HomeMy WebLinkAboutWENTWORTH BLK 1 LT 3LoT
Well Drilling Permit Number: SW
Date of Issue:
G� BG
<FP �
,t O
:Z
Parcel Identification Number: (,.) 1-w072, H 8 Z L 3
Legal Description Property Ow Qr Nae & A dress:
P'L
e sa - S
Pump Installation Date: ,�- `V A
�v
Pump Intake Depth Below Top of Well Casing: 'feet
Pump Manufacturer's Name: AY /'t er"ai,�
PumpModel:
Pump Size �'Zjip
Pitless Adapter Burial Depth: tb feet
Pitless Adapter Manufacturer's Name: �� l ' L"-^..
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection:
r T u�
Comments:
vil
tw5++- ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: TH
330 EAST 76 AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark Begich
Anchorage, AK 99507
Mayor
www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
G� BG
<FP �
,t O
:Z
Parcel Identification Number: (,.) 1-w072, H 8 Z L 3
Legal Description Property Ow Qr Nae & A dress:
P'L
e sa - S
Pump Installation Date: ,�- `V A
�v
Pump Intake Depth Below Top of Well Casing: 'feet
Pump Manufacturer's Name: AY /'t er"ai,�
PumpModel:
Pump Size �'Zjip
Pitless Adapter Burial Depth: tb feet
Pitless Adapter Manufacturer's Name: �� l ' L"-^..
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection:
r T u�
Comments:
vil
tw5++- ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: TH
330 EAST 76 AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
September 18, 1974
Stanley Hodges
3310 Eas: 40th Avenue
Anchorage~ Alaska
99504
· (Additlo~lal charges required for thes~ ~ervices)
L~ where delivered
~e~~dRe~eived
~es/Buchholz
Lot 3, Block 1, Bentuorth Subdivision - ~ndatory sewer hookup
gear H~. Hodges:
Les Buchhoh, R.S,,
Sanitarian
LB/ko
CertWJed No. 740375
'RECEIPT FOR CERTIFIED MAIL 30c (pl~s post~.ge! '
STREET AND NO.
P.O STATE AND ZiP CODE
'~.u,,~~S FOR ~
•
• Gf By
• 1 Municipality of Anchorage r>,`..y 6 � 8 9 ' '77
� -
On-Site Water and Wastewater Program
(907) 343-7904 �S�G' Y
JUL 10 2088 '.
SA
Certificate of On-Site Systems Approv.
Parcel I.D. 008-023-54 Expiration Date: 440,1tg
1. GENERAL INFORMATION:
Complete legal description WENTWORTH; BLOCK 1,LOT 3
Location (site address) 3310 East 40th Ave. *Anchorage 99508
Current Property owner(s) Michelle Sturdy Day phone 885-5694
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: 4fDate: 7/2 5� 1
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ " ' Waiver Fee $
Date of Payment 7-1-1-[? Date of Payment
Receipt Number C- .-1b I G1 Receipt Number
COSA# ,tg l �(-C--1 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: -746/is
0000000\44
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oOF A
in accordance with the guidelines and regulations established by the Municipality of Anchorage and i-•.• ... ,- Q
industry practices. The reported results describe the condition of the system/s on the date/s of the O`. < S QO
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells i�. 9 T /°1
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, i; Q
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and / . .. .
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q •,J: fr:y '. Corn-ss.
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of QO m — ° ,3 •
4�
the well or septic system. GEG makes no representation whether an alternative well or septic system O944 !'•. .cep
can be installed on the property in the event either of the current systems fail to perform adequately in Pre '' 7��b 1•`8 ,c�
the future. The content of this report is for the sole benefit of the person/party that retained GEG to `1\),\): Prores stonO\
perform the evaluation. Reliance upon the information provided in this report by any other person or �OOOoo��
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
/-} System #1 Approved for 2- bedrooms
System #2 Approved for bedrooms �� N1 OF •/I/
c\Q
Disapproved
ON-SITE /cPGam;
Conditional approval for bedrooms, with the followinFstipOg- :AND •
oer, WASTEWATER o
PROGRAM
'417-( r.-.1-3\'`r
By: L ' / I Original Certificate Date: 7-7-3 rI p
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 V Nitrate Advisory •
Septic System Advisory Arsenic Advisory. . ` • .
Well Flow Advisory Other •
COSA blue sheet 10-10-12.doc
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 1,LOT 3 Parcel ID: 008-023-54
A. WELL DATA
*BY ANCHORAGE WELL0AND PUMP SERVICE ON FILE
WITH THE MOA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO
Date completed 1963(?) Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth •32+ ft. Cased to UNK ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/3/18
fit.
