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BEAR PARK LT 2
#051-042-68 Municipality of Anchorage e Development Services Department y - iL_ Building Safety Division On -Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 Page 1 of 4 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW040271 PID Number. 051-042-68 Name: Wastewater System: ❑ New ■ Upgrade LESLIE ROMERO Address: 22729 URSA MAJOR CIRCLE • CHUGIAK, AK 99567 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 688-0112 3 O Deep Treneh ■ Shallow Trench 0 Bed O Mound 0Other son Hating: Taal Dpth flw^ w%In l gad.: LEGAL DESCRIPTION 0.45 GPD/eq. Ft 5.5 MAX Ft Black: Lot: Subdivision: Depth b Ops babm nam ofthol vada arenl depth bwwalh pipe 2.5+ — 2 BEAR PARK SEE DWG. Ft R Township: Range: Section: — — M added adios erlgind firma Gnwsl Imp: 174 (3 ® 58)rt. — SEE DWG. R Grwd ddN: Number of anew Dhtams betaae" nn«: 1 15 WELL: 0 New 0 Upgrade 5 Ft. 3 R Cla«Hbab- A C : Toa Dspft Cased To: Told absorption ant 1334+ FV9 ^SOI: D 3034/ F-810/SCH 40 PVC R, so. pt. g,gbn IIM: Slono wow IMI: hel"Ilw: GREEN GENERAL Dab baalbtl: 11/4-8/2004 R TMH: pomp sat Ab leasing Ndghl above Ground: TANK DPN FL I FL SEPARATION DISTANCES ■Septic 0Holding ■S.T.E.P. 0Other To septic Absorption Utt Holding �p w,te N«aaabw ANCHORAGE TANK DaPaaro b g 1"001" 1000/500 TankFieldStation Tanks«er un« uabdab ber a oanpwk"e�. 100'+ too'+ 100'+ — 25'+ STEEL 2/1 100'+ 100'+ 100'+ — — LIFT STATION k, oou� Ncnufaeturer.5'+ 10'+ 5'+ — — 500 ANCHORAGE TANK ORENCO SYSTEMS wnp w- ierel ab mp lsm as High rata alum at Foundation 5'+ 1 10'+ 5'+ — — 41" 41" 1 47" Pump Nob ! Nada: eeoklad kwp*:Wn@ prfan"sd br. Curtain Drain NONE KNOW /20 OSI 05 HHFI WALKER ELECTRIC BENCH MARK Remarks: OLD DRAINFIELD COMPLETELY ABANDONED PER UPC Location.na o«odpnon: TOP OF FLASHING NEAR POINT "A" M«med °..om" 99.73 Ft ENGINEEWS S *.' 4 ...•... Inspections performed by: GEG, Ltd. Dates: 1st 11/4/2004 • • • • � ....... 2nd 11/5/2004 vp 3rd 11/8/2004 of a A. esD� �I •. : 7063 .. 111 Development ervices Department Approval .s;' �.`, Owl q.Q Reviewed and approved by: Date: �4p"prareseta^°a Ode. 12/01) 1DOODO�cti'o PERMR NUMBER: SW040271 LLI AS -BUILT DRAWING h � / -LA ST' 15.91 12 6 ST2 21.34 41_83 - / ST3 24.54 43.67 / MH 26.31 44.94 MT1 44.43 66.9 MT2 59.54 61.33 MT3 58.88 79.07 76.46 FET473.05 72.99 91.45 MT 87.58 91.85 PARCEL ID 051-0 EKISTINC 7000 GALLON SEPTIC TANK. / INNEW LOCATION ON 107/4/200 4 500 GALLON T STATION 1 GARNESS ENGINEERING GROUP, Ltd. s CONSULTANTS &GENERAL CONTRACTORS 1" = 40' 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507' PHONE (907)337-0V9 • FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LESLIE ROMERO (907) 688-0112 2 OF 4 LEGAL DESCRIPTION: BEAR PARK SUBDIVISION; LOT 2. TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE -%-NEN DRAINFIELDS/ / •F so�'��► PERMITNUMBER: BUILT DRAWING PID NUMBER: SW0 AS - 051 SW040271 051-042-68 VERIFIED TANK INTEGRITY. �NAL GRADE . 98,22+ INTEGRITY GOOD ON 11/4/2004 —(usuunoN TOP OF TANK AT INLET - 92.59- n L4 EXISTING 1000 GALLON INVERT OF BUNG SEPTIC TANK AT INLET - 92.04 FINAL GRADE - 98.35 (AVG.) - INSULATION — TOP OF TANK AT INLET - 92.23 - INVERT OF BUNG AT INLET - 91.7 NEW 500 GALLON LIFT STATION 11/11/20 DRAWN W. GARNESS ENGINEERING GROUP, Ltd. C.J.G. CONSULTANTS i GENERAL CONTRACTORS tw = 40' 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-6179' FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LESLIE ROMERO (907) 688-0112 3 OF 4 LEGAL DESCRIPTION: BEAR PARK SUBDIVISION; LOT 2, TYPE OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE TANK AT 92.59 INVERT OF BUNG AT OUTLET - 91.81 OF MANHOLE . 98.77 TANK AT 92.23 .•... r11B33;...y�D En7953 .•' r`T� PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW040271 051-042-68 THE DISTRIBUTION LINE WAS 1.25 INCH PVC w/ 1/8 INCH HOLES SPACED 27 INCHES ON CENTER (24 HOLES PER LATERAL/72 HOI EAST TRENCH MIDDLE TRENCH WEST TRENCH ORIGINAL GRADE 98.50 0 HIGH POINT 98.54 0 HIGH POINT 98.59 0 HIGH POINT BOTTOM OF TRENCH 93.00 (AVG.) 93.04 (AVG.) 93.09 (AVG.) INVERT OF PIPE 95.63 (AVG.) 95.63 (AVG.) 95.63 FINAL GRADE 99.51-99.92 99.44-99.63 99.14-99.23 X11/11/2004 0 SOF C,ys;p44 DRAWN SY: ppO�l,�._•..... vr GARNESS ENGINEERING GROUP, Ltd. C.J.G. o - -*��D SCS. CONSULTANTS i GENERAL CONTRACTORS...... 1 — 4O r • • • : • • • • • • • • • • • • • • •� 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-0179 • FAX (907)338-3246 e e Grness: �4 — 449 •' 3 •' �Fp� 44fe .11�!! O�EoAy� 4���40000��� PREPARED FOR: PHONE NUMBER: 907 688-0112 LESLIE ROMERO ) PAGE NUMBER: 4 OF 4 LEGAL DESCRIPTION: BEAR PARK SUBDIVISION; LOT 2,olp TYPEPROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE WALKER ELECTRIC CLIKT WALKER 10319 Colville St. EAGLE RIVER A1C, 99577 Lioenae 5 1310 Phone 6965964 Cal 0 2236304 Email ChntAtan@ooLmn To: Green General Contracting P.O. Box 672125 Chugiak, AK 99567 Date :11-14-04 Ref :22729 URSA MAJOR CR. Permit : This is to certify that on site sewer lift station at above mentioned property has been wired in accordance with the standards of the National Electrical Code and manufactures specification. Systems were checked and performed as specified in the systems manual. Clint Walker MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO40271 Legal Description: SM -P W `LT7Z f Design Engineer: 0855 Gayness Engineering Group, LTD Owner Name: Nathan and Leslie Romero Owner Address: 22729 Ursa Major Circle Eagle River, AK 99577-0000 11/04 noa��pp c$16a Date Issued: Jul 20, 2004 Expiration Date: Jul 20, 2005 Parcel ID: 051-042-68 Site Address: 022729 URSA MAJOR CIR Lot Size: 40731 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Z✓ Disposal Field ❑✓ Septic Tank Holding Tank [—] Privy E 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. Date: _ Municipality of Anchorage y` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. NQe2 -101?) Permit Number Property owner(s) NATHAN AND LESLIE ROM RO Day phone 666-011 Mailing address (1) _ 22_729 URSA MAJOR GIRCLE EAQLF RIVER ev Mailing address (2) Zip Code 99577 Legal description (Lot, Block & Sub'd.) _ REAR PARK SUBDIVISION: OT Legal description (Section, Township & Range) N/A Lot Size_1 �i1 Acres/Sq.Ft. Number of Bedrooms _ 3 THIS APPLICATION IS FOR: Sewer Only ® Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 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. GARNESS ENGINEERING GROUP Ltd. Permit Fees: W'oo OU Date of Payment: 7 1 1(,121 Receipt Number: o55�A')' Waiver Fees: Date of Payment: Receipt Number: In GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS July 8, 2004 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic System for Bear Park Subdivision;lot2 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is currently in the state of failure and needs to be replaced. We are proposing to install a new 1000 gallon septic tank and a 500 gallon lift station with a 5 -wide trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the 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 an application rate of .45 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 3,0 minutes/inch b. Proposed Application Rate: .45 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1334 ft2 is Total Depth: 5.5 feet (maximum) g. Effective Depth: 2.5 feet (minimum) h. Width: 5 feet i. Reduction Factor: .64 j. Minimum Length: 174 feet long (3 @ 58 feet long each) k. Effective absorption area = 1334 ft2 Note the distribution line is to be 1.25 inches with 1/8 inch holes drilled 27 inches on center (24 holes per lateral / 72 holes total) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan the average slope in the area is approximately 1 to 5 percent running southeast to northwest. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. / I .E., M.S. NOTE: A site plan drawing, a design drawing, one soil log, and a 7 page construction specification letter which are all pan of the design package for this septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246' Website: gamessengineering.com ' RANKIN ROAQ _ --/---------- \ ---�,—�—�—�—�---------------------------- ------------ T ----------------- 1 j 1 p1�,,,� i LOT 8, BLOCK 2, 1141� 1 I I DEER PARK S/D i 1 EXI571NG / I / LOT 13; I 3 BEDROOM LOT 1, / BEAR PARK S/D / _ r.�1 HOUSE BEAR PARK S/D \ /EXISTING SEPRC SYSTEM TO BE , \`\ / � COMPLETELY ABANDONED /, /--—�, / / ' � I / 1 LOT '�, BLOCK 2. 1 LOT 12, )I \� \ / I J , 1 BEAR PARK S / I \ V DEER PARK S/D (NO CoNCERN) \ qs ' LOT 4. BLOCK 2 LOT 3. ROPOSED BEM PARK S/D SEP/IC SY51DA // DEER PARK S/D, (NO CONCERN) BEM PARK S/D / ' I /' LOT 3, BLOCK 2, DEER PARK S/D (NO CONCERN) Lor e. I \ \ \ `♦ `♦ BEM PARK S/D I ,'' I LOT 2. BLOCK 2, BEM PARK S/DLOT 5. ////�� ` 12 i DEER PARK S/D ♦\\ \\(NO CONCERN) H.. _ DATE: 7/8/2004 .�•S:C, '0F d DRAWN BY- a"V sy�j; GARNESS ENGINEERING GROUP, Ltd. R.A.L. � CONSULTANTS i GENERAL CONTRACTORS SCALE 1" 100. 'k* ,Y .. ........ ........'q 3701 E. TUDOR ROAD SUITE 101 •ANCHORAGE. 4% 99507 ` PHONE 907)337-61]9 ` FAX (907)338-3246 = y " PREPARED FOR PHONE NUMBER: PAGE NUMBER: NATHAN AND LESLIE ROMERO 907 888-0112 1 OF 2 .. ........ of r . .. Gam .. ss... YA a•. E_ +' LEGAL DESCRIPTION: - BEAR PARK SUBDIVISION; LOT 2 r ' .,\� ani• d p • • ..... • •' p\ �' 0 TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC SYSTEM Op�i08810 I Lu 1 I 1\ Q I J C -)of I 0 Q� EXISTING SEPTIC SYSTEM TO BE / COMPLETELY ABANDONED / /ROPOSED 1000 GALLON / SEPTIC TANK i NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH LOT LINE AND WELL RADIUS FLAGGED BY A REGISTERED SURVEYOR PRIOR TO CONSTRUCTION -PROPOSED 500 GALLON LIFT STATION — PROPOSED ORAINFIELD EXCAVATE THREE TRENCHES THAT ARE 8 FEET WIDE, BY 8.5 FEET DEEP BY 58 FEET LONG EACH (174 FEET LONG TOTAL) ADD 2.5 FEET OF CLEAN WASHED SEWER ROCK, THE DISTRIBUTION UNE IS TO BE 1.25 INCHES WITH 1/8 INCH HOLES DRILLED 27 INCHES ON CENTER (24 HOLES PER LATERAL / 72 HOLES TOTAL. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS 3701 E. TUDOR ROAD. SUITE 101 . ANCHORAGE, AK 99507 . PHONE (907)337-6179 • FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: NATHAN AND LESLIE ROMERO (907)688-0122 LEGAL DESCRIPTION: BEAR PARK SUBDIVISION; LOT 2 TYPE OF WORK: DESIGN FOR PROPOSED SEPTIC SYSTEM 7/8/2004 DRAWN BY' R.A.L. SCALE - 1 " = 40' CALE1"=40' PAGE NUMBER - 2 OF 2 "i. II r1l) � GROUNDWATER TIME (MINUTES) 10.5' 7 2/2004 6/24/9004 1 2:00 — 8` GARNESS ENGINEERING GROUP, Ltd. 2 2:30 CONSULTANTS & GENERAL CONTRACTORS 5" 1` 3 2:30 — 3701 L IUDON Ig10. Writ 10i I ANOMAG4 IK N°0] • ' 00 7-417Y - IAK -3246 - eF8511E 4 SOIL LOG - PERCOLATION TEMT 30 5` LEGAL DESCRIPTION: BEAR PARK SUBDIVISION; LOT 2 •• of r c nesse 7953 ` Opp• PERFORMED FOR: NATHAN AND LESLIE ROMERO DATE,• 6/22/2004DPTH — ••',� — 6 ,. ((feet _ _ EST HOLE 1 4���4o°9e'°�� 1 ORGANICS ZZ= ==== SOIL CLASSIFICATIONS ------ ---- 2 as GWORG I 1 I i I 3 GP ML GM CL 4 GC OL SW MH 5 ' •� SP CH SM OH 6 SC J �� I 7— DEPTH TO DATE I +TH#I // 6 DRY 6/22/2004 ii g GM/SM SRE PLAN 10-100' 70 DATE READING CLOCK NET TIME WATER LEVEL NET DROP 11 12 13 14 15 16—B.O.H. 17 18 PERCOLATION RATE 30 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 4.5 FT. AND 5.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: CALEB GALL PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: GROUNDWATER TIME (MINUTES) 10.5' 7 2/2004 6/24/9004 1 2:00 — TIME (MINUTES) READING (INCHES) 6/24/9004 1 2:00 — 8` — 2 2:30 30 5" 1` 3 2:30 — 6` — 4 3:00 30 5` 1` 5 3:00 — 8` — 6 3:30 30 5` 1` Municipality of Anchorage Page 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _ '15W �� 036 PID Number: d'Si -01+2 -(OR Name: J Gfi;% Wastewater System: 'New ❑ Upgrade o Address: p.p. ea '1'72z4t �AGLE RNte & lkIC ABSORPTION FIELD Phone:- O O No, of Bedrooms: iXDeep Trench ❑Shallow Trench Bed ❑Mound O Other LEGAL DESCRIPTION Soli Rating: O.6 Total Depth from original grade: l C), GPD/Sq. . Ft, Lot: Block: Subdivision: 2 PARK Depth to pipe bottom from original grade: St Gravel depth beneath pipe 61 --' B& Ft. Ft. Township: Range: Section: Fill added above original grade: I Gravel length: t (.0 6.61 .5t _I*F Ft. Ft. WELL: 1 New ❑Upgrade ' Gravel width: �� Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): fit '(s Cased To: 160 • Ft. Total absorption area: O SQ. Ft. Pipe material: STM O"303 /E1310 Driller: (A-0 0911.1.1�l( [Date EDrilled: Static Water Level: 35 Ft. Installer: Y1abo E-xCAJaYt Date Installed: 10-14-Rl Yield:// Pump Set at: Casing Height Aboove Ground: TANK t0 GPM U• �: • Ft. 2-1-1 Ft. SEPARATION DISTANCES JISeptic ❑ Holding O S.T.E.P. To Septic Absorption Lift HoldingPublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines % c ttkajL GE 7my.- 1000 Well -1 �--• •--, Z51� Material: Number of Compartments: 1 101i 1Zr, 1'x' -- -- -- LIFT STATION Water 1°0Surfac bolt Lot sof -15 i{ ---- ,_. '._" Size in gallons: Manufacturer: Line Foundation lOr 20, �...,. �,. ,-,..-� "Pump on" level at: "Pump o at: High water alarm at: Curtain , 10� 1i NJ 1 IV Pump Make Electrical Inspections performed by: Drain IV Remarks: BENCH MARK Location and Description: ,. eF W If►iOouJ JthrA Q.... To Pa1aT r�A,� . Assumed Elevation: .. hoc+a EIL Ngo L 9 Inspections performed by: 3 & 5 INGINSERING Dates:1st l ° ' I w -9'► , •� 17034 Eagle River Loop Road, No. 2042nd to -16-41 ,� . "• ROBERT"C.C COWA' NI�or a River, Alaska 9577 3r -19-A CE - 8801 fw.,., ,r;o �s� ��l,F� Department of Health.and Human Services approval ,••..,,..,,„^,,,.