The URL can be used to link to this page

Home My WebLink AboutSOUTHWOOD PARK BLK 3 LT 225outhwood Pork Block 3 Lot 22 #012-073-55 Municipality of Anchorage Department of Health and Human Services 825 'L" Street P.O. Box 196650 Anchorage. Alaska 99519-6650 , . ~.. Rick Mystrom http:/N, nvw.ci.anchorage.ak.us - :'" Mayor L. ~ ' ~ ' Permit Number:. #SW 020023 Date oflssue: 2-11-02 Parcel Idefitifi~[tion Numb-er': '01~073:55 Date Started: 6-2-02 Date Completed:_6-25-02 Is well located at approved permit location? [] Yes [] No Legal Description: Property Owner Name & Address: Southwood Parr BIk 3 Lt 22 ;~ * :.~ .. Kyte Embley * 2317 Raspberry Rd Anchorage, Alaska 99,502 Depth (ft) Method of DHIling [] air rotary From To 0 2 2 14 14 150 150 211 211 252 252 257 Borehole Data: Soil Type, Tbiclmcss & Water Strata stick-up gravelly silt sandy gravelly silt silty sand heaving gravelly silt water sand & gravel I--] cable tool Casing type: steel Wall Thickness: ,250 inches Diameter: _6 inches Depth: 257 feet Liner Type: Diameter: inches Depth: ~ feet Casing stickup above ground: _2 feet Static water level (from ground level): 3_~6 feet Pumping level: 257 feet after 2 hours pumping 50+ gpm Recovery Rate: 50+'gpm '.. :. · · ,. Method of Testinli:.ali:lift ' ,, -. ;..i. :--.,.,,,.,, ...... ., . Well Intake Opening Type: [] Open End [] Open Hole [-lScrecned Start~fcet Stopped - feet [] Perforations Start feet Stopped f~t Grout Type: ~entonite gramdes Volume: I 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: chlorine tablets Comments: Well Driller: Alpine Ddlling & Enterpdses PO Box 110496 Anchom re Alaska 99511 Attention: Thc well driller shall provide a well log to the property owner within 30 days of completion and thc property Alpine Drilling & Enterprises ~.VO~CE ? ~ Domestic - Commercial 4 7 7 2 I~ Pump & Water Systems #1[~, Anchorage, Ala. ska99§11 I ~ltl~ ~ ]) ~; ~-- .. QUA~ ~RIP~ON AMOU~ LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR Thank You (I Hereto//~know~ e I~e Sati~acto~/Comi:~etion d ~ ~e ~ W~,) TERMS: ACCOU~S PAYABLE AT I~ OF MO~ FOL~O~NG PURCHASE. SERVICE CHARGE AT RATE OF 1.5% P~R MO~ ~kL BE CHARGED ON OVERDUE ACCOUNTS. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7g04 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Feb 11, 2002 Expiration Date: Feb 11, 2003 Permit Number: SW020023 ~'Legal Description: SOUTHWOOD PARK BLK 3 LT 22 Design Engineer: 0000 None Required Owner Name: Kyle Embley Owner Address: 2317 Raspberry Rd. Anchorage, AK 99502- Parcel ID: 012-073-55 Site Address: 002424 66TH AVE W Lot Size: 7000 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 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 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 (9O7) 343-79O4 ON-SITE SEWER/~VELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O I ~ - 0'7 3 "~"'~" Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) LotSize ~o ~/~'o AcreS;~ '7, ooo 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 [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is ?n accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: ] ~'"~ · ~' c, Date of Payment: ~,/~"/~ 7_. Receipt Number. //~'"7 ~.~ d (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number. LOT 21 WEST SIXTY-SIXTH AVENUE N 89'53'00" E 50.00' O ','-'. · 10' SIDEWALK ';'i':'i EASEMENT '..'.'.'.' .... '.'.'.'.'.PAl.ED '..'.'.' <~'.'.'.'.'.' 7 0 '.'.'.'.' OR,V~'.'.'.'.'.'.[~ .'.'.'.'.' 30.0 ', ~__ ~0 PROPOSED ~ HOUSE P FIN. FLR. o ~ 101.0' 9.0 = ~ ~ 210 NOTE 1. AS PER TITLE REPORT PROV1DED BY, STEWART TITLE OF ALASKA. 5) CEA RIGHT OF WAY (BLANKET EASEMENT) EASEMENT IS FOR CONSTRUCTION. OPERATION, AND MAINTENANCE OF AN ELECTRIC TRANSMISSION AND/OR TELEPHONE DISTRIBUTION LINE OR SYSTEM. BOOK 7.3, PACE .351. AFFECTS: BLANKET EASEMENT WITH NOTATION THAT ELECTRIC LINES WILL CONFORM TO ALL PROPERTY LINES NO MORE THAN 2 FEET. WITHIN THE PROPERTY. NOTE 2, A PLAT NOTE SPECIFIES AN UNKNOWN WIDTH POWER AND WATER EASEMENT CENTERED ON THE REAR PROPERTY LINE. LOT 23 LOT 46 LOT 22 7,000 SQ. FT, S 8g'53'00" W 50.00' LOT 47 5outhwood Pork Block 3 Lot 22 #012-073-55 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street 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. 