HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 7 LT 12 Municipality of Anchorage "" Development Services Department " ~r'~' Bu[Iding Safety Division On-Site Water a~ Wast~ter Pr~am. 4700 S. Bragaw SL P.O. Box ~50 ~omge.~ 99519-6650 Page ~ of~ ~.d.an~omge.ak.us (90~ ~3-7904 o..sn~ w~s~w~. ~s.os~L S~S~M ~.~/O. WELL I.S.EC~O. PermitNumbe~ ~~ PIDNumbe~ ~G--~ ~0. ~37~7D E~[~ ~;ve/,~f ~q~77 ABSORPTION FIELD LEGAL DESCRIPTION ~"~ I,~ ~w,~,~'=~'~: ~,,. Well: ~New D Upgrad~ ~ ~,. I ~,. SEPARATION DISTANCES D Sept~ D Ho~ina D S.T.E,P. D OtheK ~ Septic Abso,tlon Lift H°~ing Pub~ate ~ ~ ;~la+;' c~ Tank F~ld Station Tank ~r~ ~ ~ .~,:~ ~ ~ ~e. ~ ~ ~;~ ~ENCH M~K En~[gtamp S & S ENGINEERING D~velopme~t Se~ices Department Approval Reviewed and approved by: } ~ ~ Date: C/Z~/g~ PERMIT NO 5W990220 PACE 2 OF IVlunicip. o[it oF' .A.n c h.o.r.o. 9.e' DEPARTMENT OF HE~_THAND HUMAN SERVICES ENVIRONHENTAL SERVICES DIVISION P.D. Box 196650 IAnchorage, Alaska 99519-66500Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 12, BLOCK 7, RIVERVIEW ESTATES P.I.D. No. 050-791-12 P£RMIT NO. SW990220 PAGE 3 OF 3 Municip. o[i~c oF A n_c h.o..r'.q 9.e' DEPARTMENT OF HE~_THAND HUHAN SERVICES ENVIRONMENTAL SERVICES DIVISION p.n. Box 196650 oAncho~'~ge, Al~sk~ 99519-6650 0 Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 12, BLOCK 7, RIVERVlEW ESTATES P.I.D. NO. 050--791--12 82.6' FINAL GRADE r.- 86.4' NEW 1300 GAL. ~ POLY. TANK'~ 82.4' CO1 C02 MT1 MT2 CO1 = 85.2' n _- MT = 77.3'-/ ~-MT2 = 77.3' · ~¥ATER FOUND 71.3' B.O.H. A B FCO 25.5' 15.0' ST1 27.0' 15.5' ST2 $1.0' 16.0' DBL1 $3.5' 17.0' DBL2 .~4.5' 18.0' C01 45.0' 25.0' MT1 48.0' 25.5' C02 84.0' 54.0' MT2 78.5' 48.5' PERFORMED FOR: LEGAL DESCRIPTION: :2 3- 6~ 9~ I1 13- 14 15 16- 17- 18' 19- 20. Munictpatily ol. Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~[~,~-z~Ld/~3~e. wnship. Range. Section: SLOPE WAS GROUND WATER J DEPTII? A pO E Ilepth Io Waler After ,.,. Moniloi'lng? Dale: SITE PLAN Gross Net Deplh to Net Reading Date Time Time Water D¢op PERCOLATION RAIE '~' '~''' (m~nutes;~ncht PERC HOLE DIAMETER TEST RUN ELETWEEN X./ FiAND ,_~" Fi COMMENIS · · verL Road No. 204 T,,,aDA,E. DA,E:' trey. t 86/14/2002 1~:e6 6944988 PAGE 02/02 LOCA~ON OF WELL LOCATION/SKETCH: DEPTHS MEASURED FROM:[~eas;ng top Dgrou~d surface BORE'HOLE DATA: Depth Material Type and Color From To ,U¢ ,/ Date/ I OWNER: STATE OF ALASKA,. I~EPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD C I,-,. WELL DEPTH: Depth of hole: Depth of cos;nD: DATE OF COMPLETION ft DEPTH TO STATIC WATEI~'LEVEL: it below ~ top of casTng METHOD OF DRILL~G[ , ~.a;r rotary I-I cable tool E]'e~e, ,' ' USE OF WELt" ~.do?.asfic D ;rr;gatlon ri rm~to~ I~ publ;¢ supply~] other ' CASING STICK.UP: '*~ f~. Diam: ~:~ hl. tO Casing type: °~'f~ · to WELL INTAKE OPENIN~ TYPE: ~open end* p '~creened [] perforated D open hole ' ''~ Depths of open;ngs: SCRE~ TYPE: $1oUMesh Size:., GRAVEL PACK TYPE: Volume used: GROUT TYPE:., Depth: from to., ft Diam: : ih. Length:__ TT Depth to top: ' 'Volume: :::'. DEVELO~ METHOD: Duration: I PUMPING LEVEL AND YIELD: It after Jt PUMP INTAKE DEPTH: ft Horsepower. · WELL DISINFECTED UPON COMPLETION? ,{~YES i-I NO REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNRIDMSION OF MINING & WATER MGMT 3601 C SI. ~lte 800 ANCHORAGE AK 99503-593S Phone I907)269-a639,Fex (9071E62-1384 MUNICIPAUT'/ OF ANCHORA GE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage. AK 99519-6650 (907) 343.4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial ( 'J ~LL.ut~' ~ '~'~5 Date Issued: Jul 27, 1999 Expiration Date: Jul 26, 2000 Permit Number:. SW990220 Legal Description: RIVER VIEW ESTATES BLK 7 LT 12 Design Engineer:. 0003 S & S Engineering Owner Name: Charles Luper Owner Address: PO Box 772972 Parcel ID: 050-791-12"~ Site Address: Lot Size: 40000 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River, AK 99577- 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. Ail requirements specified iq Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Ddnking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 ( 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. ~?. T~'-~;'f~llOWlng special provisions.":':', hAT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADOITIONAL PERCOLATION/8OILS '* TEST IN THE PROPOSED TESTHOLE ~2 LOCATION Received By: Issued By: 7 - Date: Date: 7- 2 7~ ?? ROBERT C. COWAN, P.E. July 20, 1999 CML ENGINEERS (907) 694-2979 FAX (907) 694-12tl 8nE FLANS 