HomeMy WebLinkAboutBROOKS VANDERWOOD LT 48BBrooks
Vand
rwood
Lot 48B
#051 - 104-69
(IT r4lIfing jEog
t i" f bt P I I
[)CC Coby
. dba
ST3LL1 VAN WATER WELLS
P.O. BOX 570272, CMUGIAK, ALASKA 99567 * TELEPHONE 688-2769
OWNER OF LAND - 136J 4E,= BORE HOLE DATA
ADDRESS
LEGAL DESCRIPTION R
OT -q IF"
PERMIT NUMBEP0009:6 _Date ofissue
TAX INDENTIFICATION NUMBER /01
Is well located at approved permit location? l4ydo No
Method of Drilling: rier"rotary cable too[
Depth of well: F
Casing Type Cr &L--Wall Thickness -inches
le
Diameter ( a inches, depth feet
Liner Type: A.)a *,j =—
Casing Stickup Above Ground: 2, feet
Static Water Level (from ground level): feet
Pumping level: feet after hrs. pumping _gpm.
Recover Rate'. gpm
Method of Testing: eiLl
Well Intake Opening Type:
Perforations Start _ q,j5topped feet
Grout Type: 0 ume
Depth: from __--ject, to feet
Pump Intake Depth: feet
Well Disinfected Upon Completion? lErles [) No
Method of Disinfection: a_ 5-0 tOP^-
C-44r-4C, STICA-djO
�-A'J'o 64'wcc n'&,Rz'Sr
go - 4-4JE r—
&_!
ATTENTION: 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.
TO/TO 39Vd NVAinns 69ZZ889 TO:00 666T/10/TO
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-~'~(~
rNr.
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)
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
Municipality o�Anchorage�
Development Services Department
^ Building Safety Division '
On -Site Water and Wastewater Program
CT Y
4700S""". =a»a=,"` .
' P.O. Box 196650 Anchorage, AK 99519-8650 --�~
www.ci.anchorage.ak.us ' .
(907) 343-7904
'
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
|MJG
Paroe|i[l H/A
Expiration Date:
1' GENERAL INFORMATION
Complete legal description Brooks Vanderwood, Lot 48B
Location (site address or directions)
Current Property ovvner(a)
Carolyn Lee
Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held byDGD for
2. NUMBER OF BEDROOMS:
3
3' TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Individual Well
Individual On -site
X
Individual Water Storage
Individual Holding tank
El
Community Class Well [�
Community On -site
E]
Public Water System
1-1
Public Sewer
0
The Municipality of Anchorage Development Services Department (DSO) Issues Certificates of Health Authority
Approval /H/V\ based only upon the representations given in paragraph 4 by on independent professional
civil engineer registered in the State of Alaska. Certificates -of Health Authority Approval are required for the
transfer cftitle (except between spouses) for properties served by a single-family on -site wastewater disposal
and/or water supply system. DSD also issues HA\s upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date ofissue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates maybe reissued fora 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. 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(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. Phone (907) 696-6111
Address 20441 Ptarmigan Blvd., Eagle River, AK 99577
Engineers Printed Name Kenneth M. Duffus Date 11/26102
Kenn th ;.i.
5. DSD SIGNATURE •® cc 7116
Approved for bedrooms.�p�^_s
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
UN Additional Comments WA 1'E S E=
AST`'�!4TE - -
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineers Report
Well Flow Advisory Other
By: Original Certificate Date: 0
(Rev.01102)
LJCILt; Il.IDtcIIIVU IM/A 014C II..I.. y dilu115 Ivlarinale
Pump on level at —in. Pump off level at in.High water alarrr
level at in.
............0 . v.......a....v v.-.. . avNv. ♦j ,.u.v-._ f?A/ JV11.I4VIA. . f�lw V
Water main 10'+ Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ ' Surface water 1001+ Driveway, parking/vehicle storage 25'+
Curtain drain50'+ Wells on adjacent lots 1001+
F. COMMENTS
House semi -vacant for past 60 days, septic field surcharged w/ 2000 gallons of water and subse ue ted w/in 48 hours.
Intermediate cleanout hetween fnnnrintinn rleannnt and santic tank
G. ENGINEERS CERTIFICATION
40
JW
t rartifil that'/ haves rlatarminar( thrnornh' f<ah4 inrnanf;nnn 4 to
F
'I,,
NI
c
• -�%ate,- f'°v
�
�
�GG
�
l C
ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY
DATE r r �i O' R �s b
AND THAT NO ENCROACHMENT EXIST EXCEPT ASj'o
INDICATED. IT IS THE RESPONSIBILITY OF THE ' = ''4 D
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID M ••••••�•
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ; '•. Duane Mark Seward /
LS - 6918
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND- r,4'rri�„+
ARY LINES. DRAWN;sf�ar .,
,l'-�i-°'...dam �x�,.rA.�•a, -. tII