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Home My WebLink AboutARVESON LT 4Arveson Lot 4 #015-273-09 Municipality of Anchorage Development Services Department Building Safety Division 5. • . _ . On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage; AK 99519-6650 Page /,of Z_ www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S W O LO t O c1 PID Number: 011. S- 27 "3 - o q Name: 2 1 - Q c, �4 n Wastewater S ystem: � New El upgrade Address: 1120 S C- Y 0,1 S'� ABSORPTION FIELD Phone: Number of Bedrooms: [I Deep Trench kr5hallow Trench ❑Bed ❑Mound ❑Other: LEGAL DESCRIPTION Soil Rating: / Z Total Depth from original grade: }� /V t / GPD/Flz • Ci Fl. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: C V S O til 5, 0 Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel Length: // O Ft. uL/ Ft. Well: X New ❑ Upgrade Gravel width: Number of lines: / Distance between lines: '0 FL Ft. Classification (Private, A, B. C): Totalep/thLI�11 Z2e Cased to: 2 Total absorption area: r ,,�/ Pipe Material: i V k u� — Ft. Z Z 7 Ft. �//)�(5� Ft2 Driller: / Q ( Date Drilled: 7 21 7i Static Water Level: I Installer. L ,,f ,41 A (,C F YI1t f il/f Dale Installed: �Ci�7iV C)7 G (p i Ft. Zs Yield: 'i- Pump Set at: U k Casing Height Above Ground: t TANK GPM h K V W /1 Ft. r S Fl. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding DuluffVPrivate Manufacturer. Capacity: From Tank Field Station Tank Sewer Line A yt c � � U►� 1V ( 2 SO Gal. Well �(� �t90 l�/ I Material: 17 Number roCompartments: Surface Water t o0l P too 1� LIFT STATION Line 191 / TV -7 /� Size: Gal Manufacturer. -- I Foundation Z o r Z v-14 \ Pump on" level at: "Pump ofr level at: High water alarm at: +E in. in. in. Curtain Drain (`f Pump Make 8 Mod Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: C a v"et 0us N(at-) P" I) 100 r 1 ,�/ / Assumed Elevation: h Dr_ !" VrSl C_ /7`Ou y C_° i Fl. Engine<k tamp FPW PW A ow *� Inspections performed by: tv/he kArIA(11 riforl Dates: 1St /C,)Z& _ / 2p .�n fir= �9Tti 2!� S'pkn Ai 2nd Development Services Department Approval • ••a • ••e• ••/'�o • �� ,• MICHAEL N. ANDERSON� Reviewed and approved by: kLfUo, 6t, Date: 10/23/0 % (Rev i:`00)�— 'or! C -9 69 .• f �� •tr. • /� �lv U (o•. • • �`Q ,-o 4 1. Flo • • o . e • • � a:�' jpq Poe, Wj r?afFS�tu�� O�,aa`•�` H too(. o5 15 � ~ Permit No. SW02010X9 2 Page of� _____- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 195650 Anchnrogo. Alaska 99519-0650 Telephone: 343-4744 On—Site YYoatevvo[er Disposal System and/or Well Inspection Report Legal Description: LOT ARVESON SUBDIVISION p|O No.: 015-273-09 1O| �|WEL IRAD US--` / / / / ` EX NG `Of17 � Cf) WELL33'LIJ | � 00 N 90*00'00^s 133.41 ASBUILT SCALE: 1"=30' LOT 4 LOT 5 01 col MT1 C05 2 �WCCI AV j OMINAL GRAdDE — FILL AV % OR AV 49 TH 0 00 CALLON TANK OCK GW MICHAEL No 6 9 AV 84.8 SEPTIC SECTION 400 ELEV. ELEV. col 23.0 T0.5 101.6 93.5 TC01 50.5 23.0 96.5 MT 41 L62 96.6 ` EX NG `Of17 � Cf) WELL33'LIJ | � 00 N 90*00'00^s 133.41 ASBUILT SCALE: 1"=30' LOT 4 LOT 5 01 col MT1 C05 2 �WCCI AV j OMINAL GRAdDE — FILL AV % OR AV 49 TH 0 00 CALLON TANK OCK GW MICHAEL No 6 9 AV 84.8 SEPTIC SECTION 400 SENT BY: KND INVESTMENTS, LTD.; 9078683793; OCT -17-06 9:04; PAGE 2/2 1 3-4�1 0202t ri D: ,• tte of Issue- kL4-og X&g2j DtSeriptitit : )Date Cojpjew:2,?_1__Q9_ Ame_§•11 q )?"Perty OwHer Nalne & Addrm.- 9pinnell Horngs 9210 Vanguard Dr sfick-Up gfaVeffy Cobbly silt gravel slIty gravel silty grevef M0 i gpw silt gravelly Silt Silt SM. 121 126 183 194 203 215 I .1-„ � "my Cming type: 9w Wall Thicknm:,aw inches Diawter, fi inches Depth: 221 �,t Liner T�pe,- Diameter — inches Depth: eet _ f C,=ftg stickup above ground: p fee �V��er icvq th-om groond level): "4e–t FumPimg leftf,22-0 feet af ter 2 hOWS PUMPi4g 40+ SpM Recovery Rate: jq+ a . m Method of Testing: ak well Intake Opening Tyve: 0 Open End 0* r e, Hole 0 scrConed Stan feet Stopped feet Ferforatiow start feet stopped feet rt ou Tylle: AMMI�� Volume: iks Depth: Start 2 feet stoppCd filet • Comments: Pump lest f01,0,w Well