804LTES! IVIUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 12, Block 7, Riverview Estates Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom dwelling on the referenced property. One test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. A second test hole will be excavated and a percolation test performed at the time of installation to insure proper drainage at the west end of the proposed trench and alternate site. At the time of excavation, 6-15-99 water was not found. After seven days of ground water monitoring, water was found at 11 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 system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/bj~ Enclosure 17034 NORTH EAGLE RIVER LOOP a SUITE 204 * EAGLE RIVER, ,,U.A~ KA 99577 DRAINFIELD CRITERIA: 5.0' DEEP ADD 2' M.O.A. APPROVED SAND 0.5' EFFECTIVE (R=I.O) 5.0' WIDE 90' LONG LOT :~ LOT 12, BLOCK 7, B.J.J.[ R.C.C. DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 1.0 GPD/SO.FT. 600/1.0 = 600 SO.FT. REO'D. 11 RIVERVIEW 7-8-99 ~N D.~VE L D P~E NT FLOW SPL] DOUBLE INSTALL PROPOSED VELL ESTATES S/D CONTRACTOR IS R£OUmED TO OBTAIN UTiLiTY LOCATES PRIOR TO ANY EXCAVATION WORK. LOT 13 PROPOSED GALLON SEPTIC TANK ----[0' UTILITY EASEMENT -- RIVER- PARk __ lO__' U.__IILIT__Y EASEMENT RD~,D DRIVE  ~ LOT 12, BLOCK 7, RIVERVIEI¥ ESTATES S/D B.,J.J.[ R.C.C.I 7-8-99I 2 OF ~rin~DESIGN CRITERIA: ~o.,..~.o~ ,~ .~o~,.~o .o ~/,,~,~ ~-'~ ' OBTAIN UTILITY LOC~TES 4 BDRM = 600 GPD ~mo~ TO *~v ~xc*v*no~ SOILS = 1.0 GPD/SQ.FT. WORK. ~oo/,.o: ~oo sO.~T. ~0'~. DRAINFIELD CRITERIA: 5.0' DEEP ADD 2' M.O.A. APPROVED SAND ~.~ 5.0' WIDE ~' a:/~ ~ PRDPDSED L C ~1250 GALLDN DE _ SCALE: N.T.<;. LOT 1 2, DR&~VN B.J.J. BLOCK 7, I c<c~ .,= R.C.C. RIVERVIEW ESTATES I **~c= 7-8-99 TRENCH PROFILE S/D I~"T: 3 OF 3 MT CO 4" DISTRIBUTION PIPE PERt. ])OWN (T~P.) INSULATION IF NECESSARY FILTER FABRIC 2'~M.O.A. APPROVED SAND -- SEWER ROCK 6" SEWER ROCK BELOW DIST. PIPE DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~650 SOILS LOG -- PERCO~TION TEST LEGAL DESCRIPTION: ~ ~ Township. Range, Section: SLOPE SITE PLAN 6- 7" 8- 9- 10- 11 WA, GROUNDWATER ENCOUNTERED? Fo.J//' ,P,,. AT W.AT DEPTH? 13- 14- 15- Gross Net De~th to Net Reading Date Time Time Water Drop 16- 17- 18- 19- 20- COMMENTS 17034 Eag/e River Loop Road Ne~ Elgle River, Aladca 99577 I // PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~ 72-008 (Re~. 4/85) .~'"'"'"'"'~"~ C ER TI F Y THAT TH~,~ TES~ WAS PERFORMED IN THiS DATE. DATE: ? /~*/ 4~-~ ~ ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 12, Block 7, Riverview Estates Subdivision June 17, 1999 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench for the proposed four bedroom house located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, 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 responsible for final grading areas subsequently depressed fi.om soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Depa~nent. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page 2 Lot 12, Block 7, Riverview Estates Subdivision June 17, 1999 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet fi.om the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, 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 fi.om the septic tank. ABSORPTION TRENCIUDRAINFIELD 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 excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Grovel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil 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 portion of the monitoring tube extending through the gravel shall be perforated from the bottom ofthe trench to the invert ofthe 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 Lotl2, Block 7, RiverviewEstates Subdivision June 17, 1999 MINIMUM MATERIAL SPECIFICATIONS: 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: Typ_e &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 of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastcwater disposal system. These inspections will occur as follows: Page 4 Lot 12, Block 7, Riverview Estates Subdivision June 17, 1999 The first inspection must be conducted afier the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 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 installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting 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 coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's 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. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineefing's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE o -.c Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-791-12-000 Expiration Date: 1/26/2024 Legal description RIVER VIEWESTATES BLK 7 LT 12 Site address 21337 RIVER PARK DR Eagle River AK 99577 Current property owner(s) OKONIEWSKI JOHN BELFORD X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: go Original Certificate Date: 10/26/2023 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 ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE 0.4 fop -E 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. 050-791-12 Complete legal description RIVER VIEW ESTATES BLOCK 7, LOT 12 Location (site address) 21337 RIVER PARK DRIVE, EAGLE RIVER AK 99577 Current property owner(s) JOHN BELORD OKONIESKI Day phone 2. ON-SITE SYSTEMS SIZED FOR 3BEDROOMS 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 24 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ 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 $ g- S--0 Waiver Fee $ Date of Payment I V / 2 / ZJ 2 3 Date of Payment COSA # D S c- 2 3 1 3 q-7- Waiver # COSA Application.doc Legal Description: RIVER VIEW ESTATES BLOCK 7 LOT 12 Parcel ID: 050-791-12 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 10/6/1999 Total depth 110 ft Cased to 80 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/09/2023 Static water level at beginning of test 33 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 42" Date of pumping 9/21/2023 ❑ Required maintenance completed, if AWWTS Comments: PREMIER PLASTIC 1000 -GAL TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 10/1/1999 ® ALL standpipes present per record drawing Total measured depth from grade 8.4 ft (max) Measured depth to pipe invert fromrq ade 4 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 Well production at time of test 4.7 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Fes„ Date 10/09/2023 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/09/2023 Results E Pass Fluid depth prior to test 20 in Water added 450 gal New fluid depth 29 in Elapsed time 1380 min Final fluid depth 20 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in (MOA 4' ED) Effective depth used 20 in (Final Fluid Depth) Effective depth (ED) remaining 28 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & ED appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft _ ®Yes if No ❑ 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 *6 ft Surface Water >100' _ ®Yes if No Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ® Yes if No ft ® Yes if No ft Yes if No ft ® Yes if No ft Wells on Adjacent Lots: ft ft ft ft ft ft Private Wells > 100' ® Yes if No ft Community Wells > 200' ® Yes if No If tank or field is under driveway comment below *Septic tank to foundation installed per existing code at installation ft 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 Finn FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN PE Date 10/25/2023 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 h 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 ;:Fm• • • • ' • • . • 4�%.- 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 satisfactoryfor current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & Fks • • • • • • • • • • • • • �urtis Huffman ! �'c'cj•. CE 128991 •�ti `�� •' • 10/25123 COSA Checklist.docx 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 050-791-12 parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description River View Estates, Block 7, Lot 12 Location (site address) 21337 River Park Dr., Eagle River, Ak Current property owner(s) Carolyn Forner & Chad Farrell pay phone 814-571-8092 Mailing address Same .. i Real estate agent FSBO Day.phone 2. TYPE OF DWELLING: :..::.- ...... ;. 0 .. Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. .NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Fx� Private Septic (] Water Storage: ❑ Holding Tank El. Community Well ❑ community El Public Water System ❑ Public Sewer Waiver request for. Distance: . Received by: Date: coSA.to.be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1566 Waiver Fee $ Date of Payment.al a2� 1 �J Date of Payment Receipt Number �) �o�l ��� Receipt Number COSA # Waiver 6. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Crewdson Engineering LLC - - Name of Firm Phone'907-280-9493 4Q3 ._ 07 Address PO Box 671389, Chugiak, AK 99567 . Engineer's Printed Name James Crewdson Date 2/27/2020 VXI i 6. DSD SIGNATURE % .. System #1 Approved for bedrooms •..