HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 4 LT 28Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171181 PID Number: 051-582-19
Dwelling: FK Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New [K Upgrade
Name
Zach Meehan
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
27907 Raven Court, Chugiak, AK, 99567
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-360-7995
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Thunderbird Heights #1 4 28
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
200'+
200'-(-
N/A
N/A
N/A
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer Tank, Inc
Capacity
1250 Gal.
Surface Water
10'+
10 +
N/A
N/A
Material
Number of compartments
Lot Line
50'+
20'+
N/A
N/A
NA
Polyethylene
2
Foundation'�
0+
0'+
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks Existing tank decommissioned per uniform plumbing code
N/A
N/A Gal.
4 inch double clean outs are PVC D3034. 4 inch tank clean outs are ABS D2661
Alarm location
Electrical installed by
N/A
N/A
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Zach Meehan / Jake Gillespie
Drainfield Co/MTD3034
Inspector Zach Meehan
BENCH MARK (Assumed elevation) 400 ft
n 1m 7/14/2017 nd 7/15/2017
Inspdeact s
Location and description
2
3`d 4,h
NW Corner House Foundation
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF A
Conditional Approval: Date
:�
5
do
4918 '•,
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2-ACHA Y J. MEEHAN
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•. No. CE83951
Septic Syste
Approved Date v Zg Z�
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'°ROFESStGN®�®
Note: this approval es not include well permit requirements.
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ASBUILT—NO CORNERS SET THIS DATE.
SEWARD & ASSOCIATES LAND SURVEYING 694-082(
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE:
FOLLOWING DESCRIBED PROPERTY:
F-A
DATE
AND THATN ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
'c 1-1
T H
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI—
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
Du8na Mtrk Sewa'd
LS -6 8 X
ANY DATA HEREON BE USED FOR CONSTRUCTION
��)
OF FENCE LINES, OR FOR ESTABLISHING BOUND—
rr
ARY LINES.
DRAWN:
.IP!`."
t
November 9, 2020
Municipality of Anchorage
Development Services
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99507
Phone: (907) 343-7904
Reference: Septic Tank to Deck Support Waiver Request for Thunderbird Heights S/D #1,
Block 4, Lot 28
Ms. Wockenfuss:
The existing 4 -bedroom house on the referenced property is served by public water and a private
septic system. A new plastic septic tank was installed in 2017 and after the tank was installed the
owner installed a new deck configuration. Based upon our findings, there is a deck pile (sonotube)
67' from the edge of ST1 to the edge of the closest sonotube. Per the owner, the inspecting
engineer, Zachary Meehan, P.E., has went out to the site and painted the perimeter of the tank on
the ground. The owner has stated the closest edge of the tank is 4 feet from the painted perimeter to
the edge of the tank to this sonotube. This is consistent with our field measurements. Per the owner,
this sonotube extends approximately 3 feet below grade. Based upon these assumptions and our
field measurements, a cross-sectional profile drawing was prepared showing the sonotube, the tank,
and a 45 -degree angle originating at the bottom of the sonotube and projecting towards the tank. As
can be seen on the drawing, the 45 -degree line intercepts near the base of the tank.
The new septic tank is HDPE plastic and is therefore not subject to gradual corrosion and ultimate
structural failure. Furthermore, the tank has only about 3.7 feet of soil cover, so it is not subject to
an extreme soil load at this time. In short, structural failure of the tank is unlikely to occur and induce
failure of the nearby sona-tube. The deck height is fairly low (see attached photo), so if the subject
sona-tube were to become compromised, it is reasonable to believe that there is limited risk to
life/safety. Also, it is important to note that the required five (5) feet separation distance between a
deck support and a septic tank is a relatively new code requirement. For decades, this type of
encroachment was allowed. Given these factors, the risk associated with this encroachment (4 feet
of separation between tank and deck support) appears to be relatively low.
