HomeMy WebLinkAboutNORTHERN LIGHTS BLK 8 LT 7No th
re
Lights
Block 8
Lo1- 7
#009-034-33
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 SYSTEM PERMIT
PERMIT NUMBER:SW980077
DESIGN ENGINEER:
OWNER NAME:GLASSMAKER ROBERT D & DEBBIE R
OWNER ADDRESS:2912 EUREKA ST
DATE ISSUED: 4/27/98
EXPIRATION DATE: 4/27/99
PARCEL ID:00903433
LEGAL DESCRIPTION:
NORTHERN LIGHTS BLK
8 LT 7
LOT SIZE: 7230 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
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 { 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
DATE:
'IS vNg~3
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Agqqv 03NIVINIV~I ]Vd[glNIq~l
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.00 ,t,0 .00 S
3DIA~gS ~3S gl]aDd
'IS VNq~Jrl3
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
- ~ WATER WELL RECORD
LOCATION OF WELL ...... ;,~
BOROUGH SUBDIVISION · LOT BLOCK . SECTION QTRS~ · SECTION TOWNSHIP RANGE MEPJDIAN
.... -*' '~- i--IN [-JE · '
Ow.
LOCATION/SKETCH; ' WELL OWNER: ~ ~I~. ~ ·
DEPTHS M~SU,ED FRO~sino top ~groun~. surface WELL DEPTH: DATE OF COMPL~ION
Depth of hole:~ ft
BOREHOLE DATA: ' . ';' " Depth Depth of casing:~ ft
Material Type and Color From ~ To
II . I ~E~3H 'i'o STATIC WATER L~VEL:
~. ~ ~ ~ ~ ~ ~ ft below ~op of casing ~ ground sudace
~ ~HOD OF D~ltUffiG: ~air rota~ ~ ca~to tool
'/~ ~ ~ other · ' : ·
/ ~ / .... ~ ' USE OF WELL: ~domestic ~"irrigat~on
~'~ ': ~ ";'"''.?:'.<.',,'' ~ "~/ public other
~ supply ~ .
Casing type:~ :.:- ".' ~in,~tO ~ft
:: · :' ~'/ ' '- ~ '":' :' '"-> '"' '~' :"' ~?"" %LL .~'"~ o~"~.e't~ ':~" en en~-~':~:"" ..... "-
S~REEN TYPE~ Diem:
Slot/Mesh Size: Length: ft
Volume used: '~ Depth to top: .
.~ % _~O~,~OeG ' Depth: from ft to ft
, _~,~ ~ .'- "- DWELOPMENT M~HOD:
,,,~,~ ~ ' ·Duration: ~
Oe~~' · . . . 'PUMPING L~EL AND YIELD:
- , -: ~ ft after hrs pumping gpm
. PUMP INTAKE DEPTH: - ft Horsepower: __
. . - ' ' ~WELL DISINFECTED UPON COMPL~ION? ~ YES ~ NO
CONTRACTOR INFOR, JI~,TION: . '. - REMARKS:
· % ~ · ~,~ · .~... . . ~ . .
Rei;ij.~er~d u ' s ~.' =~' . . -. . '-
9'~/~/ ~ ---~-----'--~'~ ~'~ ~ ' ~'~'... ----~/' PLEASE MAIL WHITECOPY OF LOG TO:
/'~""~-~'~~-~"'~"-'~-----'~-"~'~'~ -.~"~-~ ~"~,~ DNRIDIVISION OF MINING & WATER MGMT
S~nature of Authorized Re~presentat~ Date. : . .- 3601 C St, Suite 800
~ ' ANCHORAGE AK 99503-5935
.- ~.. ~ ...,..- . : ~ -~- . Phone (907)269-8639, Fax (907)562-1~84 .
VI '' f' '
unicipa i y o Ancnora?
DeveloPment ,DePartr ent
On-S~e Water and W~Mewater Pm0ram
4700 So~h BragaW Street
Box ~650 Ancho~ge; AK 995~9-6650
~.ci.anchomge.ak,us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY-APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 009-034-33
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
HAA#
Expiration Date:
Lot 7 Block 8 Northern Lights
2912 Eureka Street, Anchora.qe, AK 99503
Current Prope.~y owner(s) Trina Johnson Day phone
P.O. Box 92475, Anchora.qe. AK 99509
Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Careen Muir/Dynamic Properties Day phone 261-7639
3111 C Street, Ste. 100, Anchorage, AK 99503
Unless other/vise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS: 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
Approwl (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 be'bNeen spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD 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 for properties served by Class A
or B welts or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
pro';essional engineer's work.
