HomeMy WebLinkAboutBROOKS VANDERWOOD LT 48BBrooks
Vand
rwood
Lot 48B
#051 - 104-69
by
DOC Co. dba
;SULLIVAN WATER WELL:5
P.O. BOX i170273, CHUOIAK, ALASKA 99567 · TELEPHONE 688-27~i9
OWNER OF LAND /~E~ ~'~tc BORE HOLE DATA
DEPTH
PERM,T NUMBE~~ Date of issue ~ - ~ 2~ ~. /~
T~INDENTtFICATIONNUMBER~- /0~ - ~, (~ ~E
Method of Drilling:
Depth of well: ~
Casing Type ~"7'~I
Diameter ~ ~
Wall Thickness 0 o~ ~ inches
inches, depth '40~' feet
Liner Type:
Casing 8tiokup A~ve Ground: ~, ~et
Static ~ter Level (from ground level): ~ feet
Pumping level: ~ after hm. pumping,, gpm
Recover ~te: ~ ~pm
Method of Tesfi.g'.
Well Intake Opening Type: ~n End ~ O~n Hole
~ Scmen~; ~a~ ~et Stop~d ~t
~ Perorations S~ ~top~d f~t
Depth: from .... 0 ~, to ~ f~t
Pump Intake ~pth:. f~t
Pump Size hp Brand Name
Well Disinfe~ Upon Completion? ~es ~ No
Method ~ Disinfe~ion:
Comments:
Ori,ier, Name
ATTENTION: It is the responsibility of the property owner to submit a copy of the well [~g to the proper authority, Municipality
of Anchorage: Department of Health & Human Services and/or Depadment of Environmental Conservation, MatSu Borough:
Department of Environmental Conservation,
I0/~0 S9~d N~AIqqRs 6G~BB9 I0:~ 666I/I0/I0
MUNICIPALITY OF ANCHORAGE
Depa~ment of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 195650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Sap 08, 2000
Expiration Date: Sap 08, 2001
Permit Number: SW000360
Legal Description: BROOKS VANDERWOOD LT 48B
Design Engineer: 0000 None Required
Owner Name: Ben B. Lee
Owner Address: PO Box 670372
Chugiak, AK 99567-
Parcel ID: 051-104-69
Site Address:
Lot Size: 49514 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
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. Ail 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
(907) 343-4744 ( 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: ~ ~
Date: ~~-"~
Date: ~-- F-~'~(~
MUNICIPALITY OF ANCHORAGE
~ ARTMENT OF HEALTH AND HUMAN SL ~CES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/3 o,s ^.c s
c4 ~ r'o o K' 5 -'"'~ TO SEPTIC ADSORPTION
AddressF~GM ~ WELL
-..,, TANK FIELD
Phone(s) -- I Perm,t No. No. of Bedrooms WELL //q /
~ o~sc.,..,o. LOT LINE ~- /
Lot J Block Subdivision
~¢~ ~ FOUNDATION ~0~/~
ToWosh~0, Range, Secuoo
AS-BUILT DIAGRAM (~how location
Se~ ~ ~]~ ~ /t~ ~. ~. Or,veway. waler bodies, etc.)
TANKS U
Manula~turer Gapaoty m ~aHons
Material ~ No. ol Compaaments
TYPE OF
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER
D~pth to p~pe bottom from Total depth from original grade
onginal grade
FllI aOOe~ adore or~m aOe Gravel Oepth beneath p~pe
Gravel length Gravel w~dth
TotaJ absoft,on area Distance between lines ~ ~/~ = J
Installer ~ ~ ~ ~ ~ Date Installed
WELLS
jPRIVATE ~ OTHER 0dentifv) JJ~
OJassfficatJon (A,~,O) Tot~l Depth C~sed to
FT FT
Installe~ Date Installed:
Scale:inspections Pe.ormed ~IA$~ / ~?;~jr '~
I cedify thal this inspection was pedormed according to all
Municipal and Stale guidelines in elfect 0n this~t~ E~J~~1~ /o -- / z -- p;
. . %%, ':; ¢',~,~O. : ?' '
Health Depa~menl Approval: ..... ¢ ; ate:
'-013 (3/85)
CHUGIAK, ALASKA
688,3199
" I'"DRILLING CO.
