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HomeMy WebLinkAboutBEAR PARK LT 8ABear Park Lot 8A #051-044-03 \ Municipality of Anchorage ., Development Services Department Building Safety Division ?^; SL i On -Site Water & Wastewater Program, 4700 South Bragaw P.O. Box 196650 Anchorage, AK 99519-6650 www.a.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO10144 PID Number. 051-042-88 Na RANDY ROLOFF w/ PREFERRED COSTUME HOMES Wastewater System: ■ New ❑ Upgrade Address: C/O BROOK STILTNER W REMAX OF E.R. ABSORPTION FIELD 16600 CENTERFIELD DR. EAGLE RIVER AK 99577 Phone: No. of Bedrooms: (907) 355-7720 3 0Deep Trench 0Shallow Trench ■Bed Cl Mound 0ather LEGAL DESCRIPTION so9 Aauv 0.7 Told Opb hm awwrwi stud: 4.0 — 5.0 GPD/s4. rt n. Lot, Block: subdivision: Owth to Pas bottom hw eAgnd grodw: Grad dwte swath paw 8 — BEAR PARK 3.5 — 4.5 rt 0.5 R Township: _ Range: _ Section: ns eddad aesw w1gWA grad: Growl wmWc 43 O —0.5 rt n WELL: ■ New ❑ Upgrade G,a.d ekua 15 W. w Of en.e 3 Dbtowe bbw.m a. 4.5 R1 n cbrairaotlan Prhob. A.B.G : Totd Dpua ca..d To: Total fib„ rao Pp natrWk D 3034/ F-810 PRIVATE 101 rt 101 rt 645 so. in, DNr. Dob Dreled: steed Mdr tewt 1 70 YMoew: CALKINS CONSTRUCTION Dab MaIMd: 10/9-10/2001 WHEATON WATER WELLS 10/8/01 n Trw:Pimmv sat At ca.kw Hsgnt ma" cmm� TANK 10 Vu UNKNOWN FLI 1.5+ rt. SEPARATION DISTANCES ■Septic C! Holding 13 S.T.E.P. Gather To Sept Absorption Uft Holding Ge/Prhvle YpMi1oc1unri GREER cavaNOr N sas°ar 1000 From Tank Field Station Tank s..r un.. Wall 100'+ 100'+ — — 25'+ bwriee STEEL d orprbmmtc 2 Surface water 100'+ 100'+ — — — LIFT STATION Lot Una 5'+ 10'+ — — — sin M 9� I Foundation 5'+ 10'+ — — — an b.d at at KNh "WBann at ►rmP Yob. ar4bd bmaaotiarw pwrrme0 by: Curtain Drain NONE KNOW BENCH MARK Remarks: loaalwm and Dw"IFUM TOP OF GARAGE SLAB Aesrwd a.wtWm' 100.00 rt orasimTs WAL 4 a� } `srp Inspections performed by AWWC, INC. Dates: 1st 10/9/2001 off; ••.v 0 ........ . ...........1� 2nd 10/9/2001 3rd 10/10/2001 Q ; r y Department of Health and Human Services approval00�� a( E 7953 404c1Pr Reviewed and approved by: Date: D - .a ressA000` 0400op0o (aw.. t2/00) PERMtTNUMBER: ASBUILT DRAWING - PARCEL NUMBER: 42-88 SW010144 SWO 051-00 / I NEW WELL l I I I / / o / STI - 22.89 59.24 ST2 - 26.77 65.44 2 / DBL1 - 28.59 67.99 / DBL2 - 30.25 70.51 MTI 59.85 38.36 79.65 MT2 69.29 48.81 90.46 N00M B SSE MT3 54.14 47.49 = �3 COI 53.73 47.19 CO2 49.28 43.11 - \ a fC 703 45.15 39.03 - MT4 44.51 38.32 - CC70 ^� O� \ \ > NEW DRAINFIELD —//��12#\\. NEW 1000 GALLON ALTERNATE SITE SEPTIC TANK DBL1 DBI.2 004 10/23/2001 �/) ,. i i�r.G./J.L.M. DRAWN BY: ALASKA WATER & R'ASTENVATE.. CONSULTANTS. INC. 1- = 30• •• .• . ••• QDn� 6901 DMARR Roan, SUTE 29 • ANCHORAGE, Ax 99506 • N1011E 01)337.6179 • FAX 907)33$-3ne O V PREPARED FOR: PHONE NUMBER: PACE NUMBER: c/o BROOK STILTNER (907) 694-4200 1 2 OF 3 • QO ,0 ff me s Q ° % C 795 eQ 0�4�° •., ' .Foo LEGAL DESCRIPTION: BEAR PARK SUBDIVISION, LOT 8, ; ppedP�o/eeslo�aao p44ppoo� TYPE OF WORK: AS -BUILT DRAWING OF NEW WELL LOCATION AND SEPTIC SYSTEM PERMtrNUMBER: AS-BUILT DRAWING PARCEL a NUMBER: SWO SW010144 051-042-88 INAL GRADE 99.30+ TOP OF INLET - / I I NEW 1000 GALLON INVERT of BUNG SEPTIC TANK AT INLET - 94.85 TANK AT - 95.22 INVERT OF BUNG AT OUTLET - 94.45 10/23/2001 oa 1 F DRAWN BY: v�`,:•O. L ALASKA WATER & WASTEWATER C.J.G. CONSULTANTS, INC. N.T.S. aen� nce•ee enan a•n fo • a.Yuroafe A[ 00}nL • P11fYJF fOn11111.A1)0 • PAN (On)1}}}-})LS REPARED FOR: PHONENUMBER: rout nurecn: c/o BROOK STILTNER (907) 694-4200 3 OF 3 ,GAL DESCRIPRON: BEAR PARK SUBDIVISION; LOT 8, fPE OF WORK: PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM OCT -23-01 11:25 AM PREFERREDCUSTOMHOMES 907 357 9136 P.02 ]P. 4. >E3ox s'77itsaxS •Qfiaad.)frlsa, JttcJta.sca 9sgs7 <t1�0'X� 3me-yao�x ILA �elx Bite Bi7.1ed. To Bear Park Preferred Custom Homes Lot 8 >Qloo� PO Box 875010 - Wasllla,AK 96087 'Stell Depth 101' Grails/lt+�iu 10 Btatio Xaevex -- 70' CzLfti lgL— Size 6„ Li118r 3ftpme none Boreencd none BerPoratcd none pate Drilled 1 •6-2001 From To Farmatioa 0 2 topsoil 2 8 gravel, sand 8 16 send, little gravel 15 25 damp silt, gravel 25 65 gravel, sand 65 75 silt, send 75 101 . gravel. sand, water Dauer Milo Pitner --.... r In ra 000 MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 I =r X* S P;'c %-10,ou 2-R INs/Fc1-ivxv /0 - %_ p / I2: CoAv0N 00V ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SWO10144 Date Issued: May 30, 2001 Expiration Date: May 30, 2002 Parcel ID: 051-042-88 Legal Description: BEAR PARK LT 8 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 022520 URSA MAJOR CIR Owner Name: BROOK STILTNER Lot Size: 53327 SQ. FT. Owner Address: 22520 URSA MAJOR CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567 - This permit is for the construction of: Q Disposal Field 0 Septic Tank Holding Tank ❑ Privy Q✓ Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: E — 30 -O Municipality of Anchorage • Development Services Department / Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.sk.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 05'1 — 0*2--88 Permit Number 5'LVO/O /¢¢ Property owners) BROOK STILTNER Day phone 694-4200 Mailing address (1) 16600 CENT RFlELD DRIVE • EAGLE RIVER. AK Mai�gaddress (2) ZZ320 URSA 11AXOR CIRCLE Zip Code 99577 Legal description (Lot, Block & Sub'd.) BEAR PARK SUBOMSION: LOT S. Legal description (Section, Township & Range) N/A Lot Size 52.448 Acre FL THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well 0 Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER do WASTEWATER CONSULTANTS, INC. PermitFees.yyo • Date of Payment: -6 - a a -D► Waiver Date of Payment: Receipt Number. 1/7y8 Receipt Number. ALASKA WATER & WASTEWATER CONSULTANTS, INC. May 18, 2001 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well and Septic Design for Lot 8, Bear Park Subdivision To whom it may concern: The proposed 3 bedroom house will be served by a private well and septic system. Test holes were excavated on the property. The proposed septic system will be designed around the 30 foot radius of test hole t12. We are proposing that a 1000 gallon septic tank and a bed type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring and the percolation test results. It is our opinion that the insitu sandy soils should act as a sand filter and that, an application rate of 0.7 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 0.7 gallons/day/f12 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 643 ft2 f. Total Depth: 5.5 feet (max.) g. Effective Depth: 0.5 feet h. Width: 15 feet i. Reduction Factor: N/A j. Minimum Length: 45 feet long k. Effective absorption area = 675 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: The area for the proposed drainfield is mostly flat; in short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. if you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, 2 soils logs, and a 4 page constriction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com I \ BEAR PARK S/D; 1 \\ \\ LOT 6. BEAR PARK S/D; I \ LOT S• 1 \ \X DEER PARK S/D /1• LOT 1. BLOCK 2 PROPOSED WELL BEAR PARK S/D: ,I 100• WELL RADIUS / , \ \ LOT 7. \ LOT 10.1 / 1 `-VACANT ( c ' 1 PROPOSED \ ! �' T� /� c 3 BEDROOM \\ I I ``\AREA / HOUSE BEM PARK S/D; LOT 9. CrEPTIC TH `7-7— 4+ \ —r ARFA� i DEER PARK S/D /1; 1 , , LOT 1. BLOCK 1 ALTERNATE SITE 1 I / 1 / PROPOSED NEW SEPTIC SY57EMI`\ I I / / i— ---� (SEE DESIGN PAGE 2 OF 2) 1 / BEM PARK S/D; BEAPARK S/D; LOT 16. ; BEAR 7 S/D; LOT 1 �ACANT j �pT,C T �slb !,) G AR—D; ,m WELL RAD US , / `� Ak DATE: 5/21/2001>< F ^u�y DRAWN BY: C� ' \ . V^y ALASKA «'AfER & NVASTE«TATER C.J.G. CONSULTANTS. INC. SCALE:, 6901 DE6APP ROAD. SUITE 29 • ANCHORAGE. AA 99504 • "HONE 9671337-6179 • FAx 9Tn36azae 1 = 100 Tf "' .. :. PREPARED FOR PHONE NUMBER: PAGE NUMBER: BROOK STILTNER 694-4200 1 OF 2 Jef a GD s. LEGAL DESCRIPTION: Oy.l C 7953 .` ? TYPEBEEARDP ARK SUBDIVISION; LOT 8,OF �V4y^s�p• o`�c��'- SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM ''u ,. rofessio��� —PROPOSED NEW DRAINFIELD. EXCAVATE A TRENCH THAT IS 5.5 FEET DEEP MAXIMUM BY 15 FEET WIDE AND 40 FEET LONG. ADD 0.5 FEET OF CLEAN, WASHED SEWER DRAINROCK. INSTALL DRAINFIELD PARALLEL TO SLOPE CONTOURS o/.. ,5/21/2001 0� of u� 0 ` DRAWN BY: ' ;7 ALASKA WATER & WASTE NVATER C.J.G. CONSULTANTS, INC.E 6901 DEBARK ROAD, SUTE 29 • ANCHORAGE. AK 99501.' FHONE (907)337-6179 • FAX 9071316-7266 1 3D' " •• •' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BROOK STILTNER (907) 694-4200 2 OF 2 e A. Games: LEGAL. DESCRIPTION:QQ -7 a. 953 BEAR PARK SUBDIVISION; LOT B. �0� ' •., TYPE OF WORK: �Os^WdPFofssslotltc� DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM I / NOTE: A MANDATORY SITE VISIT BETWEEN THE ENGINEER AND THE CONTRACTOR IS REQUIRED PRIOR _ TO CONSTRUCTION. NOTE: CONTRACTOR MUST HAVE WEST LOT LINE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. / PROPOSED WELL / i PROPOSED 1000 GALLON EPTIC TANK O ALTERNATE SITE FOO i Cys ice' i i yo \\ TH12 cam/ ice/ \ Co Cb INSTAR DOUBLE CLEANOUTS —PROPOSED NEW DRAINFIELD. EXCAVATE A TRENCH THAT IS 5.5 FEET DEEP MAXIMUM BY 15 FEET WIDE AND 40 FEET LONG. ADD 0.5 FEET OF CLEAN, WASHED SEWER DRAINROCK. INSTALL DRAINFIELD PARALLEL TO SLOPE CONTOURS o/.. ,5/21/2001 0� of u� 0 ` DRAWN BY: ' ;7 ALASKA WATER & WASTE NVATER C.J.G. CONSULTANTS, INC.E 6901 DEBARK ROAD, SUTE 29 • ANCHORAGE. AK 99501.' FHONE (907)337-6179 • FAX 9071316-7266 1 3D' " •• •' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BROOK STILTNER (907) 694-4200 2 OF 2 e A. Games: LEGAL. DESCRIPTION:QQ -7 a. 953 BEAR PARK SUBDIVISION; LOT B. �0� ' •., TYPE OF WORK: �Os^WdPFofssslotltc� DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM ALASKA WATER & WASTEWATER - - - -- ------ CONSULTANTS. INC. Wi DMW RW, SUME 28 • AK H504 • KOiC (907)MI-M70 • FA . r..aaan LEGAL DESCRIPTION: BEAR PARK SUBDMSION; LOT 8, PERFORMED FOR: BROOK STILTNER DATE: 5/9/01 DE ((88t ~y�y ORGANICS TEST HOLE 1 1 C. — :,ropn 20 ' COMMENTS: GW/SW GM/SM/ML DEPTH TO DATE GROUNDWATER DRY 5/9/01 DRY 5/18/01 II +C'iACANr� 1 TH ' SITE PLAN 1 =100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) (MIN./INCH) PERC. HOLE DIA. 6• (INCHES) Nr •• FT, AND 11 II�111!11 oe "Y/, Ur9 ji Y4, DEPTH TO DATE GROUNDWATER DRY 5/9/01 DRY 5/18/01 II +C'iACANr� 1 TH ' SITE PLAN 1 =100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) (MIN./INCH) PERC. HOLE DIA. 6• (INCHES) TEST RUN BETWEEN RAS N Pes�R�S M��,v FT, AND 5.5 FT. PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6• (INCHES) TEST RUN BETWEEN 5.0 FT, AND 5.5 FT. PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) .�.O F .. ALASKA WATER & WASTEWATER y�Op o00 INC.CONSULTANTS. •4 : t 9Q oo, e p (907)136-M46 SOIL LOG — PERCOLATION TEST "'rness• " LEGAL DESCRIPTION: BEAR PARK SUBDIVISION: LOT 8,�': ff a OQ�� BROOK STILTNER 5/9/01 ., C 7953: PERFORMED FOR: DATE: `q0 (fe =��y n4�0�P�Ofessio�°oov (feet) – ORGANICS TEST HOLE 2 �OOppo� 1 'oe '$W' i. . aoeo SOIL CLASSIFICATIONS ( 1 �Ar�tr� 2 00 GW ORG 3 �:oOs GP ML GM CL 1 o.•o^>° ;: o% o' SW MH 5 SP CH SM i OH 6—' .r'. ��^`oo°o0o° SC � 0o e Q„°eo TH � 3 7 -'��'ooe DEPTH TO DATE y GROUNDWATER 12' 5901 o e Ac"000 10' 5/18/01 9 ;t.,r:oo o SITE PLAN 10 GW/SW +Jn ooe W/ SOME ML or'ooe c`9 12 rsoe° J.E'00 u J�-Ooe e 13—'o- s.O.a. 14— 1s o 16 17 18 t9 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6° (INCHES) TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. 20 COMMENTS: PERC–HOLE WAS PRE–SOAKED FOR 4+ HOURS PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W P FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z DI DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) S pF Pg5 N � MN�.�ES PERG NG�P�ER \ Parcel I.D. 051-044-03 Certificate of On -Site Systems Approval Expiration Date: V 2 Zz Z `f Legal description BEAR PARK LT 8A Site address 22520 URSA MAJOR CIR Chugiak AK 99567 Current property owner(s) BRECI X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1 /5/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval_June 2022 Development Services Department On -Site Water & Wastewater Section I U _0 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-044-03 Complete legal description Bear Park Lot 8A Location (site address) 22520 Ursa Major Circle Current property owner(s) Mark & Janet Bred Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑N Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑■ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ 1� T U Waiver Fee $ Date of Payment 1 `j 1Z110 7,q Date of Payment COSA # OS C Z'I/ 00 6 Waiver # COSA Application —June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date 2024.01.05 2024.01.05 Septic Wank Advisory Certificate of On -Site Systems Approval # OSC241006 Subdivision: BEAR PARK Block: , Lot: 8A The septic tank for this property is 23 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. fi G Mailing Address P O�'�Box 196650�` ,Anchorage; Alaska 99519 6650 * www muni�org `� �° Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 3 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ©uo 03 / Parcel I.D. 051 <.;. , - COSA# UsCr'a 1Q&6 1. GENERAL INFORMATION Expiration Date: ^`® , �� - &Z Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BEAR PARK S/D; LOT 8A 22520 URSA MAJOR CIRCLE * EAGLE RIVER, AK * 99567 CHRISTOPHER HUMPHREY Day phone 748-3881 22520 URSA MAJOR CIRCLE * EAGLE RIVER, AK * 99567 Day phone CINDY LINDBLOM W/ GREATLAND REALTY Day phone 11411 OLD GLENN HWY * EAGLE RIVER, AK * 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well IN Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 694-9125 TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. 337-6179 Date 7 ! ( Z Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By; Original Certificate Date: F (Rev. 11/05) Lela ON-SITE WASTEWATER PROGRAM Municipality of Anchorage „E , • .� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 03 Legal Description: BEAR PARK S/D; LOT 8 Parcel ID: 051- A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 10/8/2001 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 101 ft. Cased to 101 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 10/8/2001 6/26/2012 Static water level 70 ft. 71 ft. Well production 10 g,p,m. 6.6+ g,p,m, WATER SAMPLE RESULTS Coliform 0 colonies/100 ml. Nitrated• lI-arng./L. Collected by: GEG, Ltd. Arsenic: 3 • o1 ug./L. Date of sample: 6/26/2012 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments Foundation cleanout (Y/N) YES Depression over tankk(Y/N) NO Date of pumping 6/12/2012 Pumper �7 R S C. ABSORPTION FIELD DATA Date installed 10/9-10/2001 Cleanouts (Y/N) High water alarm (Y/N) N/A JR'S PUMPING Date installed 10/9-10/2001 Soil rating .p.d./ r ftlbdrm) 0_7 System type BED Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth *4.1-4.7ft. Eff. absorption area 645 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/26/2012 Results (Pass/Fail) PASS For E bedrooms Fluid depth in absorption field before test 0 in. Water added 690 gal. New depth E in. Elapsed Time: min. Final fluid depth E in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons ManholelAccess (Y/N "Pump on" level at in. "Pump off'level High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 1 131 ) Z COSA Fee & 'Y'qz Date of Paymentyz&Q Receipt Number i Municipality of Anchorage •. • Development Services Department Building Safety Division \ .. .,. On -Site Water & Wastewater Program ) 4700 Bragaw Street P.O. Box 196650 Ai Anchorage, AK 99519-6650 /✓/lj% www.muni.orglonsite �y(� (907)343-7904 LV CERTIFICATE OF ON-SITE SYSTEMS APP VAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051—ogy-007) COSA# v -f lay{ Expiration Date: 9-3 - O 7 Ex 1. GENERAL INFORMATION P Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BEAR PARK SUBDIVISION, LOT 8A 22520 URSA MAJOR CR. • CHUGIAK. AK 99567 STEVE do DIANA CARNAHAN Day phone 952-4840 22520 URSA MAJOR CR. + CHUGIAK. AK 99567 Day phone VALESA LINNEAN w/REMAX Day phone 257-0195 110 W. 38TH SURE 100 • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER 5. As certified by my seal affixed hereto and es of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the onsite water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. in conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will It confer any legal right whatsoever. Date 4 130 /0? - VVN1 Cn roly WASTEWATER Attachments: / COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Reort Nitrate Advisory Other By: Original Certificate Date: (Rw. 1 M) Municipality of Anchorage • Development Services Department Building Safety Dlviaion ` On -Site Water 8 Wastewater Program 47W Bragim Street P.O. Box 190850 Anchorage, AK 99519850 www.n=l.org/onake (90 343.7904 CERTIFICATE OF ON-SITE �YSTEMS APPROVAL CHECKLIST Legal Description: BEAR PARK SUBDIVISION, LOT BA Parcel ID: OSI- O Li `t-0 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/8/2001 Sanitary seat (Y/N) YES Total depth 101 ft. Cased to 101 ft. FROM WELL LOG Date of test 10/8/2001 Static water level 70 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: ccLt Coliform colonies/100 mi. Nltratea1 r+ng.)L. Well Log (Y/N) YES Wires property protected (YM) YES Casing height (above ground) 21 in. AT INSPECTION 4/9/2007 70 ft. 6.62 g.p.m. Other bacteria-colonies/100 ml. Amenic:61LzugJL. Date of sample: 4/9/2007 Collected by: GEG, Ltd. S. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10/9-10/2001 Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (YM) YES Depression over tank (YM) NO Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 4(11 /2007 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 10/9-10/2001 Soil rating .p.d r ft'/bdrrn) 0_7 System type BED Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth 4.08-4.6a fL Eft, absorption area 645 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/9/2007 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before testDRY in. Water added 530 gal. New depth DRY in. Elapsed Time: 3 min. Final fluid depth DRY in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN if yes, give date - D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Manhole/Access (YIN) "Pump off High water alar level at in. Cycles tested Meets alar 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanoul N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I ceAlly that I have determined through Reld inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A GARNESS Data t) l ?o % b;- COSA Fee I Y30. U 0 Date of Payment /i - 3 O — O % Receipt Number 11� r S C, >W (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 1 �r� Municipality of Anchorage Development Services Department= / Building Safety Division .. On -Site Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING A# n� Parcell.D. 051-042-88 HAIN � (A9 1. GENERAL INFORMATION Expiration Date: Complete legal description vv�� - Location (site address or directions) URSA MAJOR CIRCLE • CHUGIAK AK. 99567 Current Property owner(s) BRENDA AND RYAN SPARKS Day phone 688-6896 Mailing address Lending - --- - Mailing address Real Estate Agent Mailing address docs umnn naCt E + CHUGIAK. AK 99567 Day phone LARRY MAULDEN w/ PRUDENTIAL JACK WHITE Day phone 762-3106 3201 'C' STREET SUR 200 • ANCHORAGE AK. 99503 unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well a Individual On-site 0 ❑❑ Individual Water Storage Individual Holding tank Community Class Well 11 Community On-site 13Public Water System 13 Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines forthis application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date '8 fy Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering onslysts of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may Ouctuato during the year, and the water usage of the family being served by the systen These conditions are outside the control of the evaluator of the system. Satisfactory to., — results do not guarantee future performance of fhe system, -nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can there/ore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by an otherperson or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the illowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ON-SITE WASTEWATER "ilJlll)) Manitenance Agreements _ Supplemental Engineer's Reort _ Other ABy Original Certificate Date: (Rev. 1201) Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bregaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.ondwrage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WPARK SUBDIVISION; LOT B_ _ Parcel ID: 051-042-88 A. WELL DATA Well type MATE . If A, 8. or C provide PWSID# N A Date completed 10/8/01 Sanitary seal (Y/N) YES Total depth 101 It. Cased to 101 ft. FROM WELL LOG Date of test 10/8/01 Static water level 70 ft. Well production 10 9 - p.m -WATER SAMPLE RESULTS: Coldorm _0 colonies/100 ml. Nitrate 0.597 mgAL. Well Log (YM) YES Wires property protected (YM) YES Casing height (above ground) 18+ in. AT INSPECTION 8/6/2004 72 ft. 4 — 9 -p.m - Other bacteria 0 colonies/100 mi. Date of sample: 8/8/2004 Collected by: G.E.G. Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10/9-10/A /mac 1 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 8/12/2004 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA RUN EXONG IM Date installed 10 -to 1Soil rating .p.d ft%bdrm) 0_7 System type BED Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth •4.s'-40 ft. Elf. absorption area 645 fe Monitoring tube YES Depression over field NO Date of adequacy test 8/6/2004 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth In absorption field before fest 0 in. Water added 628 gal. Now depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >- 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N/A If yes, give date D. LIFT STATION Date installed 'Pump on" level at _in. Datum E. SEPARATION DISTANCES Size In gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot 1001+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICINOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 101+ Surface water 1001+ Driveway, parking/vahicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 cei* that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. / Engineer's PrintedZ JEFFREY A. GARNESS Date S11.7 HAA Fee $ Y}ei�_ Date of Payment Receipt Number tJ7.,�s4 (Rev. 12r01) Waiver Fee $ Date of Payment Receipt Number —7953 Apr 05 07 08:46a REIMAX Agent Service Cent F � p:.fa a • 'b oe :KA'. f v= fop• 907-258-9005 ) p.2 AS BUI LT 6 A_;e I HER`9Y CERTIFY JHAT I HAVE S'JTiVcYED THE SCALE: 5mm TATES LARD SDRTyTNC 694-082 FOLLOWING DESCRIBED PROPERTY, o. a+� "k a•�xorce laC 6orP9 DATE, �� OF Azq� AND THAT NO F.NCR6.� ENTS EXIST EXCEPT AS ............{ S,�•l INDICATED. IT 1S THE RESPONSIBILITY OF THE y: OWNM TO CETERMINE THE EXISTENCE OF ANY GRID, 1 f•� �fM" -••••' '" ! EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEM ON THE R ✓' •••.:.•� `.CANOED SU901- •i VISION PLAT. ON BE NO CIRCUMSTANCES SHDULp F& i f 3'} °i•"• 1a A ANY DA74 Y. ERCDN BE USED FOR CONSTRUCTION �m.rG f+A LS -691a OF FENCE LINES, OR ►OR ESTAB' fSHING B.CUND- i �`••-A ARY LINES. DRAWN+ 3AI80 TIONY WO OZ'09k M.6k,90 XON m OWN W-,411411 I 9�14,--Illlll I W cf) I a) 0 U) O CD a) U 0 0 (n 4- W X W U) 4- c: 0 0 tit C: 2 2 CL U) a) U) _r_ 0-0 C) M U) 4— 4— 0 E a) in 0 CL 0 +- CU a) a) En a) L- ca a) 0 4— CD a) a- 0 U) CL u) cn tVi ..#., 0 .2 E E 4— o o0 a) U) D 0) Z) C: 0 0 c 0 z 0 -.;-- m W -6 5- w E cn a) E �6 0 a) X r- W < < a) (D c� 6 a)0 cu > 0 o— E Pq r) -1.- 0 E S3 a) _0 C: _0 0 : Q) U)0 4) 4— 70 (n- -0 L- f- E L- C: Cc: 3r 0 U) 0 a) CL a) 4-0 m CL0000 (1) a) Co 4 -0 C: 0Z; 0 0 .M 0 L- (1) CU (J) ctj 0 0�. 0 U) C- CU 4-J u 0 70 0 0 C (Yi CU — 0 c- U) C: .0 rj ty 0 00 r-i C W > F M 0 0 0 L- ?: Ln 0 >-. C: a) CID t 4-J 0 G) ru 0 E 0 i *0 L ' > E >11 a) E a) 0 0 0) N© M " > O) -E > _0 E E (V < Ln e >- -0o0 0 0 :3 _0 4-J m U 0) W Q) > CU cn -0 C: -0 4- 0 0 D 0 0 " tll U) > 0 < 0— ' 0 U < E 0-0 u) v41 -- u . —Ile Lu 0o C- a) @) cn 0 0 0-0 E -a CL 4---.. 0 V) as (33 > E E 0 Qj (D C 00 4-J > < 00 0 m 0 cn ,.- -0 C- 4-J CO 4- 00 r--i c- (n a) o to C: 0 a) !E 00 Ln 0 I.- C: -0 :E? :D ai — zi Cl) ?: 70 u — :3 c O.W 0 E 0 m R r- 4 --J C% 0 T) C:) L- Lr) 0 0 S 0 LL- lO cy) 444 ANW i AW. 0-4 LU CO cv) 00 O� CN 0 LL (/)'Tl- 0 V) V) LL, LL rill Nl- ON CL V 0 AIW Municipality of Anchorage N15 Development Services Department Building Safety Division Onsite Water 3 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519.6650 www.d.anchorage.akus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-88 HAA# lZg d 1. GENERAL INFORMATION Expiration Date: Complete legal description I BEAR PARK SUBDNISION: LOT 8 _ Location (site address or directions) URSA MAJOR CIRCLE • CHUGIAK. AK Current Property owner(s) Mailing address Lending agency. Mailing address Real Estate Agent Mailing address RANDY ROLOFF w/ PREFERRED CUSTOM HOMES Day phone c/o BROOK STILTNER w/ REMAX OF E.R. Day phone 694-4200 BROOK STILTNER w/ REMAX OF E.R. Day phone 694-4200 16600 CENTERFIELD DRUE • EAGLE RNER, AK 99577 Unless otherwise requested, NAA will behold by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ■ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Mote: Alaska Water and Wastewater Consultants, Inc. shall be paid $1310' at or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(em) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone 337-6179 Address 6901 DEBARR ROAD, SURE 28 " ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 1v Z Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to protide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the tes4 and separation distances measured to readily Identifiable features. The opera tional Me of all wells and septic systems depend on the /owl soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or Arturo estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of thls report is for the sole benefit of the ownertisted above. Any reliance upon or use of this report by any otherperson orpartyIs not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filoMng stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other WATER AND ; n VVAJ I c VVA l tri PROGRAM _ ByL ad"' � �• t�o-C/� Original Certifih#)-26-01cate Date: 411/ (a«. +Wo) Municipality of Anchorage • Development Services Department = - Building onatew teweierPwam - 47W South Brapw SL P.O.80oM98850 Andwrage, AK 99519.WW www.dAnahora *A us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST aso4 Legal Description: BWAr PARK SUBDIVISION: LOT 8 Parcel ID: 051-042-88 A. WELLDATA Well type SATE IfA, B, or C provide PWSID# N/A bate compieted 10/8/01 Sanfiary seal (YIN) Y28 Total depth —10-11 Cased to -10—Ift. FROM WELL LOG Oft ortest 10/8/01 Stage water level 70 R Well production 10 9 -P -M WATER SAMPLE RESULTS: Coliform D colordestI00 ml. Nitrate 0-6 mgJL Well Log (YM) YES Wines property protected (YM) YES Casing height (above ground) 18+ in. AT INSPECTION R g.pm. Other tmcteds G colonies1100 ml. Data of $ample: 10/23/2001 COOected by- AWWC. INC. - G. SEPTICIHOLDING TANK DATA Tank Typo/Material STEEL Date Insured 10/9-10/01 Tankalze 1000 gal. Number or Compartments 2 Cieanouts(Y" YES Foundation deaWA (y" YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of Pumping NEW Pumper - Date Installed 10/9-10/01 Sell rating.pA 1t'/bdrm) 0_7 Length 43 R Width 15 R system 4" BED Gravel below pipe 0.9 R Total depth 211=!:VA tJL absorption area 845 to Monitoring tube YES Depression over field NO Date oradequacy test NEW Results (Pass/Fail - For 2 bedrooms Fiuld depth In absorption field before testes In. Water added=gal. New depth =1n. !lapsed Time: = min. Phai fluid depth= in. Absorption rate '= - g.p.d. Any rejuvenation bsatrnent (past 12 mo.) (YM & type) - It Yes, at" date - D. UFT STATION Date irtsteaed "Pump On' level at_in. E. SEPARATION DISTANCES Sirs In gallons High water alarm level at in. Cycles Meets alarm & draft requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenMi t station on lot 100'+ Absorption told on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service ane 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Suading foundation 5'+ Property ane 51+ Absorption field 5'+ Water main N/A Water service ane 10'+ Surface water 100'+ Wells on adjacent kits 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One i 0'+ Building foundation 10'+ Water main N/A Water service ane t o'+ Surface water too'+ Driveway. part rQftNcle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION I cerU& that I have determined throWh Be/d laspections end review of Mun/dpat records that the above systems are In conformance with MOA HAA guidelines In effect on this data EngineersN G JEFFREY A. GARNESS Date to _ Sl0/ HAA Fee $ ZM Date of Payment 10 - 'd S ni Receipt Number 01 J 8 cl (R1v.12MO Waiver Fee $ Date of Payment Recelpt Number