5. STATEMENT OF iNSPECT]ON 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 Apprevai Guidelines for this Health Authority Approval
application shows that the on-site water supp!y 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 flies and from my investigation and inspection the
on-site water supply and/or wastewater disposal.system is in Compliance with alt applicable Municipal and
State codes, odinances, and regulations in effect at the time of inst~t!ation,
Name of Firm Pannone Eng. Svc. Phone 272-8218
Address _P.O. Box 102954. Anch, AK 99510
Engineer's Printed Name Steven R. Para, one. P.E. Date
Engineers Comments: ~ conduc~g ~ ad~cy test, I attempt to provide a ~orc~Dt, conscmnfious : ....
reported results des~ ~e ~ffom~ce of ~e systm md~ ~e con~fions ~m~t~ed at fl~e t~e of
the test. and s~ation dis~s m~s~ to r~dily identifiable t~a~es. ~e o~rafional liJ~ of all
wells ~d septic systems depend on ~e 1~ soil c~n~tion, ~o~d wat~ levels ~a.t may flucmte
du~g the ye~ and ~e wat~ usage of ~e fm~lv being sc%v~ by ~e sycem. ~lese conditions ~e
outside the control of me evalmtor of fids system. ~1 systems ev~mallv f~I ~d ~ttsfi%to, test
results do not gnars~¢ee future ~o~m~ce ot fl~e syst~, nor do they ~antee J~e,t ~cre are no ~',
~dden defects or encroac~ents. P~ ~ ~erefore not prowde tony wa~ for fi~P~re ~To~vmce
. .. .... . .
nor gzve any estanate of bow lon~ ~e ~ xvzH continue to meet ~e o~atmnaI redu~emen[s et ~e
~EC or MOA DSD. ~e content of t~s r~o~ is for d~e sole benefit of ~e ox, ruer Hsted above. Amy
rehance upon or use of tins re~ by ~y o~' person or ~ ~s not autlto~ed nor w~.It ~t co~er ~,
leg al fi~t w~t soever.
6. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved
Conditional approval for bedrooms, w~th the' following stipulations:
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date:
,',Rev 1 Ii99)
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Re~s~,,e Date:
On-Site Water and Wastewater Program
(907) 343-7904
Legal Description:
A. WELL ~DATA
Wel/type _P
Date completed S/~/1998
Totaidepth 103 ff
Date Of"t~'t
Lot 7 Block:8 NOrthern LiahtsS/D
IfA~ B~ or C~ provide PWSID;#:
Sanitary. sealY_
'caSed, to ~ t03 ff
5/5/t998
26 ff
Parcel I.D.: 0094)34-33
Well Log Y
WireSpmperly: pmtectedY
Casing height (above:ground) 22
AT INSPECTION
1~J21/2002
S J+ g.p~m
Date installed
Cleanouts
Date of pumping.
C. ABSORPTION FIELD DATA
Date installed
Length __~t
Total depth ~ff
Date of adequacy test
E aPsed Time: O_ rain:
2. -~ O 2_ Collected:bY:
Tank Size
Soil rating
in
(Rev. 11/~9)
Dther bacteda O
Laura Pannorte
colonies/lO0 mi
gal Number~ o[ Compartments .
Depression, over tank High water, alarm
System type,
Grovel,below pipe ~ fl
Monitoring tube
For bedrooms
Wateradded gal.
in AbsorPtion rate >= g.p.d.
If yes, give date
Manhole/Access
High water alarm level at__ in
Meets alarm & circuit requirements?
SEPARATION DISTANCE~ FROMWELL ON LOT TO:
Septic tank/lift station on lot' NIA
Absorption field on lot N/A
Public sewer main 100+ ·
Sewer/septic service, line
On adjacent~lots'. N/A,.
