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HomeMy WebLinkAboutHAMANN LT 11Homonn Lot 11 050- 6 21 -14 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231036 PID Number: 050-621-14 Dwelling: A Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name Chartkunchand Torechart ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 24560 Jem Circle, Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe in rom original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hamann 11 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines istance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betwee enches From Tank Field Tank Line Ft2 Well >100' N/A N/A N/A >25' TANK ❑e Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5, N/A N/A N/A NA Foundation > 10' N/A N/A N/A L TATION Manufacturer Capacity Remarks Gal. Alarm location Elec stalled by Installer PIPE MATERIAL House to tank Tank to D3034 D3034 drainfield A.C.E.S Drainfield N/A CO/MTN/A Inspector M. Jakubisin BENCH MARK (Assumed elevation) 100 ft Inspection 1m 5/1/23 5/1/23 Location and description 2�d Bottom of Siding SW Corner 3rd 4th ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �' �, Conditional Approval: Date ���`� ,q(9, •:� �� CO . • H49 Septic System Benjam(n:5chiller � •• � Approved Date /Z /_/2o2 � ,•�� �� C E 12592 's�F • . 5/18/23 • . �(�� �F�PROFESS10�t'� cam' Note: this approval does not include well permit requirements. 4w0�`���'� (Rev u5iu2iiu) HAMAN N 7 LOT 11 PERMIT # OSP231036 E N G .N III - - i e, .. �--� ' • . . • • Benja' Schiller CE 12592 (NO SCALE) PERMIT # OSP231036 PID # 050-621-14 EXISTING WELL RADIUS OUT OF LOT 9B VIEWPORT LOT 10 REM — — — — — — — — — - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — -- 33'SECTION LINE EASEMENT JEM CIRCLE EDGE OF ROAD A fir; Q�0H Benja i Schiller CE 2592 11&23 j 'OPRO i�' 1 000-GAL SEPTIC TANK 2CO EXISTING WELL B 3.1,BDRM HOME LOT 11 S, 10'UTILITY EASEMENT �qlj of LOT 15 0 50 100 �M EM kEN ON FEET 111=50' A B MH1 33.2 29. svi 37.5 33.5 2CO 39.5 35.8 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANC FS - FLOW SPUTTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE 33' SECTION LINE EASEMENT J E M CIRCLE EDGE OF ROAD " �....,. S Off, I N 89'30'E 421.85' R&C _ �— — L=26.25'(C) �SAy L=36.13' R=50.00'(R&C) L=21.63'(R) 9�ro \ R=75.00' L=50.83' R=50.OL 'R&C) \ \ WELL 100' PROTECTIVE RADIUS 1� ✓ _ _— SEPTIC I PIPES \ �' f MANHOLE GRAVEL HOUSE DETAIL /'�+FyD� l Scale: 1 "=30' \ \ + + 8.2'x12.2' COOP 303• �O + +/ FENCE LINK / 2 8 ). Lot Acres 1 j Lot 12 C 2.5 IX 10.9'a• 2 � 1.5' CANT 10' UTILITY EASEMENT —RETAINING y�n\ WALLS 'T0 \ NOTE: THE DIMENSIONS ON THE RECORD PLAT 7 DO NOT MATHEMATICALLY CLOSE. — (C) = COMPUTED \ R = RECORD — (R&C) = RECORD AND COMPUTED \ MORTGAGE SURVEY X SCALE 1" = 60' GRID SW 0261 Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax �\ Professional Land Surveyors ken®langsurvey.com v F L"'hjonothon0langsurvey.com ©'`' •�•s_ ua I hereby certify that 1 have surveyed the following described property: 0�(� 49TH LOT 11, HAMANN SUBDIVISION (PLAT No. 73-133) *\ �\ Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a �""" """"" """' representation of the conditions that were found on the date the survey was performed. \ o \ \\ This survey does not constitute a boundary survey and is subject to any inaccuracies (�h'� ..... ... G...... . .... that a subsequent boundary survey may disclose. The information contained hereon shall V , o \ not be used to establish any fence, structure, or other improvements. QQ� s� .LS-5202.