HomeMy WebLinkAboutBERNARD BLK 3 LT 12lock Lot 12 060- 321 -34 ~~~ '_~ Municipality of Anchorage ' Development Services Department : JSr.,~ ~'~ Building Safety Division~, On-Site Water and W~ter Program, 4700 Elmore Road ~ P.O, Box 1~6~ ~chorage, AK 99507 Page of ~,ci, anchomge.ak.~ (907) 343-7904 ON-SITE WASTEWA~R DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: sw060287 PID Number: Name: JESSIE HALL Wastewater System: ~ New ~ Upgrafle Adding; PO BOX 770336 EAGLE RIVER, AK ABSORPTION FIELD 3 ~pTm~ch ~Shal~wTmn~ ~B~d ~Mo~d ~h~: LEGAL DESCRIPTION ~2 ~ 14 B~:3 Lot: 12 Suba~n; ~NA~ 3.5~P8~ le p~e ~om from o(~inel g~e: FI~ 0,SG~Vo~ dep~B ~nealh pl~: FL T~ship: Ra~e: S~n: ~1t a~ed a~e original g~e: Grovel L~gth: Well: ~ New ~ Upgrade 15 ~. 3 14`5 EXISTING PRIVATE Ft, FL 570 Ft= ASTM 30~/~F810 Ft. JESSIE HALL 6/1W2009 ~"~l .................. ~"1 , q' ,,, TANK SEPA~TION DISTANCES D Septic D Holding D S.T,E.P, D ~her: ~F .... --- SePtic A~o;~ion Lift HOIhing ~ubli~/Pdv~e Men~a~rer: ............. ..... Tank Field Station Tank Se~r Li~ ANCHO~G~ TANK 1 ~00 w~ 100'+ 100'+ .... 25'+ HDPE 2 s..~w.,~ ~0o'+ ~'+ LIFT sTATION ~t Line 5*+ 1 ~+ N/A Gal, EXISTING WELL DISCONNECTED FROM BERNARD WATER BENCH MARK L~t~n and ~dpt~m .............. SYSTEM AND CONVER~D TO A SINGLE FAMILY WELL. BO~OM OF SIDING AT POINT A 100 $&$ Engineering ............. [';~;~ Ins~ions peffo~ed by: 1~1 S, 6i[chw~ ~. ~Dates: 1~ 10/23~009 ~¢ ~F~ D ~ = ~ ev~opment 8e~ces ~e~ment A~roval Conditional Approval Date: PERMIT NO. SW060287 PAGE 2 OF 3 DEPARTMENT OF HEALTH AND HuIvrAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B, Box 196650 ®Anchorage, A~aska 99519-6650 ·Telephone,, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEN AND/OR WELL INSPECTION REPOR' LEGAL, LOT 12, BLOCK 3, BERNARD S/D P.I.D. NO. 060--321--34 ~w,ooo ~ ~ \ A GAL SEPT C- ' ~ .... TING ~_ALT. SITE__. F. CO//~' ZANK %HOUsE~DRM ~"?~ L __ __~2 ~ ..,, :' L'."b. ;:.'; i:'" ~ ;~" · SCALE' 1" = 4~' NEW ENG[~TAMP GRAVITY - ~~..../.] ,.:~ HILAND ROAD ~LATTED) / PERMIT NO. SW060287 PAGE 3 OF 3 ~dunici.~Li~c¥ o~' AnchoPaee DEPARTP1ENT OF HEALTH AND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION P,B~ Sox 196650 ·AnchoPe9e, a~asl<a 99519-6650· Tekephone'~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 12, BLOCK 3, BERNARD S/D P.I.D. NO. 060--321--34 ST1 ST,~//GRADE -- 99.0' FINAL GRADE ///-2" INSULATION .................................. : :"~'" TOP OF TANK = 95.2' NEW 1000 INLET = 94.5'/ GALLON = 94.,5 SEPTIC TANK / GRADE A B FCO 5.0' ST1 16.2 59.5' ST2 22.5' 42.6' DBL1 24.0' 4,.3.2' DBL2 27.0' 44.9' C06 51.7' 61.7' C01 15.7' 49.9' C02 18.5' 54.5' C05 20.8' 57.6' C04 44.4' 64.2' C05 46.1' 70.2' MT1 21.6' 58.1' MT2 45.7' 65.6' FINAL CO5 ,~ C01 C06 - 98.9 ~CO_4MT1 C02 MT2 C05 .................... II..11 .... 2" II~.~.{JLATION .... II ..... GRADE = 97.5' C04 = 94.0 · WATER FOUND AT 82.0' 81.5' B.O.H. ~,/tT1 = 95.5' ff MT2 = 95.5'~ CO5 = 94.0'[ C05 = 94.0'[~ C06 = 94.0'/ NOTE: EXISTING WELL DISCONNECTED FROM BERNARD WATER SYST AND CONVERTED TO A SINGLE FAMILY WELL. N. T. S. ENGIi~ iMP :3 ASBUIL_T SEWARD & ASSOCIATES LAND SUR\/EyI:~(] 694-082' HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:z/ FOLLOWING DESCRIBED PROPERTY: ~' O~ A~ E~EMENTS, COVENANTS, OR RE¢;TRICTIONS WHICH DO NOT ~PEAR ON THE RE~D~ ~BDI VISION PLAT. UNDER NO C RCUMSTANCES S~ Date. ROBERT C. COWAN, P.E. ROBERTA. SHAFER, RE. CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 Munl~pallt~ o~ Anchorage L~nd U~ O~ie~ At.n= Oan 3500 E. Tudo~ Anchorage, AK 99507 Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP ', SUITE 204 * EAGLE R1VER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Development Services Department On. Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Aug 31, 2006 Expiration Date: Aug 31, 2007 Permit Number: SW060287 Legal Description: BERNARD BLK 3 LT 12 Design Engineer: 0003 S & S Engineering Owner Name: JESSIE HALL Owner Address: PO BOX 770336 EAGLE RIVER, AK 99577- Parcel ID: 060-321-34 Site Address: Lot Size: 48372 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By:. 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 (9O7) 343-79O4 ON-SITE SEPTIC/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. /~/_/)~) ,.., ,.~ I-2 L~ Propertyowner(s) /.~-~;¢Stt ll Mailing address D~30-')OY'~;;)~'~ ~¢~,.