Driller, Alpine Dtilling & Enjprplises PO 80)e 11049.6 Anchcmya Alaska 9951, Attention: ne Well driller Shall provide a well log to the property own 16 A -M. TV owner within 30 days of coinpll-tion aad the property KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 907)696-6111/ FAX (907)696-8111 October 17, 2006 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Arveson, Lot 4 -- Lot -Line Waiver Gentlemen: After review of the as -built survey, it was noted that the absorption field was located within 10 feet of property and we are therefore requesting a waiver to 7' from lot line. We do not expect there to be any adverse effect on adjacent lots by the use of this system. If you have any questions, please contact me at 696-6111 /FAX 696-8111. Respectfully submitted, 1KHD Engineering, Inc. Kenneth M. Attachments: COSA As -Built Survey SGS Water Analysis Inspection Report by Mike Anderson, P.E. MA w v z uj W D U Q w 0 z LL Z CLaZC.)ww0Z?-•p i Z J �^ ig V (~} ttf to z iE . 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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 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW020109 Legal Description: ARVESON LT 4 Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Spinell Homes, Inc. Owner Address: 9210 Vanguard Dr. Anchorage , AK 99507 - /e/z l, izPA Date Issued: May 14, 2002 Expiration Date: May 14, 2003 Parcel ID: 015-273-09 Site Address: 011130 JEROME ST Lot Size: 10006 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [ Disposal Field D Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: L 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 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: 3G 0 Z 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/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. Permit NumberSW020/09' Property owners) A S 4 ,''j Day phone 2-1-f �-- FS -3 UZ Mailing address (1) 4112-0 1,eea� �tr ky— Mailing address (2) Zip Code T15-16 V t// 7 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size_ Y - Z— cre q Ft THIS APPLICATION IS FOR: Sewer Only ❑ Sewer and Well Y71 Sewer Upgrade EJ THIS THIS PROPERTY CONTAINS: 5 Number of Bedrooms Well Only Water Storage Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is Th accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: S'S Waiver Fees: Date of Payment: 2 p Date of Payment: Receipt Number: 0 Receipt Number: (Rev. 12100) Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 April 18, 2002 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 4 Arveson Subd. To Whom it may concern: This is a request for a new well and septic permit for the above residence. The owner is building a new single family home this spring. The perc was completed in the rear of the lot with a 4 foot elevation change along the west property line. The previous owner had filled the lot and constructed a wood retaining wall for a parking area. The soils consisted of two feet of gravel fill covering 2 feet of organic material then clean sand and gravel. A total depth of 17 feet were excavated with no water observed during excavation or after the May monitoring period. The perc was 1 minute per inch with over 50 percent clean sand. The new trench will be a 5 wide with 4 feet effective and 50 length, excavated below the organics and the bottom of the retaining wall, therefore the 50 foot set back is not required. All the ground slopes to the south as the plan shows. This new system will not affect the future development of the neighboring properties or shadow out any neighboring septic replacement areas due to the new well radius. If you have any question please call me at 345-3377 Sincerely ✓�iF-v�C� Michael N. Anderson, P.E. m Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /5/+-t U�Jf' - J7` GY LEGAL DESCRIPTION: V C. So DEPTH (FEET) 1 2 / OfSah.G�/ (ick5�, 3 4 5 6 Son y cr.