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HomeMy WebLinkAboutCAMPBELL CANYON LT 5Campbell Canyon Lot 5 #041-011-07 GARNESS ENGINEERING GROUP, Ltd. - CONSULTANTS 8 GENERAL CONTRACTORS : - ..- .T .,,. . June 12,2007 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Campbell Canyon Subdivision; Lot 5; 10607 Aletha's Mountain Way: Soil cover over septic tank. To whom it may concern: We inspected the Campbell Canyon Subdivision Lot 5 septic system on 12/22/2006. At the time there was inadequate soil cover over the septic tank. A conditional approval was granted by Deb Wockenfuss on 12/26/2006 under the stipulation that the required fill be in place by June 15, 2007. On 6/11/2007 a site visit was performed and it was found that there was adequate cover over the entire tank. Based upon this inspection we request that you grant Campbell Canyon Subdivision; Lot 5 unconditional approval for an on-site wastewater disposal system and well. If you have anylgtstions, please contact us at 337-6179. .E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, Alaska 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Websitc: www.gamcsscngincering.com Municipality of Anchorage .• •a • .. Development Services Department ; rr^ '^.•. Building Safety Division On -Site Water & Wastewater Program, 4700 South Bragaw St. o ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 Pogo 1 3 of On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO50427 PID Number: 041-011-07 Noma: PAUL MOON Wastewater System: ■ New ❑ Upgrade Address: 315 KRANE DRIVE #7 • ANCHORAGE, AK 99504 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 254-3626 4 ■Deep Trench oShallow Trench Deed 011ound ❑Other LEGAL DESCRIPTION 5vi "° "° 1.2 Tea o.wn Tam cPo/sa. FL SEE DWG. rt Block: Lot: subdivision: — 5 CAMPBELL CANYON owlh to ppb twtta,n ha. aag'v,al glace: SEE DWG. cnm,, depth ew»oth poll: 5.2 FL n Township: — Range: — Section: n ache❑ above "klal groae: Galw k g%: — SEE DWG. rt 52 FL WELL: ❑ New ❑ Upgrade Gavw width: 3 11,.nbw of See: oislmee be . Ser rL 1 — rt Cldeeiht.tim (Private, A.e,c): Tea oepthCaw Ta: Total aeewptbn eve: Ppb ,notedei: n 540+ so. rt D 3034/ F-810 orwl . bled: static water LA : b,waaec RED DOG MASONRY acts kataaw: *8/8-9/2006 n rola: Pvnp IIet At:Casing Height Above Gauna: aPu R rL TANK SEPARATION DISTANCES aseptic OHolding OS.T.E.P. 0Other TO Septic Absorption Lift Holding abse/pnvate wa'h'scu,,•n CoPoc�ty in gasme: From Tank Field station Tank S.. tk,.. "ANCHORAGE TANK •"1250 Well 100'+ 100'+ — — 25'+ wme„w: ••STEEL a te' •/2 Surface water 100'+ 100'+ — — — LIFT STATION Lot Une 5'+ 10'+ — — _ s1e h goswe. �OLY1Mer` Foundation 5'+ 10'+ — — _ an le, at ell level ob w alwm at Curtain Drain NONE KNOWNP'""p w°ee • tr,col tnepecbo,r prlwnrd br: Remarks: BENCH MARK *INSPECTED BY ALLEN MURFlTi P.E. (DECEASED) teaecon aM Dewalptbn: BOTTOM OF FRONT DOOR THRESHOLD "PER CONTRACTOR A. 100.00 n ' Inspections performed by: GEG, Ltd. Dates: 1st 8/8/2006 ENGINEER'S SEAL op 2nd 8/9/2006 �od0 3rd 12/22/2006 off: Development Services Department Approval .-, ••. ;l . Conditional Approval: lam/ Date:O6 ..................