HomeMy WebLinkAboutT13N R3W SEC 33 LT 6 E3SE4 M&BOnsite File
T13N R3W SEC 33
Lot 6 E3SE4 M&B
#008-042-14
•
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 008-042-14 Expiration Date:
1. GENERAL INFORMATION
Complete legal description T1 3N, R3W, Sec 33, Lot 6 E3SE4 M&B
Location (site address) 4424 Wright St.
Current Property owner(s) Qerarn & Sabajet Debrova Day phone
Mailing address 2932 Boniface Parkway Anchorage, AK 99504
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADLI) L
❑ Duplex APR 4 2014
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class_ Well ❑ Community El
Public Water System El Public Sewer IXI
WaiverNariance request
Received by:,
[Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 P 0
Date ofPayment _. I-4)LOIL/
Receipt Number Qat I
COSA#_ 05Cf L41 to
Waiver Fee $
Date of Payment
Receipt Number
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 Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Phone (907)272-8218
Date 3/19/2014
;7 Q TH
6. DSD SIGNATURE
System #1 Approved for
3 bedrooms �/� •Steven �2.•�linnane •'
System #2 Approved for bedrooms �I� , CE -8149 AW
Jr
�,,�
Disapproved �l�t��lA40FE55�0�P!
Conditional approval for bedrooms, with the following stipulations:
By: i Original Certificate Date: Z 0 /
The nici I' y Anch,p ge 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:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet 5 ! c
If more than 1 septic system is on the lot:
COSA Checklist # + of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: T1 3N, R3W, Sec 33, Lot 6 E3SE4 M&B Parcel ID: 008-042-14
A. WELL DATA
Well type Private . If A, B, or C provide PWSID #
Well Log (Y/N) N
Date completed VKV, Sanitary seal (YIN) Y
Wires properly protected (Y/N) Y
Total depth ft. Cased to ft.
Casing height (above ground) 16 in.
FROM WELL LOG
AT INSPECTION
Date of test
3/18/2014
Static water level ft.
31 ft.
Well production g.p.m.
2.7
9 -P.M.
WATER SAMPLE RESULTS:
Coliform `colonies/100 mL Nitrate i mg/L
Arsenic '7. e -7 ug/L Date of sample: 3I1 9 2911(
Collected by: X0--5
B. SEPTICIHOLDING TANK DATA
Tank Type/Mater
Date installed
Tank size gal. Num Compartments _
CI(Y/N)
Foundation cleanout (Y/N) _ Depression over tan
High water alarm (YIN)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Dati ' tailed Soil rating (g.p.d./ft2 or ftz/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. abs 'on area ft2 Monitoring tube _ Depression over field _
Date of adequacy test s (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water d gal. New depth in.
Elapsed Time: min. Final fluid depth in. Abso ' n rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, ' date
D. LIFT STATION
Date installed
"Pump on" level at
_ Size in gallons_
in. "P a"I vel at
_ Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot �c
Absorption field on lot ✓A A
Public sewer main Xj+ 504*
Sewer /septic service line 25+
Animal containment areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT
Property line
Water Servic
drain
F. COMMENTS
Building foundation _
Surface water
Wells on adjacent lots
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Surface water
Water main
Driveway, parking/vehicle storage
-L L/
G. ENGINEER'S CERTIFICATION
l 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
Date 3/19/2014
COSA brown sheet 10-10-12.doc
!�;o
in.
;red.
Remainder
Govt. Lot 6
SCALE : 1 " = 20'
0' 10' 20' 40'
N89°57'38"
50.14'
Wood
Shed
ic6 ocir Gravel
11.3' 8.3� / Parking
3:r Conc.
O T Pads
2262' y
O o
1—Level Wood _ (�
lc� Frame C -u
10 Residence c5i
11.2' u
i
OF A.qj� # Well
1
'49TH �0� M
,
Wood
Lee�Karabelnikoff:j� / Fence
No. 3143-5 / —
YiL
Ii„ ♦ �� 10'1
Gas Esmt.
