HomeMy WebLinkAboutEAGLE ROCK LT 25BEagl
Rock
Lot 25B
#075-092-69
EXPIRED PERMIT
STATE O!? ALASKA
!) I,; I'A R'rM I,:NT O I; NATU I~.A L I~.E$O UR, C ES
M ININ(;. LAND, WATER HYDROLOGIC SURVEY
WATER WELl.
HEFTY DRILLING
3540 AKULA DRIVE
ANCHORAGE, ALASKA 99516
(907) 345-0593
:- ' Drilling Started:
Clty/Bocough: Subdivision/USS: Block l.ot i'ropcrl¥ Owner Name & ^d¢lrcss: '~ ~
Mcrldi~. Township Runic ~don ~ o~ ~ of ~ of
~:~ Lon~: W ~AD: 2~ OK ~ Elevation: .r
BOREHOL~ DATA: rh'-., =,',,,,:~,1 .,..r:,,.,. D=pih Drilling mclhod:~ Air rotan, D Cable tool, O[h=r
· Mat=r[~l: Ty~, Color & we[ness i ,Fr~n} J T~ Well use: D Public supply~ Domestic, ~ O~er
D=pth of bolo: [ ~ ~" ~ C~ing stickup~
Casin~ dimnclcr: ~ inches casin~dcplh 7 I
$~ ~ ~L ~ Il t. incr type: Dimnc,cr: inch~ Depth:
~ R~cOvc~ rills: ~pm, Mcdmd orlcstin~:
C ~ Wclliniakcopcni,,~lypc~Opcncnd. DOpcnholc
~" , % ~ %~ O Screened; Scan: ~ Stopped
~~ SIa~: ~, SLopped
Grout l~pc: '~~ Volume
~A;:~ Pump inlake depth: fl
-,.. . ~ - Pump size bp, B~nd nome:
Wa~well disbfcclcd upon complcdon~ ~Ycs, 0 No
Mcdmd of dish~cclion: ~ I o~
D¢iller commcn{s/discl=hners:
Well Driller Name:
Company Name: Hff~ DRILLING
Mailing Address: 3540 AKULA DRIV~
Ci~: ANCHORAG~ State; ~S~ Zips, 99516
hone Number: ~ . 1-907-345-0593 / __
~ Drillers Signature: ~;~
I¢ I;1~,' ll*,lll|rl,.~ III.l* !. -'I"" **t I|l~s .. "*
DEPARTMENT OF NATURAL RESOURC~
Mi?lng, ~n~ & ~V~ter ilydrolo~ic Survey
550 W 7th Ave.. Suilc
. Anchorage, A~ 99501-3577
Telephone (907) 269~39 and FAX (907) 562-13~4
Within thc City or/(.nchora~c, it is required [hat a copy of[he well log be
scnt to thc appropriale cicy office within 60 days and lhat nnother copy oF
the well log bc scm to Ibc well/property owner within 30 days,
Pemdt Number:_ ~~0~ ~ ~.
Dale or Issue: / / · ·
Parcel IdcJHil]caliml Number: ,, -'
Is well located n~ ~pprowd pcm~i[ location? O Yes ~r O No
B'd ~6C£-S86-606 Ro3ow e~oe9 dSO:TO ~0 TE RoW
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: Apr 26, 2002
Expiration Date: Apr 26, 2003
Permit Number: SW020078
Legal Description: EAGLE ROCK LT 25B
Design Engineer; 0000 None Required
Owner Name: Steven P. Matter
Owner Address: 10242 Jamestown Dr., #D
Anchorage, AK 99507-
Parcel ID: 075-092-69
Site Address:
Lot Size: 14643 SQ. FT,
Total Bedrooms: 3 Permit Bedrooms: 3
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. Ail 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.
Issued By: ~~
Date:
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/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parce LD. D 0 ?.O - ?
Permit Number SW OZ-OO7 F
Property owner(s)
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Acres S~ .. '
Day phone
.Zip Code
Lot Size ,,//~/~ ~'/' ~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms ..~
[] Well Only
[] Water Storage
[] Jacuzzi []
[] Water Softening Unit []
Date of Payment:
Receipt Number:
(Rev. 12/00)
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is Tn accordance with app/~ble Municipal Codes.
(Signature of property owner or authorized agent).,,,/~
I
Permit Fees: ,/~), oO Waiver Fees:
/~//Z,%//gc'~ ' Date of Payment:
/
/~ '7t ~ Receipt Nur~ber.
Municipality of Anchorage
Btfild~ng Safety Dxx:ts~on
P.O. Box 19Co650 · 4700 S. Bragaw Strcct
Anchorage, Alaska 90519-6C~0 · (907) 843-8301
h ttp://~vww, cl.anchoragc.ak.us
October 8,2001
~epartment of
Public Works
Steven P. Matter
10242 Jamestown Dr., #D
Anchorage AK 99507
Subject:
On-Site Water and/or Wastewater Permit.