Please do not hesitate to call me at 337-6179 if you require further information. Thank you for your
assistance. A
S
Presi
E., M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 9950
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Municipality of Anchorage .°'y�� .
r�u�r
- Department
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV201077 COSA#: Permit#:OSP171181
PID#: 051-582-19
Legal Description: Thunderbird heights #1 Bilk 4 Lt 28
Engineer: Garness Engineering Group
Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the
deck support has been approved. The approved separation distance is 4.0 feet.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
0000. ■ 0 ... 0 .. 0 .. ■ .......... 0 0. 0 0 ... M 0 0 0. 0. 0 0 00■■ .. 0. 0. 0 0 0 0. 0 0 0 0.■ ... 0. 0 0 0 0 .. ■
Waiver is Granted: X Waiver is not Granted:
Date: 7 7�2 Approved by: l/U
Name of Revie
.................■■■.■■■.■■■■■■■■■■■■■.........■■■■■■■■■■■ r■■■.....■■■■■.....�
**** VARIAN C E/WAIVER REVIEW ****
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,,,,c,",70,- MUNICIPALITY OF ANCHORAGE
t,.cnt
On-Site Water&Wastewater Program �o� `5�;,�-
s.r I PO Box 196650 4700 Elmore Road .
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax.(907)343-7997 ,��
http:llwww.muni.orglonsite
l ci�arlmcnt 1On-Site Wastewater Disposal System Permit -7- (- I
Permit Number: OSP171181 Effective Date: 7/12/2017
Work Type: SepticTank Upgrade Expiration Date: 7/12/2018
Tax Code Number: 05158219000
Site Legal Address: THUNDERBIRD HEIGHTS#1 BLK 4 LT 28 G:1865
Site Mailing Address: 27907 RAVEN CT, Chugiak
Owner: GILLESPIE JAKE J & GINNY M Lot Size in Sq Ft: 20049
Design Engineer: Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field Q Septic Tank El Holding Tank ❑ Privy El Private Well El 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
Received By: �, /4(74Z7Date: f !
Issued By: W I,(10 yttl. Date. 71/72D/7
MUNICIPALITY OF ANCHORAGE
,f11
Community Development Department i 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. 05158219
Property owner(s) Jake J & Ginny M Gillespie Day phone 907-521-7954
Mailing address 27907 Raven Ct. Chugiak AK, 99567
Site address 27907 Raven Ct. Chugiak AK, 99567
Legal description (Sub'd., Block & Lot) Thunderbird Heights #1 Blk 4 Lt 28
Legal description (Township, Range & Section)
Lot Size .467 acres Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial El Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑X Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage El
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify tht the abo i emation is correct. I further certify that this is in accordance with
applicabl unicip:1 C►• s.
til
L1 i
(Sign a-•f p ":*'= Kwner:lOrIMPFPied agent)
Permit/Rus Fees: 42.1W;10 Waiver Fees:
Date of Payment: 1 hi I Zoll Date of Payment:
Receipt Number: 041(P 510 Receipt Number:
Permit No. U5P1" -1 LS! Waiver No.
Permit App_ - : '_..c
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ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 694-08
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY /"�'z�' ��.+�%tq
T.s%yv!a,4irQ.s4e�..rte-��so�4-.7� .v.a/Zor46Y./ DATE: P�t� O A s
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 6144
INDICATED. IT IS THE RESPONSIBILITY OF THE f •• �' '�
OWNER TO DETERMINE THE EXISTENCE OF ANY G , L.H •y
EASEMENTS, COVENANTS, OR RESTRICTIONS GRID: ���f /'�.�
f
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- f ii'. :
VISION PLAT. UNDER NO CIRCUMSTANCES SHOtA.D FB: _ Dven• MarkSeward
ANY DATA HEREON BE USED FOR CONSTRUCTION 62 of 14 ••.• LS-6918 `gam
OF FENCE LINES, OR FOR ESTABLISHING BOUND- } �`b' •.. `'°�
ARY LINES.
DRAWN: A'�q � �'•
MUNICIPALITY OF ANCHORAGE
Community Development Department ` !.. Phone: 907-343-7904
On-Site Water & Wastewater Program Fax: 907-343-7997
Septic System Owner-installer Agreement
A real estate property owner (Owner) may install their own septic system.
The department may issue an approval for a homeowner to perform work on a conventional
(not AWWTS) on-site wastewater disposal system to serve that individual's owner-occupied,
single-family or duplex home if the homeowner satisfies and agrees to the following
requirements.
