HomeMy WebLinkAboutLITTLE BEAR BLK 1 LT 6Littl
Block
Lot 6
#014-061-23
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C, EF'RRTMEN'F : HERLTH RNE:, EN',.;ZRCNMEN"f'FI[' '~ROTECTZON
25~.0 E.
F'ERM I T NO. ,:.' ~"[52;O? )
TU[:,OR R[:,.., RNCHORRGE; FIK.
ED RINNER
E~'LRC:E
L6 B'_I. LZTTLE E:ERR
I IELLz, LEt CT '- ' '
LOT 2:I ZE
RF'PL I CRNT
LOCRTI ON
LEGRL
Ehq-00 ~.'-;QUFIF.:E FE:L:".'T
MINIMUM [:,ISTFINC:E BETI4EEN R 1.4ELL RND RN~r' ON-_,I]E SE[,.IRGE [)ISF'OSF~L E;'.r'STEM
~00 FEET FOR R F'RZVRTE WELL OR 200 FEET FOR R PUSLZC kIEL. I-
WELL L]3S RRE REQUZRED RND MUST BE RETLRNED TO THE [:,EPRRTMENT
OF THE WELL COMPLETZON.
E;PECIFIE:R'rIONS RN[:, CONSTRUC:TION DIRGRRMS RRE RVRIL. RE:LE TO INSURE PROPER
I NSTRLLRT I ON.
I uEF. TIF-r THRT
· l: I RM FRMILIRR WITH THE RE;!JIREMENTS FOR ON-SITE SEWERS; RNC, WELL.':; FYE;
FERfH BN.' THE MUNZCIPRLIT"r' OF RNCHdF..RGE.
2: I WILL INSTRLL THE ~=T~.M IN RC:CORDRNCE WITH THE C:O[:'ES.
~ I GNED: ..............................................
BF'F'L I CBNT El:, RINNER
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and 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. 014-061-23
1, GENERAL INFORMATION
Expiration Date:
Complete legal description LITTLE BEAR, BLOCK 1, LOT 6
Location (site address) 6671 BABY BEAR DRIVE, ANCHORAGE, AK 99507
Current Property owner(s) TERRI-ANN H BURCELL
Day phone
Mailing address
7131 HYATT STREET, ANCHORAGE, AK 99507
Lending agency
Day phone
Mailing address
Real Estate Agent
BERNARD POWELL - REMAX
Day phone 382-3322
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site r--1
[] Individual Holding Tank
[] Community On-site r-~
[] Public Sewer
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 sample results. (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
ordinanef~and regulations in effect at the time of installation.
..~ of Firm ARCTERRA CONSULTING, INC.
~'~t~"dress 20441 PTARMIGAN BLVD.r EAGLE RIVERr AK 99577
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 co;des,
Phone 868-3792
Engineer's Printed Name KENNETH M. DUFFUS Date 11/29/10
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate dUdng the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these vadous and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can 'not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms; with the followi:na.;~i,~ul~tions:
WATER AND
'. WASTEWATER
,, PROGRAM
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. 11/05)
Original Certificate Date:
Munkipality .of Anchorage
DeveioPme t services.'Department
Bui{di~g Safety DiVision
On-Site Wat~ & Wastewater Program
4700 Bragaw Street
P.O. Box 1966.50
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: [/7~LE BEAR, ]~LO~ 1, LOT 6
A. WELL DATA
Date COmpleted, 1/61~:9~'/·
Total depth 85 lt.
Date of test
static water level
Well:production
WATER SAMPLE RESULTS:
Parcel ID: 0,1~-06~'--23
Sanitary seal (Y/N) ~, Wires properly protected (Y/N)¥
Cased to 85 lt. Casing height (above ground) 2z~+ in.
FROM WELL LOG AT INSPECTION
~eA97'/ 11/23/2010
12 g'.p.m. 7.5 g,p.m.
Coliform NEG colonies/100mL Nitrate 0.642
Arsenic: 5.0OU .mg!l:'- Date of sample: 11/23/20'10
B. SEPTIC/HOLDING TANK DATA - PUBLIC SEWER
Tank Type/Material Date.ins~lled
Number of Compartments Cleanouts (Y/N)
High water alarm (Y/N) Date of pumping
C, ABSORPTION FIELD' DATA - PUBLIC SEWER
Date installed Soil rating (g~p.d./lt2 or ~/bdrm)
Gravel below pipe __
Monitoring tube ~
mg/L
Collected by: AzcTerra
Tank size gal:
Foundation cleanout (Y/N)
Pumper
System type
It. Total depth __
Depression over field
Results (Pass/Fail) __
Depression overtank (Y/N)
__ in. Water added__ gal.
__ in. AbsOrption rate >=
Length _ ft. Width _ ff.
