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HomeMy WebLinkAboutBEAR PARK LT 8ABear Park
Lot 8A
#051-044-03
\ Municipality of Anchorage
., Development Services Department
Building Safety Division ?^;
SL
i On -Site Water & Wastewater Program, 4700 South Bragaw
P.O. Box 196650 Anchorage, AK 99519-6650
www.a.anchorage.ak.us (907) 343-7904 Page 1 of 3
Onsite Wastewater Disposal System and/or Well Inspection Report
Permit Number. SWO10144 PID Number. 051-042-88
Na RANDY ROLOFF w/ PREFERRED COSTUME HOMES
Wastewater System: ■ New ❑ Upgrade
Address: C/O BROOK STILTNER W REMAX OF E.R.
ABSORPTION FIELD
16600 CENTERFIELD DR. EAGLE RIVER AK 99577
Phone: No. of Bedrooms:
(907) 355-7720 3
0Deep Trench 0Shallow Trench ■Bed Cl Mound 0ather
LEGAL DESCRIPTION
so9 Aauv
0.7
Told Opb hm awwrwi stud:
4.0 — 5.0
GPD/s4. rt
n.
Lot, Block: subdivision:
Owth to Pas bottom hw eAgnd grodw:
Grad dwte swath paw
8 — BEAR PARK
3.5 — 4.5 rt
0.5 R
Township: _ Range: _ Section:
ns eddad aesw w1gWA grad:
Growl wmWc
43
O —0.5 rt
n
WELL: ■ New ❑ Upgrade
G,a.d ekua
15
W. w Of en.e
3
Dbtowe bbw.m a.
4.5
R1
n
cbrairaotlan Prhob. A.B.G :
Totd Dpua
ca..d To:
Total fib„ rao
Pp natrWk
D 3034/ F-810
PRIVATE
101 rt
101 rt
645 so. in,
DNr.
Dob Dreled:
steed Mdr tewt
1 70
YMoew:
CALKINS CONSTRUCTION
Dab MaIMd:
10/9-10/2001
WHEATON WATER WELLS
10/8/01
n
Trw:Pimmv
sat At
ca.kw Hsgnt ma" cmm�
TANK
10 Vu
UNKNOWN FLI
1.5+ rt.
SEPARATION
DISTANCES
■Septic C! Holding 13 S.T.E.P. Gather
To
Sept
Absorption
Uft
Holding
Ge/Prhvle
YpMi1oc1unri
GREER
cavaNOr N sas°ar
1000
From
Tank
Field
Station
Tank
s..r un..
Wall
100'+
100'+
—
—
25'+
bwriee STEEL
d orprbmmtc 2
Surface water
100'+
100'+
—
—
—
LIFT STATION
Lot Una
5'+
10'+
—
—
—
sin M 9�
I
Foundation
5'+
10'+
—
—
—
an b.d at at
KNh "WBann at
►rmP Yob. ar4bd bmaaotiarw pwrrme0 by:
Curtain Drain
NONE KNOW
BENCH MARK
Remarks:
loaalwm and Dw"IFUM
TOP OF GARAGE SLAB
Aesrwd a.wtWm' 100.00 rt
orasimTs WAL
4
a� } `srp
Inspections performed by AWWC, INC. Dates: 1st 10/9/2001
off; ••.v 0
........ . ...........1�
2nd 10/9/2001
3rd 10/10/2001
Q ; r y
Department of Health and Human Services approval00��
a( E 7953
404c1Pr
Reviewed and approved by: Date: D - .a
ressA000`
0400op0o
(aw.. t2/00)
PERMtTNUMBER: ASBUILT DRAWING
-
PARCEL NUMBER:
42-88
SW010144
SWO
051-00
/
I NEW WELL l
I
I
I
/ /
o
/
STI
- 22.89 59.24
ST2
- 26.77 65.44
2
/
DBL1
- 28.59 67.99
/ DBL2
- 30.25 70.51
MTI
59.85 38.36 79.65
MT2
69.29 48.81 90.46
N00M
B SSE
MT3
54.14 47.49 =
�3
COI
53.73 47.19
CO2
49.28 43.11 -
\ a
fC
703
45.15 39.03 -
MT4
44.51 38.32 -
CC70 ^�
O�
\ \ >
NEW
DRAINFIELD —//��12#\\.
