HomeMy WebLinkAboutPOTTER POINTE LT 4Potter Point
Lot 4
#020-091-88
Municipality of Anchorage al
Department of Health and Human Services
825 V Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
Rick Mystrom http Monro ei anchcrege aK us
Mayor
Permit Number: #SW 010192 Date of Issue: 6-15-01 Parcel Identification Number: 020-091-88
Date Started: 7-3-01 Date Completed: 7-3-01 Is well located at approved permit location? ® Yes ❑ No
Legal Description: T Potter Point Lot 4
Property Owner Name & Address: Hagen Investment LLC
PO Box 240186
Anchorage, Ak 99524
Borehole Data:
Depth (ft)
Method of Drilling ® air rotary ❑ cable tool
Soil Type, Thickness &: Water Strata
From To
Casing type: steel
stick-up
0 2
Wall Thickness: .025 inches
Bedrock
2 87
Diameter: 6 inches Depth: 20 feet
Liner Type:
H2O
67 87
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 11 feet
Pumping level: 87 feet after
2 hours pumping 20 gpm
Recovery Rate: 20 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 it 8 Volume: 1 br
Depth: Start 0 feet Stopped ± feet
Pump: Intake Depth feet
- _— — — —
--
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Clodne Tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
rouwr nr thn ,unll .lr;llw *hell nrnvvl.+ a wall Inn In th. rinm of Wl alth JE 4L.m*n Cnrvira* within AA clave of rmm�lnlinn
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
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SWO10192
Legal Description: POTTER POINTE LOT 4
Date Issued: Jun 15, 2001
Expiration Date: Jun 15, 2002
Parcel ID: 020-091-88
Design Engineer: 0000 None Required Site Address: NHN SAGE COURT
Owner Name: HAGEN INVESTMENT LLC Lot Size: 27061 SQ. FT.
Owner Address: PO BOX 240186 Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99524 -
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. 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:
//r/
Date:
Date: 4 — /S"— 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. Permit Number SWO/O/92
Property
Day phone 209L -90E)
Mailing address (1) too. AX���L
ewZ-
Mai+irtg address (2) N141-1 Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size 0 % 61 Acre S2.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
tion Is correct. I further certify that this application is being made for a
in accordance with applicable Municipal Codes.
(Signature of property ow fer of authorized agent)
Permit Fees:
o e Waiver Fees:
Date of Payment: 0 1Date of Payment:
Receipt Number: y 3 S Receipt Number:
(Rev. 12/00)
r
n
a
yr
a
n
Municipality of Anchorage - �'� �C
• '� Development Services Department ��
�
G ° .
Building Safety Division yss,.
On -Site Water and Wastewater Program
4700 Bragaw Street "'
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL _
FOR A SINGLE FAMILY DWELLING 9�_(ss��
Parcel I.D. 020-091-88 COSA #_ i7 O / /
1. GENERAL INFORMATION Expiration Date:
Complete legal description Lot L Potter Pointe Subdivision
Location (site address) 4161 Sage Circle. Anchorage AK naafi
Current Property owners) _Jack MacArthur Day phone
Mailing address 6i Sage Cir le Anchorage, AK 16
Lending agency Day phone
Mailing address
Real Estate Agent _Jodi Moses/Prudential JW Relo Dept Day phone 242-1117
Mailing Address 8oi Centernoint DriveSte. zoo Anchorage, AK qq
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
Community Class Well
❑
Community On-site
El
Public Water System
❑
Public Sewer
El
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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
As certified by my seal affixed hereto and as of the validation date shown below,
I verify
y that
r this investigation,
es application,
based on procedures outlined in the Certificate of On -Site Systems Approval
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 Pannone Engineering Services LLC Phone 272-8218
Address P O Box 102954 Anchorage AK ggS10
Engineer's Printed Name Steven R Pannone P.E.
Date /0(7 wl f� ��
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the systei
These conditions are outside the control of the evaluator of this system All systems eventually fail s
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will
confer any legal right whatsoever.
5. DSD SIGNATURE �,,
Approved for q bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �, Original Certificate Date: _10-31-09
Municipality of Anchorage
' Development Services Department
j Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: _Lot & Potter Pointe SID Parcel ID:_220-oy2.88
A WELL DATA
Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed 2oo2 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth _Zft. Cased to 20 ft. Casing height (above ground) 2. in.
FROM WELL LOG AT INSPECTION
Date of test 71;12002
Static water level ss ft.
