HomeMy WebLinkAboutROCKHILL BLK 4 LT 6Ro�kn�ie
B1ock 4
Lots 6
#015-063-27
1
Townsend, Curtis L.
From:Townsend, Curtis L.
Sent:Wednesday, March 13, 2024 10:41 AM
To:tillfamily@mac.com
Subject:9815 LONE TREE DR nitrate records
Attachments:doc24130820240206163052.pdf; Advisory-Nitrate.docx
Hello Gene,
Thanks for the call today. Attached are the most recent nitrate results for your water. Remember we took this
sample upstream of your water filter. I recommend you have your water tested downstream of the filter to ensure it
is working properly.
Nitrate concentration was reduced due to the pressure grouting
Nitrate concentration hasn’t increased since 2019
Attached is a nitrate fact sheet we issue with COSAs when nitrate concentration exceeds 10 mg/L.
Owner Name: TILL FAMILY TRUST
Site Address: 9815 LONE TREE DR Anchorage AK 99507
Parcel Number: 01506327000
Legal Description: ROCKHILL BLK 4 LT 6
https://onsite.muni.org/WebLink/DocView.aspx?id=52827&dbid=0&repo=Onsite
Here is nitrate information for this lot:
Jan 2024, MOA coordinated with the homeowner to take a water sample. Nitrate concentration was 13.8 mg/L.
results attached.
May 2019, COSA action states that nitrate sampling was done after Discovery Drilling pressure grouted the well.
Nitrates were 13.8 mg/L after the pressure grouting, SWL 34’
May 2019, a camera was run down the well to 50’ depth. No cracks or holes were present. Moisture was not
present at the pitless.
May 2019 Discovery drilling advanced probes to 33’ and grouted from 33’ to 8’
Apr 2019 The nitrate level on 4/30/2019, prior to pressure grouting, was 16.5 mg/L according to Garness
Engineering.
Dec 2006 nitrate 7.8 mg/L
Nov 2006 nitrate 10.1 mg/L
June 2003 well drilled to a depth of 203’, cased to 203’, casing perforated 50’ to 60’, wet clay found from 32’ – 58’,
another strata of wet clay was found at 150’ – 155’, another water strata was present from 195’ – 203’, SWL 28’.
Here is an example where the well log states that there are multiple water bearing strata that this well penetrates.
The casing is only perforated in one of those strata, (highest strata).
Curtis Townsend, PE
Onsite Water and Wastewater
Municipality of Anchorage
907-343-7908
. ,rr Municipality of Anchorage
Development Services Department `y 1
Building Safety Division , . ...
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
R.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: S\Y100-03919 PID Number. 015- p —
Name.
1A v -�
stem: y New ❑ Upgrade
Wastewater S pg
Address:
v -o r~,o la
ABSORPTION FIELD
Phone: Number of Bedrooms:
❑ Deep Trcli
Trench (ShanowTronch D Bed Q Mound p Other.
LEGAL DESCRIPTION
Soil Rating:
!, ,2 P ,F,
Total Depth from original grade:
r.t
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:Li
46 K. C> C_V_1
3 Fl.
_
3 Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Lergth:
0 Z_ Ft.
/�
A )L 7 D Ft.
Well: 9New Upgrade
❑
Gravel width .�
Number of lines:
Distance between lines:
Ft.
/ a FL
Classification (Private, A, B, C):
Total Depth:
Cased to:Total
absorption area:
Pipe Material:
Q Fl.
.Z FL
�)
'7 U Fly
— JD f 3
Driller. �--�
Date D Iced:
Static Water Level:
Installer. c
Sc-. �S 1
Date Installed:
Q !tfl - Q 111)
, ✓
Z FL
7ev v -eS
b3
Yield:
8
Pump Set at
O
Casing Height Above Ground:
a2
TANK
GPM
O1M1 ft.
pFL
SEPARATION DISTANCES
01keptic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
PublictPrWte
Manufacturer:
Capacity.
From
Tank
Field
Station
Tank
Sewerune
Lii 1 AcN IL
1 %JODGal.
well
✓
/
V
Material:
Number of Compartments:
Surface Water
V
✓
✓
✓
LIFT STATION
Size:
Manufacturer.
Lot Line
Gal.
Foundation
10
50
'Pump on' levet at
'Pump off level at
High water alarm at:
In.
in.
in.
