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HomeMy WebLinkAboutSHRYOCK LT 1AOnsite File Shryock Lot 1A #018-252-07 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221274 PID Number: 018-252-07 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade Name MICHAEL & DOROTHY WARNER ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 2900 NUGGET LANE, ANCHORAGE ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SHRYOCK _ 1A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface water 100'+ -- GREER 1250 Gal. Material Number of compartments Lot Line 101+ __ NA HDPE 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Installer MIKE N ANDERSON PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfteld CO/MT 3034 Inspector MNA/FWC BENCH MARK (Assumed elevation) 100 ft Inspection Is' 8/18/22Location dates: 2"d 8/18/22 and description 3rd 4t' TOP OF RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional •" Approval: Date `' �$ 2 .. .. . . .: . . Septic System Approved - Curtis Huffman ��¢ ����•, Date ®? CE 128991 .• ���� slF'P�0 8/23/22 �� pR4FESS14N ,� Note: this approval does not include well permit requirements. PID: 018-252-07 13 0 to RETAINING W Lot 11013 A -C=58,1' B -C=19.2' A -D=56.7' B -D=23,8' A -E=56,6' B -E=28.9' PERMIT: OSP221274 NUGGET LANE r --WIRE FENCE EAST 105.00' '� 2.0' CANT z DECKS O I RFTAININ(; WAI I 10' UTILITY EASEMENT 100' PROTECTIVE --WELL RADIUS WIRE FENCE Lot 2 (n O SEPTIC SECTION SCALE, NTS SHRYOCK LT 1A SUPPORT®SERVICES:AZ PREPARED FOR: ®`S�' OF`Q MICHAEL & DOROTHY WARNER Fwc.5 ®"�'� 2900 NUGGET LN C ®, 9 TTI ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 8/23/22 rtis Huffman 13030 SUES WAY SURVEY: LANG X CE 128991 w DRAWN: FWCS 8/23/2022e FirstWaterAK�gmail.com ANCHORAGE, AK 99516 SCALE: 1" = 30' ®® ssiovl ' 907-350-9566 ®®� MT CO MT EXISTING FIELD G7 ��C°�G F� DIV O INSTALLED 1250—GAL HDPE DCO SEPTIC TANK e / CO fT1 < �l MH ® BM: MH TOP MT. C r -- D - FCO -- 100' WELL RADII MH/FCO: ALL01 ADEQUATE B A 66.3' MAINTENANCE 4 BED HOUSE CA Cn J 47.4' _ C° FlfN U' 18.9' 26.0' '� 2.0' CANT z DECKS O I RFTAININ(; WAI I 10' UTILITY EASEMENT 100' PROTECTIVE --WELL RADIUS WIRE FENCE Lot 2 (n O SEPTIC SECTION SCALE, NTS SHRYOCK LT 1A SUPPORT®SERVICES:AZ PREPARED FOR: ®`S�' OF`Q MICHAEL & DOROTHY WARNER Fwc.5 ®"�'� 2900 NUGGET LN C ®, 9 TTI ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 8/23/22 rtis Huffman 13030 SUES WAY SURVEY: LANG X CE 128991 w DRAWN: FWCS 8/23/2022e FirstWaterAK�gmail.com ANCHORAGE, AK 99516 SCALE: 1" = 30' ®® ssiovl ' 907-350-9566 ®®� 0 rKj WIRE FENCE EAST 105.00' RETAINING WALL to 10' UTILITY (6 SEPTIC EASEMENT PIPES LMANHOLE \�100' PROTECTIVE 10.7' \rWELL RADIUS 66.3' `` STORY RESIDENCE \ FULL SSMT. LA W/ ROOFTOP DECK _ \ • " iEUI47.4' 1O WIRE FENCE I1 Ilii N 4!19.9' 26.0. Lot 2 \ / I Z I 2.0' CANT DECKS t/1 z RETAINING WALLS O 1 10.1'x12.1' Vi Lot 1108 O SHED o I 0 I WELL f*i WIRE FENCE N � Lot 1A -----/ \ 31,202 S.F. 10' UTILITY EASEMENTS I I Lot 4 10' UTILITY - CHAIN-LINK FENCE -/EASEMENTS WEST 105.00' Lot 115I F Lot 116 B PLOT PLAN ___ AS BUILT _X_ SCALE _ 1__= 50' GRID _ SW 3034 Project No. 22-462/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken®langsurvey.com o OF A jonothan0longsurvey.com I hereby certify that I have surveyed the following described property: LOT 1A, BLM 109, SITYROCK SUBDIVISION (PLAT No. 74-45) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _°j' Day of __�_ M'1 --I_, at Anchorage, Alaska 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. ��Q: • '•� of ?