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HomeMy WebLinkAboutLITTLE BEAR BLK 2 LT 6 W V LI U M CPAU ❑ tl OF /\ H C H 0 V /\ ,7 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014-061-33 Expiration Date: _-5- I -Z,D ZZ, 1. GENERAL INFORMATION Complete legal description Little Bear Block 2 Lot 6 Location (Site address) 6630 Baby Bear Dr, Anchorage, AK 99507 Current property owner(s) Helene G Davis Day phone Mailing address Real estate agent 6630 Baby Bear Dr, Anchorage, AK 99507 _.Cdr mi Gubser 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone (907)830-3228 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑■ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requestedby the engineer. COSA Fee $ 1 Waiver Fee $ Date of Payment 2-19 T Z0 ZZ Receipt Number (V!p ©3 SIP COSA # 05 C-1 A 1 D 5'1 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, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering (M.J.) Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 2/14/22 OF:4 kl1 *:.as TH _ * r 6. DSD SIGNATURE 3 � :'���' .. ......... System #1 Approved for bedrooms / Benjamiry chillerCE / System #2 Approved for bedrooms �F��`��F 2/14/222,,! _.. .., dW Disapproved �ll�, PROFESSO4 Conditional approval for bedrooms, with the following stipulations: `g ON-SITE 9 WAST. -V ATER r OGRAM 1n-- 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Little Bear Block 2 Lot 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA R Well log is filed with Onsite (or attached) Date drilled 12/3/1976 Total depth 56 ft Cased to 56 ft Q Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 2/7/22 Static water level at beginning of test 11.3 ft. Comments Property served by public sewer system ;010,411121111 1 Age of tan years Tank type/material Measured operating fluid �Ievetic ❑ Standpipes/foundation cleanout per Date of pumping tank drawing Parcel ID: 014-061-33 Structure served by this system Well production at time of test 8.2 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 2/8/22 T STATION ❑ Require aintenance completed Age of lift station years Lift station material Comments: SORPTION FIELD DATA Which sys ested (date installed) Adequacy test date ❑ ALL standpipes p t per record drawing Results ❑ Pass For _ Total measured depth from gra ft (max) Fluid depth prior to test _ Measured depth to pipe invert from gra ft (min) Water added gal ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state New depth in depth into effective lapsed time min ❑ Code -required soil cover over field Final epth in ❑ System presoaked Absorption rate gpd - (Required if vacant for greater than 30 days prior to Any rejuvenation treatmen date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet _ bedrooms in Q.st 12 months) E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Q Yes if No ft Neighboring Tank > 100' © Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft [D Yes if No ft >40* Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' El Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10.' ❑ Yes_ if No ft Community Wells >..200' r-1 Yes . if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells >100' _ El Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS 'Public sewer installed Drior to well drillinn XNA1 gnnrrwrzr) in 1 WA k G. ENGINEER'S CERTIFICATION .4 k��� i certify that 1 have determined through field inspections and review *.-49 TH • ' � of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. •" , Benjam rp�Schiller �¢ �Fc •, CE 12592 •��`���''� �j i��F�• 2/14/22 �'pROFESSOW COSA Checklist yellow sheet 0 0 EAST 139.92' X X X_—_ F- Zw o w J Ow>O �-' Q 0 U o N U w w OF_U UTILITY EASEMENT x w r�o N QXZ a ww� >n. 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CONNECTION FEE: DATE PAID I 1CONSE11,111ATE1 MO DAY CONNECTION FEE PAID BY: CONNECT FEE RECEIVED BY: f ��YR . •. I �� RES APT. NO UNITS AMOUNTDEPOSIT i CONNECTION INFORMATION SIZE INCH/C 0, REF CONNECTTOTRUNK CONNECT TO LAT YES 0 NO 0 YES HO C0l ECTION LOCATION j 1 .