HomeMy WebLinkAboutTUNDRA JEWEL RANCH LT 17A2Tundra Jewel
Ranch
Lot 17A-2
#051-193-32
Municipality of Anchorage '
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.d.anchorage.sk.us (907) 303-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number- Swo6e)gs-11 PID Number: C15 - If 3 - 3 2-
7 7 /sc ✓/rm
Wastewater System: ❑New ❑Upgrade
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ABSORPTION FIELD
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LEGAL DESCRIPTION
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BENCH MARK
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Inspections performed by: r I7 q< ' Dates: tr /i.J 8 o f
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Development Services Department Approval���Ty.,
^ • Christopher AL Cinncy
cC-9134
Reviewed and approved by: Date: i( J�
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ROONET P. KINKY ASSOCIAlk_. INC. Project* Po
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Municipality of Anchorage
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Development Services Department
Building Safety Division *:49TH
On -Site Water and Wastewater Program
• rustaoumragawst.
P.O. Box 196650 Anchorage, AK 99519-0650
wvnv.munl.org/onsite
(907) 343.7904
Soils Log - Percolation Test
Performed For.Jru a- I;M14 V /Cwi Date Performed:
Legal Description: Z111/714-7 jVnj/r, -1 p Township, Range, Section:
Depth
(Feet)
2Y0 o�s4.l:cs
ENCOUNTERED? / V f7
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f �
Depth to Water
6
IF YES, AT WHAT DEPTH?
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Depth to Water After
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Date
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Net Time
Depth to Water
6
IF YES, AT WHAT DEPTH?
L
Depth to Water After
0
Monitoring?
E
Date:
i
.. ..............
Christopher AL Kinney :QC
CE 9134
FA
Site Plan
��
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
or
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J
31/z 11
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31q
rcmuw�iiun"ia y.7 tm..a.hnn) PERG HOLE DIAMETER 6
TEST RUN BETWEEN 1/ FT AND ,S VZ FT
PERFORMED BY: Ch/i3Lt "- Mt K1•+n•-, I 1Ir .l4 �. r.r. CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCOROANC WITH ALLSTATE AND NICIPAL GUIDELI ES IN EFFECT ON HIS DATE. DATE: It,1131or
April 14, 2006
Municipality of Anchorage
Development Service Department
Onsite Water & Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519-6650
(907) 343-7904
Attention: Ms. Julie Makela, P.E.
Subject: Onsite Wastewater System
Lot 17A2, Tundra Jewel Ranch
Permit Number SW050284
Ms. M,
The subject septic system has been installed per design for the issued permit, see as -built
package attached. The only modification to the approved system was the installation of
insulation, along the entire piping system and above the tank.
The water well was drilled by Sullivan Water Wells to a depth of 208 feet. A water
sample was taken and submitted to Mat -Su test Lab of Alaska. The water test results are
attached for your record.
If you have any questions, please contact me at 694-2332.
Sincerely,
C_
hnstopher M. Kinney, P.E.
Attachments
Inspector: Chris Kinney
Date of inspection: October 18, 2005 YC
Location: Lot 17A Tundra Jewels
Inspected the new location of the test pit for the subject property and performed a perc
test in this location and determine that that the information remained the same as
submitted. A piezometer tube was installed for monitoring.
Inspector: Chirs Kinney
Date of Inspection: October 19, 2005
Location: Lot 17A Tundra Jewels
Inspected the trench and the installation of the tank, everything was installed as designed.
Inspector: Chris Kinney
Date of Inspection: October 20, 2005
Location: Lot 17A Tundra Jewels CO
Inspection the top of the disposal field and piping and appear to be in proper order. The
piping was stub into the craw space for hookup. This inspection was complete at 12 PM.
A second inspection was completed at 7 PM and the disposal field was backfill as shown
on the attached drawing. Insulation was installed as shown over entire field and tank.
Inspector: Chris Kinney
Date of inspection: April 13, 2006(M
Location: Lot 17A Tundra Jewcl
Final grading of area disturbed and piping trimmed for the monitor tubes.