� e ey erness. �� % m TA- / O P / . Qa °p T 2. CE -7951 6 : o�O P �0� �2(, A`o ^°"Pr��� 0° Reviewed and approved by: Date: _?h4107 (Rev. 4/06) O rellta� o� °°ODoo�O INUMBER: PARCEL ID NUMBER: SW0 AS—BUILT DRAWING I SW050427 041-011-07 PAV DELI DBL2� A B 0 PPROXIMATE LOCATION OF WATER UNE PER CONTRACTOR GARNESS ENGINEERING GROUP, Ltd. 4 CONSULTANTS i GENERAL CONTRACTORS �•""' "' "' """"" OAI L TCM VOID. 1VRC 101 • •KNORAM MI M!0) . M101[ (00)JOi)-ell• • IMI (207), UO • eDRO(:.w.O PREPARED FOR: PHONE NUMBER: PAGE NUMBER: . . . .. ......' CHOY MOON 264-3626 2 OF 3 Op. LEGAL DESCRIPTION: DRAWN BY: D v CE- {p'Q CAMBELL CANYON SUBDIVISION; LOT 5, C.J.G. O�p s� '1•Z,� Lza� ^ov p ey P�^�o� TYPE OF WORK: DATE: 4Oofess�o sio AS -BUILT DRAWING OF NEW SEPTIC SYSTEM 12/22/2006 (Rev.01105) STI 38.0 46.3 NEW DRAINf1ELD �J B ST2 42.3 53.2 ALTEaNATE SrrE DBL1 44.9 56.4 NEW 1250 GALLON SEPTIC SYSTEM OBL2 46.1 58.0 \ TH/4+ C01 60.3 76.3 MT1 64.0 80.1 CO2 105.5 126.7 ' �'• - 0�0�` 4 MT2 100.0 121.1 '' '., ,• ;'� ` r, / / \ N \ \ S E: \ 1' - 40' GARNESS ENGINEERING GROUP, Ltd. 4 CONSULTANTS i GENERAL CONTRACTORS �•""' "' "' """"" OAI L TCM VOID. 1VRC 101 • •KNORAM MI M!0) . M101[ (00)JOi)-ell• • IMI (207), UO • eDRO(:.w.O PREPARED FOR: PHONE NUMBER: PAGE NUMBER: . . . .. ......' CHOY MOON 264-3626 2 OF 3 Op. LEGAL DESCRIPTION: DRAWN BY: D v CE- {p'Q CAMBELL CANYON SUBDIVISION; LOT 5, C.J.G. O�p s� '1•Z,� Lza� ^ov p ey P�^�o� TYPE OF WORK: DATE: 4Oofess�o sio AS -BUILT DRAWING OF NEW SEPTIC SYSTEM 12/22/2006 (Rev.01105) PERMIT NUMBER: AS—BUILT DRAWING PARCEL IDNUMBER: — SW050427 041-011-07 ADDITIONAL COVER TO BE ADDED SPRING SUMMER OF 200'y FINAL GRADE ve 84.21-65.67 TOP OF TANK 1 1 I I TOP OF TANK AT INLET ve 80.67 STI RST2 /;T OUTLET - 80.63 THIS I I NEW 1250 GALLON I I INVERT OF BUNG SEPTIC TANK `INVERT of BUNG AT INLET - 80.09 AT OUTLET - 79.88 APPROXIMATE RELATIVE ELEVATION OF BOTTOM OF TESTHOLE ve 63.72 (TEST HOLE DRY) FINAL GRADE - 81.72-82.22 FABRIC NOTE: ELEVATIONS SHOT THROUGH PIPES AFTER SYSTEM WAS INSTALLED. FINAL GRADE INVERT OF PIPE MEASUREMENTS APPEAR TO BE 77.31 (AVG.) CONSISTENT WITH ORIGINAL GRADE IN THE AREA. BOTTOM OF TRENCH 72.11 (AVO.) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS S GENERAL CONTRACTORS lAl C IWM IIMD. lIIC 101 • MClO11C[ MI MSO) • Mell[ (101)")-e1T • FAX (101"Y " • Q4R w..r•rywr•ya•'n PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CHOY MOON 254-3626 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: CAMPBELL CANYON SUBDIVISION; LOT 5. C.J.G. TYPE OF WORK: DATE: PROFILE AS—BUILT OF NEW SEPTIC SYSTEM 12/22/: (Rev. OiW) all)RA)/ M CE -79;3,.. zh •' a cs 0 ° n N 01 N I U N to 1 0 P NO _ Z z Q _ 0 v o f . .•: 6 c N W N ° .. 0 Dm0 O O N z N 0i 0 om� 0 Dm CA a o 0 Z- z- co c zl Z y1 l a Ul C u° z > D ^c uN F ' C o_ Q VI ;a c < ^ % i a NO n m X ON m X ,! i � `\ r _ Cl) z 0 ° n N 01 N I U N to Z 00 0 1 0 a s NO _ O yey V X O A Ln3 . .•: 6 c _ v C C) mI m N ; /0 Di � I 0 Dm N a rO Z- z- co V v zl Z y1 l a Ul C 1 I P. co ^c F 9 u o_ Q ?Rc+ ti d n ,! `\ Am r.9;:- Cl) n ;a 7 \\\ 2 R'or So'g 0 *wS \ 8 °aQ S eeo'gz \ ft cga1= .Bi ssC 5'��3s Syi rya go o300 :$4 Ey RssA9 z+3R a`E e3 Z 00 0 1 r. O: zz 00 _ I 1 r7r� . .