Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BEAR PARK LT 6
Bear Park Lot 6 #051-042-72 Municipality of Anchorage Page 1 of 3 Development Services Department On-Sde Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 wwW.ci.anchorage.sk.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO40469 PID Number. 015-042.72 R.na Alaskan Heritage Homes Inc. Wastewater System: New Adbs.. P.O. Box 211386 Anchors a AK 99521 ABSORPTION FIELD 250-0100 ee 5' Wide Trench LEGAL DESCRIPTION SWRM.9 1.2 TaWOephka.w�'^"a"` GPaxFP 7 Ft. abck L.L 8WdiwN"t D.pn b pp Do ft. a,r OA0. C.. d.pn..n..nRq 6 Bear Park 3 Ft. 4 FL T•wwlv RO.. Srlbn. FiddadAOw�or,PWgra GrMI L.put 1-3 Ft. 40 Ft. Well: New ab".an. ra.ro." .' D,.Wbsn"w. iI 5 Ft. 1 FL cwNlr aPlrvws, A a, cl. Tolel D.qnG.ed b dwi.U.orpwn.r p. M w Private 222 Ft. 222 FL 400 Fe ASTM 3034 PVC DrJM D"e on'st . W" Ld Wheaton Water Wells 10128/05 2 FL Red Dog 11/1112004 YiNd 60 Rungb.la cww Ato &Q.1d >2 TANK GRN Fl. Fl SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other, To Septic Absorption LIR Holding udnvate From Tank Field Station Tank Sewer Line Anchorage Tank 1,000 w« >100' >100' NIA NIA >25' Steel Two (2) sue.o.W. >100' >100' WA WA LIFT STATION — NONE ON LOT talo. >5' 5' NIA WA G„ Fdub.an >5' >10' WA WA �"R.n " b ti c~Dl.n None Nin oted wroLwallod.l "°""`"°""°'"R.""'"'°�. R. BENCH MARK See U11 Line Waiver. .� Finished Floor 100.0 FL Engineer's Stamp ♦♦����aw44p Inspections performed by: TLK Dates: la 11111104 �`' 49th V ' 2nd 11111104 iN�-'�� Department of Health nd Human Services approval cl NiCNAI? C AN �TSON f � and approved by- Date: 3-.a- O G�: �S No.iini Q w �Reviewed ♦404* ESSI ��.. Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 995196655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWD40469 PID No. 051-042-72 BEAR PARK SUBDIVISION LOT 6 53,685 S.F. c `9J0 `g C 1 Page 2 of 3 k� M� �A 5 Z4O v 16 0 I S1 19.0 well S2 24.7 47.10.9 0 1 C4 33.7 57.1 r _ Mt 69.6 95.6 \ C5 73.7 100.3 m \ I sl N \ I u w e I wn! Mi I PLAN AS -BUILT SCALE P - 50' Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 995196655 - 343.7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SWO40469 N / N UU 1,000 Gallon PID No. 015.042-72 N U PROFILE AS -BUILT sowe: r -1a ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX MEMORANDUM DATE: February 20, 2006 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 6, Bear Park Subdivision Certificate of On -Site Systems Approval The plot plan completed by the surveyor for Lot 6, Bear Park Subdivision indicated a slight slope to the southwest. The absorption trench was therefore designed for placement parallel to the contours of the slope. Once the clearing and grubbing of the lot was completed the ground surface was found to be level in the area where the absorption trench was to be constructed. The contractor placed the trench in a more north/south direction to facilitate construction. The total depth of the trench is the same at each end and the bottom of the trench is level. We are confident the absorption trench will function as designed in its current location. Please advise if you have further questions. 07/24/2014 04:38 FAX Nov 02 05 12:02p John Tiehenor lel 009 907-370-2030 p.1 'WVIEICErAZ`ON YYg.TER'W LLB, INC_ 31'O 3B4nP= S7121$, VVvL eti jEL, AK 99687 <g07'� 3?6-201 ii~E3f x" XAC)0413} Name: Alaska Heritage Homes Address: P.O. Box 211386 City: Anchorage State: AK Zip Code: 99521 Well Site: Bear Park Subdivision Lot: 6 Block: Additional: Well Depth: 222 & From: 0 To: 10 Formation: gravel, sand Below Ground: 220 A. 10 30 sand, gavel Above Ground: 2 g, 30 180 loos: hardpan 180 203 silty hardpan, clay al/Min: 60 203 222 fine sand, water Level: 2 & g: 6" ID Steel Pipe: none sed: none erloratea: none Grouted: Bentonite Depth: 20'+ Develop. Method: Air Use of Well: Residential 1g Method: Rotary Used: none Installed: none 10' of pea gavel Pate Drilled: 10-28.05 Driller: Jason Tichenor MUNICIPALITY OFANCHORAGE 1viim 'R 3D0.sy1 Development Services Department 3`, 0 Pm Onsite Wafer 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Nov 03, 2004 Expiration Date: Nov 03, 2005 Permit Number: SWO40469 Parcel ID: 051.042-72 Legal DescriptionCEAR PARK §UBDIViS10N LOT.8 Design Engineer: 0014 Anderson Engineering Site Address: 22525 URSA MAJOR CIRCLE Owner Name: ALASKA HERITAGE HOMES Lot Size: 53685 SQ. FT. Owner Address: 22525 URSA MAJOR CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER. AK 99577 - This permit is for the construction of. ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Q 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, seated, and heated to prevent freezing. Received By. Date: ILL —020' Issued B . Date: // 1414 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.