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Home My WebLink AboutALPINE VILLAGE BLK 2 LT 18Alpine Villoge Block 2 Lot 18 #014-132-36 WATER WELL RECORD STATE OF ALADKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical ,C;urvuv~; LOCATION OF WELL (Please complete ellher 1(3, lb or lc.) _~lBoraugh I sa",'.','o. ILo, lB'ac' IQ /f. z , DISTANCE ~NO DIRECTION ~ROM ROAD INTERSECTIONS Streel Addross end Area of Well Location 2. WELL LOG Malarial Type Feel Below Surface Top Bottom ~ /7 o.,,i,.o P,.m,, No. $~}'g'o/SS-- A,D,L, No, Section No.I Townehip NE~ Range EE] Meridian I sO wO 3. OWNER OF WELL~ Address: 4. WELL DEPTH: (final)Jl 5.~ OF COMPLETION /'7 [] AW,r O~,,,,d [] Bo,ed [] O,her, 7. usE: I]D'V~o,,,,,Ic [] .ubltc suppl~ [] [] Irrigallon [] Recharge [] Commerical [] Teat Well [] Other: . 8. CASING: [] Threaded diam. ~). in. 1o ~ ft. Depth Weighl diam.., in. fo ft. Depth Sllckup ti 9. FINISH OF WELL: Slot/Mee~ Size: Length: Set belween fl. and Bock filling Gravel pock ft. . 15. Water Temperature , Ti, i, we,, .~vos~~,r ~K }ug~i~ ..... , Il ..... ,,or, ,,~ 1, u(~ lU ,t,e b~.~, of ,ny knowledge and belial; C(,nlrocl License Number ~Orm O2'WW~ (1~/~1) ............................... ~ilY {3 .~,mutmt.. ~HIT[. 5~uh} D6GS, ~INE 'O~illor. CANARY'Co,tamer Equipment used: II, PUMPING LEVEL below land ~urfoce and YIELD ~ft, afler ~hrs. pumping g.p.m. ~ ft. afler ~hrs. pumping ~ g.p.m. 12,GROUTING Well Grouled: [~i~ee [] No Material: [] Neat Cemenl E~ Other: 13. PUMP: (if available)'- HP Length of Drop Pipe ~ft. capacity [] Subm. [] del [] Cenlrlficol [] Other 14. REMARKS: IO. STATIC WATER LEVEL: .~ r · ,,. [] Above or [] Below land lurfoce Dote PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 /%NCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW980135 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:TAVAREZ JOSE V & MAYRA C OWNER ADDRESS:7207 BERN ST Ai~CHOP3~GE, D~LASKA 99507 DATE ISSUED: 5/26/98 EXPIRATION DATE: 5/26/99 PARCEL ID:01413236 LEGAL DESCRIPTION: ALPINE VILLAGE BLK 2 LT 18 LOT SIZE: 9425 (SQ. FT.) ~ER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION b~JST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 ~ 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18D2lC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: £EVENTY 2~ 2 3 8" DI CL 50 LOT Ii~ I I TOBBEN SPURKLAND P.E. 205 W 15TN. AVENUE ARCH. AK. 99501 (907) 279-$916 II ALPINE VILLA GE BI( 2 LOT 18 JOSE TRA VAREZ 7207 BERN STREET II WELL PERMIT DATE: MAY 2i, 1998 SHEET: ill OR/D: 2155 PE£N/T ii SW98XXXX P[D ii yyy APVO21$2, PW6 ~MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY BLOCK/LOT/TRACT BLK 2 LT 18 SUBDIVISION ALPINE VILLAGE WASTEWATER CONNECT PERMIT TAX CODE 1413236 GRID 2133 DATE OF APPLICATION SCHEDULED COMPLETION DATE [~] SINGLE FAMILY 98 - 1101 05/19/98 12/31/98 AS-BUILT [] : MULTI-DWELLING No. APTS [] COMMERCIAL STREET ADDRESS 7207 BERN ST OWNER TAVAREZ JOSE V & MAYRA C MAIL ADDRESS PO BOX 190206 ANCHORAGE, AK 99519 PHONE CONTRACTOR *UNKNOWN r--] Repair Existing Service ~-~ On Property Only ['"] Hydrant Only [~] Main Tap - To Property Line Only ['-] Main Tap & On Property Connect [~ Disconnect [] R & R - Main Tap Only CONNECT SIZE 4" REIMBURSABLE NUMBER [] City Tap [] 50' or Longer Row No. Comments: ASSESSMENTS [~] Main Line Extension ~ Have Been Levied ~...1 ~ IOwner ~" IStaff '~~~1 ISSUED /p~c0usins H CHE'CK OTHER INSPECTED BY INSPECTION FEE $ 104.00 PERMIT FEE $ 35.00 $ 0.00 DEPOSIT $ 0.00 TOTAL $ 139.00 DATE / / REMARKS PERMITTEE (Please Print) MAIL ADDRESS , PHONE SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE CUSTOMER COPY Original ' MuniCipality of,Anch, i age', Dev !0pment services 'D Pa m'ent 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 FAMILY DWELLING Parcel I.Di 014~152-56' 1. GENERAL INFORMATION HAA Expiration Date: Complete legal description Location (site address or directions) Current Property owner(s) BRAD Mailing address ,3225 Lending agency Mailing address Real Estate Agent Mailing address ALPINE VILLAGE SUBDIVISON; LOT 18, BLOCK 2, . 7207. BERN STREET * ANcHoRAGE, AK 99507 RICHARDS Day phone 563-7609 BONIFACE PARKWAY * ANCHORAGE, AK 99504. Day phone CHRIS NOVAK w/ DYNAMIC PROPERTIES Day phone 261-7670 3111'"C" STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: :5 3.. TYPE OF WATER SUPPLY: Individual Well [] ' I'ndividual Water Storage [~ Community Class Well ~] Public Water System [] TYPE OF WASTEWATER DISPOSAL: · Individual On-site [~ Individual Holding tank [~ Community On-site r-~ Public Sewer [] The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an ind~ependent 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 propedies 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-ora public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's. work. Description: A..WELL DATA Date installed , · :' , Soil ratin~ (g.l~;d'./ft~0r*ft~/bdrr~) =1: : :., ,,MUnicipality ofAnch°rage i:, · Development Services Department Building SafetY Division : .... ' ~ On:Site Water & WasteWater. program ~ :::' i 4700 South Bragaw St. . .~ P.O. Box 196650 Anchorage, :AK 9951'9-6650 '~ ~ ~'* ... .; . www.ci.anchorage.ak.us ' · ' ': . ' : "; .: (907) 343-7904 ~:I;;";!; i : 'HEALTH AUTHORITY AppRoVAL ' 'ALPINE: VILLAGE ~;//D; LOT i8, BLOCK 2,", '! ! .i !. !; F;;¢c~el ID: 014-132-36 W= ?,.11 !ype. ¢, ," PRIVATE .... :: '..If A, B, o'r .C provide PWSID# . "'. ';,Well 'Log (Y/N) YES · I!: , ..! '. :..( . ; -~ ., . :' Date completed 7//15//1998 Samtary seal (Y/N).YES .. ;~ , WIres p~operly protected (Y/N) 3'.ildel~ih'.'!65, , .ft.' . i Cased, t0 ,,65 ft.: ; .'. ~ Casing he,'ight (above ground) ,:I FROM,WELL'LOG. ' . !!: 'AT INSPECTION r Dateoftest · 7/i5/1998", -'; ':, ';,,, 1//2072'004. waterlevel ~. '40 "' ,~ ff. ':i' :'," : :; " '=' , '' ' ;t' '. .... !I;:'~24'!!;r ft. ,Well production. .. .. ~ 7' .'~ .:, .:, g.p.m... ':::.:i~;~ . _.:' ~2.28, ': g.p.m. ,WATER SAMPLE RESULTS: ~ ........ · ,. '"" ; !i ~ colonies/100 mi.. :,'Nitrate. k..%',:'mg#L. ' ' . · ,,,,,i. r; , i! '~ , :Other bacteria : ~, colonies/100 mi.' iN//A'mg./L:.: ' -' ; ' " ',Collectedib, y:':' ' '"' AKWWC, INC.' Arsenic:. :Dateof sampi~: 1'/20//12004- .... !;I~ : B. SEPTICIHOLDING TANK DATA ""il'"' ;): PHRHI¢-, 'SEWER ,. -- ;' J~ : ' , ,t ; ',, , :',' ' ::' 'i.l' ' !t ' : , ,; ; ',if'! ~ ";. :";' ''~ : ~' ....~ t'~ ' : ' TankType/Matera ' ' ' ' ',':~~ ' ":, !'"' ';~' ' i ~ ..... -- Date?nstalled Ta,h, ksize~, · ' gal.': , 'Number~fCdmpartments ';' !, i Clea I~:1[', ,! .... .., ., . .;! :,!.; ::;:: , Foundation cleanout (Y/N) ' "'; Depr i~ . ! .;. l:'Hig ar'm (Y/N) . D~te of' .:. , :.:,,p~mPer ,,.:~ ;: -, i; .