Curtain Drain
N
NL.
af35E
v�L
Pump Make b Madel
Electrical Inspectio perfanned Dy
Remarks:
W BENCH MARK
Location and Description:
Assumed Elevation:
0 O L
.e0ZtM,&
ae%•9
y�4'•aas
•1
IH
Inspections performed by: L - Dates: 1°t / is /03 �. .MaNaHNMMa�
2nd 41 tl J a3 .0 �»• - a►••a+sw•N..• Q
dUdIcianad
Development Services Department Approval % T s'"
Reviewed and approved by: Date: �' s 9 �•....+a"• �. o
(acv. tvoo) pROFESSI��„�o�
1
1
1 STANDARD 5-80R" SEPTIC
/ 1500 GAL SEP) TANK
/ 2 5—WIDE TRENCHES H
FT LONG
`c
3.5 EFFECTIVE ROCK DEPTH
c
I I I
I i
I , i
I , ►
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I
SWING AES:
AC 25. FT I I
AD 35.5
BD 50
AE 55.5
5—BEDROOM BE 64 1 I
SINGLE FAM. R f AF 95
BF 101
i� BENCH MARK AG SI I I 9
BG 55.5 I
AH 93
SH 94
/ I I
I I I
CF
TO EN•SPURKLANDw I
No. CE -2225••• I
�♦ ��
25 0 25 50 75 too f25 150
\ SCALEr 1' = 50 FT.
\ BENCH MARK.•
GARAGE SLAB
ASSUMED ELEVA 100.00 FT
TOBBEN SPURKLAND P.E. LOT 6 flLOCK 4 ROMILL SID SEPTIC SYSTEM AS BUILT
203 W 15TH. AVENUE HUGH BERTMAR/NG OCT. 21, 2003
(NCH. AK. 99501
(907) 279-3916 9815 LONE TREE DRIVE SHEET: 2/3 GRID: 2438
I PERMIT #SW020398 PID # 015-063-27 RSH040620WG
6
Monitor CleanOu -N
Clean Out
z
40
Standard Trenches]
a,
5' We
40' Long Iz q
6.5' Deep Q Q Q
3.5' Sewer rock
3' Cover 1500 gal Septic tank
I Monitor Clean Du Z 200 FLOW SPLITTER
Clean Out
NO SCALE♦�,������ 111% f
40
AV
_' 49th•..':
...........................................
t� TOBB •1•SPURKLAND• ,• AV
Ar % NO. CE -2225••' ti Ar
w
IVU JL.HLG
AS BUILT BENCH MARK
CrIRACE SLAB,
ASSUMED ELEV. 100.00
TOBBEN SPURKLAND P.E. LOT 6 BLOCK 4 ROCKHILL SID SEPTIC SYSTEM SCHEMATIC
203 W15th Ave
Anchorage Ak 99501 9815 ONE TREE DRIVE DATE, OCT. 21, 2003
HUGH BERTMARIN6 SHEET, 3/3 GRID, 2438
PERMIT # SVO20398 PID # 015-063-27 ROH04063.DV6
} HEFTY DRILLING
i= 3540 AKULA DRIVE
ANCHORAGE, ALASKA 99516
(907) 345-0593,
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
MINING, LAND, WATER HYDROLOGIC SURVEY
WATER WELL LOG
Drilling Started: 4 /-i-3 /,A i _ Cmmnleterl• . -=iA I
City/Borough: Subdivision/USS:
Block
Lot
Property Owner Name &Address:
n S Oo
�1 n 66 '
IDLE6
Meridian Township _ Range Section __ ___4 %4 of _._ t/a of t/4 of ` t/a
Lat: N—*— Long: W NAD: 27 OR 83 Elevation:
BOREHOLE DATA: (from ground surface) Depth Drilling method. % Air rotary, ❑ Cable tool, Other
Material: Type, Color & wetness I From I To
Well use: ❑ Public supply,,XDomestic, 0 Other #,
YQ U s✓ t•
� .
��—.a
Depth of hole: R, Casing stickup: -s�1, ft
Casing lype:__..Sfjq e..j..-_ .. .Thickness • 04-4;- inches'
Casing diameter:- ( inches Casing depth- 0
Liner type: -- Diameter: ._. —inches .Depth: ft:-.,
-"t'C-�A 4- F'0.Vj-L
`'-"
5�
C
/
C6
Static water (from top of casing): d.�_
$ on 6..'-
Pumping level & yield:. feet after hours at . Spin
Recoveryrate: � .
�_ gpm, Method ofttrsting
Development method..
Duration: � � � ,'
W - 0-4 10. tj 4,'Ro IL%
%5U
1S S
. � ..__.
1st
14�.-
Well intake opening type:�Open end, 0 Open hole.-:;
,_.
0 Screened; Start:...- - _ .---- fi, Stopped g
o�c.nne
.9-
Screen type:..____ _. _ Slot/mesh size
Perforated;Start: ft, Stopped
Start: ft, Stopped ft
'' II
Note:
Grout type:. r, a•n.. ._ Volume — -
Depth; from ft, to ft
Pump intake depth:. _.__. ft
Pump size , hp, Brand name:
_ .... _
Was well disinfected upon completion? --'g Yes, ❑ No:
Method of disinfection: -
-,Driller comments/ disclaimers:-_--.-_��-
j_ oyaj-,d.0SOS
Well Driller Name:
Company Name: HEFTY DRIL G
Mailing Address: 3540 AKULA DRIVE
City: ANCHORAGE State: ALASKA Zip: 99516
Phone Number: 1-907-345!! 93
Drillers Signature:
State law requires that a copy of this well log txx sent it) the State of Alaska
within 45 days. faxes are acceptable. (AK statutes 38.05.020, 38.05.035,
41-08-020,46.15.020 and AK regulations 11 AAC 93.140).
