HomeMy WebLinkAboutROSEBERRY HIGHLANDS LT 6 try
Highland
Lot 6
#050-315-64
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page I of,
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number:QS P/6/ / 175 PID Number: 6 SQ 3 J 5 6 r
Dwelling: Single Family(SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project:New ❑ Upgrade
Name:
0 0/�`/'7 ABSORPTION FIELD
Address
❑ Deep Trench Fs Shallow Trench ❑ Bed ❑ Mound
Po 3 ox 7 76z(/ 67. (2. ❑ Other
Phone ! Number of Bedrooms Soil Rating Total depth from original grade
2 21
y !r !� Li /, . GPD/SF %' 5 Ft.
LEGAL DESCRIPTION Depth to pipe invert from ori yalge Gravel depth beneath pipe
Subdivision,c ' �/ �/ / / Block Lot
Or 1 //�olT /13 S Fill added above original .rade Ft. Gravel length �q Ft.
Township J Range Section a 4- ("!�' -f Ft. 4'Z Ft.
Gravel widthBeds:Number of Lines Distance between lines
SEPARATION DISTANCES 5 Ft. — Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 577 Ftp / _ FL
Well /�� /��-t- 2s4 TANK Septic El S.T.E.P. D Holding 0 Other
�w ( Manufacturer ,7 �— Capacity
Surface Water /DO /QQ f — 4, / HO1 MC6 /�AJk-
Material Number of compartments/ 5 a
Lot Line /6 ,Q f r� Gal.
NA LIFT STATION N4
Foundation C/-�- /D .�
,,J Manufacturer Capacity
Curtain Drain 5d t so r Gal.
Pump on level at Pump off level at High water alarm at
Remarks tAJE'LLS DleiL4
DIVL AJ 12/2,21CA/7a04‘, in. in. in.
1/0 a Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank A Tank to -
Installer 1J 3a3y drainfield �`��{
/06 i S4106-1- Drainfield b3CCy/ CO/MT b31.11V
Inspector ,t or tt r2l � ,,�Q BENCH MARK (Assumed elevation) / ft
Inspection V J " / / Location and description �j
dates: 1 673-pc 2� Zr;��b 7—Q ? c6e-Cg
3rd 5/ p?7 4`h •
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En qolt p
OF At �1
Conditional Approval: Date
iiiZ�� ..• � '17 ;�$�40
i.:::- ..,,,,,,.., .. ..::
-'-.:^
%S sieven W. Erg f-
//[]PE7
Approved \ v Date cp -0 f 7 110p , _
tea '
Inspection Report_9-1-12.doc -
AS-BUILT MEASUREMENTS •
A B
ST1 13 22
ST2 21 14
DCO 30 17
CO 28 59
MT/CO 40 18
Lot 5
Tract 7
/15-20% Slope
Lot 4 45-28". Slope
R101
Irrigation c,,
New 1250 Ga,lon Well t
Septic Tank
1111,\ Lot s
112.640 ..t.
..% 1.*
Tract 1
Alternate I Ibt
Trench Site
T H 4 iy�.�C
/ o
1/5%
p
Well
'100 '
win
/ Altp•
5-20% Slop -
20-25% Scope
Lot 7
Tract 1
�
°F ROSEBERRY HIGHLANDS
s)
* 1 loo
NORTHRIM :yP.. .
ENGINEERING •
Po Box 770724swe LAYUUT
Engle River, Alaska 995774
� WASTEWATER RECORD
907. 694. 7028 SEPTIC SYSTEM Dote:
6/8/17 rETOf 3
f
Lot 45 - 21 ° 0 Slope
R100
0
Irrigation G,p
Well ALF
New 1250 Gallon ol,% 6
Lot
Septic Tank �`Ly� 112, s.f.