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. t51—U4.1-gi- Permit Number SW Property owners) Alaskan Heritage Homes Day phone 250.0100 Mailing address (1) P.O. Box 211386 Anchorage, AK 99511 Mailing address (2)225oi5 Ursa Major Circle All LA AAA, Zip Code Legal description (Lot, Block & Sub'd.) Lot 6, Bear Park Subdivision Legal description (Section, Township & Range) Lot Size 53, 05 Acrese THIS APPLICATION IS FOR: Number of Bedrooms Three (3) Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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: d C35 `= Waiver Fees: 14 5=~ Date of Payment: Receipt Number: i�; 7 (Rev. 12/00) Date of Payment: Receipt Number: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX November 2, 2004 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 6, Bear Park Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 6, Bear Park Subdivision intends to construct a new three-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the new home. No conflicts exist with adjacent septic systems or wells and the proposed septic system and well on this lot. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system and alternate site. The proposed well is also shown. The current drainage pattern is identified on the Site Plan. The drainage pattern will be maintained after development of this lot is complete. Test holes recently placed on the lot indicated poorly graded sand and gravel in the area of the absorption trenches. The accepting soils were tested and found to have a percolation rate of less than 1 minute per inch. The material contains more sand than gravel with more than 50% passing the No. 4 Sieve. Our design includes the placement of a new 1,000 -gallon septic tank along with a 38' long by 5' wide by 4' effective depth absorption trench to collect and treat the sewage generated in the house. The bottom of the trench will be 7' below the surface. The distribution pipe will be 3' below the surface. A minimum of 3' of cover will be placed atop the trenches and a minimum of 4' of cover will be placed atop the new septic tank. The ground surface on the lot slopes at shallow grades from north to south as shown on the Site Plan. The absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from the well proposed for the lot and on adjacent lots. It will also be constructed a minimum of 1 00'from any surface Lot 6, Bear Park Subdivision November 2, 2004 Page Two water in the area. If the system is constructed in accordance with our design the following statements apply: t. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, w4L'L� z Michael E. Anderson, P.E. Attachments A , v- 49th W V MICHAEL E. ANDERSON No. CE -4381 3 / / , 4 ,- 11 le �j , o zo• Drna Esnt-�— ♦ \, \\ 10 7 P 'e7+ INOTEi Verify Location of Closs C Well on Lot 3, Block 2, Deer Park No. 1. Verify 150' Separation Distance to Proposed Septic Tank and Absorption Trench. AREA PLAN SCALE V - 100' / /4` %'o �Al 98.5�� Ursa MCL Jor Clyde ,00.� 95.a SITE PLAN ®TMI 10'TBEExnt aj N8931'41'E 139.63 20' Dmq. Eamt. SCALE 1' = 50' 9th N1 E ANOCRSAI No. Q-e3B1 j ' �ORE�LEV7.103.5 n n ea apnc4.e I N 0.0N 95.a SITE PLAN ®TMI 10'TBEExnt aj N8931'41'E 139.63 20' Dmq. Eamt. SCALE 1' = 50' 9th N1 E ANOCRSAI No. Q-e3B1 j LOT 6, BEAR PARK SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom House 5' Wide Trench System Perc. Rate: LT 1 Min./Inch 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 3 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 375 SF Absorption Area 375 SF/5 SF' .5 (Red. Factor) = 37.5 LF Trench Length THEREFORE: Construct a 38' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. 3' Cover Over Trench Natural Backfill 2'6' Geotextile Fabric - Perforated 6" U_ II PVC (Holes Down) 4'0" I I ">� Drainfield Rock 5' TYPICAL 5' WIDE TRENCH SECTION ...���avilt ♦ (NO SCALE) �•�p ,...... .......... �i NOTE: Grade Area Over Trench to Drain Away. o- Minimum 6' Separation From Bedrock.. • ;.� ..I Minimum 4' Separation From Groundwater. ;��. Minimum 100' Separation From Wells in the Area. �� 4.e. �woensow Minimum 100' Separation From Surface Water or Streams. #i,� No. cc.x, , r; • MUNICIPALITY OF ANCHORAGE •w"Sulltil 111 ' DEVELOPMENT SERVICES DEPARTMENT ••P•(�"••••.., "'....... 1111 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 f 1` - 49thi • . i ........... SOILS LOG - PERCOLATION TEST • � ........................... . �'; NICINEL E DE SON d LEGAL DESCRIPTION' 11 '; No. CE -/ORI ' LOT 6 BEAR PARK S/D PERFORMED FOR' BRYAN AAFFDT 111�p......; .