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Home My WebLink AboutPOTTER POINTE LT 5Potter Point Lot 5 #020-091-89 WATER WELL RECORD RECEIRECEIVED STATE OF ALASKA VED V DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys JUN 26 IT'l 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature _o This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Alpine Drilling & Enterprises AA -9108 Registered Business Name Contract License Number Address: P.O. Box 110496 Anchorage, Ak 99511 Signed : Date: Authorized Representative Form 02-WWR (II/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer 0 0 Div. of Geological SurVe�y Eagle River riving Permit No. LOCATION OF WELL (Please complete either la, ID or Ic.) A.D.L. No. TO] Borough Subdivision Lot Block I Ib. I/e Qt ra. Section No. TownshipRange I Merldlan I Saugstad I 2 I 0 5Q WQ ... 1c. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Asas, Address: elol "e ew V i e-'" Street Address and Area of Well Location- - 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) I 5. DATE OF COMPLETION 128 ft. I 4 — 3 — 91 Material Type Top Bottom Stick-up 0 2 6. ❑ Cgble fool ® Rotary ❑ Driven ❑ Dug Gravelly Silt 2 5 El Auger ❑Jetted ❑Bond ❑ Other : Weathered rock 5 23 T. USE: ❑x Domestic ❑ Public Supply ❑ Industry Bedrock—hard 23 128 ❑ Irrigation ❑ Recharge ❑ commerical - ❑ Test Weil ❑ Other: S. CAST G: ❑ Threaded ® Welded diem. in. to 28 ft. Depth Weight 17 tbs./ft. diem. in. to - ft. Depth Stickup 2 ft. - 9. FINISH OF WELL! _ f_61Az1 Xr.t40-3o Ire-- P'S fto-y 7 8'.S 88 Typo: open end Diameter: 6" . .: S1otlMesh -Size: Length: Set between ft. and ft. Backfilling Gravel pack r r� 10. STATIC WATER LEVEL: 10 fl. 4/ 3 / 91 4/3/91 ❑ Above or ® Below land surface Date Ercipzant a&s-1 sownder I I. PUMPING LEVEL below load surface and YIELD 125 it. attar 4 ars. pumping—Z.5 a.p.m. ft, after hre, pumping g.p.m. - IZ.GROUTING Well Grouted: ❑ Yes ® No Material: ❑ Neat Cement ❑ Other: 13. PUMP; (If available) HP Length of Crop Pipe ft. ccpccity g.p.m, ❑ Subm. ❑ Jet ❑ Centrifical ❑ Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature _o This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Alpine Drilling & Enterprises AA -9108 Registered Business Name Contract License Number Address: P.O. Box 110496 Anchorage, Ak 99511 Signed : Date: Authorized Representative Form 02-WWR (II/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer 0 0 PAGE 1 OF I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW910042 DATE ISSUED: 3/28/91 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 3/28/92 OWNER NAME:SAUGSTAD JOHN G & OWNER ADDRESS:829 E. 78TH ANCHORAGE, ALASKA 99518 PARCEL ID:02009177 LEGAL DESCRIPTION: SAUGSTAD LT 2 LOT SIZE: 79447 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WELL IS TO BE DRILLED AS PER SITE PLAN ATTACHED. WELL, IS BEING DRILLED TO DOCUMENT PRODUCTION IN AREA FOR PROPOSED RESUB. OF LOT (S-9020). FOLLOWING PRODUCTION TEST, WELL MUST BE PROPERLY SEALED AND/OR TEMP. ABANDONED. THE ISSUANCE OF THIS PERMIT WILL IN NO WAY GUARANTEE FUTURE DEVELOPMENT OF 7IS LOT OR SUBSEQUENT DIVISION OF THIS LOT. RECEIVED BY: ISSUED BY:"`�"��''r _Y., i l . J .. DATE:,) �Z / DATE. Parcel I.D. 020-091-89 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: _/ () — R — % 3 Complete legal description Potter Pointe, Lot 5 Location (site address) 4350 Sage Circle Anchorage, AK 99516 Current Property owner(s) David & Jennifer Bond Day phone _ Mailing address 4350 Sage Circle Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well (] Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: "U",_.�p�..J Date:. -7/9W3. COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 440 W Waiver Fee $ Date of Payment 6/2WO Date of Payment Receipt Number 63X16 Receipt Number COSA#_ 03C131a?y 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 Anderson Engineering . Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 522-7773 Date 6/2 612 0 1 3 moo OF W :, 6. DSD SIGNATURE �1a System #1 Approved for 171 bedrooms ® `�5`. CE -438% \�® System #2 Approved for bedrooms Disapproved X, Conditional approval for bedrooms, with the following stipulations: gy. rOriginal Certificate Date: l I - 1 Theuni ' ali nchorage 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 forerrors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blce sheet ( I- _, c 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 Subdivision, Lot 5 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 4/3/91 Sanitary seal (Y/N) Y Total depth 135 ft. Cased to 35 ft. FROM WELL LOG Date of test 4/3/91 Static water level 10 ft. Well production 2.5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic N/D ug/L Date of sample: 6/14/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material AWWU Sewer Tank size gal. Number of Compartments Foundation cleanout (Y/N) Depression over tank (YIN) Date of pumping Pumper Parcel ID: 020-091-89 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 6/17/13 37.3 ft. 2.41 g. p. m. Collected by: Anderson Engrg. Date installed Clean outs (Y/N) High water alarm (YIN) C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) 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/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 Size in gallons _ "Pump on" level at in. "Pump off' level at Datum Cycles tested _ E. SEPARATION DISTANCES MITI :Ia 011[411"i3 Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main >75' Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line _ Water main Water service tine Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation _ Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Lot is Served by AWWU Sewer System. Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots > 100' On adjacent lots >100' Public sewer manhole/cleanout >1 00' Holding tank N/A Manurelanimal excrete storage areas >1 00' G. ENGINEER'S CERTIFICATION l certify that / 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 Michael E. Anderson, P.E. Date 6/26/2013 CDSA brown sheet 10-10-12.doc Absorption fiel Surface water Water main Driveway, parking/vehicle storage %0,0L E ANDUSOm ;<r CE -4381 gee in. 1 «�Municipality of Anchorage Development Services Department ��✓ =�"�4 �� Building Safety Division r' On -Site Water and Wastewater Program 1�F 4700 South Bragaw St. \ `_j 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. 020-091-89 HAA # V)' /4 G' -2 0 (, -:�- Ii Expiration Date: � — lee, 1. GENERAL INFORMATION Complete legal description Lot 5, Potter Point Subdivision Location (site address or directions) Sage Circle Current Property owner(s) Haqen Investments, LLC/Hagen Homes 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 for pickup. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY: Day phone 229.8400 Day phone Day phone 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 � �w ..+••• •. .nv, L.4i'.'.^.1M'AIXA':nNYb:^ICA'Y,i4P'rtrtLRR6M'dsKRlTY.9aucn•yn.+r..a �r The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Health Auihority 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 waste',vater 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, 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 systern 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AIC 99524 Engineer's Printed Name Nlichael E. Anderson, P.E. Phone 522-7773 Date 1211312002 �..0. tis°m�A V.L E. ANDERSOI 5. DSD SIGNATURE #®s ^` ® F'•. c?m 1% Approved for 4 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory e� ON -SI i E WATFR AND s" a WASTEWATER o °ROGRAM 7 b 00` • Di\��. JJI�J; �1v7 SFV'v,l ;' X Maintenance Agreements Supplemental Engineer's Report Other r iw Original Certificate Date: D, L.iFT STATION Septic tank/lift station on lot• NIA On adjacent. lots >100' Absorption field on lot NIA On -adjacent lots >100' Wells on� adjacent lots Building foundation Water main ...... Surface water: Driveway, parking/vehicle storage W, ell di ent1ots S,oma ac F. COMMENTS �,'Lot is --1L d by the M.unicirpl Sevier Svstcrri. VV'ail c?sInn'....asexte�ded 7';n S—.'n, M2. —L- q2k G. ENGINEER'S CERTIFICATION I cert,`fv that I have determined through field inspections and review of Municipal records that tho above systems are in conformance v.,?Lh f-v,,'OA HAA guidelines in effect on this date. Encineer's Printed Name Michaol E. Anderson. P.E. Date 1 211 31200 2 HAA ree s Date of Payment 0 . .. ....... Receipt Number W16:61 fill •It ............... ...