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TUNDRA JEWEL RANCH SUB.
LOT 17A2
AS BUILT PLAN
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33' SECTION
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it
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Rodney P. Kinney Associate ;I Ina
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FND 3" AL MON.
— 40' L.F. 4" PVC
RING-TITE
ASTM D3034 PIPE
DISPOSAL FIELD
— 27' L.F. 4" PVC
-9ING-TITS
ASTM D3034 PIPE
x-22 I' ELBOW
-NEW WELL
ASBUILT OF
WATER/SEWER UPGRADES
LOT 17A-2
TUNDRA JEWEL RANCH SUBDIVISION
DATE: 4/13/06
DRAWN BY: JLD I SCALE 1'=50' FIGURE 1
LEGEND
— —
— EDGE OF DRIVEWAY
— x
— FENCE
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OVERHEAD LINE
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4' MONITORING TUBE
ASBUILT OF
WATER/SEWER UPGRADES
LOT 17A-2
TUNDRA JEWEL RANCH SUBDIVISION
DATE: 4/13/06
DRAWN BY: JLD I SCALE 1'=50' FIGURE 1
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10/21/2005 08:20 6882259 SULLIVAN PAGE 01/02
certateb Gritting In
by
Doc co. dc+
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAIr, ALASKA 99567 -TELEPHONE 688-2759
OWNER OFLAND: -%g+iLY � 1 AM J0eif'4 %
ADDRESS:
LEGAL DESCRIPTION: _/ c ko'o'e'f k j <� z
PERMIT NUMBER:S)5" w1 -Date OflSsue,Y—* -L2!-
TAX IDENTIFICATION NUMBER: �- 19 3 - 3'
Is well located at approved permit location? (IA;av b No
Method of Drilling: rotary 0 cable tool
Depth of well: a D -4-
Casing Type SZCa< Wall Thickness • a? 5Z� Inches
Diameter '01
Inches, depth a o� feet
Liner Type: -a 0,44
Casing Stickup Above Ground: a ' feet
Static Water Level: IdA feet
Recover Rate: 40 gpm
Method of Testing: A14 j
Wen Intake Opening Type: &Open end CI open hole
O Screened: Startfeet Stopped feet
❑ Perforations Startfeet Stopped -feet
�
,�,, -&4,00.
GroutType: Volume
Depth: from t% feet, to feet
Well Disinfected Upon Completion? ta.Y< O No
Method of Disinfection: JQ stn K "" aA S-tPAM
Comments:
�.
s
57
C off 6v6 S-70.- C.J )o
D Jia /j.r�F.Oc �
Yje <
GaQ�I c -r
p �i
Mile
Driller's Name
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipalit
of Anchorage: Department of Health 8. Human Services and/or Department of Environmental Conservation. Matsu Borougr
Department of Environmental Conservation.
MUNICIPALITY OFANCHORAGE
Development Services Department 1
On -Site Water & Wastewater Program / v
4700 South Bragaw Street 1�
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Upgrade
Permit Number: SWO50284
Legal Description: TUNDRA JEWEL RANCH LT 17A2
Design Engineer: 0833 Rodney P Kinney Associates, Inc.
Owner Name: TRACY & LINDA VREM
Owner Address: PO BOX 670130
CHUGIAK , AK 99567-0130
Date Issued: Aug 12, 2005
Expiration Date: Aug 12, 2006
Parcel ID: 051-193-32
Site Address:
Lot Size: 47052 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.,
❑✓ Disposal Field ❑/ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907)343-7904( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
a.) The Tundra Jewel Ranch Lot 17A-1 200 foot well radius and northern property line shall be marked by a registered
proffessionai land survey prior to construction.
b.) A test hole a minimum of 15.5 feet in depth shall be installed in the proposed location at the time of construction.
A percolation test and 7 -day groundwater monitoring shall be conducted and submitted with the Onsite Wastewater
Disposal System Inspection Report.
