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BEAR VALLEY BLK 2 LT 4
Bear Valley Block 2 Lot 4 #020-431-17 Jug 17 20 01:14p Mcheraya `JP/el & ,:-ump Ser 9072430742 p.1 �r/',��"`••.� �c.1c?¢lQS�v�av;� .E'-„n�i�::?S vt;�3G"'�'c'r,n;�?- j - # :700 Elmore Road Mark re ch Arrchorege, AK 9�9h07 s A : r. 'r r je (90 i i9Lt Pump Installation Log Well Drilling Petrvit to uwber: SW_____ bate of Issue: Pat -eel Identification NunrYer:,?I' Legal Description Pr ertti Oivner Name & Address; II ` b� Wear r l��t (� G' ,� iaa ) Pt:mp Installation Date: r�r; rj- tt3 f 2..C� Pumrp Intake Depth Below T' )p Gf well Casit►g; feet Pump Manufacturer'sName: °. ("t c. k..+ 'Pump Model: I"m SL�FSf Pump Size �_hp Pi£less adapter Burial Depth: % Z— feet Pitless ?adapter Manuf'acturer's Marne: XV&AZIe�CA6— Hitless Adapter Installer: Weli i:tisiufected L:pon troMpletion-? cs Method ofDisinfectiots: + ,O t 'I Comments: ;J� Pump Installer ?Vance: Attention: The ramp installer shad provide a pump ii stallaliclr "og to the ;SSD within 1t} dxvs c� p zinc .ins a!rati rn, Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St.•P.O. Box 196650 Anchorage,AK 99519-6650• http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181338 PID Number: 020-431-17 ❑ New •Upgrade Name: YVAN CORBIN ABSORPTION FIELD Address: 0 Deep Trench ® Shallow Trench 0 Bed 0 Mound 16211 BLACK BEAR DRIVE*ANCHORAGE,AK 0 Other Soil Rating: Total Depth from original grade: Phone: No.of Bedrooms: (907) 301-0875 3 0.8 GPD/Sp.Ft 8 Ft Depth to pipe invert from original grade. Gravel depth beneath pipe: LEGAL DESCRIPTION SEE DWG. Ft 4 Ft Subdivision: Block: Lot: Fill added above original grade: Gravel length: BEAR VALLEY 2 4 SEE DWG. Ft. 60 F, I ownship: Range: Section: Gravel width: Beds Number of lines Distance between lines: 5 Ft. - - Ft. SEPARATIONDISTANCES Total absorption area Number of trenches: Dist.between trenches: To Septic Absorption Lift Holding Public/Private1 - From Tank Field Station Tank Sewer Lines 600 SQ.Ft. Ft Well 100'+ 100'+ - - 26+ TANK ■ Septic 0 S.T.E.P. ❑Holding 0 Other - Manufacturer. Capacity Surface Water 100'+ 100'+ - - INFILTRATOR 1060 Gal. Material: Number of compartments: Lot Line 5'+ 10'+ - - N/A HDPE 2 Foundation 10'+ 10'+ _ - LIFT STATION Curtain Drain Manufacturer: C NONE KNOWN Gal. Remarks: BOTTOM OF EXCAVATION INSPECTED FROM MOA ONSITE 'Pump on"level at: "Pump orf'level at: High water alarm at. EMPLOYEE TIM ECKLUND ON 10/8/2018;OLD SEPTIC TANK WAS HAULED OFFSITE PER CONTRACTOR;WR#OSV181074 FOR Pump Make d Model Electrical Inspections performed by. DRAINFIELD TO SLOPES GREATER THAN 25% PIPE MATERIAL EXISTING/ House to tank 03034 Tank to D3034 drainfield Installer Drainfield D3034 CO/MT D3034 TERRITORY NORTH CONSTRUCTORS, LLC. Inspector GEG, Ltd. BENCH MARK (Assumed elevation) Inspection 100.00 F,. Dates: 1st 10/8/2018 2nd 10/10/2018 Location and Description 3rd 10/11/2018 4th BOTTOM OF TRIM AT NE CORNER OF HOME ENGINEER'S SEAL Community Development Department Approval oo�o...\� Conditional approval: Date: Oo 1,_ •. DO ...1D D OA ..J:. \If A. Gorn-ss: tlh 13 C.-795 3 oQ4)4 ' \cPO n D Approve \ I wt 1—GY404V �0 /0 —/�f kci I°. I6l53 � LICENSE O esso \ #AECC884 O�ODO�� Inspection Report_1-1.12 doc C PERMIT NUMBER: PARCEL ID NUMBER: ` OSP181338 RECORD DRAWING 020-431-17 A B ST1 39.0 15.7I ST2 42.5 20.4 11\777.77777- DBL1 44.5 23.6 DBL2 45.0 25.2 THE CONTRACTOR DID NOT HAVE THIS WELL DV 45.5 26.3 T1 MRADIUS PROFESSIONALLY SURVEYED IN DURING / _ 41.5 52.4 CONSTRUCTION;LOCATION WAS TAKEN FROM A MTI 39.2 53.7 • SURVEY IN MOA RECORDS BY SHANE HOLT,PLS MT2 _ 89.5 80.5 CO2 92.9 83.0 .` • / I / / �\`� 7 O / NEW DRAINFIELD gyp - / ..- �O \ CO:� 02 r' 2 -• �V / EXISTING DRAINFIELD QN\DECK • DB ,t• N\-\\. / y4���QP • D: 1 io: / .:': • :: ;,. /E LIGSTIN / $ • B / ,'':•• '.; �• •%%.• .;'. N I ' NEW 1060 TWO COMPARTMENT INFILTRATOR .:.4 ` •; / TANK;INSULATED WITH 2"PER CONTRACTOR ti •' I ••: SHED ON"CMU"BLOCKS / / / )I( I / ti \ / I SCALE: 1"=40' '(.��\\ ♦♦♦••`F- II ♦. A. 4L At•••• c r GARNESS ENGINEERING GROUP, Ltdf7.... �'� '• _ • .„-=y--hw- --.- - •- - ENGINEERING•SALES=CONSULTING --,,,--,-,-o • • 3701 E TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(907)336-3246'riEBSITE wing gemessengneenng com • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: : W ig YVAN CORBIN 907-301-0875 2 OF 3 0 0LEGAL DESCRIPTION: DRAWN BY: ��� 'BEAR VALLEY; BLOCK 2, LOT 4 D.J.G. • .... ��was TYPE OF WORK: DATE: LICENSE* • "" ESS`"'♦♦ SEPTIC SYSTEM RECORD DRAWING SITE PLAN 10/16/2018 #AECC884 Ilill‘11,s1V14 ' PERMIT NUMBER: RECORD D RAW I N G PARCEL ID NUMBER: . OSP181338 020-431-17 FINAL GRADE=97.8-97.9 2"OF INSULATION ST2 ST 1 PER THE CONTRACTOR um IN TOP OF TANK @ INLET=94.411 TOP OF TANK @ INLET=94.41 ifeernaismor.rk I INVERT OF PIPE @ INLET=93.79 JJJ — = — . INVERT OF PIPE • @ OUTLET=93.55 \. _ _ I NEW 1060 INFILTRATOR 2-COMPARTMENT SEPTIC TANK ORIGINAL GRADE @ HIGHEST POINT=89.45 FINAL GRADE=89.0-89.5 MT CO OF FILTER FABRIC BOTTOM OF TRENCH INSPECTION BY MOA ONSITE EMPLOYEE TIM +;�I;:�:;:�:. ECKLUND ON 10/8/2018 4.0' II; INVERT OF PIPE=85.49 1_.._ 5. BOTTOM OF EXCAVATION=81.45 GARNESS ENGINEERING GROUP, Ltd i`:`• • • •'•'�I. ••; -- ,--,- -- ENGINEERING A SALES ,CONSULTING / • 3701 E TUDOR ROAD SUITE 101•ANCHORAGE.AK 99507.PHONE(907)3378179•FAX(907)33832.8•VoEBSITE.WWW m gaecsenTleenn9 COM •••• ,••• • f • • • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • :• I: A •.Garr ess W♦ YVAN CORBIN 907-301-0875 3 OF 3 •���, • C _ Z= LEGAL DESCRIPTION: DRAWN BY: BEAR VALLEY; BLOCK 2, LOT 4 D.J.G. �1 ..1% ..