WE SERVE ALL ALASKA
POST OFFICE BOX 42 - CHUGIAK, ALASKA 99567
KODIAK, ALASKA
486-4826
DATE - STARTED ........................ :.-:--'----:.:"':..L:v.: ...........................................
DEPTH OF WELL ....... :.:: ....... : ....................................................................
STATIC LEVEL OF WATER FT ....... : ..... :..':.:....: ........... :'..:..:....: ..................
DRAW DOWN FT ....... ; ..... ;..:....:: ...... '. .........................................................
GALS. PER HR ........ -:d::!~.....2.&2. .................................................................
KIND OF CASING 2~ .'_-'; :d: .... ':: ~ :-.:. ....................................
KIND OF FORMATION:
FROM ...................... FT. TO ....~ ................. FT...:2...>...: .....
.... ...::..:...'...~*~ "."~ 7.:
FROM ' FT. TO i./ FT. --
· ._ ,) -2
FROM ...................... FT. TO .... :.:: .............. FT...:!:':2.:( .......................
FROM FT. TO ..:i!::i: .............. FT.
FROM ....................... FT. TO . ~ c FT...:.:.7.:.~:.:-~- .......................
FROM ...................... FT. TO ' FT. :' ':' '" :- ' ..... :'~'
FROM ...................... FT. TO ...................... FT...::..,.-,,~ .........................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ....................... FT. TO ..................... :. FT ..................................
FROM ....................... ET. TO ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO .................... ...--.FT-_-: .............................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ....................... FT ..................................
FROM ....................... FT. TO ........................ FT .................................
MISCL. INFORMATION:
DRILLER'S NAME
DEF'AR"FMEN'¥ OF HEAL'¥H AND ENVIRONMEIqTAL. F'ROTECTION
825 L .~REE] , ANCHORAGE, AK 9950
264-4720
PERM I T Iq():
DATE ISSUED:
AF'PL. I CANT:
ADDRESS:
CONTACT F'HONE:
85()458
()7/29/85
% S&S ENGINEERING PAUL. BROOKS
SRB 196-X
EAGLE RIVER, AK 99577
694-2979
L,.E(-]AL DESCR I F':
I_ O'l" S I Z E:
MAX BEDROOMS:
SUBDIVISION: N/A
SECT I ON: 9 TOWNSH I P:
lA (SQ. FT. OR ACRES)
3
LOT: 48
15N RANGE: 1W
BL. OC, I<: N/A
L. isted below are the options available to you in designing your sept.ic:
system. Choose the option that best Fits your site.
DEPTI4 "FI'.') PIPE BOTTOM
GRAVEL DEPTH (FT.)
'T'OTAL. DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEl.~ LENGTH (FT.)
GRAVEL VOLUME (CU. YDS.
TANK SIZE (GALS)
SOIL. RATING (SQ..FT. /BR)
"lrRENCH BED W. DR;!~ I ~
4.0 4.5 4~0
5.0 0.5 3.5
9.0 5.0 7.5
2.5 17,0 5.0
38.0 34.0 41.0
19.4 21.5 30.4
000.0 **' 1,000.0 ** 1,000.0 **
125 125 125
**TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certif'y that:
1. I am £amiliar with the requirements For' on-site sewers and wells as set
Forth by thee Municipality o~ Anchorage (MOA) and the State oF Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design 'criteria of this permit. ~
5. I will adhere to all MOA and State o¢ Alaska requirements For the set bac:k
distances From any existing well, wastewater disposal system or public
sewerage System on this or any adjacent or nearby lot.
~.4. I under, stand that this permit is valid For a maximum 'of 3 bednooms and
any enlargement will require an additional permit. '
IF A [.IFT STATION IS INSTALLED IN AN AREA COVERED BY ~OA BUILDING (lODES,
THEN (1) AN EL. ECTRICAL PERMIT AND INSPECTION MusT BE OBTAINED; (2) AS-BUIL. TS
WILL NOT BE APPROVED WITHOUT AN ELECTRI.CAL INSPECTION REPORT; AND (3) THE
ELEECTRICAL. WORK MLIST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED ~.,,. ~ /~ ~ ~. ~-~ ~ '` ~ ~DATE: _.~~~~
.