Static water level
ft.
12.4 ft,
Well production N g.p.m. 5.1+ g.p.m.
WATER SAMPLE RESULTS:
Coliform N�t'colonies/100 ml. Nitrate NQg./L. Collected by: GEG, Ltd.
Arsenic: S Z D'ug./L. Date of sample: 7/3/18
B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER
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 •
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2or ft2/bdr • System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorptio - ea ft2 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 .• e: min. Final fluid depth in. Absorption rate >= g.p.d.
• y rejuvenation treatment(past 12 mo.) (Y/N &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 at '• '• wa er alarm level at in.
- Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A _ On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main *50'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line **UNKNOWN Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ***PUBLIC SEWER
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIE a . 1 LOT TO:
Property line B ' • foundation Water main
Water service lin- Surface water Driveway, parking/vehicle storage
-In drain _ Wells on adjacent lots
F. COMMENTS
*MET SEPERATION DISTANCE AT THE TIME OF INSTALL (SEWER MAIN CONSTRUCTED IN 1971)
""NO REQUIRED SEPERATION AT TIME OF INSTALLATION ""CONFIRMED WITH AWWU ON 7/5/18
.0.**"aa
G. ENGINEER'S CERTIFICATION P,•.•• '•Q,. i,_..`�L•j.
..
i . •�• /\ .:* *j
l certify that!have determined through field inspections and % �,•• %
review of Municipal records that the above systems are in • 11 •
conformance with MOA COSA guidelines in effect on this ••••
date. ♦�^'; ef• - • Game-.••F�i
Engineer's PrintedNa a JEFFREY A.GARNESS �••11 • CE 79 0,2=
•.'P •
• F"••.Z7I I ( "°k' •
Date l� l" LICENSE••4 ROFESS\Viii ••••
#AECC884
(Rev.10/12/12)
EAST 40TH AVENUE
4
N 89°59'34"E 60.00'
I X X
I X )jl
I. 9,
an e
m
x
a
r-
Y
X
ID X
a
m
3 42-41-
V
I
6
)r
16.4
12.3 f'11
bo
Ln
L4
( g r
SINGLE FAMILY 4 x
• FRAME HOUSE }w DOOOO�QO4
Q .='''' OF AtN
o
o -, 13.0 8.4 `.O p •
p�,`Q'. TH%� s�6.0o�h
O .6 DECK „ U) a* : T" VA
— • it
X
1•---I--' — °WELL X D ?
X IA SHANE A.HOLT
�j1 LS-6914 0�
s\A �0 p o
°Jas a,°n e1 b'Q
10.2
�'�0000��
141'
AS-BUILT SURVEY(NO CORNERS SET THIS DATE)
SCALE 1"=20'
I HEREBY CERTIFY THAT I HAVE PERFORMED A
10 UflLI EASEMENT MORTGAGEES INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
I X S 89°59'00"W X60.00' X
LOT 3,BLOCK 1,WENTWORTH SUB.
ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL WITHIN THE PROPERTY LINES AS NOTED AND NO VISIBLE
STRUCTURES OR FENCELINES. ENCROACHMENTS EXIST EXCEPT AS NOTED.
EASEMENTS OF RECORD.OTHER THAN THOSE SHOWN ON THE RECORDED PLAT.ARE NOT SHOWN HEREON.(UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 1ST_
DAY OF AUGUST 2003_
NOTE'ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LAND SURVEYING 9070,FB107-28
OR LOCATE STRUCTURES. TEL.345-5513
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
+ _�. . J _
�l_ ___. - ------:
1 i r.. .=t =,i ' :.„,
...m. 7n . , ..7 ,........•••••••• ....7.... ...::, 01Th .... '' ..1 iit0
t
6 ! 5 I g4 I 3 2 0I Its
I cn
0 b ti
tot 0 •X �x
, Al 43
f)
.41 .
v 40 I ': , - 4 n' BSMT.= F5I.27 1c/ in
1 • H !-4q r I r 0 , To S° \ m I 1
A
J.4114r.. . •
-,I6. �' 15 ..�. 2 D.O A s MI_ Afa -_
_
opai0 ._. __ ?iri -. A I
rff30 wi cv VI °trent 4 I W
Fovent 0vent r I 8
Kp 20' CONST. E I I
1/ 1 / 1 '&.x., Ns, II i// Vf/f/4
4� (A
L. 23 24 25 26 I 27 I 26 «
±., I 0 0 � e