• ' J Dated this the �l Day of l`/ ���? �+ at Anchorage, Alaska 4QOROFE•SSIONN- It is the responsibility of the owner to determine the existence of any easements, 040000�4 covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231036 Work Type: SepticTank Upgrade Tax Code Number: 05062114000 Site Legal Address: HAMANN LT 11 G:0261 Site Mailing Address: 24560 JEM CIR, Eagle River Owner: CHARTKUNCHAND TORECHART & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: v�zent �y1il�V Depan•tment 4/7/2023 4/6/2024 108900 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 �ecei�7eT1 y: 55 fio r Issued By: Date: Date: 7 Z 3 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. 050-621-14 Property owner(s) Chartkunchand Torechart Mailing address 24560 Jem Circle, Anchorage, AK 99577 Site address 24560 Jem Circle Day phone 907-223-2305 Legal description (Sub'd., Block & Lot) Hamann Lot 11 Legal description (Township, Range & Section) Lot Size 108,900 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo AD U) Septic Tank 0 Upgrade Q (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 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: 22 5 Waiver Fees: Date of Payment: 2 `1 20 2 Date of Payment: Receipt Number: Receipt Number: Permit No. OSP 23 1n 3 6 Waiver No. Permit App_'- : . - c March 9, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 3/9/23 Subject: Hamann, Lot 11 - 24560 Jem Circle Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with the same size designed for 3 bedrooms. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231036, Deb Wockenfuss, 04/07/23 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO HAMANN, LOT 11 FEET 0 50 100 JEM CIRCLE 3/9/23 SEPTIC PLAN EDGE OF ROAD33' SECTION LINE EASEMENT H A M A N N R O A D EXISTING WELL 10' UTILITY EASEMENT 3-BDRM HOME EXISTING WELL RADIUS OUT OF VIEWPORT DECOMMISSION EXISTING SEPTIC TANK NEW 1000-GAL SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231036, Deb Wockenfuss, 04/07/23 \ 33' SECTION LINE EASEM - U O \ L=26.25'I L=21.63' \ HOUSE DETAIL Scale: 1"=30' eA�CpM- � k'�(kORTs/IFN °F°k o, e, o estijT F k °FCk 10.9'y 220. -rte °FCk , RETAINING WALLS .5• CANT JEM CIRCLE —`EDGE OF ROAD ygCT L=36.13' L=50.83' \ \ \ SEPTIC \ PIPES IS RAVEL WELL \ \ < 8.2'x12.2• SHED O \ p0' \ \ \ 0 y --6.0'x8.0' GREENHOUSE \ NOTE: THE DIMENSIONS ON THE RECORD PLAT DO NOT MATHEMATICALLY CLOSE. (C) = COMPUTED R = RECORD —(R&C) = RECORD AND COMPUTED \ Lot 11 2.5 Acres ti� sass \ R� \ 10' UTILITY EASEMENT �M�Nti \ \ f MORTGAGE SURVEY X SCALE 1=_= 60' GRID SW 0261 _ Project No. _ 21_-581 R1 _ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Long Q & Associates, inc. (907) 522-6476 Phone o00��0 (907) 522-4625 Fax o ors OF AoOp� Professional Land Surveyors kenolongsurvey.com o! y jonothanOlongsurvey.com I hereby certify that I have surveyed the following described property: LOT 11, HAMANN SUBDIVISION (PLAT No. 73-133) p* ; 49LH•.�*OQ Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a �� ....... .. .. representation of the conditions that were found on the date the survey was performed. Q This survey does not constitute a boundary survey and Is subject to any inaccuracies Q ,1�-...G that a subsequent boundary survey may disclose. The Information contained hereon shall KENN li G. NG G not be used to establish any fence, structure, or other improvements. q�l,�y121 p� t, FPF..202.-gJ O� Dated this the ��' Day of !i�.i%"�t�.�__�L _ C��"+- at Anchorage, Alaska 4p Op S— NO o 4OQROFfSS10NA� �o It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Lot 12 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 www.ci.anchorage.ak.us (907) 343-7904 Page i of ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number:, .