•••It) Ib 1�?.••' � � UAT;oil. TYPE OF WORK: DATE: LICENSE IN U ESS\ 44 SEPTIC TANK PROFILE 10/16/2018 #AECC884 IIIIIIIIIII'U*" J �JN�IVALI`pO.e MUNICIPALITY OF ANCHORAGE �„r On-Site Water&Wastewater Program �� S PO Box 196650 4700 Elmore Road I.. *4f ' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 = °` • httpa/www.muni.org/onsite ` ' \.,. ,% l)cpartt i nt �N�HOP PG6 On-Site Wastewater Disposal System Permit Permit Number: OSP181338 Effective Date: 9/27/2018 Work Type: Septic Upgrade Expiration Date: 9/27/2019 Tax Code Number: 02043117000 Site Legal Address: BEAR VALLEY BLK 2 LT 4 G:3242 Site Mailing Address: 16211 BLACK BEAR DR, Anchorage Owner: CORBIN KRISTIN R &YVAN C Lot Size in Sq Ft: 47140 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: 2 Disposal Field 0 Septic Tank El Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: 1 U Issued By: i /”"4/ � _ Date: 1 Z-7 n..•nr S. Municipality of Anchorage • P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 s Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181074 COSA#: Permit#: OSP181338 PID#: 020-431-17 Legal Description: Bear Valley B2 L4 Engineer: Garness Engineering Group Applicant: Yvan Corbin Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 40.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. • Waiver is Granted: X Waiver is not Granted: Date: 2 7 � Approved by: ibe,, 0 0 Name of Revi=' er ***'k VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE • Community Development Department \ / Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 020-431-17 Property owner(s) YVAN CORBIN Day phone 907-301-0875 Mailing address 16211 BLACK BEAR DRIVE *ANCHORAGE.AK 99516 Site address 16211 BLACK BEAR DRIVE *ANCHORAGE,AK 99516 Legal description (Sub'd, Block & Lot) BEAR VALLEY; BLOCK 2, LOT 4 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family(SF) Ei Absorption Field ® (w/wo ADU) Upgrade Septic Tank ® Duplex (D) ❑ Renewal n Holding Tank n Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: DRAINFIELD TO SLOPES>25% Distance: 40 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP. Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: n5(oq Waiver Fees: 0115 Date of Payment: ? `M1`Z/�1�f J Date of Payment: Receipt Number: 00Cati4 Receipt Number: OOC1Q S 33? Waiver No. 031 I'I07q Permit No. QG� -`t (Rev.01/11) __ _ tguanics GARNESS ENGINEERING GROUP, Ltd �.�. «Y>Treatment System ENGINEERING°SALES CONSULTING Dcenr.ye ea/er June 14th, 2018 Municipality of Anchorage Development Service Department On-Site Water&Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Bear Valley; Block 2, Lot 4 To whom it may concern: The existing 3-bedroom house is served by a private well and septic system. The drainfield is in a state of failure and needs to be upgraded. We are proposing to install a new 1060 two-compartment infiltrator septic tank and 5-wide type drainfield. One testhole was excavated on the property and the drainfield is designed around its 30-foot radius. Comments regarding the design are summarized as follows: 1. SOILS: See attached 2018 soil log which shows, soil classification, percolation test and groundwater monitoring. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns per our site visit or the MOA wetlands mapping. 4. TOPOGRAPHY: There is a cutbank approximately 8-10' in height about 40 feet northwest of the existing testhole. Due to heavy vegetation, an accurate slope reading could not be determined; therefore, we are utilizing the MOA topo mapping to determine an approximate slope as well as our best estimation from our site visit. We are requesting that your department issue a variance from the required separation distance of 50 feet from drainfield to slopes >25% down to 40 feet. As can be seen on the attached slope waiver drawing, a line drawn at 45% two feet above the top1of rock does not "daylight" within 50 feet of the proposed drainfield. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any a uestions, please contact us at 337-6179. Thank you for your assistance. Sincerely, Je rey A. i s- -.E., M.S. Presi nt 3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com BEAR VALLEY; BLOCK 3,LOT 4 ' BEAR VALLEY; BLOCK 3,LOT 3 BEAR VALLEY; ' BLOCK 3,LOT 2 \ \ / \ // A WEOXIMATE APPROXI I LL�D/VS OO. M ,`J WELL RAO//5100. / \ 4 BEAR VALLEY; � \ /' �QO BLOCK 2,LOT 5 \ WELLAAL4 7.Rq0 US 0p. /� V BEAR VALLEY; \ / /�/' \ BLOCK 2,LOT 3 • /100'W ►'ast BEAR VALLEY; 4 r:. � O/US '•"'�• BLOCK 2,LOT 2 / � / / /i ` , AppRO X/ I-, i WELL �g 00, HO IIR 1 BEAR VALLEY; AR ,Q, / BLOCK 1,LOT 3 / / BEAR VALLEY; BEAR VALLEY; BLOCK 1,LOT 4 BLOCK 1,LOT 5 S ALE: iii 1"=100' .vo,*\\11 II1, ,,, GARNESS ENGINEERING GROUP, Ltd • ... •• • 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507*PHONE(907)337-6179•FAX(907)338-3246'WEBSITE:www.yartieieergineerr9.COm •, �p ` • L . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: I(� r'r ey •. -- ess • he YVAN CORBIN 907-301-0875 1 OF 3 �•�% 'rl CE-79p3 '�a PROJECT/LEGAL DESCRIPTION: DRAWN BY: �. . '�?.