•• DATE: 10/27/04 PROJECT No M04g9 PARCEL ID#' TECHNICIAN: T. L. KIMBROUGH Proless7ooa E" i"ems stom DEPTII TEST HOLE #=I (r«q 10.0" OB/OG SLOPE SITE PLAN 1 ] 0;20 2 25� 3 4 TH2 5 5% 0.0" TH1 6 8 SANDY — GRAVEL 9 MIXTURE W/COBBLES TO 10 " 0.0" GP/SP 10 Greater Than 50% 0% ] ] Passing No. 4 Sieve 12 DEPTH of GROSS TIME NET TIME NET DROP DATE READIN�7 WATER 13 ( MINUTES) (MINUTES) (INCHES) (INCHES) 14 9/29/04TEST HOLE PRESOAKED PRIOR TO TESTING: ] 10:15 15 16 BOH 17 18 5 10:25 11.0" RECHARGE 20 PERCOLATION RATE•>1 (MN/INCI0 PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN. 4.0 FT. and 5"n FT. WAS GROUND WATER ENCOUNTERED? NO IF YES e WI IAT DEPT119 TOTAL DEPTH OF WATER AFTER MONITORING: NONE DATE OF MONITORING: 11/2/0 COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR To TEST. TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORIMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THUS DATE: ] 0,0° CHARGE 2 10:20 5 0.0" 10.0" 3 ] 0;20 10.0" RECIIARGE 4 10:25 5 0.0" 10.0" 6 10:30 5 0.0" 11.0" MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 6, BEAR PARK S/D PERFORMED FOR: Tim Ecklund DATE: 10/27/04 PROJECT No•M0499 PARCEL ID4- TECHNICIAN: M. ELDRIDGE DEPTH TEST HOLE # 2 0m) - 1 2 3 4 5 6 7 8 9 la 11 14 15 16 17 18 19 SLOPE 25� 5% SANDY — GRAVEL MIXTURE W/COBBLES TO 10" GP/SP INET DROP Greater Than 50% Passing No. 4 Sieve i 1 0% DATE READING G OSS TIME MINUTES) NET TIME (MINUTES) DEPTH 01 WATER(INCHES) (INCHES) INET DROP 9/29/04 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 10:20 .6.0" CIIARGE 2 10:24 4 0.0" 6.0" 3 10:24 7.0" RECHARGE 4 10:28 4 0.0" 7.0" 5 10:28 10.0" RECIIARGE 6 10:32 4 0.0" 10.0" PERCOLATION RATEL-?:-l-(MN/INCI I) PERC.11OLE DIA. 6 (INCHES) TEST RUN BETWEEN.. 4.0 FT. and 5-n FT. WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? TOTAL DEPTH OF WATER AFTER MONITORING: NONE DATE OF MONITORING: 11/2/0 COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORINIE•D BY VETECII ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORA1ED IN ACCORDANCE WIT] I ALLSTATE AND NIUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 6, BEAR PARK SUBDIVISION GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,000 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 38' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 7' below the existing ground surface. A separation distance of 100' from any well and 100' between the septic tank and absorption trench and any surface water must also be maintained. A minimum of 3' of fill is required over the absorption trenches and 4' over the septic tank. In lieu of the required fill 2" of insulation and 2' of fill may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the . area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be .responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,000 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 6, Bear Park November 2, 2004 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Lot 6, Bear Park November 2, 2004 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. MUNICIPALITY OF ANCHORAGE 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. 051-042-72 1. GENERAL INFORMATION Complete legal description Bear Park L6 Location (site address) 22525 Ursa Major Cir Expiration Date:-9—/7— Current ate:6"/1_ Current property owner(s) Michael & Deborah FOrcht Day phone _ Mailing address 22525 Ursa Major Cir Chugiak, AK 99567 Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic n 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 requested by the engineer. COSA Fee $ 55D Waiver Fee $ Date of Payment (011-7-1119 Date of Payment Receipt Number Q61'a4(; Receipt Number COSA # Q 5Gj q `2 1 Waiver # 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 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907) 745-8200 Date ����.' bedrooms, with the following stipulations: By: Original Certificate Date: (15, 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 Legal Description: Bear Park L6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA FMI Well log is filed with Onsite (or attached) Date drilled 10/28105 Total depth 220 ft Cased to uk ft ® Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 6/10/19 Static water level at beginning of test 0.00** ft. Comments **Static at ground level B. TANK DATA Age of tank(s) 15 years Tank type/material Measured operating fluid level in septic tank 48" © Standpipes/foundation cleanout per record drawing Date of pumping 06/12/19 D. ABSORPTION FIELD DATA 5 wide Which system tested (date installed) 11/11/04 ALL standpipes present per record drawing Total measured depth from grade 9.5 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective O Code -required soil cover over field FE System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-042-72 Structure served by this system Well production at time of test 3.95 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ® Coliform bacteria is Negative Nitrate mg/L n Nitrate less than MRL (ND) Arsenic 6.88 ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Enginneering Date of Sample 5/28/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/10/19 Results Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 474 gal New depth 7 in Elapsed time 150 min Final fluid depth 3 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) n/a If yes, enter date 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' Z✓ Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' 7/1 Yes if No ft Private Sewer/Septic Line > 25' [D Yes if No ft Absorption Field on Lot > 100' E✓ Yes if No ft Holding Tank > 100' P Yes if No ft Neighboring Absorption Fields > 100' M✓ Yes if No