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HomeMy WebLinkAboutWENTWORTH BLK 1 LT 12Wentworth Block 1 Lot 12 #008-023-45 RPPLICRNT TOM VISSERS-HRINLINE-DO LOCBTION 40TH RVE LEGRL L &2 WENTWORTH 5052 N 86TH LOT SIZE ~44442~ 7500 SQURRE FEET MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRIVRTE WELL OR ~50 TO 200 FEET FROM R PUBLIC NELL DEPENDING UPON ]'HE TYPE OF PUBLIC NELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO B COMMUNIT9 SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 50 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS IdR~ BPPL~. SPECIFICRTIONS 8ND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. RES ~..':" E U--: E~-4 B E R __~ ::L ~. I CERTIFY THRT i: I BM FRMILIRR WITW THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY 7'HE MUNICIPRLIT9 OF RNCHORBGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDBNCE WITH THE CODES. S I GNED: ......................................... RFFLICRNT TO~F~ SSERS-HR I NL I NE-DOLL8RK ID V4, 0 ~.~-) O. V4. $ BOX 11~,69, ~TAR I~OUTE A ANCIIORAGE~ ALASKA 99~0~ SiX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF PER FOOT. 344-442.7 DRILLED AT THE RATE OF PROPERTY OWNER . LOCATION OF WELL SITE DRILLER /~ WELL LOG: 0 ..... 15~ 15 .... 54 ' 54 .... Bd.k., Std~o 7ob 3od. L and good cd.e.a.r~ cou;~e~ ~L. ~2 .... ~5' §ood oLe. ar~ osa.,t.e.~. `beo.,z.~g. q;w. ge.L ~h. oo~,f.n.cd. a. p.,zodtw_..td, ot~ o.fl 10 45 fi~e.k, o~. ow2.e-,z ,a,t.o.n. ddazq~ .hz e~o~. 1/3 Ito,z,ae- Sudsrge.,~dd~,Le- ?ttm. l~ ~lzotd.d ,be. ,~,t. ad.t.e.d 7.me. ~e.ek. o.;~ Co~g o~ ~: $18 X 65 ~e.~: $1170,00 Co~ o~ Wed,L Se-od.: g20oO0 COST INCLUDES ALL LABOR AND MATERIAL FOR GOMPL~LI~' . --: WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $11~0,~00 THANK YOU VErY MUCH. DATE BERNIE ~;:LAUS OF RAMPART DRILLING WORKS SERVICE CHARGE O F I~% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. ENVIRONMENTAL ENGINEERING DIVISION NOV 2 6 1980 Telephone 264-4720 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PF,©TECTION DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10} days for processing, 1. PROPERTY OWNER · PHONE PHONE PHONE JPHONE MAILING ADDRESS ~J PROPERT¥~E~ES~ DENT 4. REAL~OR/AGENT MAILING REE'~LbCATION ~ ~ 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other [] SINGLE FAMILY ,/),,~,o,/) ~ Two [] Five ~ ~,~//, ~ MULTIPLE FAMILY /~,Cc/~'f-' [] Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if availabie.} 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TiME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTO R INSPECTOR DIRECTIONS: I. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX ~ PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL ' DEPTH OF WELL [] COMMUNITY DATE DRILLED [~ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED [] PUBLIC UTI LITY Connection Verified INSTALLER [~Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR (~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco~5~r~y certificate) // [] DISAPPROVED DATE BY (T~.~ ~/~ LEGAL DZR~ZO~ ~/~ /~ ' d 72-010 (Rev. 3/78) CHEMICAL & G~.~LOGICAL LABORATORIESI,~,F ALASKA, INC. TELEPHONE (g07)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER Mailing Address State City MO. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for murine sample with lab ref. no. ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 , LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis snows thru Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] SamDte[oo ong~ntransit; samoleshould not be over 48 hours old at examination to ind cate reliable results, Please send new samole. Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No, Result* Analyst I I I I wNo ol colonles/lO0 mi. or NO ol Positive 3ortlons. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Presumptive 1Omi 1Omi 1Omi 1Omi 1Omi 1,0ml O,lml 24 Hours 48 Hours Confirmatory f) R 1 i ;,; �' �,� i�t Municipality of Anchorage f ti On-Site Water and Wastewater Program 'i1 �� EAUG ..t }, tL (907) 343-7904 .1) ':. .' Certificate of On-Site Systems Approval `` as 6 s I- 008-023-45 Parcel I.D. 008-023-45 Expiration Date: 11-22 -1 7 1. GENERAL INFORMATION Complete legal description Wentworth Block 1 Lot 12 Location (site address) 3120 E. 40th Ave. Current Property owner(s) Norman & Donna Resnick Day phone Mailing address 7031 Viburnum Dr. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well H Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer El WaiverNariance request for: Distance: ir r--r, Received bygad i$ 1A ' 01 1 4 Date: 42z/I5 COSA to be released to the engineer,unless otherwise request=d by t e engineer. COSA Fee $ S2--(e. Waiver Fee $ Date of Payment r 1(1 Ill l Date of Payment Receipt Number b (4th r 61 Receipt Number COSA# tYC-{� 1.3 L2 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. 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 8/16/2017 Ak• ,4 6. DSD SIGNATURE System #1 Approved for C( bedrooms ••• Seven ••'.'':ririorie . ' '� System #2 Approved for bedrooms h� Gj�.