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HomeMy WebLinkAboutUS SURVEY 3200 LT 14AOnsite File t Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: SW040179 PID Number: 090-041-53 New ❑ ❑Upgrade Name: Edward and Brenda Steil ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address HC52 Box 8865 Indian, AK 99540 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 250-0038 3 1.2GPDfSF 4.4 Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade 1.7 Ft. Gravel depth beneath pipe 2.6 Ft. Subdivision Block Lot US Survey 3200 14A Fill added above original grade 2 FL Gravel length 53 Ft. Township Range Section Gravel width 5Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station j Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 407 Ftp One Ft. well >100' >100' N/A N/A >25, TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,000caI. surfacewater >100' >100' N/A j N/A Material Number of compartments Lot Line >5' >10' N/A NIA Steel Two NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank D3034 Tankto drainfield D3034 Owner Installed Drainfield HDPE CO/MT D3034 Inspector AH BENCHMARK (Assumed elevation) 100.Oft Inspections, dates: i 8/4/04 2- 8/4/04 Location and description 31� 4'° Finished Floor. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL a ss 6tb t ' 'f Conditional Approval: Date .. 6q= t►� AV�0 's .. .......... ...... . 40� .�^ �MICNAEL E ANDERSON : w CE -4381 ..•��'` o ��e Approved Date /©-/�i; ncpm r_i-ric.wc r Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW040179 1,000 Gallon Septic Tank 80.1 PID No. 090-041-53 M U F U 5-1-04 53' (Trench Length) .9 74.8 .. �:`.• 49th `.1-77� E. PROFILE AS -BUILT " NEO, CEA438RS8N No Scale ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) MEMORANDUM DATE: October 11, 2012 TO: Jeff Poet FROM: Mike Anderson. P.E. SUBJECT: US Survey 3200, Lot 14A Septic System Permit No. SW040179 We have reviewed your comments and made the following revisions to the design and permit application for the subject lot: 1. The absorption trench site was graded flat prior to construction. The entire absorption trench was constructed in the soil lense specified in the test hole log. The alignment of the absorption trench meets the requirements of the Municipal Code. 2. An error was corrected on the final grade for the absorption trench. The profile view is now correct. 3. The owner of the property installed the system. The passage of time made it difficult to remember the exact course of events. 3540 AKULA DRIVE ANCHORAGE, ALASKA 99596 (907) 345-0593, (ynnty/nmmA: Subdivision/USS: Btock Lot .'..r�Y �lan q DEPARTMENT OF NATURAL RESOUR"S . MINING, LAND, WATER HYDROLOGIC SURVEY* WATER WELL IAC' Drilling Started: ! 4 1 D 1 CoMp 6S�i Property Owner Nana & Address:.� w4r 1 .: n a h i� S-1 ail( l �}"(SSL M of t/s Meridian /4 of 4 of ,.2 -__.......Township.......__-_.Range__..._._._.»Section..... ' -Lit NAD:IOR 83 Gcvatinn: _ ... BOREHOLE DATA- (from ground surface) Depth Drilling method: ItAir rotary ❑ Cahle tool, Odaer 'Materiah.TYPe, Com & wetness I From I To Wellvse: O Public supply, O Domestic, Cl Other — Y Depth of hole: b Q Casing stickup: It Caaiag jype t e L Thickness 0 a inches X / d.o Casing diameter. (o inches Casing depth 0 $ inches Deptic s `; U Liner type: niameter: Staticwater (from toil 0(a 'pact: In s y�c S • 1 II+ W a ��Y : 6 a % Pumping level & yield: feet after —hours at._Bllm " " Recovery rate: 30 gpm,Method oft j, —] Development method:Dursti0isI ' well intake opening type: D Open end, i Open hole ' V `` LL i..��Y 0/i p Ls Q !b a screened: Start ft,Stopped_____.__ fl I SLig— (� b 5 Screen type: Slot/meshsiu__---- it, Stopged ----- ft —' I D Perforaw.stad: ft Stopped�. Star: C0.Ssc� �o 1 /66 Note: Grout type: volume __ _---- ft P`L rti Uzt j 0 S' Depth; from ft. to __ Pump intake depth: ft IJJ I 1 1� � C)D \ 3 d f rA� Pump size hp. Brand nattte: Was well disinfected upon co,-`,�'tenon? H Yes, ❑ No 910, C © Method of disinfection: L4.�a.+ Driller comtrents/ disclaimers: �- 94 Well Dn'itetName: Company Name: HEFT' DRI1 t ttdG Mai1'tng Address: 3540 AKUTA DR E City ANCHORAGE. State: phone Numbers - 07 -34 --- Drillers Signature \ " "(\ SUM lawlrequira Data wpynl'IMx u dl k*bL. xa�n k. 11% State of Atska '•i 45 day& antes are seen itdc (AK 5011111115 38.05.020, 38.05.035, .