Received By:
Issued By:
Date:
Municipality of Anchorage
• —• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. %151— /q -3'3a- Permit Number SW
Property
Mailing address (1
hirig address (2
Wo tj
ir-
Day phone 009-C21-1) 9
Zip Code FJ'56 7 -
Legal description (Lot, Block & Sub'd.) Gol %7 %1- a% un efra Set,,/e l Vaac� 54,bLegal description (Section, Township & Range) Sr_ � 17 20 .1151U', R ) 1.✓ . S 11,
Lot Size V � O S -a Acre S .Ft. . Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well ✓P°fie
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool ' `
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
of property owner or authorized agent)
Permit Fees: qt& n
Fees:
Date of Payment: 4 I D I 10 5 Date of Payment:
Receipt Number: T I t i3 Receipt Number:
(Rev. 121CO)
Rodney P. Kinney Associates, inc.
...tail[.. lallevers a au....rs
August 12,2005
Municipality of Anchorage
Development Services
Permit and Development Center
4700 Bmgaw Street
Anchorage, Alaska 99507-1554
Subject: Upgrade On -Site Well and Wastewater
Lot 17A-2, Tundra Jewel Ranch Subdivision
Section 9, TI 5N, RI W
Attention: Julie Makela, P.E.
Dear Ms. Makcla:
The purpose of this letter is to provide the information requested from your comment sheet and our
discussion over the last week. You requested original signatures and stamps, locations of all wastewater
disposal systems and wells within 200 feet of subject property (sec Figure 2), and a revised layout of the
disposal system outside of the 200 foot radius from the well on Lot 17A-1 (see Figure 1).
You stated that a new test hole and perc test could be done at the time of construction, therefore it will be
performed and the information provided to your office.
Attached for your review are the following documents:
1. Soil log and percolation report (revised to one stamped sheet),
2. Site plan (revised per discussions) with;
a. Location of new absorption field,
b. Location of new well,
3. Sewer system details and calculations (calculations will be verified during construction),
4. New Test Hole location.
The lot is approximately 47,052 square feet, and is relatively flat, with trees along the property lines to the
east and west sides. The new absorption field will consist of a wide trench drain field, 38 feet in length, with
48 inches of sewer rock. The existing sewer tank will be removed and replaced with a 1,000 gallon tank. The
pipe will be PVC ring-titc (ASTM 3034). The old field will be abandoned in place. Due the nitrates levels in
the existing well, the Vrems are drilling a new well and want to keep the existing well for back up. No
negative impacts are anticipated to adjacent properties or conflicts with current drainage features. Please call
(907) 694-2332 if you have any questions or need additional information.
Sincerely,
RODNEY P. KINNEY ASSOCLAZES, INC.
stopher M. Kinney, P.E.
Project Manager
Attachments
CMK:djm
16515 6aaiarllel6 6rlaa a S9116 111 ■ Eula 61aar. Alaska a 99577
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WATER/SEWER UPGRADES
LOT 17A-2
TUNDRA JEWEL RANCH SUBDIVISION
PETERS CREEK. ALASKA
DATE: 7/27/05
DRAWN BY: JLD I SCALE 1"=50 FIGURE 1
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WATER/SEWER UPGRADES
LOT 17A-2
TUNDRA JEWEL RANCH SUBDIVISION
PETERS CREEK, ALASKA
DATE: 7/27/05
DRAWN BY: JLD I SCALE 1'=60-1 FIGURE 2
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Rodney P. Kinney Associates, inc.Urievers
July 27, 2005
Municipality of Anchorage
Development Services
Permit and Development Center
4700 Bragaw Street
Anchorage, Alaska 99507-1554
Subject: Upgrade On -Site Well and Wastewater
Lot 17A-2, Tundra Jewel Ranch Subdivision
Section 9, TI 5N, RI W
To Whom It May Concern:
The purpose of this letter is to request your review and approval to construct a replacement well and
absorption field on the subject lot. Attached for your review are the following documents:
1. MOA on-site permit application,
2. Soil log and percolation report,
3. Site plan;
a. Location of new absorption field,
b. Location of new well,
4. Sewer system details and calculations.
The lot is approximately 47,052 square feet, and is relatively flat, with trees along the property lines to
the east and west sides. The new absorption field will consist of a wide trench drain field, 38 feet in
length, with 48 inches of sewer rock. The existing sewer tank will be removed and replaced with a 1,000
gallon tank. The pipe will be PVC ring-tite (ASTM 3034). The old field will be exposed and disinfected
with IITII.