* : 49TH -y* . . KEN ETH G. LAN - .o ��4�F OAR '••.LS. -5202.• gJQG ••..• �Do ppb �FE'SSIONA� �� 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221274 Work Type: SepticTank Upgrade Tax Code Number: 01825207000 Site Legal Address: SHRYOCK LT 1A G:3034 Site Mailing Address: 2900 NUGGET LN, Anchorage Owner: WARNER MICHAEL M & DOROTHY L Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: �l,�cnt S' SON v Department 8/1/2022 8/1/2023 31202 ❑ Disposal Field 0 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 (2417). 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 Received By: Issued By: 8/1/2022 Date: Date: 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 018-252-07 Property owner(s) MICHAEL & DOROTHY WARNER Day phone Mailing address 5202 ANTILLEY ROAD, ABILENE, TX 79606-5986 Site address 2900 NUGGET LANE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SHROCK LOT 1A Legal description (Township, Range & Section) Lot Size 31,202 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank EUpgrade MDuplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. • (Signature of:property owner or authorized agent) Permit/Rush Fees: o� `j Waiver Fees: Date of Payment: 1 `I �C7� Date of Payment: Receipt Number: 1 I 1 I .� Receipt Number: Permit No. C�SP�� `� `4 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 15, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SHRYOCK LOT 1A – 2900 NUGGET LANE, ANCHORAGE The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by private wells and will be staked by a RLS prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221274, Rebecca Carroll, 08/01/22 FIRST WATER CONSULTING LOCATE ALL WELL RADII PRIOR TO CONSTRUCTION. SHRYOCK LT 1A DESIGN DETAILS: NEW ASB AFTER TANK INSTALLATION FOR IR. NUGGET DRIVE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221274, Rebecca Carroll, 08/01/22 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number:c� I S "-- o -�" Name: Wastewater System: ❑ New 'Upgrade tCL4AP_t_ l,t g%QN&--� Address: ABSORPTION FIELD 2RbC�, N t, et rr`r LN ANc V- 919S/q _ f Phone: 3Y6— No. of Bedrooms: 14 (Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: C7 Total Depth from original grade: ®, GPD/S . Ft.©• Lot: Block: Depth to pipe bottom from original grade: Gravel depth beneath pipe `'Subdivision: Su e7ocr, --a .3 r Ft. o Ft. Township: Range: Section: Fill added above original grade: Gravel length: / Z Ft. &5 Ft. WELL: ❑ New ❑ Upgrade Gravel width: qe Number of lines: y I Distance between lines: r 2 Ft Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: I 'g! �2 v V IaTa Ft. Ft. I C:>SG. Ft. 3C 3Zq o Driller: Date Drilled: Static Water Level: Installer: Date installed: t::; I Ft. A {`Flora=�A2vtcE Iol ?_ Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft, SEPARATION DISTANCES tMeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines &XfS�lf-%fit. Material: Number of Compartments: WeW /COE 101: •� 8 "S Surface e — LIFT STATION Water Mo't /004 1 Lot Size in gallons: Manufacturer: -� Line r �© S `— "Pump on" level at: "Pump"pump of High water alarm at: Foundation I �r 2$ � '— s r Curtain��. ..._ Pump Make 8 Electrical Inspections performed by: Drain 100 lave BENCH MARK Remarks: Location and Description: `�"IZf?.IAVf�ST Jr.t�/tn�ti -rF}� r "rAivCLS rLON'�'Ar�catZ "TF12esAotl� CoN�t:'z'4F1� LA '� Qo'.�"i'-�'1' Ct•vG� Assumed Elevation: `TCJ r�-S2_ eIoC9� u/uIF� ENGINEER'S SEAL WItNOR-'O ¢G12 `V�hl✓6Vtvl- W Taf p. FrX Y !%,*,�'N w1A't'- ,%i"c'^exr rte. te, +,� r{ r e �`� -1� t1�.1 }`tCJ hi�.