-, \. (}�.I 17 1 SERVICE STATUS iF11NK CFpVff`C 0[]hVIhCM1 GY IAf CNI•VI. LATERALASSMT.: TRUNK ASSMT.: CONNECTION FEE: DATE PAID DATE PAID AMOUNT PAID CONNECTION FEE PAID BY: CONNECT FEE RECEIVED BY: DATE- 0&MAGENCY CONNECTAGENT AMOUNTDEPOSIT i DATE DEPOSIT M0. I DAY I YR PAYER NAME PAYERADDRESS CITY STATE ZIP CODE f t BASIC I PREM. TYPE BILLCODE BILL 401CATOR TIL EI I f BILLING AGENT RATE CODE ACCT NO. CUSTOMER BILLING NOTICE BILLING DATE DATE FWD. CORRECTED BILLING ADDRESS i CORRECTED BILLING CORRECTED BILLING ADDRESS E COMMENTS S, FORM PW -023 os SEWER MAINTENANCE DEPT. 0 \ I I X m 0 . z w :r T 0 M 0 (D -h 0 0 r o 0 0' o W 0 r r -3 + 41JON BIDOIPUI ('I , X k J� "0 D 0 0 bo,N 4 a m N WLL Z Z -:3 (h I O W cn 0 c c 0- 0 W U) 0 0 c 0 0 E J V) C 0 u U)< < E . C) 0 yL N Q) 0 (1) C C - D D L OL U) L 0 L E O cl L 4) >, (D a (I E < 00 -o (r n U LL No 0 C�30 C C 0 "a 0 — 0 0 4) 0 0 4) v) > > > F 0 L c c c 0 0. 0 c c 0 a a < 0 0 c 0 z D . o a) 0 OL >, a- a 0) El Lt W 4) (D 0 c CL a OL 0 0 00 a) 0 UUJ c > 0 c 000E z w < z > E) c 0. O C) c c c 0 c 0 c > 0 C - c — 0 0 0 0 0 u w u W Q) 3: E u u) L 0 - E c E Q) a E Q) c .0 w 0 :) 0 (f) z W -i N N V) (v a U) W 2! m < 3 0 �o 0 x o E u 0 o c 0 u FERi'iI I N0. FIPPLICBNT LOCBTI3N I_EGBL [ EF RR'f MENT ' ' HEFtLTH HN .: EN',.,' I RONh'IEN'TFIL ' -"~OTEE:"f' !' ON - " - ' -'-- 9.:- 25'_1.0 E. i IjE:,OR F::[:,. , HNt..HLIRFIt¢I~ .... 2'7E -2 Er.:, RINNER BFtB"r' BEFtR PLRCE t.6 B2 LITTLE BERR SUBD 83:'.:L0 WELLSLE"r' COLIRT LOT :.-.-;I.-ZE :_.:4tDt.,] SQI_tRRE FEET MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM i¢..}(4 FEET FOR R PRIVRTE WELL OR 2EIE~ FEET FOR 8 F'UBLIC WELL. WELL LOGS. RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 3:E'.' DFW:S OF THE WELL COMF'LETION. ,_ ,_. · ' '- ' F' "l , G "'-''-- SF'ECIFICRTIONS RND C. LIN=TRU_,TILN [:.IRmRHfl-, RRE Ft',,,'RILRBLE TI] IN=,LF.E F:'ROF'ER INSTRLLRT ION. F'EF-:i--1 ][ 1' %.'RL ]C lC:, F-C,R E,~'-tE '-/ERE.' F'RC, lPl .~ I CERTIFY THAT 1: I RM FRMILIRR WITH THE REQUIREMENTS FUR ON-SITE .~,EWEF,.=, RN[:' NELL-~ RS SET FORTH Db' THE MUNICIPRLITY OF RNCHORRGE. 2' I WILL INSTF~LL THE SYSTEM IN RCCOR[:'RNCE I.,.IITN THE CO[:,EL: 8521 GOLDEN ANCHORAGE, At,.ASKA 99502 PHONE 344-0651 · _~ ,,~ _. =-' MUNICIPALITY OF. ANCHORAGr~'', '~-~ ~"~!~(:-~:,' ~-,,D'.E. PA:R:T, MF%NI;"~uF: HEALTH AND ENVIRONMENTAL. PROT:ECT'I, ON :,,-~' '~'' . '.~j'~'~ '~ · ~'. ' 825 .'L Street, Anchorage, Alaska 99~01 - ~ D~e Received: March 17, 1977 1st Inspection: Time Date Inspector 2nd Inspection: Time Date Inspector REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES o Lending Institution Request: Mailing Address: Phone: Property Owner: Neal Draheim Mailing·Address$ Star Route A Box 1635D Phone: 349-3.7'02 Legal Description: Lot 6 Block 2 Little Bear Subdivision Single Family Residence: (x) Multiple Family Residence: ( ) Well Data: Type Individual Construction .~/~/J~-~m~~ . Number of Bedrooms: Number of Bedrooms: Depth 56' Bacterial Analysis Well Log Filed ( Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-site system Installed Installer Manufacturer Soils Rate Public Uhility (~ Material Distances: Well to Septic Tank 'ho Sewer Lines Nearest Lot Line Absorption Area to Nearest Lot Line to Absorption Area .ge.Tw°, ,..i De~arrtment of Health :andl Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description[ Lot 6 Block 2 Little Bear Subdivision Co~ent s: Affadavit Attached: ( ) Letter Attached: ( Approved: ~ Disapproved: Date: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE MUNICIPALITt OF ANCHOPJ,G~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTI~, OF H.!,,\[,'r;I" 2510 East Tudor Road, Anchorage, Alaska 99504 276.2~.j~!~IRONMF. HTAI- P~OT;~(;TIQN~, REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: CM R O VA FHA 3. Name of BUyer: Mailing Address: '~4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Day Phone: Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: /~ ~- ~-~ No. Bdrms, ~ Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) 7.6 72-003(3/76)