=4(,15"arAAKtepttalians 11 AAC 93.140). DEPARTMENT OF NATURAL RESOURCES )1 Wng,Land & Water Hydrologic Snrvey 550 W 7th Ave., Suite MA And asage, AK 995013577 Tda(t ww ()07) 269.8639 and RAX E90Tj 562-1384 within the city of Anchorage. it is required data copy 01 tau sent to the appropriate city office within 60 days and that stand the well log be sent to tin: wclllpropcdy owner within 30 days. Pwmit Number. S W6 0 f Date of Issue, l IV Parcel IdentificationNumbar;loratiodlRYes �N° Is well located at approved permit Of ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jun 10, 2004 Expiration Date: Jun 10, 2005 Permit Number: SW040179 Parcel ID: 090-041-53 Legal Description: US Survey 32M Lot 14A' Design Engineer: 0014 Anderson Engineering Site Address: Unknown Owner Name: Edward & Brenda Steil Lot Size: 120320 SO. FT. Owner Address: HC 52 Box 8865 Total Bedrooms: 3 Permit Bedrooms: 3 Indian , AK 99540 - This permit is for the construction of: ❑Q 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. SEPTIC SYSTEM NEEDS TO BE INSTALLED ON SLOPE LESS THAN 25%, AND 50 FEET UPGRADIANT FROM ANY SLOPE CHANGES TO 25% OR GREATER. SEPTIC SYSTEM NEEDS TO MAINTAIN 100 FEET FROM ANY SURFACE WATER Received By. n Issued By. 4:f Date: 1,--10 ^ OY Date:rn og 8(y jatfo MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jun 10, 2004 Expiration Date: Jun 10, 2005 Permit Number: SW040179 Parcel ID: 090-041-53 Legal Description: US Survey 32M Lot 14A' Design Engineer: 0014 Anderson Engineering Site Address: Unknown Owner Name: Edward & Brenda Steil Lot Size: 120320 SO. FT. Owner Address: HC 52 Box 8865 Total Bedrooms: 3 Permit Bedrooms: 3 Indian , AK 99540 - This permit is for the construction of: ❑Q 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. SEPTIC SYSTEM NEEDS TO BE INSTALLED ON SLOPE LESS THAN 25%, AND 50 FEET UPGRADIANT FROM ANY SLOPE CHANGES TO 25% OR GREATER. SEPTIC SYSTEM NEEDS TO MAINTAIN 100 FEET FROM ANY SURFACE WATER Received By. n Issued By. 4:f Date: 1,--10 ^ OY Date:rn og Municipality of Anchorage Development Services Department Building Safety Division i Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-0650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Number SW Property owner(s) Edward and Brenda Steil Day phone 250-0038 Mailing address (1) HC 52 Box 6865 Indian. AK 99540 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 14X US Survey 3200 Legal description (Section, Township & Range) Lot Size 120,320 SF Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Three (3) Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 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. G (Signature of property owner or authorized agent) Permit Fees: � 1 b0O 4' 7 i� Waiver Fees: Date of Payment i7 / — 0 �4 Date of Payment Receipt Number. Receipt Number. (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX June 7, 2004 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 14A, US Survey 3200 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 14A, US Survey 3200 intends to construct a three-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the new home. The Site Plan and backup documentation identify the location and configuration of the proposed well and septic system and the alternate site. The property to the west of this lot is currently undeveloped and the new well and septic system locations will not conflict with the wells or septic systems in the area. Existing drainage arrows and the current drainage pattern are also identified on the Site Plan. The drainage pattern will be maintained after development of this lot is complete. Several test holes were recently placed on the lot, which indicated silty sand with gravel in the area of the absorption trench. The accepting soils were tested and found to have percolation rates of less than 5 minutes per inch. No groundwater was found during excavation but was noted at 13' below the surface during the monitoring period. Our design includes the placement of a new 1,000 -gallon