HomeMy WebLinkAboutTHIRD ADDITION BLK 26A LT 11Third Addition
Block 26A
Lot 1 1
#003 - 145 - 47
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & 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: SWO80041
Legal Description: THIRD ADDITION BOCK 26A LOT 11
Design Engineer: 0844 WATKINS ENGINEERING
Owner Name: RICARDO & GRACE SY
Owner Address: 1601 NELCHINA STREET #214
ANCHORAGE, AK 99501-
Date Issued: May 07, 2008
Expiration Date: May 07, 2009
ParcelID: 003-145-47
Site Address: 1311 INGRA STREET
Lot Size: 7000 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
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.
Date: '5-7— 9
Issued By: t / ZIL -1 ,J � Date: - 7 -09
Municipality of Anchorage
Development Services Department °
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519.6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. Dna - /LIS-- 4:7
t� 1 p n 7�� - o�4z
Property owner(s) /f�1C � I�1,7�'� �f nC S 7� Day phone �7�-- g3bo' 4'
Mailing address 1601 (vtwr�jtjA 9T oZK� Zip Code qq v/
Site address 1311 IN G" ST e' Zip Code -/'7-z /
Legal description (Sub'd., Block & Lot) � k m ! n �V C-4-1 tim 734D(k r2t A Lor
Legal description (Township, Range & Section)
Lot Size f, 006 Sq. Ft. Number of Bedrooms '6
THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN:
Absorption Field ❑ Initial
Septic Tank ❑ Upgrade ❑
Holding Tank ❑ Renewal ❑
Privy ❑
Private Well [�
Water Storage ❑
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.
owner or authorized agent)
Permit/Rush Fees: 173 Waiver Fees:
Date of Payment:_ I/ 5I SIDg Date of Payment:
Receipt Number. / 0 1 <P// / Receipt Number.
(Rev. 11105)
[Om Icy r' &c�,;lk.
REQUIRED SEPARATION DISTANCES
WELL TO:
Private Sewer line: 25'
Community Sewer line: 75'
Sewer Manhole or Main: 100'
LOT 10
Third Addition Blk 26A Lot 11
Site Plan
Grace Sy
Parcel lo- 003-145-47
Cindy W. Ellis, P.E.
October 30, 2007
Scale 1 Inch = 30 ft
25'
/ CAJ 1 140.00 /
—'1
SEWER LINE FROM HOUSE /
MUST BE 25' FROM WELL
J
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Q
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N
/ Based upon a plot plan
by Fred Walatka,
/ Registered Land
Surveyor No. 3255-S,
i April 14, 2007
Watkins Engineering, Inc
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax (907) 349-1934
49It+TIT
;
_
E_.13T_H
AVENUE
____
LEGAL WELL LOCATIONS:
West of:
15' from west wall of house
i
45' from west property line
\
LOT 12
\
_
\ \
MH
1
LLI
EAST 140.00
M(
LOT 11
CO
$
PROPOSED5
�BEPROOM
HOUSE
Car Port Asphaft 1
z V
�.
7s'z
i
LOT 10
Third Addition Blk 26A Lot 11
Site Plan
Grace Sy
Parcel lo- 003-145-47
Cindy W. Ellis, P.E.
October 30, 2007
Scale 1 Inch = 30 ft
25'
/ CAJ 1 140.00 /
—'1
SEWER LINE FROM HOUSE /
MUST BE 25' FROM WELL
J
J
Q
0
N
/ Based upon a plot plan
by Fred Walatka,
/ Registered Land
Surveyor No. 3255-S,
i April 14, 2007
Watkins Engineering, Inc
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax (907) 349-1934
49It+TIT
;
i
Municipality of Anchorage
^•1 Development Services Department
Building Safety Division
f.. jIt
On -Site Water and Wastewater Program
4700 Elmore Road '
P.O. Box 196650
Anchorage, AK 99507
www.muni.orgfonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 003.14547 COSA #
—
1. GENERAL INFORMATION Expiration Date: d
— O 9
Complete legal description Thad Addition, Blk 26A, lot 11
Location (site address) 1311 Ingra SL, Anchorage, AK 99501
Current Property owner(s) Graced Ricardo Sy / Spinnell Homes Day phone 2752302
Mailing address 1601 Nolch°na #214, Anchorage. AK 99501
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
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
r❑
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 installafion.
Name of Firm Watkins Engineering, Inc.
Address ISO Box 110443, Anchorage, AK 995114M43
Engineer's Printed Name Cindy W. Ellis
5. DSD SIGNATURE
_1� Approved for �L bedrooms.
Disapproved.