Bk. 541, Pg. 8<'
Lot 21A S89"57'19"W
I hereby certify that an accurate survey of the following
described property:
That portion of the Northeast Quarter of the Northwest Quarter
of the Northeast Quarter of the Northwest Quarter (NEY4 NWY4
NBY4 NWY4), also known as Government Lot Six (6), of Section
33, Township 13 North (T13N), Range 3 West (R3W), Seward
Meridian, according to the Official Bureau of Land Management
survey thereof, being located in the Anchorage Recording
District, Third Judicial District, State of Alaska, more particularly
described as follows: Commencing at the North Quarter corner
of said Section 33, thence S89'58'00"W 659.26 feet; thence
SO`11'30"E 164.76 feet; thence S89'57'38"W 33.00 feet to the
point of beginning; thence S00°11'30"E 164.76 feet along the
West Right—of—Way for Wright Street, thence S89°57'19"W 50.14
feet, thence N00`11'30"W 164.76 feet; thence N89'57'38"E 50.14
feet to the True Point of Beginning.
The Address of the described parcel is 4442 Wright Street,
Anchorage, Ak. April 1, 2014
was made on and that the improvements situated
thereon are within the property lines and do not overlap or
encroach on the property lying adjacent thereto, that no
improvements on the property lying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon. Easements other than those shown
on the record plat may not appear on this drawing.
Anchorage, Alaska, this 3rd day of April 1 2014.
33
E'
WI
W
91
2.7'
33'
PREPARED FOR:
PANNONE ENGINEERING
AS -BUILT
DWN. DATE GRID
JSP 4/3/2014 SW 1834
FILE NO. F. B. 2014 JOB N0.
1405 PG. 9 1408
KARABELNIKOFF
SURVEYING (sol) 337-3�
12.7'
E-
U)
w
E-+
O
O
O
fn
2.7'
33'
PREPARED FOR:
PANNONE ENGINEERING
AS -BUILT
DWN. DATE GRID
JSP 4/3/2014 SW 1834
FILE NO. F. B. 2014 JOB N0.
1405 PG. 9 1408
KARABELNIKOFF
SURVEYING (sol) 337-3�
Y�` v Municipality of Anchorage
Development Services Department
Building Safety Division
OnSito Water & Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.cf.anchorage.ek.us
i (907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
hn . FOR A SINGLE FAMILY DWELLING
Parcel I.D. -�Li
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address or directions) 4424 WRIGHT STREET • ANCHORAGE AK'99508
Current Property owners) FLOYD & MARILYN THOM
Day phone _(907) 563-6383
Mailing address 4424 WRIGHT ROAD + ANCHORAGE AK 99,508
Lending agency
Day phone
Mailing address
Real Estate Agent MARY COX W/ RE—MAX PROPERTIES
Day phone 275-8194
Mailing address 110 W 38TH SURE 100 * ANCHORAGE, AK. 99503
Unless otherwise requested, HAA will behold by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
❑
Individual On -she
❑
Class Well
❑
Individual Holding tank
ElCommunity
Public Water System
❑
Community On-site
❑
Public Sewer
0
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 samples. (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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat 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 (les 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD. SURE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
in conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 s that allwellsIs and
septic systems depend on the local soils condition, groundwater
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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC orMOA 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 8 confer any legal right whatsoever.
5. 'DSD SIGNATURE
__L,e!f Approved for 73 bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date 11 0 C
bedrooms, with the fllowing stipulations:
Manitenance Agreements 'Vi�j"�l1)1 '17T
Supplemental Engineers Reort
Other
Xv Original Certificate Date:
By:
(Rw. 12101)
Municipality of Anchorage
Development Services Department
Building Satety Division
OrPSlte Water b Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.8650
www.ci.anchorage,ak,us
(9D7) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
T13N RAW SEC. 33 LOT 6
E3 SE4
Parcel ID:0_Q 9 -0 112.-
A. WELL DATA *HOUSE
BUILT IN 1968 "ONLY 30'
REQUIRED IN
1968
Well type EMATE If A. B, or C provide PWSI0# N/A
Date completed •1968 Sanitary seal (Y/N) YES
Total depth8T–ft.
Cased to '•30'+ ft.
FROM WELL LOG
Date of test
Static water level 5g.p.m. Well production
WATER SAMPLE RESULTS:
We9 Wg (YM) NO
Wires property protected (YM) YES
Casing height (above ground) 12+ in,
AT INSPECTION
10/21/2004
25 ft
4.55 g.p.m.
