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HomeMy WebLinkAboutWENTWORTH BLK 2 LT 4Wentworth Block 2 Lot 4 #008-023-25 \ ; LO • < - - CO , . ......-_ m ,�... 5 Iw aam I s f K J 3 fi g Z a iso®$0O®A® Z Q 4� p O o n S60U, 1 ti _-T 4 � LZfibZ Lh9 N q £< pyU < 5 � ry U 6684L p<« i e O '. a-EILZI m VU PA m 6E 61E YY -A n 4 p _ O iaoW �' ,e=o db .n N c « N of CL v T � nQp Qav PU rdiyU .Y 3Uu+9i�_E r r. o. Q aa��v?�oa cwt Y. 3.�v uy.8 ud uu�o'LLc�r En°n°Oayr»33za a EL ¢"¢¢"v "v yn � "vv n�zw v-o�w>u.uiuhyn aa000000a�. uxEa nrcmro>3Sz- O� J W rt ? r o G � Time APPLI(' NT FILLS OUT UPPER HALE ;ONLY Time �IPrQgfiy OS�ner( ( Phone ._ �I�fIC� ti J]-�—T�.. Date itl Mailing Address ) �� - AZip Code (IX a C -; Date 4 _ Buyer Address Zip Code Lending Institution- - Ca fl IL1? U 1 ��1 Phone Address Zip Code Realty Co. & Agent C �rliL.tf`Y��sil f;f�ri�gr=�r��l-dcvY�c�� Phone Address -ic Z I- - Zip Code - MUNICIPALITY OF ANCHORAGE f,q Legal Description Street Location y - / ��I - �, I-\ ��-,::kv - ENVI, ,: it -L.. A - i iO Type of Residence ❑ Single Family Multiple Family No. of Bedrooms(,N jt t,t }fT 1-9 Other ( 9) APPROVED BEDROOMS Water Supply Individual - - ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Al ❑ Community - For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Well To Absorption Area Well Log Recalved Septic Tank Size Sewer Disposal [I1n� Individual Year Individual Installed: P- -J 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 Date Inspector Inspector - Inspector Inspector Pm�. Field Notes: - MUNICIPALITY OF ANCHORAGE 1. `T (-° ,_ ri ^. ENVI, ,: it -L.. A - i iO `'. �E P It Z_ S982 RECEIVED ( 9) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDJZIONAL APPROyA1' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Recalved Septic Tank Size Well to Tank i202�13/a21 CHEMICAL & GL LOGICAL LABORATORIES 6,,,t' ALASKA, INC. nF.,Np(P[gOfN TELEPHONE (907)-279.4074: ANCHORAGE INDUSTRIAL CENTER - o ® o 274-3364 5633 B Street Q ZQ O •�e,e, Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: WATER SYSTEM: I.D. NO. - - Et Satisfactory - 't ❑ Unsatisfactory Water System Name Phone No. - - - � El Sample too long in transit; sample should - ! t = 1 not be over 48 hours old at examination Mailing Address to. Indicate reliable results. Please send new sample. - City - state SAMPLE DATE; Mo. .Day Year Zip Code SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample) ❑Treated Waters with lab ref. ❑ Untreated Water ❑ Special Purposee SAMPLE Time Collected NO. LOCATION _ Collected By 2 I iJ 1l) -hit .t ��P I I'tlr 'aJ1U 3 4 5 READ INSTRUCTIONS Date Received Time Recelved�r%r` Analytical Method: ❑ Fermentation Tube �kMembrane Filter Lab Ref. No Result' Analyst .�Ca rr .I m FT -1 EDW +Noof colonies/ 100 ml. or No. of Positive ismomrs. 06-1220 (b) BACTERIOLOGICAL WATER ANAL YSIS RECORD Rev. 1978 - - Date Collected Source a.m. ..�.�.... --Time Received p.m. Lab. No. Y:mu nr M.... _-.. 24 Hours 4e BEFORE ator Gon/irmelory 24 Hours 45 Hours EMB Broth 24 hours: Broth 40 hours: COLLECTING SAMPLE Multiple Tube R.po,t:. loml Tubes Posnlve/Total loml Poreona Membrane Filter: Direct Count Coliform/looml - Verification: LTB BOB Final Membrane Filter Results ` 1 collform/loom) Reported By �l �` Date - ![ Time- f -G a.m. p.m. ZS / fJ GREATER ANCHORAGE AREA BOROUGH !/ Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 pf a Date Received 1.,5,1-73 t1Time of Inspection © !J ,' 1.11 'I Date of Inspection �� 3 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER S WATER FACILITIES FOR - 1. Approval Requested By: Address: .5 3 5 n� A 2. Property Owner: A-)ltr Phone: a 7 9 /70T Phonee 3. Legal Description: 4. Location:- 5. Tvpe of Facility to be Inspected: e %mber of Bedrooms: _ 6. Well Data A. Type dn " x. x4=L'1 B. Depth T- �O D. Bacterial Analysis C. Construction G � y 7. Sewage Disoosal.Svstem: A. Installed 8. Installer C. Septic Tank; 1. Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Field: Total Length of Lines 8. Distances: A. Well To! Septic Tank_ , Absorption Area Sewer Lines Nearest Lot Line Other Contamination B. Foundation to Septic_Tank r Absorption -Area C. Absorption Area to Nearest Lot Line Regaast for Approval of I`'i.vidual sewer 6 water Faeiticres- Page Two ✓ _ `- 9. Comments: Approved Disapproved Date Appr al.Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date 06-1220 (a) - 31AIL V! HI 41%m /Lab. No. - ALTH'AND SOCIAL SF' (ICES DEP! WENT OF HE DIVISION OF PUBLIC HEALTH C V nATF BACTERIOLOGICAL, L -,,, WATER ANALYSIS OFFICE PUBLIC ❑--'SEMI-PUBLIC ❑ INDIVIDUAL OTHER REPORT RESULTS TO Recordsin this office indicate this WATER SUPPLY to be of: ❑ Satisfactory ❑ Questionable ❑ Unsatisfactory Sanitary Status. D......... - Diameter of Well - - %• %/ Feet. , Analysis shows this Water SAMPLE to be: NAME Length of - D Satisfactory [I Questionable ❑Unsatisfactory. Water Depth Feet. Drop Pipe •' From Bottom In Utility PUMP LOCATION: ADDRESS,_ - -- If an "Unsatisfactory" or "Questionable" status is indicated above ❑ Other ZIP E Of Well PURPOSE OF EXAMINATION: you should take immediate action as recommended below. Suspected? - ❑Yes ❑No CITY ) CODE El yes -' 1. Notify consumers water is polluted. Boil or chemically ❑ No treat this water as outlined in the enclosed leaflet ADDRESS �.' �•'� - _ - "Drink It Pure." OFSOURCE to meet recommended residual standards. SAMPLE COLLECTED BY �• j 2. Increase chlorination sufficiently Determine source of contamination and take action necessary to maintain safe water supply at all times. DATE COLLECTED - e ? .TIME COLLECTED - Bm ❑ Basement Tap - 3..Check chlorination other mechanical equipment. Make certain it is Sample Collected From ❑ Kitchen Tap -0 Bathroom Tap. functioning Other (List) - _❑ 4. If after checking equipment a disinfecting residual is not obtained, Please . e e wirethisoffice for emergency assistance or advisory services. Well ❑ Dug ❑ Driven - ❑ Drilled - ❑ Bored 5. This is a surface water source and subject to pollution by man and animals. ':' ❑ Other An approved water supply source should be developed. SOURCE: ❑ Spring ❑ Cistern Dug Well or Cistern Construction: Brick or 6. Improveyour ❑spring ❑dugwell ❑driven well ❑drilled well []cistern Walls- ❑Wood ❑Concrete ❑Metal - ❑Tile '.❑ Concrete — location in relationship to your sewage disposal Top — ❑ Wood ❑ Concrete. ❑ Metal ❑ Open Top — 7, Relocate Your well to a safe LOCATION:- ❑ In Basemen[ - ❑ Basement. Offset ❑ Under House system. ❑ see enclosure ❑ In Yard ❑OtherSeptic 8. Sample too long in transit; sample should not be over 48 hours old at - - - Building Sewer - . _ Feet. examination to indicate reliable results, please send new sample. - DISTANCE TO: or Other Drainage Pipe Seepage - Feet. Tank Cess - ❑Bottle Broken in transit, please send new sample. Tile Feet. Privy. Feet Field- - Feet. Pit Feet. Pool - Other Possible g. Contact your nearest ❑ Local Health Department or [3 Alaska Sources of Contamination: - Cast - - Asbestos' -❑ _ Division of Public Health, sanitation office for bulletins, consultation and MATERIAL: BuildingSewer— ❑I ron ❑ Wood ❑Tile ❑Fibre Cement° assistance. ❑Plastic Joint Material — Type - - --/ SANITARIAN'S REMARKS - - GENERAL: Does Water Become Muddy or Discolored? C] Yes ❑ No - -- - D......... - Diameter of Well Depth - Feet. , Well Casing _ Material Diameter Depth - Length of Water Depth Feet. Drop Pipe From Bottom In Utility PUMP LOCATION: 0 I Well OffsetInt -❑Basement ❑ In Basemen ❑ Room 0 On Top ❑ Other _ Of Well PURPOSE OF EXAMINATION: Illness Suspected? - ❑Yes ❑No New Source of Supply? El yes -' ❑ No Repairs to System? ❑ Yes ❑ No READ INSTRUCTIONS ON REVERSE SIDE BEFORE 06-1220 (b). "BACTERIOLOGICAL -WATER ANALYSIS RECORD /- Date Received Time Received. �.e, Lab. No. _ Lactose Broth % '' 10cc 10cc 10cc 10cc 10cc LOcc 0.1cc 24 hours 48 hours Brilliant Green 24 hours AR hoo, EMB —Lactose Broth, 24 bra —Coliform Density_ 48 COLLECTING SAMPLE _ —MF results —Detergent Test - Reported by - ? Date This analysis indicate", Colifoim Organisms to be: - _.AGAR Gram's stain _ (Most probable No. per 100cc.) 