HomeMy WebLinkAboutT12N R3W SEC 33 LT 212 W2is c..Y�r,Wi �ID�i'x`:'L w.�.war:�:,•{aw:!''i�.:.:'o.+w:n'l.".ui/�...n ;.•p.�a.:�:.ir:uC ti::r>u_.. }'F.v�.
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Costella Ferrell
15335 Dora Avenue
Anchorage, Alaska 99516
Subject: T12N R3W Section 33 Lot W2 212
Permit #890154, PID 4016-321-05
a
The subject permit, issued -by this office fora single.family
well and/or on-site wastewater system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
T14.l:, installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation.
When applying for a new permit,`the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/1jm:200
enc: Copy of Permit
"Kids Are Our Future"
M U N I C I P A L I T Y O F A N C kl 0 R A G E
Department of Health,& Human Services
025 L Street, Anchorage, Alaska 99501 343
O N- S I T E W E L L P E R M I T ?W
Permit Number: (390154 Upgrade $'189 v/S-V
Date Issued: O0/04/09
Owner Name: COSTELLA FERRELL Day Phone:
Owner Address:'15335 DORA AVE. 273-9442
ANCHORAGE, AK 99516
Parcel Id: 010-321-05 . WYZ.
Lot Legal: Subdivision: - Lot: 212, Flock: -
Section: 33 Township: 12N Range: 3W
Lot Size 54450 (sq.ft. or acres)
Max Dedrooms: This Permit: IJF3 Total Capacity: 3
WELL: Log must be submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 0 bedrooms. I
also understan that the capacity of the total system is 3 bedrooms and
any enlargeme t ill requ re an additional permit.
Signed: -------------- DATE:
(Owner) ELLA FERR ELL �J
Issued By: -� '��- -- ----- DATE: 100Y/e�
____ ALASKA -ENVIRONMENTAL JOB Ai -'z CLOT Lor Z..'z
CONTROL SERVICES, INC.
SHEET NO. .3 of
1200 West 33rd Avenue, Suite B
• ANCHORAGE, ALASKA 99503 CALCULATED BY. DATE
(907) 561.5040 CHECKED BY DATE
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ROBERT T. KEAN
�I �-�.•, NO. avers ? i
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RECORD.
THOSE SHOWN RON'THE RECORDED THAN
PIAT ARE NOT SHOWN HEREON.
I baby certify that I bare performed a btorlatce's to•
epertlon of the tollowlnS described properly 1./
1% that no tmyrovements on propria ams ,..�•....,.....
enawch on the pre -Lee In auuflon and that thea ereta rW
roadways, UanamWlon Snts or other risible o wmeaOn
old property eeapt u Indicated bersoo.
Dated at AarhortSe, Aluk■
thl. // day o. Q1 --r 19�%
ROBERT T. KEAN A ASSOCT
Surveyors
Parcel I.D. 018-321-06
Municipality of Anchorage a
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: g- ` / 6
Complete legal description T1 2N, RM, Sec 33, Lot 212 W2
Location (site address) 3311/3321 Dora Ave.
Current Prooertv owner(s) Francis Smith Dav nhnnP
Mailing address
Real Estate Agent
160 N 00 W Apt 26 Salt Lake City, UT
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
Fx� Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 6
Day phone
84103
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
El
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for:
Received by: 7� Date: fltl aol
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_ _ �-�2 �I J Waiver Fee $
Date of Payment / Date of Payment
Receipt Number O tr1 Receipt Number
COSA # (psCj 4J 1 (P �� 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 watersupply
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and 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 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. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC
.Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 12/18/2015
6. DSD SIGNATURE
System #1 Approved for AL bedrooms
System #2 Approved for bedrooms
Disapproved
*: 49 M .
S3even
l C 814
Conditional approval for bedrooms, with the following stipulations:
By:� =—CC Original Certificate Date:
The Municipality of Anchorage 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 ° ..,
..,
If more than 1 septic system is on the lot:
COSA Checklist #? of 2
Structure served by this system I
33;kI Dorck. AVC.