septic tank along with an 53' long by 5' wide by 2' effective depth absorption trench to collect and treat the sewage generated in the house. The bottom of the trench will be 5' below the surface to provide the required separation from the bedrock. The distribution pipe will be 3' below the surface. A minimum of 3' of cover will be placed atop the trenches and a minimum of 4' of cover will be placed atop the new septic tank. The ground surface on the lot slopes at steep grades of 20% to 25% from northwest to southeast . The absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The Lot 14A, US Survey 3200 June 7, 2004 Page Two new septic system will be constructed 100' from all wells and surface water. It will also be constructed a minimum of 10' from any water service in the area. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments h 'tiL95 49th MICHAEL C. ANDERSON III, No CE -4381 A GNSG6 OF �j oW --------- N1006.54- oa 328.611 m I --- I Fm i ZO 21 ------ - -� 7 m Ct al � 2 � � m D to { To , Q7 0 a 1 fj 1 z 1 v �axw CNPD { n = o o � So � s I !� I 1 1 1 1 1 1 I I 10 D r 'Co V/ N o n ma � Sy0V 0 0�9 m �Qo ?o - 1_ i .0000 LOT 14A, US SURVEY 3200 DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom House 5' Wide Trench System Pere. Rate: <5 MinAnch 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 2' Drainfield Rock 3 Bedrooms X 150 GPD/1.2 GPD/SF (ALF lication Rate) = 375 SF Absorption Area 375 SF/5 SF ' .7 (Red. Factor) = 52.5 Trench Length THEREFORE: Construct a 53' Long x 5' Wide x 2' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 5' Below Existing Ground. Provide 4' Cover Over Septic Tank and T Cover Over Absorption Trench. Provide 2" of Insulation and 2' of Cover if Necessary. 5' TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. •,7 Minimum 100' Separation From Wells in the Area. �� Minimum 100' Separation From Surface Water or Streams: 0#.' 49th KAM E Na0EA50N No. Ce i Natural 2'6" Backfill Geotextile Fabric 6" 4" Perforated PVC (Holes Down) 2'0" Drainfield Rock 5' TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. •,7 Minimum 100' Separation From Wells in the Area. �� Minimum 100' Separation From Surface Water or Streams: 0#.' 49th KAM E Na0EA50N No. Ce i �Q�E. OF •••At ollIt v*• 491H av Municipality of Anchorage �.::::.::� Department of Health & Human Services O „ ; AUaAEL E. ANDERSON Q 4700 South Bragaw Street, Anchorage, AK 99519-e650 ®0, CE -4381 : c SOILS LOG- PERCOLATION TEST �i � pR0lESStSN���� Performed For: ;_Edward Steil Date Perform d: 4/16/�i�������� Legal Description: Lot 14A, U.S. Survey No. 3200 SLOPE SITE PLAN 1 �r/oEY 2 D L 3 o GM 5 LJ „ s b,1 �n.r �rUv 8 9 10 a 14 15 16 17 18 JWas Groundwater Encountered?. If Yes, What Depth? Depth to Water t After Monitoring 10• mlitr Date: 1 ori bi pr!,rcv. Reading Date Gross Time Net Time Depth To Water Net Drop Sin is /V: oo ✓T I/)( / 3: Z*7 /S 9 3 5! 3131 / y,So i %VC- /S 2G S,/ v7 r/,S. Perc rate: 3 min./ in. Perc hole dia.: o Perc test depth: `f!7' to Ss ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Alan Harala. I, Michael F. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Dale: P: • .S�bb 49111 PA Municipality of Anchorage h ! Department of Health & Human Services o :IWOVEL E. ANDMOa� i 4700 South Bragaw Street, Anchorage, AK 99519.6650Oy c�J �� CE -4361 .SOILS LOG - PERCOLATION TEST �i� fpf•.,•� ��,••'���'� Performed For: ;Edward Steil _ Legal Description: Lot 14A, U.S. Survey No. 3200 SLOPE 2 b i7 3 4 �M p>y5 C�ra/ 6 W/ 7 5,, a I jqliTkt2 Gi'��5 10 11 12 13 14 15 16 17 Was Groundwater Y Encountered? , Net Drop If Yes, What Depth? —/2 Depth to Water G•s8 After Monitoring 3:7.7 Date: , o PC, jCb,40C a 1114OROFESS "" Date Performed: 4/16104 SITE PLAN -3I Reading Date Gross Time Net Time Depth To Water Net Drop S / r'1 3 •/D � G•s8 � 3:7.7 /7.5-3.- . 6 : 3 V 5.88 Perc rate: 15 min./ in. Perc hole dia.: " Perc test depth: 4-C" to-r-sft. Comments: Percolation Cavity Preso_ aka or to Testing. Performed By: Alan Harnla. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: �v. V I _11- • Municipality of Anchorage On -Site Water and.Wastewater Program (907) 343-7904 � ; F C :'-Y_ Certificate of On -Site Systems Approval Parcel I.D. 090-041-53 Expiration Date: 1—N-2-0 1. 