Loading...
HomeMy WebLinkAboutSTUCKAGAIN HEIGHTS BLK 3 LT 2Stuckagain Heights Block 3 Lot #041-021-21 by DOC CO. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-275~ OWNER OF LAND: ~,~a[Z. /~O~z'~,~/~'. ADDRESS: LEGAL DESCRIPTION:_.~-~. ~ C ~ ,~1 ~, .-~, ~J H~' ~"~ PERMIT NU~BER:&;O 5 ~ Date of Issue ? T~IDENTIFICATION NUMBER: ~ I - 0~/ Is w~l I~al~ at appmv~ pe~it location? ~ ;J No Meth~ of ~illing: ~ta~ ~ cable Iool Depth of well: I / 3 Casing Type $ ;~z=-/-- Wall Thickness Diameter ~ /I inches, depth Liner Type: /O 3 .J ,~ Casing Stickup Above Ground: Static Water Level: .~ (~ Recover Rate: - ~" gpm Method of Testing: .,~1 ~ BORE HOLE DATA DEPTH inches feet qd feet feet ~,~911 Intake Opening Type: gl open end gl open hole ;.J Screened; Start feet Stopped feet ~.l-P'~erforations Start t~'O feeL. Stopped ~' O feet GroutT e F,j,.7.O.,J ,"t'~ Ct.~"~ yp '.~ Volume Depth: from 0 feet, to ~ 0 '~ feet Well Disinfected Upon Completion? ~ gl No Method of Disinfection: ~/./,a,~,~/~' ~"'O/~id,,'~ . Comments: Driller's Name A'I-rENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. 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 Upgrade Date Issued: Sap 19. 2002 Expiration Date: Sep 19.2003 Permit Number: SW020365 Legal Description: STUCK, AGAIN HEIGHTS BLK 3 LT 2 Design Engineer: 0000 None Required Owner Name: Carlton Roberts Owner Address: 9700 Basher Dr. Anchorage, AK 99507-0000 Parcel ID: 041-021-21 Site Address: 009700 BASHER DR Lot Size: 87120 SQ, FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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,Naska 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 SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ~ /~f..d'¢~, Acre~"~ THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well [] Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool [] Therapy Pool [] Day phone(~o'7 ] '~ ~J~ -c~( (~ Zip Code C/<) 5"o "7 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 in accordance with applicable Municipal Codes, ( 'g o p operty o net or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev, 12/00) Waiver Fees: Date of Payment: Receipt Number: LoT ?- EMENTS OF RECORD, OTHER THAN 'SE SHOWN ON THE RECORDED T ARE ,OT SHOWN HEREoN. F~ ~_,g'-I ~./ AS.BUILT No CORNERS SET THIS DATE I hereby cerlil'y that I have surveyt~i the following described property' Anchorage Recording ~recinct, Alaska, and'~.hat t~e Improvements situated fd '-reon are wlthi~ the property lines and do not overla[ or encroach on the propert7 lying adjacent thereto, that no improvements on prep- erty lying adjacent thereto gn~'oach on the premises in question and that t~ere are tqo roadways, tran~mL~ion lines or other visible easements on said property except as indicated hereon: Dated at Anchorage° Alaska Engineers and ~utveyors Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~l x -,,O~ L.I/'~ \~ PID Number: (C)'L~. / ~.~ - ~ Name: ~/ ~ Wastewater System: ~New B Upgrade Address: /~00 ~ ~ ~/ ~/~ ABSORPTION FIELD Phone: 522-Z772 IN°'°fBedr°°ms: ~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION Soil Rating:/, ~ GPD/Sq. Ft. Lot: ~ Block: ~ ~u~ ~. Depth topipebottomfromo~inalgrade:FL Gravel depthbeneathpipe ~ Ft. I I Fill added above original grade: Gravel length: Township: /~ N Range: ~ ~ Sect~n: ~ 0--~ Ft. ~ ~ Ft. WELL: ~New ~ Upgrade Gravel width: ~ Ft. Ft. ~Cla~2ificstion (Private, A,B,C,:~iV~. ' Total~ooDepth: Ft. Cased TO:~z~ Ft. Total absorption are~z~ SQ. Fi, Pipe material: Driller: ¢~..~ ~ ~//~ Da~ Static~a~rLev;:: In~ ~¢, ¢ ~/~..¢. Date installed: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~Septic B Holding U S.T.E.P. To Septic Absorption Lift Holding Pubtic/Pdvat. Manufacturer~ ~%~ Capacity in From Tank Field Station Tank Sewer Lines Well ¢~f lZOt ~ We ~ Material: ~] Number°fC°mpartments:2 Surface Water ~ ~ ~ ~ ~ LIFT STATION Size iR gallons: ~ Manufacturer:~ Line Foundation ~/A ~/A ~ ~ ~ "Pump o,J~leve, at, I "Pump off.vel at, I High water alarm at: Curtain ~ -- I Drain ~ ~ ~ ~ Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: ~j~ i ~/~¢ ENGINEER'S SEAL Inspections performed by: ~&r~,~/~ Dates: 1st ¢/~4 ¢,~: ~ Department of Heal~ an,d Human Services approval ~'-~--~ v. Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Permit No. of ~-- Page ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: /4) 0 / co cc) I ¢oo GA/-. · ,, d"'A ~/g. 72-013 A (2/91) MOA 25 ertff e by SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND (..?~,<L ADDRESS/(~/.X) ~r LEGAL DESCRI~ION DATE- Started Ended PE~IT NUMBER DEl>TH OF WELL ~?'1(;' /~' - 3 ,.,o! o SIAIIC LEVEL OF WATER F'[ d~m~ t DRAW DOWN Fl GALS. PER HR KIND OF FORMATION: From '~) Ft. to~4 Ft.(~"/J3''~0 ('~ '~' TM (.,~'0 }(d From Ft. to__Ft. From:2 Ft. to C~ Ft. O~.)t~"e ~ ~., .~ ~O t~e'q From_...,. Ft. to Ft. ~ , . From '~ Ft. to Jif' Ft.,.~5, I~'~ s. ~1~<. 5/'~)'~rom Ft. to Ft / 7 ~ Ft. ', ~'~'~,x) ~ . ~_~,~'lq From Ft. to From/~' Ft. to-.) b '~ ~ ' UrS~ From ~>~, Ft. to V0 Ft~r~~vO g ~J=C- From~Ft. to Ft. ~*~ From Ft. to_ Ft. Ft. to~(/~&~ /, 2~ From Ft. to_ Ft. From / Ft. to /.~ ~ Ft, (~r2Z)/d;>C~/4.. ~ ~1:~,~>7~ From,__ Ft. From_ .Ft. to. Ft. /~ t,/] ~/~ ~ ~ t From~__.Ft. to Ft. From_ I.g~'~t. to_!70 rt.~Zd~OCtC ~./~td ~/(da¢[o~'& Ft. to_ Ft From~'YD Ft. to~o Ft. (~r-,///Z,~c.~- /~7~,~/Z, t ~)~' From~ ' Ft. to Ft,-- '~ ..... ~ z * ' t~'?d~{~ Ft. to Ft._ From ~*' ~'~ Ft. to',~°° Ft. ~,,~d 0~[~ From From- Ft. to Ft. From Ft. to Ft From~ Ft. to. Ft._ From Ft. to_ Ft. From Ft. to. Ft. From Ft. to___ From_ Ft. to Ft. From Ft. to ' :ECEIVED MISCL. INFORMATION MAR ~ 1994 Munimp~lib, ~t Anchorage Dept, Health & Human Se~;iOes DRILLER'S NAME PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940015 DESIGN ENGINEER:POLARCONSULT OWNER NAME:ROBERTS CARLTON JR OWNER ADDRESS:1200 EAST 76TH AVE. ANCHORAGE, AK 99518 #1223 DATE ISSUED: 1/28/94 EXPIRATION DATE: 1/28/95 PARCEL ID:04102121 LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS BLK 2 3 LT LOT SIZE: 87120 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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: THE ORIGINAL AND REPLACEMENT TRENC~ MUST BE NOT LESS THAN polarconsult alaska, inc. ENGINEERS · SURVEYORS · ENERGY CONSULTANTS January 12, 1994 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at Lot 2, Block 3, Stuckagain Heights S/D. Dear Sir or Madam: Please accept the following design for review and permitting. The proposed system does not affect the current use of the adjacent properties and will have minimum future impact. If you have any questions, please give me a call. Sincerely, Matthew Korshin POLARCONSIJLT Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 4 System Design Calculations, Section, Sheet 2 of 4 Percolation Test, Sheet 3 of 4 Percolation Test, Sheet 4 of 4 $320 Check for Permit Fee 1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 polarconsult alaska, inc. · ~ 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 CHECKED BY DATE polarconsult alaska, inc. · 1503 West 33rd Avenue · Suite 310 SHEETNO ANCHORAGE, ALASKA 99503 CALCULATED SY ,,*,4/~,~----.. DATE ~///~' (907) 258°2420 Fax (907) 258.2419 CHECKED BY DATE SCALE .........i . i ..~.....~f- (,.5 ~ i.......~ i- ~. ~,~i~..., ...... '~'.~.*~ ~ ~"'"~""'"'"~'""~ ~'"'V'"~ "F ?"'~ ~ ~ ~ [~>~ ,~ ~zw~d ~ [ ~......~ ~, ~ [ ......~..... ~ ....... ~'"i'"'""~"""~'"' ~ ?"""~ '7" F'""~'"";""~;~'~"¢~ """~:r::~ ?:~:~ ; ' .~ .... ~.........--~ ;', ~ ...... r'"": : I ..... F'""~ ' . , :~ L...~ :~ ~.........~: ~ ~ ::i ..... ~;.....[.., ~ ..~ ~ ......; ~ ............ j- .I.4. · : J"" "~ ; ............ [....... ~ } { '. ........ ,: ~ ~ ~ [ ~ "'"~ ?"""~ ['""'! ::~ ~ '""~ f'"'""~ ...... ......... ~ L.i..J .~ ..... f :. ~ F.......~ .................. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES . 825 "L" Street, Anchorage, Alaska 99502~650 SOILS LOG -- PERCO~TION TEST LEGAL DESCRIPTION: ~+ ~, ~- ~) ~{~ Township, Range, Section: SLOPE SITE PLAN O, 4 5- 6- 7- 8- g- lO WAS GROUND WATER ENCOUNTERED? /~O IF YES, AT WHAT 12 DEPTH? E ~d0nilering? ~/ Dale: Reading Date Gross Net Depth to Net Time 'i']me Water Drop I ~/~/~- 0 ~i~. - i~" - ts ~/ ~- !/-7 / ~i~. / ~,'~. ~y~, ~, ~ V7 z ~,~. I ~,. ~ %" ~" ~o w.~ ~ ~/7 ~ ~,,. 