•••� • BEAR VALLEY; BLOCK 2, LOT 4 D.J.G. 1��0•••••'•• •• `, . • TYPE OF WORK: DATE: LICENSE ,�1f��ilf0„S`��t• SEPTIC SYSTEM DESIGN UPGRADE 9/14/2018 #AECC884 / -. DESIGN CRITERIA: GEG.Ltd.HAS A 8 PAGE SPECIFICATION NOTE THE CONTRACTOR SHALL HAVE ALL NUMBER OF BEDROOMS:3 LETTER THAT PERTAINS TO THIS DESIGN.TO j WELL RADAII SHOWN AND THE 40 FOOT SLOPE OBTAIN A COPY OF THE LETTER CONTACT GALLONS PER DAY(GPD):450 GPD SETBACKS FLAGGED BY A REGISTERED LAND PERCOLATION RATES:12 MIN/INCH GEG.BY PROCEEDING FORWARD WITH THIS SURVEYOR PRIOR TO CONSTRUCTION INSTALLATION,THE ENGINEER.WELL DRILLER, PROPOSED APPLICATION RATE:0.8 GPD/BEDROOM CONTRACTOR AND PROPERTY OWNER AGREE MINIMUM DRAINFIELD SO.FT.:562.5 FT2 THAT THEY HAVE READ THESE DRAINFIELD DESIGN: ,/ SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. MAXIMUM DEPTH:8 FEET �' WIDTH:5 FEET LENGTH:60 FEET i EFFECTIVE:4 FEET i/ f BEAR VALLEY;BLOCK 2,LOT 5 REDUCTION FACTOR:0.5 / Q` / ACTUAL SQ.FT.:600 FT' ,- O _ / P� • c)JP- Z / ,...,i �� / / PG j / LOCATIONAPPROXIMATE / OF T.H.#1 PROPOSED DRAINFIELD,..,o M r /APPROXIMATE LOCAITON OF 2-3 FOOT // % GRAD CHANGE I \mo` ' ,o EXISTING TRENCH TO REMAIN / ,, -- IN PLACE FOR FUTURE USE \C4 BEAR VALLEY;BLOCK 2,LOT 3 " DV' 9 / P 2 - 1Qp EXISTING 3EXISTING SEPTIC TANK TO BE HAULED OFFSITE PER UPC;PROPOSED f•• ••••••: •r•+•••;.:\ BEDROOM HOUS �f`�� 1060 HDPE TWO COMPARTMENT INFILTRATOR INSTALL DOUBLE ��• CLEANOUTS AFTER SEPTIC TANK AND DIVERTER VALVE .,•,! i DRIVEWAY I •.:: CONFIRM INTEGRITY OF FCO; •� ` . REPAIR/REPLACE AS NEEDED // / \ 7 4t / 7p0 wFCC 14D/US / SALE: 4"-- I „=40' Il ...6.1\ „1 N a ,3 •••�c ,I • ,., ,. ...`. �!G•/.:''• '• 'raJij• �.. GARNESS ENGINEERING GROUP, Ltd •. : .... 9 : iN \* L--,,': -•- — • • •• - ENGINEERING SAI ES a CONSULTING 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246'WEBSITE.www.garnessengineenng can •••• . . .. ' • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 fn• : A. G.mess . • YVAN CORBIN 907-301-0875 2 OF 3 0�� + C PROJECT/LEGAL DESCRIPTION: DRAWN BY: I Y BEAR VALLEY; BLOCK 2, LOT 4 D.J.G. �1. Q••p'•�•',+,` . .. —% :•• TYPE OF WORK: DATE: 4.4” 711L,V \••• LICENSESEPTIC SYSTEM DESIGN UPGRADE 9/14/2018 #AECC884 1����• SCALE 1" = 10' EXISTING GRADE MT3 CO3 15% EET 11P=�=�=�" 4 FEET \g\S\0p UN��O� t. -.--15.0 FEETf 4/s, 11 11 FEET AF WORST CASE SCENARIO (VERTICAL DROP) 40 FEET WAIVER REQUEST - 4i1... V 4 • w:.. .****** `'i •••••:,.... . .. v.,.. .1- rt..1Crii.... * GARNESS ENGINEERING GROUP, Ltd : !� ENGINEERING b SAI ES CONSULTING .�, • 3701 E TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507•PHONE(907)3374179'FM(907)138-3246•N£BSITE:wvv.gemessengmeemg con) •,,_._ PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • :ffrey A. -mess YVAN CORRIN ( 907) 301-0875 3 OF 3 i • CLEGAL DESCRIPTION: DRAWN BY: �. ••. `♦3•..• � BEAR VALLEY; BLOCK 3, LOT 3 D.J.G. �� J,,I v • •P� • TYPE OF WORK: DATE: .40 I O `SS\444 PROFILE DRAWING FOR SLOPE WAIVER 9/26/2018 J r e 14 i�•�� OF , 4 ,♦1 AGARNESS r 1 `I �e� ; *•0 GARNESS ENGINEERING GROUP, Ltd • i 491. . . • NGINEFRING SA1 FS CONSULTING s..._,.� / 00 7701 E TUDOR ROAD.SUITE 101•ANCHORAGE AK 99507•PHONE 1:1',337.6'79'FAX 19071339.3246'WEBSITE woo.,gamesze^g.^.eerny corn 4m• . SOIL LOG - PERCOLATION TEST •�C,: .4 Y-A. Gar -ss• •;��= LEGAL DESCRIPTION: BEAR VALLEY;BLOCK 2,LOT 4 *j. �••, GI s`u°•�,��� PERFORMED FOR: YVAN CORBIN DATE: 9/11/2018 ♦*�O PROFESS\�P�4.• LICENSE 44it4"`��4� DEPTH #AECC884 (feet) %R`' TEST HOLE #1 r r ✓ r SOIL CLASSIFICATIONS SITE PLAN 2 r ra.`:o;` G W ORG ✓ r ,::°.+ GP ML 3 — r r GM A CL 4r r �'i G C OL P- ✓ r o°D°o°F°c SW I MH. ; SP CH 4'5SM OH Q 6 r r 44'~�s SC �<(i ✓ r PG )k • 7 r r DEPTH TO UnTF P r GROUNDWATER �x7 N r co <</ — r r DRY 9/11/2018 Y 11 ✓ OK � '�j 1..31'.3 SCALE: 9 — r I r •M =goo (J ✓ r 10 — ✓ r ✓ r DATE K AI)�NG CLOCK NET TIME WATER LEVEL NET DROP 11 — I r TIME (MINUTES) READING (INCHES) 12 I r 9/13/2018 1 1:15 - 6" - r r 2 1:45 30 3-5/8" 2-3/8" r r 13 r • 3 1:45 - 6" r r 4 2:15 30 3- 1/2" 2-1/2" r - 14 — r - 5 2:15 6" r B.O.11. 6 2:45 30 3-1/2" 2- 1/2" 15 7 2:45 - 6" - 16 — 8 3:15 30 3-1/2" 2- 1/2" 17 — — • 18 — 19 PERCOLATION RATE 12 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES M NC SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG. Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE OR D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Ct I 8/i E� .,..//4 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME W E PHONE I �'1C>r_ 3pg PKNEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION G,,c) 13 F EA Q UA LLE LOCATIONNO. 7-3 ,4 C OF BEDROOMS UY Well n DISTANCE TO: fX Absorption area Dwelling PERMIT NO. Q 3 _ 0 2W 5- 1-- Q w F ManufacturerCt 1 N rT T -A Material _ L No. of compartments C Liq .capacity in gallons IF HOMEMADE: Inside length Width Liquid depth JAZ DISTANCE TO: Well Dwelling PERMIT NO. O FQ- Manufacturer Material Liquid capacity in gallons o w = DISTANCE TO: Well lLI 0 Foundatio � Nearest lot line PERMIT NO. J LL Z Zw No. of lines�/ Length of each line Total length of li es Trench width inches Distance between lines Icr p Top of tile to finish grade_ /C / Material beneath tile `L / inches Total effective bsor tion area gy W Length Width Depth PERMIT NO. Q(L!: W Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W 3:DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 303 � C SOIL TEST RATING INSTALLER q ^ p REMARKS O Ja n �i r C aaa APPROVED DATE LEGAL �s 711 3 o `7 j cavi Ua� 72-013 (Rev. 3/78) ���1 0- 1 F="F=l L_ I -IF ED F= FA tA CD FA CA F? K Ci FE= DEPARTMENT DF HEALTH AND ENVIRONMENTAL PROTECTION 825' STREET, ANCHORAGE, HK 9n i1 ~ 264-4720 44 E7 L_ L_ FA tA E> CA 6-4 T IF P- F�- L-4 F=� PERMIT NO. ( 8]0]95 ) ' APPLICANT ROGER LIENESCH 1113 W. FIREWEED #505 279-9308 LOCATION 'LEGAL LOT 4 BLK 2 BEHRYHLLEY SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 196 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 1"' 1=7 K IF t -l= AL CA L_ EE VJ C3 IF VA= at f? C3 FQ FA NJ EE L_ E> K F" IF FA= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD' THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). Fic E� i7_� kJ I Fic"F=* Cm "H. E: F=:" -V I C: IF Fj r-4 "—=. l :E E:= -1 C20 CA CA C3 FA L_���� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. IF L4 (--j < .2 --.