We do not anticipate any negative impacts to adjacent properties or conflicts with current drainage
features at the subject site.
Please call (907) 694-2332 if yo"ave any questions or need additional information.
Sincerely,
RODNEY P. KINNEY ASSOCIATES, INC.
Christopher M. Kinney, P.E.
Project Manager
Attachments
CMK:djm
16517 56816rI1N6 6tlaa a 5811.6 161 ■ falls liver. 6111ta ■ 99511
561.661.2332 1 Fal 561.661.1861 1 wwwreaa.nat
Project- y r w, (&RPKAgofJob No., DoteL_
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I IENUINEER'S:SEAL)
O
. 1 C^,,, Munlcirality of Anchorage
lea( DEPARTMENT O' nEALTH & HUMAN SERVIC =S
�/ - 825 'L•• Street, %w� horage, Alaska 99502-0650
SOILS LOG •- PERCOLATION TEST
PERFORMED FOR:j_G C'
V '� i1 4_._V I.Z j'✓� __ DATE PERFORMED:
LEGAL DESCRIPTION: ee�A " 2 TOwnshlp, Range, 5 nc:iOn: r
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WAS GROUNDWATER J�
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Owlh to Witir Alter
Mwllonn07 Dae:
Peadinq Oats GroSa Net Oeoth to Net
Time Time Water Oroo
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PERCCLATICN RATE (mma:esnncn) PERC HOLE DIAMETER
TETT RUN EET'.YEEN FT AND •T
01CLA1i•!^=. r nr,gA'e n+a•i nc nr+ra-tJ �ti t1rWn nrly.
P„st and Tuture pre<_ence and/Dr de_tn os groundwater can not be predicted
Tron _;esE ocserv9::or15.
PE.RFCRMEC EY: _— 1
CTRTIF1 -NAT THIS :EST '.VA<_ PERFCRMEM III
ACCCRCANCE':1I7H ALL STATE ANC ?AL;NIC:PAL GV:C ELINES.N EFFECT CN THIS CAT,-. C ATE.
�:'KB (Rev. 4/m
WASTEWATER DISPOSAL REGULATIONS, Chapter 15.65.060.0
as amended 9/25/90
TABLE 1
WATER APPLICATION RATES
FOR DISPOSAL FIELDS
(GPD/SF)
PERC. RATE
MIN/INCH
TRENCH
GPD/SF
AREA (SF)
Inches
(SF/BED)
by
C/Bed
0 - 1
0.78
N/A
0.70
1 - 5
0.64
-
125
42
(125)
2 =
0.50
3 =
375
4 =
500
5 =
625
6 - 15
0.8
1 =
188
(188)
2 =
375
3 =
563
4 =
750
5 =
938
16 - 30
0.6
1 =
250
(250)
2 =
500
3 =
750
4 =
1,000
6 =
1,250
31 - 60
0.45
1 =
333
(333)
2 =
667
3 =
1,000
4 =
1,333
5 =
1,667
)60
N/A
FILTER
1.0
1 =
150
MATERIAL
(150)
2 =
300
3 =
450
4 =
600
5 =
750
WIDE DRAINFiELD LENGTH
REDUCTION FACTOR — AF
Depth of Gravel
Trench Width 5' Feet
Below Pipe
Length Reduction
Inches
Factor
12
0.87
18
0.78
24 '
0.70
30
0.64
36
0.58
42
0.54
48
0.50
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WATER/SEWER UPGRADES
LOT 17A-2
TUNDRA JEWEL RANCH SUBDIVISION
PETERS CREEK, ALASKA
DATE: 7/27/05
DRAWN BY: JLD I SCALE 1"=50-1 FIGURE 1
Municipality of Anchorage
Development Services Department
• +� Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Chris Kinney
Legal description: Tundra Jewel Ranch Subdivision Lot 17A-2
51D
The attached paperwork has been reviewed and is being returned for the following reasons:
® Original signature or stamp missing on soil log and site pian
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate.