ft Water Main > 10' Animal Containment > 50' ✓M Yes if No ft E✓ Yes if No ft ✓0 Yes if No ft Water Service Line > 10' �✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ✓� Yes if No ft r/ Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Z✓ Yes if No ft Surface Water> 100' ®✓ Yes if No ft Property Line > 5' F71 Yes if No ft Wells on Adjacent Lots: ✓Q Absorption Field > 5' [] Yes if No ft Private Wells > 100' M✓ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ✓0 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' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓Q Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' E✓ Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS 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 CSF. A�4& r� rray,�-ems w- x g ��a s � v n � �O: � :K� •:Qi �� G 4 7 00 7 r r O © � tib. u qk 9a a a // b Y • J"~ a J 44"Y� n a••° v `� / � a Vi�9tlP4 `e9G qV J / •� / ^0 4—'' qo as u .°. Y / .f �— m ads".°.6• io.". / to �-\ \ N69'J4-11'E 139.6) 1 \ C 1 cL�l 7 / Municipality of Anchorage �a On -Site Water &Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL o51 Parcel I.D. -042-72 Expiration Date: 6 d 1. GENERAL INFORMATION Complete legal description BEAR PARK; LOT 6 Location (site address) 22525 URSA MAJOR CIRCLE Current Property owner(s) LINDA NEELY Day phone 854-2139 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex 2..own.Am WTA ❑ Multiple Dwellings (Single Family and/or Duplex) e. NU(i 2 2 2Q14 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site • Individual Water Storage -� l lndiv:�__. niurviuuai Huiuitig lank LJ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for Distance: COSA Fee $ 62-1(1— // Date of Payment_Z ZL1/ Receipt Number ('12801 COSA# (55(—J'4/q37( Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd, Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 8 ZZ Engineer's Comments: In conducting this evaluation, GEG, LtO. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines & Regulations. The reported results described the performance of the aoob`�Op, 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 ` �l 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. P n These conditions are outside the control of the evaluatorof the system. Satisfactory test o : • 4 T '•� vo0 results do not guarantee future performance of the system, nor do they guarantee that ' """' "" *• there are no hidden defects or encroachments. GEG, LTD. can therefore not provide (; any warranty or future estimate of how long the system will continue to meet the l operational requirements of the ADEC or MOA DSD. The content of this report is for �O J f r yd• .. rness: the sole benefit of the owner listed above. Any reliance upon or use of this report fo any 1, CE— P other person or party is not authorized, nor will it confer any legal right whatsoever V e 6. DSD SIGNATURE �44�4e 44p����OOa System #1 Approved for _3 bedrooms. Z System #2 Approved for Disapproved. Conditional approval for `t�, bedrooms. �Y OF bedrooms, ON-SITE with the following stipulations WATER AND m WASTEWATER (D Original Certificate Date:2 — v2 7 , 6 The ltnicipoli f or-knIchorage Develop,emt 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 en4inee's work ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (R. 11/05) v Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: BEAR PARK; LOT 6 Parcel I D: 051-042-72 A. WELL DATA *PER SURROUNDING WELL LOGS Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10-28-2005 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 220 ft. Cased to *40+ ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION bra Date of test 10-28-2005 -- Static water level 2 ft. — lir ie s awft. Well production 60 g.p.m. — !o. 6 � I'g.p.m. WATER SAMPLE RESULTS: (*10.2 MG/L 12/29/2005; 17.4 MG/L 6/13/2007)['— �S��S Coliform 0 colonies/100 ml. Nitrate NO mg /L. Collected by: OEG Ltd Arsenic: *<5 ug./L. Date of sample: 8/12/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11/11/2004 Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/10/2013 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 11/1'/2004 Soil rating (.p.d./ft r ft2/bdrm) 1_2 System type TRENCH Length 40 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth *9.44 ft. Eff. absorption area 400 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/11/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 9 in. Water added 600 gal. New depth **15.5 in. Elapsed Time: 30 min. Final fluid depth 12.75 in. Absorption rate >= 450+ g,p,d_ Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **WATER LEVEL ROSE ONLY 1" WHEN FINAL 206 GALLONS INTRODUCED INTO SYSTEM D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump oft" level —' . High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot 100'+ On adjacent lot; Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Sewer/septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manuretanimal excrete storage areas ***100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Wells on adjacent lots 100'+ Properly line 5'+ Absorption field 5'+ Water service line 10'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *5' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain **NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS **DRAINFIELD IS APPROXIMATELY 14 FT FROM SHALLOW SURFACE DRAIN. NO WATER FLOWING FROM DRAIN ON 8/11/14 AS–BUILT SURVEY IS IN MOA FILE. *WR060005 ***SPOKE WITH OWNER OF DEER PARK #1 BLOCK 2 LOT 1 , LISA BRUNE, ON 8/22. IN THE FUTURE SHE WILL NOT STORE HORSE MANURE WITHIN 100' OF WELL HEAD ON LOT 6. G. ENGINEER'S CERTIFICATION - I certify that f have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 11/05) 0 MYk�� f M 7 1A$ Wit Md(e 528 BoAfAce '2857 "'A city- Anchorago i A 5,, Phone LJob ocationto t 4. Beer Psrk.Subd'4'`; Crew: R. Durbi n/R. L ere rs ki Date: -pril P7s 1955 'jell. c.zed to r68 ft. ir.cludin€ Notes: ft. stick-up :stitic -11 1101, level; 14 it. from surface Yi Recommended ;.I.ump setting: 80 ft. Restrict flo-m to 10 GPM Depth Well Log Sand and grAvel with dry clay 50-161, Zatid'and gravel *Md wag JUIP but wouldn't proAuce 163-2110 Clay and gravel 0-2A Sand, alli, water e64 -z48 -q&nJ and grskvel 0 MYk�� f M Address5'8 8ontfuce 2857 FAWWW�gI�!!Fy�9�ryya1 5 ' '. F; Date: - i 1 1985 Notes: -'el 1 C` .,,sed t0 ?65 ft. including . ft. 1~tiC;-u- t,,ti_c ..:tier level: 1q ft, fro n surf+::c@ t? ¢, 30 u: i.iEC'J:G.'�.�ETSdEd. pump .SPtt'1:s 60 .•t. restrict flog to 10 aP:µ Address5'8 8ontfuce 2857 City:,.<AIichora969'-AK Phone: 376-x7938" Job 11, Beer Kirk Subd. '. Crew: Durbin/S, Date: - i 1 1985 Notes: -'el 1 C` .,,sed t0 ?65 ft. including . ft. 1~tiC;-u- t,,ti_c ..:tier level: 1q ft, fro n surf+::c@ t? ¢, 30 u: i.iEC'J:G.'�.�ETSdEd. pump .SPtt'1:s 60 .•t. restrict flog to 10 aP:µ Address5'8 8ontfuce 2857 City:,.<AIichora969'-AK Phone: 376-x7938" Job 11, Beer Kirk Subd. '. Crew: Durbin/S, Date: - i 1 1985 Notes: -'el 1 C` .,,sed t0 ?65 ft. including . ft. 1~tiC;-u- t,,ti_c ..:tier level: 1q ft, fro n surf+::c@ 30 i.iEC'J:G.'�.�ETSdEd. pump .SPtt'1:s 60 .•t. restrict flog to 10 aP:µ Well Log Sand and grawa ?AD$tAy SHIM iii.tit SOOW gravel Cl.a7 "d gravel 5aaiik, Silt, Waie ` Sand end bravtl U5, Municipality of Anchorage Oil Development Services Department �~ ' Building Safety Division }. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 US• �! RASH• CERTIFICATE OF ON-SITE SYSTEMS APPROVAL J FOR A SINGLE FAMILY DWELLING Parcell.D. O5l-Vj7 }a COSA# Expiration Date: 1. GENERAL INFORMATION Complete legal description BEAR PAitK Lok (o Location (site address) _ 22525 UrsA 11")gior Carlo Current Property owner(s) John Moss Day phone 1646-700Z, Mailing address X01 \f4fiston PI4ce., Ancharaic K 72504 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 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 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 )he Municipality of Anchorage files and from my investigation and inspection, the on-site water supply arfd/jor wasteyva)dr disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and'legulations in effect at the time of installation. 1 Name of Firm I:I Aub £meq iA ee R Afc-Phone z1g 39 t 6 • 7 Address U3 W. 15t` Ajf, Say 203, AnclkoeAje AV 4950( Engineer's Printed NameLAt5 Date_ 9Izz106 5. DSD SIGNATURE Approved for Disapproved. _1 bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ( �� J �// Original Certificate Date:_ (Rw 11105) Municipality of Anchorage V ; Development Services Department j Building Safety Division ��• On -Site Water i Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: BOAR 'RAt W (o Parcel ID: 05%—D LLL— 7.;t, A. WELL DATA Well type Pr;lvlh Date completed 10_18-05 If A, B, or C provide PWSID # Sanitaryseat (YIN) Y Total depth 222 ft. Cased to 21 Z ft. FROM WELL LOG Date of lest to -Lb -05 Static water level 2 ft. Well production (00 g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate AID mg/L Arsenic: N1) ug/L date of sample: 9 4 e6 B. SEPTIC/HOLDING TANK DATA TankTypelMaterial�ncnor.,G Tawkl sie.� Tank size IoW ga( Number of Compartments 7 - Well Log (YIN) Wires properly protected (YIN) y Casing height (above ground) +IB in. AT INSPECTION III,, o 8 ft. + 3.4 g.p.m. Other bacteria -.9—colonies/100 mL Collected by: L A23 SP rLk anti Date installed I I u 0 y Cleanouts (YIN) Foundation cleanout (YIN) Depression over tank (YIN) N High water alarm (YIN) / Date of pumping 111310S Pumper SAn' iw3 ?4+nn&iz5 C. ABSORPTION FIELD DATA Date installed III oy Soil rating d./ft r felbdrm) 1-1 Length 40 ft. Width 5 ft. Total depthJ•5 ft. Eft. absorption area400 ft2 Monitoring tube _ Date of adequacy test —1,14"n— Results (Pass/Fail) $$ System type Stihl u) TrcnCll\ Gravel below pipe �_ ft. yL Depression over field Al For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added�00 gat. New depth in. Elapsed Time: 15 min. Final fluid depth'1 in. Absorption rate >= L150 g p•d• Any rejuvenation treatment (past 12 mo.) (YIN & type) (fone Y.nown If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level _ in. `Pump off" level at n. High water alarm level in. Datum Cycles tested Meets alarm & c' it requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I oor+ Absorption field on lot 100'+ Public sewer main A/. A . Sewer/septic service line 25r+ On adjacent tots loo + On adjacent lots 1001 . Public sewer manhole/cleanout AL A . Holding tank W Animal containment areas 50,.