On adjacent lots N/A
Public sewer manfioletcleanoUt ;:;100+
Holding tank 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~ I ~'prOperty line .~__ _ Absorption field
~a, rat~r main ~ ~i ! %; 'v~ller se ~.ice ine ot:~:: - surface water
i age ~ ,son dj~,=.,I s
rTO: · :!~
Property line
Water Service line
Curtain drain
F. COMMENTS
· ~ace water
Wel~on adjacent lots
Water main
::Driveway, parking/vehicle storege
ENGINEER'S CERTIFICATION
I cergfy;that lhave determined through field inspection~ and
review of Municipal records that the above systemsare in
conformance wi~h MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone. P.E.
Date
HAA Fee $
Date of Payment
Receipt NuMber
(Rev. 11/99~ '
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc.
Laboratory Division
20~ W. Poller Drive
Dr/nking Water Analysis Report for Total Coliform Bacteria ^,,,o~o.
SAMPLE DATE: ~
Month
Day Year
~ Tr~ted Water
Fa~: (907) 561-5301
C
TO BE OMI~LBTED BY LABORATORY
Analysis shows Ibis. Water SAMPLE lo be:
,,~ Safisfactm3~
~ Unsatisfactory
t~ Sample over ~0 hou~ old, ~s~ ~y
.~
to ~dica~.reliab~e r~ul~. Pl~se
new sa~ple, vla's~ia~ ~eliv~ mail,
Date Rece~'ed ~~.
Anal~ical Method: ~,~"Membrane Filler
0 MMO-MUG
n Routine Seat ta
00 :hi.
Result* Analyst
Anch Fbks Jun
Repeat Sample (fo~ routine sample ~ Untreated Water
with lab ref. no. )
.~lnO ,VO~' Tlrae Collected
SAMPLE LOCATION ''rrm
Collected B~
Date:
BACTE~OLOGIC~ WATER ~Y~IS ~CO~
~O-~G R~elt~ TetG
Memb~ne Filter: ~re~
Ve~ficaflon: LTB
Fecal Col~orm Coafirmaflon
~aal Membrane Filler R~l~
Faxed
Date: Time:
Client aotified of unsatisfactory results~
Phoned SpoRe w~th Fixed
.__ Colonies/lO0 mi
COLIFIRM
Celiforr,~/lO0 mi
.................. __~_____~__....M?.m~er of the SGS Oroao tSoe ~t~ G~n~ra~e de Surveillance)
ENVIRONMENTAL FA=ILITIE$ [N ALASKA. CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIG;t~:"~I~O~[ ~EW ]'2RE;EY. OHIO. WEST
Environmental Services lac,
CT&E Ref.#
Client Name
Project Name/~
Client Sample
Matrix
1028578001
Pannoae Eng. Sty.
Lot 7 Block 8 Northern Lilr.~hts
Lot 7 t{louk 8 Northern Lights
Ena. nking Water
0
San~l~ Remarks:
All Datesfffimes are Alaska Standard Time
Pr~at¢fl Date/Time 12/30/2002 14:24
Collected I)'atelrlme 12/22/2002 16:00
Received Date/Tb'ae 12/23/2002 1t:25
Technical Direct~7_..~
WaJt;eFo Delp~, r~nt:
Nitrate-N
0200 U
Units Method
Allowable Pr~ Anal~is
Limits Date Dam
0.200 mg/L I~PA 300,0 (<-=10) 12/23/02
Irtil
Microbiology Labor&tory
Total Coliform 0
coFl00mL SMI8 9222B
12~3~2 SKW
LOT
5
LOT 6
{ :OT 6
20'
LOT
N 89'59'00" W
x
Z '~ ~" !'°1
: . 41.7' o
-' - 33.2'
o-
S 89'59'00" E
EXISTING HOUSE
8
26.1'
144.55'
CID
×
LOT 7
/
144.63'
20'
20' LOT 5 5o'
F~
C
~ -- i LOT 7, BLOCK 8, SURVE¥CERT, E,C,,'r, ON:LANTECHhosconductedophysicolsurveyofthiss
property os shown on this drawing and tho'( the improvements situated ti
LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS ore within the property lines end no encroochments exist other then not,t
440 WEST BENSON BLVD. # 103 NORTHERN LIGHTS
ANCHORAGE, ALASKA 99503 562-5291 (fox)561-6626
SU BD
EXCLUSION NOTE: It is the owners' responsibility to determine the existent
of any easements, covenants, or restrictions which do not appear on the~
recorded subdivision plot. NOTE: Under no circumstances should any doth
hereon be used for construction or for establishing property lines.