*-, 3: r-.1 F:='EE C:- IF 1 #::1 ��F= Fic"FE ICA L3 11 F. -"EF- U... BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �F="F-flr-1 3: IF I F -'_E --_"w E>E0C1E0tlE3E=FQ 7TAL, AL <2��� I CERTIFY THAT i: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: A A ISSUEDgFJ Y4.0 SOILS LOG MUNICIPALITY OF ANCHORAGE J DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �1 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ��ii PERFORMED FOR: Harv -\1 DATE PERFORMED: ri LEGAL DESCRIPTION: L� )ay- S-)iJ UI— SLOPE SITIf PLAN 1 2 3 4 5 6 7 8 9 11 12 13 14 15 Id 17 18 19 20 COMMENTS G-� tvA drag �'� ti5 ro o wl h ,Y�,��r�� j1 � A ��e� ,J ak ■1■ EVEN NONE mKINE MENE Date Gross Time Net Time MEMO 00110 Emil Email' EMKIN Emalm 100010 Net Drop WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? L4I/� �fliravna4r Reading PERCOLATION Date Gross Time Net Time Depth to Water Net Drop '2.:53 1 i0�,,►� ? . SG _ �9 +x.1.0 z 12:64 1OM16 2.04 I. 0 "2-0 " i-2-0 3 1:2c7 V Y11in 2.02 1. Vi +H20,• s y l I.sl I l�rnlr�. �:� z 12s- ZS PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND i?f /Z FT c F � 1�ol ct5 abo)� q,� �. PERFORMED BY: (iDYI%%yY �Oa fe,S CERTIFIED Bl� 72-008 (6/79) DATE: WATER WELL RECORD STATE OF ALASKA VV `� DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys �j Drilling Permit No. _ LOCATION OF WELL (Please complete either lo, Ib or Ic.) A.D.L. No. _ la. Borough Subdivision Lot I Block Ib. 1/agtrs. Section No. TownshipND Range ED Meridian _of_of—of— SD WEj Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Street Address and Area of Well Location 2. WELL LOG Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (final) ft 5. DATE OF COMPLETION 6, E] Cable tool [] Rotary Driven El Dug ❑ Auger Jetted Bored Other: 7. USE: ❑ Domestic E] Public Supply O Industry Irrigation ❑ Recharge El Commerical Test Well ❑ Other: 8. CASING: [] Threaded 0 Welded diam. in. to�ft. Depth Weight Ibs./ft. diam._____in. toft. Depth Stickup ft. 9. FINISH OF WELL: Type:_Dlameter: Slot/Me h Size: Length: Set between ft, and ft. Backfilling _ Gravel pack .._... 10. STATIC WATER LEVEL: ft. ❑ Above or t_J Below land surface Date Equipment used: 11 . PUMPING LEVEL below land surface and YIELD ft, after hrs, pumping g.p.m. ft. after hrs. pumping 9-p M. 12.GROUTING Well Grouted: E] YesE] No Material: O Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. Subm. ❑ Jet ® Centrifical Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best Registered Business Name Contract Address: - - 15. Water Temperature —_° F El C of my knowledge and belief; License Number Signed: ._-, Dote: Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer • • 561 8 9,07 • Municipality of Anchorage u s `t On-Site Water and Wastewater Program Neb .`: (907) 343-7904 S, ° � a L'�I •� b lZ Certificate of On-Site Systems Approval � c.,' ' ci �l 6 t .w Parcel I.D. 020-431-17 Expiration Date: ilisif 1. GENERAL INFORMATION: Complete legal description BEAR VALLEY; BLOCK 2, LOT 4 Location (site address) 16211 Black Bear Drive*Anchorage,AK 99516 Current Property owner(s) Yvan Corbin Day phone 301-0875 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® 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: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: / Date: /6/17A COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ o9Lc7 -5 Waiver Fee $ Date of Payment l Dllpir8 Date of Payment Receipt Number Q 2.326-0 Receipt Number COSA# 06C6/56-.3 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: _ 1/0/c_6 It 6 _op0C00 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF L 'N% in accordance with the guidelines and regulations established by the Municipality of Anchorage and ,��.•••"" ; ••.- industry practices. The reported results describe the condition of the system/s on the date/s of the c P.• ' •••.' --QAA evaluation. Separation distances were measured to readily identifiable features. Hidden defects or `► Vn encroachments may exist that were not identified during the evaluation. The operational life of all wells :V�•• 4 TI /. •.3 VO and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 V''''' '''' Q groundwater levels (that may fluctuate during the year), quality of construction (materials and r workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and .-.•- liftQ are outside the control of GEG. Satisfactory test results do not guarantee future performance of the (le,f A. Gorne-s: 0 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of l/ l''•• C 05 - BOO the well or septic system. GEG makes no representation whether an alternative well or septic system VV sd • .. `J .