Permit Number: SW000491
Legal Description: Eagle Rock Lot 25B
Dear Steven P. Matter:
An On-Site Water/Wastewater Permit, number SW000491, issued by this office for a single-family
system, will expire on November 27, 2001. This permit was valid for 365 calendar days.
Ifthis was a well pemxit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to
this office for review, approval and documentation. This as-built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As-built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit may be issued.pee of
charge for a second year if the application for the renewal is received on or before the date of expiration
of the original permit.
When applying for a new permit, the fees are: $320.00 for a wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerel~
Manager
On-Site Water and Wastewater Program
Enc: Copy of pc,mit
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650. Anchorage. AK 99519-6650
(907) 3434744
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Nov 27, 2000
Expiration Date: Nov 27, 2001
Permit Number: SW000491
Legal Description: EAGLE ROCK LT 25B
Design Engineer: 0000 None Required
Owner Name: Steven P. Matter
Owner Address: 10242 Jamestown Dr., #D
Anchorage, AK 99507-
Parcel ID: 075-092-69
Site Address:
Lot Size: 14643 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date: ~//'~
~ EX/STING CASSUMED,) SPOT EXIST.
(~ WELL
~ OWNER (TYP) PROPOSED
WELL ~ ~0' PRWATE
S 52'36'00" E ~ I
~48.00'
I/~ ~, ' ~ ~l ~ PROPOSED LOG ~:.
..... ~:~J ....
~ ~ ~ ~'~ ~ : -- · .. ~..
EXIS~NG S$ LtNE
e~r~ ~r /"~ N 52'56'00" W
~NGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
EXCLUSION NOTE:
IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION.
TO VERI~ PROPOSED BUILDING GRADE RESTIVE TO FINISHED GRADE AND UTILITY CONNECTIONS,
AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION P~T.
'PLOT P~N CERTIFICATE:
I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING OESCRISED PROPERTY:
LOT 2S B, EAGLE ROCA' SUBDIVISION
AND THAT THE PROPOSED IMPROVEMENTS AND DR~INACE PATTERNS ARE AS SHOWN HEREON.
~ ~ a ~ LOT: BLOCK:
~? ~. _..~ ERIC P. FUGLESTAD
~ ~ND SURV~OR
. F~... ~"~ ~. sueo,v,s,o,:
~ -~.. ~..._? ~. ~ GLE ~OCK 3500 CRI~NDeN
~...~.~,~;/..;._,.,....& (~o~) ~-~,,
.. ._ ............ .,
~t ~ - SEWARD umm~. / 20-01.06 .
~t Eric P, Fuglestod ~.~
~% ~. P~T .o. 2000-44 sc~:
~. ~ -.. ........ ,.~. 1" =30' epf ..
,~:~ ............... ;~:.- ~~.~
Parcel I.D. 075-092-69
1. GENERAL INFORMATION
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & 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 FAHILY DWELLIN6
Expiration Date: ~ - -.~' ~ /7L
Complete legal description EAGLE
LoCation (site address or directions)
Current Property owner(s) STEVEN
Mailing address PO BOX
Lending agency
Mailing address
Real Estate Agent
Mailing address
ROCK SUBDIVISION; LOT 25B
ALYESKA HIGHWAY, GIRDWOOD~ ALASKA..
MATTER Day phone 783-~0045
1118 *: GIRDWOOD AK, 99587
Day phone
GEORGE McCOY W/ PRUDENTIAL JACK WHITE Day phone
3201 C STREET * ANCHORAGE, AK * 99503
783-0313
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. -TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage r-]
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 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 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 dat'e 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 Firm GARNESS ENGINEERING GROUP, Ltd.
Address 370i E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 337-6179
Date
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 & 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 re'adily identifiable 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~f~the-~wner-~isted~ab~ve~-Any~re~iance.up~n` ~r-use~f-this-rep~rLby-any
other person or party is not authorized, nor will it confer any legal tight whatsoever.
DSD SIGNATURE
~ Approved for
Disapproved.
,-~ bedrooms.
Conditional approval for
bedrooms, with the fllowing stipulations:
~ ~ ·
· WASTEWA ER- :
Attachments:
.j
. Manitenance Agreem(~nts'
HAA Checklist
Septic System Advisory
Well Flow Advisory
Supplemental Engineer's Reort
Other
(Rev. 12/01)
Original Certificate Date:
MunicipalitY. of Anchorage
,Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box.196650 Anchorage, AK 99519-6650
www,ci.anchorage,ak,us
(907) 343-7904
Legal Description:
A. WEEL DATA
HEALTH AUTHORITY APPROVAL-CHECKLIST
EAGLE ROOK SUBDIVISioN; LOT 25~ Parcel ID:
,075-092-69
Well type'~ PRIVATE , ~ If A, iB, or C provide PWSID# N/A, . Well LOg (Y/N)
Dat~', ~ Wires (Y/N)
o~pleted 6/27/2002, Sanitary seal (Y/N)'YES properly Protected
Total depth 108 ft.
Date of test
Static water level
. WdlI.Dr6duction .