6
15% 11110
'1144411111111ilik 1111111111
Tract 1
I 1 'i
Alternate 1 1 s'''' o siTrench Site • .�TH4 9 9
9/1/16
No Groundwater
O
0,\ , • Well
0
�L`, ' 100
--7,,_ /
S '''th'0p
Lot 7 20-25% Slope / o
/ 15-20% Slope
e A — :1 ' U' M N S
E A B
ST1 13 22
ST2 21 14
Z DCO 30 17
CO 28 5'
MT/CO • 0 8 Tract 1
�..wM��
. ��°�.' `'` R❑SEBERRY HIGHLANDS 1' = 50'
NORTHRIM *~a9m ,,, RECORD
ENGINEERING LOT 6 1
Po Box 770724 .a. . t I L A Y❑U T
Eagle River, Alaska 99577 6 { r7s WASTEWATER RECORD
dav S
907. 694. 7028 `/ SEPTIC SYSTEM 6/14/17 r2ccE, of 3
Foundation Cleanout Elevation @ 94'
/ Tank Cleanouts Elevation @ 89'
Fin ^amide Opposing Cleanouts Between Septic Tank & Trench
!Elevation @ 88.5' ,..L.'� i a-To Mid-Point of' Trench
1250 Gallon Steel
levation @ 89' 'Anchorage Tank' Elevation @ 88.3'
Solid Pipe
Monitor Tube
Elevation @ 86'-92' l'lnai , CO-ope Slope
Original Elev @ 81.5'-87' 0I I____
FilterFabric .�IIII __30
Elevation @ 80' ��Witil
� �
4,5 IF:�.
Effective Depth 3, X• ipiYA �>
Elevation @ 77' _ =I O=e=/=it
TH Elevation @ 67,5' —S'0 J
4.4.,iF�**,
NORTHRIMA
• �,._ Vit, TRENCH END VIEW R❑ SEBERRY HIGHLANDS
ENGINEERING 9m� ���. ''
Po Box 770724 ji SEPTIC TANK PRDEILE LET 6
Eagle River, Alaska 99577 a
1.907.694.7028 � �1� SEPTIC SYSTEM RECORD "6: /8/17 BY: SE r°": 1• = s ' :3 of 3
6/8/17 I SE
Certified Drilling Log
DOC CO dba
BILL & COLE
l'► ULLIVAN WATER WELLS
41.PO. Box 670269,Chugiak,AK 99567 688-2759
OWNER OF LAND: Michael Quinn Bore Hole Data
ADDRESS: PO BOX 772641 Eagle River, AK 99577 Depth
LEGAL DESCRIPTION Roseberry Highlands Lot 6 From To
DATE: January 2017 0 2 Casing Stickup
PERMIT NUMBER: 0SP161195 DATE OF ISSUE: 8-22-16
TAX IDENTIFICATION NUMBER 05031564000 2 4 Overburden
Is well located at approved permit location: fYes No 4 12 Silty Sand& Gravel w/Cobbles
Method of Drilling: ®air rotary ❑cable tool 12 220 Bedrock Gray
Depth of Well: 400' 220 312 Bedrock Green
Casing Type: Steel Wall thickness .250 inches 312 345 Bedrock Gray w/Quartz
Diameter: 6 inches, depth 44 feet
Liner type 345 400 Bedrock Gray
Static Water Level: 10 feet
Recovery Rate 1 gpm I f gph
Method of Testing Air
Well Intake Opening Type: ri open end ®open hole --
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 lbs
Depth:from 2 feet, to 42 feet
Well Disinfected Upon Completion: ®yes ❑no
Method of Disinfection: Chlorine 50 PPM
Comments:
WATER Q ITY TESTING
Conform I e 9 CoI/100mL
-Nitrates 3 mg/L
Arsenic P uglL
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
DOC CO dba
�ULLIVAN.,« a COLE
WATER WELLS
'� ► P.O. Box 670269,Chugiak,AK 99567 688-2758
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number:
Legal Description Property Owner Name &Address
Roseberry Highlands Lot 6 Michael Quinn PO BOX 772641 Eagle River, AK 99577
Pump Installation Date: 5-22-17
Pump Intake Depth Below Top of Well Casing: 404 feet
Pump manufacturer's Name: Goulds
Pump Model: 75810411C
Pump Size: 1 hp
Pitless Adapter Burial Depth: N/A feet
Pitless Adapter Installer: N/A
Disinfected Upon Completion? ® yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer:N/A
Pump Installers Name: Sullivan Water Wells
Attention:The pump installer shall provide a pump installation log to the D50 within 30 days of pump installation.
