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Home My WebLink AboutBEAR PARK LT 5Bear Park Lot 5 #051-042-71 MUNICIPALITY OF ANCHORAGE On -^Situ Water & Wastewater Program PC Bax 1066!* 4700 E7rrwm Road An[hCr;§g_•, N3Ska99519- Phone' (PM _%$? 7904 Fmm; (1WI 343-7097 hdP.Awww.rmnimrgfona110 On -Site Wastewater Disposal System Permit Permit Number. OSP22119! Work Type., Se *;Tank Upgrade Tax Code N umbar: 0.5104271000 Site Legal Add rens; BEAR PARK LT 6 (3:155$ Sit,c MailIng Address: 22541 URSA MAJGR CIR, Chuglak Owner_ SIMS CHARLES A & HANNAH L Desig n I- n9ineer; FIRST WATE R CONSULTING Effective Iia to Ex p iratl0 n Date, Lot SIZE' in Sq Ft Total Bcalrooms; �tierlr e 1117 LL Uttpartmcnr &ZTf2022 eW71 12023 477$4 This permit Is for the -c-o nstrtl ction of: ❑ Disposal Field Ff Septic Tank ❑ Holdilig Tarek 0 Privy ❑ Private Wf.II L Water Storage AI I im ns#ruc6an shal I be In accords nce with: 1, The alta ched approv-L!-d der ign, 2- All req uirernenis specified in Anchorage Miuridpal code Chapters 15-55 and 15, 65 a nd the State of Alaska Wa5texvater Disposal RageAallon s (16AAC72) and arinki nU 1N2ter ReguleUortis (18AAC80) :3. The wastowatar oodo rogvii= Ei,,iW:w lWrva Juring the inntellallcin- The engineer U1 all Iluliry+ Ll ie Uewulupi ikr- -i it Services [NipLarbrnont per AMC 15.65. Provid-o nolifientlan by calling [907) 343-7904 (241?)_ 4- From October 119 to April 15, a s u bs urface soil absorption system urw*r oxtst ion duTf rkg freezing wealhcr shall be either; a. Opened and GIosed €art the Same deny, or h- Covered, sealers, and heated to prevent freezing Received 13Y' Date: 1 I I Lesued By;PeAc_cxDate/we"? - ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 1 051-()lAa-1 t Property owner(s) Hannah & Charles Sims Day phone Mailing address 22541 Ursa Major Circle, Chugiak, AK 99567 Site address 22541 Ursa Major Circle, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) BEAR PARK LOT 5 Legal description (Township, Range & Section) Lot Size 47,764 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank Q Upgrade x (D) ❑ Holding Tank ❑ Renewal EJDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: aD' 5 Waiver Fees: Date of Payment: % I _I 31,2 0' Date of Payment: Receipt Number: ®131 L( N Receipt Number: Permit No. 0 S e a -'� 11 � 9 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 9, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: BEAR PARK LT 5 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 5-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221197, Rebecca Carroll, 06/21/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COM� OSP221197, Rebecca Carroll, & DESIGN DETAILS: sEff IC - P"c Cwc s INSTALL NEW 1500—GAL HDPE .ST -EP' TANK. MAINTAIN 10'+ FROM FOUNDATION, 100' TO WELLS, 100' TO SURFACE WATER, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. NSTALL PER AMC 15.65, 15.55, & MASS ... TANK BEDDING, SEPARATIONS, MATERIALS,... �v P IN NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK. VERIFY PRIOR TO CONST. T��ESMT. BEAR PARK LT5 SUPPORTgSERVICES: F®® PREPARED FOR:F `�� HANNAH & CHARLES SIMS _ '01, 22541 URSA MAJOR CIRCLE C �* 9 TI CHUGIAK, AK 99567 .� FIRST WATER CONSULTING DATE: 6/9/2022 rtes Huffman �g4 SURVEY: LANG r� . CE 128991 w 13030 SUES WAY DRAWN: FWCS , 6/9/2022' �Af ANCHORAGE, AK 99516 SCALE: 1" = 30' 907-350-9566 FirstWaterAK@gmail.com PAGE: 1 of 1 ®®��®®® Municipality of Anchorage.