The property owner and excavation equipment operator may perform work on no more than
one owner installed project in a 12-month period.
As owner of (legal description) TA LAn A er b'i r 3 h� ;a his a I S'1 L Z& I agree the
following items are true and accurate. J
1. My experience installing septic systems is as follows.
TUsrficc - /err CFj io 7/Lt, //7,r s ex/m/Pry t4-)/it Agi, e
2. The name of the excavation equipment operator is. JLl4e 4i/es/A'(
3. There will not be compensation for installation services rendered.
4. I will be actively involved with the septic system installation at all times.
5. The name of the inspecting engineer is -7,-614A lv ee /Y-A
6. I agree to discuss the following items with the ins sting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.150.
c. 2-hour minimum advance notice given to the On-site Water & Wastewater
Program for all required municipal inspections.
7. I agree any changes I make to the items listed above will require a new approval before
performing work.
8. I agree to have the project-specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
e
Owner's printed name: )4' �-7(�fe,,SpC�,
Owner's signatur:': , iL,L/ /1/ Date: 7//37( 1
rP
[
Septic System Owner Installer Ag -mencFeb2015.doc
~'% MUNICIPALITY OF ANCHORAGE £
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME I, J, !1
. _ ~ UPGRADE
~ ~z Manufacturer~ ~>~ Materia~p No. of compartments ~
LiqI c~a~y in gallons Inside length Width Liquid depth
I ~O IF HOME.DE: ~ ~ __
~ ~ DiSTA~~11 ~~ PERMIT NO.
~ ~urer ~ Material /~pecityingallons
~ FoundationI Nearest 'ot~o PE"MiT~g
,o. oflines / Length of e~, Totallongtho~¢, Trenchwid~, Distance bet.en lines
~ ~inches
~ ~ ~ Top of tile to finish grade Material beneath tile
0 ~, 7~ches Total effective~rT~ea
< ~ Type of crib ~iameter Crib depth Total e~ption area
d Cla~ . ~ ~epth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank~ Absorption area{s)
OTHER
SOl L TEST RATING
INSTALLER
REMARKS
APP O ED " DATE LEGAL
72-013 {Rev. 3/78)
or-.I--S ~_ TE
F'ERMIT NO. ( 79060.;' >
RPF'L I Iz:RNT H I LE:UF.: C:,~fE:RENB, ER
LOCSTION RRVEH LOOP
LEGRL LOT 2El E:LK 4 THUNDERBIRD HTS.
T"r'PE OF '-';OIL RE:SORE:TIOt~ S',r'STEr'I IS: TRENCH
I--1LIr-4 T IS I !~ ,-:IL I T"r' IDF Ar-.IC'H~_.RFtGp:
DEP8RTMENT OF HE8LTH BND ENVIRONMENTBL PROTECTION
8-25 "L" STREET., 8NCHORRGE, R,K. 99501
264-4720
5EI..-IEF: F'EF-:P1 ~. T
_S,R~2 BOX 412 E. R.
LOT SIZE
dE.
6E:E:-3:gi9
20000 'SQURF,'E FEET
MRXIr'IUH HUME:ER OF BEDRrIOMS = 4 SOIL RRTING (SQ FT,.'BR>= 8.5
THE REC!UIRED SIZE OF THE SOIL RE:SnF,:PTION SYSTEM IS:
£:,EF'TH-- .~_-: I_EI'.IL3TH=----'_.--' --4 1.3 F-: Fl'-..' E L DEF'TH= ,:---;
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRIr~FIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEH THE SURFRCE OF.THE
GROUND RND THE E:OTTOM OF THE EXCRVRTION <IN FEET>.
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE r,llNir,lur,1 DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE
END THE BOTTOM OF THE E:.'.';CRVRTION (IN FEET>.
F:EL-..!I_I T F-:EB, SEF'T I i_-:. TR r-4 F:.'.-~ T SE=-- 125~-~, I_3RLLC~[-.!'---';
PERMIT RPPLICRNT HRS THE RESPONSIE:ILITY TO INFOF.:t'I THIS DEPRRT/'IENT [:,UF:ING THE
ZNSTRLLRTZON ZNSPECTIONS OF RNY HELLS RD.~RCENT TO THIS F'ROPERTY RNC, THE
NUHE'.ER OF RESIDENCES THRT THE HELL HILL SERVE.