`� I_ J J�V��� a/ Reviewed and approved by: Date: 72-013 (Rev. 9/91 ) MOA 25 PERMIT NO. SW970360 PAGE 2 OF 2 Municipa(ity of Anchorage DEPARTMENT OF HEALTH AND HUKAN SERVICES ENVIRONMENTAL SERVICES DIVISION R0, Box 196650 • Anchorage, Alaska 99519-6650 • TeL 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR V�ELL INSPECTION REPORT LEGAL LOT 2, BEAR PARK SUBDIVISION P.I.D. NO. 051-042-68 o A B FCO 26.0' 2.0' ST 1 20.5 16.5' ST2 26.5' 19.0' DBL1 29.0' 20.0' DBL2 30.0' 21.0' d C01 54.0 27.5' Ln MT1 5 2. 5 26.0 CO2 39.5 46.5' NEW 1000 GAL. MT2 38.5 4. SEPTIC TANK CO2 MT2 n WEL oa)z + 1001 �O� 2 m� �dtUS co 080 / / # TH 08L2 LOT 2 1 ALT. SITE L0�) s ,, NEW TRENCH /moi �ayP�� COI = 103.8' CO2 = 104.1' STl ST2 FINAL GRADE 103.3' MT1 Col MT2 CO2 SCALE 1" 40' ENGINE OF. _,t4 s, NEW 98.2' 1000 GAL 98.0' SR"�� E� 1 •.,';7 4th •• �• + SEPTIC TANK Col CO2 = 98.0' 1 = 97.9 " t 6m•M, b� N, a a` .H.M.!!. • �� G� 0ROBERT C. COWAM � �Q MT2 = 92.9' CE -$$01 • NO WATER FOUND t✓ tai=4;�t%C'4J 88.9' B.O.H. JAN -29-98 THU 02:33 PM M—W DRILLING 907 3453287 P.01 0'--' -.1 M W DRILLING, Inc. <t , v,c�. nee ✓ : P.O. Box 110378 • 10330 (Nd Seward Highway (907) 349.9535 ANCHORAGE, ALASKA 99511" DRILLING LOG Well Owner 5 Use of We1LD DME ' Location (address of: Township, Range, Section, if known; or distance main road LQ -T Z BEAR PARK 81SPIVISION Size of casing--LL—Depth of Hole 1 63 —feet Cased to--j-fiD—k"eet Static water level,I I -ft. (� R%, '(below) land surface. Finish of well (check one) open end ( X ) Screen ( }; Perforated ( )• Describe screen or perforation,_ Well pumping test at y gallons ped (WK) .4X (minute) for—thours wit nn r� ft, of drawdown from static �oyel. I Y Date of completion ' WELL LOG Depth in feet from + ' ground surface Give details of formations penetrated, size of material, color and hardness �2T_TO 1 ,� . r•.r. fiTLT. ! 1 TO ?0 T . , 2()_—TO 57 - _TO 911 ____ALTO._ 9 2 TO.. 1 1 s, �11 .T0 130 BROWN GRAVRLLY SIF,.T[ 410 �e - 1.30 0, 153 SANDY GRAVEL: 68EY SAaOI, wAYI"f��E A�L.-�C, - 1 1 TOtip, ._ 1 F. tF. i T0 163— ate?) • STLTY-, GRASAI;Lt,Y -TO-- 3 — CQNTRACTOR" TO- -3—CQNTRACTOR' .r. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970360 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:JOHNSON, CRAIG OWNER ADDRESS:P.O. BOX 772241 EAGLE RIVER, ALASKA 99577 PARCEL ID:05104268 LEGAL DESCRIPTION: BEAR PARK LT 2 LOT SIZE: 40731 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: M U/tel rbw�l PAGE 1 OF 1 DATE ISSUED:10/10/97 EXPIRATION DATE:10/10/98 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ISSUED BY: )"�-u{` /'), - 10 -- rZ DATE : / () 10- 917 LA Pm HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN S&S� ,-ineening October 6 , 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Bear Park Subdivision ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 6942979 FAX (907) 6941211 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavtion, no water was encountered in the test hole. After seven day groundwater monitoring, the monitoring tube within the test hole has been checked and found to be dry. Attached is the proposed design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, IU/2'/t,"- Robert C. Cowan, P.E. RCC/j lm Enclosure MUNICIPALITY OF ANCHORAUt ENVIRONMENTAL SERVICES DIVISION OCT 0 7 1991 RECEIVED 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 " = fi0' SITE PLAN DESIGN SCALE �\rnviu'o Zi v'ow t�7 .m OFCD pN0 cn � r, N OTIM �, �i `v Zvmm C� �01I +� cn O 0-0 m< x O 11 011 Z M co c:-3z`♦'` j W W C:) 0-4 zxra �lC ►—] A*-, O G7 i v r �m Z� ' ��� tai O 0 to > D � z 0 i x co o b 0 ``• 5��0 �� ao� I n N r�4 0ct ai \ o rn \ `4 Z2- `\ ♦♦ A),<w y�C v O A A r;qo z 0, D Z c +7 `\ ♦\`♦2 ♦♦`\ nVl<m COQ T ♦ ♦ li m 2M 00 vmor-w^ I z ;zCa it�iim3jmZ I z v -v N to \\`14 r - NO r, 00, ZZA `\ RI 0 N o 'Ofy mm-�� mm fA z40M 00 s Z Z OA 0 Z D a o) O i Z z-4 z o y o O \ \ C7 G7 ;v z D O \ py \1p fie,\ �.. ••. \i \ o c n N , Uffix 4 ��• `\ =rte V. r CO n S T. tA M ���1 HF R ' • ••'''•b z v �A `\ \`� 0 a� 7 '4 4 e Municipality of Anchorage 10 . k* DEPARTMENT OF HEALTH & HUMAN SERVICES q 825 "L" Street, Anchorage, Alaska 99502-0650 ' SOILS LOG — PERCOLATION TEST ry "' "• • •r••••' %, �� $ ROBERT C. COWAN �� PERFORMED FOR: V� J��l��aa DATEPERFORMED •� LEGAL DESCRIPTION: L -0"P Z QEA2 ��►Qic �/� Township, Range, Section: r F� SLOPE SITE PLAN OK( AAkC,5 w 2 �w 3 Gross Time ML Depth to Water 4 bf a Y ��.• :O 5 +� �• O��ID�O 6`. 8 9\% •` A &L W/-rP'Ac.E5 aF Stzr 10 12 13 a:... 15 16 a • f �. 16.0. N• 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Oepth to Water Ari Monitoring? 510 Date: 1 �do 20 -{ I t� IL—�I PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN (0 FT AND —7 FT COMMENTS S & S ENGINEERING I 'l&z. Ai Z-- CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: a o• ACCORDANCE wftkttbwirAI�i4I44ii MAL GUIDELINES IN EFFECT ON THIS DATE. DATE: %� /-7 lel 72-008 (Rev. 4/85) Gross Time Depth to Water O��ID�O 20 -{ I t� IL—�I PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN (0 FT AND —7 FT COMMENTS S & S ENGINEERING I 'l&z. Ai Z-- CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: a o• ACCORDANCE wftkttbwirAI�i4I44ii MAL GUIDELINES IN EFFECT ON THIS DATE. DATE: %� /-7 lel 72-008 (Rev. 4/85) 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. 051-042-68-000 1. GENERAL INFORMATION Expiration Date: Complete legal description Bear Park L2 Location (site address) 22729 Ursa Major Cir., Chugiak, AK 99567 Current property owner(s) ROBINSON ANDREW & HAYLEE Day phone Mailing address 22729 Ursa Major Cir., Chugiak, AK 99567 Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/Wo ADU�t F1 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 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 $ /-( S Date of Payment 4 —2-c( - 2 2 Receipt Number M-713 3 COSA# O!SG221172. 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. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC. Phone (907) 406-1058 Address 19162 Mountain Rd., Chugiak, AK 99567 / Townsend ;`' Engineer's Printed Name Curtis Date . ° V C 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Z P Sel ER G 9i"�44ENT�S� ll��� Original Certificate Date: '-s—rJ -2o2a 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 Well Flow Advisory COSA Checklist blue sheet Arsenic Advisory X Other S4%\ +m.