NEW 1000 GALLON
ALTERNATE SITE
SEPTIC TANK
DBL1
DBI.2
004
10/23/2001
�/)
,. i i�r.G./J.L.M.
DRAWN BY:
ALASKA WATER & R'ASTENVATE..
CONSULTANTS. INC.
1- = 30•
••
.• . ••• QDn�
6901 DMARR Roan, SUTE 29 • ANCHORAGE, Ax 99506 • N1011E 01)337.6179 • FAX 907)33$-3ne
O
V
PREPARED FOR: PHONE NUMBER:
PACE NUMBER:
c/o BROOK STILTNER (907) 694-4200
1 2 OF 3
•
QO ,0 ff me s
Q ° % C 795 eQ
0�4�° •., ' .Foo
LEGAL DESCRIPTION:
BEAR PARK SUBDIVISION, LOT 8,
;
ppedP�o/eeslo�aao
p44ppoo�
TYPE OF WORK:
AS -BUILT DRAWING OF NEW WELL LOCATION AND SEPTIC SYSTEM
PERMtrNUMBER: AS-BUILT DRAWING PARCEL a NUMBER:
SWO
SW010144 051-042-88
INAL GRADE
99.30+
TOP OF
INLET -
/ I I NEW 1000 GALLON
INVERT of BUNG SEPTIC TANK
AT INLET - 94.85
TANK AT
- 95.22
INVERT OF BUNG AT
OUTLET - 94.45
10/23/2001 oa
1 F
DRAWN BY: v�`,:•O. L
ALASKA WATER & WASTEWATER C.J.G.
CONSULTANTS, INC. N.T.S.
aen� nce•ee enan a•n fo • a.Yuroafe A[ 00}nL • P11fYJF fOn11111.A1)0 • PAN (On)1}}}-})LS
REPARED FOR: PHONENUMBER: rout nurecn:
c/o BROOK STILTNER (907) 694-4200 3 OF 3
,GAL DESCRIPRON:
BEAR PARK SUBDIVISION; LOT 8,
fPE OF WORK:
PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM
OCT -23-01 11:25 AM PREFERREDCUSTOMHOMES 907 357 9136 P.02
]P. 4. >E3ox s'77itsaxS •Qfiaad.)frlsa, JttcJta.sca 9sgs7
<t1�0'X� 3me-yao�x
ILA
�elx Bite Bi7.1ed. To
Bear Park Preferred Custom Homes
Lot 8 >Qloo�
PO Box 875010
- Wasllla,AK 96087
'Stell Depth
101'
Grails/lt+�iu
10
Btatio Xaevex
-- 70'
CzLfti lgL— Size
6„
Li118r 3ftpme
none
Boreencd
none
BerPoratcd
none
pate Drilled 1 •6-2001
From
To
Farmatioa
0
2
topsoil
2
8
gravel, sand
8
16
send, little gravel
15
25
damp silt, gravel
25
65
gravel, sand
65
75
silt, send
75
101
. gravel. sand, water
Dauer Milo Pitner
--.... r In ra 000
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
I =r X* S P;'c %-10,ou
2-R INs/Fc1-ivxv
/0 - %_ p / I2: CoAv0N
00V
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SWO10144
Date Issued: May 30, 2001
Expiration Date: May 30, 2002
Parcel ID: 051-042-88
Legal Description: BEAR PARK LT 8
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 022520 URSA MAJOR CIR
Owner Name: BROOK STILTNER Lot Size: 53327 SQ. FT.
Owner Address: 22520 URSA MAJOR CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK , AK 99567 -
This permit is for the construction of:
Q Disposal Field 0 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, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: E — 30 -O
Municipality of Anchorage
• Development Services Department
/ Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.sk.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 05'1 — 0*2--88 Permit Number 5'LVO/O /¢¢
Property owners) BROOK STILTNER Day phone 694-4200
Mailing address (1) 16600 CENT RFlELD DRIVE • EAGLE RIVER. AK
Mai�gaddress (2) ZZ320 URSA 11AXOR CIRCLE Zip Code 99577
Legal description (Lot, Block & Sub'd.) BEAR PARK SUBOMSION: LOT S.
