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HomeMy WebLinkAboutPETERS GATE BLK 1 LT 2Peters Gate Block 1 Lot 2 #051-541-24 Municipality of Anchorage•°- © Development Services Department Building Safety Division s On -Site Water and Wastewater Program, 4700 S. Bragaw, St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907)343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Permit Number. SW04i Name: Rrinn R I inAo Mov..11 PID Number: Wastewater System: ® New ❑ Upgrade Address: 19891 Thornton St., Chuaiak,K. 99567 ABSORPTION FIELD phone: Number of Bedrooms: ® Deep Trench ❑ Shallow Trench Dead 0 Mound 0 Other: LEGAL DESCRIPTION Sell Rating: Total Depth from original grade: 1.2 GPD/Ff 13 Ft. Black: Lot: Subdivision. Depth to pipe bottom from original grade: Gravel depth beneath pipe: 1 2 Peters Gate 3 Ft. 10 Ft. Township: Range: Section: Fill added above original grace: Gravel Length: 9.65+ Ft. 19 Ft. Well: ® New ❑ Upgrade Gravelwidth: Numberoflines: Distance between linea: 3 Ft. 1 --Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Private 50 Ft. 24 Ft. 380 Ftp D3034 & F810 Driller: Date Drilled: Static Water Level: Installer: Date Installed: Sullivan 8/2 1 126 Ft. Dakota Diggers 6/23/05 Yield: Pump Set at. Casing Height Above Ground: GI tlJ r:YC _V TANK 0.33 GPM unknown Ft. 2 Ft SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To I Septic Absorption Lift Holding Publiefferhiate Manufacturer:Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank .1000 Gal. well 100'+ 100'+ NA NA 25'+ Material: Numbarof Comparhnents: Steel 2 Surface water 100'+ 100'+ NA NA LIFT STATION Lot Line 5'+ 10'+ NA NA be : anu aurar: .;, . `G3I: Foundation 5'+ 10'+ NA NA "Pumpan" level at "Pump off' level at: - High water alarm at: in. In. in. Curtain Drain NA *50'+ NA NA Pump Make 8 Model Eleoldcal Inspections performed by: Remarks: *none known BENCH MARK Location and Description: Dual foundation cleanouts Top of deck sana tube Extensive fill placed over field Assumed Elevation:100 Ft. Engineer's Stamp 44 •S9 si ,� ..• T Inspections performed by: KND Engineering, Inc.Dates: 1516/23/05 ...:a9 Development Services Department Approval 2nd ., S a„ „'�' tt 3rd 9119/05 M.l Duff s Reviewed by: + �;1KennCE •;�B� °i�9Fo•%.�/3,,,,••'��AV and approved (R. 1290 Date: /7 /z N 1 pROFESSIO Po �.w1zv.11f kclt AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW0403961 PETERS GATE BLOCK 1, LOT 2 PID# 051-541-2 ~I ASBUILT SURVEY BY. J O I Lr) C1 CHUGIAK, AK. 99567 N (907) 230-5942 CLEANOUT A-2=18.5' co"nuh . 9.s x FINAL GRADE ct 98.4 ®� O B-2=25.0' rn CAR: 09/130/05 O O 0" IM O A-3=26.0' 0 Z 50' PRAPHICS SCALE Am �: 0406I.OWG _ SCALE:1 "=50' A-1=17.6 ASBUILT SURVEY BY. CLEANOUT CLEANOUT MONITOR TUBE P.O. BOX 671693 B —1=18.6' CHUGIAK, AK. 99567 00. (907) 230-5942 CLEANOUT A-2=18.5' co"nuh . 9.s x FINAL GRADE ct 98.4 ®� :.. « B-2=25.0' As T-.. CAR: 09/130/05 0" IM aa: NW1262 A-3=26.0' Am �: 0406I.OWG FILTER FABRIC (907)696-6111/FAX (907)696-8111 n \ B-3=39.2' A-4=33.7; GAL B-4=45.3 :a TANK 65.7 SEWER ROCKIcz.7 O A-5=46.2' 93.0 92.8 B-5=52.4' I 9,7; 19' OF`Z4 / ��A �r911 * . 9 Tx * / ,1a/ is ii kAW 87, as j lk 'qv�ssl°"13.' i PREPARED FOR: ASBUILT SURVEY BY. LINDA MAXWELL FRED WALATKA AND ASSOCIATES P.O. BOX 671693 ENGINEERS AND SURVEYORS CHUGIAK, AK. 99567 ANCHORAGE, ALASKA (907) 230-5942 (907) 248-1666 FIELD BOOKS co"nuh . IMB ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 �.omr. DRAM: mmp :.. « CK MM: KMD As T-.. CAR: 09/130/05 0" IM aa: NW1262 Am �: 0406I.OWG 'm "' 04061 (907)696-6111/FAX (907)696-8111 �m Cl) �m mo'2 ooh -, o MZOM 0 MM - z° m;u o� m U 9 m THORNTON St. N00°09'00"W 245.00 1 �- L 130.7 to ePBc tents neighbor' well �Ab X Section Line Easement � d ti 0 20k 2.0 a p —90.7 24.0 o N co CD t:a V 0 M N N f.77 O O 10' Utility Easement — — — — — — N00009'00"W 245.00 0 / o co s i O ics._ - rr.��.t' - - - o 9 M. l Certttteb Ortffing log by DOC co. dm -SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759 OWNER OF LAND: Q'4!1jq'u a ADDRESS: LEGAL DESCRIPTION: �9 t'''tr (A %;t O I U DATE: PERMIT NUMBER: n q -D 34` ,Date of Issue- r -L.. TAX IDENTIFICATION NUMBER: 011 -I-- Is well located at approved permit location? 