�- t'•� /01 Z,iriia Inspections performed by: a r Dates: 1st o.oa sa•.aarr.f naaee>a.>anRan..11 v+I ov, !-,H. ky +1 2nd /0126/96 ,..; .�,,.•........:.:.........�, , -xep 7 TNrat ll�alga g Steven R. Pannone r': °: Department of Heal and Human Services approval p 0149 bis r� _ ���o:f����Q�S�y,� U' Dater '�,, Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 �__-_-- A S�-,BUILT WASTEWATER ABSORPTION SYkT M LOT i, SITYROt;K ti i I � I I Exist 1250 Septic Tank—. To be Ve�lflecl_l_',_ I Driveway I ; T. .Swlny-Ties rn I A 1 n 231S 34,5' (-=4 153,7' f—` �+50,5' 55,5` Well po;! L:qs [-i/_ Wal ¢( � I 'i. T � f; I I I I I - Weil I 10 Wat k' lSITYRI:,: WG ® .....��. /�5A�9 ,45.a ,4 ••e'�s®7A I - '��Git� P•'••• A ®M®s! - �o 49TH ...............................................� I • • ••••• ......•••.••...... b'M%Steven PREPARED FORT R. Pannone: y 0 CIM Mike Warner "®® .e No CE at4s a� 2900 Nugget Dr, v®���"•,•,�,py0,29 ''� I Anchorage, AK 99516 ��4w� -GC1la''_ew®® -Qo/�� % lla r _' =e) _ •. es_ -gym?_ 1 117 U / / JKO OJ 71 Driveway I ; T. .Swlny-Ties rn I A 1 n Exist, Crib to Remain No wells or septic systems within ! 200' of proposed System. �__tNew trench 65' long, 2' wide D' effective 1 II 5' L c t LII l2 1-1 11V CIS narnni.Prl. by T1HHS I I on 10/25/96, n 231S 34,5' (-=4 153,7' 45,5' �+50,5' 55,5` 5 1 27,d' 60,2' Exist, Crib to Remain No wells or septic systems within ! 200' of proposed System. �__tNew trench 65' long, 2' wide D' effective 1 II 5' L c t LII l2 1-1 11V CIS narnni.Prl. by T1HHS I I on 10/25/96, n I 1 I o I I I I I 1 h I I Sall Rating = 2'50 sf/br 1VI,V sr. Rau Deslgnl o' E..rftictive 10' Total /Depth 6 ?' U101n, 'V Long Total cbsorption PANNONE ENG: SVC P n BOX 142025 ANCHnRAGE, ALASKA 99514 272-8218 AS -BUIL I AS—BUILT DE I AILS 313 WASTEWATER ADSORPTION SYSTEM LOT 1, SITYR❑CK I I I I c tn1 I inONV3-10— j:si ti#i I a I IL I IIi 2H i I 0 I � I I Ip�p�_t {d' s I ria I I� IFI5?'ri L C y l h<I L OI I Io II MMI I 1 WIN] d J I I d JJLl G W° I 3Qnl aollNawT—f(�ft G". ml—° U Il [1 # fa M I� (fPl I I (tel c� I i(#��{#►� r� 1fUNV313 --- roar c I I I �, rU I 1 I I I c I I _ 11 ... I - � -- '� 1nf1NV3'I� I I-e,s v w - I I i i-1 1fU7NV313 4- C v 1n�N'?3'1'J ti n QX CU.o LL � u 4- fi' $ 4- NOIlwaNn0.1 O O .. _ I�------------------ - v CI\Work\1-SITYRK,DWG (15{11. ,. .......... PREPARED FOR, I PANNONF FN(,. CVC. �wLi •: a nr O4 AI .® I Mike Warner I P. fl: R0X 142025 I O IV V. VG U ru i °P om`�.°• oba2a ° �•" 12900 Nugge t Dr, I ANCHORAGE; AL ASKA 99514 h•'�'............ IK\ _�� I AnrhnrnnP; AK 99510 I 274-0303 272-A?lO FAX I ®Q®n:�! �� e►�m r907> 346_6591 nnATEt 4 -PI -97 I NOT TO SCALE AS -BUILT ® Minueip -ty of Anchorage Department of Health and Human Services 825 1" Street RickMystrom, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 June 17, 1997 Steven R. Pannone, P.E. PO Box 142025 Anchorage, Alaska 99514 Subject: Waiver Request for Lot 1 Shyrock Subdivision Waiver Request #WR970025, , PID 11018-252-07 Dear Mr. Pannone: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 5 feet from the east property line to the septic system. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljw 117 Warner Property WR# WR970025 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet PTD# 018-252-07 HA# Date Received: June 13, 1997 Legal Description: _ Lot 1 Shyrock Subdivision Engineer: Steven R. Pannone, P.E. Permit # SW960345 PO Box 142025, AnchoraRe,Alaska 99514 Applicant: Michael Warner Waiver Requested: Lot line waiver to the east propertyline of 5 foot. Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: x Waiver is NOT Granted: List Conditions or Reasons for. above: 5up_ oa. Pj6Rd,/ 7- 34 Date: %— �]- I % By: P#A1 Name of Reviewer C Rec #: � `L: Amount: $ ���v�� Date Paid: (.P- -cI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 i1 L�(SYi ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960345 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:WARNER MICHAEL M & DOROTHY L OWNER ADDRESS:2900 NUGGET LN ANCHORAGE AK. 99514 PARCEL ID:01825207 LEGAL DESCRIPTION: SHRYOCK LT 1A LOT SIZE: 31202 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:10/10/96 EXPIRATION DATE:10/10/97 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING S. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE TOTAL 63 FEET OF LENGHT OF THIS L SHAPPED TRENCH MUST BE MEASURED ALONG THE CENTERLINE OF THE TRENCH. RECEIVED BY ISSUED BY:. /0 - 2F- ?� DATE: to [Z& ceL DATE: E N6'AlAfl? C 191-4 &0 � (?F_(vrsreo 1v T / i,, /$'/veR To 7Xow EIVX i 107' /1vE IN onDF_R To kEEn DFS T7d� 5 % Szope Ta T/i ST, Zx, 1roA) Y?e:too@%. ), ,' 'I �' �-. 1, I lol KY i 1', i 11 0 i; I int; 11 v I.;1 i . � � I, � , t- I ", ;_, t: �: -i ! 11; t;, 11 �7 C 1!: ( wil j 10 t L i K 1 40050", "i 0. v; cc Y' v 0 L-11 1!: 11 aI watur Sys Il_ sL111.1, sys to, llitr W, I I v 1: -'.- ;] 1t 1;' a C1 111 1 vu, 5 ! til V'-%il I S uch i 11S ta 116 t ltins . u ci h(E'fl it r In s a s v r v n s 'i o i. a r L ':tilitiylSiu11 11 11 (1 a Ix 6 Ori 1. S im aF1 A 03 vi" A i to I I i kJill b v raq u I red Lit o L i I w, t a4-%.,-. 1m V i Ya 1,01' M q It i d L 10 rl S IM I ater LiOn Am,;l,c:,t ,-i , 1 7 '�", . f; C C- /0 0 1, Solve I, Systupi sof;!.%' rl(A 1.,eet the 17'O -foot v' v 'I I dist.uI4-o aad is unly 67 fuef, tht-wiAll and, t.,i.. rail -,itbor- 1S U031 VPr'VUXhQQ131 10 NO; from tat wil L !I v L ,y0 u h a v C y 0 m r 11 d Le ' t a S t a A an a rc ealar t.. s -to prulx<:l. th'; hoalth of an"O"O Wrinkinq toe mLor. Steven R. Pannone, P.R. P.O. Box 142025 Consulting Enghieer Anchorage, Alaska, 99514 (907) 272-8218 (907)272-8218 Fax October 8, 1996 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 1, Shyrock Subdivision Upgrade Permit Gentlemen: My firm was contacted to investigate the possibility of installing of a replacement system at the above referenced property. The existing crib system has failed. The owners are having the septic tank and crib pumped every ten days. The system was installed in 1973. I was requested to investigate the possibility of installing a new system adjacent to the existing system. A single test holes was excavated on September 29, 1996. The soil report and percolation test results are attached. No ground water was encountered. The lot is approximately an 0.75 acres in size. It slopes to the north at a rate of approximately one to three percent. The proposed installation will be located greater than 100 feet away from the well serving this property and 25 feet from the water service lines. The surrounding systems are located greater than 100 feet from the proposed installation. Both neighboring wells are located greater than 100 feet from the proposed system. The existing septic tank will be inspected and if found competent, reused. A new tank will be installed if the existing tank is not found competent. The existing soil absorption field will be reused. A diverter valve will be installed between the septic tank and the two drain fields. The new drain field will be selected for use. See attached design. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, Steven R. Pannone, P.E. Attachments: c:\W0MJ-s1Ivttx.001 I C\ DESIGN WASTEWATER ABSORPTION SY T LOT 1, SITYRO'C.K Well New Zabel Z2000 Flow Director >I L R i-• a Driveway zi oaa Exist 1250 g' - 57. i Septic Tank To be Vqf ied N �f 3 e;gi � x O 25%--i r i 0 Well ~_ 2%--- I .' 491H ,on R. Ponnor No. CE 8149 PREPARED FOR, Mike Warner 2900 Nugget Dr, Anchorage, AK 99516 (907) 346-6591 Exist. Crib to Remain No wells or septic systems within 200' of proposed system. Proposed trench 63 LF Soil Rating = 250 sf/lor 4 Bedroom House 1000 sf Rqd Deslgni 8' Effective 10' Total Depth 2' Wide, 63' Long Total absorption = 1008 sf PANNONE ENG. SVC P. O. 13OX 142025 ANCHORAGE, ALASKA 99514 272-8218 4TE, 10-7-96 DESIGN '96 Et 1'=60' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PERFORMED:``',l�r3.9c%:`r'+wt..;°�'` LEGAL DESCRIPTION: L—O'T l 5 1i t2cxK sl.D Township, Range, Section: DEPTH SLOPE SITE PLAN ( ©�Tl r— 1 2_ 3 4 5 6 7 8 9 10 11 12 31415 13- 14- 15 16 17 18 19- 9n �Rrave-S w(-nom«� �saNT� lit r iZ Dt IKI,06, WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After Monitoring? "t�sR{ Date: Reading Date Gross Time Net Time Depth to Water Net Drop ■■■■■■■N ■ lad 6.74 `/ ■O■lWOVEN= 3 L 3/4 ^/ 13 1 Z 3 (6 s/ t/ /a- 13 1 131 3 ('-1/8 L/S zt 3 46 Vy `/ Reading Date Gross Time Net Time Depth to Water Net Drop lad 6.74 `/ r © R 3 L 3/4 ^/ 13 1 Z 3 (6 s/ t/ /a- 13 1 131 3 ('-1/8 L/S zt 3 46 Vy `/ PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN S FT AND FT COMMENTS t �ST�I©C� CVAs �F2GSC9:aK�� PERFORMED BY: ;S, R (' PLA2A/Dn)G—i ' �' .t I 'V CERTIFY THAT THIS/TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Gki I 001 POI I Z200 Flow Divider Zabel 100-D Flow Director RANDNEWFOR94 F and �11! I 'F'I, IN Ilct, I-: I Villa( r� j- Lit llt,t! I',., - I:, :11,11C eflet.:lk vmltle,[}jcl '111 "� I 'I , i -h� ��jv , , I; t I I to instillt. Al 071`1�-t Ti�ctmmuf.mmi-vl from -,j- TlAj!", M!'t I --Ilicd PVC .11ld C'u-I.N. bl,cl Lifetime W;ii-i,iiiit\,if*l),Ill'l.11l,IL[Cri)lll,ll)tlf,l,ltjlL't',,I,,iL-,tII)ll:,lk, . 111I. -1110t include rep I ziccinCtl 1 1',111- 111'r IOU l',, Z,i!,t- I I: I, Id, I- "til i; I, it it 1 1 1. Flow Divider - Z200 1. The Flow I)i% Me). III': I II'll'C'I CHILICIlt ILI_ the septic tiAllk Illk"Ill, -,f 1 j);IrcI-tcd IL'171171.1' design that instirc, t!it. I 1, 11\ 1, evvnk Ij% Itic'I C% CIL l if the Him I)j\ i(II-i I it ;! j,I,I-fL,CtIN . lc% cl, 2. The inlet I)II-Cof dIL' I 1-1\\ I)J\ijCI i�k(IllItILMI'd sOthatcffluunt \Nil! ill ,1 !1''111 crosspilIC in 11N'0I'tjiidI 3. Distributes fit)\\ Tette! I I l'in D-I)oxc, In illi - folds th;it irc 1 11 ! ri It I I (.11\ I. or I:: t !L I I Ill settling. 4. Testing shows th,i,- tNIthil divisiortoftheflim \N,,, Illrnl,l 50/50. A timthi,! D -box or manifold ki.,ii- the tlIm (111ticl tht"N., Silille Condition'. Special Features! • ManU61CtUIVII fit I I I I I I I (h 1) 11 It I l,IL"l P'N'll • Always ilISLINI an il\ I': I 11, t,\ . • Doesn't create solid, 1)uAd Lij,. • Will not clo" • Lifetime Warriltit't Laboratory Test Results using 10001111 samples (0, A% cra"U Level Distribution Right Port Left Port 400- 1/6" Tilt Right Port 5c Left Port 4L) Ill 1/8" Tilt lidd (If \01.11 ChoILL- ,ljjkl Right Port 51. Left Port 49-l� !M Flow Dircctor - 7200-D Ti),- F!, .•%. " ) it , 1 ! 