Legal description (Section, Township & Range) N/A
Lot Size 52.448 Acre FL
THIS APPLICATION IS FOR:
Number of Bedrooms 3
Sewer Only ❑ Well Only ❑
Sewer and Well 0 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.
ALASKA WATER do WASTEWATER CONSULTANTS, INC.
PermitFees.yyo •
Date of Payment: -6 - a a -D►
Waiver
Date of Payment:
Receipt Number. 1/7y8 Receipt Number.
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
May 18, 2001
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Well and Septic Design for Lot 8, Bear Park Subdivision
To whom it may concern:
The proposed 3 bedroom house will be served by a private well and septic system. Test holes
were excavated on the property. The proposed septic system will be designed around the 30 foot
radius of test hole t12. We are proposing that a 1000 gallon septic tank and a bed type drainfield
be installed. Comments regarding the proposed design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring
and the percolation test results. It is our opinion that the insitu sandy soils should act as a sand
filter and that, an application rate of 0.7 gallons/day/ft2 should be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 0.7 gallons/day/f12
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 643 ft2
f. Total Depth: 5.5 feet (max.)
g. Effective Depth: 0.5 feet
h. Width: 15 feet
i. Reduction Factor: N/A
j. Minimum Length: 45 feet long
k. Effective absorption area = 675 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
4. TOPOGRAPHY: The area for the proposed drainfield is mostly flat; in short, there are no
slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. if you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
M.S.
NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, 2 soils logs,
and a 4 page constriction specification letter which are all part of the design package for this
septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
I \
BEAR PARK S/D; 1 \\ \\
LOT 6.
BEAR PARK S/D; I \
LOT S• 1 \
\X
DEER PARK S/D /1•
LOT 1. BLOCK 2
PROPOSED WELL
BEAR PARK S/D:
,I 100• WELL RADIUS / , \ \ LOT 7.
\ LOT 10.1 / 1 `-VACANT
( c ' 1
PROPOSED \ ! �' T� /� c
3 BEDROOM \\ I I ``\AREA
/ HOUSE
BEM PARK S/D;
LOT 9.
CrEPTIC TH `7-7— 4+ \
—r
ARFA� i DEER PARK S/D /1;
1 , , LOT 1. BLOCK 1
ALTERNATE SITE 1 I /
1 /
PROPOSED NEW SEPTIC SY57EMI`\ I I /
/ i— ---� (SEE DESIGN PAGE 2 OF 2) 1
/ BEM PARK S/D;
BEAPARK S/D; LOT 16. ; BEAR 7 S/D;
LOT 1
�ACANT j �pT,C
T �slb !,) G AR—D; ,m WELL RAD US , /
`�
Ak
DATE:
5/21/2001>< F ^u�y
DRAWN BY: C� ' \ . V^y
ALASKA «'AfER & NVASTE«TATER C.J.G.
CONSULTANTS. INC. SCALE:,
6901 DE6APP ROAD. SUITE 29 • ANCHORAGE. AA 99504 • "HONE 9671337-6179 • FAx 9Tn36azae 1 = 100 Tf "' .. :.
PREPARED FOR PHONE NUMBER: PAGE NUMBER:
BROOK STILTNER 694-4200 1 OF 2 Jef a GD s.
LEGAL DESCRIPTION: Oy.l C 7953 .` ?
TYPEBEEARDP ARK SUBDIVISION; LOT 8,OF �V4y^s�p• o`�c��'-
SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM ''u ,. rofessio���
—PROPOSED NEW DRAINFIELD. EXCAVATE
A TRENCH THAT IS 5.5 FEET DEEP
MAXIMUM BY 15 FEET WIDE AND 40
FEET LONG. ADD 0.5 FEET OF CLEAN,
WASHED SEWER DRAINROCK. INSTALL
DRAINFIELD PARALLEL TO SLOPE CONTOURS
o/.. ,5/21/2001 0� of u�
0
` DRAWN BY: ' ;7
ALASKA WATER & WASTE NVATER C.J.G.
CONSULTANTS, INC.E
6901 DEBARK ROAD, SUTE 29 • ANCHORAGE. AK 99501.' FHONE (907)337-6179 • FAX 9071316-7266 1 3D' " •• •'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
BROOK STILTNER (907) 694-4200 2 OF 2 e A. Games:
LEGAL. DESCRIPTION:QQ -7
a. 953
BEAR PARK SUBDIVISION; LOT B. �0� ' •.,
TYPE OF WORK: �Os^WdPFofssslotltc�
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
I /
NOTE: A MANDATORY SITE VISIT
BETWEEN THE ENGINEER AND THE
CONTRACTOR IS REQUIRED PRIOR
_
TO CONSTRUCTION.