°- © Development Services Department Building Safety Division e, . Onsite Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW030265 PID Number: 051-042-71 NameJohn Heron : Wastewater System: ® New ❑ Upgrade Address: B 672282, Chuaiak.AK. 99567 ABSORPTION FIELD ❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound ❑ Other: Phone: 688-9490 Number of Bedrooms: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade : 1.2 GPD/Ft` 8.0 Ft. Block: Lot Subdivision: Depth to pipe bottom from original grace: Gravel depth beneath pipe: 5 Bear Park 3.88 Ft. 4.12 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 0.4-2.04 Ft. 65 Ft. Well: ® New ❑ Upgrade Gravel width: Number of lines: Distance between lines: 5.0 Ft. 1 na Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Private Ft. 224Ft. 650 Fig D3034 & F810 Driller: Date Drilled: Stsbc Water Level: Installer: Date Installed: Sullivan 7/29/0 0 Ft. RPC 10/14/2003 Yield: Pump Set at: Casing Height Above Ground: TANK 25 GPM unknown Ft. 2 Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public/PrivatE Manufacturer:Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1500GaI. Well 100'+ 100'+ NA NA 25'+ Material: Steel Number of Compartments: 1 2 Surface Water 100'+ 100'+ NA NA LIFT STATION Lot 5'+ 10'+ NA NA ize : anu ac ureic Gal. Foundation 5+ 10+ NA NA 'Pump on' level at: "Pump ofr level at: High water alarm at: n. in. n. curtain Drain NA *50'+ NA NA Pump Make &Model Electrical Inspections performed by: Remarks: *none known BENCH MARK Location and Description: Top of sona tube Assumed Elevation: 100 Ft. Engineer's Stamp OF A44 , Inspections by: KIND Engineering, ;;;�,• performed Inc.Dates: 1Bt 10/14/2003 ! ..;,� •..•,•, Developme 2nd • ••.. .•... ...,�•...I KennCE%71.t• u ut Ji ej; t Services Department Approval 3'd Io t oy ��:�. Reviewed it • OSA �t/•3��• and approved by: Date: 5 •••��0,:' AFD• (Rev. 12/00) deoFESs ��4 IAS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030265 I BEAR PARK SUBDIVISION LOT 5 PID# 051-042-71 A -H= 50.3' B-H= 50.7' U3lucas;D.a W9 t EXISTING 1500 GAL SEPTIC TANK TH03-1 X1' -PM 5 �Src N MT SLOPE=FLAT z H rn w SCALE, 1' = 30' FINAL GRADE 99.26 / 92. VMiRS 87.8 T SEWER ROCK .� 83.7 65' 73.7 .n PREPARED FOR; JOHN HERON PO BOX 672282 CHUGIAK, AK, 99567 (907) 264-1825 SCALE: NTS FIELD BOOKS COMMM: ND ENGINEERING SOUNDAR' LANG DRAWN: WAC STADNG: CILEC; : KMD 20441 PTARMIGAN BLVD. ASSUar. LANG DAM: 10/28/04 EAGLE RIVER, AK 99577-8736 DWG. RLE: GRID: NUN FFA..................................................._.__._.__.. ... 03102 1 , , KND ,- , , , , E� G GPEtiP \N RE 1p0, , A -C=15' B -C=18.6' A -D=19.6' H 93.81 93.9 B -D= 30.7' «w r aEA A-E= 24.5' B -E=54.2' W 40 A—F= 55.7' A J J ti 1500 GAL $ B -F=52.8' ` SEPTIC am TANK A -G= 26' B—G= 55.5' 88.2 88.12 A -H= 50.3' B-H= 50.7' U3lucas;D.a W9 t EXISTING 1500 GAL SEPTIC TANK TH03-1 X1' -PM 5 �Src N MT SLOPE=FLAT z H rn w SCALE, 1' = 30' FINAL GRADE 99.26 / 92. VMiRS 87.8 T SEWER ROCK .� 83.7 65' 73.7 .n PREPARED FOR; JOHN HERON PO BOX 672282 CHUGIAK, AK, 99567 (907) 264-1825 SCALE: NTS FIELD BOOKS COMMM: ND ENGINEERING SOUNDAR' LANG DRAWN: WAC STADNG: CILEC; : KMD 20441 PTARMIGAN BLVD. ASSUar. LANG DAM: 10/28/04 EAGLE RIVER, AK 99577-8736 DWG. RLE: GRID: NUN FFA..................................................._.__._.__.. ... 