HomeMy WebLinkAboutWENTWORTH BLK 2 LT 5Wentworth
Block
Lot 5
#008-023-24
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MUNICIPALITY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 9951~-~650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: May 14, 2004
Expiration Date: May 14, 2005
Permit Number: SW040122
Legal Description: WENTWORTH BLK 2 LT 5
Design Engineer: 0000 None Required
Owner Name: Verlan Lebaron
Owner Address: PO BOX 75263
FAIRBANKS, AK 99707-5263
Parcel ID: 008-023-24
Site Address: 003250 41ST AVE E
Lot Size: 8085 SQ. FT,
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] 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 notiflcafio~ 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~
5. The following special provisions.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF
THERE ARE ANY QUESTIIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER
PROGRAM AT 907-343-7904.
-WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN
DETERMINED, THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND
NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED UNTIL AN APPROVED WASTEWATER DISPOSAL
SYSTEM HAD BEEN CONSTRUCTED.
Issued By: ~ Date:
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/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Lot Size C~I 0 ~'~"'" Acres~
Propertyowner(s> V ~,...--~"'\0~/~ ~ JO '~__ J"~C)J/~ Dayphone
Mailing address (l> ~.~ t a~ ~ I ~_,~ ~~
Mailing address (2) ~ C ~ ~ ~--~ ~ ~ ~ ~~ Zip Code
Legaldescription(Lot, Block&Sub'd.) '~ (~ ,~W O( ~ . ~
Legal description (Section, Township & Range) ~~' ~, ~ J ~
Number of Bedrooms ~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
[] Well Only
[] Water Storage
THIS PROPERTY CONTAINS:
Hot Tub [] Jacuzzi []
Swimming Pool [] Water Softening Unit []
Therapy Pool []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Waiver Fees:
Date of Payr~ent:
Receipt Number:
.~' LOT ,5. BLOCK 2 IIAS ~
28.1~ OF THE L~ IS CO.RED
41st. STREET
~0.0 30.0
'~ S89'59'00"W 60.00
..
0 ~7~
0 ' ~ 0
,~*, S89'59'00"W 60.00 ~%
VERTICAL DATUM WAS ASSUMED
Date Scale Le~a} Description
~FOR: PRESTIGE IIO~IES 5/i0/04 I" = ~0' ~t 5 {Brock
2
· ~,--~{~ * ~,~. ~. 1735 24 00101 WENTWORTH
9330 Vanguard ~rive. Suite ~03 Drawn by Field Book
({0v) 9SZ-~O~O CEF/DLM
I hereby
that
by me. or at m2 direction, and that the improvemen~ situated thereon
are within the property lines and do not overlap or encroach on the
property I~ln{ adjacent thereto unless othe~ise shown. That no
~.'
improvements on the property lying adjacent thereto encroach on the ~,:49~
~~...............~
to verif~ proposed building grade relative to finish grade and utility
connections and to determine the existence of any easement, covenant.
or restrictions which do not appear on the recorded subdivision plat. ~'..
Reproduction may cause distortion. ~, .~ j
LOT 5. BLOCK l~ HAS ~
28.1% OF THE LOT IS COVERED
41st. STREET
30.0 30.0
· % S89'59'00"W 60.00
/
ZONED R2M-~ultiple-famlly residential dis~icL
~o ~,~ '~
.
0
I
.~[ 589'59'00"W 60.00 ~%
I
Date Scale Legal Description
FO~: PEESTIGE HOMES 5/10/04 1" = 30' ~t 5 [Block
I
r.~...~ * s.~*t. ~*. 1735 24 00101 ~'ENTW0RTH
9330 Vangusrd Drive. Suite 203 Drawn by ?ield Book SUBDIVISION
(907) 5a~-6o5o CEF/DLM
by me, or at my direction, and that the Improvemenb situated thereon
are wi~ln ~e property lines and do not overlap or encroach on the ~,*
.
property l~dng adjacent thereto unless otherwise shown. That no
improvements on ~e property lying adjacent ~hereto encroach on the
premises in question ,nd that there are no roadways, transmission
to verify proposed building grade relative [o finish grade and utility
connections and to dete~ine the existence of any easement, covenant.
or restric~ons which do no[ appear on the recorded subdivision plat. ~ ~'.. ,.~
~sted dis~nces prevail over scaling.
Reproduction may cause distortion.
Municipality of AnchOrage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
Anchorage, AK 99519-6650
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 008-023-24
1. GENERAL INFORMATION
cos^#
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
WENTWORTH S/D; BLOCK 2~ LOT 5
5250 E. 41ST AVE * ANCHORAGE~ AK * 99507
FORECLOSURE Day phone
Day phone
TODD MCCORMACK W,/ PRUDENTIAL Day phone 244-4085
,.3801 CENTERPOINT DRIVE~ #200 * ANCHORAGE~ AK * 9950.3
Unless otherW~sb requested, COSA will be held by DSD for pickup.