& A COSA Checklist Legal Description: BEAR PARK Lot 2 Parcel ID: 051-042-68 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 12/3/97 Total depth 163 ft Cased to 160.7 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 27 in. Date of flow test for COSA 128'2020 Well production at time of test 5.5 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.339 mg/L ❑ Nitrate less than MRL (ND) Arsenic 11.62 ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 4/5/2022 Static water level at beginning of test 134 ft Comments SWL measured 4/5/2022 at 134'. Arsenic filter on kitchen faucet, operation not verified. B. TANK DATA Age of tank(s) 25 years Tank type/material .0plid5tea1 Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Jan 27, 2022 D. ABSORPTION FIELD DATA Which system tested (date installed) "`°2063 ❑ AL1_ standpipes present per record drawing Total measured depth from grade 5.8 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station 18 years Lift station material steel Comments: Adequacy test date i2J81 o Results E✓ Pass For 3 bedrooms Fluid depth prior to test 1/3/4 in Water added 451.5 gal New depth 3/5/6.5 in Elapsed time 1433 min FE-1Code-requiredsoil cover over field Final fluid depth 1/3/4 in ❑ System presoaked Absorption rate 451.5 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Apr 2022 water levels MT3 1"/ MT5 3" / MT6 4". Other MTs had no water. COSA Checklist yellow sheet 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' Q Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment : 50' Q Yes if No ft Q Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft E] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓Ll Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main.> 10' _ - _Q Yes- if No ft Community Wells > 200' (Q.Yes___if No.._ ft_ Water Service Line > 10' Q 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' Q 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' Q Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that / 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. f `49 1114 4tSY Ura .,oma• CtdlE � c ff L �'�. L COSA Checklist yellow sheet Lift Station/Pump Vault Maintenance Log Owner `t (' ��t3 i i Street Address z- n1 foe, Septic Tank: -Sludge level inches -Pumping: required es o -Pumping comp) ted a no Lift station: i -711� - -Pump basket cleaned a no -Effluent filter cleaned no t -Control floats cleaned no -Proper float settings confirmed e no Operation satisfactory� e no Alarm System: -Dedicated electrical alarm circuite no -Audible and visual alarm inside dwelling no -Alarm system operates satisfaacto not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection Ves -Ground water intrusion around pipe penetrations rimesZ -Weep hole functional no -Manhole lid: Functional e no Insulated jgDno Properly Secure no Other -All manufacturer required inspections and maintenance completed Ves no Comments: Qualified Maintenance Provider: 1 Technician �1 C�U�'1� _ Date of maintenance Company �CAY U 'ffi Signature ��` Date441-11 d Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221172 Subdivision: Bear Park Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is 25'years old. A leaking septic tank may be a source of contamination to_ the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. r Mailing Address P O Box�96650 Anchorage,w Alaska 99519 6650 *ww muni org , Arsenic Advisory Certificate of On -Site Systems Approval # OSC221172 Subdivision: Bear Park, Lot 2 -- A water sample revealed an arsenic concentration of 11:42 micrograms per liter (ug/L). 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. 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. 051-042-68-000 1. GENERAL INFORMATION Expiration Date: Complete legal description Bear Park L2 Location (site address) 22729 Ursa Major Cir., Chugiak, AK 99567 Current property owner(s) Andrew & Julia Hallead Day phone (231) 510-6745 Mailing address 22729 Ursa Major Cir., Chugiak, AK 99567 Real estate agent Laurra Davis Day phone (907) 406-0250 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 412.50 (COVID-19) Waiver Fee $ _ Date of Payment 1 � ) 31,20020 Date of Payment Receipt Number © i 500 y Receipt Number COSA # OSC201693 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC. Address 19162 Mountain Rd., Chugiak, AK 99567 Engineer's Printed Name Curtis Townsend m-sim����.r_ril ism System #1 Approved for 3-- bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 406-1058 Date 12/22/2020 O A�, TH u o o u /i• L Townsend ?-'•, Datai 2 'L z .No C "R�b�pROFESS1Gt1A�' �� Conditional approval for bedrooms, with the following stipulations: OF �V nN-SITE m =� WATER AND WA o J J-��F3C�GF�A I ,��J� JSER�� By: J tip• ! ,e�C Original Certificate Date: /Z -2.q-20 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S4&1 �ItSe Ste COSA Checklist Legal Description: BEAR PARK Lot 2 Parcel ID: 051-042-68-000 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1213/97 Total depth 163 ft Cased to 160.7 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 27 in. Date of flow test for COSA 12/8/2020 Static water level at beginning of test 134.6 ft. Comments B. TANK DATA Age of tank(s) 23 years Tank type/material sept"sleel Measured operating fluid level in septic tank 5 OR Standpipes/foundation cleanout per record drawing Date of pumping 12/10/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1114-812004 ❑ ALL standpipes present per record drawing Total measured depth from grade 5.8 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field ON Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: MT3/MT5/MT6. Other MTs had no water. COSA Checklist yellow sheet Well production at time of test 5.5 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ON No ❑ Coliform bacteria is Negative Nitrate 0.434 mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.815 ug/L ❑ Arsenic less than MRL (ND) Collected by Brandon Jones, Brandon's On -Site Services, LLC. Date of Sample 12/8/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station 16 years Lift station material steel Comments: Adequacy test date 121812020 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 1/3/4 in Water added 451.5 gal New depth 3/5/6.5 in Elapsed time 1433 min Final fluid depth 1/3/4 in Absorption rate 451.5 gpd Any rejuvenation treatment (past 12 months) no 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' U✓ Yes Community Sewer Manhole/Cleanout > 100' ® Yes if No ft M Yes if No ft Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' [✓ Yes if No ft Neighboring Absorption Fields > 100' F71 Yes if No ft Water Main > 10' Animal Containment > 50' 7 Yes if No ft Q✓ Yes if No ft 0 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0✓ Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' U✓ Yes if No ft Surface Water> 100' E✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' F(l Yes if No ft Private Wells > 100' F71 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 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' 23 Yes if No ft If absorption field is under driveway comment below Property Line > 10' FV1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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. .