Eft. absorption area ff~
Date of adequacy test
Fluid depth in absorption field before test
Elapsed Time: __ min. Final fluid depth
lt. (bottom of effective)
For__ bedrooms
New depth in,
Any rejUvenation treatment (Past 12 mO.) (YIN & type) _If yeS, giVe date __
g.p.d.
D. MFT STATION
Date installed
"Pump on' level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at~
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septi:c tank/lift station on lot NA
Absorption field on lot NA
Pablicsewer main 73'+
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/c[~nout 100'+
Property line
Water Service line
Curtain~drain
F. COMMENTS
Animal containment areas 50'+ Manure/animal, excrete storage areas
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 FIELD ON LOT TO: - PUBLIC SEWER
Building foundation Water main
Surface water Driveway, parking/vehicle storage,
Wells on adjacent lots
100'+
· 'pa
review of Municipal records that the above systems are in "~'.. ~.
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNE'[T~ M. DU]rFUS
Date II/23/2010 ::'~:":'
COSA Fee $490.00 + $294.00 RUSH ($784)
Date of Payment ~/?xo[ie
Receipt.Number 00.~'1~ C
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
Or>Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650 - ]
Anchorage, AK 99519-6650
www.muni.org/onsite
· (907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEFIS ,b, pp FOR ,b, SINGLE FAHILY DWELLING
COSA#
Expiration Date:
Parcel I.D. Olq-O l
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
LITTLE BEAR; LOT 6~ BLOCK 1,
6671 BABY BEAR DRIVE '~ ANCHORAGE, AK 99507
LAURENCE NAKEA Day phone
6671 BABY BEAR DRIVE * ANCHORACE, AK 99507
Day phone
344-3536
Day phone
Un/ess otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ..%
3. TYPE OF WATER SUPPLY:
Individual Well ~r~
Individual Water Storage
Community Class Well [~
Public Water System
TYPE OF WASTEVVATER DISPOSAL:
Individual On-site ~
Individual Holding tank
· Community On-site [_~
Public Sewer
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 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.
Nameof Firm GARNESS ENGINEERING GROUP. Ltd.
Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attemptod to pmvido a thorough,
conscientious enginee#ng analysis of the system in accordance with ADEC and MOA
DSD Guido/ines & Regulations. The reported results descdped the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily idontifiablo features. The operational life of all wefts and
septic systems depend on the local soils condition, groundwater levels that may
£ucfuate dudng the year, and the water usago of the family being served by the system.
These conditions ere outside the control of tho eva/uator of the system. Satisfacto~/ test
results do not guarantoe future perfocmance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provfde
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 I~gal right whatsoever.
5. DSD SIGNATURE
~ Approved for
bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advi.sory
bedrooms, with the fllowing stipulations' ,,~..
,~ v,, .....-~ ~
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
Odginal Certificate Date: , ~'"~ ~.~ 0 '~ ~) (~
Municipality of Anchorage
Development Se ices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bmgaw Street
P.O. Box 196850
Anche~age, AK 99519-6650
www.muni.oeg/onsite
(~07) 343-7~04
CERTIFICATE OF 0N-SITE SYSTEHS ~,PPROVAL CHECKLIST
Legal Desc~pflon:
UTILE BEAR; LOT 6, BLOCK
ParcellD:
A. WELL DATA
Well t,Aoe PmVAT~ If A, B, or C provide PWSID~ N/A
Date completed 1/6/1977 Sanitary seal (Y/N) YES
Total depth 85 ft. Cased to 85 ff.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 1/6/' 1977 5/11/2006
Static water level 24. ft. 28 ft.
Well production 12 g.p.m. 6.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonlas/100 mi. Nitrate .~,~._mg.~.
O
colonies/100
mi,
Arsenic: .N.~ ug./L. Date of sample: 5/11/2006 Collected by: G£G Ltd,
SEPTIG/HOLDINO TANK DATA PUBLIC SEWER
Date installed
Tank Type/Material
Tank size gal. Number of Com~
F/ujdatio d~~..~~ 2r tank ~/N) H~h water alarm (Y/N)
C. ABSORPTION FIELD DATA
~atment (past 12 mo.) (Y/N & tTpe)
Date installed Soil rating (g.p.d./ff*or ft~/bdrm) System type J
Length ft. Width ft. Gra~ ft.
Total depth It. Eft. absoll~tion ama ft' ~ Depress7 over field --
Date of adequacy test ~'~ail) ~ For bedrooms
Fluid depth in absoq~tion flel~. Water added gal. New dep~ in.
Elapsed Time: .mlrr~. Final fluid depth in. Absoq3tion rate >= . g.p.d.
If yes, give date
D. UFT STATION
Date installed Size in gallons
In.