• CE-8149 • Disapproved A '-frOFESS1mP Conditional approval for bedrooms, with the following stipulations: iJ • n'V-tiiTF UVATER AND r'. Z VvA5 ! EVVA I ER 6 i RC)C-IRAM - C, Original Certificate Date:17'-aZ-Z 1 7 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 COSA blue sheet_E - If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Wentworth Block 1 Lot 12 Parcel ID 008-023-45 A. WELL DATA Well type Private If A. B. or C provide PWSID # Well Log (YIN) Y Date completed 7/2/1980 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 65 ft Cased to 65 ft Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 7/2/1980 8/7/2017 Static water level 45 ft. 34 ft Well production 10 g p.m 6.2 -{- g p m WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 8/7/2017 Collected by PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (YIN) Depression over tank (YIN) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft` 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.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "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: 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 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 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 Survey on file. G. ENGINEER'S CERTIFICATION .alb AgkZtk, ! certify that 1 have determined through field inspections and "4::_n �� .• `rr� + #.77 � review of Municipal records that the above systems are in *; .0\ conformance with MOA COSA guidelines in effect on this date. ' % -•• �� Engineer's Printed Name Steven Pannone _- g •S{even ..Pannone . Date 8/16/2017 r��l ��. CE-8149 ���i COSA canary sheet_2-6-15.doc Parcel I.D. 008-023-45 Certificate of On -Site Systems Approval Expiration Date: / V - 3 0 - /" 1. GENERAL INFORMATION Complete legal description Wentworth, Block 1, Lot 12 Location (site address) 3120 E 40th Ave. Current Property owner(s) Marko & Victoria Radonich Mailing address Real Estate Agent 5900 OlimDia Circle 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: Municipality of Anchorage Individual Well f r; On -Site Water and Wastewater Program ❑ (907)343-7904 sxezrr Community Class Well Certificate of On -Site Systems Approval Expiration Date: / V - 3 0 - /" 1. GENERAL INFORMATION Complete legal description Wentworth, Block 1, Lot 12 Location (site address) 3120 E 40th Ave. Current Property owner(s) Marko & Victoria Radonich Mailing address Real Estate Agent 5900 OlimDia Circle 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water sys.e ., ❑ Public Sewer ❑ Waiver/Variance request for: Distance: / Received by: /'G/k*�F Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ qq/i' p - Waiver Fee $ Date of Payment �Ia4Il3 %�.- Date of Payment Receipt Number l5°�i �a Vl Receipt Number COSA # O5 C 1313 55 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907)272-8218 Date 7/17/13 Conditional approval for bedrooms, with the following stipulations: By: AX / Original Certificate Date: -7-3 2-13 Th uni ali of A rage 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 COSA blue sheat r 1.. c If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Wentworth, Block 1, Lot 12 A. WELL DATA Parcel ID: 008-023-45 Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/2/80 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 65 ft. Cased to 65 ft. Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 7/2/80 7/12/13 Static water level 45 ft, 21 ft. Well production 10 g,p.m. WATER SAMPLE RESULTS: , Coliform � — colonies/100 mL Nitrate .N /[� p mg/L Arsenic X/IV) ug/L Date ofsampie: .Z l 6.9+ 9.p -m. Collected by: A�' G' S. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Nu Compartments _ Cleanouts (Y/N) Foundation clean ) _ Depression over tank (YIN) _ High water alarm (Y/N) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) S pY e Length ft. Width Gravel below pipe ft. Total depth ft. Eff. absorption area Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fail) For_ bedrooms Fluid depth in absorpti d before test in. Water added gal. New depth in. Elapsed Ti min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off"level at Cycles tested WELL ON LOT TO: Septic tank/lift station on lot 40" NIA Absorption field on lot 'fit' N/A Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main r service line ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Service line Sudace-vnatCr Curtain drain ' Wells on adjacent lots F. COMMENTS in. Manhole/Access (Y/N) High water alarm level at in. 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+ 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 7/17/13 COSA brown sheet 10-10-12.doc Surface water Water Driveway, parking/vehicle storage LOT 13 10' UTILITY EASEMENT LOT 16 F_ O A EAST FOURTIETH AVENUE N 89'59'45" E 60.00' Gftht'E4 w 2¢.4' rj ro EXISTING' 6 HOUSE 5.2' n 2.9 16.8d M: 6.7` In LOT 12 O 26" SEWER MANHOLE S 89.59'00" W 60.00' € OT 17 AS -BUILT Lot 12, Block 1, Wentworth Subdivision LAND & CONSTRUC110N SURVEYORS-PLANNERS—ENGINEERS 440 West BensonBoulevard, SUlte 200 Phone: 562-5291 Anchorage, Alaska 99503 Fax: 561-6626 Rd: P-386 Odd: SW1735 Wm axn 2007L152 f-t/PREF:96094 W 0 A IN. m w V O LOT 11 LOT 18 NOW.. 1) MS ORAWNG 5 NOT TO BE MOOPEO FOR USE AS A PLOT PLAN. Ord«ed ey Carmen ®reakey Legend: — Set Fnd Apllc elmtlpbe® Mpholt G. , s/e•R0 w/CAP p 5/e• Re O wnt.r W1 3.29' ALMM- MONUMENT Forme—%—%— °vetl1On9 •>' Llyht Pala {TWaud UeRkx' EXCLUSION NOTES: U;- thn owners' rxponelbAlty !o d.l .m .the .ai.tence of ooy eaxmxla, cawnania, a realdceene which da not oppmr on tha recorded v dMe.o plot. NOTE: Und.r no tlrcumatanoee ehaald any dot. hereon be .aed for cwfalrucllon or for eaioblMr, props!, IMna. SURVEY CERTMCATION: LANTECH hoe conducted o phy,d afw.ay of lht, properly as shown on thla dro.Mg and lhaf the knprov.menle allaat.d thereon are withh Ue properly i M. antl no envoochmartte axle! other than natal. Oale: JULY 24, 2007mown By 7M SO .V=20' Chewed ey AP