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LLJ N W N LU LL O LL O Lu a Z O I— H N M �F El L c� a� O N C L Q) N U) O Ln (6 O LZ r \ U z a W w 0) C/) Q LCi J W LL Z O a w U) m Q 4i U c ca U) &I U) (D a - v 1 Cl) 0 V m 0 N W O CL O C CL o E c E - c o N >, N V L .Id LU � d c t Q L M A � 00 0 69- (D R m (D LL N m 0 0 I&1 0.352 8.90 Forge Engineering 5/7/24 N/A N/A N/A > Benjamin Schiller, P.E. Property is served by public sewer. (907) 522-7773 EAST 41st AVENUE 0 0 M M N 89059'00" E 60.00' ----------- _i GRAVEL / DRIVEWAY -- LOT 4 WELL 8,085 sq. ft. X FENCE NCE X� x x24.0' + 1 N \ d7 x CANTILEVER m I12.7'I 12.8' �O x n Z z o -1�1' 0 12.8' O 0 CANTILEVER LOT 5 C:) IT1 0 2 -STORY x W FRAME o HOUSE o xCn k� Z W A X m x -4 A m � x X ASPHALT DRIVEWAY; x 24.0' x 10.3' x x _ x 10' UTILITY EASEMENT —EO r U TYEp UTILITY LES —S 89059'00" W 60.00' h EO - EO— Ep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th DAY OF MAY, 2024, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services 907.290.8949 225 VV 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 c0CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. O� $88--3 Oa� Expiration Date: I - 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent WENTWORTH; BLOCK 2, LOT 4 3300 E. 41 ST AVENUE *ANCHORAGE, AK 99508 ESTATE OF KAREN BROWN Day phone 33COE. 41ST AVENUE *ANCHORAGE, AK 99508 Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) N Duplex It' IBM ❑ Multiple Dwellings (Single Family and/or DuporITTAL 0C) 22 2014 3. NUMBER OF BEDROOMS: 4 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: II/u Distance:= Received by: �� Date: def/ e COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ L Date of Payment �� 1,7 Receipt Number 050S'01 COSA# 014'1 1.55Y Waiver Fee $ Date of Payment Receipt Number Waiver* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 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, L1D. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwaterievels 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE �� System #1 Approved for _ bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date 0oo6o�pp 0F.A(°4�p ..................:....� , •.,`�ef)1 Garn ss. G �n �.(I•.l CE -795 o��O bedrooms, with the following stipulations: O -SITE WATER AND =o WASTEWATER J�x PROGRAM BY:��� Original Certificate Date: / 0 -2 q� The ripaorage Develogemt 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 M." 11MR% Nitrate Advisory Arsenic Advisory Other 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 Lo 0 V - 0;2--3 2S Legal Description: WENTWORTH; BLOCK 2, LOT 4 Parcel ID: -9Se-232—M A MF_0 A. WELL DATA *PER 1973 GAAB DOCUMENT IN MOA FILE **PER SURROUNDING WELL LOGS. Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed PRE -1973 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *54+ ft. Cased to **40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test NO WELL LOG 9/25/14 Static water level ft. 25 ft. Well production g.p.m. 1.95 g,p.m, WATER SAMPLE RESULTS: STEEL STORAGE TANK EMPTIED, RE—FILLED AND EMPTIED AGAIN. Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: ANCHORAGE WELL & PUMP SERICE Arsenic: 18.6 ug./L. Date of sample: 8/20/14 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 (Y/N) _ High water alarm Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth ft. Eff. Pumper Soil rating (g.p.d./ft or Width ft2 Monitoring tube System type Gravel below pipe ft. 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 'Pump on' level at in. Size in gallons Manhole/Access (YIN) 'Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAi t station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main *50'+ Public sewer manhole/cleanout *50'+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIEL N'COT TO: Property line Bui oundation Water main Water service line Surface water Driveway, parking/vehicle storage C rain Wells on adjacent lots F. COMMENTS *MET CODE AT TIME OF INSTALLATION. 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 JEFFREY A. GARNESS Date 10 7-71, 4 (Rev. 11/0.5) CE -793 apof esslon°< Municipality of Anchorage Community Development Department Development Services 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 # 141554 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of Wentworth Subdivision. This inspection revealed an arsenic concentration of 18.6 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.