL
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. 020-091.85
1.
GENERAL INFORMATION
Complete legal description ? Lot 1, Potter Point Subdivision
Location (site address or directions) Saqe Circle
Expiration Date:. ~'- ~--
Current Property owner(s) Haqen Investment, LLClHaqen Homes
Mailing address P,O. Box 240186 Anchoraqe, AK 99524
Lending agency
Day phone 229-8400
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:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding tank
[] Community On-site
[] Public Sewer
The Municipalit7 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 pedod 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 vedfy that based on the information obtained from the
Municipality of Anchorage flies 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 Anderson Enqineerinq
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name _Michael E. Anderson, P,E.
DSD SIGNATURE
~ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date ?-/08/02
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: .~;~. - "2. C- - ,.~ 2..
Municipality of Anchorage
Development Services Department
Building Safety D~vision
On-Site Water & Wastewatar Program
4700 South Brogaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www,ci.anchorage,ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot t. P~ttsr Point SubdNl$1en
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 37 ft.
FROM WELL LOG
7r~t~0Ol
· 2~ g.p.m.
Nitrate .5 mg./I.
Collected by: A- Hafala
Number of Compartments
Depression over tank (Y/N)
Pumper
Soil rating (g.p.d./ft~ or ~/bdrrn)
ff. Width
Eft. absorption area
~ Monitoring tube
Results (Pass/Fail)
in. Water added
A. WELL DATA
Welltypepdv~e
Data C°mpleted7~tr2001
Totaldepth 48/ft.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Date of sample: .~
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size . gal. - -
Foundation cleanout (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length.
Total depth ff.
Date of adequacy test
Fluid depth in absorption field before test
Elapsed Time: mi~' Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type),
Parcel ID: 0204)91-85
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24
AT INSPECTION
8r20/2001
gp.m.
in.
Other bacteria 0 colonies/lO0 mi.
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
in,
System type
Gravel below pipe ft.
' Depression overfield
For bedrooms
gal. New depth in.
Absorption rate >= g.p.d.
If yes, give date
LIFT STATION " ' '
Date installed Size in gallons
'Pump on" level at in. 'Pump off' level at.
Datum Cycles tested
E. SEPARATION DISTANCES
Fe
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main
Sewer/septic service line >2~'
Manhole/Access (Y/N)
High water alarm level at
Meets ala~n & circui! requiremeels?,
in.
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Properly line.
Water main Water service line ·
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain
COMMENTS
Absorption field
Surface water
Building foundation
Surface water
Wells on adjacent lots
Water main
Driveway, parking/Vehicle storage
· Lot is served by oublic sewer. Well wes hydro fractured to increase m:~'-~. Well Flow after fr._~ac~_'.-,_~ 20 GPM
G. ENGINEER"S CERTIFICATION ,~.'~:~ OF ,~q~[~,. ' '
I certify..,_ ,,, ~- ___ _ _that I have determined through field inspections and
rev~ew or Mun~clpal recorcls tilat the above systams are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pdnted Name Michael E. Anderson, P.E. .
Date 2/9/02
Waiver Fee $
Date of Payment 7.- / I ~ /~ 7_.. Date of Payment
Receipt Number ! ~ ? c/~). Receipt Number
(Rev. 12/00)
02/23/2000 07:42
FES-ZO-OZ IO:~6,~
9073336686
T-4~4
P,¢~ 02/05
P.OI/gl F-O03
CTSE EnvJm~ 8ef~4col Inc.
)rinking Wa~er Analysis Report for Tola[ Coliform Baclm/a ~.~,.,.,.,.,.,.,.~ m~.~mu-s~
" ~Ub-TanCG~O, Lr.~,UY'W*n~.SU~.mX "I TOaaCOMKE~OBYLA~.P~i~
wlt~ ll~ irM. B& · , .)
T~
Aaa~ bb~le~ ~"g~,,4enln~e Film'
~3 MMO-MU43
FEB-12-02 OS:3TPM FROM--CT&E ENVIRONL~NTAL SRV
J~K CT&E Environmental
Services
Iflc,
90?5515361
T-29~ P.02/03 F-?71
CT&E R~f.# 10207S3001
Client N.me Anderson ~n§i~cerJn§
Project Name/~ Potter Po~t S~
~ient S. mple ID Po~cr Point S~ Lot 1
Matrix DriVing Water
Orde~d By
PWSID 0
Sample I~ emmks:
Client PO~
Printed Date/Time 02/12/2002 14:01
Collected Date/Time 02/0S/2002 16:02
Received DatefZ'lme 02/0~2002 16:30
Allowable Prep Anal~s
parameter Results PQL Units Method Limits Date Date Init
Watert, Departz~ent:
Nitr,~t e-N 0.200 U O200 rng/L EPA 300.0 (<I O) 02/09/02 JDT
l~c]:obiol o~' Labo~atoL"Z
Total Col,fcrm
35 OB, No Coli
co~lOOmL SMI8 ~222B (<1)
02/0~02 KAP
Received Time Feb.12, 5:38PM
INV. TEL:lg075690055 ~J" Feb 06'02 1u:4r r~o.uuo r.v~
t'i¥80:01~00~ '8 '
HAGEN
INV.
Feb Ob'V2
TEL :19075690055 .....
POTTER POINTE
',!
· 1 ":20'
~VLO:OI ZO0~ '8 'qad