AF'PL.~CAN'T': % S.,.~ ENSZ~ERINB F~UL. BRDO~S '
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG PERCOLATION TEST
PERCOLATION
TEST
DATE PERFORMED: q -"Z.-.~' ,- ~
LEGAL DESCRIPTION:
1
3
4
5
8
SLOPE
10
11
12
13
14
15
16
17
18
19
2O
No. ~457-E
COMMENTS
8 '& ~ ENGINEERINffi ~ .~RB 196X
72-008 (6/79)
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~ ) ~ (minutes/inch)
I I'
PERCOLATION RATE
TEST RUN BETWEEN FT AND
FT
Parcel I.D. 051-104-69
Municipality of Anchorage
Development Services Department
· -. Building Safety. Division.,
· On-Site Water and Was. tewater 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
Expiration Date: ~ - ~. -7- (D '3
GENERAL INFORMATION
Complete legal description Brooks Vanderwood, Lot 48B
Location (site address or directions) 20816 Helluva Street. Chugiak, AK 99567
Current Property owner(s) Carolyn Lee
Mailing address 500 Jeanell St., #8, Carson City, NV 89703
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER 0F BEDROOMS: ~
Day phone (775) 883-8278
Day phone
Day phone
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
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 4 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 private or Class C well
and may be reissued with new water sample results. (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 engineer s work.
4. STATEMENT OF INSPECTION BY ENGINEER
x
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(are) in compliance with all
applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm KND ENGINEERING, INC.
Address 20441 Ptarmigan Blvd., Eagle River, AK 99577
Phone (907) 696.6111
Engineer s Printed Name Kenneth M, Duffus
5. DSD SIGNATURE
/ Approved for
Disapproved.
'.~ . bedrooms.
Date 11 ~26~02
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer s Report
Other
Original Certificate Date:
/ / 0:2._
(Rev. 01/02)
'",i:.~.,~'~i~,~,~" · ' ·
· . ~,.:.,..~,~,~..=~,,~?~..,. . . ,
.... .:::;'% D.~stailed. NA
~': ~p 0n I~vel at
.DatUm
in.
SE'PA~ION 'DISTANCES FROM WEEL ON:LOq~ :TO i, . ~ '
Septic:.tank/lift statio'n on. lot, ..'1'00'+ . On '~dji~i"16~:.'.."'~:~.iJ'0:~
Absorption'field on.. ot. 100!+'..
Date 171126102
Public.sewer main 75'+ .:i:.'Po'blic .gew~r manho e/c ean0Ut: 1,07+ '''';'':'' ""
.......... :?.~.:~"-" ~.:,~.:.....~,~:.,. ,,:....:,~:,~?~.~.~,~?;,.~.~,... ..-: .~.~:.,:~.;...,~-~,~?.~..~.:.....>?... ....... · ..:.:,?~.¢~...:.?~..~:.. ~.~.:~
· SewA~./septic se~ice..li~e:..' 25~ :; ...... ' '" '~"'" ....... ' "'" ............ :'
-"~ HoIding.'.~,ank'.~. 't8'0'~ ' ~ '~:~ :''~':'
. . ,.~,:';ZJ~'~:._. ~'~.:;'{~.';.:":~'~? ,*'.t'.."¢.::';";~;.';~7;:;;~;~;/:~.::. f.~',:./' ~::? ..:~. ~.~:..;..~,"~:'i~.:'.~:.'~: ~, .
SEPA~TION'.. DISTAN'OES. F~OM }~E~T C/HOLDING ~ANK....O~' EOT;:TO::.:"
'~' '"" *: "~:?':~';;;~.'?'.":,"~;' '" .' ~...':,: .,....? ...':.: ::.~::?.* :~.,?~.~ "F. '.
Buildi~g fOundation. '5'+, Prope~y linB"?'~+ .. ~bsocpJJoh field
Water. main '10'* .... ' ...... '" ....... ':';""~aJ~'se~i~'.line "~0;'+" Su~ace.water '.100~+.
.., , ................ ,;;:. : -. .~.,.. ............. ;..;'.:;...".: , . .. · .
Well~,o~ .~djacent lots. '~ 00f~ ......
