HomeMy WebLinkAboutLITTLE BEAR BLK 1 LT 2Little Bear
Block 1
Lot 2
#014-061-19
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DEPARTMENT OF HEALTH AND ENVIRONMENTAL t.,ROT'CTI ON
F 2510 E. 'TUDOR RD. . ANCHORAGE, E Ak:. S49!5,07
PERMIT NO.
APPLICANT ED RIi'• NEF 3:10 WE:LLSLEY COURT f:44? 1 I._ l
LOCATION ��(=1E'•'r' 'EEAR PLACE
LEGAL L2 Bi LITTLE BEAR S/D LOT SIZE_ =�10 � =:01 IARF. FEE r
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYS..f-F M Is
Inset FEET FOR A PRIVFITE: WELL.. Cid: 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE RE.s !LII RED AND MUST BE RETURNED 'TO THE DEPARTMENT 14111-11N -:0
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO I INSURE PROP1.:,�M:
INSTALLATION.
I CERTIFY THAT
:i.: I AN F19M I L I FIR WITH THE REQ I REMENTS FOR ON --SITE SEWE RS AND WELLSt !' : ::;F-
l:
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL II tTALL'THE SYSTEM IN ACCORDANCE WITH THE CODES.
APPLICANT ECS RINNER
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Municipality of Anchorage ° r�
On -Site Water and Wastewater Program `
(907)343-7904
Certificate of On -Site Systems Approval
-- ---- P-areel-I.D-0--14-061=1 -Expiration Date: 2 -
1. GENERAL INFORMATION:
Complete legal description LITTLE BEAR: BLOCK 1, LOT
Location (site address) 6731$t4#14 Bear Drive *Anchorage
Current Property owner(s) Alex Cullen
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 434-987-9563
Day phone -. -.. .
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
IN
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
WaiverNadance request for. Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ Q ?0 1 Waiver Fee $
Date of Payment 6 a 7 ) o a a Date of Payment
Receipt Number 07 a H G Receipt Number
COSA # () S Ca a 1 a H a Waiver #
ql�
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: Gamess Engineering-GroupL-td-(GEG)------------- --Phone:---907-337-6179--------------
Address: 3701 East Tudor Road, Suite 101 -Anchorage, Alaska 99507 _/ J
Engineer's Printed Name: Jeffrey A. Garness Date: <y12-
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
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
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
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
system/s; therefor, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6.
By:
DSD IGNATURE 0F
System #1 Approved for bedrooms O
System #2 Approved for bedrooms p ��T C)
Disapproved m �gSrR�No
m 1
Conditional approval for rr bedrooms, with the following stipla%ns: GA_j R
�zy_t-et,-044'Pc ttil STV`�`� U�114 ID�e1'C �Iact�f ���s M \�g,0����
FRVICES
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_ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Tj
COSA Checklist
Legal Description: LITTLE BEAR; BLOCK 1, LOT 2
Parcel ID: 014-061-19
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Well production at time of test 6.7+ gpm
-- - --Date drilled— �� -- — --
Water storage tank volume NSA gallons
Total depth 90 ft
Well disinfected for coliform test? ❑ Yes no No
Cased to u"K"ow" ft
Coliform bacteria is Negative
n Sanitary seal is functioning correctly
Nitrate 7-4 mg/L ❑ Nitrate less than MRL (ND)
A Wires are properly protected
Arsenic ug/L Arsenic less than MRL (ND)
Casing height (above ground) 12+ in.
Collected by GEG, LTD.
Date of flow test for COSA 5/11/22
Date of Sample 5/11/22
Static water level at beginning of test 17.7 ft.
