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