•: N c 0 —' A � mI m N ; n Di � I Z 00 0 1 r. O: zz 00 _ I 1 r7r� W t� l c 0 —' A � mI m 0 n Di � I w N ml � 1 Z- z- co V v zl Z y1 1 I ^c 1 z< o ?Rc+ ti 1 ,! `\ Am r.9;:- ZD ;a \\\ s9 TQC g C W \ S \ 2 rya *otic oRs^+• Q^ zz 00 Eg_ r7r� sgS"¢3 sea c 0 —' A y _M Xin3» +ogi 0 n w rRe•Ro a REQ Z- z- co n ^c :� z< o ?Rc+ ti E it 8 s `\ a.,TP c Y � N w `\ MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SWO50427 Legal Description: CAMPBELL CANYON LOT 5 Design Engineer: 0009 A.W. Murrill Company, Inc. Owner Name: PAUL MOON Owner Address: 315 KRANE DRIVE #7 ANCHORAGE. AK 99504 - Date Issued: Nov 08, 2005 Expiration Date: Nov 08, 2006 Parcel ID: 041-011-07 Site Address: NHN ALETHN'S MOUNTAIN WAY Lot Size: 47319 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of. ❑d Disposal Field [D Septic Tank Holding Tank ❑ Privy Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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: Issued By: Date: -4�44 Z1:5:71�: Date: o Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 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. DUI- nu -o'+ Permit Number SW Property owner(s) A 111I Y 1� GMS f Day phone Mailing address kC 315 yajUc 4)1^ # q- A 1 A Zip Code c7C1 JD LI Site address Code Legal description (Lot, Block & Sub'd.) t Legal description (Section, Township & Range) Lot Size `1 q, 51 q Acres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool I certify4t t the above information Single j jily Dwhing and is in �p EI ■ ■ of property owner or authorized agent) Permit/Rush Fees: Date of Payment: I/0`�5 1o, Receipt Number:��60 —gp- (Rev. 09/04) Well Only Water Storage Jacuzzi Water Softening Unit N I further certify that this application is being made for a with applicable Municipal Codes. Waiver Fees: Date of Payment: Receipt Number. A.W. Murfitt Company_ CONSULTING ENGINEERS & TESTING 13810 Vmuc Way • Anchca-jW, ALi%ka 99515 • Tekphone (907) 345.2737 • FAX (907) 345-3264 November 2, 2005 Municipality of Anchorage Department of Health & Human Services On -Site Services Section 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 ATTENTION:Mr. Dan Roth RE: Well & Septic System Design Four Bedroom, Single Family Dwelling Lot 5, Campbell Canyon Subdivision Branch Associates Anchorage, Alaska Our Job 05-370.04 Dear Mr. Roth: The referenced property represents an undeveloped 1.1 acre parcel. Mr. Greg Branch of Branch Associates has proposed a four (4) bedroom, single family dwelling on the lot as shown on the attached site plan, Plate 2. Our design data is summarized in the following dialog. 1. SOILS: Attached is a copy of the soil log/percolation test data and Site Plan Plate 1. The log (done by others) documents a Gravel (GP/GW) soil profile from a depth oft feet below the ground surface to a depth of 8 feet. This is followed by a Silty Gravel (GM) to 12 feet, and then back to Gravel (GP/GW) to a total depth of 18.5 feet. No water table was encountered while excavating, nor was water found at the time of monitoring on 11/2/05. The receiving soil has a percolation rate 1.25 minutes per inch, and should not be frozen or allowed to freeze during construction. 