+ Manure/animal excrete storage areas 10 o '4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 108+ Property line lor+ Absorption field 10't Water main t o + Water service line 101+ Surface water Al. 0. Wells on adjacent lots 1 ooI+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 50 Building foundation 10 r+ Water main 1014 Water Service line I Or+ Surface water IV. O. Driveway, parking/vehicle storage 10 r Curtain drain 0. Wells on adjacent lots 100'+ F. COMMENTS * 1.,/atVE2 0A File G. ENGINEER'S CERTIFICATION 4F. a.Cgs1�' I certify that I have determined through field inspections and 4jP review of Municipal records that the above systems are in i .'49TH conformance with MOA COSA guidelines in effect on this date. • • + s,(' it �, Engineer's Printed Name � ARS Sur k14r,� % . VS UF;< g' / ?� . LAR E: SSU {IAyD. j Date III log J+1` 11°CO r COSA Fee $ Waiver Fee $ Date of Payment p �� Date of Payment Receipt Number _ O 4I3� Receipt Number (Rev. 11/05) SGS ReEN 1084815001 Client Name Tobben Spurkland F.E. Project Name/a Bear Park Lot G Client Sample ID Bear Park Lot G Matrix Drinking Water P% SID 0 Sample Remarks - PRELIM IN:\RY - Printed Date rime 09/22/2008 10:20 Collected DateTme 091092008 15:30 Received Datelrime 09.092008 16:27 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Methal Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug.'L EP200.8 C (<10) 09/16/08 0920.08 NRB waters Department Total Nitmte'Nitritc-N ND 0.100 mg(L SN1204500NO3-F B (<10) 09/15/08 ID7_ Microbiology Laboratory Colony Count Total Coliform Fecal Coliform p 0 0 co1.100mL col/100mL col.'IOOmI. SN1209222B SM20 9222B SN1209222B A A A (<200) (<D (<I) 09109'08 090908 09/09/08 ULC DLC DLC Municipality of Anchorage • --t Development Services Department '7t'� Building Safety Division On -Site Water and Wastewater Program s A T 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 Parcell.D.. COSA # 0117241 Expiration Date: 10 —'13-02 1. GENERAL INFORMATION Complete legal description 9F_412 TA-IZ1L L_ur to Location (site address) (AKSA MA,)oiz- Current Property owners) Se►2E�SA "OSS Day phone 55 .0 Mailing address Lending agency Mailing address 2262.5 iAPSA MA -,ICV L+I�c.L�i CmA(TlAr_ +r— 915Hi- Real Estate Agent _F'SFSo Day phone Mailing Address Unless otherwise regbested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:3 C64 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [r Individual On-site L2 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 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. Name of Firm aegla River Engineering Services Phone VI •( —S l°l 10421 VI -VV HO., we Address €agla River, AK 99577 - Engineer's Printed Name C hri�zo %sz- t2- And D S. DSD SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. 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: -7' /3-o-7 (Rev 11105( 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: REA12 PA-iQIL L47T V Parcel ID: 0 % 0 2— Lf/ A. WELL DATA Well type_BLVO. jZ� If A, B, or C provide PWSID # _ Well Log (4JN) YES Date completed LQJaglo5 Sanitary seal a) _Y� Wires properly protected (I) YEAS Total depth ft. Cased to waft. Casing height (above ground) ':� in in. Date of test Static water level Well production FROM WELL LOG 1y�a.B�oS hn g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate ,L mg/L Arsenic: Lz.�_ ug/L date of sample:GI/ �0? B. SEPTIC/HOLDING TANK DATA TankType/Material SCPTtC /','rr--tlL- Tanksize ;lf.O_Q_0gal. Number of Compartments oZ AT INSPECTION ft. f x.41 g.p.m. Other bacteria _R—K colonies/100 mL Collected by: C N A tzt-FS V0 Ai �7 "-I rJ I Date installed It' i i d-ov F- Cteanouts @N) Ls Foundation cleanout ©N) It;� Depression over tank (YO _&Q High water alarm (Y/@) N 0 Date of pumping CIOS/o Pumper '5R r 5 C. ABSORPTION FIELD DATA' Date installed 1111tio Soil rating (g.p.d./ft2 or tt /bdrm) I • a-- System type SHAU_Cto -r{2Enlc + Length SFO ft. Width 5 ft. Gravel below pipe + ft. Total depth I I_ ft. EH. absorption area q ftZ Monitoring tube YC S Depression over field t -J0 Date of adequacy test Resultsas Fail) R4S5 For, bedrooms Fluid depth in absorption field before test _Z_ in. Water added gal. New depth in. Elapsed Time: Z min. Final fluid depth ,� in. Absorption rate >= +5o g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/&& type)n/orJ r_ KnJ�u" If yes, give dateI_ y_rLi l rII c D. LIFT STATION Date installed Size in gallons 'Pump on" level at _in. 