Comments
B. TANK DATA AWWU SEWER'
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (m
Measured depth to pipe invert from grade
❑ N/A — pressurized field
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material /
Comments:
Adequacy test date
Results ❑Pass For bedrooms
Fluid depth prior to test in
(min) Water added gal
Li Monitor tubes go to bottom o ective. If not, state
depth into effective
❑ Code -required soil er over field
❑ System pres ed
(Required if nt for greater than 30 days prior to
date of t
introduced gallons
'Deficiencies:
COSA Checklist yellow sheet
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
❑ Yes
if No
Septic Tank/Lift Station on Lot > 100'
Yes
N/A
Community Sewer Manhole/Cleanout > 100'
*50'+
❑
if No ft
❑ Yes
if No
ft
Neighboring Tank > 100'✓❑ Yes
if No ft
Private Sewer/Septic Line > 25' 0 Yes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No N/A ft
Holding Tank > 100' ❑✓ Yes
if No
ft
Neighboring Absorption Fields > 100'
0 Yes if No ft
-------- ------------
Animal Containment > 50' Yes
if No
ft
0 Yes
if No ft
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No ft
❑✓ Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required) My SEWEN
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water > 100'
El Yes if ft
Property Line > 5'
❑ Yes
if No
ft
Wells on Adjacent Lots:
if No ft
Absorption Field > 5'
El Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'
[j Yes
if No
ft
Communi ells > 200'
0 Yes if No ft
Water Service Line > 10'
❑ Yes
if No
ft
If is tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter dist
Building Foundation > 10'
❑ Yes
o ft
Property Line > 10'
es
if No ft
Water Main > 10'
❑Yes
if No ft
Water Se . Line > 10'
❑ Yes
if No ft
ace Water > 100'
❑ Yes
if No ft
F. ENGINEER'S COMMENTS
*ADEC/MOA STANDARD IN 1977
if less than required)
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100' ❑ Yes if No ft
Community Wells > 200' ❑ Yes if No ft
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
COSA Checklist yellow sheet
OF���v:9s4p
,J A.
rness.,
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• -7 Municipality of Anchorage ar
t On-Site Water and Wastewater Program ` . L61111111 ;
(907) 343-7904 SAF ETT
Certificate of On-Site Systems Approval
Parcel I.D. 014-061-19 Expiration Date: -L — 26 l E
1. GENERAL INFORMATION
Complete legal description Little Bear Block 1 Lot 2
Location (site address) 6731 Baby Bear Drive
Current Property owner(s) Christopher & Kathleen Souser Day phone
Mailing address 6731 Baby Bear Drive Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer
WaiverNariance request for: Distance:
Received byq' t,t,1kj jA 4C ( Date: LO [ 2-t/
l c')
COSA to be released to the engineer,unless otherwise requested by t ngineer.
COSA Fee $ G-2 ( Waiver Fee $
Date of Payment 6-1c)-I Date of Payment
Receipt Number (712?(OL Receipt Number
COSA# OSC 1, -/ J 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 6/14/2018
.....
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6. DSD SIGNATURE
/`� System #1 Approved for .3 bedrooms -•.2.• an
System #2 Approved for bedrooms fa 9,•• CE-8149•
Disapproved �1k% OFESSiO-"
Conditional approval for bedrooms, with the following stipulations:
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•
W AGER A AT z
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s./��fl4�n/r¢rQ`��G
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By. •
.�� = ` Original Certificate Date: z
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 N .N • • t ........
COSA blue sheet r
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: Little Bear Block 1 Lot 2 Parcel ID:014-061-019
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 2/2977 Sanitary seal (Y/N) Wires properly protected (Y/N) Y
Total depth 90 ft. Cased to *40+ ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 2/2/1977 6/7/2018
Static water level 23 ft. 37.4 ft.
Well production 25 g.p.m. 5.2 g.p.m.
WATER SAMPLE RESULTS:
Colifornllt 4.YG colonies/100 mL Nitrate i • 19 mg/L
Arsenic 11D ug/L Date of sample: 6/7/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
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 (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.) (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 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 100+ On adjacent lots 100+
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
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
*ADEC/MOA standard in 1977.
G. ENGINEER'S CERTIFICATION �4OF 04
I certify that I have determined through field inspections and
A
*'
review of Municipal records that the above systems are in - TH j\ *#r�
conformance with MOA COSA guidelines in effect on this date. ••••".t• f
Engineer's Printed Name Steven Pannone •••tieveri i2.•i annone• 0
Date
6/14/2018 �}l�y�•• CE-8149
kli\\ ``• •44�
COSA canary sheet_2-6-15.doc
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'```�\\ AS-BUILT NO CORNERS SET THIS DATE
O 4:,44 I hereby certify that I have performed a Mortgagee's inspection
ai '� • • • . I of the following described property:1OT 2. BLOCK 1.