~'(z/ 0 ~ 0 ~ '7 ~ Name A~Ctes5 Phone Number of Oedr~ms: LEGAL DESCRIPTION 8,oc~ Let Subdivision: PID Number: .,. 0~'0-"b"P-/- Wastewater System: [] New [] Upgrade ABSORPTION FIELD ~OeepTrench i~ Shallow Trench I-~ Eed I"1 Mound r~ O~e~ Soil Rating' Depth ID pipe bottom from added above ~xiginal grace: /.d' FI. Total Oepm from original grace. Gravel Oap~ beneath p~pe: Gravel Length: Tow~sn,p Range' Section: Ft. FI. FI. Well: [] New [] Upgrade Clas$.fica~on (Private, A. B. C). I Total Depth: I Cased to: fir-,,.,,x/.~ I ! g 7 ~,. ~'~'. °'/"eh Ip,,,e P,~;/I,~.? Oa,,O,~leC: T~r~m~~ Septic Tank / ,~e,, I I ~J "/ width; p.4 tm-,/", Tot~ ab~pfi~area: FI. Ft3 .Ir~talleC. Number Cf lines: I Distance between I~nes I ] -- FL Date Installed: ~/g /~ TANK 'SEPARATION DISTANCES 151 Septic [] Holding I'-] S.T.E.P. [] Other: Manufac~urec Absorption Lift Holding Public/Private Field Station Tank Sewer Line Maledal: 5/"ee/ Size: 'Pump On' level at. Pump Make & Iv~del Inspections performed by: ICapac, y: ! OO~ GaL Numt:er of Compartments: LIFT STATION IElec~ical Inspe~on$ perf~'med by' BENCH MARK Locati~ and Oes~puo~: ~/' [oc~Pt~r~ .c~ocu:,, oD 16'0.0 ~'' Development S~..~ s Reviewed and approved by: P.{Oo.. Dates': la' / '7_ Department Approval Date: PERMIT NO: SW020374 PAGE 2 OF 2 JEM CIRCLE /~_. .... PI~ NO: 050-~2~-~4 .............. · .......... ~-~'-1-1- ........... 74-FOOT LONG ~ o~/,.~ ~ ," HAMANN SID SOIL ABS.'i~NCH ~r/p, ~ ~ ~W. 4.2' GVL. BELOW PIPE X X.'/~ . ~ T.H. 1000~ALLON X X ~ WELL / ,,j,. ~2 SEPTIC TANK PARALLEL TO NEW TRENCH ~ ,, ,, , ON NORTH SIDE OF TEST HOLES ~ FROM: COR. A" COR.' C" ~ '-, TO: ~ '-.S.T.C.O. "E" 32' 53' S.T.C.O. "F" 38' 58.5' DBL. C.O. "G" 4t' 61' -- ...... ~ 80' 88' -:, .......... ~- PLAN VIEW TR. C.O. "H" '~' ~ ~ < "~:~' 111' 125' ~ .... ~:~ ~ ~-.. TR.M.T.'T' -,,,,, , ...... - .... ,, SCALE: 1" = 50' ,,j,, , ', ,. · '.. ',. TR. C.O. 140' 158' :';~e; ¢ ~, e.~eee eeeeee ee eeee*a'e ~ ~ ' '. ~.;. ' ~ ~c~ ~ ~' ~' ,~ ';'. ~ ,' , . :' ~' ~:..:;~-:'...~ ~ <::~'. ~; ~'~ ~ .~- . 2' SOIL INV. 93.2' 4.2' EFF. GRAVEL ~__BOT. TRENCH ELEV. 89.0' F2" INSULATION 1'000- GALLO'N! . SEPTIC TANKi ' ~_INV. 96.3' BOTTOM T.H.#2 ELEV. 80.6' WATER @ ~.6' 12/6/02 CROSS-SECTION NOT TO SCALE LOT 11, HAMANN SID SEPTIC SYSTEM INSTALLATION AS-BUILT INSPECTION REPORT FLAT]'OP TECHNICAL SERVICES SCALE: AS NOTED 14530 ECtlO STREET DRAWN BY TFM ANCHORAGE, ALASKA 995 ! 6 MARCH, 2003 Mumc pahty of Anchorage Department of Health and Human Services · 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mystrom http:l/www.ci.anchorage.ak.us Mayor Permit Number: #SW 020374 Date of Issue: 9-26-02 Parcel Identification Number: 050-62~-14 Date Started: 12-'13-02 Date Completed: 12-14-02 Is well located at approved permit location? [] Yes [] No Legal Description: Hamann Lot 17 Property Owner Name & Address: Dr. Richard Burmeister Bethard Construction P 0 Box 770392 Ea~lle River Alaska 99577 Borehole Data: Depth (It) Soil Type, Thickness & Water Strata From To stick-up 0 2 organics & silt 2 4 silty cobbly gravel 4 85 Bedrock 85 187 Method of Drilling [] air rotary [] cable tool Casing type: steel Wall Thickness: .250 inches Diameter: _6 inches Depth: 86 feet Liner Type: ~ Diameter: ~ inches Depth: Casing stickup above ground: _2 feet feet Static water level (from ground level):e~"~et Pumping level: 187 feet after _2 hours pumping _5 gpm Recovery Rate: 5 gpm Method of Testing: air li~t Well Intake Opening Type: [] Open End [] Open Hole [] Screened Start ~ feet [] Perforations Start~ feet Stopped ~ feet Stopped ~ feet Grout Type: Bentonite #8 Volume: I bg Depth: Start_0 feet Stopped ~ feet Pump: Intake Depth ~ feet Pump size __ hp Brand Name Well Disinfected Upon