NOTE: CONTRACTOR MUST HAVE
WEST LOT LINE FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
/
PROPOSED
WELL
/
i
PROPOSED 1000 GALLON
EPTIC TANK O
ALTERNATE SITE
FOO
i
Cys
ice'
i
i
yo
\\ TH12
cam/
ice/
\ Co
Cb
INSTAR DOUBLE CLEANOUTS
—PROPOSED NEW DRAINFIELD. EXCAVATE
A TRENCH THAT IS 5.5 FEET DEEP
MAXIMUM BY 15 FEET WIDE AND 40
FEET LONG. ADD 0.5 FEET OF CLEAN,
WASHED SEWER DRAINROCK. INSTALL
DRAINFIELD PARALLEL TO SLOPE CONTOURS
o/.. ,5/21/2001 0� of u�
0
` DRAWN BY: ' ;7
ALASKA WATER & WASTE NVATER C.J.G.
CONSULTANTS, INC.E
6901 DEBARK ROAD, SUTE 29 • ANCHORAGE. AK 99501.' FHONE (907)337-6179 • FAX 9071316-7266 1 3D' " •• •'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
BROOK STILTNER (907) 694-4200 2 OF 2 e A. Games:
LEGAL. DESCRIPTION:QQ -7
a. 953
BEAR PARK SUBDIVISION; LOT B. �0� ' •.,
TYPE OF WORK: �Os^WdPFofssslotltc�
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
ALASKA WATER & WASTEWATER
- - - -- ------
CONSULTANTS. INC.
Wi DMW RW, SUME 28 • AK H504 • KOiC (907)MI-M70 • FA . r..aaan
LEGAL DESCRIPTION: BEAR PARK SUBDMSION; LOT 8,
PERFORMED FOR: BROOK STILTNER DATE: 5/9/01
DE
((88t ~y�y ORGANICS TEST HOLE 1
1 C. —
:,ropn
20 '
COMMENTS:
GW/SW
GM/SM/ML
DEPTH TO DATE
GROUNDWATER
DRY 5/9/01
DRY 5/18/01
II +C'iACANr�
1
TH '
SITE PLAN
1 =100'
DATE READING
CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
(MIN./INCH)
PERC. HOLE DIA. 6• (INCHES)
Nr
••
FT, AND
11
II�111!11
oe
"Y/,
Ur9
ji
Y4,
DEPTH TO DATE
GROUNDWATER
DRY 5/9/01
DRY 5/18/01
II +C'iACANr�
1
TH '
SITE PLAN
1 =100'
DATE READING
CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
(MIN./INCH)
PERC. HOLE DIA. 6• (INCHES)
TEST RUN BETWEEN
RAS N
Pes�R�S M��,v
FT, AND
5.5 FT.
PERCOLATION RATE
<1
(MIN./INCH)
PERC. HOLE DIA. 6• (INCHES)
TEST RUN BETWEEN
5.0
FT, AND
5.5 FT.
PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
DATE
READING
CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
.�.O
F ..
ALASKA
WATER & WASTEWATER
y�Op
o00
INC.CONSULTANTS.
•4 : t 9Q
oo,
e p (907)136-M46
SOIL LOG — PERCOLATION TEST
"'rness• "
LEGAL
DESCRIPTION:
BEAR PARK SUBDIVISION: LOT 8,�':
ff a
OQ��
BROOK STILTNER 5/9/01
., C 7953:
PERFORMED FOR: DATE:
`q0
(fe
=��y
n4�0�P�Ofessio�°oov
(feet)
–
ORGANICS TEST HOLE 2
�OOppo�
1
'oe
'$W'
i. . aoeo
SOIL CLASSIFICATIONS (
1 �Ar�tr�
2
00
GW ORG
3
�:oOs
GP ML
GM CL
1
o.•o^>°
;: o% o' SW MH
5
SP CH
SM i OH
6—'
.r'.