Certified Drilling Log 11
DOC CO dbe
hiUU°AiJ
WATER WELLS
ler P.O.Box 670269,Chugiak,AK 99567 666-2759
OWNER OF LAND: Michael Quinn Bore Hole Data
ADDRESS: PO BOX 772641 Eagle River,AK 99577 Depth
LEGAL DESCRIPTION Roseberry Highlands Lot 6 From To
DATE: 10-6-16 0 2 Casing Stickup
PERMIT NUMBER: DATE OF ISSUE:
TAX IDENTIFICATION NUMBER 2 4 Overburden
Is well located at approved permit location:Ekes ❑Na 4 15 Silty Sand &Gravel w/Cobbles
Method of Drilling: ®air rotary ❑cable tool 15 20 Soft Bedrock
Depth of Well: 420' 20 194 Bedrock Gray
Casing Type: Steel wall thickness 2S0 inches 194 329 Bedrock Gray Hard
Diameter: 6 inches, depth 44 feet
Liner type 329 344 Bedrock Gray
Static Water Level: 60 feet 344 362 Bedrock Green Hard
Recovery Rate 1 n gpm ® gph 362 420 Bedrock Gray
Method of Testing Air
Well Intake Opening Type:❑open end ®open hole
❑ Screened Start feet Stopped
ri Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 lbs
Depth:from 2 feet,to 42 feet
Well Disinfected Upon Completion: Zyes LI no
Method of Disinfection: Chlorine 50 PPM
Comments:
WATER Il rItSitl -
Colikwm Wolf wOrnni
-Nit=tee . t o L
Arsenic- ug&
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough:Department of Environmental Conservation.
00C co dna
iiie
!CbLL1fIAN WATER WELLS
P.O.Box 670269,Chu9iak,AK 99567 688-2759
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number:SW 05P161195 Date of Issue 8-22-16
Parcel Identification Number: 05031564000
Legal Description Property Owner Name&Address
Roseberry Highlands Lot 6 Michael Quinn PO BOX 772641 Eagle River,AK 99577
Pump Installation Date: 5-18-17
Pump Intake Depth Below Top of Well Casing: 390 feet
Pump manufacturer's Name: Goulds
Pump Model: 5SB10411C
Pump Size: 1 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Installer: Sanders &Sanders
Disinfected Upon Completion? ® yes ❑ no
i
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer:Martinson
Pump Installers Name: Sullivan Water Wells
Attention:The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
I •
1
Lot 5 .. N
•
I
I
1 ,� Tract 7
/ a 65
/ —
Lot 4 /
\\ / / / OO 0, 5
N. '' AIL
N. ....,1I f ��►� G�
\ ISWELL
.O I o
\ ,...
moi wo
b
0
ck U,
\
-04y / Lot 6
\ 9 112,640 s.f.
, ♦
-$ - tel. :
Tract 1 o -�� -- --_ \
a ______ ot
h
\ Y .
119.5'
N 0557'34E $''$�• SEPC ';Icl
.13.23' .f PIPES 'N
N tiL:
\\ �N � Fo,15
I I
N
\ N 85 37'58"E .1-0.i,�� 71.9-:
` ECSERpp1U WELLJLot 2A
\-- - 102.20 ` PROS
Nar '4' 442` /
sy0pRy 1�
/
41V
S5 f
oLihtil —
5
Lot 7 ..
c-..o I
o
Tract 1
HOUSE DETAIL
/ SCALE: r=30'
/
/ 24 x
/ N
/ T
cP I q1)\
my
- '0 •
17
Z�
4.0' @
1O
CD
.9
23' 2).o
PLOT PLAN AS BUILT X SCALE 1' = 60' GRID NW 0155 Project No. 16-281/B5
11500 Daryl Avenue, Anchorage, Alaska 99515-3049 3e3. ry
Lang & Associates, nc . (907) 522-6476 Phone ..a,‘,
(907) 522-4625 Fax d �`�
Professional Land Surveyors kenOlangsurvey.com v` �F.AC `<<
Y jonathanOlangsurvey.com ,b,f ....
. ''•'9s
I hereby certify that I hove surveyed the following described property: P .• 49TH / :17
LOT 6, ROSEBERRY HIGHLANDS (PLAT 2014-58) $,
Anchorage Recording District, Alaska. and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto. that - / '
no improvements on the property lying adjacent thereto encroach on the surveyed -•
KENN G. :
premises and that there ore no roadways. transmission lines or other visible a0,\,. s�L(c`t
trj
easements on said properly except as Indicated hereon.
.••.LS-5202.•'' cP
Dated this the 6". Day of fie`'( , ?C , at Anchorage, Alaska o�
It Is the responsibility of the owner to determine the existence of any easements. \"\'''.-
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
On-Site Water & Wastewater System Permit
OSP161195
05031564000
WellSeptic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
Tax Code Number:
Work Type:
Permit Effective Dates: August 22, 2016 to
Design Engineer: NORTH RIM ENGINEERING
Subdivision: ROSEBERRY HIGHLANDS
Site Legal Address: ROSEBERRY HIGHLANDS LT
Owner/Address: QUINN MICHAEL
Initial
August 22, 2017
6 G:0155
PO BOX 772641 EAGLE RIVER AK 995772641
Site Mailing Address:
Lot Size in Sq Ft: 112640
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
1. The entire field and alternate is not within a 30' radius of a percolation test. An addition test is
to be done prior to construction. Submit results with the Inspection Report.