DEPARTMENT OF NATURAL RESOURCES
Mining, Land & Water hydrologic Survey
550 W 7th Ave., Suite 900A
Anchorage, AK 99501-3577
Telephone (907) 269-8639 and FAX (907) 562-1384
Within the City of Anchorage, it is required that a copy of the well log be
sent to the appropriate city office within 60 days and that another copy of
the well log be sent to well/property aowner within 30 days.
Permit Number: 'n3 .
Date of Issue: —ID /�/ vv
Parcel Identification Number: b 1C
Is well located at approved permit location? 0 Yes or 0 No
Municipality of Anchorage
Mark Begich, Mayor
Building Safety Division
P.O. Box 196650 •4700 Bmgavv Strcct
Anchoragc, Alaska 99519-6650 • (907) 343.8301• Fax (907) 343.800
September 24, 2003
Hugh Bertmaring
5600 E 9801 Avenue
Anchorage, AK 99507-6612
littp://%%,%v%v.muni.org
Subject: On -Site Water and/or Wastewater Permit.
Permit Number: SW020398
Legal Description:'Rockhill 'Block 4 Lot 6
Dear Mr. Bertmaring:
An On -Site Water/Wastewater Permit, number SW020398, issued by this office for a single-family
system, will expire on October 8, 2003. This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to
this office for review, approval and documentation. This as -built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As -built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for anew permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well .
permit.
If you have any questions, please call this office at 343-7904.
Sin ly,
ko
Ja s Cross, P.E.
Manager
On -Site Water and Wastewater Program
Enc: Copy of permit
e
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW020398
Legal Description: ROCKHILL BLK 4 LT 6
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Hugh Bertmaring
Owner Address: 5600 E 98th Ave.
Anchorage , AK 99507-6612
Date Issued: Oct 08, 2002
Expiration Date: Oct 08, 2003
Parcel ID: 015-063-27
Site Address:
Lot Size: 44555 SO. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
F✓ Disposal Field Z✓ Septic Tank E] Holding Tank [] Privy Private Well F-] 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:
��l z
Date:
Date: U 0Z
Municipality of Anchorage
• ...f Development Services Department
Building Safety Division
�. On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Q
4;-,
O ;, -
�c�'Kt:�Yi�
sr-•-� z
5 • [ i r
Parcel I.D. 6/5 !'(o -"a7 Permit Number SW 020398
Property owner(s) �ty ' Day phone
Mailing address (1)
Mailing address (2) 4 Zip Code 9q2
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size L
�"SS Acre q.Ft. Number of Bedrooms b
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well '[� Water Storage ❑
Sewer Upgrade /❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi' i I
❑
Water Softening Unit 17
Swimming Pool
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 unicipal Codes.
(Signature of property owner or authorized Pgent)
tie
Permit Fees:/ % Waiver Fees:
Date of Payment: I �42I'V L Date of Payment:
Receipt Number: 1 /l Receipt Number: 1
(Rev. 12;00)
T.SP d X1.1 D P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 6 BLOCK 4 ROCKHILL S/D
HUGH BERTMARING
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
Anchorage, Alaska 99519-6650
September 30, 2002
We are submitting an application for the installation of a well and septic system for this lot. The
submittal consists of three (3) drawings showing the present improvements on the lot and the
adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and
septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system,
(sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic
system design is based on the following :
Ground Water at 11.5 ft.
Use Standard 5 -Wide Trench
Soil Rating. From Testhole 07/28/00
<1 min/in =1.2 gal per sq.ft/day
No. of Bedrooms 5
Required Area per Bedroom: 15011.2 = 125 sq.ft.
Total area required: 125 x 5 = 625 sgft
Bottom Rock At 6.5 feet
Top Rock At 3 feet
Rock Depth 3.5 feet
Reduction Factor 0.54
Minimum Trench Length 625 x.54 / 5 = 67.50 ft.
USE two trenches at 40 ft each
SYSTEM CONFIGURATION
STANDARD 5 -WIDE TRENCH
TOTAL LENGTH
80 FT
TOTAL WIDTH
5 FT
TOTAL DEPTH
6.5 FT
ROCK DEPTH
3.5 FT
COVER
3 FT
SEPTIC ANK
1500 GAL
The installation of this well and septic system will not prevent wells and septic systems from being installed on the
adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
I I
I'
1 STANDARD 5-OMROOM S£PnC
I 1500 GAL SVW TANK
/ 2 5-WME' IMCHES N
FT LONG
s
15 EFTECTNE ROCK DiEPW
/ PROA
SIAM
Well
I I
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I
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I
OF
�•,�p�................ ♦ I
4 th .•`�
...