® Incomplete; missing test hole date on soil 129. 7 day groundwater monitoring results, pert
test information on soil log
® Incomplete; missing location of all wastewater disposal systems and wells within 200 feet
of subject property
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
® Proposed system too deep for soils information submitted. Test hole must extent 6 feet below
total depth of proposed obsorption field
❑ Well log required.
❑ Omission in narrative. _
❑ Insufficient fill over tank or field._
(a Other. 1.) Why installing new well? What is going to hoppen to existing well? 2.) Please
explain what HTH is?
Name of reviewer: Julie Mokela, P.E.
Date: 8/4/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
�6z�c i
Municipality of Anchorage
*AE
Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-193-32 COSA # Q5C J D Q- 50 ep
Expiration Date:
1. GENERAL INFORMATION
Complete legal description TUNDRA JEWEL RANCH LOT 17A2
Location (site address) 22570 NEEDLES LOOP, CHUGIAK, AK 99567
Current Property owner(s) MITCHELL/MILDRED
STANLEY TRST. Day phone
Mailing address PO BOX 671690, CHUGIAK, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent LES BAILEY & ASSOC.
Day phone
Mailing Address
Unless otherwise requested, COSA will be
held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑ .
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 andlor 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 ARCTERRA CONSULTING, INC. Phone 865-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 04/02/12
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational fife 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,
ArcTerra can not give any estimate of how long a ,
system will function satisfactory for current or future.46
.... .
occupants or can ArcTerra guarantee that no unseen " ._
encroachments, deficiencies or discrepancies exist. J ;_..
5. DSD SIGNATURE
Approved for 13 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Arsenic Advisory
Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory_ Other
By: Original Certificate Date:
Municipality of Anchorage 4r°`
• '� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TUNDRA TEWEL RANCH LOT 17A2 Parcel ID: 051-193-32
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #
Date completed 9/28/05 Sanitary seal (YM) Y
Total depth 208 ft. Cased to 207 ft.
FROM WELL LOG
Date of test 9/28/2005
Static water level 122 ft.
Well production 40 9 -
p.m -WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
3127/12
Coliform NEG colonies/100mL Nitrate 6.89 mg/L
Arsenic: ND mg/I Date of sample: 03/27/12 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Sevtic/Steel Date installed 1oh9/2006 Tank size 1000 gal.
ft.
9 -
p.m -
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N
High water alarm (Y/N) N Date of pumping 3L26/12 Pumper TRs
C. ABSORPTION FIELD DATA
Date installed 10/19106 Soil rating (g.p.d./ft2 or ft2/bdrm)1.2 System type Shallow Trench
Length 40 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 10.9 ft. (Measured 3/27/12)
Eff. absorption area 200 ft2 Monitoring tube Y
Date of adequacy test 3/27/12
Depression over field N
Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 490 gal. New depth 4.8 in.
Elapsed Time: 20 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _in. "Pump off" level at _in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 751+
Sewer /septic service line 251+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 1001+
Holding tank 1004
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 51+
Water main 101+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 301+ Water main 301+
Water Service line 301+ Surface water 100'+ Driveway, parking/vehicle storage 3'
Curtain drain 50'+ (None Known) Wells on adjacent tots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t 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 date.
a
Engineer's Printed Name KENNETH M. DUFFUS
Date 4/2112
COSA Fee $490.00
Date of Payment
Receipt Number�JJ�o
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS.