♦ % . 7 Waiver Fee S) Date of Payment . .......... .. Receipt Number.-. 12/06/2002 13:25 FAX 9075625449 Alaska Pum & Supply 14004 j .31 WAM T JESVPUMT REPORT AA •/Z"00 Z. LA K ieftlocation-,79- S. crem From 4�- To - Casing Size Screea Slot. -R,eift 'irks: l000Y dx rr 14de -a PUMO Informatioi, hitik.e Depth: _POP PUMP Size51Y� 14, P, Air Line Depth; A 'ge;. GPM, Max-r;nYdwn; Igo% Static'Water Level. v.:Discbir D PUM 6n ec Date. Timc -Water Flow Remarks, Live] GPM Received Time.,Dec, 6 ONO 1 :2 7PM 70�4 e -ox �w.,pe WrY 7LA irr.-e 7J.1110(e 3 3'k 0 VI %q atA 4u-,&rck Pro dt.Ar. l id P% :21 57 6,)PAI f I N V�1,/,/7- 12/06/2002 13:23 FAX 9075625449 t2— E-02:I7:aB ,^_T end E ME Environ AAL Laboratory Division Alaska Pump & Supply AerCW PulnO a Well -561530Y ilf X001 K m , ti rpl yS^1r o Member of the SGS Group (Socl9t'6" 306nlrale de'SoNailtancel. ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, ,PILORIOA_ ILLINOIS_MARYLA.'.lb, MI,�NIGAN, MISSOURI, NEW JIMSEY, OHIO, WEST VIRGINIA Received Time Dec, 6• I:ZIPM 200 W. Potter Drive Drinking Wger Analysis Report for Total Coliform Bacteria Te: ( oil 6102-2343 B 16°6 READ JWSZ IZUC770XS MY REVERSE ADE BEFORE COLLECT LYG S"PLE Fwc (907) 561-5301 ' MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY:LABORATORY Analysts shows this Water SAMPLE to be: ❑ PUBLIC WATER SYSTEM I.D. 0 , � , r I I I Sacist'actory PR7VATli WATER SYSTEM Q LInsaticilactory Send esoru n Send lmole Q N '��IIG] Ptl4r� � U1'1G tA- p Sample over 30 hour old, insults may be unreliable 3 7� J PFS! ❑ Sample too in transit; sample should �� am r not be ov Dhours old at examination Mot Nomo� to indicate reliable results- Please scud new sample via special delivery mail Mmlut.,Atlarm zvc io Date Receivedsj�/t0-2 - ' Tima Received Pt ' -136 ❑ SendRtsurr: O Saidinvoree pnalysie Began - CaePao Nw m canwnnema Analytical Method: $ MembtarcFiltcr ❑ MMO-Wo ModlnV.aErec - .moa+- ' Number of c6lonies/100 ml. City Lab ReL No. Result* Analyst SAMPLE DATE: m Month Day Year %� �ay SAMPLE TYPE: ❑ Routine ❑ Treated Water Sent to A.D.E.C. Anch Fbks Jun El Re cat Sample (for (orte sample d Untreated Water Faxed with tab ret. no. t7_T;mc; 0 Special Purpose Time CoNeeted Client notified of unsatisfactory results: SANI]?LE LOCATION Collected By 17 ❑ Phoned Spoke Withaaed s!e#t-r AIV�? 1%, �Fr 4, it A 3le- GOf Date: Time: pkc{e Print BACTERIOLOGICAL 'WATER ANALYSIS RECORD A1M0-MUG Result., Total Coliform -E COB _ Membrane Filter. Direct Count Colonirs/100 ral Veriticstion: LTB _ BGB _ COLIFIRM rnrc-rno Naderor., ro cnun - ON • Or&r Saaak Feral Coliform Confirmation _ Final Membrane Fina Results ml ��l By Date �� ! I UZ-- rCotliforrano0 Time ! 3 b hrs Reported i ti l -f—' Coma ents: K m , ti rpl yS^1r o Member of the SGS Group (Socl9t'6" 306nlrale de'SoNailtancel. ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, ,PILORIOA_ ILLINOIS_MARYLA.'.lb, MI,�NIGAN, MISSOURI, NEW JIMSEY, OHIO, WEST VIRGINIA Received Time Dec, 6• I:ZIPM 12/06/2002 13:24 FAX 9075625449 Alaska Pump & Supply A&! CT&E Environmental Services Inc. CT&E Ref.# 1028031001 Client Name Aarow Pump & Well Service Project Name/# Lot 5 Potter Pointe Client Sample ID Lot 5 Potter Pointe Matrix DrWicing Water PWSID 0 Sample Remarks Pan=eter Kesults Waters Department Nitrate -N 0.200 U Microbiology Laboratory Total Coliform TNTC OB [a 002 All Datesflimes are Alaska Standard Time Printed Date/Time 11/27/2002 1410 Collected DatuTime 11/25/2002 14:25 Received Aatef 1we 11/25/2002 14:50 Technical Director_ Stephelye%fde Released By Allowable Prep Analysis PQL Units Method Limits Dain Datc Init Received Time Dec. 6• 1:27PM 0.200 mg/L EPA 300.0 (<=10) 11/25/02 JS col/100mL SMIS9222B (<=1) 11/25/02 SKW Cha Z c-) - CJ c} �.) I. rTl � C7 r'- 41 � CD IJ.J C {,h ca C [: cD t O + \J 3 C �' •-G 'G. 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