........Z:....,
i� •=•• TO B SPU I NNE' � I
No. CE -2225
1�
TA
25 0 25 50 75 100 f25 150
\ SCALEr 1' = 50 FT.
TOBBEN SPURKLAND P.E. LOT 6PLOCK 4 ROCKELL SID SEPTIC SYSTEM DESIGN
20315TH. AVENUE HUGH BERTMAR/NG SEPT. 30, 2002
(NCH.. AK. 99501 9815 LONE TREE DRIVE SHEET 23 GRID: 2438
907 279-3916 �
PERMIT #SV020XXX PID # XX ROH040620VG
i
I 1 ►
I I I I
I' ► , 1
I STANLIARO 5-mrvA v crm - - — _ _ ► ► - - —
1500 GAL SUM TANK ►
2 5—NDE TRENCHES , ,
/ FT LONG
I 15 D7ECMT ROCK DEPTH ► I
/ I I
9
/ PROPOSED 5—BEua1W
SINGLE FAM. RESIDENCE I 1
p I 1
-A- ae
I 1
I I
CF %%%fa
.............
•
\ 0 ........... .. ............... I
T BEN PURKLAND.E
A ,
No. CE-22250
•.ti =
1
25 0 25 50 75 100 Ir2s 150
\ SCALEr I' = 50 FT.
TOBBEN SPURKLAND P.E. LOT 6�LOCK 4 ROCKELL S/D SEPTIC SYSTEM DESIGN
203 W 157H. AVENUE HUGH BERTMARING SEPT. 30, 2002
ANCH. AK. 99501 9815 LONE TREE DRIVE SHEET: 2/3 GRID: 2438
907 279-3916
PERMIT #SV020XXX PID # XX R004062.DW6
E
Clean Out
Standard Trenchest
5' Vlde
40' Long
6.5' Deep
3.5' Sewer rock
3' Cover
Clean Out
NO SCALE
CleanOu 3
0
z
a,
a,
3
�i
� A
0 0 0
1250 gal Septic tank
Clean Out- Z 200 FLOW SPLITTER
/Yu J(.NLL
ASSUMED ELEV. 100.00
TOBBEN SPURKLAND P.E. LOT 6 BLOCK 4 RBMILL S/D SEPTIC SYSTEM SCHEMATIC
203 W15th Ave 9815 LONE TREE DRIVEOT.2
C, 2002
Anchorage Ak 99501 DATE•
P7Q-'IQIA 11 HUGH BERTMARIN5 SHEETi 3/3 GRIDS 2438
PERMIT #: SV020xxx PID # xx ROH04063.DV6
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
w_ ww.ci.anchorage.ak.us
(907)343-7904
Soils Log - Percolation Test
Performed For: 14 tAL r, 4 T, e -'A -f—; Date Per
Legal Descnpton: L_ C) -(p K a -i 1Zoc L, Township, Range, Section: _
Slope
.G of 41\�A�
,N ewMsy��
A% Ila
Deptti
(Feet)
;.I Silj-
2-i "L.
2.
13-
i 'I.
3 -
r
WAS GROUND WATER
ENCOUNTERED?
Date
Gross Time
Net Time
IF YES, AT WHAT DEPTH?
Net D c�
Depth to Water After
Mon!lor!ng7
1�• +J
Date: _L�/
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net D c�
T -e rc
DC �I•/1, A
`•
-- — E - — , o• u rru co/ .'CMC, MULt DIAMETER b goTEST RUN BETWEEN 4_FT AND �FT
CU.`.'?,:ENT$
PERFORI,IED BY: j s t s
�i CERTIFY THAT THIS TEST WAS
=ERFORINAED !N ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
� 04 0 Z
MUNICIPALITY -OF ANCHORAGE
t�
Development Services Department ,� `) Phone: 907-343-7904
On -Site Water & Wastewater Section _-' Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-063-27
Legal description ROCKHILL BLK 4 LT 6
Site address 9815 LONE TREE DR
Current property owner(s) TILL FAMILY TRUST
Expiration Date:
7/29/2025
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Uvd`z�f�
Original Certificate Date: 9/18/2024
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 X
Tank Age Advisory X Arsenic Advisory _
Other
COSA Approval—June 2022
q '�
. . . . . . . . . . . . . . .