Well production 1.20 g.p,m
WATER SAMPLE RESULTS:
Colifonn-�/ colonies/100 mL
Arsenic:
B. S TIC/HOLDING TANK DATA
Tank Type teriai
Tank size
Foundation cleanout(YIN) _
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length : ft.
&.2 g.p.m.
-7
Nitrate O mg/L Other bacteria �—colonies/100 mL
Date of sample: zh & 20/27/08 Collected by: Laura Pannone
Date installed
Number of Fompartments _ Cleanouts (Y/N)
Soil
Width
overtank(Y/N) _ High water alarm (Y/N)
System type
ft. Gravel below pipe . ft.
Total depth ft. Eff. absorption area _f? Monitorin be Depression over field
Date of adequacy test Results (Pass/Fail) r _ bedrooms
Fluid depth In absorption field before test_ in. Water added_ gal. New depth_ in.
Elapsed Time:—min. Final fluid depth _ in. Absorption rate
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
...
D. LIFT STATION
Date installed izejtrmyiions
'Pump on' level at_ in.'Pu evelat_In.
Datum Cy etested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfift station on lot NIA
Absorption field on lot NIA
Public sewer main ioo+
Sewer /septic service line —2s+
Manhole/Access (Y/N)
High water alarm level at In.
Meets alarm & circuit requirements?
On adjacent lots moo+
On adjacent lots zoo+
Public sewer manhole/cleanout —1oo+
Holding tank —&oo+
Animal containment areas zoo+ Manure/animal excrete storage areas moo+
SEP TION DISTANCES FROT SEPTICIHOLDING TANK ON LOT TO:
Building found atio Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots —t=�—
SEPARATION DISTANCE FROM ABSORPTIO D ON LOT TO:
Property line Building foundation Water main
Water Service line Surface water Driveway,
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R Pannone P.E.
Date to l �4 ih4i
COSA Fee $ 1430
Date of Payment ZR
Receipt Number 107501
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
Is
storage
,en R. Panni
r:o. CE 8149
u
SCS Refa
1085837001
Client Name
Pannone Eng. Srv.
Project Name/N
4361 Sage Ct
Printed Date/Time
10/302008
13:58
Client Sample ID
Lot 4, Potter Pointc
Collected Date/Time
10272008
10:00
Matrix
Drinking Water
Received Date/Time
10272008
10:40
Technical Director
Stephen C. Edc
PWSID
0
Sample Remarks:
Paramctcr
Results
PQL Units
Prep
hfethod
Method
Analysis
Container ID Limits
Date
Date
]nit
Waters Department
Total Nitratc/Nitrite-N 0.705
0.100 mpJL
SM20 4500NO3-F Q
(<10)
1028/08
1DZ
Microbiolocy
Laboratory
Colony Count
0
Total Coliform
0
col/100mL
SM20 9222Q A (I)
1027/08
DLC
Fecal Coliform
col/IOOmL
SM2092226 A (q)
1027/08
DLC
0
coVI00mL
SM209222B A (<I)
1027/08
DLC
j4t1VV l�) AV040
Municipality of Anchorage
• Development Services Department �•'` ""'3r�,
Building Safety Division:
On -Site Water and Wastewater Program °
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 0*—6y-92 COSA+f_ X80119
Expiration Date: — O I
1. GENERAL INFORMATION
Complete legal description Lot 4 Potter Pointe Subdivision
Location (site address) 4361 Sage Circle, Anchorage AK 99516
Current Property owner(s) Jack MacArthur Day phone
Mailing address
Lending agency
4361 Sage Circle, Anchorage AK 99516
Day phone
Mailing address
Real Estate Agent Shari Boyd/Prudential-JW Day phone 762-5849
Mailing Address sboyd@alaska.net
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
ED
Individual Water Storage
❑
Community Class Well
❑
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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
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 Pannone Engineering Services LLC Phone 272-8218
Address P.O. Box 102954 Anchorage AK 99510
Engineer's Printed Name Steven R Pannone, P.E. Date 2/16/08
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with htOA DSD Guidelines & Regulations. Ile reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. 71e content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
__jZ Approved for L+ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
COSA Checklist
Septic System Advisory
X
79-c� �- l - D 8
Well Flow Advisory
Nitrate Advisory
Municipality of Anchorage e
Development Services Department
\ Building Safety Division 1 _
On -Site Water & Wastewater Program ' • "'
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 4 Potter Pointe 5/D Parcel ID: 02 0— d q—g
A. WELL DATA
Well type P I If A, B, or C provide PWSID N
Date completed 7/3/2001 Sanitary seal (Y/N) Y
Total depth 87 ! ft. Cased to 20 ft.