1, 1 11m [)I\ idcr with I p,it- U1,11t"I -!k I " , , .11' . tkItliltl il'LJ(C!hVCftlU- vill 01, It I. I lidd (If \01.11 ChoILL- ,ljjkl llt!ll 10 IL"I IIJItlI IleCtIt'j 1111-Imilicalli, 1-C,11II'Ll' the w,l�, the cll,ndary firlLl :inti litkIlit"lif 11J, I t[L)c'm I)vrtocIl;ul--c tile 11VI (,I I, 11.111gil, the I' ,tht. F!"Tur little Uofoltu- (I'llt 1i, 1h1, I. -„-ill,. 3'L' n, It IIJI111CI) 11111 I I'loll- I iL'111 It N I'i: LK-Ilt hi. -A I 'Lit It"LlIl - Hll-, W Mlilmlloll. i. At i k (.,ilk 1I I(,, Illitlk lk-r\ t III I I 11, , I11111tI11\ ,.111 R-thrUl I thIl Idd thC I )j'J'ORLIMI 10 regi • . GRED 'R ANCHORAGE AREA BOR'%'1GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ea5J/ G MAILING ADDRESS PHONE /�d91/I�/✓1l�iV LOCATION�i`'/l/��J�� d,��r/E �G' LEGAL DESCRIPTION G�T� ���y✓G/JG/� f!/!, SEPTIC TANK: DISTANCE cc�� cc i _ NUMBER OF FROM WELLMANUFACTURER MATERIAL fjh`G COMPARTMENTS INSIDE LENGTH INSIDE WIDTH v LIQUID DEPTH `LIQUID CAPACITYZ1-sz' GALLONS. SEEPAGE PIT: , , , isxisxiU x73 NUMBER OF PITS / DIAMETER OR WIDTH_, LENGTH-=, DEPTH LINING MATE RIAL1011 CRIB SIZE: DIAMETER �—DEPTH 1L_ DISTANCE FROM: WELL ��5✓ rte, TOTAL EFFECTIVE BUILDING FOUNDATIONS 7 NEAREST LOT LINE /` ABSORPTION AREA (WALT_ AREA) J7��� SQ. FT ADDITIONAL ABSORPTION WELL: 7l>f % ./J1JJ=rs �� �e;7�% GrJ� Gam. G�ic� /f�'/'✓Z�u-c-.c%� ��>✓i.�:�� TYPEiF'✓ �'C/�J7� CONSTRUCTION DEPTH _ ��/ / DISTANCE FROM: BUILDINGNEAREST NEAREST SEPTIC�r_/�U FOUNDATION�Gv� LOT LINE SEWER LINE �'e TANK SEEPAGE/Z /__,r SYSTEM CESSPOOL OTHER SOURCES,!! � '�!/��l/if/�sy»?5;7�" APPROVED DISAPPROVED c/ REMARKS DISTANCES:DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: 't2'i lJL_/ tl y fv ANn LOT SLOPE: \ REMARKS: — A - DATE G.A.A.B. Form No. EQ -031 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM LOT 1, SITYROCK v aL yy a. °a' a !1 a u ,LL d Y l FL- C Ld R O S J c LA u *a d z uWc L Q 3eni aoliNOW ; w o 0)cuv WC , Ca h 0 1 $; Li AMNV310 • z e• lL A tU u > r 1nONtl310 L ... -. ---- inONtl310 p+' anlnn JW08MQ r- - C ..NC -p S 41 L kD ,5 -y CDi OJ 4J L +• l AnONtl310C ¢ i' 4- Cl. d ti -pjv. Ln -fj 1nONtl313 Gw p F4 l w {, 0 3 +rC� ...I ......:...... �y�� LA - o u 0F o: �,.. '• ',"j�®�® NOIlbQN(310j F- IN (�n :� ¢gni Cl\Work\1—HIGNS,dwg Z -p(U-0 ..................R.....� r�PREPARED FOR, PANNONE ENG, SVC. is :,Steven R. Pannoner'�j� Mike Warner 4# X ' No. CE 8149 ��/� P, Q, BOX 142025 `'o,,.��{aAll 2900 Nugget Dr, ANCHORAGE, ALASKA 99514 ®b "••••• • ••••" ®+ Anchorage, AK 99516 274-0308, 272-621B FAX (907) 346-6591 DATEi 10-7-96 ToSCAL DESIGN GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3330 "C" STREET ANCHORAGE, ALASKA 99503 �) p TELEPHONE 274.4561 Ae h1i(0 I,N\. SEWAGE DISP®SAL, SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT *' �' JJY)" ",1�-"�g^ -- MAILING ADDRESS �J �'`- p / s � PHONE y�"�� INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE_ AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH ✓ G� —SEEPAGE PIT_ TO BE INSTALLED BY DRAIN FIELD _ , OTHER GL':' V • f�0 ora SOIL TEST RESULTS A Us "`r — -- NOTE: THIS PERMIT IS NOT VALip WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITFIOUT FIINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT'PO PROSECUTION. SEPTIC TANK SIZE jI J� u (� TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK -- 1 FOUNDATION TO SEEPAGE PIT �J DRAIN FIELD SEEPAGE AREA SIZE ;F_ 'e/`�AL `x ' ` -- SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK _ SEEPAGE PIT C r DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK - SEEPAGE PIT /� Q —• DRAIN FIELD _. ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK _J --. SEEPAGE PIT —. DRAIN FIELD— --. SEPTIC TANK, I -G&- /—. SEEPAGE PI'I —. C.