44-`tts 0 No ILI Method of Drilling: Wirfotary 0 cable tool Depth of well: -S n O Casing Type 71=e: L Wall ThicknessS inches Diameter�l inches, depth -� L fMeet Liner Type: 'ty l P ✓ 2 Not 1=J.t/9T' Q Casing Stickup Above Ground: c2 • feet Static Water Level: feet Recover Rate: ��s2 Cin" ,4 Method of Testing: 1lt - Well Intake Opening Type: 0 open end 0 open hole 0 Screened; Startfeet Stopped feet 0 Perforations Start feet Stopped feet ,,., P1 Grout Type: 137 ` ' r'-- k7Vo1�lume ! S '� S Depth: from J feet, to 'x D feet Well Disinfected Upon Completion? 1 Kes 0 No Method of Disinfection: C h c, J t..r,: $J Comments: HOLE DATA Com;'.Vc SY',GK J') G - r3ci7dac/c �Rcc�! jz !-r1,�cTJ1� /3r:,,e#ct K,ti+t S��Je1.riC 4 1 r ill . K 6 <<.d Driller's Name LA_ - -1• ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number. SW040396 Legal Description: PETERS GATE BLOCK 1 LOT 02 Date Issued: Sep 21, 2004 Expiration Date: Sep 21, 2005 Parcel ID: 051-541-24 Design Engineer: 0070 KND Engineering Site Address: 19891 THORNTON STREET Owner Name: BRIAN & LINDA MAXWELL Lot Size: 55321 SQ. FT. Owner Address: 19891 THORNTON STREET Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , A 99567 - This permit Is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: Issued B'r' I Y Date: Municipality of Anchorage Development Services Department Building Safety Division -i; 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 Parcel I.D. 051- zy "2y Permit Number SW Property owner(s) Brian & Linda Maxwell Dayphone 23n-Sg42 Mailing address (1) PO Box 671693 Chugiak, AK� 99567 MCeg/ address (2) I X11 .Z��N. ��� av1 �I l'/L(.�,1k..1, L Zip Code 1290-4 Legal description (Lot, Block & Sub'd) Peter`s rate Mork 1,Lot 2 Legal description (Section, Township & Range) Lot Size r)5.3 'P'1 Acres1Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ® Water Storage Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool ❑ Water Softening Unit D 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 in accordance with applicable Municipal Codes. of property owner or authorized agent) Date of Payment: Date of Payment: Receipt Number: 5Uf� \A111 Receipt Number: (Rev. 12/00) co Wo.1\ X15' a (t-55 aL9lA )Q.M KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 /FAX (907)696-8111 September 14, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: New sewer/well permit — Peter's Gate, Block 1, Lot 2 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot. On August 23, 2004 one testhole was performed for the proposed system. The results of this test are attached. The general slope of this lot is from east to west at a grade of approximately 20-3070. We have designed our system utilizing the existing testhole that was excavated for the proposed 3 -bedroom house. The lot will be served by an individual well, located on the northern portion of the lot. We propose to install one 2 -foot wide deep trench. Water was not encountered during the excavation or monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, IK1:iID Engineering, Inc. Kenneth M. uffus, E. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Owner/Contractor Specs WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN K UNDEVELOI NO PUSUC MALS wDMN Too' OF PROPOSED SYSTEM. NO PTXYATE mus "I MO' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPDC SYSTEMS MTNH YW OF PROPOSED NELL EXCEPT AS NOTED. PETERS GATE S/D, BLOCK 1, LOT 2 % ��� OF AL`S'' 1 ,* 4A 1H* , ,1 ♦�ALIXMilrur usit/ s1� r FESS10030 dV DESIGN DETAILS 3 BORM X 150 GPD - 450 GPD 450 GPD/1.2 GPD PER SO. FT. (2.5 MIN AN.)- 375 SO. FT 375/(2x10) — 18.75 FT. TRENCH USE 1 TRENCH — 19'(L) X 2' (W) X 10'(D) Total depth of system is 13' from original grade. Total depth of gravel below distribution pipe is 10'. NOTES: 1. USE 1000 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2" HD BURIAL FOAM IF <3' COVER 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS dE SEPTICS. ESMTS, PROPERTY LINES, WATER LINES, ETC. PREPARED FOR: BRIAN dE LINDA MAXWELL PO BOX 671693 CHUGIAK, AK. 99567 FlELD BOOKS BOUNDARY: STAXMR ASs M.T: WALAI ENO. rxc ACRD FILA COMPUTED. DRAW": WAC *NEa`M- KMD DATE: 09—L, mn NW12f 'SOB N" 04061 Scale: 1"= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 111 I1 WASTEWATER DISPOSAL SYSTEM DETAILS PETERS GATE S/D, BLOCK 1, LOT 2 IIj. 100'I RAD .4's / v 2 STORY 0 3 BEDROOM KND 18' FRAME HOUSE 401+ �, 0 , CO 0 PROPOSED 1000 GAL TANK 400/ + PROP ED PRIMARY SYSTEM CO TH04-1 15-20%O 20' 25-30% PROPOS D RESERVE SYSTEM 100' RAD I .