SGS Ref.#
1120946001
Client Name
ArcTerra Engineering and Surveying
Project Name/#
Tundra Jewel Ranch Lot 17A2
Client Sample ID
Tundra Jewel Ranch Lot 17A2
Matrix
Drinking Water
Sample Remarks:
Parameter Results
Metals by ICP/MS
Arsenic ND
Waters Department
Total Nitrate/Nitrite-N 6.89
Microbiology Laboratory
E. Coli Negative
Total Coliform Negative
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
LOQ Units Method
5.00 ug/L EP200.8
0.100
03/30/2012 12:00
03/27/2012 16:45
03/28/2012 10:15
Stephen C. Ede
Allowable Prep Analysis
Container ID Limits Date Date lnit
C (<10) 03/28/12 03/29/12 ACF
mg/L SM21450ONO3-F B (<10)
100mL SM219223B A
100mL SM219223B A
03/29/12 AYC
03/28/12 DLC I
03/28/12 DLC
Municipality of Anchorage s
a.5.,
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval 4 121096
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
17A2 of Tundra Jewel Ranch subdivision. This inspection revealed a nitrate
concentration of 6.89 milligrams per liter (mg/L) was reported for the
property's well water sample. 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.
Municipality of Anchorage
• Development Services Department ,•' '`.
Building Safety Division ,
Onsite Water and Wastewater Program `
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. h!5 1 -ICO- o3;� COSA#
Expiration Date: - - 0 7
1. GENERAL INFORMATION
Complete legal description T n r^a Jt f '�a.-7r- k -1 -
Location
Location (site address)
Current Property owner(s) v`�;netct:' %2tC e�y'nt,yn Day phone
Mailing address P.0. _Rox (1,70130 (GUp; /t� �}1� 9gS(e7 Ol�p
Lending agency
Day phone
Mailing address
/�
Real Estate Agent 13etr
5zai 611-fndf-.n
Day phone d ala- 0,La-3
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding Tank ❑
Community Class Weil
❑
Community On-site ❑
Public Water System
❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for 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.
f—
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Eagle River Engineering Services Phone (Al19421 VFW Rd., Suite 2e 1
Address Eagle River, AK 99577
Engineer's Printed Name Cbrit4cD{!Qr lam\. • Woodl Date 11 lel o�2lc
M
5. DSD SIGNATURE Itcy; w CE10381
✓ Approved for 3 bedrooms. "_
Disapproved.
�1ssr
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �. / Original Certificate Date:
all
(Pa . 111051
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsde
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: %u adr a l b1).L i il6K h 10 17 AP- Parcel ID: n _15' 1- t q 'J -3 �_
A. WELL DATA
Well type FriVaIf �'_ If A. B, or C provide PWSID # _ Well Log N)
Date compietedq�*NY/05 Sanitary seal 6ITI) Ug4_ Wires properly protected &N)
Total depth aoY ft. Cased to ao� ft. Casing height (above ground) min.
FROM WELL LOG AT INSPECTION
Date of test 9 Ia.8105
Static water level / P- a-. ft.
Well production Nn g.p,m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 7 70 mg/L
Arsenic: 0 mg/l Date of sample: VIY/4
B. SEPTICIHOLDING TANK DATA
Tank Type/Material _ t i C / 5i -A U
4 PIAS t om4rrodi0✓1
Other bacteria/ m colonies/100 mL
Collected by: CkPl'GS f2at1.,7
Date installed ID/Wo-696
Tank size j' 000 gal. Number of Compartments c;L Cleanouts (4�1) ( &,,-
Foundation cleanout (ON) 10-4 Depression over tank (YQ �,Q High water alarm (Y4% �n o
Date of pumping n JO+ Pumper (Areu) Cnrzsirr rr/iD» ti
C. ABSORPTION FIELD DATA
Date installed J211JLab Soil rating (g.p.d./fe or fe/bdrm)I . �- System type .Shallol 1 �rX/7Gll
Length 4!O ft. Width .moi ft. Gravel below pipe _ 4 ft.