'Pump off" lev Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot + 100I Absorption field on lot +10o, Public sewer main -+ 10 o' Sewer /septic service line has' Animal containment areas + t�0 i Manhole/Access Igh water alarm level at in. Meets alarm li circuit requirements? On adjacent lots -410c), On adjacent lots + I (,r,)' — Public sewer manholelcleanout + I c-) (') ' Holding tank S� Manurelanimal excrete storage areas +100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 4-50 Property line+� , Absorption field -+15 ' Water main -I-1 O Water service line + I o' Surface water -t- I h0 ' Wells on adjacent lots -t IC)W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: property line rp I Building foundation -r 10 I Water main tr I O' I Water Service line 4-101 Surface water + 1_ 1 Driveway. parking/vehicle storage '.20 Curtain drain + SO' Wells on adjacent lots + 100 F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and QA,: review of Municipal records that the above systems are inCEIN conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name ��n�r OUR 12. tmx-YDate 711I 1 f C-+- • .... COSA Fee S L Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 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 Arsenic Advisory Certificate of On -Site Systems Approval # 070241 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6 of Bear Park Subdivision. This inspection revealed an arsenic concentration of 17.4 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. III Ire$3 SCS Rer.N 1072732001 Client Name Eagle River Engineering Project Name/N Dear Park Lot 6 Client Sample ID Dear Park Lot 6 1ltairix Drinking Water PIIVBID 0 Sample Remarks: All Date.%71mes are Alaska Standard Time Printed Date/Time 06/27/2007 8:28 Collected Datdrime 06/132007 15:30 Received Date rime 06/142007 14:15 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Method Container ID Limits Date Date Init Metals by ICP/M9 Arsenic 17.4 5.00 Waters Department Total Nitrmc/Nitrite-N ND 0.100 Microbiology Laboratory Total Coliform 0 ug/L EP200.8 C (<10) 06/18/07 0627/07 TIC mg/L SM204500NO3-F D (<10) coVI00mL SM209222O A (<I) 06/19/07 JDS 06/14/07 DLC Ll�ndnWr OA2, Municipality of Anchorage Development Services Department \\ Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street ■ • .. P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onslte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-042.72 COSA #_ OL(`,,��?j 1. GENERAL INFORMATION Expiration Date: to - -2- - Q & Complete legal description Lot 6, Bear Park Subdivision Location (site address) 22525 Ursa Major Gide chugiak. AK Current Property owner(s) Alaska Heritage Hones Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 211386 Anchorage, AK 99521 Unless otherwise requested, COSA will be hold by DSD for pickup. 2. NUMBER OF BEDROOMS: - 3: TYPE OF WATER SUPPLY.- Individual UPPLY:Individual Well Individual Water Storage - Community Class Well Public Water System Three (3) Day phone 250-0100 Day phone Day phone 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 Onsite 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. TYPE OF WASTEWATER DISPOSAL: 0 Individual On-site 0 ❑ 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 Onsite 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 seat affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Phone 522-7773 Engineers Printed Name Michael E. Anderson, P.E. Date January3, 2006 6. DSD SIGNATURE _L��Approved for / bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory_ Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other By: /�(� / Original Certificate Date: 3 — 6 cl (Rw.1 LOS) Municipality of Anchorage Development Services Department swift Safety Division On.Ske Water 6 Wastewater Program .. 4700 sragaw, Sheet P.O. BOX 196650 Anchorage. AK 99519.6050 wo W.munl.org/orslte (907)943.7804 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Descdptim: Lot e. Bear Park Subdivision Parcel ID: 015-042-72 A. WELL DATA Web type PAvate If A, S. or C Provide PWSID # _ Web Log (YIN) Y Date completed ,LOQU5 Sanitary Seal (YIN) Y Whes Properly protected (YAV) Y Total depth 222 �t Cased to 222 R, Casing heIDM (above ground) 24 M. FROM WELL LOO AT INSPECTION Date of test 1 J0 Stadc water level 2 P, Web production 80 g.p.m. WATER SAMPLE RESULTS: Cobform Nitrate ©. L mg& Arsenic: IQ, f, mgA Date Of Semple. i2h9�05 B. SEPTICIHOLDING TANK DATA Tank TypeNatertal seacts el Tank Size 1.000 gal. Number of Campannm tS 2 F=41don cleanout (YIN) Y Depression over tank (y N) N Date of pumping New Construction p C. ABSORPTION FIELD DATA rt. g.p.m. Other bacteria _0 colonieaNOD mL Collected by: t� Date installed 11/11/2004 Cbanouts (Y1N) Y High water alarm (YIN) N Date Inatabed 11H 1104 Sob rating (g.p d.Ae or tt:lbdrm)1.2 OPDISF item type 6' Wkle Trench Length 40 ft. Width 6 E. Gravel below pipe 4 fL Total depth --L--IL ER. abaorplon was 400 11' Monitoring tube over 0ekl N Date of adequacy Lest New Const Results (PaaslFalo For _bedrooms Fkdd depth In absorptlon Meld before test in. Water added_ gal. New depth in, Elapsed TMne: min. Final fluid depth in. Absorption rate k g.p.d. Any reluvenabon treatment (past 12 mo.) (YIN & type) If yea, give date D. LIFT STATION Data installed Size in gallons 'Pump on" level at _ In. 