SEP~TION-DISTANCE FROM AB'SORPT ON..~FIELD :ON.' LOT .TO:
,;.:;": ".~: ); ~.' '~ ~.; ~ ..~, ~. %-~ ~.L:~ '.~.:';, .:
Prope~ .li~e 10'+ .B'
main
. ;-=~'~':~;:.:"~ ',.?'{= ,'~,,'~'d~;,~: ;~.~.~-,'.:.,.= .:,, :~,..-.
wate~.:S~ice'line 10"+ Su~ace:.wat~r.'.":'t~.;~ ....... ;: "'": :"" ..................... '~' "'
. DriVeway ..par~ng/veh c e'stora e
.'~'.' ~:.~::',~:;:.'L~ ~: '~ ". ~.%,~,~'.:.::J,~ ~," · :" ~"~ .:~ "t '. '~. '~ ~ . ~ "~; '.' ' ' -
cu~ain drain 50~+ Wells: On:adjacent',.'lots'..'L100~,.
F."..'.COMMENTS : " ....
....... . ....................................... ~(.(~;;L.~;;~;¢.~.':;;:.~;.::.~:~q~ ef'~,;':~ '";?~?, ..'¢-r.::'* .~..'~,'~ .r~:...:?,,~..~.-. ~.......,. ¢.'~. _;:.;..:~..:L*.:-LF' ;h:' '
Hou~mi,vacan~' for past' 60 days., septic field.~mharged .wi. 2O00'galldn~ ~f Water and.:subsequeg~.~Med'.w/n .48'.'hour.
Inte~eBiat~ 'elean°u{~b~8~n'~¢8a~¢d~;'C ~h0u't '~ n ~ :~'¢~-:~t~h~;*?'!,';'~ ~:· .':~..";~.d;..~.,':. ~. "..
· '"'"'"'":"" '"" ' '" .... "~' '"' "'"':' ":":' "' ..... :'":' '"'" "'" ~"
...... . . . ......... .. ,. ,.. ;: , ,..-~. .~: .. .?.,:~ :.,... ,, ..: . ..,,... ..... ..,~, .,,.., ~.~,' ~.,
e...ENGINEER s. CERTIFICatION ~ ....... ..,-.,.,.. ...... . ....... . .,,,.-4 .... -.,...... :,.,.,..,.., ....~: ~..,.. .........
.... ..... . . .. ....... . ..... . .. .. ... ..... : .........
. .. .... . .... . · ., .... . .... . .. ,. ~.~.... ~.,~
~;' '~": :. ' ¢'? " ~¢ ~",'~'~ ': .... '~'l~ ~'~i~.i~..~'x.?
,.......~ ..... ... . ~~..
......... · '~ ./7 ~:',..:..' .. .~'. ~.,.- ..
~ Foe ..'..$3l~:00
· ? .~.;:~..?~?:." :'~..,v".>: . .'~..~:~?: :~.~?:~'~:':%~:::~;:-:.':%:¢:~:~;s~.;~. ' ~.~;L.,?~:. '~?} +~;~::. ,~' ::~F;~-:,-.,.:,.-'~2~,:~:.~..,.?..:.:;~:F~..~.~..~ q ,.~.: :..~ .
~ato:6f:~'agm~nt· '1'~[0~ :." .':. :.' · · ."'". ''B~t~:;f.:~&~.:" ~- .. · ':,':. ~ .' · . ·
.: :.,.~.: .??. ~x..'.~. ..... ?~.~....~..?. ~".-::..~.,'..~;.~. z~;~?.:,~?b.¢.. · J ' .. ..;..~,:.- .... "....~ .~. ~:~ yu~*.[ .... ' ~.'" ~' .. · ."
~,~..~m~...:.'.: .o?~o?:~".7~.:::..:' .~ :' ...: ::. :?:~;'~':.~3~7S~,.~.~:~.~¢.:'": .':.~' '..~.' .'.
(ROv:"~2/Oi~ .............. -~:~.' ......... ':..' '~ .L:~.+:¢~.. '~ ............ ?...~?::'.'.? .~..:',-...~.,. :...?,. r~.'.....~'~:~.:~'~x'?:.~'.: '.~.,'-~ ".. ':~.'/?.~. :'¢:.'~
ASBUILT
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS~ COVENANTS, OR RESTRICTIONS
WHICH DO NOT APP~EAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SI-IOluL.D
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES= OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE;
DATE=
GRID=
FB:
DRAWN=
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
OF A/~'.~,,
?"