2. The trench is to be installed parallel to the contours.
ate:
Date:
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION V JUL
Gretchen Stuller
Parcel I.D. ~ 5~_,,,) "~ ! 5 - ~'
Propertyowner(s~ ./~//~ ~',. ~ O/,,t/',,~' Dayphone ,Z~-~ ~'-¢-~ ~'~'
Mailing address rd &~.,~'7 '72 ~'.~,/
Site address /DI"~ v'~ ,~.
Lega descr pt on (Sub d., Block & Lot) ~O.5~_~e/~ /7~,~(~=.~,~' .
Legal description (Township, Range & Section)
Lot Size //2., ~./-/~Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN:
(~;~] all that apply)
Absorption Field ~ Initial
Septic Tank Upgrade []
Holding Tank ' [] Renewal []
Privy []
Private Well
Water Storage
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D).
Multiple Dwellings (SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner o~,,e~thorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
oql OD
Waiver Fees:
Date of Paymenb
Receipt Number:
Waiver No.
Permit App_9-1-12.doc
MEMO
Steve Eng, PE, PH
P.O. Box 770724, Eagle River AK 99577
(907) 694-7028
SteveEngPE~gmail.com
Date: 7/12/16
To: MOA On-Site Services
Subject: Roseberry Highlands Lot 6
Septic System & Well PermitDesign
Number of Pages:
This is a new subdivision. Most of the neighbor lots are undeveloped. A new conventional septic
system & shallow trench is being utilized. Private water wells serve the area lots- a well permit is
requested for the well site.
Please review the wastewater system design for the single family home. I have included design
plans & specs, design guidelines, & soil tests. If there is need for additional information or
clarification please give me a call.
Thanks-Steva~
[xL'RT IM
~ E,~?EERING Roseberry Highlands Lot 6
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is a new 4-bedroom, single family home. This is a new
subdivision and most of the neighboring lots are not developed. These lots are large and are
served by private water wells. No adverse impacts are expected from development. No
conflicts to the other lots will take place by this septic system construction. A previous
subdivision soil test revealed sandy soil with low silt. The test hole from the subdivision
did not cover the entire area for the trench; a perk test will be completed prior to
construction. An application rate of 1.2 GPD/FT2 with 0.5 reduction factor for utilizing a 5'
wide trench. Trench Length = 500 FT2/5'x .58 reduction factor = 58'; 1 line ~ 58'. No
bedrock was encountered. Groundwater separation was maintained.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
· Two compartment, 1250 gallon septic tm~k. Watertight couplings on inlet & outlet.
· 5' minimum between the tank and bed. 10' to property lines.
· 3' of cover or insulation is required for trench; an equivalent of 1" insulation for 1' soil
cover may be used. 2" Minimum thickness for insulation.
· Tm~k & solid pipe must be set on well compacted, stable soil.
· 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tm~k and the absorption field, not more than
10' from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
· All cleanouts must extend to at least ground level.
· In solid pipe rinds, ASTM D-3034 may be used in lieu of cast iron.
· Trench to be placed level, minLmum of 4' to groundwater, 6' to bedrock from
drain-rock.
· Drain rock to be ½ inch to 2 ½ inch screened. Drain rock to be distributed uniformly
throughout the trench.
· Perforated pipe to be installed level with perforations down.
· Silt barrier (filter fabric) to be installed above the drain rock.
· Smeared trench sides must be raked or scarified before drain rock placement.
· The finish grade must be mounded to promote drainage away from trench.
· Insulation must be placed over any pipe installed under driveways or parking areas.
· Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
· Sewer Service Line is minimmn 2% slope.
· Septic Tank to be pumped every two y_e~0~..or when required.
· Insulation board to be extruded d~*t~}~m~p0'Iystyrene (Dow Styrofoam HI/equal)
is 4.5'.
2% slope.
DESIGN NOTES:
1. Total Depth of Trench
Terrain Slopes Southwest.
2. Sewer Service Line minimum
3. Privof. e Wot. er Wells.
4. Check Well/Septic Seporation
Prior To Construction.
5~ Ploce Trench Porellel To Contours.
6. Additional Perk Test
Prior To Construction.