~:4 !:.! ,;,. :i '"' ' '"' : YES , '18+ in. AVENUE Z N 89759'00"E 130,00' ONE STDRY SINGLE FAMILY HaME ,I S 89?59'00"%/ 130,00' ~ ', SHANE A. HOLT.-' ~,~ ".. LS-6914 .."~ ,%;;.. ........... |rlf.. iMFOI~MAiION tli-~[ON i5 tOP, ttt[ USt. OF LLN,~iNG INSiliUiiON$ SPrCirI(;ALL¥ JO StlUW..AN1 CONJ-LIC;i$ ~- EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDIT STRUCTURES OR FENCEUNES. EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS NOTE: ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPER OR LOCATE STRUCTURES. PAVING MAY BE SHOWN APPROXIMATELY DUE TO SNOW CONDITIONS. D WELL -- X AS-BUILT SURVE ND CORNERS SET I HEREBY CERTIFY MORTGAGER'S INSPE DESCRIBED PROPER' LOT 18, aLaCK 2, . viAGE RECORD SIDLE IMPF THE PROPERTY LINI ~XZST aT.ER THAN INDICATED) ~AT?D~T ANCHDRA ~A~I~F JANUARY HaLT LA~D SURVE~ 345-5513 Municipality of Anchorage Development Ser i s Depadment Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 995196650 www.ct.a nchorage.ak.us (eO~) 343-?9O4 Parcel LD. 014-132-36 t. GENERAL INFORMATION Complete legal desc~ption CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ALPINE VILLAGE SUBDIVISION; LOT 18, BLOCK 2, ' Expiration Date: / ::;Z -.A, O -'o I Location (site address ordirec'dons) 7207 BERN $1NEET * ANCHORAGE, AK .99507 Current Property owner(s) Mailing address Lending agency. Malling address Real Estate Agent Mailing address HOSEA TRAVREZ Day phone c/o MIKE JOY w/ PRUDENT]AL JACK WHITE Day phone MIKE JOY w/ PRUDENTIAL ,JACK WHITE Day phone 529-5730 3201 "C" STREET SUITE 200 * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Indivldual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On'site Individual Hclding tank Community On-site Public Sewer The Municipality of Anchorege 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 AJaska. 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 d[spossl 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 engineers work. 4. STATEMENTOFINSPECTION BYENGINEER As certified by my seal affixed hereto end as of the validation date shown below, I verify that my investigation, based on precedures outlined in the Health Authori~ 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 bedmoms and type of structurre indicaled herein. I further verify ~hat besed on the information obtained from the Municipality of Anchorege files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance wi~ all applicable Municipal and State codes, ordinances, and regulations in effect at the Ume of Installation. Name of Firm . ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Address ., 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. (~ARNESS, P.E. Engineer's' Comments: In conducting this evaluation, A WWC, Inc. alfempfed to provide a thorough, conscJentioue engineering analysis of the system In accordance with ADEC end MOA DSD Guidelines & Regulalk~s. The reporfed results described the perfonnanue of the eystem under the conditions enceuntemd at the time of the test, end separation d/stances meesurad to ~edily Identifiable fealure& The operational life of eft wells end eeptlc