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HomeMy WebLinkAboutQUICK BLK 3 LT 3 Quick Block 3 Lot 3 #016-203-50 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?  Yes  No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Well Log Permit Number: #__________ Date of Issue: ________ Parcel Identification Number: __________________ Date Started: _________ Date Completed: _________ Is well located at approved permit location? Yes No Legal Description:_________________________________________________________________________ Property Owner Name & Address: _______________________________________ _______________________________________ _______________________________________ Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Method of Drilling air rotary cable tool Casing type: _________ Wall Thickness: inches Diameter: inches Depth: feet Liner Type: _________ Diameter: inches Depth: feet Casing stickup above ground: feet Static water level (from ground level): feet Pumping level: feet after hours pumping gpm Recovery Rate: gpm Method of Testing: _________ Well Intake Opening Type: Open End Open Hole Screened Start feet Stopped feet Perforations Start feet Stopped feet Grout Type: _________ Volume: _________ Depth: _________ Start feet Stopped feet Well Disinfected Upon Completion? Yes No Method of Disinfection: Comments: Well Driller: _____________________________ Company: _____________________________ Mailing Address: _____________________________ Water Sample Results: Arsenic: _________ ug/L Nitrates: _________ mg/L Total Coliform Bacteria:_________ colonies/100mL Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP231383 Work Type: Well Initial Tax Code Number: 01620350000 Site Legal Address: QUICK BLK 3 LT 3 G:2731 Site Mailing Address: 12284 DIVISION ST, Anchorage Owner: BRADLEY ROBERT Design Engineer: This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: t»cnt hS, Department 11 /17/2023 11 /16/2024 15745 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: S S �r� '�U ff r-, y Issued By: Date: Date: r 7- 20 2 4 ON -SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 016-203-50 Property owner(s) Robert Bradley Day phone (907)229-8153 Mailing address PO Box 110226 Anchorage AK 99511 Site address 12284 Division St Anchorage AK 99515 Legal description (Sub'd., Block & Lot) Quick Blk 3 Lt 3 Legal description (Township, Range & Section) Lot Size 15,745 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial Single Family (SF) Septic Tank ❑ Upgrade ❑ (w/wo ADU) Holding Tank El Renewal❑ (D) ElRenewal Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well n Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 Waiver Fees: Date of Payment: i t '7-0 Z Date of Payment: Receipt Number: Permit No. rS i .Z 31 S 33 Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc I'% - 1 A 31 DATE 12/31/2023 TIME 12:00 AM INSPECTOR SCHEDULED SUBDIVISION -QUICK BLOCK/LOT/TRACT BLK 3/ LT 3/ INDICATE NORTH J_ SIZE MAIN: ITYPE MAIN: t> 1 DEPTH AT MAIN., AT PROP. LINE: LkD, of COMMENTS: NJ f vJC,, il� MIA JeV-04 Ct INSPECTED BY: IDATE.,,??- 23 I Q w N O ` T (� •a����J'S !1I Z O WLD �ZZ U nX N i : �{ Zi cnOJ a rnti i LL_ ti : o f > < w� a �{ © �O �� z Z Upd N 5 ~ a c cnw TWO N 0): 2�� wa > viva -' U Cl)IL > J o o a0 p dw a J /fi L 1 * \RAG �• _ J h U cn Z cn O 1 L N¢ a- = m U can z > _ rn U 6 �1 I }U = 00 oZ •�o o WW L Q wWW a Ja wp i� 2�� W � W (�N 4'" ��ff \/ w =o o Z=� Q3 _ �,o N I p w _ IL J a F- cn o a � J a N 89E 191.99' I I I co Z) Q o a y,o£ N o o z z Q m m M o `" I a WF- p ap zw F 46.0' o I cn wwoU w� w� �� r ~ \® O IWI 06 I wl��� �_ �m WW o > �o.o'o?'