~'~¢~: '~f'~''' Zip Code Site address ~ ~7 H~t~ ~ Z~p Cod~ Legal description (Township, Section & Range) Lot Size ~ ~ Sq. Ft. Number of Bedrooms ~ THIS APPLICATION IS FOR ([~all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Day phone " 50-2 qqYT"/ THIS APPLICATION IS AN: Initial Upgrade Renewal I cedify that the above information is correct. I further certify that this application is beir Single Family Dwelling and is in accordance with applicable Municipal Codes. " ' ' ' "' 17034 E~gle River Loop Road No. 2C)4 (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) o~q~vs- Waiver Fees: Date of Payment: Receipt Number: made for a August 11, 2006 ROBERT C. COWAN. P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-12~ 1 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 12, Block 3, Bernard Subdivision It is requested that you issue a permit to install a new septic system to serve the proposed three bedroom dwelling on the referenced property. A test hole was excavated and a pemol.ation test performed. The approximate Jocation of the test hole is located on the attached s~te plan. At the time of excavation 7/14/06, ground water was found at 14 feet. After momtonng, ground water was found at 15.5 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic sysiem. The construction of this system will not prevent any future development on any of the adjacent properties. Ifyou require additional information, please contact us. Sincerely, Robert 12. Cowan, P.E. RCCrojj Enclosure 17034 NORTH EAGLE RIVER LOOP · SUffE 204 · EAGLE RIVER. ALASKA 99577 / 1" = 40' DESIGN SITE-PLAN If'~¢-...,. ,~ · '__" =o I / / ~_ __,, L.u. ~ L -- ~o ~ ,~//' I~ .~~// " I >~ ~ I ~ ii~ /f / /~uo I ' ' ~ ~ . ~ ~ "~  ,,Xo, - I ~ i ~ , ~oo WELL RAmUS I J I Pedo;med For: Legal Description: Municipality of Anchorage Development Services Department Building SafeTy Division On-Sile WaTer and Waslewaler P~ogram 4700 South Bragaw P.O. Box 195650 Anchorage. Al( 99519-6650 ww~v cl.anchoracle ek.u$ (907) 343-7904 Soils Log .?',, / '~ .7 'ZT.... ..... - Percolation Test -,x~;--- ~ /,. ~Tt~ T~shlp, Range, Section: · 's lope Sile Plan I / / / / / / / / ,! 8- 9- 10- 12- 13- WAS GROUND WATER ENCOUNTERED? IF YES. AT WIIAT DEPTI,, .o.,to.,.0. Reading Dale Dross Time Nel Time Oe~th To Waler [i Net Drop I 18- 19- 20- COMMENTS PERCOLATION RATE ~.~ (.*~*~.d~) PERC tlOLE DIAMETER .mnq ROBERT C. COWAN, P.E. CN1L ENGINEERS (907) 694-2979 FAX (907) 694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 12, Block 3, Bernard Subdivision August 1 I, 2006 GENERAL: SEPTIC TANK INSTALLATION: 1. The scope of this project includes the installation ofa ne~v 1000 gallon HDPE septic tank a septic trench to serve the proposed three bedroon~ residence located on the referenced property. Construction shall be in accordance with the approved site plan hnd design drawings, Municipal pcnmt vath any special provisions or cond~tions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be esponsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department or ADEC if re~tuired, for system installations. Owners installing their own systems must ~lso receive prior approval from the respective agency. A septic tank is to be constructed by a certified septic tank m. nufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling o~: shifting of the tardy. 17034 NORTH EAGLE RIVER LOOP" SUITE 204 * EAGLE RNER. ALASKA 99577 Page 2 Lot t2, Block 3, Bernard 8ubdlvlslon August t¶~ 2006 All standpipes on the septic tank shall extend a minimum of 12 inches above fl~ fl grade. Septic tanks installed with less than ,1 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building fou dation. In the line between the tank and the leachfield there shall be two adjacent cleant~uts (unless an effluent pumping system exists within the septic tank). These cleanouls shall be located on undisturbed soil not more than 10 ft. from the tank. The first clean6ut, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean*toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavatibn become smeared, they must be raked or scratched (ruffed-up) before gravel (s~wer rock) placement. J Once the gravel is installed, the distribution pipe is to be installed lev I with the perforations faced downward. Gravel is then to be placed over the distribution pipe to p/~o,,~ a~i~immuTbO~f~li~ ~ict~ o~r~ilPiP~el layer and the native s!il backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The porlion of the momtormg tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a' depression after settling. Page 3 Lot12, Biock 3, Bernard Subdivision August11,2006 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type ofpipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (DowI Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fined with watertight couplings (Caulde~ equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must between the final leachfield gravel layer and the native soil backfill. Al1 leachfield gravel (sewer rock) shall be 0.5"-2.