HomeMy WebLinkAboutNETTLETON ACRES #1 LT 4 Onsite File
Nettleton
Acres # 1
Lot 4
#015 - 062 - 65
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181044 PID Number: 015-062-65
Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: [' New [' Upgrade
Name: ABSORPTION FIELD
Matthew B. Bonney
Address 0 Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
7349 Feather Place Anchorage AK 99507 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 0.45 GPD/SF 7.4 / 8.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.4 / 2.0 Ft. 6.0 Ft.
Nettleton Acres #1 4 Fill added above original grade Gravel length
Township Range Section 4.2 / 2.1 Ft. 57 / 56 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 3.0 Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 1356 Ft2 2 >12 Ft.
Well >100' >100' N/A N/A >25' TANK I I Septic ❑S.T.E.P. ❑ Holding ❑Other
Manufacturer Capacity
Surface Water >100' >100' N/A N/A Greer Tank 1250 Gal.
Material Number of compartments
Lot Line >5' >10' N/A N/A • Steel 2
NA
Foundation >10' >10' N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain None Noted Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034Tank to D3034
Installer drainfield
Glacier Masonry Drainfield D3034 CO/MT D3034
Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft
Inspection 151 5/04/18nd 5/05/18 Location and description
dates: 2
3rd 4th Top of foundation at point B.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date „ ; .61,.1,
i*'49TH i\ •*9
I, .• % Benja•' chiller . j
00�<0•. CE 12592 •<<`�/
�JJ '., 4/25/19 .;'C
Ai,. .—
Approved Date�`-`l 7 Itlit PROFESSI= ...—
Inspection Report_9-1-12.doc
NETTLETON ACRES #1 LOT 4
PERMIT # OSP181044 PID # 015-062-65
-// ALTERNATE SITE:CAT III SYSTEM W/25'
/• // LONG x 3'WIDE x 6'EFFECTIVE DEPTH
/// jai' II
2x 56'LONG x 3'WIDE,6'EFFECTIVE DEPTH
rS- - - , / // ABSORPTION TRENCHES
.�/ 1250-GAL-SEPTIC TANK
// CO3 C01 N
/ 21MT2 N
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�'<P q t' SLOPES>=25% SV2 13.5 27.4 CO-CLEANOUT
�/*.49 TH %\ , SLOPES>=46% 2C0 12.8 29.8 2C0-DOUBLE CLEANOUT
4 FS 12.5 31.7 FCO FOUNDATION CLEANOUT
/ CO1 25.3 39.6
C01 21.5 38.9 FS FLOW SPLITTER VALVE
Benja in Schiller / 0 50 100 MT-MONITORING TUBE
rf I''•• . cA 2.2Ot9 = = = NM FEET CO2 28.3 34.6
MT2 34.6 57.2 SV-SEPTIC VENT
i,48.��i 4'2. 10••.4.'_..:r CO3 34.4 56.8 TH-TEST HOLE
\ 1 1 -50 C04 40.4 52.1 PT-PERC TEST
NETTLETON ACRES #1 L4
PERMIT # OSP181044 PID # 015-062-65
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Certified Drilling Log
DOC CO dba
IILLLÜf!AEN
WATER WELLS
le—. P.O. Box 670269,Chugiak,AK 99567 688-2759
OWNER OF LAND: Jamie Dittrich Bore Hole Data
ADDRESS: 9210 Nettleton Drive Depth
LEGAL DESCRIPTION Nettleton Acres#1 Lot 4 From To
DATE: 9-4-18 0 2 Casing Stickup
PERMIT NUMBER: OSP181044 DATE OF ISSUE: 4-16-18 2 4 Overburden
TAX IDENTIFICATION NUMBER 01506265000
Is well located at approved permit location: Yes No 4 18 Silty Sand &Gravel
Method of Drilling: air rotary cable tool 18 41 Silt& Sand
Depth of Well: 125' 41 69 Silty Sand &Gravel
Casing Type: Steel Wall thickness .250 inches 69 104 Sandy Gravel
Diameter: 6 inches, depth 124 feet
Liner type 104 108 Tight Sand & Gravel
Static Water Level: 108 feet 108 125 Sand &Gravel
Recovery Rate 8 gpm gph
Method of Testing Air
Well Intake Opening Type: 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 QUALITY TESTING 1
Co lto m Nec coo 00mL
Nitrates_ �� mg/L
Arsenic N P ugh.
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
miojULLIVAN WATER WELLS
P.O. Box 670269,Chugiak,AK 99567 688-2759
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number:SW OSP181044 Date of Issue 4-16-18
Parcel Identification Number: 01506265000
Legal Description Property Owner Name&Address
Nettleton Acres#1 Lot 4 Jamie Dittrich
Pump Installation Date: 9-7-18
Pump Intake Depth Below Top of Well Casing: 130 feet
Pump manufacturer's Name: F&W
Pump Model: 4F07T05301S
Pump Size: 1/2 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Installer: Sullivan Water Wells
Disinfected Upon Completion? yes no
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.