• TM ... j ................. COSA Checklist yellow sheet �� Curtl L: yownse d o*- Date iZ 2 No. CE 11 % w,- PROFESSIoOA�. ,Z�, ENGINEER'S MUNICIPALITY F ANCHORAGE Awe Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ��~ Fax: 907-343-7997 Lift Station/Pump Vault Owner U, j 1 P,,.1 rl Street Address 2--% U" t''S<,, Septic Tank: -Sludge leve( inches -Pumping: requikd -yen no -Pumping complete e no Lift station -Pump basket cleaned no -Effluent filter cleaned, es no -Control floats cleane s no -Proper float settings confirmedt e no -Operation satisfactory -!:ie: no Alarm System: -Dedicated electrical alarm circutL 2e no -Audible and visual alarm inside dwellin6 es no -Alarm system operatics sa�e�5y1 not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations ves o -Weep hole functional es no -Manhole lid: Function no lnsulatedj/es no Properly Secure no Other -All manufacturer required inspections and maintenance completed Q�Sno Comments: Qualified Maintenance Provider: Technician ' .-(ham �f �Date of maintenance Company Signature Date lit- p _U Septic Tank Advisory Certificate of On -Site Systems Approval # OSC201693 Subdivision: Bear Park, Lot: 2 The septic tank for this property is 23 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $8,000 to $10,000. 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. s Maihng�Aildress PU�Box 1'96650* Anchorage, Alaska 995196650 *www muni org • • a"* aae„, • �-° Municipality of Anchorage 1.„,.::: ,-...--.,..,. .-..: i� .i-, `a On-Site Water and Wastewater Programthi (907) 343-7904 s w r c T v Certificate of On-Site Systems Approval Parcel I.D. 051-042-68 Expiration Date: _( //7/d 1. GENERAL INFORMATION Com. . - ription Lot 2, Bear Park Subdivision ,,,' - 22729 Ursa Major Circle Chugiak, Alaska 99567 .r.+ Chris & Judith Ricci Day phone (321 ) 427-7679 44) Y a ng a••ress 2272• Ursa Ma"or Circle Chu•iak Alaska 99567 - _ - ^ A-, ; , Broke Stiltner/Re/Max ER Day phone (907) 244-6742 , . 2. T` 1 . h!!,7-7;.` i' , .. ® 'e,.•=: I Ily (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Z Individual III Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Vq. 19d Date: 1,/i 7//g COSA to be released t e engineer,unless otherwise requested by the engineer. COSA Fee $ 5-0 , — Waiver Fee $ Date of Payment I -- I I- 142) Date of Payment Receipt Number 2t 5/ Receipt Number COSA# DJ C I$I O t5 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone (907) 232-1347 Address PO Box 871347 Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard Date 1 Y - ► t 6. DSD SIGNATURE System#1 Approved for 3 bedrooms • . 411111111114' System#2 Approved for bedrooms J Disapproved t i w l l arp r Conditional approval for bedrooms, with the following stipulations: yitit<. o,k\f OF .. 04. m WONATERSITF AND • WASTEWATtR PROGRAM �� . , By: /.(,G% 0-c Original Certificate Date: I7/ 3 The Municipality of Anchors 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 blue sheet s c 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: Lot 2, Bear Park Subdivision Parcel ID: 051 -042-68 A. WELL DATA Well type Pvt If A, B, or C provide PWSID# NA Well Log (Y/N) Yes Date completed 12/2/97 Sanitary seal (Y/N) YeS Wires properly protected (Y/N) Yes 441) Total depth 163 ft: Cased to 161 ft. Casing height(above ground ' 18+ FROM WELL LOG AT INSPECTION Date of test. 12/2/97 1 /6/18 Static water level 135 ft. 134.1 ft. Well production 6 g.p.m. 4 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0.25 mg/L Arsenic 16.7 ug/L Date of sample:12/20/17 Collected by: Pinard Engineering B. SEPTIC/HOLDING TANK DATA • Tank Type/Material Septic/Steel Date installed 10/16/97 - 1 /29/98 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Yes Foundation cleanout(Y/N)Yes Depression over tank(Y/N) No High water alarm (Y/N) No for ST Yes for LS Date of pumping 8/29/17 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 11 /4 -8/04SoiI rating (g.p.d./ft2 arittiiitiobt4 0.45 System type Trenches Le. - . :tir. :ft. Width 5 ft. Gravel below pipe 2.5+ ft. d ,r -. ., : ''„tti .. . absorption area 1334 ft2 Monitoring tube Yes Depression over field No li Ar. a .f„a _. ;,, /6/18 Results (Pass/Fail) Pass For 3 bedrooms `;`. • - - - - - - - - before test 1 in. Water added 480 gal. New depth 2'5 in. Elaik*ed .111, . Final fluid depth 1 in. Absorption rate >= 450+ g p d A ejr.uvenatief (past 12 mo.) (Y/N &type) None Known If yes, give date >13 D. LIFT STATION Date installed 11 /4 - 8/04Size in gallons 500 Manhole/Access (Y/N) Yes "Pump on" level at 41 in. "Pump off' level at 41 in. High water alarm level at 47 in. Datum Bottom Basket Cycles tested 2 Meets alarm&circuit requirements? yes E. SEPARATION DISTANCES • WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 501+ Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 + Property line 5'+ Absorption field 5'+ Water main 101+ Water service line 10'+ Surface water 100'+ Wells on adjacent Iots100'+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 101+ Water Service Iine10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION +Y� I certify that I 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 Paul E. Pinard "� i Date 1/10/18 t/ C1-47113 .4"Ae • rWOfESSIOr6P AN C8 COSA yellow sheet_2-6-15.doc • Municipality of Anchorage 4c L I •F C' Development Services Department \ �! Building Safety Division �� SA CY On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage,AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # OSC 181015 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Bear Park Subdivision. This inspection revealed an arsenic concentration of 16.7 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. 