�. OF PREPARED FOR: BRIAN do LINDA MAXWELL ^^If�[] PO BOX 671693 * 4r: l All !!! VVV / * CHUGIAK. AK. 99567 F�&ENNETH Y. D % CE-7EI � 1rs7'. ��.: FESSLOTl� FIELD BOOKS COWUTM Zzmr. paw: sr""nc . CHCCKM- KMD AST' WALATKA DATE 09-14 o"°. na: pao- NW12E Am nr.04061—DRW i10B "" 04061 Scale: 1"= 20' PAGE 2 OF 2 L"L\] LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1 KINM ENGINEERING, INC. 4A 20441 PTARMIGAN BLVD. of EAGLE RIVER, AK 99577-8736 ,004 ti SOILS PERCOLATION TEST Performed for: Linda Maxwell Date Project: Peters Gate B1, L2 TEST HOLE u 04-1 Depth (Feet) 20- ORG/OL —red /brown SEE ATTACHED SITE PLAN overburden I FOR HOLE LOCATION GM/SM - gray, mod. dense, cobbles to 3'+ B.O.H. 0 Was Groundwater encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 8/30/04 Reading Date Gross Time Net Time Depth to Water Net Drop 1 8/30/04 1:00 - 6" - 2 1:10 10 min 19/16" 47/16- 3 1:11 - 6" - 4 1:21 10 min 112/16" 44/16- 5 1:22 - 6" 6 1:32 10 min 114/16" 42/16- 7 1:33 6" _ 8 1:43 10 min 2" 4" 9 1:44 - 6" 10 1:54 10 min 2" 4" 11 1:55 6" 12 2:05 10 min 115/16" 41/16" ' Water Added Percolation Rate _2.46 (min/ in) Pere Hole Diameter 6" Test Run Between 6 feet and 7 feet 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. 11K D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER. AK 99577-8736 696-6111/FAX (907) 696-8111 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: PETER'S GATE BLOCK 1, LOT 2 GENERAL: 1. The scope of this project includes the installation of a septic tank and/or drainfield to serve a single family residence on the referenced property as delineated on the attached Municipality of Anchorage (MOA) permit and site plan. 2. Construction shall be in accordance with the approved site plan and design drawings, MOA permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. KND Engineering Inc (KND) assumes no responsibility of the accuraty of the as -built survey provided by the owner or owner's representative. 4. The owner or contractor is responsible to notify the engineer of any discrepancies noted on the design plans or drawings prior to commencing work. These discrepancies could be, but not limited to, possible encroachments, surface water, varying soils, unplatted easements, types or use of dwellings on or adjacent to property, nearby public wells, etc. 5. The contractor shall be responsible for locating any necessary underground utilities, easements, property lines and surface water. The owner and/or contractor shall ensure, if deemed appropriate, that a registered land surveyor prior to construction flags all setbacks. 6. The contractor shall be responsible for verifying all pertinent separation distances and component layout. 7. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 8. The MOA Development Services Department On -Site Water & Wastewater Program must certify contractors installing wastewater disposal systems. Owners installing their own systems must also receive prior approval from said MOA Department. SEPTIC TANK / HOLDING TANK / LIFT STATION INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent damaging, settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade. 4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will ensure that the fill over the tank does not exceed the burial depth rating. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 feet from the tank. The second cleanout, in line, shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. Pa"n 1 n(1 Reference: Peter's Gate 111, 12 Date: 09/14/61 Page: 2 of 3 7. All H.D.P.E. tanks shall have a vertical length of 4 -inch perforated drainpipe besides the tank extending to the bottom of the tank to above grade to monitor ground water. 8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy forces in high -groundwater areas. 9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence. 10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA guidelines. 