$" screened gravel with 1¢ passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must current M.O.A. or D.E.C. requirements, which ever requirement applies. Fcmco, or be installed than :onform to Page 4 Lot12, Biock 3, Bernard Subdlvl=lon August11,2006 INSPECTIONS: Typically there will be a minimum of three (3) inspections r~quired during the install. Iion of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, its, trenches, or beds and before the installation of any gravel. A septic tank ma ! be set in place, but may not be backfllled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before 'the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the in., aIlation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecti ~g engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinaie, direct or control in any way the contractors activities. The owner shal! contract with the contractor to perform the work outlined in these specifications and plans and m accordance with the attached M O A. permit There will be no !contractual arrangement cxmting between the contractor and S & S Engmeenng. S & S Engmecn. ng shall be the owners representative and will inspect the work as stated above to document the',contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. [. fth S & S Engineering shall have no liability to the owner or to others for acts or omismons o e contractor or any other persons performing work on this project or the failure of the cbntractor to carry out the work in accordance with these construction documents. S & S Efiginecring's inspecting engineer will not be responsible for the construction means, methods, :echniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / IlqSTAT ~ ~nchomge, AK 99501 DEPT. OF ENVIRONMENTAL CONSERVATION / eHO : {907) 269-7624 [ FAX: {907) 269-7650 .................. / hnp://www.slate.ak.u~dc~ome.htm DIVISION OF E IRONMENTAL HEALIH / DRIVING WATER PROG M Yoshi Nix S&S Engineering 17034 N. Eagle River Loop Road, Ste. 204 Eagle River, AK 99577 Subject: July 31,2006 Stewart Water System; PWSID# 212754; Stewart Subdivision, Block 3, Lot 12 Drinking Water Well Dear Mr. Nix, This letter s regard ng a well located at Stewart Subdivision Block 3, Lot 12. The well is currently connected to the Stewart Water System, a Class A public water system owned and operated by Mr. Bernard Stewart. During recent telephone conversations you explained to me plans to d sconnect the well at Stewart Subdivision Block 3, Lot 12 from the public water system so it only serves the single fanlily home on Block 3, Lot 12. The ADEC drinking water program has no objections to disconnecting this well from the public water system. Once the well has been physically disconnected from the Stewart Water System it will be considered a private well and will not be regulated by ADEC. All disconn&ted pipes must be capped and welded. Please provide written notification to ADEC once the well has b~en physically disconnected from the Stewart Water System and provide photo documentation of the prbject and modifications. Sincerely, Environmental Program Specialist II:~stcv, an B3, LI2 private well.doc 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 www. muni.org/onsite (907) 343-7904 ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET To: $&$ Enqineerinq Legal description: Bemm-d, Block 3, Lot 12 The attached paperwork has been reviewed and Is being returned for the following reasons: Original signature or stamp missing on Calculation error in design. Additional soils information needed. Water monitoring results inadequate. [] Discrepancy in information submitted. [] Topographic information missing or inadequate. The site plan shall have a descrl tion of the topography, areas of excessive slope, and extent of slopes and surface drainm f~ patterns within 100 feet of