2. ABSORPTION DEEP TRENCH DESIGN: a. Percolation Rate: 1.25 minutes per inch. b. Allowable application Rate: 1.2 gallons/day/ft 2 c. Number of Bedrooms: 4. Page 2. MOA, DHHS 05-370.04 November 2, 2005 d. Design Flow: 600 gallons per day (at 150gallons/bedroom). e. Minimum Absorption Area: 500 s.f E Max Total Depth (below original grade): 10 ft. (4.0 ft. cover, 5.0 ft. sewer rock). g. Width: 3 ft. IL Minimum Length: 50 ft. L Effective Absorption Area = 500 s.f. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system There are no streams or drainages on the property. 4. TOPOGRAPHY: The septic site slopes to the north and west at an average of 6 percent. 5. IMPACTS: On the basis of the available site information, there are no wells or septic developments within 100 feet of this system Accordingly, there will be no adverse impacts on adjacent wells or septic systems nor restrictions to future development of adjacent lots. 6. WELL and SEPTIC INSTALLATION: There are no plans for anon site well for this property. The subdivision is served by a community "Class A" well. The septic system designed herein shall be constructed in accordance with the most recent AMC 15.65 by an approved septic system installer. The installations shall be completed in accordance with the requirements of the On Site Septic Permit. Page 3. MOA, DIIIIS 05-370.04 November 2, 2005 Please call our office at 345-2737 if you have any questions or need additional information. Sincerely, A.W. Murlitt Company Z4 - Allan W. Murfitt, P.E. Registered Civil Engineer 4977-E COPY TO: Mr. Greg Branch at Branch Associates. ATTACHMENTS: 2 Percolation Test Reports, Deep Trench Design Plate 1, and Site Plan Plate 2. IL LO ) q Q „ k � u Z 2| \| �5§ ae■|�, ) �Ka /r±|;!}( /12' 4 IL LO ) q Q „ k � u Z 2| \| ) | e ■ r--4 �LL ,o! r � ■�- E f2 M k �kca #E�� �© r- U) %f 2 aU) m=cam o- m -s OD wo t�§0;(D Oa/2§kfEA 3 £ƒZ §EI3f[{� E� 0-- ����Et/� r§ 2o<-E<2ce-a ~a \§__§ �ƒ22222a \§ U/§ §ACL>�k§-- 0 \f&�§2EZ ka £}« §�a2C:Ec f) f�Io§#�gE §E(19LrE32ai mE-O:Ja U)000UU z�»n(<LC<n=eM0 z w w 6+ w (6 r-.: 6 6 | | , c Wim§ £ Q c 0 14A j| RM ■ r--4 �LL ,o! r � ■�- E f2 M k �kca #E�� �© r- U) %f 2 aU) m=cam o- m -s OD wo t�§0;(D Oa/2§kfEA 3 £ƒZ §EI3f[{� E� 0-- ����Et/� r§ 2o<-E<2ce-a ~a \§__§ �ƒ22222a \§ U/§ §ACL>�k§-- 0 \f&�§2EZ ka £}« §�a2C:Ec f) f�Io§#�gE §E(19LrE32ai mE-O:Ja U)000UU z�»n(<LC<n=eM0 z w w 6+ w (6 r-.: 6 6 | | , c Wim§ £ Q c 0 14A j| 09/00/03 FRI 14:28 FAX 907 278 0879 KARLITC DESIG% 10003 • • MUNICIPALITY OF AN040PAGE • DEVCLOPMENT SERVICES DEPARTMENT/BUILDM SAFETY DIvLSION ON-SITE WATER AND WASTEWATER PROGRAM 000 SOUTH BRAGAW ANCHORAGE, AK 99519 2ROJEC7 #: SOILS LOG - PERCOLATION TEST PERFORMED FOR: Southcentral Timber Development DATE PERFORMED: 5/0/2o0t _EGAL DESCRIPTION: lot S Campbell Canvon TEST HOLE # 4 OG/OL/PT GM/GP with Very Coarse Sand WAS GROUNDWATER ENC0INTERED7 NO S GP/GM L IF YES, WHAT DEPTH? 0 1' Nominal Rock Size P sit De M of WATER N,Wo.�er AFTER MONITORING: E GP/GM r - 3' Cobbles t91t -12x slit DATE. BOH 18• SITE PLAN N Sea Site Plan Ste Site Plan 411r �avvnl�WAir2 /J1rc►EIN4 Ik�E Qy &w. MI/RFITI; READING DATE GRoss TINE NET TIME STH OF. WATERORT NET Start 5/9/04 12:02 8' 1 T2:12 10 Or Recharqe 12:13 0' 2 1223 10 Dry so Recharge t2:24 0' 3 12:34_j ic Dry 0' PERC RATE: 1.25 MIN./INCH FERC. HOLE DIAMETER: 6' TEST Rum 9ETWCCN_ 5.0 FT. AND 6.0 T. COMME4M Test Hole Pre Soaked Prior to Percolation Test V. o..c-•.