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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