,:,`Q'•' ••`s .• LITTLE BEAR SUBDIVISION
i*' 49th i. .7 -,
• Anchorage Recording District,Alaska.and that the
•• '.. I`.' r e Improvements situated thereon are within the property lines
. r••• w.. •✓" and do not overlap or encroach on the property lying
•. I'nzobet ' •.otko:ff / adjacent thereto,that no improvements on the property lying
s • r adjacent thereto encroach on the premises in question and
�_ '. 11036 - .'SJ R that there are no roadways,transmission Ines or other
SCALE: - 20' /f '• . . •�,�o visible easements on said property except as indicated
11""•TS$IoMr. hereon.
Ay
I ` �� Dated at Anchorage,Alaska
1\\�` day of JUNE .2018.
EASEMENTS OF RECOR OTHER THAN &-1 1,tb this 1 FRED WALATKA&ASSOCIATES,LLC.
THOS nu THF RECORDED
PLA-ARE NOT SHOWN HEREON. Engineers and Surveyors 1
UNLESS OTHERWISE NOTED Holt.FB 18-2,pg 64 BE 907.248-1666
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES Rei
Division of Environmental Services —
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcell.D.# HAA#
1. GENERAL INFORMATION
Complete legal description Lot 2; b.2ock 1; L.i t2e Bear Subdivision;
Location (site address or directions) 6731 Baby Bean Dkive
Property owner
Steven 9
Donna
PuxceUa
Day phone 349-7936
Mailing address
6731 Baby
Bean.
Dni.ve Anchorage,
Ataska 99507
Lending agency
Day phone
Mailing address
Agent Carot Douthit RE/MAX PROPERTIES Day phone 257-0116
2600 Cordova StAeet
Address Smito # 100
Anchorage, Ata6ka 99503
Unless -otherwise requested, HAA will be held for pickup.
if 2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer XX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
1I
By:
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Phone
Address 17034 Eagle River Loop Road No, 204
;.ar ; .1ver, Alaska 99577
Engineer's signature Date
� eleoauooe�+ c>/a Y*rrea♦w+kE
oonc , J. '-il FER 1
U,9°o f lo. 3 15
DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
moo..--
Additional Comments
UJITIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA W21
Municipality of Anchorage
Department of Health & Human Services _
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �Z7- \�'CLi---1�26-06ZAParcel LD
A. WELL DATA
Well type P(Lty If A, B, or C, attach ADEC letter
Log present/N)
Total depth t
Sanitary seal (®N) —
Date of test
Static water level
Well flow
Pump level
ADEC water system number "-\ IN
Date completed -11 Driller 'Pf-A (
Cased to Casing height \2
Wires properly protected�'aY N)
FROM WELL LOG
'y - Z2 -n -7
2.17 g.p.m.
0 �-
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 4
AT INSPECTION
/ MUNICIPALITY OF ANCHORAGE
3 &- VIRONMENTALSERVICESDIVISION
lit
✓�R F -CEI V E D
v�-
On adjacent lots a�
Absorption field on lot ' J.k ; On adjacent lots
Public sewer main C5,o Public sewer manhole/cleanout
Sewer service line Petroleum tank
I rS k,:r Ta VAf�-
WATER SAMPLE RESULTS: /
Coliform � 0--> Nitrate y� /
!� Gam` ' �� ✓ 0•"''2 °Ir� • Other bacteria
S & S ENGINEERING
Date of sample: �' �'�Z Collected by: WeS4 Eagle-Rlver'koap Rona N--. ?04
Eagle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts(Y/N)
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES
Wells) on lot
Tank size
Foundation cleanout (Y/N)
Alarm
Pumper
C/HOLDING TANK TO:
On adjacent I
To prope me Absorption field
Surface water/drainage
72-026 (Rev. 7/91) Front
Compartments
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Foundation R 1 , 1992
Water main/service line-
RECEIVED
i � � I
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
Meets MOA electrical codes (_Y/N<)
SEPARATIO ISTN 6 ANOE FROM LIFT STATION TO:
W on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Width
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM
Well on lot
To building found
On adjaceenn d
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
Cycles tested
Soil rating
—Gravel thickness
mp off" level at
Surface water
Cleanouts present (Y
System type
—Total dgpth— /
Date of adequacy test
RPTION FIELD TO:
On adjacent lots
Cutbank
r
If yes, give date
Property line
To existing or abandoned system on lot
Water main/service line_
Driveway, parking/vehicle storage area
bedrooms
i certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeq.gtjj !ie date of this inspection.