'Pump or level at _ In. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot >1mm' Absorption field on let >IW Public sewer main NIA Sewer hhepdo service dne >217 Animal containment areas WA Manhole/Acr ess (YM) High water alarm level at Meeh alarm 6 Preair CWMn rrrants9 On adjacent Iola >100' On adjacent lots >1W Public sewer menholehieanout N/A Holding tank WA Manure/animal excrete storage areas WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >5 Property it">6 Absorption field >b' Water main WA Water service line >1(T Surface water >1W Wells on adjacentlots >1mm' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line F Bullding foundation >10' Water main NIA Water Service l ne >1m' Surface water >1W Driveway. paAdnyveNde dwsge >10' Curtain drain Now Noted Walla on adjacent iota >tmm' F. COMMENTS: See Lot Line Waiver for Abacrptlon Trench. O. ENGINEER'S CERTIFICATION I ced* that 1 have determined through Held hspedlons and review of Municipal records that the above systems are in oonfamance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 116i2amB COSA Fee i z --a eo Date of Payment -,141-7 Q Receipt Number15Lo7V R". pros) a in. Walver Fee $ 1-1 S _ cD Date of Payment T-7 /, Q1 o Recelpl Number -i 5 W-14 (h 144 FTM�J SCS ReEN 1058399001 alent Name Anderson Engineering Project Name/N Lot 6 Dear Perk Subd Client Sample ID Lot 6 Dear Park Subd hlatris Drinking Water PWSID 0 All DatesiMmes arc Alaska Standard Time Printed Datdiime 01/112006 15:26 Collected Date/time 12292005 14:30 Received Date rime 12292005 16:25 Technical Director Stepben C. Ede Sample Remarks: 3532 - QCS recovery Is biased high (I I1%s samples confirmed past hold time with passing QCS. i Metals by ICP/M3 Arsenic 10.2 5.00 Microbiology Laboratory Total Coliform 0 ug/l. EP200.8 C 01/07/06 01/09/06 SCL col/100mL SM209222B A (<-1) 1229/05 DPT Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitrate -N 0.100u 0.100 mg/L EPA 353.2 D (h10) 1229/05 3C i Metals by ICP/M3 Arsenic 10.2 5.00 Microbiology Laboratory Total Coliform 0 ug/l. EP200.8 C 01/07/06 01/09/06 SCL col/100mL SM209222B A (<-1) 1229/05 DPT ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) January 6, 2006 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 6, Bear Park Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The lot lines on this property were not clearly marked during construction of the absorption trench. The south end of the absorption trench was inadvertently placed within 5' of the south property line. Placement of the absorption trench at thislocations will have no adverse affect on septic systems or wells in the area. We therefore request a waiver be issued allowing the trench to be 5' from the southern property line. Sincerely, � n "1 cil-I' L E0414c Michael E. Anderson, P.E. � 491h MICHAEL E. ANDERSON Municipality of Anchorage Development Services Department r Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 060005 PID#: 051-042-72 HAM 060013 Permit#: 040469 Date Received: 1/17106 Legal Description: Bear Park Lot 6 Engineer. Anderson Engineering Applicant: Alaska Heritage Homes Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ............................................................................... Waiver Is Granted: LI -11 Waiver is not Granted. List Conditions or Reasons for above: Date: By: i.....i... ................................:.::..::.:.::.... ..i...i...i..... me., Rec#: 1117106 Amount: $175.00 Date Paid: 1/17/06 m glia MmAcipality of Anchorage / 1'O. IALC IJ(ili(1 • AIMIIOMgI'. AL�.kn 9(xi19•ffii0 • Tcicphrnu (0(17) 33.4�R9)1 • rLLC (tX)%):Si�S�R-�(JI) 47(X) BmWaw Si met • Aiwhomgf. Alaska 90.507 Mayor Mark Begich 3/2/2006 Mike Anderson Anderson Engineering U�Aenlnni.org Building Snfcty Division Subject: Waiver Request for Bear Park Lot 6 Waiver Request #WR060005 Parcel 1D #015-042-72 HAA#060013 or Permit # 040469 Dear Engineer, Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poct Engineering Technician On -Site Water & Wastewater Program Community, Security, Prosperity M ho�ffs ns,d osr '� p � •` a n'o � � p' .Ac �. e°i�• b eG•i1 �,°r ° e 0 oos. 902 p e�e �pp�Gr'•rV ■ 6 G i ti Cw a pp^y a°o. eeo "v �Ce�eerE 660 jeCi ep c ��K p6e, 'd'vbC�^ -01, p 0 &: P9 p4 p ■en� e��•�rp �M 660 0.rp.�n C° O�•ey bMee 6 to. p poM pa. r�.°. °P°° a �e V de R •J. s e ^.�� nor■ Y � 0. e o eV�y a°b'O�e e CVs?qeo o' o ■ COC. ■- GGGi^pp .. ^. do ^o :ip ° r e n ■ C 2 r6;^a�� o p �d ° C p C. 00.■ &^re 6 a Sv c d $• I 11 � �xx \ s O N to r-4 t.1 m C7 E m 9 M O '•V F a ol j o / b / / / / / / IJ\ O / c / N / m / N / / / / / / / / / / / N T �xx Na ao ■ � a N �2 O 0 N P Y �rJ � s O N to r-4 t.1 m C7 E m 9 M O '•V F a ol j o / b / / / / / / IJ\ O / c / N / m / N / / / / / / / / / / / N T D G N �2 O >>> � � p gnyt•ur/ 4 o o � d j r I