��^`oo°o0o°
SC
�
0o e
Q„°eo
TH
� 3
7
-'��'ooe
DEPTH TO
DATE
y
GROUNDWATER
12' 5901
o e
Ac"000
10' 5/18/01
9
;t.,r:oo o
SITE PLAN
10
GW/SW
+Jn ooe
W/ SOME ML
or'ooe
c`9
12
rsoe°
J.E'00 u
J�-Ooe
e
13—'o-
s.O.a.
14—
1s
o
16
17
18
t9
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6° (INCHES)
TEST RUN BETWEEN 5.0 FT. AND 5.5
FT.
20
COMMENTS:
PERC–HOLE WAS PRE–SOAKED FOR 4+ HOURS
PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W P FORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z DI
DATE
READING
CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
S pF
Pg5 N � MN�.�ES
PERG NG�P�ER \
Parcel I.D. 051-044-03
Certificate of On -Site Systems Approval
Expiration Date: V
2 Zz Z `f
Legal description BEAR PARK LT 8A
Site address 22520 URSA MAJOR CIR Chugiak AK 99567
Current property owner(s) BRECI
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 1 /5/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
COSA Approval_June 2022
Development Services Department
On -Site Water & Wastewater Section
I
U
_0
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-044-03
Complete legal description Bear Park Lot 8A
Location (site address) 22520 Ursa Major Circle
Current property owner(s) Mark & Janet Bred Day phone
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑N Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 23 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑■ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ 1� T U Waiver Fee $
Date of Payment 1 `j 1Z110 7,q Date of Payment
COSA # OS C Z'I/ 00 6 Waiver #
COSA Application —June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
2024.01.05
2024.01.05
Septic Wank Advisory
Certificate of On -Site Systems Approval # OSC241006
Subdivision: BEAR PARK Block: , Lot: 8A
The septic tank for this property is 23 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more,
not including engineering, surveying or MOA permitting fees.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
fi G
Mailing Address P O�'�Box 196650�` ,Anchorage; Alaska 99519 6650 * www muni�org `� �°
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 3 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
©uo 03 /
Parcel I.D. 051 <.;. , - COSA# UsCr'a 1Q&6
1. GENERAL INFORMATION Expiration Date: ^`® , �� - &Z
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BEAR PARK S/D; LOT 8A
22520 URSA MAJOR CIRCLE * EAGLE RIVER, AK * 99567
CHRISTOPHER HUMPHREY Day phone
748-3881
22520 URSA MAJOR CIRCLE * EAGLE RIVER, AK * 99567
Day phone
CINDY LINDBLOM W/ GREATLAND REALTY Day phone
11411 OLD GLENN HWY * EAGLE RIVER, AK * 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
IN
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
694-9125
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
N
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there 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
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
337-6179
Date 7 ! ( Z
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By; Original Certificate Date:
F
(Rev. 11/05)
Lela
ON-SITE
WASTEWATER
PROGRAM
Municipality of Anchorage „E ,
• .�
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 03
Legal Description: BEAR PARK S/D; LOT 8 Parcel ID: 051-
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES
Date completed 10/8/2001 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
Total depth 101 ft. Cased to 101 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 10/8/2001 6/26/2012
Static water level 70 ft. 71 ft.
Well production 10 g,p,m. 6.6+ g,p,m,
WATER SAMPLE RESULTS
Coliform 0 colonies/100 ml. Nitrated• lI-arng./L. Collected by: GEG, Ltd.
Arsenic: 3 • o1 ug./L. Date of sample: 6/26/2012
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments
Foundation cleanout (Y/N) YES Depression over tankk(Y/N) NO
Date of pumping 6/12/2012 Pumper �7 R S
C. ABSORPTION FIELD DATA
Date installed 10/9-10/2001
Cleanouts (Y/N)
High water alarm (Y/N) N/A
JR'S PUMPING
Date installed 10/9-10/2001 Soil rating .p.d./ r ftlbdrm) 0_7 System type BED
Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth *4.1-4.7ft. Eff. absorption area 645 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/26/2012 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test 0 in. Water added 690 gal. New depth E in.