S & S ENGINEERING
Signature- 17034 Fag le River Loop Road No 04
1. IS
g Eagle River, /Alaska 99577
e:; i ceJ 7 oUao .
Engineer's Name
p, oho ,�,,-„
Date _. ��� `c-, IZ 3',i`(i a Rif
HAA Fee $ ,% Waiver Fee: $
Date of Payment 3—�/ 9 9-- Date of Payment
Receipt Number Receipt Number
/I CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
��eonnronr ` 5633 B
STREET
ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS RESULTS fox INVOICE # 51696
Chemlab Ref.# 92.0879 Sample # 1 Matrix: WATER
Client Sample ID
L2 B1 LITTLE BEAR
S/D
Client Name :S & S ENGINEERING
PWSID
: UA
Client Acct :SNSENGP
Collected
MAR 6 92 @ 14:30
hrs.
BPO# PO# :NONE RECEIVED
Received
MAR 6 92 @ 14:45
hrs.
Req#
Preserved with
AS REQUIRED
Ordered By :R. SHAFER
Analysis Completed : MAR 6 92
Laboratory Supervisor;—STEPHEN C. EDE
Released By : 'Q C ���
C"
...................................................................
Parameter Results Units
-------------------------------------------------------------------------
NITRATE-N 0.32 mg/l
Send Reports to:
1)3 & S ENGINEERING
2)
Method Allowable Limits
---------------------------------------------------
EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
...... ... ............. ............. ........... .._.�..
1 Tests Performed See SPecial Instructions Above UA -Unavailable
ND- None Detected See Sample Remarks Above
NA- Not Analyzed LT -Lees Than, GT -Greater Than
IM? SGS Member of the SGS Group (Societe Generale de Surveillance)
UN I C I PF;L 11 Y OF A1,1 riot Ac .
i1E-Pff,TiMEPI OF HEALTH MNID ENVIRMNIME PRO ECTION
825 L Street, AnchorDc'P. A_fzsha 9`;501.
264-41720
1: Time 3:00 a.m. 11,2
Late 11 -29 -77 --Tuesday
Time
Date
Date Received: November 28, 1977
43: Time
Date
Insp Pratt Snsp rnsa
!2EOUEST ''OR APPROVAL OF INDIVIDUAL SEWER AND W1,%TER FACILITIES
1, Lending Ir,s itu;.ion Request_: National Bank _of_Anc horage
Mailing Address: Post Office Box -3-3859 _99509 _ Phone: _____279-2506 _
Z. Property O�:n�er : Lawrence J. Sebring-- -�_. Phone: 344_3069__
Mailing Address;: Star Route A Box 1540C 99507
3, Lec=al Description: Lot 2 Block 1 Little Bear Subdivision- _—______
Babv Bear Drive, 2nd house in on right hand side
4 Single Family Res.denCe: (x) Number of Bedrooms: -
multiple Family Residence- 1) Number of Bedrooms:
-
5. ;^jell. System: Individual Well (x) Cor:auunity/Pub3_ic S_vs'l--em ( )
Permit # Depth of Well - -, Well Log on file (x)
Construction
bacterial Analysis C1.._, cz ��=�
6. Sewage Disposal System: On-si e System ( ) Puhlic Utility (x�
Permit $ I Installed - J Installer T— ----_---_--_-_--
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate
Material
7. Distances: ,Jell to Septic ','ar.} -- to Absorption Area
to Sewer Line - - Nearest Lot line -- ^-` Absorption. Area
to Nearest, Lot Line
li Page .3n�ro
DelpartPient of Ilea t -h and EnvironmentalI'roi-ectlol"t
Request for Approval of individual Sewer and Water I'aci]_l"t1_OS
Iega.l Descriptiorl: Lot 2 Block 1 Little Bear Subdivision
C°onunents :
Aztadavit Attached: ( � ) Letter Attached: ( )
Approved:
Disapproved:
Department Worksheet:
Date:
Date;
4.
1
6.
Realtor/Agent:
.Mailing Address: _
Legal Description:
Street Location:)
Single Family Residence: D-�o Number of Bedrooms:
Phone:
'Multiple Family Residence:. ( ) Number of Bedrooms:
'Water Supply: *Individual Well Public/Community System ( )
:If Individual Well: well depth
i
'If Community System, name of system
'Sewage Disposal System: On System
'If On-site System, date o£ installation:
( ) Public System M__,
*NOTE: A well log is required, on ALL wells drilled since 6/75.