•.... 0... Au 1 My A4 F "mmew rawrsFv THAT THIS TEST WAS PERFORMED tN ACCORDANCE 09/20/03 FRI 14:28 FAX 907 279 0879 RARUT DESIGN 11009 �• MUNICIPALITY OF ANCHORAGE DEVELOERVICES DEPARTMENT/BUILDING SAFEIVISION ON- ITE WATER AND WASTEWATER PROGR 4700 SOUTH BRAGAW ANCHORAGE, AK 99519 QCT #. SOILS LOG — PERCOLATION TEST AFORMED FOR: SomHKe2ral ri &teDertloowmt DATE PERFORMED: GAL DESCRIPTION: DESCRIPTION ° capawl an °n TEST HOLE # s OG/OL/PT GP/GW S Z IA Golden to Golden Rust N GP/1 WAS G ATBt EmCYj4TeW-07 401 IF YES. WHAT DErlti? DEEM OF WATER AFTER MOSITORNG: DATe BOH 111.5' S L 0 okaC P I I \\20 C720J�1cIIJnTC2 MaJrT0n1,J j D(WIF R7 Anl rT'ua,`(TF See Site Plan READe+G DATE GR= WTT DRO►Stxt S/9/K tt2211F.32e- ::•: GM is% to 29% Y ;♦ Sit Tt332 1463 GP/1 WAS G ATBt EmCYj4TeW-07 401 IF YES. WHAT DErlti? DEEM OF WATER AFTER MOSITORNG: DATe BOH 111.5' S L 0 okaC P I I \\20 C720J�1cIIJnTC2 MaJrT0n1,J j D(WIF R7 Anl rT'ua,`(TF See Site Plan READe+G DATE GR= WTT DRO►Stxt S/9/K tt2211F.32e- 4N*E-'TDEffH�0F Rechar Tt332 1463 e' 1Usf. 16 1 Orye' PERC RATE: _1.2i_ HIN.1" PERC. HOLE DIAMETER:_ TEST RuN DETweEN S1 --FT. AND6�T. COMMENTS: Test Hole Pre Seawed Prior to P°rc°lation Test TEST PERFORED BY: AHI, MICNA E ANDERSON, CERTIFY THAT THIS TEST WAS PtiIFDF;HEu IN SI 3 209C4FM�E WITH ALL STATE. AND t'1UNICe'AL GumijNEs ON THis DATE: MUNICIPALITY OF ANCHORAGE o ( � Development Services Department s 4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 041-011-07-000 Legal description CAMPBELL CANYON LT 5 Expiration Date: 1/24/2024 Site address 10607 ALETHA'S MOUNTAIN WAY Anchorage AK 99507 Current property owner(s) MOON PAUL M S & HYO YREVOCABLE LIVING TRUST X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 21 Original Certificate Date: 10/24/2023 'This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 041-011-07 Complete legal description CAMPBELL CANYON LOT 5 Location (site address) 10607 ALETHA'S MOUNTAIN WAY, ANCHORAGE, AK 99504 Current property owner(s) PAUL & HYO MOON REV. TRUST... Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 17 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ J 5-0 Waiver Fee $ Date of Payment /a_z/ Date of Payment COSA # 05C,2 -3)q0 -Z_ - Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: CAMPBELL CANYON LOT 5 Parcel ID: 041-011-07 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed 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 COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 47” Date of pumping 10/11/2023 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/9/2006 ALL standpipes present per record drawing Total measured depth from grade 9.8 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 10/13/23 Results Pass Fluid depth prior to test 12 in Water added 710 gal New fluid depth 19 in Elapsed time 75 min Final fluid depth 12 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 62 in (MOA 5.2’ ED) Effective depth used 12 in (Final Fluid Depth) Effective depth remaining 50 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per visual observations, elevation measured shots & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/20/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/20/23