1—N-2- 1. GENERAL INFORMATION: Complete legal description US SURVEY 3200; LOT 14A Location (site address) 419 Indian Road *Indian Current Property owner(s) Ed & Brenda Steil Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® . Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 223-1570 Day phone 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. r COSA Fee $ 12, 50 coo Waiver Fee $ Date of Payment q - ?_'Q Date of Payment Receipt Number V C125( Receipt Number COSA # OS C Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systemis on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. IGNATURE System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foll ..%14 ... : ;e` Prness CC, Prpj_ggio�G #AECC884 p_1TY�pF���i���� rsult�tiER A� b� S T : rn By: ( rOriginal Certificate Date: V ^Z� 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other �A S Svc 31,"v,; L, 1'V4 Legal Description: US SURVEY 3200; LOT 14A If more than 1 septic system on lot: COSA Checklist # 1 of I A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7/27/04 Total depth 105 ft Cased to 60 ft N Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/21/20 Static water level at beginning of test 43.1 ft Comments vil B. TANK DATA i Age of tank(s) A8 years Tank type/material SEKIi 'EE Measured operating fluid level in septic tank 51 Al Standpipes/foundation cleanout per record drawing Date of pumping 6/23/20 D. ABSORPTION FIELD DATA Parcel ID: 090-041-53 Structure served by this system 1 Well production at time of test 7.6+ gpm /Water storage tank volume NIA gallons Well disinfected for coliform test? ❑ Yes ❑ No 12Co 11 form bacteria is Negative Nitrate ; mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L (Arsenic less than MRL (ND) Collected by GEG LTD. Date of Sample 8»4/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Which system tested (date installed) 814/04 Adequacy test date 9/21/20 ❑ ALL standpipes present per record drawing Results ❑Pass For 3 bedrooms Total measured depth from grade 6.7 ft (max) Fluid depth prior to test 11 in Measured depth to pipe invert from grade 3.58 ft (min) Water added 458 gal ❑ N/A — pressurized field 16 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 120 depth into effective E lapsed time min M Code -required soil cover over field Final fluid depth 13 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced NIA gallons If yes, enter date N/A Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) r7l Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100' Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ✓M 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' Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Community Wells > 200' Q✓ Yes if No ft Animal Containment > 50' Q✓ Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' p✓ Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' r7l Yes if No ft Surface Water > 100' M Yes if No ft Property Line > 5'✓1 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' FV -1 Yes if No ft Water Main > 10'✓0 Yes if No ft Community Wells > 200' Q✓ Yes if No ft Water Service Line > 10' ❑✓ 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' 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' Q Yes if No ft Private Wells > 100' FZ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS OAV u V G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet #AECC8B4 Er ' Lot 13A 4- — Lot 138 Lot 13D _ S80'10'55"E 100.00` A110.73' S, A32.1.8' O 0 (Not 2x r .ate R50.00' R50.00' CO Construct,d) ed) OF A o o�'� 0 Stag 0 40 80 I I US SURVEY FEET NOTES -All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. 95-32. -49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no circumstances should any data hereon be used for establishment of property lines. -It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed. AS BUILT SURVEY LEGEND 49/ih Star S; rveying LLC 321 Fireoved Drive Lot 14A, 4t1 wen Anchorage, AK 99508 US SurveyNo. 3200, �, Utility Pole X907)StarSu 11 leremyCai49th5tarSurveying.com Indian, Alaska US Septic Vent W.O. 2042 1 DATE: 10/6/20 SCAM 1"=80'