� , ;rewd9on S stern #2 Approved for bedrooms �%,••. 011527 Disapproved'\PROFESS\�'� :. Conditional approval for bedrooms, with the' -following stipulat ons' n�0". .. ;.. Original Certificate Date: $y-- The Municipality of Anchorage Development Services Division (D D) 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 Chealist blue sheet COSA Checklist Legal Description: River View Estates, Block 7, Lot 12 Parcel ID: 050-791-12 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/6/99 Total depth 110 ft Cased to 80 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 21 25120 Static water level at beginning of test 22 ft. Comments B. TANK DATA Age of tank(s) 20.3 years Tank type/material Septic tank/plastic Measured operating fluid level in septic tank K ❑ Standpipes/foundation cleanout per record drawing Date of pumping 7/29/2019 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/1/99 ❑ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field AN Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test). Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 3.5 gpm. Water storage tank volume0 gallons, Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than; MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Crewdson Engineering Date of Sample 2/25120 C. LIFT STATION ❑ Required maintenance. completed Age of lift station years Lift station material Comments: 'one toilet flush initiated flow to the drainfield Adequacy test date 2/25/20 Results Pass For3 bedrooms Fluid depth prior to test 23 in Water added 450+ gal New depth 27 in Elapsed time 30 min Final fluid depth 23 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) No If yes, enter date From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 6* ft Surface Water > 100' ® Yes E. SEPARATION DISTANCES ft Property Line > 5' ❑✓ Yes if No From Private Well on Lot to: (Please enter distances if less than required or if community well) Wells on Adjacent Lots: Septic Tank/Lift Station on Lot > 100' Absorption Field > 5'[]✓ Community Sewer Manhole/Cleanout > 100' Yes 17.1 Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ✓M Yes if No ft Holding Tank > 100' ❑✓ Yes if :'No ft Neighboring'Absotption Fields > 100' ft If septic tank is under driveway comment below Animal Containment>150 _ ,.... From Absorption Field on Lotto: (Please enter distances if less than required) Lj✓ Yes if No ft Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Manure/Animal Excreta Storage > 100' Property Line > 10' Community Sewer Main > 75' 71 Yes if No ft 0 Yes if'No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 6* ft Surface Water > 100' ® Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'[]✓ Yes if No ft Private Wells > 100' Yes If No Water .Main > 10' []✓ Yes if No ft Community Wells > 200' 0 Yes AfNo if Water Service Line > 10' Q✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lotto: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100'. Yes if, No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' M Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS In accordance with Inspection Report approved on 6/24/2002 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this data COSA Checklist yellow sheet OFA4 ll' .......rlt J F. 9son t \ pR�FESStfl���.` AL C��i�'`� Parcel I.D. 050-791-12 1. GENERAL INFORMATION Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 (907) 343-7904 FOR A SINGLE FAM'LY DWELLING Expiration Date: c~. ~ fo -~ 2... Complete legaldescription RIVER WE'W ESTATES SUBDMSION; LOT 12, BLOCK 7 Location (site address or directions) 21337 RIVER PARK DRIVE * EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CHUCK LUPER 21337 RIVER PARK DRIVE Day phone 696-5060 * EAGLE RIVER, AK 99577 Day phone BROOK ST1LTNER w/ REMAX PROPER~ES Dayphone 694-4200 16600 CENTER,ELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well E~ Individual Water Storage Community Class Well F"l Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) I~sues Certificates of Health Authority Approval (HA, A) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued fcr a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pdor to closing for the engineering services provided. 