HomeMy WebLinkAboutchecklistCOSA Checklist
Legal Description: SOUTH LAKEWOOD HILLS; BLOCK 2, LOT 3
Parcel ID: 015-511-28
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
R Well log is filed with Onsite (or attached)
Date drilled *1967 Total depth 178 ft
Cased to UNK ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 9/23/2025
Static water level at beginning of test 125.5 ft
Comments *NO LEGAL DESCRIPTION ON WELL LOG.
B. TANK DATA
Measured operating fluid level in septic tank *51"
Date of pumping t b j
❑ Required maintenance completed, if AWWfS
Comments: TO SLUDGE IN ST1. 50.25" IN ST2
D. DISPOSAL FIELD DATA
Which system tested (date installed) 9/19/2002
Q ALL standpipes present per record drawing
Total measured depth from grade 12.5 ft (max)
Measured depth to pipe invert from grade 7.6 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective *58
.X Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 1977 gallons 9/23/2025 date
Any rejuvenation treatment (past 12 months) NO
If yes, enter date
Well production at time of test 7.5+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes 0 No
[9/coliform bacteria is Negative
Nitrate 1, 00\ mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L El Arsenic less than MRL (ND)
Collected by GARNESS ENGINEERING
Date 9/23/2025
T STATION
❑ Require tenance co
Age of lift station rs
Lift station rial
ents:
Adequacy test date 9/23/2025
Results Q Pass
Fluid depth prior to test 19.25 in
Water added 579 gal
New fluid depth 21 in
Elapsed time 35 min
Final fluid depth 14 in
Absorption rate 450+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 62 in
Effective depth used 18 in
Effective depth remaining 44 in
Comments/Deficiencies: *BASED UPON GEG ELEVATION TO INVERT OF HIGHEST CO INVERT.
COSA Check] ist_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100'
]Z Yes if No ft
Neighboring Tank > 100' M Yes if No ft
Disposal Field on Lot > 100' Q✓ Yes if No ft
Neighboring Disposal Fields > 100'
R Yes if No ft
Sewer Line/Main > 100' Ry/ if No ft
Sewer Manhole/Cleanout > 100'
Q✓ Yes
if No ft
Sewer Service/Septic Line > 2521 Yes
if No ft
Holding Tank > 100' 0✓ Yes
if No ft
Animal Containment > 50' Yes
if No ft
Manure/Animal Excreta Storage > 100'
0 Yes if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10' 0 Yes if No *51+ ft Surface Water > 100' Q✓ Yes if No ft
Field to Foundation > 10' 0 Yes if No ft
Tank to Property Line > 5' p Yes if No ft
Field to Property Line > 10' [Z]Yes if No ft
Water Main/Service Line > 10' ❑✓ Yes if No ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL.
Wells on Adjacent Lots:
Wells > 100'
Community Wells > 200'
FZ Yes if No ft
0 Yes if No ft
If tank or field is under driveway comment below
NOTE: EXISTING STEEL SEPTIC TANK AT THE END OF ITS USEFUL LIFE.
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6979
Engineer's Printed Name Jeffrey A. Gayness, P.E. 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 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.
COSA Checklist_May2025.docx
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