'Cased to 108 ft. -
FROM WELL LOG ' -
6/27/2002
· -80
2O
WATER SAMPLE RESULTS:
co'i;o
I rm (~) colonies/100 mi.
Arsenic! N/A mg./L.
·, ! .,,:, DATAi
SEPTIC/HOLDING TANK
g,p.m.
NitrateO 1~,6' mg./k.i,
Date of sample: 5/25/2004
PUBLIC
Casing height (above ground)
AT INSPECTION
6.16 g.p.m.
5/25/2004-
79 ~
Other bacteria
Collected by:
SEWER·
YES
YES
24+ in.
coloniesll00 mi.
GEG, Ltd.
Tan,k ~Type/Matenal
Tanksize gal.
Number of Compadments
Fouhdati~)n cleanoUt (Y/N) Depression over tank (Y/N)
Date 'of IJumping i
ABsoRPTION FIELD DATA
Date installed Soil
Length tl: ~ . ff.
T0t~l del~th
Date installed
Cleanouts (Y/N)
i. High wai~
Pumper i. i'
rating (g.p.d./ft~or ft~ i' , Sy-~t~ tYpe 'i
Width ' ' / : - ?ft. ' GraVel below pipe
,,~"'~'- ~ Results (Pass/Fail)
Da~e of adequacy test , ;'
.Fluid deCth in absor~ field before test .' ' in. ' · water added - gal. ~ New depth
El~l~;eS',~ min.. . Final fluid depth' in. ; Absorption'rate >= ____'
~~enation treat (p :~ -iIf yes, give date
est 12 mo.) (YIN & type)
~ "t ,I? , ' ' -
-ft.
g.p.d.
in.
-~Depression Over field
For bedrooms
D. ~LIFT STATION
Date installed Size in gallons '
~'Pump on" level at in. ~...
Datum ~ -Cycles tested
SEPAI~TION DISTANCES
' Manhole/A~
High water alarm level at
Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on let 100'+ On adJaceni lots
'Absorption' field on lot 100'+ ~ "On adjacent lots
in,
Public sewer main 75'+
Sewer/septic service line 25'+
100'+
100'+
Public sewer manhole/cleanout 100'+
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:' p U B LIC S EWER
Bdilding foundation · Property line ~ ' ., Absorption fieldr '
Water main ~. Water service line . - Surface water ~
Wells on adjacent 10ts '. . !~ . .~~~""~'~
Property line __..__~oundation ..... Water main~.
Water~ Surface water ' Driveway, parking/vehicle storage
F. COMMENTS ' ,
ENGINEER'S CERTIFICATION ~
Engineer's PriTed N~e JEFFR~ A. GARNESS v~,J.' . ..'~,~ ~
"" .......... '
Go
I certify that i have determined through field inspections and
roview of Municipal rocords that the above systems a'ro in ~
conformance with MOA HAA guidelines in effect on this date.
Date of payment
~ Receipt Number
(Rev. 1~01)
Waiver Fee $ r
Date of Payment
. Receipt Number
25 C
/ THIS LOT IS SERVED BY
,,;~ ./" ~~ "CITY" SANITARY SEWER
.(/" .-'
'
25
D
~ ~%~ House c
-,.-~ SNOW ,~ .... , ~ ~ ,
THIS
VISIB
THER
BY
.,~ . .
..
ALL B~RINGS AND DISTANCES SHOWN ARE RECORD, UN.SS NOTED OTHERWISE.
EXCLUSION NOTE:
IT IS THE RESPONSmlLI~ OF THE OWNER TO DETERmlNZ THE EXISTENCE OF ANY EASEMENt,
COVENANTS. OR RES~ICTIONE WHICH DO NOT APP~R ON ~E RECORDED SUBDIVISION P~T.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTmN OR FOR
ESTABUSHING BOUNDARY OR FENCE UNES.
AS-BUILT CERTIFICATE:
I HEREBY CERTI~ THAT i HAVE SURV~ED THE FOLLOWING DESCRIBED PROPERS:
AND ~AT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED.
' _.~ttJJ~. LOT: ~K: ERIC P. FUGLESTAD
~-, . .~. ~ SEWARD ,m~ ~,/ 04-01.02 15.73
e=~% . ...S~ 2000-44 ,,
~]*., No.7218-S ,,.~ ANCHORAGE
E'd 9LEE-ESL-LOG Ro3ow e~doaD d80:[O ~0 I~ ReM
I 1[°
H$1I
o ~
I
o:
m
i
I
I
~80~/9~/~0
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Mntrh
1042875001
Gamess Engineering Group, Ltd.
Ea~le Rock, L25B Hose Bib
Eagle Rock, L25B tlose Bib
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 05/28/2004 12:52
Collected ~Date/Time 05/25/2004 9:40
Received Date/Time 05/25/2004 12:40
Technical Director/~.~/~/,~C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Waters Department
Nitrate-N
0.145 0.100 mg/L EPA 300.0 B (<= ] 0) 05/25/04 JJB
· Microbiolo~ Laboratory
Total Coliform
0
col/100mL SMI8 9222B A (<=1) 05/25104 DKC