11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing Code. The contractor is solely responsible for the abandonment procedure. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavaction become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations facing downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per manufacturer's specifications and MOA requirements. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. The following pipe materials are MOA approved for use in septic system installations: Type of Pipe Perforate adw Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. If deemed necessary, a sieve analysis should be performed. 7. When sand is being used as a filter material, its gradation specification must conform to current MOA or DEC requirements. Reference: Peter's Gate 81,1.2 Date: 09/14/0.4 Page: 3 of 3 INSPECTIONS: Typically there will be three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the sewer rock, distribution lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and attached plans and in accordance with the attached MOA permit. All materials, components, and construction practices shall comply with the MOA's and the State of Alaska's latest ordinances, regulations, or policies regarding wells and septic systems. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such deficiency. There will be no contractual arrangement existing between the contractor and KND Engineering Inc. KND shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the MOA. KND shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. KND's inspecting engineer will not be responsible for the construction means, methods, and techniques, sequence, procedures or the safety precautions incident to this project. BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR, AND WELL DRILLER ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS. Legal Description: _..� COSA Checklist Peters Gate Block 1 Lot 2 If more than 1 septic system on lot: CASA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 8/21/05 Total depth 500 ft Cased to 24 ft ® Sanitary seal is functioning correctly ❑E Wires are properly protected Casing height (above ground) 24+ in Date of flow test for COSA 10/15/19 Static water level at beginning of test 70 ft. Comments B. TANK DATA Age of tank(s) 14 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 IN Standpipes/foundation cleanout per record drawing Date of pumping /111-4 /a O.D. D. ABSORPTION FIELD DATA Which system tested (date installed) 6/23/05 0 ALL standpipes present per record drawing Total measured depth from grade 15.6 ft (max) Measured depth to pipe invert from grade 6'5 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-541-24 Structure served by this system 1 Well production at time of test '33 gpm Water storage tank volume 300 gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 0.44 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 3/24/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/15/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 2 in Water added 600 gal New depth 14 in Elapsed time 30 min ®Code -required soil cover over field Final fluid depth 2 in Absorption rate 600 + d ❑System presoaked p gp (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced _gallons Comments/Deficiencies: Mer Site verification elevations MT does extend to bottom of trench. COSA Checklist yellow sheet E. SEPARATION DISTANCES µ' 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' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'R] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft Yes if No ft ft If septic tank is under driveway comment below 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: ® Yes 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 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 ft Surface Water> 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I 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. CASA Checklist yellow sheet Well Water Advisory Certificate of On -Site Systems Approval # OSC191550 Subdivision: Peters Gate , Block: 1, Lot: 2 This well's productivity was determined to be .33 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. `-"�".�`"xt�sr,d �Cia�Cs7�ar 'm �,.� �l �iaska