Completion? [5~ Yes [--] No Method of'Disinfection: chlorine tab/ets Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a xvell log to the property owner within 30 days of completion and the property OCT-I~-~00~ 1 !: 40 r-'¢~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water end Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage,ak.us (907) 343-7904 P.O1 ON-SITE SEWE~ELL SUBMITTAL COMMENT SHEET To: ted moor~ Legal description: hamann lot 11 The attached paperwork has been reviewed and is being returned for the following reasons: [~ Original signature or stamp missing on ~ [-I Calculation error in design. [] Additional soils information needed.. , [-1 Water monitoring results inadequate. E] Discrepancy in information submitted. r'"l Topographic information missing or inadequate. [] Incomplete; missing [-'] Incomplete; missing ~ [] Additional adequacy test information needed. [] Water sample unacceptable. E] Measured/proposed distances/dimensions missing, [] Locations of all soils, percolation and water monitoring tests not shown. I-'] Proposed system too deep for soils information submitted. , [-~ Well log required. [] Omission in narrative. ~ [] Insufficient fill over tank or field. ~3 Other. ~v~., erwell not in conduit Name of reviewer. Joe aoodal! Date: 4/t0103 Please supply the necessary information and m-submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Sep 26, 2002 Expiration Date: Sep 26, 2003 Permit Number: SW020374 Legal Description: HAMANN LT 11 Design Engineer: 0019 Flattop Technical Services Owner Name: Dr. Richard Burmeister Owner Address: PO Box 770392 Eagle River, AK 99577- Parcel ID: 050-621-14 Site Address: Lot Size: 108900 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 1-~ 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. Received By: Issued By: Date: 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 SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLI'NG Parcel I.D. Property owner(s) Mailing.address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) ,/..,:,t I1., Legal description (Section, Township & Range) Permit Number SWOZO~7~. Day phone Zip Code Lot Size //~,gc~, ?~C.~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Aores~ Number of Bedrooms ..~ j'~ Well Only [-'] I~ Water Storage [-I Jacuzzi r-] Water Softening Unit r-] I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or' authorized agent) Permit Fees: 6-~-~2. ~ Date or Payment: <~ / I~' / 0 ~,. Receipt Number: ~S~? ~ (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 September 9, 2002 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 11 of Hamann S/d, located on Jem Circle in Eagle River. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil log, the native material between 2 feet and 10 feet below ground surface is a silty sandy gravel with a measured perc rate of 2 minutes per inch. Using a somewhat conservative soil application rate of 0.8 gpd/sq. It, this proposed 3-bedroom residence requires a total absorption area of (3 x 150)/0.8 = 563 square feet. The proposed 71-foot long trench design with an effective gravel depth of 4.0 feet has a total absorption area of 568 square feet. The topography of the lot in the area of proposed construction slopes down towards the south southwest at approximately 15%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. e~'--- WELL / ...... ~EPIIC kOl ~ ~". ^REA .......................................... ~ ........ 2- ~ ........ ~'- ......... . ~ CONSTRUCT 71-FOOT LONg'OIL ABS. Y~ENCH ~ ' ~ / ~' ...... ~::~.~FE~T~ .'. / ~ ~ . ~ ...... '~ ~ ............ ~ -.q ...................... ,... ~' ~ ~ TRENCH ~ 3-BDRM ~ " .