HomeMy WebLinkAboutPOTTER POINTE LT 7Pott¢ Point¢
Lot 7
#020-091-91
Municipality of Anchorage
Department of Health and Human Services
825 'L' Street
'P.O. Box 196650 Anchorage. Alaska 99519-6650
Rick Mystrom http:/Nn~w,ci.anchorage ak.us
Mayor
Permit Number:. #SW 010115 Date of Issue: 5-15-01
Date Started: 5-20-01 Date Completed: 5-21-01
Legal Descrlptiola:
Property Owner Name & Addr~s:
Parcel Identification Number: 020-091-91
Is well located at approved permit location? [] Yes [] No
Potter Point Lot 7 '~
Hagen Inv LLC
PO Box 240186
Anchorage, Ak 99524
Borchole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
, sbck-up 0 2
Organics and silt 2 4 '
silt 4 11
gravelly silt 11 35
bedrock 35 207
h20
135 140
190 207
Method of Drilling [] air rotary [] cable tool
Casing type: steel
Wall Thickness: .025 inches
Diameter: _.6 inches Depth: 40 feet
Liner Type:
Diameter: ~ inches Depth:
Casing stickup above ground: _2 feet
feet
Static water level (bom ground level): 31 feet
Pumping level: 207 feet after
_2 hours pumping 2.5 gpm
Recovery Rate: 2.5 gpm
Method of Testing: air lift
Well Intake Opening Type:
[] Open End [] Open Hole
[] Screened Start __ feet Stopped
[] Perforations Start __ feet Stopped
feet
Grout Type: Bentonite # 8 Volume: 1 bg
Depth: Start _.0 feet Stopped _+ feet
Pump: Intake Depth ~ feet
Pump size hp Brand Name __
Well Disinfected Upon Completion? [] Yes [] No
Method of Disinfection: Clorfne Tablets
Comments:
Wall Drillzr:
Alpine Drilling & Enterprises
P 0 Box 110496
Anchorage AK 99511
Attemion: The well driller shall provide a well log to the property owner within 30 days ofcompletion 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: May 15, 2001
Expiration Date: May 15, 2002
Permit Number: SW010115
Legal Description: iPO'I-rER POINTE SUBDIVISION LOT 7 .
Design Engineer: 0000 None Required
Owner Name: HAGEN INVESTMENT LLC
Owner Address: PO BOX240186
ANCHORAGE, AK 99524-
Parcel ID: 020-0gl-gl
Site Address: NHN SAGE COURT
Lot Size: 20000 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. 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 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.
Received By:
Issued By:
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/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number~
Property owner(s) //,~'~x.] ,~'~,//~._~T/r~-"~'~' ~ ~ Day phone
Mailing address (1) ~ ~' ~ ~D/~ ~'~
IT address(2) ~ ~E ~O.R~ ZipCode
Legal description (Lot, Block & Sub'd.) ~7 ~ ~ ~ ~ ~
Legal description (Section, Township & Range)
Lot Size ~ Acres~ Number of Bedrooms ~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Well Only
Water Storage
Jacuzzi
Water Softening Unit
I certify~.,~at_the abo~ve)infor .mation is correct. I fudher certify that this application is being made for a
Slng~F~m'~y and is in accordance with applicable Municipal Codes.
'(Signature of p operty ~ ' gnt)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 17-/00)
/ 2 oO. o
Waiver Fees:
Date of Payment:
Receipt Number:
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COSA Checklist WELL ONLY.docx
COSA Checklist
Legal Description: POTTER POINTE LOT 7 Parcel ID: 020-091-91
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 5/21/2001 Total depth 207 ft
Cased to 40 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 28 in.
Date of flow test for COSA 7/16/24
Static water level at beginning of test 32 ft.