Coliform 0 colonies/100 ml. Nitrate0.10 mg,/L. Other bacteria 0
10/21/2004 coloniesH00 mi.
Arsenic: N/A mgJL. Date of sample: l0 28 2004 Collected by: CEG. Ltd.
B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER
Tank Type/Matehal
Date installed
Tank size gal. Number of Compartments — CleaooutrfY
Foundation cleanout (YM)
(YIN) — High water alarm (Y/N)
...acv' pumping Pumper
C. ABSORPTION FIELD DATA
Date inata9ed Soil rating (g.p.d./tt=or ft%bdnn)_ System typa
Length ft. Width ft. Gravel below
ft.
Total depth ft. Eff, absorption area_ ft' Monitoring tub Depression over field
Date of adequacy test Results a9) For_
bedrooms
Fluid depth to absorption field be — in. Water added — al.
g New depth —in.
Elapsed Time: n. Final fluid depth _ in. Absorption rete k
g.p.d.
Any eJuvenatbn treatment (past 12 mo.) (Y/N 8 type)
N yes, give date
D. LIFT STATION
Date Installed _—
Size in gallons ma.
"Pump on" level at _in. "Pump otP a4a ---
n. High water alarm level at in.
fl F,m
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot N/A
Absorption field on lot N/A
Public sewer main *50'+
Sewer /septic service line2_ 5'+
*ONLY 50' REQUIRED IN 1968
On adjacent lots
On adjacent lots *50'+
Public sewer manhole/deanout *50'+
Holding tank NSA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
PUBLIC SEWER
Building foundation
Property line Absorption field
Water main
Water service u ace water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line
Building foundation,:: Water main
Water service line
Surface water ay, parking/vehide storage
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and D
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this data. • • • {
JEFFREY A. GARNESS `•. 7953
Engineers Printed Name • `
Date 11' re^ed Profesepno\�c
HAA Fee $ Jr—
/ Waiver Fee $
Date of Payment l �J l� Date of Payment
Receipt Number �1100���7 Receipt Number
(Rev. rtior)
MAW Cox
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.731
Iseam P. 002
sr- 4A
SURVEY TYPE
SYMBOLS 1
Q AS -BUILT — NO CORNERS SET
DRAINAGE""
<ooa ASSUMED ELEV. ® WOOD DECK
❑ PLOT PLAN - AS -BUILT - LOT SURVEY -TOPOGRAPHY -e—$-9 MOOD FENCE, : , ASPHALT
❑ LOT SURVEY
^�- CHAIN LINK FENCE v: •: a CONCRETE
-NOTE:
❑
Fences are shown in their approximate
RECERTIFICATION Ai -BUILT - NO CORNERS SET
locations only.
It is the responsibility of the builder or owner; prior to
.LEGEND - hub 8 tock -found ❑ Set C
construction,to verify proposed buitdinggrade relative
_
iron rebor -found 0 set •
to finished grode and utility connections and to determine
iron pipe -found 0 set O
the existence of any easements, covenants or restrictions
brass tap -found ®- set 0
which do not appear on the recorded subdivision plot.
alum. cop -found , e Set Q
Lot Survey Certification
y��wt•�
`'y.E C!r- R. 1''"ti
Pre ar d by
BENCH IWARK. INC.
I hereby certify that I have.
surveyed the shown
L se,c •c°
properly
,e•°
� ,V r.. .. S -1i.
Professional Lend Survevors
and described hereon, and'•''
�•
the Improvements situated
therean are within the
property liner and do not
�` %•/a,.c .°..t
overlap or encroach on•,
°="w%d(ei• o+Y
adjacent properly,except
as Indicated hereon, !; • aualaz G. AIA10V
Easements of record, �;,;f • No. 3781-S
other than those shown ,.';� °•.,•• ,.•'�S`
on ti.e recorded plat, +'aiPPpe`sS� %-0,
ore not shown hereon.
Scale, 111=401 ' Drawn by:... 1•.AH
Date Surveyed: 3_27-86 Checked by- DGM
Dote Drown: - 3-27-86 1
Grid: 1834 1
W.O. 86-037
Legal Description;
SEE BACY OF THIS SP+EET