Certificate of On -Site Systems
Approval Checklist
art
T1 2N, RM, Sec 33 Lot 212 W2
Parcel ID_� 1-06;
Legal Description:
A. WELL DATA
Well type P fivate If A, iB, or C provide PWS ID #
Well Log (Y/N) N
Unknown Y
Wires (YIN) Y
Date completed. Sanitary seal (Y/N)
properly protected
Total depth 98+ ft. Cased to unknown ft
Casing height (above ground) 12+ in.
FROM WELL LOG
AT INSPECTION
Unknown
12/16/2015
Date of test
Staticwaterlevel Unknown ft.
97 ft.
Well production Unknown 9 -P.M.
5.5+ 9:p -m.
WATER SAMPLE RESULTS:
Coliform nj colonies/100 mL Nitrate 0• LOS mg/L
Arsenic 0- S ug/L Date of sample: 12/16/2015
Collected by: PES
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
Date installed
Tank size gal Number of Compartments _
Cleanouts (Y/N)
Foundation cleanout (Y/N) _ Depression over tank (YIN)
_ High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm)
System. type
Length ft. Width
ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft2 Monitoring tube — 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.) (YIN &type) y
If yes, give date
..,
D. .LIFT STATION
Date installed Size in.gallons
Manhole/Access (YM)
"Pump on" level at in. "Pump off" level at
in. High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements,?
E. SEPARATION DISTANCES
WELL -ON LOT TO:
100+
100+
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot 100+
On adjacent lots 100+
Public sewer main 75+
Public sewer manhole/cleanout 100+
Sewer /septic service line 25+
Holding tank 100+
Animal containment areas 50+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Absorption field
Water main Water service line
Surface water
Wells on adjacent lots
- _
- f
ABSORPTION FIELD ON LOT TO:
Property line Building foundation
Water main
Water Service line Surface water
Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
G. _ -ENGINEER'S CERTIFICATION
1 certify that f 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.
Steven R. Pannone
Engineer's Printed Name }even �2.. nnan
Date -12/18/2015 CE �
COSA canary-sheet_2-6-15.doc
If more than 1 septic system is on the lot:
COSA Checklist # 2 of 2
Structure served by this system 1
3311 Do -o- Ave.
Certificate of On -Site Systems Approval Checklist
Legal Description: T12N, RM, Sec 33, Lot 212 W2
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Date completed Unknown Sanitary seal (YIN) Y
Total depth Unknown ft. Cased to Unknown ft
FROM WELL LOG
Date of test Unknown
Static water level Unknown ft.
Well production Unknown 9 -P.M.
WATER SAMPLE RESULTS:
Cofiform colonies/100 mL Nitrate 0.479 mg/L
Arsenic ug/L Date of sample: 12/16/2015
I
B. SEPTIC/HOLDING TANK DATA
of 19
Parcel ID:ID84' 321-06
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
12/16/2015
4.2+
g.p.m.
Collected by: PES
Tank Type/Material Date installed
Tank size gal Number of Compartments _ Cleanouts (Y/N)
Foundation cleanout (Y/N) _ Depression over tank (YIN) _ High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA r
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft Eff. absorption area ft2 Monitoring tube _ 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.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed I. I Size in gallons
"Pump on" level at in. "Pump off' level at
Datum Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment argas 50+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line Building foundation _
Water Service line Surface water
Curtain drain Wells on adjacent lots
F. COMMENTS
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+
Absorption field
Surface water
Water main
Driveway, parking/vehicle storage,
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
Date 12/18/2015
COSA canary sheet 2-6-15.doc
Municipality of Anchorage prGE
Development Services Department
Building Safety Division
$A ETY
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC151685
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
of T12N R3W Sec33 Lot 212 W2 Subdivision. This inspection
revealed an arsenic concentration of 12.5 micrograms per liter (ug/L) for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 ug/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Information on arsenic is available from the On -Site Water and Wastewater
Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage a>�E
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC151685
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
of T12N R3W Sec33 Lot 212 W2 Subdivision. This inspection
revealed an arsenic concentration of 25.0 micrograms per liter (ug/L) for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 ug/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Information on arsenic is available from the On -Site Water and Wastewater
Program website (www.muni.or-/off nsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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