`cam can be installed on the property in the event either of the current systems fail to perform adequately in � i'e,. i'".1.l.1,,• 0Ao the future. The content of this report is for the sole benefit of the person/party that retained GEG to �� aPr0fessio0°oQ perform the evaluation. Reliance upon the information provided in this report by any other person or \\\OOOO�� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved ��,�` '\-\‘ 1 Qt.,vvc> Conditional approval for bedrooms, with the=$�lowirr��lt fir tions . WATER AND m ', WASTEWATtR z= c PROGRAM —: 0 ,o�� ma. .. SER\10-5 /'f r By: v.,� G Original Certificate Date: JO / f g7 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 , Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc 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 VALLEY; BLOCK 2, LOT 4 Parcel ID: 020-431-17 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/26/2018 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 200 ft. Cased to 200 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/26/1983 8/22/18 Static water level 38 ft. 42.1 ft. Well production 1.5 g.p.m. 0.6+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate 5.35 mg./L. Collected by: GEG, Ltd. Arsenic: <5 0 ug./L. Date of sample: 8/22/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/PLASTIC Date installed 10/8/18 Tank size 1060 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) N/A Date of pumping NEW Pumper - C. ABSORPTION FIELD DATA *BELOW FINAL GRADE Date installed 10/8/18 Soil rating ((p.d./or ft2/bdrm) 0.8 System type TRENCH Length 60 ft. Width 5 ft. Gravel below pipe 4.0 ft. Total depth *7.5.+ ft. Eff. absorption area 600 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test - in. Water added NEW gal. New depth - in. Elapsed Time: - min. Final fluid depth - in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) - If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at '• wa er alarm level at in. _ _• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots *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 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 50'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS .••PSE OF.. �'••,q• � G. ENGINEER'S CERTIFICATION • . • • I4' Zvi I certify that!have determined through field inspections and 9 I T i review of Municipal records that the above systems are in i conformance with MOA COSA guidelines in effect on this • •••• • ' •: date. ♦r^ Je - A. Gorness:: .I ..• IE-79 : i Engineer's Printed Name JEFFREY A.GARNESS • d>.• � I /, �CP: /1!...4 / '1 O `•3w...11.!IV' \, �. Date t O /L j LICENSE14., �APOF`S`\ 4 #AECC884 • (Rev.10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT I e � 907-343-7904 On-Site Water and Wastewater Section j Fax: 343-7997 i www.muni.org/onsite Well Water Advisory Certificate of On-Site Systems Approval # OSC181553 Subdivision: Bear Valley, Block: 2, Lot: 4 This well's productivity was determined to be .6 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ' : 4'"2'+ 907-343-7904 On-Site Water and Wastewater Section ` ; Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181553 Subdivision: Bear VAlley, Block: 2, Lot: 4 A water sample revealed a nitrate concentration of 5.35 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address:P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org __ 4 ° 4 (, aor . b _ o ° DR i , .X.),(1),., o . ]Dzi. r _:`-4-.__ r C...,' �. • C = lk 1 . (Th(f) b , , . 0 /,. 00 43. \ \ GRt�VF1 1 0 �. r_ 9. .` J'cAo U' ° TWO STORY o} \ �_ -F- -\ \,\ ° WOOD FRAME n C p n ° ° NOME I. j � ° z ,� SEP% c.3` II 4 1. o 4a " G�i,A VF-! ° li: SHED Q \ ,�ON. ° °L \ \63o-`° \ \ \377Cn n 13 \ / - kA a\� a 1"E 296.32 ;7G CE OF 4L�\�, \ ° N35345 le, "' ,. 1 \ CURVE CHART No property corners were found or set during A 'i F. BURNETT Bobby F. Burnett NO DELTA RADIUS LENGTH this survey. House placement is based on an r' is-asst 2941 arriage Drive As-built survey dated 5/28/2009 by Shane Holt , :,c f) •• /c -tc Anchorage, Alaska 99507 10 125'27 17 50.00 109.48 Land Surveying. Improvements from previous (907) 350-5541 © „ survey have been Re-Certified during this \\ astor►a 07'48 03 1047.07 142.56 survey, and are as shown. 116..Ni.r Date Scale Legal Description 10/11/2018 1” = 40' I hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated thereon Grid Lot 4 Block 2 are within the property lines and do not overlap or encroach on the SW AS-BUILT property lying adjacent thereto unless otherwise shown. That no Drawn b Field Book BEAR VALLEY SUBDIVISION improvements on the property lying adjacent thereto encroach on the Y PLAT # 76-209 premi%es in question and that there are no roadways, transmission BFB ASB-2018 lines or other easements on said property except as shown. Municipality of anchorage --� Development Services Department Building Safety Division\`;i On -Site Water 8 Wastewater Program r \lam 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 Parcel I.D. COSA# C) 9 0 I G I 1. GENERAL INFORMATION Expiration Date: 2—/0 — 0 cl Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BEAR VALLEY S/D: BLOCK 2. LOT 4 16211 BLACK BEAR DRIVE • ANCHORAGE. AK • 99516 SCOTT ERICKSON Day phone 345-8167 16211 BLACK BEAR DRNE " ANCHORAGE. AK * 99516 Day phone LINDA HOPP W/ PRUDENTIAL Day phone 563-5500 3801 CENTERPOINT DR, #200 • ANCHORAGE; AK » 99503 -_-__--Unless otherwise requested,-COSA will be held by DSD for pickup.