any I~rt of the system or portion of the lot intended for use fo~ on-site wastewater disposal, AMC 15,65,030 D, Please provide this information on the site plan, Incomplete; missing Incomplete; missing Additional adequacy test information needed. Water sample unacceptable. Measured/proposed distances/dimensions missing. Locations of all soils, percolation and water monitoring tests not shown. Proposed system too deep for soils Information submitted. Well log required. [~] Omission in narrative. Insufficient fill over tank or field. [] Other. Provide verification as to the classification of the existinq well, Name of reviewer: Deb Wockenfuss Date: 8/22/06 P£R~ilT NO. $W010003 PACE. 2 or 3 Munlcip. (~lit oF An_ch.qc~.q.e , DEPARTHENT OF HE~.~FH AND HUFIAN SERVICES ENVIRONHENTAL SERVICES DIVISION P/3. Box 196650 e._Anchopoge. Al~$k~ 99519-6650 · Teteohone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 13, BLOCK 3, BERNARD_S/D P.LD. ~0. 060-321--35 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251185 Parcel ID 060-321-34 Legal description BERNARD BLK 3 LT 12 site address 18699 STONEHILL DR Expiration Date: 51 // 4 CZ (�. Current property owner(s) SNELL JACOB X The On -site system(s) is/are approved for — _ bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: 30 This system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 submittal. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other MUNICIPALITY 0 F ANCHORAGE 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. 060-321-34 Complete legal description Bernard Block 3 Lot 12 Location (site address) 18699 Stonehill Dr. Eagle River Current property owner(s) Jacob Snell Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well serving #__I_ dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: Al Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 16 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS F* Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ K 0 Waiver Fee $ Date of Payment D. 1201 Z� Date of Payment COSA # 05C 2// t( Waiver # COSA Application_Apr2025.doc COSA Checklist Legal Description: Bernard Block 3 Lot 12 Parcel ID: 060-321-34 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA J❑ Well log is filed with Onsite (or attached) Date drilled 10/30/1969Total depth 84 ft Cased to 69 ft ✓❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 20+ in. Date of flow test for COSA 3/7/24 Static water level at beginning of test 53 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 3/18124 * Required maintenance completed, if AWWTS Comments: *Property vacant since pumping date. D. ABSORPTION FIELD DATA Which system tested (date installed) 6/17/2009 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 5.75 ft (max) Measured depth to pipe invert from grade 5.25 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. -1 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci Well production at time of test 5.3 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes Z Nc ✓❑ Coliform bacteria is Negative Nitrate 2.07 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L © Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 5/1/25 STATION ❑ Require` A nR tenance completed Age of lift station rs Lift station material Comments: Adequacy test date Results Q Pass Fluid depth prior to test 3/7/24 0 in Water added 450 gal New fluid depth 0 in Elapsed time 1 min Final fluid depth 0 in Absorption rate 450+ and FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in COSA Checklist —June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' P] Yes if No ft P] Yes if No ft Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' W Yes if No ft Holding Tank > 100' F.7 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ✓❑ Yes it No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' n Yes if No ft Q 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 Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' © Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No It Private Wells > 100' © Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10' ❑✓ 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 Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date III- ` 9 - Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. +� "�"�� # It I'll ## The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The,` ��ll- 11��'�1## now