MUNICIPALITY OF ANCHORAGE �`,� t%q�,\it
DEVELOPMENT SERVICES DEPARTMENT //'*!: `• �� •9,+A
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 0/1 ....*: 49 TH ')\
SOILS LOG AND PERCOLATION TEST . sen Schiller
� /
1
1 � •.
��F�P CE szm 92 ,.•��/
LEGAL DESCRIPTION: NETTLETON ACRES #I LOT 4 �ll;‘479PROFESSIO‘+P�—
PERFORMED FOR: MATT BONNEY \\�����
DATE: 5/5/18 PROJECT NO.:
Professional Engineers Stamp:
PARCEL ID#: 015-062-65 TECHNICIAN: J. M ILLETTE
DEPTH PERC # 3
(feet)
1 SLOPE SITE PLAN
2
3
c .4
6
7
8
9
10 WAS GROUND WATER ENCOUNTERED?
IF YES rq WHAT DEPTH? L
11 DEPTH OF WATER AFTER MONITORING:
DATE OF MONITORING:
12
DEPTH TO
13— DATE READING GROSS TIME NET TIME WATER NET DROP
(MINUTES) (MINUTES) (INCHES) (INCHES)
14 5/5 TEST HOLE PRESOAKED PRIOR —0 TESTING:
15 1 12:15 4-0/16
16 2 - 12:45 30 5-10/16 1-10/16
3 12:46 4-0/16
17
4 1:16 30 5-6/16 1-6/16
18 5 1:18 4-0/16
19— 6 1:48 30 5-5/16 1-5/16
20
PERCOLATION RATE:22.9 (MIN/INCI-I) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS:
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road 3 `•.�
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
httpa/www.muni.org/onsite
/ 111
ALJ
4"•C•.,0PP6�
On-Site Water & Wastewater System Permit
Permit Number: OSP181044 Effective Date: 4/16/2018
Work Type: WellSeptic Initial Expiration Date: 4/16/2019
Tax Code Number: 01506265000
Site Legal Address: NETTLETON ACRES #1 LT 4 G:2439
Site Mailing Address: 9210 NETTLETON DR, Anchorage
Owner: BONNEY MATTHEW B Lot Size in Sq Ft: 54000
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy Ell Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The
Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit
stamped and signed results with the As-built Inspection Report. If the results require a design change,
construction of the system will stop pending On-Site review and approval.
Received By: 1)/ i /iely/ Ai Date: /
Issued By: A`, / Date:
1 P/, 5
MUNICIPALITY OF ANCHORAGE
Community Development Department /
\ Phone: 907-343-7904
Development Services Division - Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-062-65
Property owner(s) Matthew Bonney Day phone C152--07 05
Mailing address 7349 Feather Place, Anchorage, AK 99507
Site address 9210 Nettleton Drive
Legal description (Sub'd., Block & Lot) Nettleton Acres #1 , Lot 4
Legal description (Township, Range & Section)
Lot Size 54,000 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(IM all that apply)
Absorption Field n Initial ❑X Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade U
Duplex (D) F.
Holding Tank ❑ Renewal
Multiple Dwellings
Privy [ (SF and/or D)
Private Well ❑X
Water Storage ❑
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 or authorized agent)
Permit/Rush Fees: 7 9 Waiver Fees:
Date of Payment: 4714 0 Date of Payment:
Receipt Number: 0 ..5-13-6-D Receipt Number:
Permit No. OSP/0/O L(ct Waiver No.
Permit App__-:• ::_..c;
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
April 13, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Nettleton Acres #1, Lot 4 – 9210 Nettleton Drive
Septic system design and permit application
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 4-bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well, septic location
and alternate site. No conflicts exist between this proposed system and any other well or septic
system, whether on this lot or adjacent lots.
The ground surface on the lot slopes moderately-to-steeply from Nettleton Drive down toward the
back of the lot. In the area of the home, the slopes range from 5%-15%. The slopes toward the
northwest corner of the home range from 10%-25%. The septic system is located in that area.
There are no slopes within 20’ that are 25% or greater, and although there is a small section of
25% slopes within 50’, the design meets the requirements 16.55.210.B.1.d (the surface elevation
is within 10’ of the invert of the lateral). Drainage arrows are shown on the site plan showing the
grade and direction of flow. Stormwater drainage will not impact this septic system.
The new trench will be constructed parallel to the slope as much as possible. It will be a minimum
of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate
site is located more than 12’ away.