3/77 NQ ,ctS 1�td�- 1' vA3 �)-oL
4
AUNICIPAL11
_•r ANk;iYQ,R,A45,;
Department
of Health'arbu
Environmental
Protection.
0
825 L Street, Anchorage, Alaska
99501
279-2511,
ext. 224, 225
guest
for Approval of Individual Sewer and
Water'Facilties
1
1.
Property
Owner:
�� C5
Cy� zG�•
Phone:
Mailing
Address: �J
i2.
' Name of
Buyer:
'Mailing
Address:
Phone:
3.
Lending
Institution:
Mailing
Address:
Phone:
4.
1
6.
Realtor/Agent:
.Mailing Address: _
Legal Description:
Street Location:)
Single Family Residence: D-�o Number of Bedrooms:
Phone:
'Multiple Family Residence:. ( ) Number of Bedrooms:
'Water Supply: *Individual Well Public/Community System ( )
:If Individual Well: well depth
i
'If Community System, name of system
'Sewage Disposal System: On System
'If On-site System, date o£ installation:
( ) Public System M__,
*NOTE: A well log is required, on ALL wells drilled since 6/75.
3/77 NQ ,ctS 1�td�- 1' vA3 �)-oL
Municipality of Anchorage
• f Development Services Department��� ,-
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _0 I - D6/- !t— COSA# O Cl O 1 (0 3
1. GENERAL INFORMATION Expiration Date: ! —
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
LITTLE BEAR S/D: BLOCK 1. LOT 2
6731 BABY BEAR DRIVE ' ANCHORAGE. AK • 99507
ROBERT TREBBLE Day phone 541-926-3490
Day phone
Real Estate Agent ANTHONY BORGES W/ REMAX Day phone 257-0431
Mailing address 110 W. 38TH, f100 ' ANCHORAGE. AK ' 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3.' -TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
❑
Community On-site
❑
Public Sewer
0
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certiried 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 riles 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. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 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, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there ere 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.
5. DSD SIGNATURE
_1/ Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the filowing
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Y OF
ON
.
ONSITE '�c=
WATERAND
: WASTEWATER
s� PROGRAM '
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: t/ �,� 1-il, Original Certificate Date: 6—/0-09
(R.,. IIMS)
Municipality of Anchorage ,
Development Services Department
\ .. Building Safety Division
On -Site Water & Wastewater Program "
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: LITTLE BEAR S/D; BLOCK 1, LOT 2 Parcel ID: D/ !f — Q C& /—/ 9
A. WELL DATA *ASSUMED BASED ON SURROUNDING WELL LOGS. SEE ATTACHED.
Well type t'EiNATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 2/2/1977 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
Total depth 90 ft. Cased to "40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 2/2/1977 5/26/2009
Static water level 23 ft. 15 ft.
Well production 25g,p,m, 5.7 g,p•m,
WATER SAMPLE RESULTS:
Coliform _0 colonies/100 mi. Nitrate 0.586 mg./L. Other bacteria _0 colonies/100 ml.
Arsenic: 1 ug./L. Date of sample: 5/28/2009 Collected by: GEG Ltd.
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_
I
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./Wor
Length ft. Width
Total depth - - ft. Eff. absorptio a ft,
dp /'— System type
ft. Gravel below pipe ft.
Monitor)ng tube_ Depression over field
Date of adequacy lest Results (Pass/Fail) For bedrooms
Fluid dept�abso n field before test _ in. Water added _gal. New depth _in.
Elapsed Tn. Final fluid depth in. Absorption rate >= g.p.d.
A rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off level at.=====irr—High water 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'+
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout •50'+
Holding tank N/A
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 FIEO1�L TTO:
Property line B ' ' oundation Water
PUBLIC SEWER
Water service line_,----' Surface water Driveway, parking/vehicle storage
Wells on adjacent lots
F. COMMENTS
*ADEC/MOA STANDARD IN 1977
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 6 / s/y 4
COSA Fee S y 10 Waiver Fee $
Date of Payment G' 4 5 � o
Receipt Number q�0 4 yy
(Rev. 11105)
Date of Payment
Receipt Number
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