03102 1 FROM FAX NO. Aug. 20 2002 05:54PM P1 iT P'i Vit, by 000 CoA. WTER WELLS Gk SULLIVAAe TELEPHONE 688-xw I? K, ALAPKA 99567 i�cv P.O. BOX 670272, CHUGIA p?. OWNER OF LAND: 0 it ADDRESS: LEGAL DESCRIPTION: C'' 0e.. MAL( DATE: BERM;I eNt M B E P- - D a t e, q f Issue" TAX I DIE NTI FI QATI 0 N N U M 6 ER: I_- 4L4tA 7 Is well located at approved permit ocatio0 ID No Method of Drilling: ki-eeKtary -j cable tool Depth of well: Casing Type S=gSc7-4-Wall Thickness inches Diameter 6 inches, depth feet Liner Type: Casing Stickup Above Ground:'feet Static Water Level: 44444-lIr%IG feet RecoverRate: Atr qpm Method of Testing; LA -t well Intake Opening Type: men end 0 open hole ;I Screened; Stprt feet Stopped feet -a Perforations Start feet Stopped feet Grout Type:/-%F-,,J'y'"4 vol Depth: from. 0 - feet, to '10" feet Well Disinfected Upon Completion? 0 Yes Zi No Method of Disinfection: Comments! A Y 6A'dlla�- ariller's Name ATTMTION: It is the responsibility of the property owner to submit a copy Of the well log to the proper authority. Municipaiit,, of Annhornop: r3poArtment of Health & Human SPrvic,.P.q,Anej/nr PPOartmont of Pnvirnnmf tal Cnn.qp.rvntim NAAtR[, Rnm, 0n Department of Environment6i Conservation. e:. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 P-A7s��; 10 %l/� 7 60D Z/:,, ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030266 Legal Description: __ear a `Loi'05- Design Engineer: 0070 KND Engineering Owner Name: John Heron Owner Address: PO Box 672282 Chugiak , AK 99567- Date Issued: Jul 23, 2003 Expiration Date: Jul 22, 2004 Parcel ID: 051-042-71 Site Address: Unknown Lot Size: 47764 SO. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank .'❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date:2-q 103 Date: 72 -3lo- Municipality of Anchorage Development Services Department ma Building Safety Division On -Site Water and Wastewater Program r x a 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. a k. us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-71 Permit Number M010 2 4:5 Property owner(s) John Heron Day phone 688-9490 Mailing address (1) P.O. Box 672282 Chugiak, AK. 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub d) Bear Park Subd. Lot 5 Legal description (Section, Township & Range) Lot Size 1.10/47,764 Acres/Sq.Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: '> Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: XD ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-8111 July 11, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: New sewer/well permit — Bear Park Subd. Lot 5 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot. On June 20, 2003 one testhole was performed for the proposed system. The results of this test are attached. The general slope of this lot is flat. We have designed our system utilizing the existing testhole that was excavated for the proposed 5 -bedroom house. An individual well will serve the lot, located on the south- western portion of the lot. We propose to install one 5' wide shallow trench. Water was not encountered during the excavation or during monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, MHD Engineering Kenneth M. Duffus, P. . Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISPOSAL SYSTEM DETAILS%SITE 'PLAT BEAR PARK SUBDIVISION LOT 5 KND 11 � "' o' NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. OFA \ �9 Vr VKENN H....ETH FU CE -7116 / �4�' i P�F'ESSIONP�' o�d DESIGN DETAILS 5 BDRM X 150 GPD = 750 GPD 750 GPD/1.2 GPD PER SQ. FT. ( >1 MIN/INJ 625 SQ. FT (625/5'(W)) X 0,5(REF) (4,0' GRAVEL) = 62.5 FT. TRENCH USE 1 TRENCH - 63 (L) X 5' (W) X 4.0'(D) Total depth of system is 8.0' from original grade. Total depth of gravel below distribution pipe is 4.0' NOTES: 1. USE 1500 GALLON SEPTIC TANK, INSULATE IF <4' OF COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 27. SLOPE INTO SEPTIC TANK, 