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-063-27
Complete legal description ROCKHILL BLOCK 4 LOT 6
Location (site address) 9815 LONE TREE DRIVE, ANCHORAGE, AK 99507
Current property owner(s) TILL FAMILY TRUST Day phone
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
3. TYPE OF WATER SUPPLY: E Private Well Fj Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units F-1 Community Well or Public
M Water Storage
4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic R Private Septic serving 2 dwelling units
R Holding Tank 0 Community Septic or Public Sewer
5. SEPTIC TANK: Z Steel ❑ Plastic ❑ Concrete F-1 Fiberglass
Age 21 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: E] AWWTS F-1 Bed E] Deep Trench Z Wide Trench El Seepage Pit
Waiver request for:
Expedited review requested: Fj
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 $
Date of Payment 2-, X
COSA # L5 2 -
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: ROCKHILL BLOCK 4 LOT 6 Parcel ID: 015-063-27
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 6/23/03 Total depth 203 ft
Cased to 203 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 7/30/24
Static water level at beginning of test 28 ft.
Well production at time of test 4.5 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 12.1 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 7/31/24
Comments: Well water nitrate results are less than past COSA and well was scoped at that time – see MOA
record docs. Visual observations seemed fine at inspection.
B. TANK DATA
Measured operating fluid level in septic tank 49”
Date of pumping 7/29/24
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) 9/11/03
ALL standpipes present per record drawing
Total measured depth from existing grade 11 ft (max)
Measured depth to pipe invert from grade 6.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
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) N
If yes, enter date
Adequacy test date 7/30/24
Results Pass
Fluid depth prior to test 27 in (North Trench Tested)
Water added 750 gal
New fluid depth 36 in
Elapsed time 1440 min
Final fluid depth 27 in
Absorption rate 750 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 42 in (MOA 3.5’ ED)
Effective depth used 27 in (Final Fluid Depth)
Effective depth (ED) remaining 15 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate with the north trench having 3.5’ ED. Tested north trench only – south trench had no fluid &
approximately 3.4’ ED with a raw total depth from existing grade of 10.9’ & lateral at 7.5’ from grade.
COSA Checklist.docx
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/22/24
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
8/22/24
MUNICIPALITY ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
907-343-7904
On -Site Water and Wastewater Section -ax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC241343
Subdivision: Rockhill, Block: 4, Lot: 6
A water sample revealed a nitrate concentration of 12.1 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
MUNICIPALITY -OF ANCHORAGE
DEVELOPMENT sEvics DEPARTMENT I
907-343-7904
On -Site dater and Wastewater Section 3 Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241343
Subdivision: Rockhill Block:4, Lot: 6
The septic tank for this property is 21 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
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.
Mailing Address P Box 196650 Anchorage, Alaska 99519 6650' uirww muni org
EPL9& S
f.
r3 Municipality of Anchorage cto.4,t 9v 'a
On-Site Water and Wastewater Program
(907)343-7904 SA l**
Certificate of On-Site Systems Approval
2-1Parcel I.D. 015-063-27 Expiration Date: (2---
1.
. GENERAL INFORMATION:
Complete legal description Rockhill:Block 4,Lot 6
Location (site address) 9815 Lone Tree Drive*Anchorage,AK 99507
Current Property owner(s) Sohrab Tafreshi&Rebecca Buckner Day phone 764-0524
Mailing address 9815 Lone Tree Drive*Anchorage,AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: :. TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community 0
Public Water System ❑ Public Sewer ❑
WaiverNariance request for. Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 6 50 Waiver Fee $
Date of Payment 5113//'9 Date of Payment
Receipt Number 0�"(pf dReceipt Number
COSA# (3561q/U.40 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: 51 1 3!j 9
In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system O` '
in accordance with the guidelines and regulations established by the Municipality of Anchorage and o .. '
industry practices. The reported results describe the condition of the system/s on the date/s of the <::/
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or • N.-��;c •'�•v lip
encroachments mayexist that were not identified duringthe evaluation. The operational life of all wells *1; 4*Q T .
and septic systems depend upon a variety of variables, including but not limited to, soil conditions. el
groundwater levels (that may fluctuate during the year), quality of construction (materials andVA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and ... . . a
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the •,J:. e A. Comes
system/s;therefore,GEG makes no warranty(express or implied)regarding the future performance of OA CE— • QGI
the well or septic system. GEG makes no representation whether an alternative well or septic system 9 •. / ;c 00
can be installed on the property in the event either of the current systems fail to perform adequately in � o, ••�. .i3. '/qc
the future. The content of this report is for the sole benefit of the person/party that retained GEG tor0;ess�0�o`=
perform the evaluation. Reliance upon the information provided in this report by any other person or �4Iedao�
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
System#2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stippulatiiorr;.
&aA o GUVV' vt A cA� J. 0 erpi
c Wf 11
„ F N itvxkcz - � - �✓
res �I 4 'a' rd-6A1 -+k2 Via , Pet i od 1 c ±tc4
By: l/��`%% % = Original Certificate Date: — /7
I
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
COSA Checklist
Legal Description: Rockhill; Block 4, Lot 6 Parcel ID: 015-063-27
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
t❑Well log is filed with Onsite (or attached) Well production at time of test *5 gpm
Date drilled 6/23/03 Water storage tank volume n/a gallons
Total depth 203 ft Well disinfected for coliform test? ❑Yes No
Cased to 203 ft Coliform bacteria is Negative
Q Sanitary seal is functioning correctly Nitrate *0'F mg/L ❑Nitrate less than MRL (ND)
0 Wires are properly protected Arsenic ug/L ■❑Arsenic less than MRL(ND)
Casing height(above ground) 18+ in. Collected by GEG, LTD.