5. STATEMENT OF INSPECTION BY ENGINEER As.certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the, on-site water supply and/or wastewater disposal system is(ara)`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 3701E TUDOR ROAD, SUITE :101 "ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date fl 2 3 + `-.Engineers Comments: - Inconductingthisevaluation, GEGprovidedan engineering evaluation offhe welt endlorseptic system inaccordanre with the *"`>♦ guidelines and regulations established oythe MunicipatilyofAnchomgeandindusfrypredims: The micortedresullsdandbe the OF 144144 - conditionollhesysteaVsonthedate/s oftheevaluafion. separation distances were measuredioreadlyidengriablehafums. Hidden defects orendmachmenms may exist that ween not identified during the evaluation.The operational fife of all welts andsepdc �# systems depend an a vadelyot vanables induding, but got limited to, soft conditions groundwaterlews (that mayfluduate during the year), quality otconsfnrcthmimaferials and workmanship), and the water usage of the family utilizing the systews. These -conditions wn vary, and are outside the control of GEG. satisfactory test resulfs do notguaredtee future turnic marrce o/Ihe ...... ..... ....:..... system/s, therePore, GEG makes no warranty (express orimpoed) regarding the future pedarmance offhe well orseptic system. %' " " "• GEG makesno representation whether an aliematim welforsepfm system can be inslagedon the propertyin the event either oflhe 10 cummul systems fail. The content ofthisrepadis torthe sole benefit of the penon/pady who retained GEG. Rekance upon the ••r•y •, information providedin this report by alryolherperson orpary,, including but not limited to subsequentiompedypurclurnts,isnot � Ci cri authorized. In short, GEG disavowsanylegaldutyfo anyone ofberthan the persaNpady who paid forlhisrepod. 1./tel CE- 3 �= 6. DSD GNATURE ♦� �t„S"��� System #1 Approved for 13 bedrooms. System #2 Approved for bedrooms. Disapproved. �1011l(luuttil Conditional approval for bedrooms, with the following stipulation s`\�QP���Y OF q/yo1�rrr'!' J—i`F -ATF m WATER AND z= �o W -f hvvxf ER 0 AS DoOGRAM <' Original Certificate Date. Y The :Munic/pality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSH) based only upon the represenatations given in paragraph 5 by an independent professional:civil engineer registered in the State of Alaska. The'Municipality. of Anchorage is not responsible forerrors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory, Well Flow Advisory Other .(Rev. 10112/12) If more than 1 septic system is on the tot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: BEAR PARK S/D; LOT 2 Parcel ID: 051-042-68 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 12/3/1997 Sanitary seal (YIN) YES Total depth 163 ft. Cased to 160.69 ft. FROM WELL LOG Date of test 12/3/1997 Static water level 135 ft. Well production 6 g.p.m. Well Log (YIN) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 1/14/2015 132 4.85 WATER SAMPLE RESULTS: l�1\ Coliform U colonies/100 ml. Nitrate Onmg./L. Collected by: GEG, Ltd. Arsenic[ 117-1ug./L. Date of sample: 11/4/15 B. SEPTIC/HOLDING TANK DATA Tank Type/Material - SEPTIC/STEEL - Data installed 10/16/97-1/29/1998 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date Of pumping. 2/19/2015- Pumper _ - JR'S PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 11/4-8/2004 Soil rating .p,d./ T ftlbdrm) 0.45 System type MULTIPLE TRENCH 3@58 Length 174 TOTAL ft. Width 5 ft. Gravel below pipe 2.5+ ft. Total depth;5.8,5.5,6.1ft. Eff. absorption area 1334+ ft2 Monitoring tube YES Depression over field NO Date of adequacy test "`1/14/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRYIDRY/5.5 in. Water added 680 gal. New depth : erDRY/5s in. Elapsed Time. 440 min. Final fluid depth 3/DRY/DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date NOTE: HOUSE WAS VACANT AT TIME OF TEST. SYSTEM WAS PRESOAKED WITH 2000 GALLONS ON 1/13/2015. WATER WAS INTRODUCED EVENLY INTO ALL THREE TRENCHES DURING ADEQUACY TEST. 680 GALLONS TOTAL. PART OF CENTRAL TRENCH IS SLIGHTLY SHY ON SOIL COVER. NO FREEZING ISSUES NOTICED OR REPORTED. �r "PER WALKER ELECTRIC INSPECTION REPORT 11/14/2004, ON FILE W/ MOA. D. LIFT STATION FLOAT MEASUREMENTS ARE TO TETHER CLAMP Date installed 1114-8/2004 Size in gallons 500 Manhole/Access (Y/N) YES "Pump on" level at 41 in. "Pump off' level at 41 in. High water alarm level at 47 in. Datum BOTTOM OF BASKET Cycles tested 3 Meets alarm & circuit requirements? 'YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lots 1001+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 751+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 254 Holding tank NIA Animal containment areas 501+ Manure/animal excrete storage areas 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 10'+ Water service line 104 Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation . 10'+ Water main 10'+ Water service line 10'+ Surface water 1004 Driveway, parking/vehicle storage- 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 1004 F. COMMENTS G. ENGINEER'S CERTIFICATION AW i iff i I certify that I have determined through field inspections and review of Municipal records that the above systems are in 0 conformance with MOA COSA guidelines in effect on this 0 date.+♦ci -Engineer's Printed Name JEFFREY A. GARNESS # /�1 Date n tz3l sJ (Rev. 10/12/12) Municipality of Anchorage 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 Arsenic Advisory Certificate of On -Site Systems Approval # OSC 151063 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Bear Park Subdivision. This inspection revealed an arsenic concentration of 10.2 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.or onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. lie Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �i Parcel I.D. 051-042-68 1. GENERAL INFORMATION Expiration Date: i Complete legal description BEAR PARK S/D; LOT 2 Location (site address) 22729 URSA MAJOR CIRCLE, CHUGIAK, AK, 99567 Current Property owner(s) FORECLOSURE Day phone C/O AGENT Mailing address 22729 URSA MAJOR CIRCLE, CHUGIAK, AK, 99567 Real Estate Agent BRIAN BRODERICK W/ PRUDENTIAL Day phone 562-6464 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverlVariance request For: Received by: __ L COSA to be released to the engineer. COSA Fee $_ Date of Paymenl Receipt Number COSA # QT1�7�01 3 Date: 2 by the engineer. X15 t'C) Waiver Fee $ _ jzDate of Payment ��� Receipt Number Waiver # Distance: - TYPE OF WASTEWATER DISPOSAL: Individual On-site ■ ❑ Individual Holding tank ❑ LI Community On-site ❑ ❑ Public Sewer ❑ Date: 2 by the engineer. X15 t'C) Waiver Fee $ _ jzDate of Payment ��� Receipt Number Waiver # Distance: - 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. t 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. Phone 337-6179 Date Engineer's Comments' In conducting this evaluation, GEG, LLD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA ������ \ DSD Guidelines 8 Regulations The reported results described the performance of the -WWC O� / 1 \!