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED, 1 5, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED FOR, JOHN HERON PO BOX 672282 CHUGIAK, AK, 99567 (907) 264-1825 FIELD BOOKS BOUNDARY: LANG STAKING ASBUILT: DWO. FlIE: ACAD MUE: 03057. COMPUTED: DRANK: CHECKED: DATE: CRID: JOB No.: 03057 Scalel 10= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 WASTEWATER DISPOSAL SYSTEM DETAILS BEAR PARK SUBDIVISION LOT 5 / / / / / / / KNE ZZ 5 6 �5�\I S N� SLOPE=FLAT D) SLOPE=FLAT PROPOSED 1500 GAL SEPTIC TANK C9 78' ii ...FIELD BOOKS cow,nm: B NDARY: ANG DRAW: VBG C, O AWUILT: DATE: 7/14/ W oz Acro 19 E: 03057.DWG '10B "°'` 17, i LL Lu Lu w 03-1 E = FLAT In A-4 a � cn 0O m M 0� n� �* 9.TH *� �. ............ ... ..,..._I EEN. ... .. sK�' CE -7116 .' sv� 1 10 A AW P�FESSI013P5' Aw CO /------- ------ 43'/ PREPARED FOR: JOHN HERON PO BOX 672282 CHUGIAK, AK. 99567 (907) 264-1825 ...FIELD BOOKS cow,nm: B NDARY: ANG DRAW: VBG STAKING: CHECKED: KMD AWUILT: DATE: 7/14/ Dw. nM cRID: NW155 Acro 19 E: 03057.DWG '10B "°'` 03057 -----------¢ -- Scale: 1'= 20' PAGE 2 OF 2 =11 1 J UJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 KJIV D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 6 G AC V# CE 7116 SOILS PERCOLATION TEST kz�119 fESSOP\' Performed for: John Heron Date Performed: 6/20/03 Project: Bear Park Lot 5 TEST HOLE # 2003-1 Depth ORG/OL- red/brown silty SEE ATTACHED SITE PLAN 1 -peer overburden w/ organics FOR HOLE LOCATION 19- 20- SP/gp - grey loose sandy gravel w/ occ. cobbles to 1' coarse sand & moisture increasing w/ depth. Insitu material suitable as filter. B.O.H. HOLE PRESOAKED PRIOR TO TEST Was Ground water encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 07/01/03 Reading Date Gross Time Net Time Depth to Water Net Drop 1 7/1/03 1:00 6" - 2 1:05 5 min dry 6" 3 * 1:06 6" 4 1:11 5 min dry 6" 5 1:12 6" 6 1:17 5 min d 6" 7 1:18 6" - 8 1:23 5 min dr 6" 9 * 1:24 6" 10 1:29 5 min dr 6" 11 1:30 6" - 12 1:35 5 min dry 6" * Water Added Percolation Rate < 1 (min/in) Perc Hole Diameter 6" Test Run Between 4 feet and 5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. FROM : VIDEO CORNER John & Beth Heron PO Box 672282 Chugia k, AIC 99567 907-688-9490 Municipality of Anchorage PO Box 196650 Anchorage, AK 99519-6650 FAX NO. : 9076680244 Jul. 14 2003 12:51PM P1 RE: Landowner construction of septic system _ .. _._ ......._ .....:: .. _..... ..... To whom it concerns: — -- I will be installing the septic system on Lot 95, Bear Park subdivision in Peter's Creek, AK. by myself'. My wife and I will be the owners of this lot upon closing on it after successful drilling of a well (prior to septic installation). KND engineering will•beinspecting the construction ofthe system per municipality requixc.-ments and the system will be installed according to MOA c.odes/requirements. If additional information is needed, we can be reached at 907-688-9490 or by cell at 406-546-4147. Thank you. r• L7.7:". 1-: Municipality of Anchorage 9/ VL4 �• 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 /gyp Parcell.D.05,1-17142-71 COSA # 6100 ' �O Expiration Date: Il - -7 - D 7 1. GENERAL INFORMATION Complete legal description Rear Park l nt 5 Location (site address)5,41 Ursa Majnr r4rrlP, rhugink, AK Current Property owner(s) John Heron Day phone mx Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: , 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER 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 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 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. • 1 � 1 • 1 ' 1 • • 1 • 1 • - i • i Engineer's Printed Name KENNETH M_ DIFFUS Date 7/20/07 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 during 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 various 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 OFAC, 11 system will function satisfactory for current or future ��p(E,...