"Pump o~" level at in. "Pump ~__~~. High ~ter alarm level at '
~ Cycles tested. Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanlUlllt station on lot N/A
Absorption field on lot N//A
Public sewer main 75'+
Sewer Iseptic service line 25'+
Animal containment areas 50'+
On adjacent lots I C)~ 'F ~
On adjacent lots 100'+
Public sewer manhole/cieanout I00'+
Holding tank N/A
Manure/animal excrete storage areas
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water se '
PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
SEWER
Property llne Building foundation. Water main
Water sewice line Surface water ~cle storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections end
review of Municipal records that the above systems are in
conformance with MOA CO,SA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
CC)SA Fee ~
Date of Payment
Receipt Number
(e~v. 1 ~/05)
Waiver Fee $
Date of Payment
Receipt Number
$GS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
1062324001
Gamess Enginccrlng Group, Ltd.
Little Bear Lot 6 Block I
Little Bear Lot 6 Block I
Drinking Water
All Dates/Times are Alaska Standard Time
PHnted Date/Time 05/22/200~ 9:54
Collected Date/Time 05/I I/'2006 10:45
Received Date/Time 05/I 1/2006 I ] :3 I
Technical Director Stephen C. Ede
t4etals b~ 'rcp/HS
Arsenic
ND 5.00 ug/L EP200.8 C (<-10)
05/12/06 05/17/06 SCL
Waters Department
Nitrale-N 0.754 0.100 mg~ EPA 353.2 B (<-I0) 05/11/06 ALR
Hicrob/.oloeJy Laborato~d'
TotalColiform 0 colll00mL SM209222B A (<-I) 05/11/06 TLF
B~BY
DRZVE
8. O0 10' 23" E.
~ ..~E RECE VED
~ INSPECTION APPOINTMENTS ~~.~)
TIME ~ TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECT~:~
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHO~A'GE
DEPT. OF $]EALTH &
) ~EPA~m~T O~ ~L~U ~ ~UW~O~E~T~k ~OT~C~IO~
825 L Street - Anchorage, Alaska 99501 ~NVIRONMENTAL ~ [:OTECT ON
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
BEO~EST FOB ~PPBOVAE OF I~DIVIDH~L ~TE~ A~D
DI ~fi~TIO~8: Complete all parts on paoe 1. Ineomplato roqu~sts ~ill not bo proeessod. ~lease allo~ ten {10) days for processing.
1, PROPERTY OWNER ' ~HONE
MAILING ADDRESS
PROPERTY RESIDENT (If different {rom above) PHONE
PHONE
2. BUYER
MAILING AD D~ESS
3. LENDING INSTIT,T,O,
4. REALTPR/AGENT. ~:,[~ PHONE .
MAI LI~6'~D~ ESS '
6. TYPE OF RESIDENCE
[~' SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED.
.~ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72 010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
Pf=RMIT NUMBER
2. WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[~]Septic Tank or []Holding Tank
Size:~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest ~ot Line
5, COMMENTS
[j~-"'7~PP ROVE D FOR .~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
GREATER ANCHORAGE AREA BOR~
Department of Environmental Quality -~-"c~
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received March 7, 1977
Time of Inspection 9:30
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
1. Approval requested by: Spokane Mortgage Company
Mailing Address: 3201 C Street, Suite 250
2. Property Owner: Draheim Construction
% Marwick
4.
5.
6.
Phone:
Phone: 349-3702
Mailing Address: Star Route A Box 1635-D
Legal Description: Lot 6 Block 1 Little Bear Subdivision
Location:
Baby Bear Drive
Type of facility to be inspected Single Family No. of bedrooms 3
Well Data:
Permit #76307
A. Type Individual
C. Construction
Sewage Disposal System: Public Utility
B. Depth 85 '
$. Bacterial Analysis O ~,/~. ~z/,~
A. Installed B. Installer
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
1. Size
1. Absorption Area
Total length of lines
2. Manufacturer
2. Material
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
C, Absorption area to nearest lot line
E0-034 (1/74/ Pam~ I nf twn sss~n
P~ge 2 of two pages - R¢~'~st for Approval of Individual ' ~er & Water Facilities
'Legal DescriDti0n Lot 6 Block 1 Little Bear Subdivision
Comments
Approved ~.~~ Disapproved Date ~
ApprOval .,Valid for one year from date signed
Greater Anchorage Ar~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
./
REQUEST FOR APPROVAL OF
'[N~JI"~IDUAL SEWER and WATER FACILITIES
2. Property Owner:
Mailing Address.~
3. Name of Buyer:
CONV_
Mailing Address: . ~ o'A y' Day Phone:
4. Name of Lending Institution:
Mailing Address: ~' ~¢ ~¢'~ ~¢~--~ Phone:_
5. Name of Realtor or Agent:
Mailing Address: ~/0
6. Legal Description: ~/' ~
.ooatio.:
/
Type of Facility to be Inspected:
No. Bdrms..~
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well ~
.Individual
9. Sewage Disposal System
Type of System: Public Utility.
If Individual, date of installation
Individual (on-site)
72-003(3/76)