-HOUSE . ~1 . LOT 12 . ~ '. 158' - ' TAN~ .' ~ . LOT LOT 14 ~'~ - HAMANN SlD - ~R 1~0' ~ . LOT 15 ~ LOT 11, HAMANN SID PROPOSED WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 100 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 2002 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. INSTALL NEw 4" D-3034 1000-GALLON SEPTIC TANK INSTALL ~,_~.~,'~ , 71-,F, OOT LONG TRENCH WITH I ~-~., 4.0 EFFECTIVE GVL. BELOW PIPE ~ I ~ "A" 4" DIA. F-810 PLAN VIEW SCALE: 1" = 10' CLEANOUT MONITOR TUBE 3 1 ORIGINAL GROUND -- FILTER BABRIC -- 2" RIGID INSULATION 4" F-810 PERF. 1/2" - 2 1/2" GRAVEL BOTTOM OF TRENCH CROSS-SECTION "A - A" SCALE: l" = 5' LOT 11, HAMANN S/D SEPTIC SYSTEM CONSTRUCTION PLAN AND CROSS-SECTION FLATI'OP TECHNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 SEPTEMBER, 2002 TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: __Lot 11. Hamann S/D DATE PERFORMED: July 25~_200~2 PERFORMED FOR: Frank Bethard DEPTH (feet) 1 10 12- 13- 14- 15- 16- 17- 18- 19- 20- GM/GP Gray sandy silty gravel Some cobbles and boulders Siltier above 4 feet 3s ML Tan, gravelly silt Dense, hard a.H, SLOPE Depth to Groundwater Date Seeps_@_8'-0" 7/25/02 '~W~ter (~ 8'-0" 81710-2 SITE PLAN Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 7/25 12" Presoak 2'(_3_/8 --877 12~Presoak 27 112 Add water & start 3:25:30 23 3/8 #-i 3.:55.~30 30 20_9/16 2 11116 Add water 3.~56 23 9/16 #2 4:26 30 20-5]-8 2 15116 Add water 4.~28 23 5/8 #3 4:58 30 20 11116 2 15/16 I I PERCOLATION RATE 11 (minutes/inch) PERC HOLE DIAMETER 6" TESTRUN BETVVEEN 3.5 FTAND 4.0 FT COMMENTS: PERFORMED BY FLAI=I'OP TECHNICAL SERVICES. I ~7"..~.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: .~'~,/,~ )L ~ 2_ O O ~_. TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: __Lot_l_1. Haman[~S/D DATE PERFORMED: July.25L_2_002 PERFORMED FOR: Frank Bethard DEPTH (feet) 1 11 14-- 15-- 16-- 17-- 18-- 19-- 20-- Pt and loam GP/GM Gray silty sandy gravel w. small cobbles Water seeps (downhill side only) ML Tan rocky silt Dense, hard (Not impermeable) B.H. SLOPE SITE PLAN . JEM CIRCLE Depth to Groundwater Date .~Seeps ~-T-0~0" 7125/02 W~t~r (~, .T2'-2" 8/7i0:2 Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 7/25 12" Presoak 31 12" Resoak j 31 Start 11:45:35 27 #1 11:5_0:_-35 5 23-~/-8 3-3/8 Add water 11:51:30 27 #2 11:56:30 5 23 718 3 1/6 Add water 11:57 27 3/16 #3 12:_0_2 5 24 3 3/16 PERCOLATION RATE 2 TEST RUN BETVVEEN :3~0 (minutes/inch) PERC HOLE DIAMETER FT AND 3.5 FT 7II COMMENTS: Recommend desiflQ be based on 0.8 gpd/sq, ft. PERFORMED BY FLA'i-rOP TECHNICAL SERVICES. I ~' ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: G~ttop Technical$~ 14530 Bcbo Street, Anchorage, AK 99516 (907) 34s43ss Lot 11, Hamann S/D Jem Circle, Eagle River Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a 1000-gallon septic tank that discharges effluent into a 71-foot long soil absorption trench containing a total of 4.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buffed utilities. Prior to the start of construction the contractor shall arrange to have a land surveyor set laths along the western portion of the properO, line south of the proposed trench at 50- foot intervals. This staking should begin approximately lOO feet east of the westernmost properO, corner and continue southeastward for 150feet. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved atter settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1000-gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 71-foot long trench to a total depth of 6.0 feet below ground level on the high side. The long axis of the excavation shall parallel an existing contour of the land. Prior to the start of construction the contractor shall arrange to have a land surveyor set laths along the western portion of the property line south of the proposed trench at 50-foot intervals. This staking should begin approximately l OO feet east of the westernmost properO, corner and continue southeastward for 150feet. 3.2 The bottom of the excavation shall be level. Any compacted or Smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 4.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipe laid level such that the pipe inverts are no less than 4.0 feet above the bottom ofthe sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. MUNIMPAUTY OF ANCHORAGE Ci 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. 050.621-14 Expiration Date: 1. GENERAL INFORMATION Complete legal description HAMANN LOT 11 Location (site address) 24560 JEM CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) MICHAEL ROWE & YAN LIU Mailing address Real estate agent 24560 JEM CIRCLE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: 3 Day phone Day phone Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ / LY -6 Date of Payment g0/41 Receipt Number '30116L- I COSA # O�S)C2 I 1 q71 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ / LY -6 Date of Payment g0/41 Receipt Number '30116L- I COSA # O�S)C2 I 1 q71 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 819/2021 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 coriditions 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of 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 A these various and dynamic characteristics and are outside the control of the evaluator of the r well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: •'�,9 ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWrS . / * ' Z-�' . •:* r 6. DSD SIGNATURE • • • _ / • • Curtis Huffman System #1 Approved for 3 bedrooms ����F6,'•, CE 128991 l�sfF�FloPROFESS1EWO0Np��� System #2 Approved for bedrooms �1�\\ Disapproved Conditional approval for bedrooms, with the follow``\cQ�!�� �V oma, �J ON-SITE IAIATC[� A yin rf1 y rPCrq� WAST --- ER ? = PROGRAM � By: Original Certificate Date: 2 - The 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: HAMANN LOT 11 Parcel ID: 050-621-14 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 12/14/2002 Total depth 187 ft Cased to 86 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/15/20 Static water level at beginning of test 116 ft. 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) MIS Collected by Date of Sample 7/30/2020 Well production at time of test 2.2 gpm Comments WELL / FLOW DATA PER GEG LTD TEST ON 6/15/2020. B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank **48" ® Standpipes/foundation cleanout per record drawing Date of pumping 4/22/2021/ D. ABSORPTION FIELD DATA Which system tested (date installed) 12/6/2002 ® ALL standpipes present per record drawing Total measured depth from grade 7_0 ft (max) **7.1 Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: _ **MEASURED 7/30/2021. Adequacy test date 6/15/2020 Results M Pass For 3 bedrooms Fluid depth prior to test 23 in **31" Water added 477 gal New depth 29 in ® Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 150 min ® Code -required soil cover over field Final fluid depth 25.25 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: ADEQUACY / FIELD DATA PER GEG, LTD TEST ON 6/15/2020. *AT MT F 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' ® Yes if No ft Wells on Adjacent Lots: 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' Surface Water >_100' _ ®_Yes, 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 From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® 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' ® Yes if No _ 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' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water >_100' _ ®_Yes, _if No _ ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / 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. low •'�� TM �¢I .... ... vw . Curtis Huffman ��� ����•.