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HomeMy WebLinkAboutWENTWORTH BLK 2 LT 7Wentworth Block Lot 7 2 #008-023-22 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 008 -023-22 Certificate of On -Site Systems Approval OSC241518 Expiration Date: Legal description WENTWORTH BLK 2 LT 7 Site address 3230 E 41 ST AVE, APT B Current property owner(s) OBILLO VILLAFLOR R & X The On-site system(s) is/are approved for 6 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: Original Certificate Date: 12/18/2024 This Certificate of On-� a Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department u ❑ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 008-023-22 Complete legal description Wentworth Block 2 Lot 7 Location (site address) 3230 East 41st Ave. Current property owner(s) Villaflor & Johnette Obillo Day phone 2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank © Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ ?- y U, Date of Payment Z-/7 A-( -( COSA #C 6` Waiver Fee $ Date of Payment Waiver # COSA Application June 2022 Legal Description. COSA Checklist Wentworth Block 2 Lot 7 Parcel ID: 008-023-22 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 7.4 qpm Date drilled 1975* Total depth 40+* ft Water storage tank volume None gallons Cased to 40+* ft Well disinfected for coliform test? ❑ Yes ✓❑ No W Sanitary seal is functioning correctly 0 Coliform bacteria is Negative 0 Wires are properly protected Nitrate mg/L Nitrate less than MRL (ND) Casing height (above ground) min. Arsenic ug/L Arsenic less than MRL (ND) Date of flow test for COSA 12/6/24 Collected by Arcterra Consulting Static water level at beginning of test 25 ft. Date 12/3/24 Comments *Per previous COSA dated 1/13116 by Jeffrey A. Oarness. Total depth &cased to are based upon surrounding well logs. DATA Measured operating Elul tic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: BSORPTION FIELD DATA Which s m tested (date installed) ❑ ALL standpip resent per record drawing Total measured depth fro rade ft (max) Measured depth to pipe invert fro rade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies COSA Checklist—June 2022 C. LIFT STATION ❑ Required maintenance completed A e of lift station years Lift station ma Comments: Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in arption rate gpd FIELDSUS — POST RECOVERY Effective depth record drawings) Effective depth used in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ✓❑ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'✓❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50'✓❑ Yes if No ft ✓❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' v Yes if No ft ❑✓ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water ing Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundation= Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ❑ Yes if No ft ❑ Yes I ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft Surface Water > 100' Wells on Adjacent Lots at'Co_ ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft If tank or field is under driveway com G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date 64A Af ,% Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 s CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 008-023-22 Expiration Date: 1. GENERAL INFORMATION Complete legal description WENTWORTH; BLOCK 2, LOT 7 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 3230 EAST 41ST AVENUE KYLE MAZE Day phone 529-0054 3230 EAST 41ST AVENUE ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 6 4. 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 waiverNariance request for. N/A _ Distance;= Received b : Date: COSA to be release the engin r, unless otherwise requested by the engineer. COSA Fee $ LJ Waiver Fee $ Date of Payment Date of Payment Receipt Number ()(,1 (010 G Receipt Number COSA # SSG, p 1 QO (,,:, Waiver # 5. 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 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 fries 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. Address 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG provided an engineering evaluation ofthe well and/orseptic system in accordance with the guidelines and regulations established by the Munfcipafify ofAnchorage andfndustry pradlces. The reported results describe the condition of the system/s on the data/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not ideMirred during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited lo, soil conditions, groundwalerrevels (that may fluctuate during the year), quality of constmchan (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the central of GEG. Sofisfaclory test results do not 9uammee future performance of the systenve, therefore, GEG makes no warranty (express orimphed) regarding the future performance of the wall or sop tic system. GEG makes no representation whether an altemative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefil of the person1pady, who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is ria authorized. In shod, GEG disavows any legal duty to anyone other than the pensordpany who paid far this report. Phone 337-6179 Date _ 11 sslf41 a 6. DSD SIGNATURE O�PFO '�, �• f �•" System #1 Approved for _45L7 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: \� I OF AA WATER AND Original Certificate Date: ! ^ It;--/ The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10112112) Nitrate Advisory Arsenic Advisory Other N 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: WENTWORTH; BLOCK 2, LOT 7 Parcel ID: 008-023-22 A. WELL DATA *ASSUMED—BASED UPON SURROUNDING WELL LOGS Well type PRIVATE If A, B, or,C provide PWSID# N/A Well Log (Y/N) NO Date completed 1975(?) Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth. *40+ ft. Cased to *40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test Static water level �o Well production g.p.m. `WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: ► ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material AT INSPECTION 12/29/2015 12.5 Nitrate b 31 mg./L. Date of sample: 12/28/2015 PUBLIC VA -1 Collected by: GEG. Ltd. Date installed Tank size gal. Number of Compartments _ Cleanouts (Y/N) _ Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water alarm Date of pumping Pumper. C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft�or ft Length ft. Width Total depth ft. Eff. absorptio a ft2 d System type ft. Gravel below pipe - 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.) (YIN & 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 High water alarm level Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NSA On adjacent lots 100'+ Absorption field on lot NSA 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: Building foundation Property line Absorption Water main Water service line Surface Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE OT TO: Property line B ' oundation Water main Water service line Surface water Driveway, parking/vehicle storage Wells on adjacent F. COMMENTS G. ENGINEER'S CERTIFICATION 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 am JEFFREY A. GARNESS Date 13/6 (Rev. 11/05) Ci WJ F ar `` e - a 4 Ves(C sa. f {lea 4 h li Wd Y A S.Se✓ C.4f3 J N "'A49'4= d6.00' i OF A` gg >d ��j\SII /j/,SJ/��,.•i.�(y(If Y ` Y EASEMENTS OF RECORD, OTHER THAN`.eR"� THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. t, 9p 10 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a MortageWa in- theallowing de bed property: LQi 7, �� 2,4Cnr�6varf>� 3v� -Anchorage Recording Precinct, Alaska, and that the dmprove- meats situated thereon are within the property lines and do i not overlap or encroach on the property lying adjacent there- to, that no IMvements on property lying adjacent thereto 01imeroach on Kepremises In question and that there are no ,roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Aiaalm this. JI;0 may, at 17y/y ie 90 FRED WALATKA & ASSOCIATES Engineers and Surveyors , ; IT FILLS OUT UPPER HAI.,,_ ONLY Address Zip Code [~ Single Family / .~ Multiple Family NO. of Bedrooms Water Supply ~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth {attach Icg if available). [] Public Utility Sewer Disposal [] Individual Year Individual Installed: " Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Inspector Inspector Inspector Inspector ( ~ ) APPROVED BEDROOMS ~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well Io Tank Septic Tank Size 72-023 (3182) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~JNICIPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH EN¥1,~ONMENTAL PROTI~IoN ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 OCT 6 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW[ DIRECTIONS: Complete ali parts on page 1. Incomplete requests wgl not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE John T. a~d t~ay Jones, ~r. 276-0645 MARLING ADDRESS c/o Realtor PROPERTY RESIDENT (If different from above) - ' '~2'~0 E. 41st. Avenue, Anohoraget Alaska ~¢~04 2, BUYER Colleen L. Cox and Shelley M. Caffrey MAI LING ADDRESS 1~ Nelchina A~t. 1. Anchora~e~ Alaska 3. LENDING INSTITUTION Coast Mort~e Co MAI LING ADDR ESS P.O. Box 1200. Anchor~e. Alaska 99510 4. REALTOR/AGENT Century 21-ToWn a~d Country Lynn Burns ~IAI LING ADDR ESS '11[; W. Northern Lights, Sg~b208 , Anchora~e~ A~.ska 115 W. Northern Lights, Suite 208, Ancho2age, Al~sk~ PHONE PHONE 279-3330 PHONE 279-0665 PHONE 276-2233 5. LEGAL DESCRIPTION Lot 7, Block 2 Wentworth Subdivision STREET LOCATION 3230 E. 41st. Avenue, Anchorage,~Alaska 99504 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other [] SINGLE FAMILY [] Two [] Five J~ MULTIPLE FAMILY [] Three ~ Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well Icg is requ'ired for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM E~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date may have c.h~ged .to If system is over two (2) years old an adequacy test is required publmc by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 724310(3/78) THIS SIDE FOR OFFICIAL USE ONLY : DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME I TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: I, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER SUPPLY PERMIT NUMBER [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size'. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL AESORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line [~ APPROVED FOR ~_0 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED DATE/ ~ "-C~'~' ~. /0//t/- ~' O ~'" BY (Title)~.~ ~J~ LEGAL DESCRIPTION 72-010 (Rev. 3/78)