HomeMy WebLinkAboutPOTTER POINTE LT 3Potter Pointe
Lot 3
#020-091-87
Municipality of Anchorage Page 1 of 3
Development Services Department
OnSrte Water and Wastewater Program
4700 South Bragaw Street
P.O. Boz 196650 Anchorage, AK 99519-6650
www.cianchorageak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40158
PID Number. 020-091.87
R.ns
Ha en Investments LLC
Wastewater System: New
.Gd.ea
P.O. Box 240186 Anchors a AK 99524
ABSORPTION FIELD
242-0 838
Falrgoan.
Municipal Sewer System
LEGAL DESCRIPTION
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SEPARATION DISTANCES
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Inspections performed by:
Dates: 1"}
449 h
Department of Health
and Human Services approval
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Reviewed and approved by:
ml0 � Date:
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Municipality of Anchorage
Department of Health and Human Services Aim
825'L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom http,Nwww a anchorage A us
Mayor
Permit Number: #SW 040158 Date of Issue: 5-28-04
Date Started: 5-28-04 Date Completed: 6-02-04
Legal Description: Potter Point Lot 3
Property Owner Name & Address: Hagen Inv.
PO Box 240186
Anchorage. Alaska
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Stick up
gravelly silt
bedrock
0 2
2 9
9 166
Parcel Identification Number: 020-091-87
Is well located at approved permit location? ® Yes ❑ No
99524
Method of Drilling ® air rotary ❑ cable tool
Casing type: steel
Wall Thickness: .250 inches
Diameter: 6 inches Depth: 13 feet
Liner Type:
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 29 feet
Pumping level: 166 feet after
2 hours pumping 2_5 gpm
Recovery Rate: 2_5 gpm
Method of Testing: airlift
Well Intake Opening Type:
❑ Open End ® Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite # 8 Volume: ! bg
Depth: Start 0 feet Stopped 2 feet
Pump: Intake Depth feet
Pump size ho Brand Name 11
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Well Driller. Alpine Drilling & Enterprises
PO Box 110496
Anchorage Alaska 99511
Attention: The well driller shall provide a well log to the property o%Nner within 30 days of completion and the property
..........,. a i �u...r .a .... moi. .....n r. ..., �... .r.• .,., a r•..... n. _ •... ..•.. •. in a._.. .r... .,..•..
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
Permit Number: SW040158
Legal Description: Potter P6f6_t6 ..Lot 3 7
Design Engineer: 0854 zzzzzz
Owner Name: Hagen Inv.
Owner Address: P.O. Box 240186
Anch , A 99524 -
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: May 28, 2004
Expiration Date: May 28, 2005
Parcel ID: 020-091-87
Site Address: 4341 Sage Circle
Lot Size: 25190 SO. FT.
Total Bedrooms: 0 Permit Bedrooms: 0
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑✓ Private Well ❑ Water Storage
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:
/ Date: i
Date: �— g
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 SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. MQ-Cr//—g7-000Permit Number SW
Property owner(s'ALgt,3 J—,/V I '466�ta
�8
Mailing address (1) A/0.
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Z07-0t4772:0-4VAJ72!_
Legal description (Section, Township & Range)
Lot Size Acre q.Ft.
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
X
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
nation is correct. I further certify that this application is being made for a
Is in accordance with applicable Munigtpal Cc)des.
5
(Signature of �roperty caner authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: 0 y Date of Payment:
Receipt Number: % 3 Receipt Number:
(Rev. 12/00)
i:i
NYSTROM
c1r),
Un
rAl,
NYSTROM
• �� .fGE•
•t ; Municipality of Anchor . � '
On-Site Water and Wastewater Progra • MAY 11 2017
(907) 343-7904 E*Y
12.
Certificate of On-Site Systems Appro 6 8 L
Parcel I.D. 020-091-87 Expiration Date: / S~ 17
1. GENERAL INFORMATION:
Complete legal description Potter Pointe; Lot 3
Location (site address) 4341 Sage Circle
Current Property owner(s) Brenda&David Avery Day phone 301-7111
Mailing address
Real Estate Agent Stephanie Richardson Day phone 529-1844
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
E Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer
WaiverNariance request for: Distance:
Received b Date: 51/64-
COSA to be released to th engineer,unless otherwise requested by the engineer,
COSA Fee $ 6It - Waiver Fee $
Date of Payment S l I l 1 c 1 Date of Payment
Receipt Number Cecott41 Receipt Number
COSA# OSG 11 !l 1 J Waiver#
5. 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 Certificate of On-Site Systems 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: Garness Engineering Group,Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
QOQ�oopp�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OFA �
in accordance with the guidelines and regulations established by the Municipality of Anchorage and � ..•...•. •.,.. c rn
industry practices. The reported results describe the condition of the system/s on the date/s of the Qoo,�P. • �V
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 4g H .._� nn
encroachments may exist that were not identified during the evaluation. The operational life of all wells ' . '�Flu
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and 4VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,andVA
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 0 J = r-, A. Car essi
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of Qn � 0
the well or septic system. GEG makes no representation whether an alternative well or septic system VQ s ''• -<PP
can be installed on the property in the event either of the current systems tail to perform adequately in �f�, ,fi ..