Date of flow test for COSA .5/21/19 Date of Sample
Static water level at beginning of test *33.8 ft.
Comments *well flow adequacy and Nitrate sample done after well work to mitigate Nitrates.
B. TANK DATA TANK LIQUID LEVELS WERE NOT CHECKED C. LIFT STATION
Age of tank(s) 16 years ❑ Required maintenance completed
Tank type/material "°"°""' Age of lift station - years
12 Standpipes/foundation cleanout per record drawing Lift station material -
Date of pumping 4/30/19 Comments: NO LIFT STATION
CLEAN OUT AT NORTH END OF EAST
TRENCH HAS A HOLE IN ITS CAP
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2003 Adequacy test date 3/26/19
■❑ALL standpipes present per record drawing Results ['Pass For 5 bedrooms
Total measured depth from grade *11.1 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 6.25 ft(min) Water added 915 gal
0 N/A—pressurized field New depth 3 in
0 Monitor tubes go to bottom of drainfield. If not, state Elapsed time 45 min
depth into effective^3 FEET
j Code-required soil cover over field Final fluid depth 0 in
Absorption rate 750+ gpd
0 System presoaked NO
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test) N/A
Gallons introduced N/A gallons If yes, enter date
Comments/Deficiencies:'AT Mrs **IN SOUTH MT
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100'
Q✓ Yes if No ft ✓❑Yes if No ft
Neighboring Tank> 100' ['Yes if No ft Private Sewer/Septic Line >25' El Yes if No ft
Absorption Field on Lot> 100' ['Yes if No ft Holding Tank> 100' ✓Q Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment>50' ✓❑Yes if No ft
Q Yes if No ft
Manure/Animal Excreta Storage> 100'
Community Sewer Main> 75' E✓ Yes if No ft ['Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q✓ Yes if No .5+ ft Surface Water> 100' ( Yes if No ft
Property Line > 5' Q✓ Yes if No ft Driveway/Parking>0' ✓EYes if No,comment
Absorption Field > 5' ✓❑Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓Q Yes if No ft Private Wells> 100' QYes if No ft
Water Service Line > 10' Q✓ Yes if No ft Community Wells>200' Q✓ Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' Q Yes if No ft Driveway/Parking>0' Q✓ Yes if No, comment
Property Line > 10' Q✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ['Yes if No ft Private Wells> 100' ✓l Yes if No ft
Water Service Line > 10' Q✓ Yes if No ft Community Wells>200' Q Yes if No ft
Surface Water> 100' E✓ Yes if No ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL.
TESTED SOUTH TRENCH ONLY. NORTH TRENCH HAD A LIQUID DEPTH OF 1 INCH.
oa60o�.,,
G. ENGINEER'S CERTIFICATION o=c OF 14_ N
Do•` 9s�o�
I certify that I have determined through field inspections and review OO :• �— O,'
of Municipal records that the above systems are in conformance with Q . . 9 , . 0
MOA COSA guidelines in effect on this date. av ••,J- filii
kmess.=aQ E— 953 .. bO(14 ;r ••s/y� 17�Aoo
COSA Checklist yellow sheet �QO� o essio oer
#AECC884 00000 0
Jeff Garness
From: David Har <dlharper2@gmail.com>
Sent: ay, May 10, 2019 12:43 PM
To: Jeff Garness
Subject: 9815 Lone Tree
Jeff, we ran the camera from 0 to 50 feet and found no cracks or holes. The pitless did not appear to have any moisture
around it. There were no apparent flaws above 50 feet.
David Harper
Aarow Pump and Well Service LLC
Sent from my iPhone
1
MUNICIPALITY OF ANCHORAGE
•
DEVELOPMENT SERVICES DEPARTMENT • 4;2-) 907.343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # 0SC191160
Subdivision: Rockhill , Block: 4, Lot: 6
A water sample revealed a nitrate concentration of 13.8 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
Discovery Drilling Inc
Daily Drilling Report
Project No. /-./ ,--/(Z- DATE: 577G/;1 Client: /-7%,-,, -,e,..,? /'
Project Name and Location I Geologist: 4/4
La P 7" - Loot Geotech: Environmental:
Equip:Rig Type: 7/2-or
4/(/( G Carrier: Co , '5,/-7-•
4' ,.— "
/ /'e��,+!'/iia
/ Support:/07-
Hours
07-Hours Description of work root- Mobe Travel Rig Other Stand Down
Start j Stop a • to site n site work ky irn
07001 000 /14q / L / I i
/DOD I 4)(/.1.7!, p(c)bP QG
o5 ', t g
10 3 ' 4: C � f
f1 "
�(t "Q( !fit [ y
- ;
oit� I A Q�„� I K-GROUT®
L0 0
• BAROIO n One-Sack Borehole Grouting and Plugging Material
1 I I I Pr• Description QUIK-GROUT®one-sack grouting and plugging material is a sodium
bentonite-based grout designed for grouting water wells, monitoring wells,
and for plugging boreholes. QUIK-GROUT grouting and plugging material
does not contain any polymers.