2 ~'n. .5 %" ~" ~8- ~ ~/~ ~ m~. z~,,. ~ ~" ~/~" 20- PERCO~TION RATE ~' ~ (minute~inch) P~C HOLE DIAMETER ~// TEST RUN BETWEEN ~ FTAND ~ COMMENTS PERFORMED SY: ~o/~[~d~ ~/~ I ~- ~'~"'"- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUiDELiNES IN EFFECT ON THIS DATE. DATE: /~/o~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~--~0..'(' / LEGAL DESCRIPTION: t DATE PERFORMED: Township, Range, Section: ""r'-/~d ? /~2~J) SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? pO E ,eplh to Wat,r A,er ¢% D,te: Monitoring? I,,.,)f',~/ , 8 9 10 11 12 13 14 18. 19- 20- Reading Date Gross Net Depth to Net Time Time Water Drop ~ ,1~ ~.,'~ - ~,, _ 2 I/~- I ~.,,~ I ~h I Yz." I" 5 ~/7 ~ ~,~ I ~,~ 5 ~" ~" ~ ~ ~,~ I ~in ~ ~" PERCOLATION RATE ~' (minutes/Jnc~q) PERC HOLE DIAMETER ~ # TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORMED BY: ~0//~' fc~ ~/~ , ~-~¢~----~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE; DATE; 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O ,l- l NAA# 1. GENERAL INFORMATION Completelegaldescriptio. ~-~, ~, ~¢~"'~' Location (site adUress or directions) .. -...': property OWner,. '-' Mailing address ,/~.00 Lending'agency Day phone izz Day phone 5'22 -ZT?Z Mailing address. Agent Address · Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank community On-site Public sewer If community Wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 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 of 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 with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~°/~ r'co"rd"u ]?L Phone 2~'~"2 ~?-D Address I~'0~ u/..~_.1p,~ /~'/C ~ Engineer's signature ~~~. ~'--"-'-'-'~ _ Date Z.//~//?~-' DHHS SIGNATURE Approved for __ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of hemes and their lending institutions in order to satisfy certain federal and state requirements. Fmployees of DHHS do not conduct inspections or analyze.data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the p?ofessional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type ~rl'vcc~ Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Z-/~/?z./ Driller Cased to Total depth ~--~ob ~-'~. Sanitary seal (Y/N) "// Date of test Static water level Well flow Pump level1 FROM WELL LOG / ~-~o PT. Casing height Wires properly protected (Y/N) Y Z FT- AT INSPECTION ~ g,p.r~ ~: > o 0 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /[/~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main //~/~- Sewer service line / WATER SAMPLE RESULTS: Coliform (~ Date of sample: ~- h~/~' ~ Nitrate ! ~' Y~' 5/~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 2-/'~/~ Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping A'/~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~' F~. On adjacent lots To property line ~ ~ ~ /':% Absorption field / ~' /'~'~ Sudace water/drainage /~'/~-~ Tank size // ~'00 ~-~. Compartments ~ Foundation cleanout (Y/N) ~ ·Depression (Y/N) /tJ Alarm tested (Y/N) ~ Foundation '~ .~ Water main/service line /'Vo'~,~.~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons -- Vent (Y/N) -- "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested -- SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot f On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed 2_/¢o/? z/ Soil rating (GPD/FF) Length ¢~"~ r¢'~'' Width 2 ~ ~ ]'~'F~ Gravel thickness Total absorption area ~ 2 ~' /'?T- ~ Cleanout present (Y/N) Date of adequacy test /"~o7L' ~¢~¢-z4,,'r~c/ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) /['/' System type Total depth Depression over field (Y/N) __ for -- After test -- If yes, give date -- Bedrooms SEPARATION DIS'FANCE FROM ABSORPTION FIELD TO: Well on lot ,/~-© )~-'7~- On adjacent lots -1-/DO t~. Properly line To existing or abandoned system on lot Cutbank /'~/'¢-r¢_~ Water main/service line Driveway, parking/vehicle storage area ~ ~' To building foundation On adjacent lots Sudace water Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Engineer's Name ~"-~¢/E. //~5¢~ Date Z¢/~/? ~ '% EA~ V; AU$~AN o t~ HAA Fee $ Date of Payment Receipt Number 72-026 (~)' Back Waiver Fee $ Date of Payment Receipt Number