TI-,-II-'I ( 2 ) I /'-,ISPECT I ~3t-45 RRE REI~-!I_I I F:EB,
E:RCKFILLIHG OF RNY SYSTEM HITHOUT FINRL INSPEC:TIOt~ RND RPPROVRL BY THIS
[:,EPRRTHENT HILL BE SUBJECT TO PROSECUTION.
I'.ilr. IIHUM DISTRNCE BETIdEEN R HELL RtID ANY ON-SITE SEHRGE DISF'OSRL SYSTEM IS
~00 FEET EOF'. A PF:IYATE HELL; OR
:1.50 TO 2£'~0 FEET FR. Or,1 A F'URLIC HELL DEPEI'.IDIr. IG uPor.,I THE T"r'F'E OF F'UBLIC HELL
OTHER F.:EQUIREMEt-ITS MAY APPLY. SPECIFICATIOt"IS FIND COI'.ISTRUCTION DIAGRAMS ARE
Ft',,,'AILRt3LE TO II',ISURE PR. OPER It'ISTALLATION.
F"EF:r"I I T E :;,-:: F' 'r F:E$ b. ECEI','IBER _--<: ::I_ .. ::LS~- ,---'- _c~.
I CERTIFY THRT
1: t Rt,1 FRMILIRR HITH THE REQUIREHENTS FOR ON-SITE SEHERS AND HELLS RS SET
FORTH BY THE HUNICIPRLITY OF RNCHORRGE.
2: I HILL INSTRLL THE SYSTEH IN ACCORDRNCE HITH THE CODES.
~:: I UNDERSTAHD THRT THE ON-SITE SEHEF: SYSTEM MRY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE HORE THRN 4 E:EDROOHS.
..... ---
I ~ ,'----------RPPL
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6-
7-
8
9
10-
11
12
13
14
15
16
17
18
19
2O
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION I-1 PERCOLATION
TEST
Pouch 6-650, Anti, orate, Alaska 99502 2'/6-222~J
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
It..T
WAS CROUND WA, ER /JO
ENCOUNTERED? , O
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Cross Net Depth to Net
Time Time Water Drop
(minutes/inch)
PERCOLATION RATE
DATE:
~ TEST RUN BETWEEN FT AND FT
PERFORMED BY: C-'~ ~ ~~ CERTIFIED BY: ~/~ ~~
72-008 (7/76)
G£ BG
y of Anchorage
On -Site Water and Wastewater Program c
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 051-582-19Expiration Date: 02-2
1. GENERAL INFORMATION:
Complete legal description THUNDERBIRD HEIGHTS #1 • BLOCK 4, LOT 28
Location (site address) 27907 RAVEN COURT, CHUGIAK AK 99567
Current Property owner(s) JAKE AND GINNY GILLESPIE Day phone 521-7954
Mailing address
Real Estate Agent
27907 RAVEN COURT CHUGIAK AK 99567
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:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver/Variance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ �'(� 2 D G
Date of Payment
Receipt Number G
COSA # OSG 2()16 Z13
Waiver Fee $ l 6 16,7-6 co uln
Date of Payment I I I I1I AQa Q
Receipt Number () ( lO f (Q C
Waiver# O UZO)D77
tp
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 systern 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: Jeffrev A. Garness Date: t ► 10/2Z)
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 V
System #1 Approved for bedrooms
x.11 T y l
f. ..........
J : A. Corn -
\cJ
ta OfG5S10�` r
#AECC884
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the oowing s%l�tions y
wA.��FRr���'
111 � i `� aU c„ -•
o pRp;; q rFp m
a 4 _
l
Original Certificate Date: I I —/ 7--7—C20
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 shoe! 10-10.12.doc
COSA Checklist
Legal Description: THUNDERBIRD HEIGHTS #1; BLOCK 4, LOT 28 Parcel ID: 051-582-19
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
DATA
PU�
❑ Well log d with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for C
Static wate
,Atel Ovateat beginning of test ft.