4. STATEMENT dE INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigatlo.rlr based on procedures outlined in the Health Authority Approval Guidelines for this application, shows th'at the 6n-site water supply and/or wastewater disposal system is(are) safe, functional and adequate forth~ numbe? of bedrooms and type of structure indicated herein. I further vedfy that based on the informat~(~n obtained from the Municipality of Anchorage files and from my investigation and inspection, the · onJsite 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone. Address 6901 DEB~RR ROAD, SUITE 2B ' ANCHORAGE, AK 99504 Engineer's Printed Name JEI-I-I<EY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thoreugh, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desctfbed the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate dudng the year, and the water usage of the family being served by the system· These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future perfonwance of the system, nor do they guarantee that there are no hidden defects or encroachments. A WWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authortzed, nor will it confer any legal ~fght whatsoever. 5. DSD SIGNATURE ~ Approved for '~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: % ..' Attachments: HAA Checklist Septic System Advisor/ Well Flow Advisor/ ManJtenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Sewices Department Bulkltng Safety Division On-Sits Water & Wastewatsr Program 4700 South Bmgaw ~. P.O. Box 196650 Anchorage. AK 99519-6650 www.cLanclx~age.ak.us (~07) S43-~g04 Legal Description: A. WELL DATA Co HEALTH AUTHORITY APPROVAL CHECKLIST RIVER VIEW EST. S/D; LOT 12, BLOCK 7 Parcel ID: 050-791-12 Well type PReVAT~ If A, B, or C provide PWSIDft N/A Well Log (Y/N) YES Date completed 10/7/99 Sanitary seal (Y/N) YES Wtms properly protected (Y/N) YES Total depth 110 f. Cased to 80 ft. Casing height (above ground) 24.+ in. FROM WELL LOG AT INSPECTION Date of test 10/7/99 5/23/2002 Static water level 16 .ft. ,32 .ft. Well production 5 g,p.m. 6.5 g·p.m. Nitrate 0.2 mg.lL. Other bacteria 0 .colonies/100 mi. Date of sample: 5/23/2002 Collected by: AKWWC, INC. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Material PLASTIC Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 5/23,/2002 Pumper, ABSORPTION FIELD DATA Date installed 10/1/1999 Soil mtiog ~ ft=/'odrm) 1.2 Length ,38 ft. Width 5 .ft. Date ins~lled 10/1999 Cleanouts (Y/N) YES High wateralarm(Y/N) N/^ CHUGACH PUMPING Total depth S.7 .ft. Eft. absorption ama .380 ff~ Monitoring tube YES Date of adequacy test 5/23/2002 Results (Pass/Fail) PASS Fluid dep~ in absorption field before test 4 in. Water added 1.369 gal. ElepsedTime: 15 min. Final fluid depth 5.5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) System type TRENCH Gravel below pipe 4 ft. Depression over field. NO For 3 bedrooms New depth 7 in. 450+ g.p.d. NONE KNOWN If yes, give date - O. UFT STATION Date installed Size in gallons "Pump on" level at in. "Pump~.JJ~ Da..~ _.~"'~CC~es tested E. SEPARATION OISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tiff station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line. 25'+ 100'+ High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100' + Public sewer manholelcieanout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation §'+ property line. §'+ Absorption field Water main N/A Water sewice line 10'+ Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main Water service line 10' + Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 100'+ Driveway, parking/vehicie storage 10'+ , F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal recorcls that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Pri?ed Nf~me JEFFREY A, GARNESS Date ~]2'~/~)'~' ~/' '~'~ Waiver Fee $ Date of Payment Receipt Number. N $9°58'50'E 160.00' $3O-pIP£$ (TYF) o DATE 13 ~ NO~: E provided budding I connectic r ~ J ~semen~ oppear ~ / 0 ~ RI~RVEI RIVER PARK DRIVE / , .... P~T ' 79-5 .~tK CT&E EnvtronmentaIServiceslnc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrh Ordered By PWS1D Sample Remind: 1022954001 aa~ Wa[ct & Wastewater Consulunt~ Inc. LI2, B7 River View Est Outside I-lose Bib Drinking Water ,All Dates/Times are Alaski Standard Time Printed Date/Time 05/28/2002 15:18 Collected Date/Time 05/23/2002 I$;00 Received Date/Time 05/24/2002 13:30 Technical Dtr~~ Released By Allowable Pr~p Ansi) sis Paramete~ R~sut~ PQL Units Melbo~ Limits Date Date Init Namers Department Nitrate.N 0.200 U 0.200 mg/L EPA 300.0 (<10) 05/24/02 JDT MlLcrobioloilty Laboratory Total Coliform 0 co]/lOOmL SMI8 9222B 05/24~2 ICAP