Well production at time of test 4 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 7/16/24
Comments __________________________________________________________________________________
B. TANK DATA – PUBLIC SEWER
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA - PUBLIC SEWER
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist WELL ONLY.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No NA ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No NA ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 7/24/24
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
7/24/24
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.cLanchorage.ak.us
(9O7) 343-79O4
CERTIFICATE Of HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-091-91
t. GENERAL INFORMATION
Complete legal description"
Lot 7, Potter Poinl~ubdivislon
Expiration Date: ~ '- '~- 0 I
Location (site address or directions) Sage Circle
Current Property owner(s) Hagen Investments, LLC/Haqen Homes Day phone 229-8400
Mailing address
P.O. Box 240186 Anchorage, AK 99524
Lending agency
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 Municipality 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 pdvate or Class C well and may be reissued with
~.. '. ' ...new water sample results less than 30 days old. (Ced, J.ficates 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'
i'~' "' 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 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(aro) 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 Anchora.qe~ AK 99524
Engineer's PHnted Name Michael E. Anderson, P.E.
DSD SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 522-'///3
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
· . Odginal Certificate Date:
Municipality of Anchorage
Development Services Department
Bulld~ng ~afety Division
On-~lte W~te~ & Wastew'ater Program
4700 South Bragaw St.
P.O. Box 196650 Ancho~ge, AK 99519-6650
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desc~ption: Lot~,potterpoin~ubdlvtsiion
Pamel ID: 020-091411
WELL DATA
we~ b~e ~
ifA, B, otC provide PWSID #
we~ Log ff~N) Y
Date completed
San~arv ~ Om) [
Wres pmpedy protected (Yin) Y
Total depth 207 fl.
Cased lo 40 ft.
Casing height (above ground) >24 in.
FROM WFU LOG
AT INSPECTION
Dat~ of test 5/21/2001
Static water level 3t ft.
Well production 2.5 g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 c~lonies/100 mL
Nilrate 2 mgJI.
Other bacteda 0 c~oniesil00 nd.
Date of ~ample: t/30r2002
C~lec{ed by: A~w Pump and Well
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Munldl~lS~verl~stem
Tank siz~
C~mou~ (Y~N)
Foundation deanout (Y/N)
C. ABSORPTION RELD DATA
Date instal]ed Soil rating (g.p.d./~ ~' ~Fodrm)
in. ' · Absorptlo~ cate >= g.p.d.
, ~:..: .~ ' ff yes,'glve date
TolM depl~ ft.
~__~ d a~m~ua~ test
Flul~d~ept~ in absorp0on field before test in.
6H~e. ~ ~'eaunent (past '~2 mo.) (Y~ & type)
LIFT STATION
Date installed Size in gallons
'Pump on' level at in. 'Pump off" level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lilt station on lot
Absorption radd on lot
Public seu~r main >75.
Sewer Iseptic sewice line >25'
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhele/cleenout .100'
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Ouilding foundation
Water main
Wells on adjacent lots
Pmpert~ line __
Water sewice line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorpllon radd
Surface water
Water Service line
Cortain drain
F. COMMENTS
Building foundation
Water main
Surface water
Wefts on adjacent lots
ENGINEER'S CERTIFICATION
I certify that I have detemtlned Etrough field inspections and
review of Municipal recon:fs that fire above systems am in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E Ande~on, P.E.
Date 3/4/2002
Date of Payment ~ ~/~ -O~-
Receipt Number .//.~ ~'~) ~' ~'~
Waiver Fee $
Data of Payment
Receipt Number
FEB-OI-O2 Q6:12~ F~3~CT&£ ENVII~ttEHTkL
,~1~___ CT&E Environmental Servlce' Inc.
9675615~01
TOOT3 P.OZ/05 F-462
~'~t &~ R~t.# 1020528001
Client ~ame Aarow Pump · WCll Semite
p ~J~ Na m~ Po~ Polntc
~nt Sampk ~ ~t 7 P~ Po;nrc
~l~ D~g Wmer
Ord~ By
pwsm 0
Sampln Remarks:
Client ~
Printed Date/Time 02/01/2002 I?:52
Collected l~tdTime 01~30~20~2 9:~
~Jv~ ~lme 01~2 10:20
Techukal Dir~or St~h~ ~ Ede
Altowablc Prep AGilysLs
Limits Date Date Init
0.200 U 0.200 ms/L EPA 30o.0 (<10)
01~1/02 JDT
Coliform
coI/lO01nL SMI8 9-~L~R
(<1)
01/30/02 SBH