'NUMBER OF BEDROOMS: 3
3. TYPE OFWATER 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 ·
The Municipality of Anchorage Development Services Department (DAD) 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. DaD 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 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 engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the valida~ion date'shown below, I '~rify:t,~at ,mc;
investigation, based on procedures outlined in the Certificate of On-Site .Systems Approval Guidelines for this application,
· 'shows that the on-site water supplyand/or wastewater disposal system is (are) safe, functional andadequate
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.
Phone 337-6179 .
Address 3701 Eo TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date ] 4/ '~//// ~
Engineer's 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 all wells and
septic systems depend on the local soils condition, groundwater 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 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 or 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 it confer any legal right whatsoever.
DSD SIGNATURE
Approved for _~
Disapproved.
Conditional approval for
'"-.."
bedrooms. ~-~.~ ~ ~1~-o1/~ · ~
WATERAND m:
- . STEWAT . .
bedrooms, withthe following stipulations: ~ · P~OG~M · -
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
utner
,_/~'"/~ Original Certifi cate Da te:
CATE 'OF ".,)N=S~I-~E S~y'~EMs A'P~PROYA'L 'C"HE:CKLIST
.YES
ft.
YES
· ground) 2'.4~,.. ,, 'in.
AT 'IN~ECTIO:N
50 g:.p~m.
. - 4.:72 g;p:m.
Ot'her'baCte~ia:~ ::!~' colOnies/lo0 mi.
,Cefl~'=~ed,-by: GEG Ltd.
t.,,p,U ucI
G~I.I:~ow pipe. , : ' ff.
~,,~mssion',over find
Fbr bedrooms
New depth in.
· in. '/~'~'~io~ .t_~e >= g.p.d.
If':yeS~ give date ' .
E. SEP~~,DlST~a~CES
SEPARATION DISTANCES 'FROM WELL ON EOT TO:
Septic tan ,Idtift state.on lot ~N/A
Absorption field on,.l~t ,, N/A
PUblic sewer main 75'+
Sewer/septic service ~ne 25',+
ANimal' contai,n merit ah~s
On adjaCent, lots .-~,/A
on a jacen jots
Public sewer, manhote/cleanout
Holding ta..nk N,?A:
Manure/an~ima] excrete storage ar,~
SEPA~TION DIS~NGES F:ROM SEPTIC/HOLDING TANK ON:'LOT TO:
rB uiJding" fOL~,L .datio n
'Water
50'+ 1,00.+'
I BLIC S,EWERI
Property.line . Absorption field
Water service line 'Surface water .,... ~
G. E~EER'$ · C:ERT~! CATION
confermanCe
date.
Engineer's :Printed Name.
~re.,in
in .effaCt. o.n. th~s"
;J.EF~REY A., GARiNESS
Date
COSA' Fee $ ~i ~0
Date.of'Payment ./,-~,' ':/,'- ~ -'"'~ 0
.(Rev. 11105)
Waiver-Fee $
Date. of,,Payment
Receipt 'Number
SGS Re/# 1106467001
Client Name Garness Engineering Group, Ltd Printed Date/Time 12/16/2010 17:08
Project Name/# Wentworth B2 L5 Collected Date/Time 12/07/2010 16:00
Client Sample ID Wentworth B2 L5 Received Date/Time 12/07/2010 16:15
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/13/10 12/16/10 KDC
Waters Department
TotalNitrate/Nitrite-N 0.274 0.I00 mg/L SM20 4500NO3-F B (<10) 12/08/10 AYC
Microbiology Laboratory
E. Coli Ne~oative 1 100mL SM20 9223B A 12/07/10 DLC
Total Coliform Negative I 100mL SM20 9223B A 12/07/10 DLC
.... . ..-., .' :' r~unicipalitv'ofAnchorage ·
· ' .... ., '*DeveloPment Services Department
· Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995-19-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
cos^.
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
WENTWORTH S/D, LOT 5, BLOCK 2
Hl~r.
3250 E. AVE~ ANCHORAGE AK, 99507
WALTER AND KENDA GARRET'r
3250 E, AVEr ANCHORAGE AKn 99507
Day phone
Day phone
222-1539
TODD SCHLEGEL w/ COLDWELL BANKER Dayphone
2525 C STREET~ ANCHORAGE AK~ 99505
230-6159
Unlessotherw~e~queste~ COSA wgbeheldbyDSD ~rp~kup.
2..NUMBEROFBEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well []
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 samples. (Certificates may be reissued for a pedod of up to one year with valid water
· samples.) Certificates are valid for one year for properties ~erved 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 vedfy that my
investigation, based on procedures outlined in the Certificate of On. Site Systems Approval Guidelines For this appficat!on,,
sh~ws that the~n-site water $upp~y and/~r v~astewater disp~sa~ $ystem is (are) sa~e' functi~na~ and ~dequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the , ....
infortnatiop obtained from th.e 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 ap~)licab[e Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name o~'Firm GARNESS ENGINEERING GROUP. Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE. AK 99507
Phone
Engineer's Pdnted Name JEFFREY A. CARNESS, P.E.