The test holes were dug in preparation for this design, whereas the home location and adjacent
wells were located afterward. Our design meets the soils found in nearby TH#2, although that does
not encompass the entire septic area and alternate site. We ask to dig a new test hole at the time of
construction to verify depth to bedrock, groundwater, and perk rates. In the case that the new test
hole allows for a deeper trench, we will ask for permission to use a deeper (and shorter) trench
layout.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181044, Deb Wockenfuss, 04/16/18
Please refer to the attached test hole logs, soils lab analysis, plan and profile pages for the septic
design. If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
4/13/18
19.5%
18.8
%
21.9%20.7%23.6%588.05
8
4
.
0
5
8
0
.
0576.0572.0568.
0
ALTERNATE SITE: CAT III SYSTEM W/ 25'
LONG x 3' WIDE x 6' EFFECTIVE DEPTH
FCO
10050 0
FEET
1"=50'
2x 56' LONG x 3' WIDE, 6' EFFECTIVE DEPTH
ABSORPTION TRENCHES (MIN 12' SEPARATION)
4-BDRM HOME
PROPOSED WELL
10' T&E EASEMENT
NOTE:
NO SLOPES >25% WITHIN 20', OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
MEETS 16.55.210.B.1.d FOR SLOPES WITHIN 50'
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH
WELLS OR SEPTIC SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1 NETTLETON DRIVENETTLETON ACRES #1 LOT 4
Apr 13, 2018
TH#2
SLOPES > =25%
SLOPES > =46%
SV1
SV22CO
CO1
MT1
CO3
MT2
CO2 CO4
SEPTIC SYSTEM IS >100' FROM PROPERTY LINE SEPTIC SYSTEM IS >100' FROM PROPERTY LINESEPTIC SYSTEM IS >100' FROM PROPERTY LINE
12.012.0
1250-GAL SEPTIC TANK
MIN 10' SEPARATION FROM FOUNDATION
AND 5' FROM FIELDS
10.0
FS
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181044, Deb Wockenfuss, 04/16/18
NETTLETON ACRES #1 LOT 4
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 60 MIN/IN
APPLICATION RATE: 0.45 GPD/SF
3' WIDE DEEP TRENCH SYSTEM
1250-GAL SEPTIC TANK
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
6"
1'-6"
6'
Apr 13, 2018
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 8' BELOW GRADE
FLOW LINE ELEVATION: 2' BELOW GRADE
TOP OF TRENCH ELEVATION: 0.5' ABOVE GRADE
600 GPD / 0.45 GPD/SF / 6' DEEP / 2 SIDES = 111.1 LF TRENCH REQUIRED (112 LF SPECIFIED)
INSULATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181044, Deb Wockenfuss, 04/16/18
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Nettleton Acres #1 Lot 4
2/16/18
J. Millette
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
NO
-
none
6:51
3/30
7 6/161
24.0 6
3 4
7:21 30 8 10/16 2
1' OB
(gm/sm) tight silty gravel
015-062-65
Matt Bonney
7:22 3
7:52 30 4
7:53 5
8:23 30 6
1 4/16
Professional Engineers Stamp:
Apr 13, 2018
with some sand,
cobbles and boulders
3/30/18
7 6/16
8 10/16 1 4/16
7 6/16
8 10/16 1 4/16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181044, Deb Wockenfuss, 04/16/18
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 2
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Nettleton Acres #1 Lot 4
2/16/18
J. Millette
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
NO
-
none
7:45
3/30
4 6/161
60.0 6
4 5
8:15 30 5 0/16 2
1' OB
(gm/sm) tight silty gravel
015-062-65
Matt Bonney
8:16 4 6/163
8:46 30 4
8:47 5
9:17 30 6
10/16
8/164 14/16
Professional Engineers Stamp:
Apr 13, 2018
with some sand,
cobbles and boulders
3/30/18
4 6/16
8/164 14/16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181044, Deb Wockenfuss, 04/16/18
ePlAgS
RUSH
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
015-062-65
Parcel I.D. Expiration Date: ! (
1. GENERAL INFORMATION
Complete legal description Nettleton Acres #1 Lot 4
Location (site address) 9210 Nettleton Drive
Current property owner(s) Matthew Bonney Day phone 952-0708
Mailing address 7349 Feather Place, Anchorage, AK 99507
Real estate agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic n
Water Storage (l Holding Tank
Community Well ❑ Community n
Public Water System lI Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ /2 Waiver Fee $
Date of Payment � o�,s`l Date of Payment
Receipt Number Receipt Number
COSA# 03(1.(g P 13p 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 4/25/19
OF. AC.gstlt
Oa
*. 49TH II;IIN •
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6. DSD SIGNATURE
•
System #1 Approved for bedrooms
Benjarrt�n6chiller
System #2 Approved for bedrooms TO�Fcs• • CE •1/192 47..0.'