Elapsed Time: min. Final fluid depth E in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons ManholelAccess (Y/N
"Pump on" level at in. "Pump off'level High water alarm level
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tank/lift station on lot
100'+
Absorption field on lot
100'+
Public sewer main
N/A
Sewer /septic service line
25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
5'+
Property line 5'+
Absorption field
5'+
Water main
N/A
Water service line 10'+
Surface water
100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ 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
G. ENGINEER'S CERTIFICATION
i certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1 131 ) Z
COSA Fee & 'Y'qz
Date of Paymentyz&Q
Receipt Number i
Municipality of Anchorage •.
• Development Services Department
Building Safety Division \ .. .,.
On -Site Water & Wastewater Program )
4700 Bragaw Street
P.O. Box 196650 Ai
Anchorage, AK 99519-6650 /✓/lj%
www.muni.orglonsite �y(�
(907)343-7904 LV
CERTIFICATE OF ON-SITE SYSTEMS APP VAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051—ogy-007) COSA# v -f lay{
Expiration Date: 9-3 - O 7
Ex
1. GENERAL INFORMATION P
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BEAR PARK SUBDIVISION, LOT 8A
22520 URSA MAJOR CR. • CHUGIAK. AK 99567
STEVE do DIANA CARNAHAN Day phone 952-4840
22520 URSA MAJOR CR. + CHUGIAK. AK 99567
Day phone
VALESA LINNEAN w/REMAX Day phone 257-0195
110 W. 38TH SURE 100 • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
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 On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
5.
As certified by my seal affixed hereto and es 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 onsite water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
Information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system !slate) 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
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
in conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines B Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there 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
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will It confer any legal right whatsoever.
Date 4 130 /0? -
VVN1 Cn roly
WASTEWATER
Attachments: /
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineers Reort
Nitrate Advisory Other
By: Original Certificate Date:
(Rw. 1 M)
Municipality of Anchorage
• Development Services Department
Building Safety Dlviaion `
On -Site Water 8 Wastewater Program
47W Bragim Street
P.O. Box 190850
Anchorage, AK 99519850
www.n=l.org/onake
(90 343.7904
CERTIFICATE OF ON-SITE �YSTEMS APPROVAL CHECKLIST
Legal Description: BEAR PARK SUBDIVISION, LOT BA Parcel ID: OSI- O Li `t-0 3
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 10/8/2001 Sanitary seat (Y/N) YES
Total depth 101 ft. Cased to 101 ft.
FROM WELL LOG
Date of test 10/8/2001
Static water level 70 ft.
Well production 10 g.p.m.
WATER SAMPLE RESULTS: ccLt
Coliform colonies/100 mi. Nltratea1 r+ng.)L.
Well Log (Y/N) YES
Wires property protected (YM) YES
Casing height (above ground) 21 in.
AT INSPECTION
4/9/2007
70 ft.
6.62 g.p.m.
Other bacteria-colonies/100 ml.
Amenic:61LzugJL. Date of sample: 4/9/2007 Collected by: GEG, Ltd.
S. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 10/9-10/2001
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YM) YES Depression over tank (YM) NO
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
Date of pumping 4(11 /2007 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 10/9-10/2001 Soil rating .p.d r ft'/bdrrn) 0_7 System type BED
Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth 4.08-4.6a fL Eft, absorption area 645 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 4/9/2007 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption field before testDRY in. Water added 530 gal. New depth DRY in.
Elapsed Time: 3 min. Final fluid depth DRY in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN if yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (YIN)
"Pump off High water alar level at in.
Cycles tested Meets alar 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cieanoul N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I ceAlly that I have determined through Reld 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
Data t) l ?o % b;-
COSA Fee I Y30. U 0
Date of Payment /i - 3 O — O %
Receipt Number 11� r S C, >W
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
1 �r� Municipality of Anchorage
Development Services Department=
/ Building Safety Division ..