B. TANK DATA
Age of tank(s) 3 years
Tank type/material °"'
Measured operating fluid level in septic tank n/a
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 8/14/2020
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 1011&79
❑ ALL standpipes present per record drawing
Total measured depth from grade *7.8 ft (max)
Measured depth to pipe invert from grade *4.1 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective "3.7'
Well production at time of test
Water storage tank v e gallons
Well disinf
,,eeW Tfor coliform test? ❑ Yes ❑ No
soliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
c ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
1FT STATION
r_,Requl aintenance
Age of lift station
Lift station materia
Adequacy test date 10/2/20
Results a Pass For 4 bedrooms
Fluid depth prior to test "13.75 in
Water added 885 gal
New depth "4$.25 in
Elapsed time 170 min
'
❑ Final fluid depth -10-75 Code -required soil cover over field p In
❑ System presoaked Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: 'MT/SUMP DOES NOT EXTEND TO BOTTOM OR IS PARTIALLY FULL DEBRIS (DIRT).
`"INTIALLY ADD D WATER DIRETLY TO MP 3Q GALLONS ADDED TO SI IMP WHI H CAUSED LIQUID DEPTH TO
RISE TO TOP OF DISTRIBUTION LINE. SWITCHED FLOW TO DOUBLE CLEANQUI AFTER TANK AND LIQUID LEVEL IN
SUMP IMMEDLIALLY DROPPED ADDED 3Q5 TO DBL CO WITH LIQUID DEPTH DROPPING TO 20.75" QED ANOTHER
25GALLONS WITH LIQUID DEPTH REMAINING AT 20 75"
COSA Checklist yellow sheet
E. SEPARATION DISTANCES IPUBLIC WATER
1~tb rivate Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift S n Lot > 100'
❑ Yes
Community Sewer Manhole out > 100'
ty —
❑ Yes if No ft
Yes��-iif,.No
ft
0 Yes if No ft
Property Line > 5'
Neighboring Tank > 100' ❑ Yes
if No ft
P ' ewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields >
Private Wells > 100'
Animal Containm _�,;ZO` ❑ Yes
if No ft
❑ Yes
if No ft
ft
Community Wells > 200'
✓] Yes if No ft
Water Service Line > 10'
Manure/Animal Excreta Storage >
if No
Com ewer Main > 75' ❑ Yes
if Na ft
F1 Yes
if 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'
0 Yes if No ft
Property Line > 5'
Q Yes
if No
ft
Wells on Adjacent Lots:
Wells on Adjacent Lots:
Absorption Field > 5'
M Yes
if No
ft
Private Wells > 100'
✓� Yes if No ft
Water Main > 10'✓Q
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
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'Cj✓
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No ft
Surface Water > 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
*TANK IS 10+ FEET FROM HOUSE FOUNDATION. EDGE OF ST1 TO EDGE OF CONCRETE SONOTUBE FOR DECK IS 6'-7"
REQUESTING WAIVER FROM SEPTIC TANK TO DECK SUPPORT (SEE ATTACHED LETTER/DRAWING). SEPTIC TANK HAS
GRAVEL PAD OVER IT THAT IS A DRIVEABLE SURFACE; BOLLARDS INSTALLED - SEE PHOTO.
G. ENGINEER'S CERTIFICATION o� OF A
I certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with p* H * t7D
MOA COSA guidelines in effect on this date. �....: • • • . • • 1 . . • • • • • • • • • • .. • .
Q J r y A.
Q� 9,• '' CE 79 3
COSA Checklist yellow sheet �Q� Pro f esstoo
#AECC884
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ASBUILT-NO CORNERS SET THIS DATE. S51ARD & ASSOCIATES LAND SURVEYING 694-082�
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
,,,- �L
FOLLOWING DESCRIBED PROPERTY: L ;)k
)F A4
DATE -
.7 . . .......
AND THAT NO ENCROACHMENTSA"�� ... 4
EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI 01
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB- Duano Marr Seward
ANY DATA HEREON BE USED FOR CONSTRUCTION L5
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN:_