9
Disapproved �, k PROFESStHAv�+AM/
Conditional approval for bedrooms, with the following stipulations:
\Qk\111(
tOF((r((((,
O/ter'.
ON-SITE -1)r
WATFR AND
WASTEWATER z1
PROGRAM cpm
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"144;rSERNI���\o�`
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By: (c„ti E Original Certificate Date: . _ /
The Municipality of Anchorage Development 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 C,eckhst b ce s"eet
COSA Checklist
Legal Description: Nettleton Acres #1 Lot 4 Parcel ID: 015-062-65
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) Well production at time of test 8 GPM gpm
Date drilled 9/4/18 Water storage tank volume gallons
Total depth 125 ft Well disinfected for coliform test? ❑ Yes ❑� No
Cased to 124 ft Q Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate 6.48 mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L * Arsenic less than MRL(ND)
Casing height(above ground) 24 in. Collected by Forge Engineering
Date of flow test for COSA 9/4/18 Date of Sample 4/5/19
Static water level at beginning of test 1 08 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) <1 years ❑ Required maintenance completed
Tank type/material Septic/ Steel Age of lift station years
Measured operating fluid level in septic tank N/A Lift station material
❑■ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping New Construction
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 5/5/18 Adequacy test date
❑■ ALL standpipes present per record drawing Results ❑Pass For bedrooms
Total measured depth from grade 11
.6"0.'ft(max) Fluid depth prior to test in
Measured depth to pipe invert from grade 5.6/4.1 ft(min) Water added gal
❑ N/A—pressurized field New depth in
O Monitor tubes go to bottom of effective. If not, state Elapsed time min
depth into effective
❑■ Code-required soil cover over field Final fluid depth in
El presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced N/A gallons If yes, enter date
Comments/Deficiencies: New Construction
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100'
p✓ Yes if No ft ❑✓ Yes if No ft
Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft
Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' [' Yes if No ft
-✓ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water> 100' B Yes if No ft
Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' E Yes if No ft Private Wells > 100' ❑✓ Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓Q Yes if No ft
Water Service Line > 10' S Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft
Water Service Line > 10' E] Yes if No ft Community Wells > 200' El Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION OF AL \ 1
I certify that 1 have determined through field inspections and review ��kP•
i
10
of Municipal records that the above systems are in conformance with ,'*'49 11.1
NJ.,IIP:
*0,
MOA COSA guidelines in effect on this date. / ie : .: : : OA
r, • Benja• chiller
t♦� ��c•.. CE 12592 �`Z.?
f4�' ,., 4/29/19 .,•�v�
COSA Checklist yellow sheet kt,\PROFESS` .0
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • J '- 907 343 7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory'
Certificate of On-Site Systems Approval # 0SC191132
Subdivision: Nettleton Acres #1 Lot: 4
A water sample revealed a nitrate concentration of 6.48 milligrams per liter (mg/L).
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. 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.
Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
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.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
PLAT NO. 92-114
NETTLETON ACRES UNIT 1
LOT 4
54,000 S.F.
S 89°59'22"E 360.00'
• 70.0' 7 •
b 0
SEPTIC SYSTEM CT; V
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• BUILDING ' GRP��OR��f o'
I . a
- SEPTIC SYSTEM W M 20'I Q 40'
O w 0 J
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Z WELL r Z W
Io z
1 �� =40'
10' T. & E. ESMT.
__— I •
S 89°59'22"E 360.00' •
;n 38.0'
ai
0 28.0'
ad
25.0•
0 c
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9.5',meg 37.5•
DECK o W
AS —BU I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE N n
'
PROPERTY DEPICTED ABOVE ANO THAT NO •40,111104 A. o
GASTALDI LAND .ENCROACHMENTS EXIST EXCEPT AS INDICATED. *Se_ •OFq� 1. 12.0'
IT IS THE RESPONSIBILITY OF THE OWNER TO
SURVEYING, LLC P'V••• .• .• 4 .
. . 3.0'
JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, c,� ••_' •
2000 E. DOwLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT • *: 49�H • :* j DECK
ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. 11.9e#7.4.•qac„„p/,� '=
PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA �J
A m•. J 0. Gestalt]] • / 24.0•
GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 7 o LS-6091 .• �'
ESTABLISHING BOUNDARY OR FENCE LINES. �. - •.• 3/19/2019 '� 411,
Sw2439 3/19/2019 ap .. . . .........•a s.
ANCHORAGE RECORDING DISTRICT, ALASKA •, afes,,ana1�a°.• BUILDING DETAIL
F.B. JOB NO. li111,11S�
18 oa NA14
NOTE: NO CORNERS SET THIS DATE
SCALE: 1”=2O'