FROM WELL LOG
Date of test 7/3/2001
Static water level 11 ft.
Well production 20 9. p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 0.244 mg/L
Arsenic: 0 ugt
B. StPTIC/HOLDING TANK DATA
Tank Tvo Material
Tank size \ gal.
Foundation cleanout
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length
Total depth _ ft.
Date of adequacy test
Well Log (Y/N)
Wires property protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION .
2/7/zoos
31 $.
4.1 g.p.m.
Other bacteria 0 colonies/100 mL
Date of sample: 217/2008 Collected by. Laura Pannone
i
Number of Compartments
Date Installed
Cleanouts(Y/N)
Depression over tank (Y/N) _ High water alarm (Y/N)
Pumper
Soil rating (g.p.aA�orfeibdrm)
ft. Width
Eff. absorption area fe
Results (Pass/Fall)
System type
ft. Gravel below pipe
tube— Depression over field
For _ bedrooms
Fluid depth in absorption field before test _ In. Water added_
Elapsed Time: min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _
Absorption
ft.
New depth_ in.
If yes, give
...
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in. "Pump off' level at _ High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 7 '
Absorption field on lot�'1A
Public sewer main
Sewer /septic service line 7-S
On adjacent lots / Oc
On adjacent lots / re) ' -
Public sewer manhole/cleanout 1004 -
Holding
OD` -
Holding tank S�
Animal containment areas /6,0 T Manure/animal excrete storage areas /GOA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells
Property line
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Wates in
Water Service line
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date
COSA Fee $ 1f %U
Date of Payment L/
Receipt Number d cJD
(Rev. 11105)
Driveway, parking/vehicle storage
Waiver Fee $
Date of Payment
Receipt Number
U
No. CE 8149
0
SGg
SCS ReLN
1080519001
Client Tame
Pannone Eng. Srv.
Project Tame/N
Lot 4 Potter Pt
Client Sample ID
Lot 4 Potter Pt
Matrix
Drinking Water
P%N'SID 0
Sample Remarks:
All Dateslrimes are Alaska Standard Time
Printed Date/1'ime
02/15/2008 12:49
Collected Date?ime
02/07/2008 12:20
Received Daterrime
02/07/2008 12:45
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results P0L Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10)
Waters Department
Total Nitrate/Nitritc-N
0.244
0.100 mg/L SM20 4500NO3-F
E
(<I0)
Microbiology Laboratory
Colony Count
0
col/IOOmL SM20 9222D
A
(<200)
Total Coliform
0
col/IOOmL SM209222B
A
(<I)
Fecal Coliform
0
col/IOOmL SM2092220
A
(<I)
02/13/08 02/14/08 Mll
02/12/08 LCP
02/07/08 DLC
02/07/08 DLC
02/07/08 DLC
Municipality of Anchorage
-. Development Services Department
\�Building Safety Division
On -Site Water and Wastewater Program S. �„
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPR
JV
FOR A SINGLE FAMILY DWELLING�
Parcel I.D. 020-091-88 HAA # ; fr AQ���
Expiration Date: 3 0 — O -2-
1.
1. GENERAL INFORMATION
Complete legal description 4; Lot 4 Potter Point Subdivision
Location: (site address or directions) 4361 Sage Circle
Current Property owner(s) Hagen Investment, LLCIHagen Homes Day phone 229.8400
Mailing address P 0 Box 240186 Anchorage, AK 99524
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual On-site ❑
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer 21
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 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 Finn Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 1129102
.� OF t
c..0F..q .<Qt.,
A
WC—HAI. L ANDERSON
S. DSD SIGNATURE "4381 •' �`
J i
V Approved for bedrooms. cbQfO PeorrssV"�';O� J
,n`LB99a��
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: %. <<.C/ Original Certificate Date:
(Fay. 12/00)
Municipality of Anchorage V ;
• Development Services Department ;
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6850
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 4. potter point Subdivision Parcel ID: 020.091.88
A. WELL DATA
Well type Private If A. B, or C provide PWSID # _ Well Log (YIN) Y
Date completed 7C.i12001 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth Cased to 20 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 7412001
Static water level 11 ft. fL
Well production 20 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate _.L mg./l. Other bacteria 0 colonies/100 ml.