«vc-( 7 ci 8 (-rk4c`r Oupi 9— to- 11 t0 11 12 13 14 15 i6 FA0 t( om vF kj(e— 18 19 20 S/o WAS GROUND WATER , O ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Wf1Y Alter Matllortltg? t4 0 n i Dae DATE R1 OF A("31 /� MICHAEL N. ANDERSON :, I CE -9 69 0 Z�— PERCOLATION RATE Immuteymen) PERC HOLE DIAMETER V L�1 TEST RUN BETWEEN s FT AND (:P FT u5� S ` w, L c / JOMMENTS -- f AA 'i'Ytwt rGi �c wv.7y PERFORMED BY: Nf l e "'a ` �!$t. 1 e Y ♦ron I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For. Soinell Homes Legal Description: Lot 4 Aeon Subdivision r— � SLOPE I Fi 61, 11 13 15 17 GM Fill TESTHOLE NO 5%-18% Silt Date Performed: 5/20/02 SITE PLAN TIVE ELEVATIO/N�� MED DATUM (T9) OG/OL I South Original es.a Ground Was Groundwater Level - No I 1' FlN. RIC 9� hG. DRNE 8 After Monitoring Dry GM Date: 5/27/02 with SP dP Sa EL-lois• b8 Y O 1 PRonsm sx 0 6UILDIND r- xn I OG/OL South Original Ground Was Groundwater Level Encountered? No If Yes, What Depth? Depth to Water After Monitoring Dry GM Date: 5/27/02 with SP Bottom of Perc. Rate: 6.4 Min./Inch Perc. Hole Diameter: 8" 21 Hole -19' Test Run Between 9 Ft. and 10 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Alan Harala I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 5/27/02 33' E 10 11 12 13 1 South Was Groundwater Encountered? No If Yes, What Depth'?— Depth epth?Depth to Water After Monitoring Dry GP/GM Date: 5/27/02 18I 1 SM Bottom of Perc. Rate: 1.9 Min./Inch Perc. Hole Diameter: 8' 21 Hole - 23' Test Run Between 8 Ft. and 9 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Alan Harala I, Michael F Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 5/27/02 C 33' Municipality of Anchorage �""'' ""�,49th '�p}"'+ Department of Health & Human Services �""'"� 825 L Street, Anchorage, AK 99502-0650 0`•'• ANDER! �� c"nANDERE SOILS LOG - PERCOLATION TEST Ia QCrf°•, h'a Performed For. Soinell omuc 1INNIAFE5;; ._H Legal Description: Lot 4 ArveaQaSubdivision Date Performed: 5/20/02 SLOPE SITE PLAN North 1 GM DAua°' RELATIVED (rM). r N 90'00'00"E 135.41' 2 Fill b a un 15% silt i > ----- 3 TH2 A' A.L. °RNf TESTHOLE NO $ '-=+.a a " 4 I n e 'l nN.PR. 103.5 5 OG/OL 8 o PRCUNW euaauc av r2- ,< Original : I 6 Gmd. Lvl. I ....m w.nxatmmwxv -r I I � cewa[ wmm+ E 10 11 12 13 1 South Was Groundwater Encountered? No If Yes, What Depth'?— Depth epth?Depth to Water After Monitoring Dry GP/GM Date: 5/27/02 18I 1 SM Bottom of Perc. Rate: 1.9 Min./Inch Perc. Hole Diameter: 8' 21 Hole - 23' Test Run Between 8 Ft. and 9 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Alan Harala I, Michael F Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 5/27/02 C 33' Municipality of Anchorage e° On -Site Water & Wastewater Program (907)343-7904 UBMITTAL NOV 2 2014 CERTIFICATE OF €0ITiES6 TEM' PPROVAL, r Parcel I.D. 015-273-09 i Expiration Date: J 1 r 1. GENERAL INFORMATION F. SH/ j Complete legal description ARVESON S/D; LOT 4 Location (site address) 11130 JEROME STREET, ANCHORAGE, AK, 99516 Current Property owner(s) ANDREA HUHNDORF Day phone Mailing address Real Estate Agent P.O. BOX 39490, NINILCHIK, AK, 99639 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 907-394-3714 Day phone = TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site Li Public Water System ❑ Public Sewer ❑ W aiverNanance request for. COSA to be released to the engineer, COSA Fee $ 8�!`(06) Waiver Fee $ Date of Payment / /a(2I/N Receipt Number 07W `t COSA# 03GL11&19 Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site watersupply 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. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the lime of the test, and separation distances measured to madly identifiable features. The operational life of all wells and septic systems depend on the local soils condition, gmundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control ofthe evaluatorofthe system. Satisfadorylest results do not guarantee future performance of the system, nor do they guarantee that then= are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty orfuture estimate ofhow long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _ System #1 Approved for ! System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. bedrooms, with the following Phone 337-6179 Date Ilisb li Original Certificate Date: tOFt til rri� ON -SIT€ �Q-r WAT R rz,- Th"unicipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other rn4„ imnm\ If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA ARVESON S/D; LOT 4 *PER PREVIOUS COSA'S. Well type PRIVATE If A, B. or C provide PWSID# N/A Date completed '7/21/2002 Sanitary seal (Y/N) YES Total depth *223 ft. Date of test Static water level Well production Cased to *223 ft. FROM WELL LOG *7/21/2002 *164 ft. *40+ n n m WATER SAMPLE RESULTS: Coliform ND colonies/100 ml. Arsenic: ND ug./L. B. SEPTICIHOLDING TANK DATA Nitrate 0.501 mg./L. Date of sample: 11/11/14 Parcel ID: 015-273-09 Well Log (Y/N) *YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 11/8/2014 125 3.86+ Collected by: GEG, Ltd. **SEE ATTACHED LETTER Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Date installed 10/26/2002 Cleanouts(Y/N) **YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping Pumper •^I o. QV,` cx v%J eO� Yyx I q C. ABSORPTION FIELD DATA "'eELOW EXISTING GRADE TO BOTTOM OP M Date installed 10/26/2002 Soil rating .p.d./ft r ft2/bdrm) 1_2 System type 5 -WIDE TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth ***12.3 ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 11/8/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 36 in. Water added 600 gal. New depth ****43in. Elapsed Time: 120 min. Final fluid depth 40 in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date NOTE: MONITORING TUBE EXTENDS APPROXIMATELY 4.6' BELOW THE INVERT OF THE DRAINPIPE. ****LAST 360 GALLONS INTRODUCED CAUSED NO RISE IN LIQUID LEVEL. 360 GALLONS ABSORBED IN 90 MINUTES PRIOR TO WATER BEING SHUT OFF. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump ofr level at er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfiift station on lot 1001+ On adjacent Iota Absorption field on lot 100'+ On adjacent lots Public sewer main "O" Public sewer manhole/cleanout Sewer /septic service line 25'+ Holding tank Animal containment areas 59+ Manure/animal excrete storage areas 1W+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main N/A 5'+ Property line 5'+ Absorption field 54 Water service line 101+ Surface water iflIjr. Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line """7' Building foundation 19+ Water main WA Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain NONEKNOWN Wells on adjacent lots 100'+ F. COMMENTS " SEE ATTACHED LETTER. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printedame JEFFREY A GARNESS Date U12- �y. (Rev. 10112/12) GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS -: - November 21, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road, Anchorage, Ak 99519-6650 (907)343-7904 REFERENCE: Arveson S/D; Lot 4 COSA. To whom it may concern, GEG recently performed an adequacy test and inspections to acquire a COSA for the subject property. A design, but no as -built drawings could be found in the DSD database. However, previous COSAs were issued on 8/21/20112 & 5/2/2013. The fact that previous COSAs were issued would lead one to believe that DSD had the inspection report at one time. Based upon an as -built survey, it appears that the trench was installed 7 feet from the property line. Previous COSAs reference this distance, but no waiver reference number could be found. It is assumed that the waiver was granted previously. Also, only one cleanout was installed after the tank. Based upon the as -built survey (dated 12/19/2002), the system appears to have been installed that way and it has been approved several times in this configuration. Based upon the aforementioned facts, we request that you approve the system in its current configuration. NOTE: The data provided on the attached COSA is based upon prior COSA submissions. please contact us at 337-6179. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com 13 IiS 3W0213f t 00'9L Mt100.800001kj .70 I� M > L \ { Q ^ Y 0 a J N x = CD Q0- <F w m. 0 F, Rrmv X � .PL rilM/9 .S'ft o .L'Ol ioV, M ,0'01 Wc Z 0 A N; p x W m c e0 O C T C z 0.01 0'» .0'[Z 0'f ♦ o N034 iD �9'II O O X h3 w U a w aNs3 Kiln .o L t 7 7 •i LLI F_ HpEon ow I � C]ZQW W OZ },o Z wu� z < o Gi-z3�0V) `� N WWZZ wz=o �t5Z F w 0ZLZ 0a in N F = j X 0 W O W W ZOO O N —((OW ZU� UU� z N ~05z +lJ O Qof X w li U(n �W m�0 LLJ O Faz dw�xC!:V) W p w W F O f— U O U O r�Uwz�zm(= Oz LU z wdwz2wwm o Lu0U(n 0aorcQ zd z = a w� o o� ad D= w U WN N (--- Z (n U Lo O U) J am¢0 o a LLJ — Q 'L ul `J 0 ]C CO � O a3 d. N LLTw U w U z M cDO=N o x CL Q w n I"40ro N 0 y a w .00'9L A,00.90.00 N (7 N II Parcel I.D. 015-273-09 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description AryeSOn, Lot 4 Expiration Date: A . ' — ( 3 Location (site address) 11130 Jerome Street Anchorage, AK 99516 Current Property owner(s) Thomas P. Huhndorf Dav Dhone Mailing address P.O. Box 39490 Ninilchik, AK 99639 Real Estate Agent Chris Swires 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: Individual Well F1 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Day phone TYPE OF WASTEWATER DISPOSAL: Individual F1 Holding Tank ❑ Community ❑ Public Sewer n Received by: 0-A. Date: COSA to be released he a gineer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number COSA # 4 5 c I E, 13 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phorie 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E 6. DSD SIGNATURE System #1 Approved for L� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following By: ! c Original Certificate Date: L-2— 13 Theunic' it forage 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 COSA blue sheet ( '- :, c Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-273-09 COSA #_ C 61114- Expiration !QExpiration Date: / / ` .2 % 2 1. GENERAL INFORMATION Complete legal description ARVESON LOT 4 Location (site address) 11130 IEROME STREET, ANCHORAGE, AK 99507 Current Property owner(s) THOMAS P. HUHNDORF Day Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO BOX 39490 NINILCHIK, AK 99639 Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank Community Class Well ❑ . Community On-site [] Public Water System ❑ Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 08/10/12 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ` O,, y encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE NATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date:_&_ (Rev. it� Municipality of Anchorage oQP�E eu • '� Development Services Department Building Safety Division a On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ARVESON LOT 4 Parcel ID: 015-273-09 A. WELL DATA Well type PRIVATE Date completed 7/21/02 Total depth 223 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (YM) Y Cased to 223 ft. FROM WELL LOG 7/21/02 WATER SAMPLE RESULTS: ft. g. p. m. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 8/3/12 ft. 4.5+ g.p.m. Coliform NEG colonies/100ml- Nitrate ND mg/L Arsenic: ND mg/I Date of sample: 8/3/12 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA TankType/Material Septic/Steel Date installed 10/26/02 Tank size 1 250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 8/2/12 Pumper Denali C. ABSORPTION FIELD DATA Date installed 10/26/2002 Soil rating (g.p.d./ft2 orft2/bdrm) 1 .2 Systemtype Shallow Trench Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 10 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/3/12 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _in. "Pump off' level at _in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ On adjacent lots 1 00'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ Wells on adjacent lots 100'+ F. COMMENTS 1 G. ENGINEER'S CERTIFICATION � y�•••• .•sit i I certify that t have determined through field inspections and �• •••0" •• •• • +f� review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. m TZ. Engineer's Printed Name KENNETH M. DUFFUS •. � i Date 08/10/12 �vA�FESSIONP�i` COSA Fee $490.00 1 Date of Payment Receipt Number (Rev. 11 /05) Waiver Fee $ Date of Payment Receipt Number 44M 1203-21A Grid 2635 EN 13030 015-273-09 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and Thomas P. Huhndorf, (herein "Permittee"), whose address is P.O. Box 39490, Ninilehik, Alaska 99639. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Dedicated by the plat of the subdivision known as Arveson Subdivision, according to Plat Number P-559, recorded on the 20'b day of October 1960, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The West Ten Feet (W 10') of Lot Four (4), Arveson Subdivision, according to Plat Number P-559, recorded on the 20th day of October 1960, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Four (4), Arveson Subdivision, according to Plat Number P-559, recorded on the 20'h day of October 1960, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel") 2. Encroachment. Permittee proposes to construct and continue the existence of the following improvements on or within the real property subject to said Easement: Encroachment Permit - Page 1 of 4 A septic leach field that encroaches approximately Five Feet (5) reducing to Three Feet (3') into said Easement for a distance of approximately Fifty-two Feet (52'), (herein "Encroachment"). 3. Permit. Chugach hereby authorizes Permittee to construct and continue the existence of the Encroachment in its existing location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days ofwritten demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. Encroachment Permit - Page 2 of 4 C. Permittee fails to make the payment described in paragraph 7, above. 10. Tenn. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof 11. Entire Apreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION, INC. By: Shelly Schm&,-�Senior Manager Distribution Engineering Date: I D I Q- I t' a> BY =P.��umdorf Date: q /(, /'. , J-3 Encroachment Permit - Page 3 of 4 STATE OF ALASKA ) ss: THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this '-V day of 2013, by STATE OF ALASKA ) ss: THIRD JUDICIAL DISTRICT Lq'wo" Kbl- Notary PubVe- in and for the State of Alaska My commission expires: (0 ��, i I 0 Th, �) yre,, o g instrument was acknowledged before me this day of v 2013, by_ Senior Manager, Distribution Engineering of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corpora 0 Cotiny Publie/in and for the State of Alaska My commission expires: /Z =`' CST P UBLIC A� OF E,&J -isg Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Encroachment Permit - Page 4 of 4 POWERING ALASKA'S FUTURE October 8, 2013 Michael N. Anderson 4661 Natrona Avenue Anchorage, Alaska 99516 Subject: Encroachment Permit for a Septic Leach Field Arveson Subdivision, Lot 4 Grid 2635, Map1203-21A, EN13030 Dear Mr. Ancerson: Enclosed is a copy of the approved Encroachment Permit you requested for the proposed secondary leach field that would encroach into the easement on the west side of the above referenced property. Chugach will have this document recorded. If you have any questions, please call me at 762-4646. Sincerely, Kee-,✓ r 2udia Roberts Right -of -Way Agent Il Enclosure Chugach Electric Association, Inc. 5601 Electron Drive, P.O. Box 196300, Anchorage, Alaska 99519-6300 • (9071563-7494 Fax (907) 562-0027 • (800) 4787494 www.chugochelectric.com • info@chugachelectric.com August 16, 2013 Michael N. Anderson, P.E. 4661 Natrona Ave. Anchorage, AK 99516 Grid: A2635 Re: Letter of Non -Objection To whom it may concern: ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907)334-7753 FAX (907) 334-7798 ENSTAR Natural Gas Company has no objection to the proposed secondary septic leach field encroachment into west utility easement situated adjacent to and coincident with the west boundary line of Arveson Lot 3, Section 21, Township 12 North, Range 3 West, Seward Meridian, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Jennifer Diederich Right of Way & Permitting Agent ENSTAR Natural Gas Company cc: File August 16, 2013Cm 1911 Timothy and Kimberly E. Dolph 5661 E. Cherry Circle Wasilla, Alaska 99654 Dear Timothy and KimbertyDelph: SubJect to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the secondary leach field encroaching into the utility casement at Lot 3, Arveson subdivision, also known as 11120 Jerome Streect, city grid 2635. This letter of non -objection in no way precludes GCl Communication Corp froin full use and enjoyment of any rights it may have within any portion Of the utility casement and or the right-of-way, including unlimited access for servicing its facilities. Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any dairiage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, Acceptance Date Markus Kofoid OSP Design Engineer GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax Municipality of Anchorage 0�. a•Y 1, Development Services Department Building Safety Division r ` On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. Ai5-271-09 COSA# n(o051J Expiration Date: — a- 3 1. GENERAL INFORMATION Complete legal description ARVESON LOT 4 - Location (site address) 11 i t % "'RO 1P ST ANCHORAGE.AK99516 Current Property owner(s) ST VF erNI Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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. ame of Firm .ND ENGINEERING /•.. - �1 .Cu Z • - -• Name KENNETH u - Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. S. DSD SIGNATURE __LZ Approved for _q__ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: ttu� l t u urrrrr� OFA WATER AND '_ �•. PROGRAM 11�ff COSA ChecMist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: "" / , ,: Original Certificate Date: 10—.23-06 Municipality of Anchorage a. • ., Development Services Department Building Safety Division ` Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ARVESON LOT 4 Parcel ID: 015-273-09 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 7/21/02 Sanitary seal (Y/N) Y Total depth 223 ft. Cased to 223 ft. FROM WELL LOG Date of test 7121/02 Static water level 164 ft. Well production 40+ g.p.m. WATER SAMPLE RESULTS: _ Well Log (Y/N) Y Wires property protected (Y/N) Y_ Casing height (above ground) 24 in. AT INSPECTION 8/24/06 1 3 5 ft. 4.5+ g.p.m. Coliform _Q_colonies/100mL Nitrate 0.33 ma/L Other bacteria 0 coionies/100 mL Arsenic: -RD mgA Date of sample: 8/24/06 Collected by, KND Engineering, Inc B. SEPTIC/HOLDING TANK DATA Tank Type/Material�S,gntic/Steel Date installed 10/26/02 Tank size 1250 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alar (YIN) N _Date of pumping a/24/06 Pumper McDonalds C. ABSORPTION FIELD DATA Date installed 10/26/2002 Soil rating (g.p.d./fe or fe/bdrm) J.2. System type Shallow Trench Length 3Q ft. Width -, ft. Gravel below pipe eft. Total depth 1Q ft. Eff. absorption area 500 fe Monitoring tube Y Depression over field N Date of adequacy test 8/24/06 Fluid depth in absorption field before test2—in. Elapsed Time: AQ min. Final fluid depth.2 in. Results (Pass/Fail) Pass For _4_ bedrooms Water added A00 gal. New depth -IIA -in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date----- D. LIFT STATION Date installed 'Pump on" level at_in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Acoess (Y/N) `Pump ofr level at_in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements?_ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main 751+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/clesnout 100'+ Holding tank _ 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 10 0 1 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line S ' + Absorption field 5 ' + Water main 10'+ Water service line 10'+ Surface water 1 00'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7'+ Building foundation 10'+ Water main 10 1 + Water Service line 101+ Surfacewater 100'+ Driveway. parking/vehicle storage 10'+ Curtain drain 50'+ Wells on adjacent lots 10 0 1 + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 7-116 Engineer's Printed Name KENNETH M DLIFFLS /��q'•..�O�7i�;•�•c �� jOAOFESSI�NP= Date 10/17/06 COSA Fee $430.00 Waiver Fee $ 417S Date of Payment Date of Payment Receipt NumberReceipt Number. (Rev. 11105)