-- .... --- --------- 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systenis 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 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 8 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 -3 bedrooms. Disapproved. Conditional approval for Attachments:y COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the fllowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other y'OF', • ON-SITE WAERAND •m WASTEWATER PROGRAM By: Original Certificate Date: — I O — D (Rev 11105) \ Municipality of Anchorage , 1 Development Services Department ° Building Safety Division On -Site Water & Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: BEAR VALLEY S/D; BLOCK 2, LOT 4 Parcel ID: -(2.2 _0 - L431-17 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 6/26/1983 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES i Total depth 200 ft. Cased to 200 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/26/1983 5/26/2009 Static water level 38 ft. 25 ft. Well production 1.5 g.p.m. 0.8 g,p,m, WATER SAMPLE RESULTS: Coliform��I colonies/100 ml. Nitrate 3`'Img./L. Other bacteria colonies/100 ml. Arsenic: rV 0 ugJL. Date of sample: 5/26/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date Installed 7/12/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) ^ NO High wateralarm (Y/N) N/A I Date of pumping 9/8/2008 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA [*BELOW EXISTING GUD7E Date installed 7/12/1983 Soil rating (g.p.d./ft'o /bd 196 System type TRENCH Length 49 ft, Width 2.5 ft. Gravel below pipe 6 ft. Total depth $9.25 ft. Elf. absorption area 588 ft' Monitoring tube YES Depression over field NO Date of adequacy test 5/26/2009 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test 43 In. Water added 450 gal. New depth43 in. Elapsed Time: 0 min. Final fluid depth 43 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 Manhole/Access "Pump on" level at in. "Pump off' leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 59+ 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 ► 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 JEFFREY A. GARNESS �Q Date t' kloc1 ��' e, COSA Fee t/ Date or Payment Receipt Number 4 MR �� (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number tyr .: /C/ X�7//9953 e, •b�7..!O.�l'' e�4v� Municipality of Anchorage • Development Services Department t° j Building Safety Division ° On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # 090161 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 4 of Bear Valley subdivision, the well's productivity was determined to be 0.8 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage \ N e Development Services Department Building Safety Division ` s• arr -- On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 090161 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of Bear Valley subdivision. This inspection revealed a nitrate concentration of 7.34 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS ReEN 1092214001 Client Name Garness Engineering Group, Ltd. Project Name/a Bear Valley B2 L4 Client Sample ID Bear Valley B2 L4 Matrix Drinking Water PWSID 0 Sample Remarks: Printed Date/rime Collected Datelrime Received Date/rime Technical Director 06/032009 14:27 05262009 16:00 05262009 16:30 Stephen C. FAc Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/I, EP200.8 C (<10) 0529!09 06/01/09 NRB Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 7.34 0.100 mg(L SM20 4500NO3-F B (<10) 06/01/09 JD! 0 coVI00mL SM209222B A (<200) 0526/09 DLC 0 col/IOOInL SM209222B A (<I) 0526/09 DLC 0 col/100mL SM209222B A (<I) 0526/09 DLC o OF A4. -q r..• p 49 Vit+ .poo .............................� Ir L = 1 42.56 - HONEY LANE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY OR LOCATE STRUCTURES. AS -BUILT SURVEY NO 1'= ' NO CORNERS SET THIS DATE SCALE:1' - �U I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4. BLOCK 2. BEAR VALLEY SUB. ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED DATED AT ANCHORAGE. ALASKA THIS 28TH_ DAY OF MAY 2OD9 HOLT LAHO SURVEYING TEL. 3+5-5513 11023. FB 136-32 MUNICIPALITY OF ANCHORAGE AL • '� 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. # 020-431-171, HAA # `��Y 4SS S 4 1. GENERAL INFORMATION Complete legal description Lot 4, Block 2, Bear Valley Subdivision Location (site address or directions) 1 621 1 Black B ar Drive Property owner Brian D. Benson Day phone 3,15-135..) Mailing address 16211 Black ��ear {give ianchorace, AK 99517 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (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 021 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 Anderson Engineering Phone Address 522-7773 1 Engineer's signature Date 7/14/99 C':l.kL� � Gur � k 7 r 4014 � v 9 * � 6. DHHS SIGNATURE _JZ_ Approved for TH R �EE bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is sueeested that periodic testing be performed to insure the wells continued suitability. Current nitrate More information on nitrates is available from the On-site Services Program, a14149 -r 949-!x-44 . Additional Comments By: Date 7— 1 ( -2 1 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 orderto 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'br omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 Municipality of Anchorage RECEIVE D DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 15 199 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90Uc °f Anon pt. ea th Human Services Health Authority Approval Checklist Legal Description: Lot 4, Block 2, Bear Valley Parcel I.D.: 020-431-17 A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 6/26/83 Total depth 200' Cased to 200' Casing height (above ground) 2.5 ' Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 6/26/83 7/10/99 Static water level 38' 48.2' Well production 1 .5 g.p.m. .7 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 5.75 ma/L Other bacteria 0 Date of sample: 7/8/99 Collected by: _ s- Gilbert B. SEPTIC/HOLDING TANK DATA Date installed 7 /f 2 / 8 3 Tank size 1 , 0 0 0 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Date of Pumping 7/ s/ c)g Pumper A P 1 u C. ABSORPTION FIELD DATA Date installed % / ` 2 i 8� Soil rating (g.p.d./ft2 or ft2/bdrm) System type Deep Trench Length 49' Width 2.5' Gravel thickness below pipe 6' Total depth 10, Effective absorption area 588 SF Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 7/10/99 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test (in.); 41 " Immediately after 650 gal. water added (in.): 49" Fluid depth 41 " (ins) Minutes later: 60 Absorption rate = >450 g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date Zvi A 72-026 (Rev. 3/96)* D. LIFT STATION - '= None on Lot Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank oni lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation >51 i Property line >5, Absorption field >51 Water main/service line >10' Surface water/drainage > 10 0 Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: r I Property line > 10 Building foundation > 10' Water main/service line > 10 Surface water >100' Driveway, parking/vehicle storage area >50' Curtain drain Nc)n,.i on T.nt Wells on adjacent lots --gfl jam' ` LA, F. ENGINEER'S CERTIFICATION olI certify that / have determined thru field inspections and review of Municipal rem h°a ems are in conformance with MOA HAA guidelines in effect on this date. Signature ;°TH 3 ° 140 "• a a r oY ° y'' ' Engineer's Name Michael E. Anderson, P.E. Date 7/14/99 i HAA Fee Date of Payment Tl Receipt Number ifs `. 72-026 (Rev. 3/96)* s Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. '/I03�G During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot Block ,_ of [.��y Subdivision, the well's productivity was determined to be (�. 7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 bedroom residence is 0,3/2„ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health :authority Approval. JUL-14-99 15;13 FROM-CTE ENVIRONMENTAL 5615301 T-819 P.02/03 F-408 CTAF- Environmental Services Inc. ZAN lwm- Nitrate -N 5.75 k - - �riw r. �rriiiirirwr r� EPA 300.0 10 man 07/09/99 07/09/99 SCL CUE ReP.# 993292001 Client POAr Client Name SG Technical Printed Date/Time 07/14/99 13:19 Project Name/# 16211 Black Bear Collected Date/Time 07/08/99 18:05 Client Sample ID 16211 Black Bear Received Date/Time 07/09/99 08:15 Matrix Drinking Water Technical Director: Stephen C. Ede Ordered By PWSID 0 Releasrtl �7 Sample Remuks: Attowabte Prep Analysis Parameter Results PQL units nethoo t-imits Dare Date tnit Tocat Cotiform 0 C00100m1 SM19 9222E 07/09/99 KAP Nitrate -N 5.75 0.500 m9/1. EPA 300.0 10 man 07/09/99 07/09/99 SCL Received Time JuI-14, 2:14PM : �. MUNICIPALITY OF ANCHORAGE " DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 40 i Location (address or directions) I(v2l L c�fr Bir Or Asld rv4er ALff 5k_ 99614, (b) Applicant Name — Telephone: Home Business i Applicant Address lIeZZ�a k:,_r Pr, — c) Applicant is check one Lending Institution 0 ; Owner r ( ( ): g @1'; Buyer ®; Other EI (explain); s �. (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address - —�_-- ---.-- --- — -- Telephone � � " � a55 (f) Mail the HAA to the following address: Please call: Mary Cramichael, 563-3655— 2. TYPE OF RESIDENCE Single -Family Ed Multi -Family ❑ Other Number of Bedrooms 3 _ 3. WATER SUPPLY Individual Well R" Community ❑ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteg Public El Community ❑ Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my inveszRgatlori of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functtcna and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the ;nfcrmation 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 hQYff�1 •A6�> . j 3� Telephone Address Date® 6. DHEP APPROV L Approved for edrooms by Approved _ Disapproved Terms of Conditional Approval 1 J N • �1 C.j.• i}�BOC•\O•nO.Y � 0 VR. t9C eYi.•.e �.�. .. f". de J. Corwin .