Date of sample: 1128@002 Collected by: A Hargis
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
Tank size gal.
Number of Compartments
Foundation cleanout (YIN) _,
Depression over tank (Y/N) _
Date of pumping
Pumper
C. ABSORPTION FIELD DATA
Date installed
Soil rating (g.p.d.lfe or ftp/bdrm)
Length ft.
Width ft.
Date installed
Cleanouts (YIN)
High water alarm (Y/N)
Total depth ft. Eff. absorption area fe Monitoring tube
System type
Gravel below pipe ft.
Depression over field
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test _ In. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NIA
Absorption field on lot NIA
Public sewer main >100'
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm t1 circuit requirements?
On adjacent lots NIA
On adjacent lots NIA
Public sewer manhole/cleanout >100'
Sewer /septic service line >25, Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Water main
Wells on adjacent lots '
Absorption field
Water service line Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line
Curtain drain
F. COMMENTS
Surface water
Wells on adjacent lots
Driveway, parking/vehide storage
G. ENGINEER'S CERTIFICATION
1 70
certify that I have determined through field inspections acrd o * . 49TU r,;,; +- d,
review of Municipal records that the above systems are in r a
conformance with MOA HAA guidelines in effect on this date.01,
L•.i
Engineer's Printed Name Mlchael E. Anderson, P.E.
v
Date 10102 `C�06tieeSS�ce�O��.
HAA Fee $ o Waiver Fee $
Date of Payment O Date of Payment
Receipt Number. y J�� si Receipt Number
(Rev. 12!00) .
JAN -29-02 03:41PM FROM-CTiE ENVIRONIENTAL SRV
■
G CTBE Environmental Services Inc.
%■._ t� ire arrrrrrrrrrrrrrrrrr
CUE M.10
1020499001
Client Nome
Anderson Engineering
Project NameN
Potter PointS/D
Client So nple 1D
Potter Point SID; Lot 4
Motrl:
Drinking Water
Ordered fly
(<1)
PWSID
0
9075615301 T-952 P.01/01 F-289
Client PON
Printed Date rime
Collected Dste/rime
Received Date/time
Technical Director
Released By A
01@912002 15:41
01/28/2002 15:10
0128/2002 15:30
Stephen C. Ede
Sample R. marks:
Allowable Prep Analysis
Perimeter Results PQL Units Method Limits Date ' Date Init
!!&lura _Daeart:ma=
Nitrate -N
0.200 U
0200 mg/L
EPA 300.0
(<10)
01/28/02
IDT
micro iology L&boretory
Total Coliform
0
col/100mL
SM199222D
(<1)
01/28/02
KAP
Received Time Jan -29. 3:43PM
HRGEN INV. TEL:19075690035 �. Jan 29'02
POTTER POINTE
LOT 4
27.061 S.F.
E�
witom
Orr K.W
T
SAGE CIRCLE 1
I
1
10' L 0: E
S' SNOW STORAGE Mr. / 4C PAMC i
70.3- WELL
•
0
FINAL STRUCTURE K -BUTT
BUILDING DETAIL
SCAM 1•.20'
Q U T
I NmwGD1m'7wAT 1 WIYE %VAw= THE
LAID SURKYNC
PA 'T Dow= AGOVE ANO TWIT No
E 0CROACWwflf DOST cwm AE O IMCCAM.
ASlu" RLS.
rt K THE OtSAOIaW" OPTHEOATO
T SM AKNUE
DODWIIE THE DOSTZMXOFANTEA30"M
, AIASNA 00602
COTS OR AQTRICrad lIOCN DO NOT
KAS-19U
2b -M4
APPEAR ON THE REOORDEO SUmor MN pW.
UNDER NO CIRCUMSTANCE/ SHOULD ANT DATA
DATE
HEREON tic UlCD FOR CCMl11 UMM 011 POA
1/0/2002
E7TAKANNo DOIA1OW OR FDR•CUMEL
400 NO.
ANCHORAGE RECOMM DISTTOCT. ALAW
M.
NOTCI NO Co11NER/ !ST THIS DATE.
Received Time Jan -29. 10:42AM
10:27 No.001 P.02
I
Oc
rr �
' �' � � •i � :. �.: •� QUO. .. .
SAGE CIRCLE
10' T. do E ESMT.
5' SNOW STORAGE ESMT.
97-104
POTTER POINTE
LOT 4
27.061 S.F.
KA
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