/♦ 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 antl\�•' � septic systems depend on the local soils condition, groundwater levels that may •0. fluctuate during the year, and the water usage of the family being served by the system. •p * ` These conditions are outside the control Drina evaluatorofthe system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that / .....:. .4 ... ................... 0 there are no hidden defects or encroachments. GEG, LTD. can therefore not provide 0 any warranty or future estimate of how long the system will continue to meet the....10 operational requirements of the ADEC or MOA DSD. The content of this report is for t � „ t ilia sole benefit of the owner listed above. Any reliance upon or use of this report by any 0 C� '� IJ a' r y A. Garness ':oJ Qj= nor will it confer an le right whatsoever. C I other person or party is not authorized, y al g g �. ,T.• C -7 6. DSD SIGNATURE ���r�1PROF S"`.��J System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. \G\eP�`SY QFAVCtiO r� Conditional approval for bedrooms, with the following stipulation. ON-SITE G� WATER AND " J�z= nnnnnnu _10-� vu.•. 11 tti4 r. Original Certificate Date: t S rhe unicipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rea_ 1C112112) 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 S/D; LOT 2 Parcel ID: 051-042-68 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES Date completed 12/3/1997 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 163 ft. Cased to 160.69 ft. Casing height (above ground) 18+ in. Date of test Static water level Well production FROM WELL LOG 12/3/1997 135 ft. 6 g.p.m. WATER SAMPLE RESULTS: Coliform0— colonies/100 ml. Nitrate [•L)�; mg./L. Arsenic:lL Lug./L. Date of sample:, I u� B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank'' (YIN) NO Date of pumping a ) Pumper C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE AT INSPECTION 1/1412015 ft. 9— p.m- Collected by: GEG, Ltd. Date installed 10/16197-1/29/1998 Cleanouts (YIN) YES High water alarm (YIN) Date installed 11/4-812004 Soil rating OE> ft'lbdrm) 0.45 System type MULTIPLE TRENCH 3@58 Length 174 TOTAL ft. Width 5 ft. Gravel below pipe 2.5+ ft Total depth 5.8,5.5,6.1ft. Eff. absorption area 1334+ ft Monitoring tube YES Depression over field NO Date of adequacy test **1/14/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRYORY/5.5 in. Water added 680 gal. New depth 8/DRY/5.5 in. Elapsed Time: 440 min. Final fluid depth 3/DRY/DRY in. Absorption rate >= 450+ g.p.d Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date NOTE: HOUSE WAS VACANT AT TIME OF TEST. SYSTEM WAS PRE-SOAKED WITH 2000 GALLONS ON 1113/2015. WATER WAS INTRODUCED EVENLY INTO ALL THREE TRENCHES DURING ADEQUACY TEST. 680 GALLONS TOTAL. PART OF CENTRAL TRENCH IS SLIGHTLY SHY ON SOIL COVER. NO FREEZING ISSUES NOTICED OR REPORTED. *PER WALKER ELECTRIC INSPECTION REPORT 11/14/2004, ON FILE W/ MOA. D. LIFT STATION FLOAT MEASUREMENTS ARE TO TETHER CLAMP Date installed 11/4-8/2004 "Pump on" level at 41 in. Datum BOTTOM OF BASKET Size in gallons 500 "Pump off" Ievel at 41 in. Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on 100'+ Manhole/Access (Y/N) YES High water alarm level at 47 in. Meets alarm & circuit requirements? 'YES On adjacent lot: On adjacent lots 100'+ Public sewer main -WA- Public sewer manhole/cleanout -N64_ Ida Sewer /septic service line 25'+ Holding tank -N*' 75- -�L Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main - I0 Water service line 19+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main -+4, -00> iU 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 t 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 Datea'� //s (Rev. 10112112) Municipality of Anchorage Community Development Department Development Services 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 Arsenic Advisory Certificate of On -Site Systems Approval # OSC151063 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 2 of Bear Park Subdivision. This inspection revealed an arsenic concentration of 15.1 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.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. J I U !O 326.92. s' c 5 b p / Oq�e Tpss m 2Sr / WELL Eusnxa N HOVSE / / m m O 23.5' / / o Z ^. H / / ❑ 3 / y6 hyo d ° 6 UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTA13USHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANOAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT 5UR1 SURVEY TYPE SYMBOLS ❑ FWNDATIW A9-Bulli SET REBAR DR�I"D ASPHALT ❑ RNAL STRUCTURE AS WILT ❑ PLOT PLAN A9-BUILT LOT WR4 y TOPOGRAPHY O FOUND REBAR ...... NCS '" CONCRETE a WOOD FENCE WOOD - ... ... ... AS-BUILT ... NO COMIERS SET 0 KCQRr11RCA7lW AS-BUILT _ NO CORNERS SET 004 ASSUMED ELEV. j I( I(. METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTED. SURVEY CERTIFICATION •++�>•\�r� OF q•^C•q S•I E Prepared by John 'Jr. Assoc. PLOT PLAN aMm mAer.nre�.w!L WAwNaw orwM,, Gwrr.x, ♦O•• ♦,••e' Professional nd Surveyors A.In n.v.n.•.m a•aa.rrM mwmy artA.0 In ... .w.b �P*wy ••�•• .• �.a Brink Driv. ANCHORAGE. ALASKA 99504 tlo+wm. . en. . mIn`B, eemrwly.Nn '�� Ree. Lot S.F. Rea. Plat File No.92h sa- •� ^ cRae:ober 1E" = S50' e.M•wla,vEew'm. ANIt FOUNDATION AS-BUILT N.rIaea.Iesry.a :�1.}�. r - / •�• •• •. •• .,.� •JOHN Date Sureyed: Drawn b REJ Chocked b01/15/15 JMK r^. vw ^M i'. .•• ROBERT S JR Date Drawn: 01/16/15 Grid: NW1558 W.O. 15-08 FINAL STRUCTURE A5-BUILT �;''•.,•. .4121—s .',jam �.le •tea Legal Description: I, wort c Je r., Awry a ewe ••'•.. ....✓� ♦♦ O w.ety. mN let o,a aet r e. WrrrnManop ^eHnamdmn�1. mail � •Ia p�0 reB910na1 `♦♦♦ O�■.....+• BEAR PARK �' I �;iL- MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services / On -Site Services Section & P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-042-68 HAA #U> Y121 S L 1 (,`� 1. GENERAL INFORMATION Complete legal description Lot 2, Bear Park S/D. Location (site address or directions) NHN Ursa Major circle Property owner Craig Johnson Day phone 688-0920 Mailing address PO Box 772241, Eagle River, Ak 99577 Lending agency Residential Mortgage/Kelly HutchisoDay phone 222-8800 Mailing address 1400 west Benson, Suite 200, Anchorage, AK 99503 Agent _ Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: XXX Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system,' provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Ray. 1/91) Front MOA N21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING phone G q y — D-7 -7� 17034 Eagle River Loop Road No. 204 Address Eagle River,. Alaska 99577 Engineer's signature 6. DHHS SIGNATURE YApproved for Disapproved. Conditional approval for Additional Comments M bedrooms. Date 3/1,1 R �y ROBERT C. COWAN t � 1 �'�1,•,E -,801 ,+A,,� ii t `; h„�,, ! `•V J,1'J `, f }yam bedrooms, with the following stipulations: Date3-26-79 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional' engineer registered in the State, of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 RECEIVEu Municipality of Anchorage MAR 19 1999 DEPARTMENT OF HEALTH & HUMAN SERVICNICIPALITYOFANCH Environmental Services Division ENVIRONMENTAL SERVICES 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: �T, Z' 96A/,) SLI-) Parcell,D.: ®S1! - Cy ')L - G S A. WELL DATA Well type yp t- If A, B, or C, attach ADEC letter. ADEC water system number Log present (DN) �lFs Date completed a- '_— 2 Total depth ) Cased to /( Ojo l Casing height (above ground) Sanitary seal (Y/N) ��,5 Wires properly protected (Y/N) FROM WELL LOG Date of test jZ �- '.7,- / 7 Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 AT INSPECTION Nitrate O -7 a 6 Other bacteria o g.p.m. Date of sample: S -zz - �� Collected by: [�dj�V L()(deu S S ENGINEERING B. SEPTIC/HOLDING TANK DATA 17034 EaLAi a sIiver Loop Road No, 20+4 Eagle Riv,:r, Alaska 99577 Date installed ! 0 /J 6 61 7 Tank size ° Number of Compartments -.2- Cleanouts O/N) YAJ Foundation cleanout &/N) Y J Depression (Y/@ /y 0 High water alarm (Y(9 N Date of Pumping 31 /-7 / a 9 Pumper J_ R C. ABSOFIPTION FIELD DATA Date installed b a - Soil rating .d./ft2 or ft2/bdrm) r � Length ' 60 O S System type Width 3 Gravel thickness below pipe R It "s c. /I Is- Total depth % ! 2 Effective absorption area 6 o 0 J' % Monitoring Tube present (YDN) Y41 Depression over field (Y/& N o Nl e¢ - L fi. i s 7-//4N a Y 444 3 0L.0 Date of adequacy test Results (Pass/Fail) i For -3 bedrooms Fluid depth in absorption field bef�utes re test (in. Immediately after gal. water added (in.): _ Fluid depth (in Absorption rate = g.p.d. Peroxide 72-026 (Rev. 3/96)* (past 12 months) (Y/N) If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump on" level *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot %�d t On adjacent lots Absorption field on lot. �?o ! fi On adjacent lots Public sewer main WA Public sewer manhole/cleanout NIA `� Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line S Absorption field r Water main/service line Surface water/drainage Wells on adjacent lots l 00 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 0 �4 Building foundation Water main/service line Surface water I 00 Driveway, parking/vehicle storage area Curtain drain n, o ►, k N a w ri Wells on adjacent lots /00 f F. ENGINEER'S CERTIFICATION cl ;k I certify that / have determined thru field inspections and review of Municipal recor`iN�the-abaV,e'sns are in conformance with MOA A guideli s in effect on this date. C-� A Signature J�ti•ia, •aa aa•' a c;Secs xa••es.sae•Y.�1 • r e Engineer's Name /[ d�j,�it T C. Cc�w,q.., d•..... ...,...,� cost t C cQWANCE 8801: Date 3 ( / a� „i, ;�;�AV HAA Fee $% Date of Payment Receipt Number 4 7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 IKIMENTAL SERVICES DIVIS,. FEB Q 6 1998 RECEIVED CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-042-68 HAA # 'IA E` Q f LLL 1. GENERAL INFORMATION Complete legal description Lot 2• Bear Park Subdivision Location (site address or directions) NHN Ursa Major Circle Chugiak, AK Property owner Craig Johnson Day phone 694-3800 Mailing address P.O. Box 772241 Eagle River, AK 99577 Lending agency Day phone Mailing address Agent _ Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1 /91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone17034 Eagle River- Loop Road Nm 204 Address Eagle River, Alaska 99577 Engineer's signature 6. DH7�Approved GNATURE for Disapproved. Conditional approval for Additional Comments By: bedrooms. auTir Date '), % G / -I V O1= --a •.-� :o ROBERT C. COWAN t Or - CE - 8801 r -CE -8801 i , bedrooms, with the following stipulations: Date The-:unicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority App,--. dal Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 .:::ONMENTAL SERVICES DIVI e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES FEB 0 6 1998 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3UGE I V E Health Authority Approval Checklist Legal Description: Lot 2 3 Aam, iwRK- suIt0N'srad Parcel I.D.: 051 -042--6$ A. WELL DATA Well type P&WN1rE If A, B, or C, attach ADEC letter. ADEC water system number t -j Log present 7N) Yes Date completed 12-2-4-7 Total depth 14%1 Cased to / (QO • &°I Casing height (above ground) Sanitary seal (DN) YES Wires properly protected 04) FROM WELL LOG Date of test 1 Z r Static water level 1 S6* Well production ( g.p.m. WATER SAMPLE RESULTS: Coliform O AT INSPECTION 2 1f YC Nitrate D • /y3 MJIL Other bacteria D Date of sample: I A 9 �T Y Collected by: S & S ENGINEERING 17084 Eagle River aop 1KOads No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99677 g.p.m. Date installed 10 - 16- 91 Tank size I o ao Number of Compartments �Z Cleanouts QYN)Yom_ Foundation cleanout ®N) YES Depression (YAM High water alarm (Y/110 FJ 0 Date of Pumping 1`� c VJ Pumper C. ABSORPTION FIELD DATA Date installed 1-e -I(. -9'1 Soil rating .p.d./ft or ft2/bdrm) 0.4 System type f-E4GIj4 Length (.0 Width 3 Gravel thickness below pipe 5 Total depth /o •5 -12 Effective absorption area 600 Monitoring Tube present (9/N) c S Depression over field (Y/& 1J e Date of adequacy test t�tuj Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after— gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) `i If yes, give date -` 72-026 (Rev. 3/96)* D. LIFT STATION Size in gallons Manhole/Access (Y/N) eat*"Pump off" level at' High water alarm leve: *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 110,' On adjacent lots 100, -1- Absorption Absorption field on lot I 1 Zo + On adjacent lots 10014 Public sewer main IJ �Or Public sewer manhole/cleanout Sewer /septic service line 25 "F Lift station f � SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 10 Property line So •t Absorption field 8 Water main/service line 10 1t Surface water/drainage 00 + Wells on adjacent lots 1001 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line fb �i- Building foundation 20, Water main/service line 10I+ Surface water I oo t f Driveway, parking/vehicle storage area 4o 4 - Curtain drain 00ye- Koo0tj Wells on adjacent lots ( 001 F. ENGINEER'S CERTIFICATION I certify that / have determined thru field inspections and review of Municipal re�stems are in conformance with fOA H44A uideline in effect on this date.. r, •• •. Signature ,.•..a.,�,.e Engineer's Name ea e C- Cd �✓�^� Date SL -7 S HAA Fee $ 3M VD Date of Payment 1� Receipt Number t bQ-b 6 1 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number AC C�'A�: