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Home My WebLink AboutBEAR PARK LT 11B¢or Pork Lot 11 ¢051-042-75 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page ~ of ~./ www.ci.anchorage.ak.us (907) 343~7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~)_~t 0 j &O?> PID Number: (~ FEDERAL NATIONAL MORTGAGE ASSOCIATION Wastewater System: [] New [] Upgrade Address: 400 COUNTRYWIDE WAY SV-35 SIMI VALLEY, CA ABSORPTION FIELD Phone: Number of Bedrooms: 4 I~' Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION 1.0 ~pD~t~ 10 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 11 BEAR PARK 2.8 Ft. 7.2 Ft. Township: Range: Section: Fill added above odglnal grade: Gravel Length: 1.1 - 1.3 Ft. 45 Ft. Gravei width: Number of lines: Distance between lines: Well: [] New [] Upgrade 3 Ft. 1 N/A Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: EXISTING PRIVATE Ft. Ft. 648 Ft~ ASTM 3034/ADS/F810 Driller: Date Drilled: StaticWater Level: Installer: Date Installed: Ft. TWEED EXCAVATING 6/22/10 Yield: GPM Pump Set at: Casing Height Above Ground: Ft. Ft. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: · T~ To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity: Tank Field Station Tank Sewer Line PREMIER PLASTICS 1300 Ga~. Material: Number of Compartments: We, 100'+ 100'+ .................... 25'+ HDPE 2 Su~aoeWatar 100'+ 100'+ .................... ~ / LIFT STATION Size: Manufacturer: Lot Line 5'+ 10'+ .................... N/A Gal. "Pump on" level at: "Pump off" level at: in. High water alarm at: Foundation 5'+ 10~+ .................... in. in. Curtain Drain .......... NONE KNOWN .......... Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: BOTTOM OF SIDING AT POINT A Assumed Elevation: 100 Ft. Engineering Engineer's Stamp Inspections performed by: t.~_~l~_t_ $;Birehwood Lp. Rd. Dates: 1st 6/21/2010 -- . ~ ~Alosko W~7 2nd 6/22/2010 Conditional Approval Date: Reviewed and approved by: /~./~'"~ ~Z/. te' 7-,/~ '?>~ ~/ PERMIT NO.OSP101003 PAGE 2 OF 4 Municipo, kitsy o¢' Ancho~'o, ge DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, &700 BRAGAW STREET P,D, Box 196650 ®Anchoro, 9e, Ato, sko, 99519-6650 ·Telephone: (907) 343-7904 ·www,ci,oncho~-o. 9e,o,k,u: ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 11; BEAR PARK S/D P.I.D. NO. 051--042--75 EXISTING TANK PUMPED, CRUSHED, AND ABANDONED I ~ VIEW STATES LOT 35 ~( VIEW ~TATES LOT 1 1! EXISTING DEEP RETAINED FOR FUTURE USE NEW 1500 HDPE SEPTIC TANK ''''". / NEW DEEP/ -.. //-TRENCH/ ...~o~ .. TO BE MUST NOTE: NO 90° COUPLERS USED. ALL TURNS NOT EXCEED 45°. I TOP OF \ SLOPE~t ENG :P PERMIT NO.0SP101003 PAGE 3 OF 4 DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, &700 BRAGAW STREET P,B, ]}ox 196650 ®Anchorage, A~osko 99519-6650 ®Telephone, (907) 343-7904 ·www,ci,anchopage,ak,u: ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL, LOT 11; BEAR PARK S/D P.I.D. NO. 051--042--75 PARK LOT 12 EXISTING DEEP RETAINED FOR FUTURE USE EXISTING TANK PUMPED, CRUSHED,- AND ABANDONED NEW 1500 HDPE SEPTIC TANK 24 KNIK VIEW ESTATES LOT 25 TOP OF SLOPE~, · . .... . , CO3 KNIK VIEW [-"' '". / NEw DEEP/ '. / /-TRENCH · . .c? // / ~OTE: ?~ / / NO 90~ COUPLERS TO BE USED. ALL TURNS MUST NOT EXCEED 45 ENGINEE 50' STAMP PERMIT NO0SP101003 PAGE 4 oF 4 [vlunic[pcLi~cy of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, /+700 BRAGAW STREET P,B, ]}ox 196650 I ancho~'oge, a(osko 99519-6650 I Te/ephone: (907) 343-7904 ·www,ci,ancho~-a9e,ak,us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 11; BEAR PARK S/D P.I.D. NO. 051-042-75 FINAL INLET - 94. ST1 ST2 /-GRADE - 98.8' LON I~ LENE I ~- OUTLET FINAL GRADE -~ ORIGINAL GRADE - 93.4' NO MT1 =83.4' MT2=83.4' TOP OF TANK -- 95.7' = 94.3' A B ST1 26.2' 28.6' ST2 27.3' 31.6' DBL1 28.1 ' 33.4' DBL2 28.2' 54.5' TMT 29.0' 32.8' DV 28.2' 55.5' C01 122.1' 158.7' MT1 125.4' 159.7' C02 141.9' 170.4' MT2 141.4' 170.5' C05 85.2' 125.9' CO1 =94.5' C0~~=94.7' · WATER FOUND 77.4' B.0.H. On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP101003 Tax Code Number: 05104275000 Work Type: Septic Upgrade Permit Effective Dates: ~'/~O/~O to Design Engineer: S & S ENGINEERING Subdivision: BEAR PARK Site Legal Address: BEAR PARK LT 11 G:1558 Owner/Address: FEDERAL NATIONAL MORTGAGE ASSOCIATION 400 COUNTRYWIDE WAY SV-35 SIMI VALLEY CA 930656298 Site Mailing Address: 22618 URSA MAJOR CIR, Chugiak Lot Size in Sq Ft: Total Bedrooms: 46801 4 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. IssuedB,: ,~-,f~ ~_~/~.~,¢I~¢~'- Date: Date:~/~ Apr.26.2010 09:35 PM PAGE. 1/ 1 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O, Box 196650 Anchorage, Alaska 99507 www, muni.org/onsite (907) 343-7904 ON-SITE SEWERNVELL PERMIT APPLICATION /~ "~ FOR A SINGLE FAMILY DWELLING Parcel I,D, 05t 042 75, Property owner(s) FEDERAL NATIONAL MORTGAGE ASSOCIATION Mailing address 4o0 COUNTRWIDE WAY SV-35 SIMI VALLEY, CA Site address 22818 URSA MAJOR CIR Legal description (Sub'd., Block & Lot) LOT 11; BEAR PARK $/O Legal description (Township, Range & Section) Lot Size.... ~ 6, ~{ Sq. Ft. Day phone Zip Code 93065 6298 .Zip Code Number of Bedrooms 4 THiS APPLICATION IS FOR ([~ all that apply): Absorption Field Septic Tank Holding Tank Privy Pdvate Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is Single Family Dwellin is in I further certify that this application is being made for a with applicable Municipal Codes. (Signature of agent) Permit/Rush Fees: ~-'7_)..~.. Date of Payment: (Rev, ~tt05) Waiver Fees; Date of Payment: Receipt Number: ROBERT C. COWAN . CIVIL ENGINEERING April 26, 2010 PH: 907-694-2979 FAX: 907-694-1211 HEALTH AUI'HORITY APPROVALS SEWER & WATER MAIN EXTENSIONS ~EWER & WATER INSPECTION ENGINEERING,STUDiES AND REPORTS WELL INSPECTION & FLOW TEST SITE ROAD DESIGN SOIL TEST // ; PERCOLATION TEST' STRUCTURAL& MECHANICAL II',~ PECTIONIS, ONSITE W/'STEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 11; Bear Park S/D It is requested that you issue a permit to install a new deep trench and 1300 gallon HDPE septic tank septic system to serve the existing four bedroom house on the referenced property. A diverter valve will be installed to allow the existing system to be used a t a later date. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (4/8/2010) water was not found. After seven days of monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you requir.e, jadditional information, please contact us. Sincerely' / Enclosure 15861 S. Birchwood Loop Road - C~hugiak, Alaska 99567 SITE-PLAN DESIGN 1"=80' SCALE moo Oo °~ ~RJOR SITE-PLAN \ o 0 '-.t 15' UTILITY LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 1 16 17 18 19 20 ROBERT C. COWAN, RE. ROBERT A. SHAFER, EE.. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 DATE PERFORMED: //j' <~¢~-~ ~//~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT ~~ O DEPTH? p Depth to Water Alter 0 Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RTE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~Z~ FT PE.,:OR,,.,ED,,¥: .- r ACCORDANCE WITH ALL STATE AN~ MUNICIPAL GUIDELINESY/' //IN~FF~T ON THIS DATE. DATE: ' , ' ' ,~ MUNICIPALITY OF ANCHORAGE DII~RTMENT OF HEALTH AND HUMAN SER~IES "', " Environmental Health Division .,, ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Namel DISTANCES Ad~r~s; - ' ~0 SEPTIC ABSORPTION ~,¢ ~. ~ ~ ~~ ~,~. . TANK FIELD WELL ~hone~s}~ ~o. o~ ~ WELL s I~' ~ ~ LOT LINE LEGAL DESCRIPTION Township, Range, Section ~ [~ ~ ~ ~ ~ W AS-BUILT DIAGRAM (Show Iocat,on of wen, septic system, property hnes, foundat,on, driveway, water bodies, etc.) ~ I TANKS N ~ SEPTIC ~ HOLDING ~ 'M~~ ~ C apac,ty ,n gallons ~ateriai No. Of Compadments ~ f j~[% TYPE OF SYSTEM .]I,~ ~TRENCH ~ BED ~ W. DRAIN B OTHER '~' ~i~'~_ ....... Depth to p~pe bottom from ¢otal depth from original grade original grade ~ / Fill added above original grade Gravel depth beneath p~pe ~-~;eZl%n%{h Gravel w,dth .otalabsorptlonarea~.~..~ ~+~'Distanoe~etweenllnes '/~ FT ~ ~' ~ Dine Installed ~_~ PRIVATE ~ OTHER (Identify) Classd.cation (A.B,C) ~otal Depth Cased to ¢ F, FT Instaile~ Date installed: · REMARKS: Sc.~e: ~ ,~ 5. ~.~,.~.'S S~ ~ ~ ~ Inspections Pedormed by: I 17034 Eagle Ri~er L~ Road H~. 2~, c~ily t~t this inspection was peflormed according to all Eagle River, Alaska 99577 Municipal and Stale guidelines in effect 0n this date: ~~ ~ Health Department Approval: ~ Date: ~--/~ ..... "~ ...... ' ~ ' 72-013 (3/85) l!iheiSi....iE ie ill gElR ~ ~/:~t:.'.' e9577 i::' l'"i ill} i".t ii~l :t'!: ,5 ':? ':-'i. '"- :,:.iVeY? 9 SCALE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST LEGAL DESCRIPTION: 2 6 - ~.'} tO-~-a ~ 12 -'~ 16 17 , ,) VATER ~x..~., (% DATE PERFORMED: ~--~ - SITE PI_AN Gross 1 Net Time Time _ , ',/.._? ,) Depth t9 Water Net Drop COMMENTS PERFORMED BY: 72-008 (6/79) PERCOLATION RATE TEST RUN BETWEEN CERTIFIED DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 8:25 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 1PHONE I I~Ew MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ~ Z Manufacturer Material No. of compartments Liq. capacity in gallons Inside length Width Liquid depth I ~ IF HOMEMADE: ~.~ ~ ~ Well / Dwelling PERMIT NO. ~ ~ Z DISTANCE TO: O ~ ~ Manufacturer /~ Material Liquid capacity in gallons ~ ~ DISTANCE TO: Well ~' F ounda~ I N ear est lot lineI P ERM~ * ,e~h~f ,ines Trench Distance begones ~ .~'; ~ No. of lines Length of ~t~e~h~in~ Total : ~ Top o~ tile to finish ~rade ~ Material beneath tile Total effective absor~tio~ area/ ~ L inches Length Width Depth PERMIT NO. ~ ~ T~Oe of crib Crib ~iameter rib depth Total effectiuo absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~~ ~~- ~ SOIL TEST RATING INSTALLER APPROVED . SRB lg6X DATE LEGAL 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: ~ --8-- <~ LEGAL DESCRIPTION: 1 2 3 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O liebert A. Sh~r ~ Ne. 1457-E COMMENTS WAS GROUND WATER x I S ENCOUNTERED? ~ (~L P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERFORMED BY: 72-008 (6/79) CERTI FlEDge' Drill Casin~ Durbin Drilling CO. Mile 1.2, Lucas Road P.O. Box 871348 Wasilla, Alaska 99687 (9O7) ~ 376-WELL Name: Floyd Gray's Constr~cti~n Address'~28 Boniface 2857 ' City: Anchorage, AK /Ph°ne:376-7938 Job -- - Location~.O'r. ll, Bear Park Subd. Crew: R. Durbin/S. Zachari~sen/R.Legerski Date: April 29, 1985 Notes: Well cased to 265 ft. including 2 ftt.. stick-up Stati'c water level: 14 ft. from surface GPM: 30 -~rc~Tn~-~ed pump setting: 60 ft. Restrict flow to l0 GPM Well Lo~ Sand and gravel Depth / 0-15~ 150-~62 162-~40 Mostly sand with some gravel 240-~ 62 262-~ 65 Clay and gravel Sand, silt, water Sand and gravel G Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 ;;M7 Certificate of On -Site Systems Approval Parcel I.D. 051-042-75 Expiration Date: C, — 1. GENERAL INFORMATION: Complete legal description BEAR PARK S/Q,• LOT 11 Location (site address) 22618 URSA MAJOR CIRCLE, CHUGIAK, AK 99567 Current Property owner(s) CHARLES JETTON Day phone 719-330-5562 Mailing address 22618 URSA MAJOR CIRCLE, CHUGIAK, AK 99567 Real Estate Agent ANNELIESE HENLEY Day phone 854-0310 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) 1771 Duplex 1771 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: .3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage E] Holding Tank 1771 Community Class Well 1771 Community 1:1 Public Water System 1:1 Public Sewer 1771 WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55-10 Date of Payment V, 13,11 q ' I o 'q Receipt Number o 19 �7 COSA # 135r-1916174 Date: Waiver Fee $ Date of Payment Receipt Number. Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site.water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 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: CZ Z In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o� OF q in accordance with the guidelines and regulations established by the Municipality of Anchorage and �.. • • • ..• • 504 industry practices. The reported results describe the condition of the system/s on the date/s of the O P Q evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, • • • • • • • • • • • • • • • • • • • • • • • • • groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ..... .. ......... ........ are outside the control of GEG. Satisfactory test results do not guarantee future performance of the f r A. Gorn ss: system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QO CE em the well or septic system. GEG makes no representation whether an alternative well or septic systs c G can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to �0 dpro f e s s10�°\ perform the evaluation. Reliance upon the information provided in this report by any other person or O�O��D000Q party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms TYtpF System #2 Approved for bedrooms Disapproved `a INAT' ; �� m Conditional approval for bedrooms, with the followirgwipAo D P TSR �'OC' ot:HVt ,�� `, i Original Certificate Date:—Co—( 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 _ C Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc Legal Description: BEAR PARK S/D; LOT 11 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/29/85 Total depth 265 ft Cased to 265 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 11/15/19 Static water level at beginning of test 23 9 ft. Comments B. TANK DATA Age of tank(s) 9 years Tank type/material PLAsTIc Measured operating fluid level in septic tank 4411 ON Standpipes/foundation cleanout per record drawing ! Date of pumping 1 —2—G —11 D. ABSORPTION FIELD -DATA DEEP TRENCH Which system tested (date installed) 6/22/10 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.1 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-042-75 Structure served by this system 1 Well production at time of test 7.1 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate ND mg/L ❑ Nitrate less than MRL (ND) Arsenic 6.39 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 11/15/19 C. LIFT STATION red maintenance completed Age of lift sta years Lift station material Comments: Adequacy test date 11/15/19 Results Q✓ Pass For *3 bedrooms Fluid depth prior to test 0 in Water added 920 gal New depth 0 in Elapsed time 0 min ❑Code -required soil cover over field (INSULATED) Final fluid depth 0 in Absorption rate '600+ and ❑ System presoaked NONE (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) GalFons introduced gallons If yes, enter date Comments/Deficiencies: `SEPTIC SYSTEM SIZED FOR 4 BEDROOMS, BUT HOUSE IS ONLY 3 PER MOA RECORDS. TESTED 2010 TRENCH DID NOT EVALUATE 1985 & 1987 TRENCHES. DIVERTER VALVE APPEARED TO BE DIVERTING FLOW TO THE 2010 TRENCH. COSA Checklist yellow sheet E. SEPARATION DISTANCES *CANNOT CONFIRM SEPARTION DISTANCE TO 1985/1987 TRENCHES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑v Yes if No ft Private Sewer/Septic Line > 25'E] Yes if No ft Absorption Field on Lot > 100' ❑� Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No ft E✓ Yes if No ft ft If septic tank is under driveway comment below F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No **5+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑v Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' ❑r Yes if No ft Private Wells > 100'r❑ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' r❑ Yes if No ft Water Service Line > 10' ❑r Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' P1 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS - -- - - -- — -- - - -- **MET SEPARATION DISTANCE AT TIME OF INSTALLATION. ***ASSUMED. G. ENGINEER'S CERTIFICATION 1 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. COSA Checklist yellow sheet oo��•0F• � `� -- �� ••.ter 0� �'..4 A ................. et. Garne s, � Opp CE -79 3 �� s I 40ea r 0 f e s sio�oo� #AECC884 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Lot 11; Bear Park Subdivision Expiration Date: Location (site address) 22618 Ursa Major Cir. Current Property owner(s) Fedreal National Mortgage Association Mailing address Day phone Lending agency Mailing address Day phone Real Estate Agent Mailing Address Bob Brock Day phone 261-7678 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s & s Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Rober~A. Shafer DSD SIGNATURE ~'/ Approved for Disapproved. Conditional approval for bedrooms. Phone 694-2979 bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other /~~Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegalDescription: ~T //j~'~-J~-~ ~/~ Parcel!D:(~::~z:~/--~-'~ A. WELL DATA .c,"""-'"~ We, .^, or C .rov e Date completed ~/,~/~ ' Sanitarysea~N) Total depth c~ /ft Cased to ft. FROM WELL LOG Date of test Static water level Well production .WATER SAMPLE RESULTS: Well Log(~l).~ Wires properly pmtecte([~)~ casing height (above ground) /~/~1c in. AT INSPECTION g~z,o ~C),O g.p.m. ~ / Coliform 0 coloniesll00 mL Nitrate N~ mg/L Arsenic: I~,~ ~"~ Ug/L date of sample: _ '_~3/fi~9 Tank size . ~ gal. Num~rofCompa~ments Foundation cleanout (WN) ~ Depression over tank ~/N) . Date of pumping ~/~/ Pum~r. ~ C. ABSORPTION FIELD DATA Date installed ~to Soil rating (g.p.d./ff Length ~ ff. Width ~ fl.. Total depth ~ ~ ff. Eft. absorption area Date of adequacy test ~ ~~ Results (Pass/Fail) Fluid depth in absorption field before test ~ in. Elapsed Time:~ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (WN & ~pe) g.p.m. Other bacteria 0 'Coloniesll00 mL Collected by: Date installed Cleanouts (Y/N) High water alarm (Y/N) 1(.5 System type I~E.P-~ Gravel below pipe '"~"Z- ft. Water added f gal. in. Absorption rate >= Depression over field b/ For z'l bedrooms New depth -'" in. ~C3~ g.p.d. If yes, give date -- D. LIFT STATION / Date installed /,.J//~ Size in gallons Manh ' / ~ "Pump on" level at.. in. "Pump off"~p,.v~4---7'"~ High water alarm level at Datum ~ Cycles tested Meets alarm & Circuit requirements? in. E. SEPARATION DISTANCES Absorption field on lot. · Public sewer main Sewer/septic service line ' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ,/~) /00 'Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout / Holding tank Manure/animal excrete storage areas /od SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ L{. Property line 5'- lA Absorption field Water main ~) ~ Water service line ~/(::) ~ Surface water · Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ [~)~t-/L Building foundation Water Service line /& % Surface water Curtain drain ~1~ (~-~q ~,,~ Wells on adjacent lots Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through fieM 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 Nam~~°~'''' ! Date, "'7"' { Z -/d COSA Fee $ Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number / / / AS-BUIlT I hereby certify that I have surveyed the following described property:/- ~ 7" i {, Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on prog~erty lyin~ adjacent thereto encroach on the premises in question and t~at there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at E~agle River, Alaska this ~'~ 'T'b" dayof "-'~ ~/¥ ROBERT C. JOHNSON SCALE: Registered Land Surveyor No. 880-LS 1" = L~," Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & 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 FAHILY DWELLING Parcel I.D. 051-042-75 1. GENERAL INFORMATION HAA# 0q' 0~ Expiration Date: Complete legal description' BEAR Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PARK SUBDIVISION; LOT 11, :-'' 22618 URSA MAJOR CIRCLE * CHUGIAK, AK * 99577 TODD & MARILYNN WEATHERFORD Day phone 688-7757 22618 URSA MAJOR CIRCLE * CHUGIAK, AK * 99577 Day phone LES BALLY W/ PRUDENTIAL VISTA Day phone 689-6451 166555 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 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 · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [~ Community On-site ]--1 Public Water System [~] Public Sewer ]-'-1 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 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 Health Authority 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. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, con.~cientious 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 sen/ed 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. DSD SIGNATURE L,~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ,,~'~. , ~ ~ ~. ON-SffE . ~ ~ : WASTEWATER Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ..' Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 12/01) Original Certificate Date: 7- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: BEAR PARK SUBDIVISION; LOT 11 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 4/29/1985 Sanitary seal (Y/N) YES Total depth 265 ft. .. Cased to. 265 ft. Parcel ID: 051-042-75 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) YES YES 21 .in. Date of test FROM WELL LOG 4/29/1985 AT INSPECTION 7/2/200¢ Static water level 14 ft. 25 .ft. Well production 30 g.p.m. 4.36 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Nitrate 0.1 mg./L. Arsenic: N/A mg./L. Date of sample: 6/18/2004 Other bacteria 0 colonies/lO0 mi. Collected by: KND ENGINEERING B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) Date of pumping 7/2/2004 Pumper, NO Date installed 7/7/1987 Cleanouts (Y/N) YES High water alarm (Y/N) N/A JR's PUMPING Length 75 Total depth '7.3-9.0 Date of adequacy test Fluid depth in absorption field .before test ft, Eff~ absorption area 900 ft2 Monitoring tube**YES 7/2/2004 Results (Pass/Fail) PASS **40.25 in. Water added 730 gal. C. ABSORPTION FIELD DATA pBELOW EXeS'riND CEADEI Date installed 7/10/85 & 7/7/87 Soil rating (g.P.d./ff2or~ 225 System type DEEP TRENCH .ft. Width 2.5 ft. Gravel below pipe 6.0 .ft. Depression over field NO For 3 bedrooms New depth **53.5 in Elapsed Time: 740 min. Final fluid depth **49 in. Absorption rate >= 456 g.p.d. · Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **MONITORING TUBE ONLY EXTENDS 49.5 INCHES INTO DRAINFIELD. LIQUID LEVEL WAS BROUGHT TO THE TOP OF DISTRIBUTION LINE AT THE END OF ADDING WATER. LIQUID LEVEL AT LAST RECOVERY READING WAS 0.5 INCHES BELOW INVERT OF DISTRIBUTION LINE. LIFT STATION Date installed Size in gallons "Pump on" level at in. ~ High water alarm level at. Da...~.~.u.~tum ~ Cycles tested Meets alarm & circuit requirements?. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ On adjacent lots 100'-I- Absorption 'field on lot '1~0'~~ On adjacent lots 100'+ Public sewer main N/'A Public sewer manhole/cleanout Sewer/septic service line 25'+ Holding tank N/'A 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'-I- Surface water. Wells on adjacent lots 100'-l- 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 Curtain drain NONE KNOWN Wells on adjacent lots COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. N/A 100'+ 100'+ 10'+ ¸in. Engineer's Prin}ed/Name Date JEFFREY A. GARNESS HAA Fee $ ~-//,'~ ~ Date of Payment Receipt Number ('~5//~'~ (Rev. 12/01 ) Waiver Fee $ Date of Payment Receipt Number Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 051-042-75 1. GENERAL INFORMATION Complete legal description BEAR PARK SUBDI¥$1QN; LOT 11 Location (site address or directions) 22618 URSA MAJOR CIRCLE OHU$1AK, AK Property owner Mailing address Lending agency Mailing address MARGARET JOHNSON c./o CAROLINE STRF_.ANO WITH Day phone (540) 665-4112 COUNTRY RF. AL.TY Day phone ;h-'~O ~ ,'¢ E~'~.~: Agent__c/o CAROLINE STREANO WITH COUNTRY REALT'rDay phone Address P.O. BOx 671925 CHUGIAK, AK 99567 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: (907) 688-8500 If community weft system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site xxx Holding Tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC /ng fo the legality and status of system. 72-025 (Rev. I191) Front MCA ;~I Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,400.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy 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 Mur)i,¢i~al and State codes, ordinances, and regulations in effect on the date of this inspection. ~ ,,~//1 Name of Firm ALASKA.WATER..'&W'ASTEWATER CONSULTANTS INC. Phone (907) 337-6179 Address 6901 DEBARF~ ROAD,/S~I 'F_,~~ANCHORAGE, ALASKA 99504 / / Engineer's Signature ~',___,.,_.~ tj system in accordance with ADEC and ~O,A D! performance of the system under the condition measured to readily identifiable features. The o pta a thorough, conscientious engineering7 analysis of the ~ls Guidelines & Regulations. The reported results described the encountered at the time of the test, and separation distances oerationa/ life of ali wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of ,~ ! ~. . ....... j ..' '... ...... · 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 for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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. 6. DHHS SIGNATURE ~ Approved for ~' bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version Legal Description: BEAR A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth ;~65' Sanitary seal (Y/N) MUnicipality of Anchorage R E C E I V DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental services iDiVision 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4~{~T I 0 Z000 MUNICIPALITY OF ANCHORAGE Health Authority,Approval Checkli~NVIRONMENTAL SERVICES DM$10N PARK SUBDIVISION; LOT 11 Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number 051-042-75 YES Data completed Cased to 265' YES N/A 4/29/1985 Casing height (above ground) 21" Wires propedy protected (Y/N) YES Date of test Static water level 14' Well production ' 30 WATER SAMPLE RESULTS: Coliform ~ Date of sample: 10/5/2000 B. SEPTIC/HOLDING TANK DATA Date installed 7/7/1987 Tank size Foundation cleanout (Y/N) YES Date of Pumping 9/25/2000 C. ABSORPTION FIELD DATA Date installed .7-10-85/7-7-87 Length 7.5' Width Effective absorption area. 900 Date of adequacy test 9/25/2000 FROM WELL LOG 4-/29/1985 AT INSPECTION 9/22/2000 31' g,p,m. 6.2 g.p,m, Nitrate ~ ~mg/L Other bacteria Collected by:. A,W.W.C., INC. 1250 Number of Compartments 2 Cleanouts (Y/N) YES Depression (y/N) NO High water alarm (Y/N) N/A Pumper JR'S PUMPING Soil rating (g.p.d./ft2 o~ '57' LONG TRENCH/ADDTIONAL 18' ADDED. **MEASURED IN FIELD. 225 System type TRENCH ;~.5' Gravel thickness below pipe 6' Total depth *.7.3'-9.0' SQ,FT. Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Results (Pass/Fail) PASSED For. 3 Bedrooms gal. water added (in.~__~~~[, 450+ Fluid depth in absorption field before test (in.); Fluid depth 47" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Computer Vemlon 35" Immediately after 885 673 Absorption rate = N/A If yes, give date D. LIFT STATION Date installed Manho[e/Access~(Y/N) High water alarm level at* Size in gallons ~ 'Pump on" I~.1~~'~''''~ 'Pump off" level *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 100'+ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots 100'+ 100'+ N/^ N/A . Public sewer manhole/cleanout 25'+ . Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ SEPARA:I;ION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain 10'+ Building foundation 100'+ N/A NONE KNOWN Absorption field Wells on adjacent lots 5'-I- 100'+ 10'+ Water main/service line 10'+ Driveway, parking/vehicle storage area 5'+ Wells on adjacent lots 100'+ field inspections and review systems are in conformance on this date. JEFFREY A. GARNESS Date of Payment /~) Receipt Number (3 72-026 (Rev. 3/96)* Computer Waiver Fee. $ Date of Payment Receipt Number -,% oY 8£EI889i06 : 'ON BNOHB A±]UB~ A~±NnOD : WOmB MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11 Bear Park Subdivision (T15N R1W Section 4) H~-1282 Location(addressordirections) Ursa Major Street (b) (c) United BAnk of Ala~one: Property Owner Home Mailing Address Business 376-4147 Lending Institution Same as above Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) MailtheHAAtothefollowinaaddress:or:Checkhere[],ifholdforpickup. Listcontactpersonanddayphonenumberbelow. S & S Engineerinq 17034 Eaqle River Loop Road ¢204 Eaqle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [~x Number of Bedrooms four (4) WATER SUPPLY Individual Well::~3~: Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~x Public [] 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 fRev 8/86/ Front 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 investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S Enqineerinq Telephone Address 17034 Eaqle River Loop Road ~204, Eaqle River 99577 Date Engineer'sSeal This department has received written confirmation from the engineer regarding the Conditional Approval of January 8, 1987. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. DHHS APPROVAL Approved for four (4) bedrooms by ~ -'~' ""~'/',-~'-"~ Date XXXXXXXXXXX Approved Disapproved Conditional July 14, 1987 Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back ROBERT A. SHAFER HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST ~ SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN July 13, 1987 CIVIL ENGINEER 694-2959 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 RECEIVED REFERENCE: Lot 11; Bear Park A conditional Health Authority Approval was issued on the referenced property in January, 1987. The conditions of this approval required the on-site wastewater disposal system to be upgraded to four bedrooms. This work was accomplished under permit #870150 and a copy of the on-site ~astewater disposal inspection report is attached. Request yo~sue the final HAA at thiS time. '.AS/ss SRB 196X EAGLE RIVER, ALASKA 99577 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 GENERAL INFORMATION (a) Application Date January 7, 1987 Legal Description (include lot, block, subdivision, section, township, range) "':: Lot 11; Bear Park Subdivision Location (address or directions) Ursa Major. Street (b) Applicant Name United Bank of AlaskaTelephone: Home Business 376-4147 Applicant Address Wasilla, Alaska (c) Applicant is (check one): Lending Institution ~; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution same as above Telephone Address (e) Real Estate Company and Agent Address Telephone (f) I~fl~[the HAAtothefollowing address: S & S ENGINEERING 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [Xi Multi-Family [] Number of Bedrooms 4 Other Page I of 2 ".' i"! 72-025 (11184) attesting to the legality and status. SEWAGE DISPOSAL ::!" "" Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th~ legality and status. Note: If community well system, must have written confirmation from the State Dep. artment of Env ronmenta Conservation WATER SUPPLY '- Individual Well [] Community [] Public [] "i~ .. pROvIDI 5. ENGINEERING FIRM TIONS, TESTS, FILE SEARCH, D AND INFORMATION As certified by my seal affixed hereto and as of the validation date sh own below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on. the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Telephone 694-2979 Address 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Date January 7, 1986 The existing on-site wastewater disposal system was installed in July, 1985 for a three bedroom residence and was approved for three bedrooms on a Health Authority Approval application dated December 5, 1986. This system will require upgrading for the existing four bedrooms. A Municipal permit and new soil test will be required for the upgrade work to be performed after breakup and Prior to July 1, 1987. E n g i n eff..~.~-""~_ Approved for 4 bedrooms by te · ' ' C~)nditiona ..~- Approved Disapproved Terms of Conditional Approval Funds are to be escrowed to cover cost of upgrading as stated above. CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP issues Health Authority Approval certificates based solely upon the representations given in p~iragraph 5 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 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 //' Z GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~['~ ~~ Telephone: Home Business ~q Applicant Address ~ ~ ~ ~o~ ~,~'~ ~sf[[~ ;~ ~ Applicant is (check one): Lending Institution~; Owner/builder ~; Buyer D; Other D (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: S & S ENGINEEI~!~G SRB 196X EAGLE RIVER, AK 99577 TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [~ Public [] 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 I of 2 72-025 (11,84) ENGINEERING FIRM PROVIDIN~INSPECTIONS, TESTS, FILE SEARCH, D,A~A AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING SR B 196X Address Telephone Date EAGLE RIVER, AK 99577 DHEPAPPROVAL ,' Approved for Approved ~N, . Disapproved Terms of Conditional ApProval r ~ bedrooms by ~~(~, -~'~ Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 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 (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: DEPT. OF HEALTh ENVIRONMENTAL PRO ~ I! RECEIVED WELL DATA If A, B, C, D.E.C. Approved (Y/N) Date Completed /-/' ~ ~,_~5' Yield ! ~--~,, ~~ Depth of Grouting r .- - Pump Set At t.,'/',/c. ~// Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/I~L~ · On Adjoining Lots ! ' On Adjoining Lots Well Classification Well Log Present~/N) Total Depth ~--~ ~, . Cased to Static Water Level / ~ / Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: ! To Septic/Holding Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhote Water Sample Collected by Water Sample Test Results Comments ~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ¢_~ ~,,J~,~4,~4. · Date //-a-~ B. SEPTIC/HOLDING TANK DATA Date Installed -7-/o- _~ Standpipes ~1) Depression over Tank (Y~I~ Size /~c~ O No. of Compartments ~-- Air-tight Caps (~N) Foundation Cleanout (~N) Date Last Pumped ~ ,.~ ~/ -~ Vv~.¢~- T'zc~,~¢t~' Pumping/Maintenance Contract on File (Y/N) Ir'l~/ i~- ' for ~ Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: (ot4- To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation ~ D / To Disposal Field J~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ -/¢~- Width of Field c//,~2 It ,,..,.-.--., Type of System Design Length of Field -~ ~ Depth of Field Gravel Bed Thickness [~ L~' ~:~ Standpipes Present ~.~/N) 12-~r-~, ~ Date of Last Adequacy Test Square Feet of Abso~ea Depression over Fi~/~ ~V Results of Last Adequacy Test Separation Distance from Absorption Field: /o.'~/ To Water-Supply Well To Building Foundation Lot To Water Main/Service Line /O I-lc' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line /(3 / To Existing or Abandoned System on · On Adjoining Lots ~ ~ ;_fo To Cutbank (if present) t,.//,~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test· Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha,t,t Jaa~e..~he. ckecL~erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. a ~,~ ~'N(~INEERING, Signed ,',~ - Date CompanycA ~.,. ~, '~,,..-- ,..-...L.= ,~, V"K, AK ~5~7 MOA No, Receipt No. 2,~/ ~/,~' Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 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 r-~ _ GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name~ ~~/ ~ ~ ' ~ r Telephone: Home Applicant Address! ~--~'-"~ ~/"~ 2--f'~ ,=~-"~ Applicant is (check one): Lending Institution D ' Owner/builder [] ' Buyer [] ' Other [~ (explain); Business ~'.,'¢~ ~'-¢-~ l'Z.._~' (d) Lending Institution Telephone Address (e) Real Estate Company and Agent _ Address __ ~-~./~- ~. L~:.. ~ ~/~,~, Telephone ~ ~;i~-~ (f) e HAA to the fotlow~ng address: , SRB 198X-' TYPE OF RESIDENCE Single-Familyj~ Multi-Family [] Number of Bedrooms ~'~ Other WATER SUPPLY Individual Well ~, Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public[] 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) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by rny seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 .~ ~ ~ ~.;'~G~JF-.~ii~ Telephone Address Date DHEP APPROVAL Approved for ,~/-~-.~-~-~/bedrooms by Approved ,/~ Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 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 ,~, '5~ c~ ~ '~ CHECKLIST-264_4720FEBRUARY 1984 i j U L ~ ~ ~iQ~,',~"~ WELL DATA Well Classification Well Log Present ~)N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~) Separation Distances from Well: To Septic/H~dfl'T~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~ Water Sample Collected by Water Sample Test Results Comments S ~¢. If A, B, C, D.E.C. Approved (Y/N) Date Completed '~'"' ~-~ - ~ Yield Depth of Grouting '--"- Pump Set At t.,) ~ ~/'~, Sanitary Seal on Casing ~,1) Depression Around Wellhead (Y~.~ Cased to · On Adjoining Lots ~ c:>'~ ' · On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date B. SEPTIC/H~L-BfN~ TANK DATA Date Installed Standpipes ~N) Air-tight Caps ~'N) Depression over Tank (Y/.~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Sepbc/~ ...... = . ank. To Water-Supply Well ~ IG:~"~ To Property Line \ ~ ~-~- To Water Main/Service Line .~t~ ~ ~ Course Size t, ~=,~:, No. of Compartments "2- Foundation Cleanout~N) Date Last Pumped t.~ j,~ ' for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-~26(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~..Z.-~' ¢ Date Installed ~ - 1 ~-- ~' Width of Field ~ ~ Square Feet of Absorption Area ~:~ ~' ''~ Depression over Field (Y('~ Results of Last Adequacy Test /~/~ Separation Distance from Absorption Field: To Water-Supply Well ~ c:=,."~ ~ To Building Foundation "~'~ ~ Lot t,~ To Water Main/Service Line ~ ~"¥" To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area II:z~fL-~ Type of System Design '"~.~1. ! Length of Field ~ ~ Depth of Field L Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ~ To Cutbank (if present) tl' I~' Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Compan'~, PH. Receipt No. '" P ym nt q- 5 Amount: $ Page 2 of 2 72-026 (11/84)