012-073-55 1. GENERAL INFORMATION Complete legal description Lot 22, Block 3 Southwood Park S/D Location (sEe address or directions) 2424 West 66th Expiration Date: Current Property owner(s) Tom Emblv Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 2. NUMBER OF BEDROOMS: Day phone 243-2171 2317 Ras~berryRoad, Anch AK 99502 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 3 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] []~ Individual Holding tank [] Community On-site [] [] Public Sewer [] 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 are valid for one year far 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 cf the validation date shown below, I vedfy that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance v~th all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Enq. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 8~24~2002 Engineers Comments: in conducting an adcquae,.' tesL I attempt to pm~'idc a thorough, conseicntions cogincc~ng anab'sis of thc ~.~tem in accordanco with MOA DHHS Guidelines & Regulations. Thc rcpon~ results deseribc thc performance of thc system under the conditions encotmtered at the time of thc lest, and separation distances measured to readily identifiable fcalures. Thc operational life ofall ,,,,'ells and so, dc ~..~[ems depond on the local soil condition. ~rotmd ~'ater Ire'els that m~' llucmam during the yam'. and the water usage of thc fm'nily being servccl D,.' the system. These conditions arc oulside thc control of thc cvalantor of this ~.,tcm. All s)'slems eventually fail and satisfacto~7 test resul~s do not guarantee future ix'H'ormanec of the ~tcm, nor do they. gum'antec that them arc no hidden defects or encmachmems. PES can therefore not provide any warrant, for future porformance nor give any estimate of bmr long the ~'stern ,),'ill continue to meet the operational requirements of the ADEC or MOA D[ l[IS. The content of this report is for thc sole benefit of d~¢ owner listed abo~'e. A~y relianco upon or usc of this report by any other Ix'rson or party, is not authorized nor will it confer any. legal fight ~'lmtsocver. 5. DH~/SIGNATURE Approved for .-~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X :... %; ..... ,..cj ,~ Maintenance Agreements Supplemental Engineer's Report Other By: Expiration Date~,~ Original Certificate Date: Reissue Date: Municipality of Anchorage Development Services Depar[ment Building Safety Division On-Site Wat~ and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage, ak. us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type PRIVATE Date completed 5/25/2002 Total depth, :~$7 .ft LOT 22, BLOCK 3 SOUTHWOOD PARK If A, B, or C provide PWSID # ~ Sanitary seal Yl~S Cased to 25? ft FROM WELL LOG Date of ~est 6/25/2002 Static water level 36 ft Well production 50+ g.p.m WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Nitrate - ~ mg/I Date of sample: 8/20/2002 Collected by: SRP B. SEPTIC/HOLDING TANK DATA Ta.nk Type/Material N/A Date instaIlecJ Tank size Cleanouts ., Date of pumping C. ABSORPTION FIELD DATA Date installed Soil rating or ft2/bdrm) NIA Length fl W~dth fl Total depth ft Effective absorption area __ft2 Date of adequacy test ~ Results ) Fluid depth in absorption field before test ~ in Elapsed Time: .. , min Any rejuvenation treatment (past 12 mo.) (Y/N & type) (Rev. 11/99) Parcel I.D.: 012-073-55 Well Log YES Wires properly protected YES .. Casing height (above ground) 24 in. AT INSPECTION 6/25/2002 36 50+ g.p.m Other bacteria-~' coloniesl100 mi Arsenic/'J mg/I gal Number of Compartments · Depression ov~ tank . High water