Applications/Functions • Can seal or grout plastic and steel casings
• Can seal downhole instrumentation in test and observation holes
• Can plug abandoned boreholes and earthen cavities
• Not recommended for use as a cement additive
Advantages • Easy-to-use one sack grout
• Dust-free mixing
• Can be mixed and pumped using conventional rig equipment
• Rehydratable
• No heat of hydration
• Can develop a 20%active solids slurry weighing 9.4 lb/gal (1.13 glcm3)
with hydrostatic gradient of 0.489 psi/ft(11.1 kPa/meter)
• Can create a low permeability seal to prevent entry of contaminants
from the surface
• Can develop a permanent,flexible seal to prevent commingling
between aquifers
• NSF/ANSI Standard 60 certified •
Typical Properties • Appearance Beige to tan granules
• Specific gravity 2.6
• pH (8% slurry) 8.2
• Electrical Resistivity 0.98 ohm-meter
• Yield Volume 26.3 gallons per 50-lb sack
99.5 liters per 23-kg sack
• Permeability(in fresh water) 2.5 x 10"8
cm/sec
Recommended For maximum results, pre-treat make-up water with Soda Ash to less than
Treatment or equal to 100 mg/I total hardness and to a pH range of 8.5—9.5.
The recommended mixing rate is one 50-lb (23-kg) sack of QUIK-GROUT
grouting and plugging material per 24 gallons(91 liters) of fresh water to
create a 20%active solids by weight grout with a density of 9.4 lb/gal or
1.13 g/cm3.
Copyright 2011 Halabudon
.Rev.5/3101! !DP 023
QUtK-GROUTis a regrs:ered U2dematk of Hatkbmrcn
Because the conditions of use of this product are beyond the sellers control,the product is sold vnthout warranty either express cr implied and upon condition that
purchaser make as own test to de:ermine the suitability for purchaser's application. Purchaser assumes all risk of use and handling of this product.This product will be
replaced if defective in manufacture or packaging cr if damaged Except for Such replacement.seller is not liable for any damages caused by this product or its use
The statements and recommendations made herein are believed to be accurate. No guarantee of their accuracy is made however.
Recommended Mixing Do not over mix and do not use a centrifugal pump.
Procedure 1. Using a mixing device, blend one sack of QUIK-GROUTh grouting and
plugging material into 24 gallons (91 liters) of fresh water. Rate of
addition should be about 20 to 30 seconds per 50-lb(23-kg) bag.
Note:The resulting slurry should have an oatmeal consistency
containing unyielded or partially yielded bentonite.
2. Pump slurry through tremie pipe into hole without delay. Grout slurry
should be pumped through tremie pipe from bottom of interval to
surface to ensure effective displacement. Maintain submergence of
tremie pipe a minimum of 10-feet within grout column for uniform
displacement.
Additional Information • The grouting material and method selected will depend upon the
specific subsurface environment including all prevailing geological and
hydrological factors and any existing regulatory requirements. The
grouting process may not be complete until the grout is static at the
desired level.
• The use of bentonite may not be appropriate in environments where
the formation water chemistry has a total hardness greater than 500
parts per million and/or a chloride content of greater than 1500 parts
per million.
• If questions arise regarding subsurface environments it is always best
to consult your local Baroid IDP representative to determine if the
Baroid product of choice is appropriate for the given conditions.
Packaging QUIK-GROUT grouting and plugging material is packaged in 50-lb(23-kg)
multiwall paper bags, containing 0.7 ft3(0.02 m3).
Availability QUIK-GROUT grouting and plugging material can be purchased through
any Baroid Industrial Drilling Products Retailer. To locate the retailer
nearest you contact the Customer Service Department in Houston or your
area IDP Sales Representative.