On -Site Water 6 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
A#
n�
Parcell.D. 051-042-88 HAIN
� (A9
1. GENERAL INFORMATION Expiration Date:
Complete legal description
vv�� -
Location (site address or directions) URSA MAJOR CIRCLE • CHUGIAK AK. 99567
Current Property owner(s) BRENDA AND RYAN SPARKS Day phone 688-6896
Mailing address
Lending
- --- -
Mailing address
Real Estate Agent
Mailing address
docs umnn naCt E + CHUGIAK. AK 99567
Day phone
LARRY MAULDEN w/ PRUDENTIAL JACK WHITE Day phone 762-3106
3201 'C' STREET SUR 200 • ANCHORAGE AK. 99503
unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
a
Individual On-site
0
❑❑
Individual Water Storage
Individual Holding tank
Community Class Well
11
Community On-site
13Public
Water System
13
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 5 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 less than 30 days old. (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 forthis 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date '8 fy
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering onslysts of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
Ouctuato during the year, and the water usage of the family being served by the systen
These conditions are outside the control of the evaluator of the system. Satisfactory to.,
— results do not guarantee future performance of fhe system, -nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can there/ore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by an
otherperson or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the illowing
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
ON-SITE
WASTEWATER
"ilJlll))
Manitenance Agreements _
Supplemental Engineer's Reort _
Other
ABy Original Certificate Date:
(Rev. 1201)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bregaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.ondwrage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: WPARK SUBDIVISION; LOT B_ _ Parcel ID: 051-042-88
A. WELL DATA
Well type MATE . If A, 8. or C provide PWSID# N A
Date completed 10/8/01 Sanitary seal (Y/N) YES
Total depth 101 It. Cased to 101 ft.
FROM WELL LOG
Date of test 10/8/01
Static water level 70 ft.
Well production 10 9 -
p.m -WATER SAMPLE RESULTS:
Coldorm _0 colonies/100 ml. Nitrate 0.597 mgAL.
Well Log (YM) YES
Wires property protected (YM) YES
Casing height (above ground) 18+ in.
AT INSPECTION
8/6/2004
72 ft.
4 —
9 -p.m -
Other bacteria 0 colonies/100 mi.
Date of sample: 8/8/2004 Collected by: G.E.G. Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 10/9-10/A /mac 1
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) N/A
Date of pumping 8/12/2004 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA RUN EXONG IM
Date installed 10 -to 1Soil rating .p.d ft%bdrm) 0_7 System type BED
Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth •4.s'-40 ft. Elf. absorption area 645 fe Monitoring tube YES Depression over field NO
Date of adequacy test 8/6/2004 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth In absorption field before fest 0 in. Water added 628 gal. Now depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >- 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) N/A If yes, give date
D. LIFT STATION
Date installed
'Pump on" level at _in.
Datum
E. SEPARATION DISTANCES
Size In gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAiR station on lot 1001+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTICINOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 101+ Surface water 1001+ Driveway, parking/vahicle storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 cei* that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. /
Engineer's PrintedZ
JEFFREY A. GARNESS
Date S11.7
HAA Fee $ Y}ei�_
Date of Payment
Receipt Number tJ7.,�s4
(Rev. 12r01)
Waiver Fee $
Date of Payment
Receipt Number
—7953
Apr 05 07 08:46a REIMAX Agent Service Cent
F
� p:.fa a •
'b
oe
:KA'. f
v= fop•
907-258-9005 )
p.2
AS BUI LT
6 A_;e
I HER`9Y CERTIFY JHAT I HAVE S'JTiVcYED THE SCALE: 5mm TATES LARD SDRTyTNC 694-082
FOLLOWING DESCRIBED PROPERTY, o. a+� "k
a•�xorce laC 6orP9 DATE, �� OF Azq�
AND THAT NO F.NCR6.� ENTS EXIST EXCEPT AS ............{ S,�•l
INDICATED. IT 1S THE RESPONSIBILITY OF THE y:
OWNM TO CETERMINE THE EXISTENCE OF ANY GRID, 1 f•� �fM" -••••' '" !
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEM ON THE R ✓' •••.:.•�
`.CANOED SU901- •i
VISION PLAT. ON BE NO CIRCUMSTANCES SHDULp F& i f 3'} °i•"• 1a A
ANY DA74 Y. ERCDN BE USED FOR CONSTRUCTION �m.rG f+A LS -691a
OF FENCE LINES, OR ►OR ESTAB' fSHING B.CUND- i �`••-A
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Municipality of Anchorage N15
Development Services Department
Building Safety Division
Onsite Water 3 Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99519.6650
www.d.anchorage.akus
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-042-88 HAA# lZg d
1. GENERAL INFORMATION Expiration Date:
Complete legal description I BEAR PARK SUBDNISION: LOT 8 _
Location (site address or directions) URSA MAJOR CIRCLE • CHUGIAK. AK
Current Property owner(s)
Mailing address
Lending agency.