Total depth 15 ft. Eft. absorption area,2P0 fe Monitoring tube j� Depression over field fn
Date of adequacy test/)LW CC r154. Results Pas ail):J3" Forbedrooms
Fluid depth in absorption field before test _Or in. Water added gal. New depth QV In.
Elapsed Time: 0 min. Final fluid depth _kr in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) _-,,one k riom j i If yes, give date ___d In
D. LIFT STATION
Date installed Size in gallons-M{anhole/Access Y �—
'Pump on' level at _in. 'Pump ofr level at )�F Hin. L-,igh water alarm level at in.
DatumCycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot t I no, On adjacent lots -r 100,
Absorption field on lot -t 100,
Public sewer main + 100'
Sewer /septic service line 1 d 5
Animal containment areas +100
On adjacent lots 4100,
Public sewer manhole/cieanout t 1001
Holding tank -t--is '
Manure/animal excrete storage areas rt 00'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation t 5 ' Property line �'Absorption field
Water main + t O ' Water service line -t ICN Surface water + 100
Wells on adjacent lots f 100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line +t O 1 Building foundation -tl O ` Water main 4 10 '
Water Service line 4-10' Surface water +-I 00 ' Driveway. parkingivehicle storage
Curtain drain +150 1 Wells on adjacent lots -#-100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and Z�f
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. :gigI TIXI FR R WOOD
Engineer's Printed Name � STytDkioz
Date II fro Lo 6
COSA Fee $ "o
Date of Payment Yl - 1&Cp
Receipt Number 8g543
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 060554
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
17A2 of Tundra Jewel Ranch subdivision. This inspection revealed a nitrate
concentration of 7.7 milligrams per liter (mg/L) was reported for the
property's well water sample. 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.
IR
w9fe;R]
SGS Ret#
Client Name
Project Namd#
Clicot Sample ID
Matrix
Sample Remarks:
1166553001
Eagle River Engineering
Tundra Jewel
Tundra Jewel Ranch Lot 17A2
Drinking Water
All DateWrimes am Alaska Standard Time
Printed DateMme
11/072006 13:17
Collected Datdrime
10272006 12:00
Received Daternme
10272006 13:02
Technical Director
Stephen C. Ede
Parameter
Results PQL
Univ
Method
Container ID
Allowable
Limits
Prep Analysis
Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00
ug/L
EP200.8
C
(<10)
10/3110611/02/06 TK
Waters Department
Nitrate -N 7.70
Microbiology Laboratory
Total Coliform 0
0.100 mg/l. EPA 353.2 B (<10) 1027/06 ALR
col/100ml. SM209222B A (<I) 1027106 DPT
oVENT 0VENT
WILDWOOD DRIVE n
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LEGEND
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33' SECTIONCO4
LINE EASEMENT
# LIGHT POLE
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( IN FEET )
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I Rodney P. Kinney Associates, inc.
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AL MON.
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18A
SURVEY CERTIFICATION: Rodney P.
Kinney Associotes Inc. has conducted a
OF\\ physical survey of this properly as
cS�...••...... Q`1 shown on this drawing and that the
improvements situated thereon are
within the property lines and no
�,
y, 4 O encroachments exist other than noted.
'""" "" ""' EXCLUSION NOTES: It Is the owners
responsbility to determine the
•••••••• ••••••••••••••••••.... existence o any easements,
Kevin U. Smith covenants, or restrictions which do not
i 9234 './� appear on the recorded subdivision
//JJ33� plot. NOTE: Under no circumstances
11^'bj'�%•�� i should any data hereon be used for
\�-oleeslaMt ? the construction or for the
establishing of properly lines.
ASBUILT OF
LOT 17A-2
TUNDRA
JEWEL RANCH SUBDIVISION
EAGLE RIVER, ALASKA
DATE:
SCALE:
1 1 11
50'
JOB No.:
04/13 06
=
DRAWN BY:
CHECKED BY:
I I
GRID:
CFK
KMS
NW 1259