Undevetop6
/15-20Y. SR~pe
)% S(ope
°PeNew 1250 G(lton
}t;ic T(xnP
15-207, tope
l/
Undeveloped
Undeve[o
,ope
~[tern~te
Trenc/~e
UndeveLoped
N OR THRIM
ENGINEERING
.~0 BOX 770724
~ogle River, AIo~ko
907. 694. 7028
RBSEDERRY HIGHLANDS
LBT 6
WASTEWATER DESIGN
SEPTIC SYSTEH
1' = 100'
PLAN
LAYFIUT
8/18/16 o¢ 3
0
C
0 [/
01.1
h
~- 0
C
u
c
0
0
0 []
+~ ~
0 (3)
SOILS LDG - PERCDLATI~N TEST
Dale PerCmrmeoh 8/15/07
Per¢ormecl For~ Lee Coy
DEPTH
(FEET)
14
15 -
~7 -
18 .-
Description: Raseloemry HtghtamcIs Lot; 6
(Previously Roseloerry Ridge Hightonds
l]rgo, nlc
See Loco. i;tom Mc~p
SM
Silty Sc~nol
W/ Gravel
Low Silt
Cobbles
Lot 6)
Slope ne6r 25%
Groundwcter? Yes
Depth 15'
Wcter Depth
i
AF~cer Monitor'ing.,~ Dote, 10/15/07
Do~ce Gross Time Net Time Depth Ne~ Drop
8/I5 0 -- 4, --
8115 10 -- 4 ....
8/15 ~0 10 mir' 8' 4'
8/15 20 -- 4, -__
8/15 30 lO
Percotation Rate 8.5 min,/Inch Pert Hole Run Between 4' ond 5'
Pe,,"{:ormed By~9, I ~ CERTIFY THAT THIS TEST WAS
I%,r'formed in Accordonce with Att St(~l;e/Municipot Guidelines in EPCect
DN THIS DATE. DAfD 8/15/07
tWOR THf~iM'"~ ' *~"'"'~"~'~ TESTHBLE LDG
~, :~gu~'~ ", · T, H, 4
ENOtNEERtNS ..........
.o~.,,0,~, I '~2: GEBTECHNICAL
Lo~ 5 ~
8/15/07 )¢ 5
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
OSC261145
Parcel ID 050 -315-64 Expiration Date:
Legal description ROSEBERRY HIGHLANDS LT 6
Site address 19567 MOUNT MAGNIFICENT CIR
Current propertyowner(s) RAGSDALE HALEY ANNE &
X The On-site system(s) is/are approved for 4 bedrooms
By:
5/7/2027
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date:
5/22/2026
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,
bevelopment 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 Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other
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 Application
1. GENERAL INFORMATION
Parcel I.D. 050-315-64
Complete legal description ROSEBERRY HIGHLANDS LOT 6
Location (site address)
19567 MOUNT MAGNIFICENT CIRCLE EAGLE RIVER, AK 99577
Current property owner(s) RAGSDALE HALEY ANNE & CALV� Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well serving # 1 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: ■❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 9 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench M 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 $ V Waiver Fee $
Date of Payment 2 "`' Date of Payment
COSA # Waiver #
COSA Application_Apr2025.doc
COSA Checklist.docx
COSA Checklist
Legal Description: ROSEBERRY HIGHLANDS LOT 6 Parcel ID: 050-315-64
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 JANUARY 2017 Total depth 400 ft
Cased to 44 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 5/7/26
Static water level at beginning of test 8 ft.
Well production at time of test 1.5 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 6.07 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 5/7/26
Comments: 2 wells on lot w/ one as an irrigation-agricultural well w/ spigot at top of casing.
B. TANK DATA
Measured operating fluid level in septic tank 49"
Date of pumping 5/8/2026
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA
Which system tested (date installed) 5/24/2017
ALL standpipes present per record drawing
Total measured depth from grade 16.1 ft (max)
Measured depth to pipe invert from grade 6.2 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 5/7/2026
Results Pass
Fluid depth prior to test 6 in
Water added 600 gal
New fluid depth 9 in
Elapsed time 1440 min
Final fluid depth 6 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 36 in (MOA 3’ ED)
Effective depth (ED) used 6 in (Final Fluid Depth)
Effective depth remaining 30 in
Comments/Deficiencies: Approximate total measured depths from existing grade.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No *5+ ft
Field to Foundation > 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/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
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
*Met code at time of installation.