+i DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL.. A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS, GRAVED HACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. zlu-ki— - G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. n--, DATE / %!; . � / 8 /_�YAPPLICANT'S SIGNATURE X FORM NO. EQ -016 comiftuction. gel -faU "One test is worth a thousand opinions" 5828 TUDOR ROAD, ANCHORAGE, ALASKA 99507 a TELEPHONE 333.8472 Performed For DAPre Com.��gSMuSSeA Date Performed 5- I 72 Legal Description: Lot l Block Subdivision_ L0.)rSO- This Form Renorts Soils Loq _Percolation Test—_ 0 to t2 M 8 n In 0enth C.,n+ Cnil f'Vharari-oricf irc Was Ground Water Encountered?Pt) If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H2O Net Drop 0 �4 1 ( e.'4 tl (aa I• � Was Ground Water Encountered?Pt) If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate Minute Proposed Installation: Seepaae Pit epf Drain Field Death of Inlet '- 7-1 Depth 1'0 Bottom Of Pit O 'rrenc-F-4 r n M M E N T S : _—gyp s _Jai' �a—u�r� L_� �/L �_ keel e6 d sty Test Performed By_i�vt—,/i�, _ Data certified By:.sT57�< A -A 6 M t9- afso9 9 LOA- D a t e_— GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 2798686 Date Received— - Time of Inspection Z� Date of Inspection./�j' REQUEST FOR APPROVAL OF INDIVIDUAI. SEINER & WATER FACILITIES FOR 1. Approval Requested Address: S ��%.l fli_ %� f/� / __ Phone: l 2. Property Owner:sj� f Phone: 3. Legal Description: 4. Location:/i/�i f�j�� GCi�/✓ 5. Type of Facility to he Inspected:^ S i✓G /� i41-%� Number of Bedrooms: 6. Well. Data: A. Type_,s 1, 2 ,� �9 5' �. B. C. Construction D. 7. Sewage Disoosal Svstem: Depth Z�Ll Bacterial Anal sis J,. Y e� ��� 1,/i�i A. Installed B. Installer C. Septic Tank: 1. Size — - 2. Manufacturer, D. Seepage Pit: I. Size 2. Material E. Disposal Field: Total Length of Lines 8. Distances: A. Well To: Septic Tank Absorption Area _ Sewer Lines — -- �, Nearest Lot Line/Other Contamination B. Foundation to Septic Tank Absorption Area C. Absorption Area to Nearest Lot Line RequeEt for Approval of In idual Sewer & water Facilities 1 -age Two 9. Comments: //i/ /%�Ge= p�✓ .�iJri����_ ��'%�'L��/tiyf ���i-G,���/✓vim �<1C /,�'L% Aorroved Disapproved Date Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM T certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date llo.jo Two J f yo 'i vi c y 'i A I` N O N co fl - 4i N 0 0 O i ti C) i N LO N i VI - C) O 0 L Lf� O') Y U 0) co L- 0 O L C _Q Q Z J —J U W O O 2 Z CO CDO o0') N ZZ N U U Q) ca J (n 0 X 0 0 Q Q m (Q C O C: O i N O N cu O cn E O U I L) 0 cB Oil LL 4.- CLCL 4 N L �9 fQ O <11 q C== a � U m � (B cv CU N L I` N O N co fl - 4i N 0 0 O i ti C) i N LO N i VI - C) O 0 L Lf� O') Y U 0) co L- 0 O L C _Q Q Z J —J U W O O 2 Z CO CDO o0') N ZZ N U U Q) ca J (n 0 X 0 0 Q Q m (Q C O C: O i N O N cu O cn E O U I L) 0 0 4.- 4 N L cn fQ O (B L CU cn t O -a ~ O ~ a) U i 0 O v a) aa) C 'a) .- N cn = N a) O i (B Q ._ ai L O cn i > O a) V ( 7 O -0 U ' NN _ O Q Q U a _ 4--N — O ca a) p i� 3 a) O Q O •Y) �: _ z L a cn j c Q 0 o m O C Q CL Ea) Q N L U) O v O E_ X a) R C L U) -� N 0 Ln SNE m -0o > Q- O Q Q N N 70 — En 0 > U LL. 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SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MOA WAIVER #WR970025 (FIELD TO EAST PROPERTY LINE). 