and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year, ! and the water usage of the family being served by the system. The operational life of all well and septic i systems are subject to these various and dynamic characteristics and are outside the control of the evaluatorM of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist r� KENUET}i JUFFt1S CE / I l a COSA Checklist June 2022 1k 11Ik,1 R��►'►s Certificate of On -Site Systems Approval Parcel I.D. 060-321-34-000 Expiration Date: 3/7/2025 Legal description BERNARD BLK 3 LT 12 Site address 18699 STONEHILL DR Eagle River AK 99577 Current property owner(s) HALL JESSIE H JR XThe On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 3/29/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 060-321-34 Complete legal description Bernard Block 3 Lot 12 Location (site address) _18699 Stonehill Dr. Eagle River Current property owner(s) Jessie Hall Day phone 2. ON -SITE SYSTEMS SIZED FOR - BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age is - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS J❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ .j 0 Waiver Fee $ Date of Payment Z b Z Date of Payment COSA # U C_ `y j U C Waiver # COSA Application_June 2022 COSA Checklist Legal Description: Bernard Block 3 Lot 12 Parcel ID: 060-321-34 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA J❑ Well log is filed with Onsite (or attached) Date drilled 10/30/1969Total depth 84 ft Cased to 69 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 20+ in. Date of flow test for COSA 3/7/24 Static water level at beginning of test 53 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 3/18/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/17/2009 0 ALL standpipes present per record drawing Total measured depth from grade 5.75 ft (max) Measured depth to pipe invert from grade 5.25 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. V Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficie COSA Checklist June 2022 Well production at time of test 5.3 Qpm Water storage tank volumed gallons Well disinfected for coliform test? ❑ Yes ✓❑ Nc 0 Coliform bacteria is Negative Nitrate 2- S mg/L 0 Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 3/7/24 e,LIFT STATION ❑ Require �nb Age of lift station . Lift station material Comments; ce completed Adequacy test date 3/7/24 Results ✓❑ Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 0 in Elapsed time 1 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Received Date/Time 03/08/2024 12:14 03/07/2024 12:56Collected Date/Time 1240921001 Matrix SGS Ref.# Client Sample ID Bernard Blk 3 Lot 12 Client Name Project Name/# Printed Date/Time 03/18/2024 16:10ArcTerra Consulting Inc Technical Director Stephen C. Ede Bernard Blk 3 Lot 12 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS HGS03/15/24EP200.8ug/LArsenic 03/14/24ND5.00 (<10)B Waters Department EBH03/14/24SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 2.55 0.200 (<10) C Microbiology Laboratory PHK03/08/24SM21 9223B100mLE. Coli Negative 1 A PHK03/08/24SM21 9223B100mLTotal Coliform Negative 1 A 2 of 5 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' Community Sewer Manhole/Cleanout > 100' n Yes if No ft W Yes if No Neighboring Tank > 100' R Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' W Yes if No ft Holding Tank > 100' 21 Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' n Yes if No ✓Q Yes if No ft _ Community Sewer Main > 75' Yes if No ft Manure/Animal Excreta Storage > 100' Q Yes if No ❑ N/A - Served by Community Well (not on lot) or Public Water ft ft ft ft ft From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No ft Surface Water > 100' J❑ Yes if No ft Tank to Property Line > 5' ✓❑ Yes Field to Property Line > 10' ❑J Yes Water Main > 10' 0 Yes Water Service Line > 10' ❑✓ Yes F. ENGINEER'S COMMENTS if No ft Wells on Adjacent Lots: if No ft Private Wells > 100' if No ft Community Wells > 200' © Yes if No ft ✓❑ Yes if No It if No ft If tank or field is under driveway comment below 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 Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date---'y Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, Arc Terra can not give any estimate of how long a system will function satisfactory for current or future occupants or can AreTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist -June 2022