�-SS 5-0. s Q Icol W W C3 I O N pZ CO~ U CV wlugl Y 00�U) 4.0' cl �N � Z ZO ww QzCO 00 � (� U d f- Q Z UJa b 00 " w �2 ar ow u� l w l Cr) o p C! LL TZ 't EL > N W I I Z U) Z m �> w C\f N > h U U 06 I— 0 m< v> m w Z p 5 w p F- N FIJI 0 d b 60.0' LO aao I Z 2 cnw mcn pD a r FI F I 40.0' N y _ H o¢ W H >_ o N °IWI 1 rMi M N I > Q 2 2 U Q� �H p W W I- Q ¢ \� 1 W F- Q Q° J a a W 2 00 F- cn U <) Q w ICI J J �� mw z z lol co aa� � U) I i 0 Z � CC 2 z �`� ZU SpU_z Cl) = w o� > / O w w p W = F cn W U 0¢� d I w w p W 0 �� Wp° z � � a j w u p ° 4 p U V Z} � i ,0£ w w Z Z U O p �a M--------_ �— ----_SO ------ U` U' U a'p craw Z U J 5' SANITARY SEWER EA_ ;F_ SD�� I Z O O cn W Z m0 U) D d p Cn tA2.1 �� EXISTING ASPHALT N N a p m Ln U m O W Z U �' O Z S89W192.04 "� �aXXXxw �o F-a� �P w H I O co W W W w d W m Z U co n- M —ss� —ss :N—ssssssss ssssLE ssssssssssssss ss N— ss—{ I O w O U �_ Z U, CO F mm jF-Q Vc) 00 z w U V� 0 W o x "_ o wp pw} ZO c7 W X ;�) l-) l`i F ji @: p m w W m N Wx QCO W 2U2 Z(ncn O J Qw F-Lnw 5Sw MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC241504 Parcel ID 016 -203-50 Legal description QUICK BLK 3 LT 3 Expiration Date: Site address 12284 DIVISION ST Current property owner(s) BRADLEY COMPANY LTD LLC X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 12/6/2024 This0 rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other Rush MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 016-203-50 Complete legal description Quick Block 3 Lot 3 Location (Site address) 12284 Division Street, Anchorage, AK 99511 Current property owner(s) Robert Bradley Day phone (907) 229-8153 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age N/A - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑■ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ LNG G Date of Payment Z �/ Z° 7— COSA # COSA# o5GZy /So Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 11/14/24 N/A N/A N/A > (907) 522-7773 Benjamin Schiller, P.E. LOT 6A REBAR\UTILITY N 00020'12" W 82.00' POLE 20' 1 -L -` EO— E( 5' UTILITY EASEMENT EO — Imo--------- �,_ 10' WATER, TELE. & ELEC. EASEMENT UTILITY PEDESTAL Cn l z1 LOT 3 A� 15,745 sq. ft. �I ml 00 ml ml Vj mI m WELL z N I LWJ r = m -14.4' m < I 36.0' IF I FIELD INLET O CATCH BASIN 2 -STORY o o FRAME HOUSE sq LL20' 8.0' 0 DECK 2.0' 26.0' 31.5' O ' 1 SEWER CLEANOUT ASPHALT DRIVEWAY o :P S 00022'15" E 82.00' - - DIVISION STREET 0 15' 30' NOTE DRIVEWAY LOCATION IS APPROXIMATE DUE TO SNOW AND ICE COVER. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (2018-81) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR EO— EO— OVERHEAD UTILITY LINE FX— x x x x ii 00 (0-x 0 W cn fV m I 11i1111111116A AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, BLOCK 3, QUICK SUBDIVISION ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS SHOWN IN RELATION TO THE PROPERTY LINES. DATED THIS 4th DAY OF NOVEMBER, 2024, AT ANCHORAGE, ALASKA. ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC f C.O. A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM JOB # 23028 7 NO CORNERS SET THIS DATE I SCALE 1" = 30' 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949