337-6179 .
o
Engineer's Comments: .9..F. ~.~.~,~
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineedng analysis of the system in accordance with ADEC and MOA ~,~...
system under the conditions encountered at the b'ma of tho test, and separation
distances measured th readily identifiablo features. The operational life of allwells and ~ ~ ~,'14 ~~ ~ \ "...'~
septic systems depend on the local soils condition, groundwater levels that may ............. ;...-~
fiuctuatedudngtheyoar, andthawatorusageofthofamilybeingservedbythesystem. ~J//tl ~ii '.~'
These conditions are outside the control of the evaluator of the system. Satisfactory test ....
there ere no hidden defects or encroachments. GEG. LTD. can therafore not provide ~0~~,~' E- 3
any warranty or future estimate of how long the system will continue to meet the '
operational requirements of the ADEC or MOA DSD. The content of this report is for '~t~ Pro ·
..
DSO SIGNATURE ,~." ON-SITE '-.'~
~- WATERAND
Approved for '~ bedrooms. ~~ :. WASTEWATER
Disapproved. ~ :. PROGRAM
Conditional approval for __ bedrooms, with the fllowing stip~Jlations: ~,.-~,,,) ......
Attachments:
CaSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maiotenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
(Rev~ 11/05)
Municipality of Anchorage
Development Services Department
Building Safeb/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 SYSTEHS APPROVAL CHECKLIST
Legal Description:
WENTWORTH S/DI LOT 5, BLOCK 2
Parcel ID: OO~-O,~-~
A. WELL DATA
Well type pR~VAT~ If A, B, or C provide PWSID# N/A
Date completed 6/20/2004 Sanitary seal (Y/N) YES
Total depth 77 ft. Cased to 77 fi.
Well L°g (Y/N)
Wires properly Protected (Y/N)
Casing height (above ground)
YES
YES
18+ in.
FROM WELL LOG
Date of test 6,/20/2004
Static water level 45 ft.
Well production .30 ,g.p.m.
AT INSPECTION
4/28/2008
2,,
5.7
g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: 0 ug./L.
Nitrate 0 mg,/L. Other bacteria 0 colonies/100 mi.
Date of sample: 4/28/2008 Collected by: CE(:; Ltd.
SEPTIC/HOLDING TANK DATA PUBLIC SEWER
Tank Type/Material : : Date in~tall(Jd
Tank size gal. Number of
nk(Y/N) High water alarm (Y/N)
~ ....
I~g Pumper
ABSORPTION FIELD DATA PUBLIC SEWER
Date installed. ~ Soil rating (g.p,d./ft~or ft'lbdrm) sy, stem type
Length ft. Width ff. G'rav~ ff.
Total depth ft. Eft. absorption area ft~ Mon~/Depression over field
Date of adequacy test ~ail) ~ For bedrooms
Fluid depth in absor~ in. . Water added .. gal. New depth in.
Elapsed Time: ...--n'fl~-. Final fluid depth in. Absorption rate >= g.p.d,
~treatment (past 12 mo.) (YiN & type) If yes, give date
D. LIFT STATION
Date installed ~ Size in gallons Manhole/Access (Y/N) ~~
"Pump on" level at in--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 N/A
Absorption field on lot N/A
Public sewer main 75'+
Sewer/septic service line 25'+
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
N/A
N/A
100'+
N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: p U B El C S EWER
Building foundation Property line Absorption field ~
Water main W~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line Building foundation. . Water main ~
Water service line Surface ~ehicle storag~e'
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 JEFFREY A. GARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11~5)
Waiver Fee $
Date of Payment
Receipt Number.
10: 14P FRO~I: T0:~8~4~ P.
Aarow Pump & Well Service, LLC
P.o. Box 110496
Anchorage, AK 99511
Office: (907) 346-9355 · Fax (007) 333-8976
Eagle River: (907) 622-9335
07997
CUSTOMER .--~ JOB SITE
~ '"'"'/- IY'(V ' "-
OUA~ DESCRIP~ON PRICE AMOUNT
TOTAL ~BOR
~ORK ORDERED BY~ CATE COMP. TOTAL
I
~BOR
Thank You
SIGNATURE
',! Hereby Acknowledge the Satisfaclo~/Campletlon ef the Above Described Work and agree that II above work is not paid lot In g0 clays I agree ~o altew karow
I~/mp & Well Serv;ce, I..I..C. Ihe ~q!Jht Io remove unpaid for equ!pm~t a,td charge lot labor elma~ly parleyed & labor Io remove unpaid for equlp~ent.)
LOT 5, BLOCK 2 [1AS
~ 41st. STREET
.-
I ~' .L'. ~ :,
~1 '
. ~ ENCROACHING OI~WAY
Date ;cale LeEal Description
FOR: Todd Schlegel 5/13/2008 l" = 30' ~[ 5 {Block
~,,~ ~ ~.~. ~. 1735 280058 WENT~'ORTII
9330 V,agu,rd D~ve. Suite 203 Drawn by Field Book
(907) 562-6050 CEF/D~i 232
by me. or at my direction, and that the improvements situated thereon
d
~sted distances prevail over scalinl.
Reproduction may cause distortion.