systems dopend on the louel soSs condiffon, gmundwaler fevele ~hat may fluctuate dudng the year, end the water usage of the fam#y being servel by the system. These cond/lions em outs/de the contra/of the evaluetor of the system. Satisfecfoty test results do not guarantee futura performance of the system, nor do they guarantee that thera arra no hMden dofecfs or ancroachmante. A WWC, inc. sen therafora not pmvfde any warranty or futura e~Jmate of how long the system wfll continue to meet the operational mqulrarnente of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner #sled above. Any mlisnse upon or use of this repe~t by any other person or pen'y Is not authorized, nor will lt confer any legal rlght whatsoever. 5. DSD SIGNATURE ,, ~ Approved for -~ bedr°°ms. Disapproved. · Conditional approval for __ Phone 337-6179 o,,, · ~: ON-SEE ~ . WATER AND . ~ : WAST~ATER : . ~moms, wi~ ~e fll~ng SfiPula~ons: ~ ~ PROG~M ~.... .-"~'~ Attachments: I-IAA Checldist Septic System Advisory Well Row Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: c~ ,,~_ ~ - O / Municipality of Anchorage Development Services Department Or.~ta Water & Wastewater Program 4700 So~h Bmgaw St P.O. Box 196650 Ancflmage, AK 99519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescflpt]oft: ALPINE VILLAGE S/D; LOT 18, BLOCK Parcel ID: 014-132-36 A. WELL DATA We~ type Date completed Total depth s5 It. Steflc water level Well pmducflm WATER SAMPLE RESULTS: If A. e, or C provide PWSID# N/A ?/~5/98 Sanaary FROM W~ ~ LOG ?/~s/~s 7 Collfoml .~ c~loldes/100 mi. Date of sample: 9/4/2001 B. 8EPTIC/NOLDING TANK DATA g.p.m. PUBLIC wen Log (Y/N) W~ms prope~ pmected (Y/N) Ca,~ng height (above ground) AT INSPECTION 9/~/~oo, 31' It, 3.5+ g.p.m. AWWC, INC. YES YES 18+ SEWER T~< ~,~W,,~, ~ ~,"ed Tank size gal. Number of Comparlme~ Loundaflon cleanout~ ~/N) High water a~mn (Y/N) C. ABSORPTION FIELD DATA Date Installed Soil mflng (g.p.d./lt'or It¥odrm) System type / / ,. E,. .,. ,,' :.,,. FlUid depth In ,bsorpflon fleM~.~.b~..-~.t~e['"~ ,.Water added_, g~l_.. . New dept~ In Elapsed Time: _ Final fluid dapth In. Absorpllon rate >= g.p.d. ~trealment (past 12 mo.) (Y/N & type) fl'yes, give date D. UFT STATION .Oa~:instelled SIzeln gallons ~ Pump on' level et In. 'Pump n. High water alarm level et i~ ~ ~ Cycles tested Meets elarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM W~ ~ ON LOT TO: Seplic tank/liE ~telton on lot N/A .nZeoq~on field on lot Publlo ~wer main ~' 75'+ ~nver I~e~o sewlce line 25'+ o~ ad, cern ~ ~ oo'+ On adjacent lots 1 o0'+ Public eewer manhote/cteanout Holing tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC Building foundalJon . Properly line Abeeq~lon field ,100'+ SEWER Water maln Water sen4 ~"-$-utface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building founda~on Water main Water eervlce llne Surface water~ ~---Dl'i~a~, ~hicle Momge ~urtab~, ~ Wells on ao'Jacentlots. F. COMMENTS _ · I certify that I have determined through field Inspecffone ~ mvlev/ of Murddpal leonrds ~et ~he ebove sy~en18 em In conformance with MOA HAA guidelines In effect on this date. o.te *?p, HAAFee$ :~C~ .~C~ Receipt Number (Rw. Waiver Fee $ Date of Payment Pacelpt Number U6="l i J 33YD~ 'ON ZYgd 'gl ~09 I -- T