Baroid Industrial Drilling Products
Product Service Line, Halliburton
3000 N. Sam Houston Pkwy E.
Houston,TX 77032
Customer Service (800) 735-6075 Toll Free (281) 871-4612
Technical Service (877) 379-7412 Toll Free (281) 871-4613
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and 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
Parcel I.D. Ors - 063 -Z7
1. GENERAL INFORMATION
COSA# CAP r)tST
Expiration Date: 3 - / %' O %
Complete legal description
l.ot 6,
G toc k yi
Rock hill S iy
Community On-site
❑
Public Sewer
Location (site address)
9aiS
l.oAs Tr.e
Drrwe
Current Propertyowner(s) H41? Cer-fff7orine Dayphone 929 -0727
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
946/S 1OA& T✓ye Drive /{n�/prpG� hk 99.Sox
Day phone
jr.41w EricksuA, Pr&c1e# ia1 Dayphone 2Y2-9282
_3bol C>n1r1-pxijA1- Do-., 4ncA,. +&c 99.re-3
Unless otherwise requested, COSA will be held by DSD for pickup. Pl eater Carl R ew /rbr @ 2 Y L - 9 ?_8z
wkn fa -r,1 �r �hc4_a.
2. NUMBER OF BEDROOMS: 5" rswdy .r,
3. 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 Onsite 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 engineers 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 Onsite 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 FW -Aon Phone 3Ys - i 3,-s—
Address- /'1530 ECHO' roman 13.,% A -7c/7 99s'�G
Engineer's Printed Name The�,dorr r. --rcv.c• Date Dec 6, 2•aOG
5. DSD SIGNATURE
ZApproved for r bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:L-7 11-rl
(Rw 1bDS1
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot-&" fj/octf Y, .Rock AU/ S/ -D _ ParcelID: 01s-067-77
A. WELL DATA
Well type Pvt If A. B, or C provide PWSID # Well Log (Y/N) Y
Date completed 6/ u/912 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 2y3 ft. Cased to 4i+3 ft. Casing height (above ground) -Se in.
FROM WELL LOG AT INSPECTION
Dale of test 6 / Z3 16 -T rr I Ze /zoos
Static water level 28 ft. 29 ft.
Well production a g.p.m. If 3s + g. P.M.
WATER SAMPLE RESULTS: See tonrwienl PA f.ec&e tr.riI
Coliform O colonies/100 mL Nitrate 7.8 mg/L Other bacteria I_colonies/100 mL
Arsenic: ppb date of sample: rr /16Io6 Collected by: Fla t,Ey I -c% S. c
�>;/8/-Por
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material See trc / Skoe / Date installed 9 /11 / 403
Tank size IS'4V gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) _Y Depression over tank (YIN) N High water alarm (YIN) Al. A
Dale of pumping 9 /1 / 06 Pumper Rile'• - !i c,obw.
C. ABSORPTION FIELD DATA
Date installed / rr /03 Soil rating (g.p.d.W or ft2/bdrm) /•2• f�1 System type s =µ' 4'JerW)AJC'c/04
Length P.o ft. Width S ft. Gravel below pipe 3.s ft.
Total depth_ ft. Eff. absorption area 7 Y ft' Monitoring tube Y Depression over field Aj
Date of adequacy test io / 20/ 2u0C Results (Pass/Fail) r'Rr _ For__bedrooms
Fluid depth in absorption field before lest 0.0 in. Water added ?6� gal. New depthp 11tTn.
Elapsed Time: 77 min. Final fluid depth win. Absorption rate >= 75-0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) None know- If yes, give date P. A.
D. LIFTSTATION ?J -A-.
Date installed
'Pump on' level at _ in.
Datum
Size in gallons
"Pump off' level at_ in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM
WELL ON LOT TO:
Septic tankAift station on lot
1 / a'
Absorption field on lot
116),
Public sewer main
N• *-
Sewer /septic service line >
2S'
Animal containment areas
P. A.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots > loo
On adjacent lots > 100,
Public sewer manhole/cleanout N- A,
Holding tank P. A
Manure/animal excrete storage areas N• A
in.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 140, Property line SS' Absorption field x zs'
Water main N• A•- Water service line > IoSurface water
Wells on adjacent lots > 0 6 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 2Z' Building foundation So' Water main N. A,
Water Service line '> to' Surface water rGo ' Driveway, parking/vehicle storage' 7=� f
Curtain drain /Ona C inn Wells on adjacent lots L'
F. COMMENTS rn,1H.1 /FF &w l,` rovmp It Ca/IcC)LVC,( 11 / 16 / o6 ani
thoWla ru. 1 M♦ /mac egvS ��. aug,ces 7Nl^. .,
1z/8/)-rwheMe LB
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.
Engineer's Printed Name TJF 0oo001-t F. /100''e—
Date 0- / 8/ 2-&O
COSA Fee $
Date of Payment 17-/ 11 I O
Receipt Number ,9 3 5
(Rev. 11/05)
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Ano,ly/'icn chcum�l 7, $(inr♦/�
A.
•'tr',•' 11 A7ar�1A
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THLODORE F. };r DRE /' F'
CE -3529 . c� C
Waiver Fee $ J
Date of Payment
Receipt Number
Municipality of Anchorage
•
Development Services Department
Building Safety Division '
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 060587
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 4, Lot 6 of
Rockhill subdivision. This inspection revealed a nitrate concentration of 7.8
milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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