alarm __ System type Gravel below pipe Monitoring tube __ fl Depression over field For bedrooms gal. New depth Absorption rate >= If yes, give date in. g.p.d. D. LIFT STATION Date installed 'Pump on' level at Datum Size in gallons N/A in'Pump oft' level at Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA Absorption field on lot N/A Public sewer main 110 Sever/septic service line 84 in ManholelAccess High water alarm level at ~ in Meets alan~ & cimuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 110+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation N/A Property line __ Absorption field Water main Water service line Sudacewater Drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line NIA Building foundation Water main Water Service line · Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS LOT SERVED BY PUBLIC SEWER IN VV66TH AVE. ENGINEER'S CERTIFICATION I certify that I have determined through field inspectk~ns and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Pdnted Name Steven R. Pannone, P.E. Date 8-24-02 HAA Fee $ .~'75 ,'"/- ~ /"~U,.~, ~._ Waiver Fee $ Date of Payment <~'/Zc//0~'' ,~ .,,~, Date of Payment Receipt Number 0~ ~7 ~- Receipt Number (Rev. 11/99} ,~tE CT&E Environmental Services Inc. CT&E Ref.# 1025342001 Client Name Pannone Eng. Srv. Project Name/# L22. B3 $outhwood Park Client Sample ID Garage Faucet Matrix Drinking Water Ordered By PWSID 0 Samplc Remarks: All Date~dTIme~ are Alaska Standard Time Prtnted Date/Time 08/23/2002 16:42 Collected Date/Time 08/20/2002 11:30 Received Date/Time · 08/20/2002 l 1:45 Technical Director Stephell. Ue Ede Released By~~[ ! Waters Depar tmen~ Nitrat¢-N M~crobiology Laboratory Results 0.200 U PQL Units Method Allowable P~-~ Analy~i~ Limits Date Date 0.200 mg/L EPA 300.0 (<=10) 08/21/02 xo~.l/4OO~,&, OMt8 9'~22B .' (e-l) 0g/20/02 Init JDT YAP CT&E Environmental 200 W. Potter Drive _inking Water Analysis. Report for Total Coliform Bacteria ~,: · ,RF,.,iD ,I/~T. RUC"[ION$ ON I~,E~ $ID£ BEFORE CO,t.r~CTEVG SA,'EPZ..E Fax: (90'I) S6t .S301 ~fUST BE, CO.M. PL ~ 1/:D BY WATER .RUPPLIER El ])UBLI C WATE,~ SYSTE~Y[ I.D. # El PRJ-~A1T, ~'ATF~R SYb-I'~M ]~,Ioat h Day Year . Romlnc 0 ~r~t~ ~'ater Repeat 5amp~e (for routine s~mple ~ U~it~ Water ~lth lab re[ no. -) . ocA ,os .Time Collected Collected By. l:t~ ' BACTERIOLOGICAL WATER ANALYSIS RECORD M,%tO.-XIUG Result: Tat~l C~llform ' £. Coti Membrane ~'llten Direct Count (~'"~ ,,, Calonles~lO0 mi Vertflcatlon: LTB BGI~ COLIFIR,~! Fecal (:nllferm Confirmation Fens! Membrane Filter Results C~) Cal~form/100 mi TO BF., COMPLETED BY LA~OP-~TORY Andy.si,, shows O~is Wa:e~: SAI~'LE to be: ~ ' Unshtisfnctoty El' Sample over 30 ~ou~ old. tesulm may be unreliable - . Sample too long in tta~mlt; sampln should not be over~ I~ou~ old at examination ~o indicate reliable results. Plnas¢ et'nd new sampln ~ta special <!elivery mail. · Anhly~k. ul Mothod: l~Membr~e Filter · C~ I~tMO-MUO · , * N~m~e~ o~'c~onlcs~tO0 rnL ".Lab Ref. ~o. Result* Analyst Se.t tsA.B.~.C. Anm Fbt~ Jun [] Fixed D~te: ~ Tima: Client notified of unsatisfactory results: · . · Phoned Spoke with Fazed ' 10T 21 WEST SIXTY-SIXTH AVENUE N 89'53'00" E 50.00' ~0.2 .'.v.'.'.' ~ EXISTING 0 o · ~ flOUSE 9.1 O. o o o 4.8 c~ o* o', 21.0 NOTE I. AS PER 11TLR REPORT PROVlDED BY, STEWART TITLE OF ALASKA. 5) CEA RICIIT OF WAY (BLANKET EASEMENT) EASEMENT IS FOR CONSTRUCTION. OPERATION. AND MAINTENANCE OF AN ELECTRIC TRANSMISSION AND/OR TELEPHONE DISTRIBUTION LINE OR SYSTEM, BOOK 75. PACE 2,51. AFFECTS: BLANKET EASEMENT WlTH NOTATION TItAT ELECTRIC: LINES WILL CONFORM TO ALL PROPERTY LINES NO MORE THAN 2 FEET WITHIN THE PROPERTY. NOTE 2. A PLAT NOTE SPECIFIES AN UNKNOWN WlDTH POWER AND WATER EASEMENT CENTERED ON THE REAR PROPERTY LINE. LOT 23 LOT 22 7,000 SO. FT. Tho loc~tlon of tho structure(B} ..... es ohown 0ri tlll~ record c~rawlng (a~-bul!t~~Jt~,~'ltle 21, ^M~oT _. S 89'53'00" W 50.00' 47 LOT 48