� CE 128991 ..•���� OFES51 Na��-1ft—�. ft ft 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. Flame 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: & 4 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 system/s 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. DSD SIGNATURE System #1 Approved for-3—bedrooms System #2 Approved for ` bedrooms go Disapproved Conditional approval for bedrooms, with the followin i J fr h. Gor —s.. t1 �rr4�`-y v 1CQC.,t/Orcressio #AECC884 tY SOF (r((rr���� ON-SITE WATER AND R' 4%Lu PROGRAM 90 Original Certificate Date: 7-/0- 20 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 _— _— Nitrate_ Advisory - ----------- Septic -System -Advisory- ___.. __..___.__.-_ _ Arsenic Advisory Well Flow Advisory Other COSA blue sheel_10-10-12.cloc JJ{{ nnli Legal Description: HAMANN S/D; LUT 11 It more than 'I septic system on loft: COSA Checklist # 1 of I A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1111/02 Total depth 187 It Cased to 86 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flog/ test for COSA 6/15/20 Static water level at beginning of test 116 ft. Comments B. TANK DATA Age of tank(s) 17.5 years Tank type/material STEEL Measured operating fluid level in septic tank 50" ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/18/2020 � D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 12/6/02 ❑ ALL standpipes present per record drawing Total measured depth from grade *7.0 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field ❑ 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 N/A gallons Comments/Deficiencies: `AT MT COSA Checklist yellow sheet Parcel ID: 050-621-14 Structure served by this system 1 Well production at time of test 2.2 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No X Coliform bacteria is Negative Nitrate mg/L © Nitrate less than MRL (ND) Arsenic ug/L r'�71 Arsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample 6/15/20 C. LIFT STATION ired maintenance completed Age of lift statl�,. years Lift station material Comments: Adequacy test date 6/15/20 Results [DPass For 3 bedrooms Fluid depth prior to test 23 in Water added 477 gal New depth 29 in Elapsed time 150 min Final fluid depth 25.25 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date NOWC 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' r7l Yes if No Community Sewer Manhole/Cleanout > 100' [�✓` Yes if No ft 7 Yes if 1'\10 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 it Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' R� Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M -/Yes if No ft Q 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' ® Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Yes . if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' R Yes if No ft Water Service Line > 10' Q 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' n✓ Yes if No ftIf absorption field is under driveway comment below Property Line > '10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > '10' M Yes if No ft Private Wells > 100' [✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' r✓ Yes if No ft Surface Water > 100' ✓/ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet #AECC884