-.1 A0 h� ae. v•ecc` �\� � nditional CAUTION Date Seai f r7 r. d The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph S above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) UG 14 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1884 RECEIVED 264-4720 Legal Description: 412t 4 clad, 2 f fir- A_Aee, A. WELL DATA Well Classification �Yl If A, B, C, D.E.C. Approved (Y/N) All. Well Log Present (Y/N) _ Date Completed &12& 43 Yield46 0 WM 4(7 Total Depth Cased to ZOO Depth of Grouting NSA Static Water Level 41,5 Pump Set At Casing Height Above Ground .3 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot l On Adjoining Lots ��Od To Nearest Edge of Absorption Field on Lot L14& /E`/n Adjoining Lots 4_100 To Nearest Public Sewer Line �/A To Nearest Public Sewer (:Icannii4/luhnhnin All Tn Ncarnet Rcwcr Ccrviec 1 inn nn 1 nt Water Sample Collected by 14411�- hl . szf �6 1 ; Date' S - gas Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed '-'- Size gal No. of Compartments 2 Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped OylK/I0WInNea, 56vs Pumping/Maintenance Contract on File (Y/N) NIA ; for /V 1A Sed Holding Tank High -Water Alarm (Y/N) NIA- Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/Holding Tank: To Water -Supply Well (Zp, * To Building Foundation Ap r To Property Line 4- 2C) To Disposal Field 6 K To Water Main/Service Line 4- To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIE Soils Rating in Ab� Date Installed i Width of Field — Square Feet of AN Depression over Fi Results of Last Ads Separation Distanc To Water -Supply V To Building Found Lot N/A To Water Main/Ser To Stream/Pond/L To Driveway, Parki Comments D. LIFT STATION 1 Date Installed Size in Gallons — "Pump On" Level at High Water Alarm L Tested for Electrical Codes (Yi Comments DATA ✓ ,ption Strata p/ Type of System Design F - Length of Field 414 N � '3a Depth of Field /0 Gravel Bed Thickness Q rption Area Standpipes Present (Y/N) — d (Y/N) Date of Last Adequacy Test uacy Test �cS'I<llaVi/ from Absorption Field: II & _)( To Property Line `s / ion ,:10 To Existing or Abandoned System on On Adjoining Lots 4-501 -e Line 4' 150N To Cutbank (if present) _ _ _ �A e/or Major Drainage Course N/4 r Area I or Vehicle Stora I e Area YV! " Check mitted 3ed I certify t vect ec Signed Compa y Receipt No. Date of Payment 00' Amount: $ �,C) Page 2 of 2 72-026 (11/84) at — Dimensions Manhole/Access (Y/N) — "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA om Rating Against HAA Request "" 3 �V-rn f; v/erified, gr conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date 0 ' (1 "0G AiwyialfA MOA No. `3T 05 - 21 S %0 0,09090 j S,/ Engineer's Seal J. Corwin 4i i� gn :• o CE -5283 September 12, 1983 Lienesch, Roger and Lynne 1113 :fest Fireweed Anchorage, AK 99503 Subject: Lot 4, Block 2, bear Valley Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: A well log submitted to this office for Our files and C review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. It there are any further questions, please call this office at 264-4720. JR20/ej/E2 Sincerely, Jim Roberts Associate Environ.rtiental, Specialist FIELD PUMPING TEST DATA SHEET PROJECT; 4, fir; DATE OF TEST: �•g � LOCATIQN OF 4lELL (Legal Description): j�4; Alkil Z&L&fJc-46 WELL DEPTH:. 2tV FT. CASING: FT SCREEN: DATE DR I L411(Q COMPLETED: -ylz eg DRILLER: 1h �n STATIC WATER LEVEL (Top of Casing): -.c5 FT apses Time Since Clock Pumping Started/ Depth to Drcovery Pumping Remarks Time Stopped, , !1i n . Water, ft . Recovery Rate , GPl� i1 0 1 44,5 (swl)1 0 RECOVERY 0 our) our ours ours 0 1 Start 0 Corwin & associates,inc. Consulting Engineers 4790 Business Park Blvd. • Bldg. D • Suite One • Anchorage, Alaska 99503 • (907) 561-6151 ADEQUACY TEST LOG LEGAL DESCRIPTION: Lo S/OCAZ, B&Or . NUMBER OF BEDROOMS: 3 DATE TIME SEPTIC TANK LEVEL READINGS REMARKS g $5 •`35 10 q=q!4-6-.o' f 0 TSS 3,9 + / /0:05 3,q ` % 0 10.15 + 0 10.25 ,q' +0 io: 35 4,0' PERFORMED BY: DATE: �•� 8 N Cl a, _ s Lr. r R M oo r— � In r rh N f+1 N (suoTTe9) pagzosgy sajeM CD 00 F4 w U ro -0-0 C O 0 V, c^ V. coN m CU , i4 N M �7 U 'a ro E U H CL N � rn N � � p m -.r . 01 L` in p LO v — -A- -19 19 d M Cl a, _ s Lr. r R M oo r— � In r rh N f+1 N (suoTTe9) pagzosgy sajeM O O i■ F4 w -0-0 O N m CU M �7 E N O O O p 4_ 4- >' C in p LO C.3 O 01 d C C U O •'i •rl N \Dco N ri O ri M ro Cl a, _ s Lr. r R M oo r— � In r rh N f+1 N (suoTTe9) pagzosgy sajeM i■ Milillil in Ism 191111OWLM NINE MM OM liMwEad- IMMEMM IMMEMMrso— NPMW MEMO Cl a, _ s Lr. r R M oo r— � In r rh N f+1 N (suoTTe9) pagzosgy sajeM �L 0�_ - ,i -n/ Li7'!;"' -5f) � C., ji,�,Aj r.lfT_/iti- -)At,-P—�%� ��7t 1f":!'i ftp ✓ ��` Time APPLIC 'NT FILLS OUT UPPER HAL ONLY r.,roperty Owner< ' :.� le . / "_ ;�� J✓��` Phone Mailing Address r✓ '_ r i j - Zip Code C ;'?.. d- 4 ?- Buyer Date Address Zip Code Date Lending InstitutionPhone Inspector Inspector Inspector I� Address ` ei_. i- L_ _ � f. Zip Code ,A -I, 61 Realty Co. & Agent C E� Phone �V Address Zi Code p RECEIVED Legal Description u C. Ala C/ Street Location ( ) CONDITIONAL APf ROVAJy, '1 a/ Type of Residence DATE Single Family Multiple Family No. of Bedrooms— Soils Rating ❑ Other Well To Absorption Area / [! v Well Log Received 4/0 Water Supply Individual Community �- Y A ACH WELL LOG. A well log is required for all wells drilled For wells drilled prior to that date, give well depth (attach log since June 1975. if available). ❑ Public Utility Sewer Disposal 6a` Individual /❑ Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time CQ>L'A Date Date Date Dat Inspector Inspector Inspector Inspggtor o^ Fields Notes: MUNICIPALITY OF ANCHORAGE ,A -I, 61 DEPT. OF HEALTH & C E� ENVIRONMENTAL PROTECTION �s L" -- J UL RECEIVED ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APf ROVAJy, '1 a/ DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area / [! v Well Log Received 4/0 Septic Tank Size Well to Tank M23 (3182)