Phone 9073603389
Date " 7'09
44TH. a
;_ Cibdy W. Ellis
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:
77/7
(A. 11,05)
Municipality of Anchorage
• Development Services Department .
Building Safety Division
Onsite Water & Wastewater Program '
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Third Addition Block 26A• Lot 11 Parcel ID003.14537
A. WELL DATA
Well type Pd If A, B, or C provide PWSID # _ _ Well Log (YIN) Y
Date completed e -'4-0s Sanitary seal (YM) Y
Total depth 187 ft. Cased to 167 ft.
FROM WELL LOG
Date of test 8114108
Static water level 37 ft.
Well production 100 g P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate O mg/L
Arsenic W� ug/I Date of sample: -i 3I
B. SEPTIC/HOLDING TANK DATA
TankType/Material NA-AWWUsewer
Tank size
Foundation cleanout (YIN) _
Date of pumping
Wires property protected (YIN) Yes
Casing height (above ground) 24 in.
AT INSPECTION
NA -new
ft.
g.p.m.
Other bacteria 15 colonies/100 mL
Collected by: Rocky Trainor/ Watkins Engr
Date installed
of Compartments _ Cleanouts (YIN)
Pumper
High water alarm (YM)
C. ABSORPTION FIELD DATA
Da lied Soil rating (g p.d./1`1:2 or ft'/bdrm) System type
Length
Total depth ft. Eft.
Date of adequacy test
Width
area _ft=
ft. Gravel below pipe
Monitoring tube _ Depression over field _
J,
s/Fail) For bedrooms
Fluid depth In absorption field before test In. W9,
Elapsed Time: min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
ft.
gal New depth in.
)Irfata '= g.p.d.
If yes,
D. LIFT STATION
Da e
Size in gallons
Manhole/Access (Y/N)
'Pump on' level at _ In.
'Pump off ev
High water alarm level at in.
Datum
Cycles tested
Meets alar & circuit regw 9
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NA
On adjacent lots NA
Absorption field on lot NA
On adjacent lots NA
Public sewer main 75+
Public sewer manhole/cleanout too.
Sewer /septic service line 25'
Holding tank NA
Animal containment areas leo+
Manure/animal excrete storage areas 100.
S RATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation
roperty
field
Water main
rAbsorption
Water se
Surface water
Wells on adjacent lots
S PARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line
uilding foundation
Water main
Water Service line
Surface water
Driveway, parking/vehicle storage
Curtain drain
Wells on adjacent lots
F. COMMENTS: Wen only. House is connected to AW VU sewer service. Well log has inwnect date. Well was drilled in 2008.
G. ENGINEER'S CERTIFICATION �P' •• q y+
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in ••• �j��
conformance with MOA COSA guidelines in effect on this date. y _
Engineer's Printed Name Cindy W. Ellis Ai; Ci dy W.rEllis :�
Date 81//00 CE.tos
COSA Fee $ ` Waiver Fee $
Date of Payment �^" 1 D — +'� �i Date of Payment
Receipt Number Receipt Number
(Rev. 11/05)
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: 114 feet
Pump Manufacturer's Name: Myers
Pump Model: 2NFL5-12-4
Pump Size 314 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: cambel
Pitless Adapter Installer: n/a
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Recirc
Comments:
Pump Installer Name: Aarow Puntp & li'ell Service LLC
POBox 1)0496,Anchorage, AK. 99511
(907) 346- 9355
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Development Services Department
Building Safety
..�Q�
Division
j
On -Site Water & Wastewater Program ,•F``"
4700 Elmore Street
P.O. Box 196650
Mark Begich
Anchorage, AK 99519-6650
Mayor
www muni oro/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number:
SWO80041 Date of Issue: 5-7-08
Parcel Identification Number: 003-145-47 Replacement Only: YES NO
Legal Description
Property Owner Name & Address:
Lot 11, Block 2611, Third Addition
Grace Sy
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: 114 feet
Pump Manufacturer's Name: Myers
Pump Model: 2NFL5-12-4
Pump Size 314 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: cambel
Pitless Adapter Installer: n/a
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Recirc
Comments:
Pump Installer Name: Aarow Puntp & li'ell Service LLC
POBox 1)0496,Anchorage, AK. 99511
(907) 346- 9355
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
ALPINE DRILLING & ENTERPRISES
Permit Number: #SR'080041 Date of Issue: 5-7-08 Parcel Identification Number: 003-145-47
Date Started: 8-13-b,T Date Completed: 8-14'kTg Is well located at approved permit location? ® Yes ❑ No
Legal Description: Third Addition Block 26A Lot 11
Property Owner Name & Address: Ricardo & Grace Sy - Spinney Homes
1601 NELCHINA St. #214
Anchora o, Alaska 99501
Iloreholc Data:
Depth (ft)
Method of Drilling ® air rot
rotary ❑Cable tool
Soil Type, Thickness & Water Strata
From
To
Casing type: steel
stick-up
0
2
Wall Thickness: .025 inches
organics & silt
2
3
Diameter: 6 inches Depth: 167 feet
gravelly silt
3
23
Liner Type:
silty gravelly sand
23
36
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
silt
36
110
Static water level (from ground level): 37 feet
gravelly sift
110
120
Pumping level: 167 feet after
silt
120
135
2 hours pumping 100 gpm
gravelly silt
135
143
Recovery Rate: 100 gpm
silty water sand & gravel
143
167
Method of Testing: gLfift
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Stan feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite granules Volume: 2
Depth: Start 0 feet Stopped ? feet
Pump: Intake Depth feet
Purnp size hp unsud Panic
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P.O. Box 110496
Anchorage, AK 99511-0496
1 1
--
4ltention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
iter or the well driller shall provide a well log to the Development Services Department within 60 days of completion.
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SCS RefM
1093773001
COentName
Watkins Engineering
Project NamdM
Third Addition 826A, LI I
Client Sample ID
Third Addition B26A. LI I
Matrix
Drinking Water
Sample Remarks:
Printed Date fiote
Collected Datellime
Received Date?ime
Teebakal Director
08/07/2009 g:46
07/312009 12:40
07/312009 14:10
Stepleo C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Mesad Cominer ID Limits Date Date
Init
Metals by ICP/MS
Arsenic 6.70 5.00 ug/L EP200.8 C (<10)
Nates Dacartment
Total Nitrate/Nitrite•N
ND
0.100 mg/L SM204500NO3-F
B
(<10)
Microbiology Laboratory
Colony Count
5
coUl00mL SM209222B
A
(Q00)
Total Coliform
0
col/100mL SM209222B
A
(<I)
Fecal Coliform
0
col/100mL SM209222B
A
(<I)
08/05/09 08/06/09 NRB
08/05/09 LCE
07/31/09 DLC
07/31/09 DLC
07/31/09 DLC
MUNICIPALITY OF ANCHORAGE
WASTEWATER
CONNECT PERMIT
7
oU
8126.0;.;
WATER & WASTEWATER UTILITY DATE OF APPLICATION: 09/02/2008
3000 ARCTIC BLVD.
PHONE:(907)564.2762 SCHEDULED COMPLETION DATE: 12/312008
BLOCK/LOT/TRACT: BLK 26A / LT 111 ® SINGLE FAMILY
SUBDIVISION: THIRD ADDITION ❑ MULTI -DWELLING No. APTS 1
❑ COMMERCIAL
TAX CODE: 00314547000
GRID: SW1432
STREET ADDRESS: 1311 INGRA ST Anchorage, AK 99501
OWNER: BY GRACE & RICARDO-
MAIL ADDRESS: 1601 NELCHINA STREET#214 ANCHORAGE, AK 995015502
PHONE
CONTRACTOR Pisanos Dirt Works
ASSESSMENTS
❑ Repair Existing Service
❑ Main Line Extension
® On Property Only
❑ City TapX❑
Have Been Levied
❑ Hydrant Only
❑ To Be Levied
❑ Main Tap - To Property Line Only
Comments:
® Main Tap & On Property Ccnnect
Row No.
❑ Disconnect
❑ R & R - Main Tap Only
QMer I Stan
CONNECT SIZE 4 in
ISSUED WWECM
INSPECTION FEE $
54.00
54 PAID ❑ CASH
PERMIT FEE $
48.00
❑ CHECK #
$
0'0
® OTHER
REIMBURSABLE
DEPOSIT $
0.00
NUMBER
TOTAL $
102.00
GATE L1_ _ o8 ,
REMARKS '
PERMITEE (Please Print) Pisanos Dirt Works
MAIL ADDRESS 190W. Northern Lights Blvd Anchorage
SIGNATURE
PHONE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
INSPECTOR COPY
DATE SCHEDULED 12/31/2008 TIME 12:00 am INSPECTOR
SUBDIVISION THIRD ADDITION BLOCK/LOT/TRACT BLK 26A / LT 11 /
INDICATE NORTH
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SIZE MAIN:
TYPE MAIN:
DEPTH AT MAIN: /D
AT PROP. UNE:
CONNECT LOCATION:
COMMENTS:
INSEPECTED BY )DATE:
S- a