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 05/15/2026
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 &
05/15/26
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC261145
Subdivision: Roseberry Highlands, Block: , Lot: 6
A water sample revealed a nitrate concentration of 6.07 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.
IMailing Address: P. 0. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org I
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P. O. Bax 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
�� Municipality of Anchorage •
On-Site Water and Wastewater Program
-t1 j, / (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-315-64 Expiration Date: q'^ f 1 7
1. GENERAL INFORMATION
Complete legal description Roseberry Highlands Lot 6
Location (site address) Mt Magnificent,Eagle River,AK
Current Property owner(s) Quinn Day phone 229-4966
Mailing address same
Real Estate Agent Quinn Day phone 229-4966
,,
2. TYPE OF DWELLING: ti � �-
® Single Family (w/wo ADU) i
❑ Duplex '
❑ Multiple Dwellings (Single Family and/or Duplex) .1fl -
c`4r Q! 6 Lg/art
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: _ Date: .4/is//7
COSA to be released to the engineer,unless otherwise equested by the engineer.
COSA Fee $ 6cf.30 Date:
Date of Payment to /61 I R Date of Payment
Receipt Number 0002 5G 3-6 Receipt Number
COSA# (J C7/ .2.9t3 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 64$r',A(1.7,��
SOF4 4t
6. DSD SIGNATURE
System #1 Approved for bedrooms. 4101.
( • .;c►
F` Steven Vv.. •ng
System #2 Approved for bedrooms. fie s`•. P 6256
a
41
Disapproved. 4 9�o p ��'!
Conditional approval for bedrooms, with the following stipulations:
ON-SITF 1�.
WATER AND r•
vv, STEWATER
PROGRAM
70 rC_
By: h,.., �^, -� Original Certificate Date: �� — 1 7
The Municipality of Anchorage Devlopment 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9.1.12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate .,f Or Site Systems Approval Checklist
Legal Description: _?OJE3 Ry hife/M-64J LOT £ Parcel ID: 052JS/564,/
A. WELL DATA
Well type T If A, B, or C provide PWSID# Well Log (YIN) y
Date completed 37401/7 Sanitary seal (YIN) / Wires properly protected (Y/N)
Total depthyaO ft. Cased to `74-/ ft. Casing height (above ground) Z in.
FROM WELL LOG AT INSPECTION
Date of test. _ / 7
Static water level to ft. ft.
Well production / g.p.m. g.p.m,
WATER SAMPLE RESULTS:
Coliform d colonies/100 mL Nitrate A/L mg/L
Arsenic //b ug/L Date of sample: 5/25/1 7 Collected by: NZ,
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Si°T/C�7S7 L Date installed_ cf',2.S7//‘
Tank size /Z5°gal. Number of Compartments 2_ Cleanouts (YIN)
Foundation cleanout (YIN) y Depression over tank (Y/N) A/ High water alarm (Y/N) I
Date of pumping /tE14.) Pumper
C. ABSORPTION FIELD DATA
Sffl>i�t.ac,J
Date installed S/2 6.1/ Soil rating (g.p.d./ft2 or ft2/bdrm) / . System type 71z c./f
Length ft. Width 5 ft. Gravel below pipe ? ft.
Total depth dONft. Eff. absorption area SI 7 ft2 Monitoring tube / Depression over field N
Date of adequacy test /1.7 (.J Results (Pass/Fail) For 1"{ bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >- g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION Am
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot /670 f On adjacent lots /GG t
Absorption field on lot l DG f On adjacent lots /Q G rt
Public sewer main /04 "'r Public sewer manhole/cleanout . /6D
Sewer/septic service line 2'� Holding tank (C) "1-
Animal
Animal containment areas 50 Manure/animal excrete storage areas /oa, (7-
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 t Property line / O (:14 Absorption field '1"--
Water main r/& 1` Water service line / rt Surface water /cm '7,-
Wells on adjacent lots /7o '
ABSORPTION FIELD ON LOT TO:
Property line l0 'f- Building foundation /C '7- Water main /4 f
Water Service line /G t Surface water /OG t Driveway, parking/vehicle storage /id f
Curtain drain
50 'f Wells on adjacent lots /QG (14-
F.
F. COMMENTS
• L.ow Pg o-1 cuc/ (19770,0 1 G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections andCSF a
review of Municipal records that the above systems are in •°"
conformance with MOA COSA guidelines in effect on this date. Ai'3s4k:A=` u
Engineer's Printed Name
Date 7t7i 7 '
'/8/!?
:z.
COSA yellow sheet_2-6-15.doc