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4�Paprales st°^°ate
perform the evaluation. Reliance upon the information provided in this report by any other person or 'OOP'
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for I bedrooms
System #2 Approved for bedrooms �QP�,�� J A/VC,Sa
Disapproved ON-SITE
Conditional approval for bedrooms, with the follywing t.l io`diD s`
WASTEWATER c
PROGRAM _s.
.
� f
Bye_ Original Certificate Date: 5 - 13
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: ` r
COSA Checklist K Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue shee[10.10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Potter Pointe; Lot 3 Parcel ID: 020-091-87
A. WELL DATA
Well type Private If A. B. or C provide PWSID# N/A Well Log (YIN) Yes
Date completed 6/2/2004 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth 166 ft. Cased to 13 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/2/2004 5/10/2017
Static water level 29 ft, 65.1 ft.
Well production 2.5 g.p.m. 1.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG. Ltd.
Arsenic: ND<5 ug./L. Date of sample: 5/3/2017
B. SEPTIC/HOLDING TANK DATA AWWU
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm i _
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d_/ft4or ft'/bdr System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption - -a ft? Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor. .n field before test in. Water added gal. New depth in.
Elapsed T •- -: min. Final fluid depth in. Absorption rate >= g.p.d.
rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at . wa er alarm level at in.
9- Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main 75 + Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AWWU
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIE I : I OT TO:
Property line Bu' • - . oundation Water main
Water service line Surface water Driveway, parking/vehicle storage
drain Wells on adjacent lots
F. COMMENTS
I
0�60. O..
G. ENGINEER'S CERTIFICATION ' of 4 L °00
(r444:' _ • • • 9s�4p0I certify that I have determined through field inspections and T *Opreview of Municipal records that the above systems are in • '• Dconformance with MOA COSA guidelines in effect on this j1date. - � � Garn ss.•' jEngineer's Printed Na e JEFFREY A. GARNESS — �p•,cPO
Date c1 tr/9- k,., •PaP‘1.�, ,1 .`��p
rofessioY' z '
%DO0000a�
#AECC844
Pev 11/051
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program ., .�.
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _20-091-87 HAA# nu* �
Expiration Date: _ _7-,6_-09_
1. GENERAL INFORMATION
Complete legal description Lot 3 Potter Pointe Subdivision
Location (site address or directions) 4341 Sage Circle ciasiL -
Current Property owner(s) Hagen Investments, LLC Day phone 2420830
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O. Box 240186 Anchorage AK 99524
'Unless otherwise requested, NAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑
Individual Holding tank 1:1Community 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 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) 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 less than 30 days old. (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
As certified by my seat affixed hereto and as of the validation date shown below, 1 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 Finn Anderson Engineering • Phone . 522.7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 3/31/2005
S. DSD SIGNATURE
Approved for �_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:� Z�_ (it/, / &wx� Original Certificate Date:
(Re,. Vi00)
Municipality of Anchorage
. ` •�,
• �• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196850 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
'1
Legal Description: ° �"'_. '"'•°iA""'Isbn Parcel ID: 020-09147
1
A. WELL DATA
Well type Pr e�q If A, B, or C pie PWSIO # _ Well Log (Y/N) Y
G Date completed Sanitary seal (YM) Y Wires property protected (YIN) Y
Total depth JR -It. Cased to _11 -ft. Casing height (above ground) 24 n.
E:
FROM WELL LOG AT INSPECTION
I'
Date of test 'So"
it
Static I' Static water level 29 R
'I
Well production 2.5 9.p -m. 9 -p.m -
WATER SAMPLE RESULTS:
Coliform _Q_,coloniesl100 ml. Nitrate mg./l. Other bacteria 0 colonies/100 ml.
Date of sample: 313AW5 Collected by: uce
B. SEP"WHOLDING TANK DATA
Tank TypelMaterial Dale installed
Tank size gal. Number of Compartments _ Cleanouts (YIN)
I' Foundation deanout (YIN) _ Depression over tank (YIN) _ High water alarm (YIN)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
r Date installed Soil rating (g.p.d.te or felbdrm) _ System type
Length it Width
ft Gravel below pipe ft.
Total depth _ fL Eft. absorption area ftp Monitoring tube _ Depression over field
Date of adequacy test Results (Pass/Fall) For _bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
I Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g•p•d•
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. UFT STATION
Date installed
'Pump on level at _ in.
Datum
Size in gallons
'Pump off` level at _ in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/ iR station on lot WA
Absorption field on lot WA
Public sewer main >7S
Sewer /septic service line >2S
Manhole/Access (Y/N)
High water alarm level
Meets alarm & circuit requirements?
On adjacent lots >IW
On adjacent lots >1W
Public sewer manhole/cleanout MW
Holding tank WA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main
Wells on adjacent lots
Water service line
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service fine Surface water
Curtain drain
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Wells on adjacent lots
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
oonfamance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E Anderson. P.E.
Data 3131=5
Driveway, parkirghtehide storage
HAA Fee $ 677 Waiver Fee $
Data of Payment �� I 05 Date of Payment
Receipt Number ,551 1/. Receipt Number
(Rev. 77ralr)
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