•••q occupants or can ArcTerra guarantee that no unseen c e� • ;s't�r, encroachments, deficiencies or discrepancies exist Iii• Ku:.r.a.:. L. U `�•'A. MP 5. DSD SIGNATURE . _Iffo� Approved forbedrooms. ,r+t�F9'•..7�2z�°Of;��% Disapproved. 14X AOFESS.tI Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other BY / Original Certificate Date: R — 7–!27 (Rn 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Sfte 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* Rear Park Let 5 Parcel ID: 051-042-71 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 7/29/03 Sanitary seal (YIN) -Y Total depth 224 ft. Cased to 224 ft. FROM WELL LOG Data of test 7/29/03 Static water level flowing ft. Well production 25 9 - p.m - WATER SAMPLE RESULTS: - Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 24in. AT INSPECTION 7/19/07 unknown ft. xp/, &V- ueC� l�r ✓es:•id / /t.u.cw r s 411 `� i/"7/p g.P.m. Coliform _tZaolonies/100mL Nitrate a_ 11 mg/L Other bacteria 0_colonies/100 ml- Arsenic: L Arsenic: /J Q mg/1 Date of sample: 7/19/07 Collected by: AreTerra Ena. B. SEPTICIHOLDING Tank Type/Materiai Septic/Steel Data installed 10/14/03 Tank size 1500 gal. Number of Compartmentq_Z Cleanouts(Y/N) ]IFoundation cleanout(Y/N) Y Depression over tank(Y/N)19 High water alarm (Y/N),.N&Date of pumping 7/17/07 Pumper JR PUMPING C. ABSORPTION FIELD DATA Date installed 10/14/03 Soil rating (g.p.d./fte or fe/bdrm) 1.2 System type D TRENCH Length -U ft. Width -k ft. Gravel below pipe 4.12 ft. Total depth $ ft. Eff. absorption area 650 fe Monitoring tube 1f Depression over field 11 Date of adequacy test 7/19/07 Fluid depth in absorption field before test 4.5 in. Elapsed Time: 420 min. Final fluid depth j,5 in. Results (Pass/Fail) PASS For,$_ bedrooms Water added 770 gal. New depth 12 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date ----- D. LIFT STATION Date installed NA 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 10 0 1 + Absorption field on lot 100'+ Public sewer main 7S'+ Sewer /septic service line 251+ On adjacent lots 10 0' + Public sewer manhole/cleanout _ 1 00'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 10 0 0 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10 1 + Absorption field --S'+ Water main 10'+ Water service line 10 1 + Surface water 100'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -IQ±-Building foundation 10+ Water main _ 10 1 + Water Service line 10'+ Surface water 10 0'+ Driveway, parking/vehide storage 10 P + Curtain drain 50'+ Wells on adjacent kits -10 0 1 + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review Of Municipal records that the above systems are in 1k .•' • -, f j conformance with MOA COSA guidelines in effect on this ` date. s Engineer's Printed Name KENNETH M- DUFFl15 ��` �1,•.;:' Date _07!20!2007 t��Fpy. COSA Fee $430.00 Date of Payment 9-3-07 Receipt Number _q (Rev. 11/05) Waiver Fee b Date of Payment Receipt Number SGS Ref. #: Client Name: Project Name: Client Sample ID: Matrix: PWSID 1073578 Arc Terra Bear Park, L5 Bear Park, L5 Drinking Water SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tei: (907) 562-2343 Fax: (907) 561-5301 All dates/Umes are Alaska Standard Time Printed