Mailing address
Real Estate Agent
Mailing address
RANDY ROLOFF w/ PREFERRED CUSTOM HOMES Day phone
c/o BROOK STILTNER w/ REMAX OF E.R.
Day phone
694-4200
BROOK STILTNER w/ REMAX OF E.R. Day phone 694-4200
16600 CENTERFIELD DRUE • EAGLE RNER, AK 99577
Unless otherwise requested, NAA will behold by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
■
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
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 5 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 less than 30 days old. (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.
Mote: Alaska Water and Wastewater Consultants, Inc. shall be paid $1310' at or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal axed 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(em) 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone 337-6179
Address 6901 DEBARR ROAD, SURE 28 " ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 1v Z
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to protide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the tes4 and separation
distances measured to readily Identifiable features. The opera tional Me of all wells and
septic systems depend on the /owl soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or Arturo estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of thls report is for
the sole benefit of the ownertisted above. Any reliance upon or use of this report by any
otherperson orpartyIs not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the filoMng stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
WATER AND ; n
VVAJ I c VVA l tri
PROGRAM _
ByL ad"' � �• t�o-C/� Original Certifih#)-26-01cate Date: 411/
(a«. +Wo)
Municipality of Anchorage
• Development Services Department = -
Building
onatew teweierPwam -
47W South Brapw SL
P.O.80oM98850 Andwrage, AK 99519.WW
www.dAnahora *A us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
aso4
Legal Description: BWAr PARK SUBDIVISION: LOT 8 Parcel ID: 051-042-88
A. WELLDATA
Well type SATE IfA, B, or C provide PWSID# N/A
bate compieted 10/8/01 Sanfiary seal (YIN) Y28
Total depth —10-11 Cased to -10—Ift.
FROM WELL LOG
Oft ortest 10/8/01
Stage water level 70 R
Well production 10 9 -P -M
WATER SAMPLE RESULTS:
Coliform D colordestI00 ml. Nitrate 0-6 mgJL
Well Log (YM) YES
Wines property protected (YM) YES
Casing height (above ground) 18+ in.
AT INSPECTION
R
g.pm.
Other tmcteds G colonies1100 ml.
Data of $ample: 10/23/2001 COOected by- AWWC. INC. -
G. SEPTICIHOLDING TANK DATA
Tank Typo/Material STEEL Date Insured 10/9-10/01
Tankalze 1000 gal. Number or Compartments 2 Cieanouts(Y" YES
Foundation deaWA (y" YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of Pumping NEW Pumper -
Date Installed 10/9-10/01 Sell rating.pA 1t'/bdrm) 0_7
Length 43 R Width 15 R
system 4" BED
Gravel below pipe 0.9 R
Total depth 211=!:VA tJL absorption area 845 to Monitoring tube YES Depression over field NO
Date oradequacy test NEW Results (Pass/Fail - For 2 bedrooms
Fiuld depth In absorption field before testes In. Water added=gal. New depth =1n.
!lapsed Time: = min. Phai fluid depth= in. Absorption rate '= - g.p.d.
Any rejuvenation bsatrnent (past 12 mo.) (YM & type) - It Yes, at" date -
D. UFT STATION
Date irtsteaed
"Pump On' level at_in.
E. SEPARATION DISTANCES
Sirs In gallons
High water alarm level at in.
Cycles Meets alarm & draft requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenMi t station on lot 100'+
Absorption told on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service ane 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO:
Suading foundation 5'+ Property ane 51+ Absorption field 5'+
Water main N/A Water service ane 10'+ Surface water 100'+
Wells on adjacent kits 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One i 0'+ Building foundation 10'+ Water main N/A
Water service ane t o'+ Surface water too'+ Driveway. part rQftNcle storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
0. ENGINEER'S CERTIFICATION
I cerU& that I have determined throWh Be/d laspections end
review of Mun/dpat records that the above systems are In
conformance with MOA HAA guidelines In effect on this data
EngineersN G JEFFREY A. GARNESS
Date to _ Sl0/
HAA Fee $ ZM
Date of Payment 10 - 'd S ni
Receipt Number 01 J 8 cl
(R1v.12MO
Waiver Fee $
Date of Payment
Recelpt Number