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/8/2024 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 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 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 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 5/8/24 MUHMPAUTY OF AHC HORAGE Development Services Department 3 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-252-07 1. GENERAL INFORMATION Complete legal description SHRYOCK LOT 1A Expiration Date: Location (site address) 2900 NUGGET LANE, ANCHORAGE, ALASKA 99516 Current property owner(s) DOROTHY AND MICHAEL WARNER Day phone Mailing address 5202 ANTILLEY RD, ABILENE, TEXAS, 79606 Real estate agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-( Waiver Fee $ Date of PaymentgAzh--L Date of Payment Receipt Number 1 i 2Z0 l Receipt Number COSA# 05G22/y 2a Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE. AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8118/2022 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 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 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 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or no estimate of how long a system will function satisfacto�Q;•' • • • •S�-`�� for current or future occupants or guarantee that no unseen encroachments, deficiencies or /g.' discrepancies exist can be given by First Water Consulting FWf,,S *'49 Tii •'* �� .• ...... 6. DSD SIGNATURE r Curtis Huffman - System #1 Approved for bedrooms��� �<`��s•,. CE 128991 ••.���'� System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: C,\Q p ff Y pF �6,, ON_ o oVVAT M W FR qlVf)G) Z5 r—n PRO A7 iJJ2J� C,' ERV I CE By Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other • Legal Description: SHRYOCK LT 1 B Parcel ID: 018-252-07 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1966 Total depth 97+ ft (PER ACOUSTIC READING) Cased to 40+ ft (ASSUMED) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/6/22 Static water level at beginning of test 74 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Structure served by this system Well production at time of test 2.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 0.202 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L _ ® Arsenic less than MRL (ND) Collected by FW'C Date of Sample 7/1/2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Which system tested (date installed)10/25/1996 Adequacy test date 7/6/22 ® ALL standpipes present per record drawing Results E Pass For 4 bedrooms Total measured depth from grade 13.9 ft (max) Fluid depth prior to test 40 in Measured depth to pipe invert from grade 6_3 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 48 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective IR SHOWS 8'. SHOTS SHOW 7.8'ED Elapsed time 1400 min ®Code -required soil cover over field Final fluid depth 39 in ® System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: WESTERN MT/CO AT GRADE. SHOTS SHOW 7.8'ED. TRENCH OPERATING IN MIDDLE EFFECTIVE DEPTH (ED). N rwir's -> 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 Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft ® 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' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® 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 ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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 *5 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 *MOA WAIVER #WR970025 (FIELD TO EAST PROPERTY LINE). G. ENGINEER'S CERTIFICATION l certify that / 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. TH i •+ Curtis Huffman VIP.. CE 128991ti��� ROFESSION��'��.