Dalefiime: 08/03/07 1215 Collected DateMme: 07/19/07 20:00 Received Dateffime: 07/20/0710:45 Technical Director. lStepheri-E Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date Init Bacteria 0.00 9222B 0720/07 07/20107 dlc Nitrate 0.11 0.10 mg1L EPA 300.0 10.00 07/31/07 07/31/07 jds Arsenic ND 5.00 ug/L 200.8 10.00 07/31/07 07/31/07 tk Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Tri 14)ss,�;6d co °M «* I&RTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING lo Parcell.D. 051-042-71 HAA# t��Jgg Expiration Date:.^L� 1. GENERAL INFORMATION Complete legal description Bear Park, Lo Location (site address or directions) 22541 Ursa Major Circle, Chugiak, AK 99567 Current Property owner(s) John Heron Day phone 688-9490 Mailing address POR6722R.7 rhugiak AK gA567 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Day phone 3. 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 ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 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 Health Authority 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 KND FNGINFERING, Inc- Phone (907) 139640 11 Engineer's Printed Name Kenneth M. Duffus Date 11/03/04 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 in land use, local soil characteristics, groundwater levels that may fluctuate during 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 various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE _JZ Approved for 5 bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory bedrooms, with the o�ti OF 4�,°`1 ••.9si •IP IN�1LIIm11p b1 . ......•17e...::..*0 rs Kenneth M•D 7116.. . QY m m OnIPSaTnGRAM •' � ,.�_• .... -;moo Maintenance Agreements Supplemental Engineers Report Other By:�� Q Ate^ �'� Qom— Original Certificate Date: It ls[64 1vlunicipality of Anghorage` Development Services Departi-64"if ° Building Safety Division On -Site Water & Wastewat607P ogf6ff " " �? � � � 4700 Soutfi Bragaw St. �ox 660 nc�io'rage AK 9-66,50" �� ci anch'orage a'k us " IMI oil rating " - w MM/bdrm) s 'Y'.s.,,.,, 5; on sewer records that the above systems are in tOA HAA guidelines in effect on this date. Waiver Fee $ Date of Payment Receipt Number _ . 499TH �mif4Jee<®ars�a��aas�fh�eie• - t' FROM :KND 11— 4-04: 4:47PM; MIN b PairnerA aallla Mary. MldMwa CommanMy Ruplim" Parr Pito e: iii 7466008 FAX NO. :8683793 Nov. 05 2004 08:59AM P2 ;907 r,613201 k 4/ 4 pSo. *%Ur Quality T"W" Client SGS Em ronmental 200 W. pdftr Anchorsp, Ak. 00510 Alin.: ForedTsylor Clara ID: lot 5 Bear Park4047218001 PWSID #: source: M.S.T.L.#: 20041084 Sample MRM: CorrimsMs: mmmi ... .._I afirm r] to Prepared PA. box 2740 pow, AL 88648 Fax: (007) 7406010 OatO ArrWW:11r1104 Report Data: 1114104 Sampo Date:1028I04 Sample Time: 1515 cdkmw By: SM 4600 -NW) E Total N031NO2 mall. -CMDL 0.50 11/4104 1114104 10.0 UWW: MRL-MarirodRWA1-8vel MCL - mm comminsm LOW E = RerWWad Value H y Abave MOI. 1) . Loa/ to ollutlan raid By Jon Paul Campbell supervisor g0� EPTIC CLEANOUTS 1T 6 PLOT PLAN AS BUILT X SCALE 1" = 50' GRID NW 1558 Lang & Associates,inc. 11500 Daryl Avenue, Anchorage, —6476 Registered Land Surveyors (907) sal --4625 Faxne www.longsurveyors.com / info®langsurveyore.com I hereby certify that I have surveyed the following described property: LOT 5, BEAR PARK SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the properly lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _� Day of at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. OT 7 No. 03-183 0F A a*oP�. 49 SDO OUJ TH� '• 9, o QOc KENNErH G. LS -55202