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HomeMy WebLinkAboutHIGHLAND TERRACE #4 TR 5AHighland Terrace #4 Tract 5A #050 - 311 - 09 ¢  Municipality of Anchorage .,-'~~-~, Development Services Department Building Safety Division On-Site Waler & Wastewater Pr~ram, 4700 Bragaw P.O. Box 196650 Anchorage, AK 99519~650 ~.ci.anchorage.ak.us (907)~3-79~ Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Repod Pe~it Humbert SW030194 PID Numbe~ 050--31 1--09 N~me:ROY LEB~NC Wastewater System: M New ~ Upgrade ~dress: 10021 WILDWOOD STRE~ * ~GLE R~ER. AK 99,577 ABSORPTION FIELD Phone: NO, of Bedims: (907) 694-8570 3 D ~ep Trench I Sha~low T~h D Bed ~ Mound D~her LEGAL DESCRIPTION ~.o ~. - T~CT 5A HIGH,ND TER~CE ~4 3.1 M~ - - - SEE DWG. WELL: a New D Upgrade 5.0 PRIVATE 200 n. 8 ~ 450+ ~. ~ D 3054/ F-810 KRYSTAL-LIN DRILLING 8/2/2003 20 ~ OWNER 5/20-22/2003 1.2 ~1 UNKNOWN ~l 2'+ ~ TANK SEPA~TION DISTANCES .s.,,~ ~,o,~ ~s.~.~.,. ~,.~* To Septic ~so~tion Uft Holding ~'& ~ ~n :~'~' ~ ' '"' 1250 Tank Reid Station Tank ~ ~ ~ we, 100'+ 100'+ - 25% STEEL ~ ' ' 2 s~. w~., ~oo'+ ~oo'+ - - .~;'...~ LIFT STATION ~ Lot Une Foundation 5'+ .... I Oro~n NONE KNOWN ~~: I~ "~ Cu~a~n ~e~o~: B~NCH ~ARK BOSOM OF SEPTIC TANK IN ST1 97.42 Inspections pedormed by: GEG, Ltd. Dates: 1st 5/20/2003 2nd 5/20/2003 3rd 5/22/2003 ~,."' ~ Development S~s ~adment Approval ~:"/4~ !JJl~ [ '"~ Conditional approval: Dote: / / R~viewed and approved b Date: PER~ NUM~:R: AS-BUILT DRAWING SW030194 A B ST1 45.79 68.60 ST2 54.64 75.46 DBL1 57.95 77.58 DBL2 59.48 78.54 CO1 86.21 93.61 UT1 87.20 94.40 CO2 97.82 82.14 UT2 97.24 81.60 NEW 1250 GALLON SEPTIC PARCEL ID NUMBER: 050-311-09 \ \ \ DBL2~ \ DRNNIqELD / / GARNESS ENGINEERING GROUP, Ltd. ·-~-'~:~- CONSULTANTS & GENERAL CONTRACTORS PREPARED FOR: IPHONE NUMBER: [ PAGE NUMBER: ROY LEBANC 694-8570 2 OF' 5 LEC, N. DESCRIPTION: HIGHLAND TERRACE #4, TRACT 5A DRAWN BY: K.D.M. 1YPIF OF WORK: AS-BUILT DRAWING DATE: 9/19/2008 PER.~NU.;~.; AS BUILT DRAWING .'~C~,,0 NU'B~": SW.030194 - 050-311-09 INBULAllON 1~04.N~ 90_ I oRAD6E. 1 ~ ~ 1250 GALLON ~ or 8UNC~ [ ~ SEPTIC TANK AT IN~ - 101.77 t/ TOP OF TANK AT ,.,.~U3I. ET ,- 102.31 ~'%'N--INVERT OF BUNG AT OU13.-rT .. 101.49 TH#3 FILTER 95.34-95.57 PiPE - 91.80 (AV~.) e9,40 (^V~.) PREPANEO FOR: IPHON£ NUMBER: I PAGE NUMBER: ROY LEBLANC I 694-8570 I 3 OF 3 LEGAl. DESCRIPTION: DRAWN BY: HIGHLAND TERRACE #4, TRACT 5A K.D.M. DATE9~/19/2008 TYPE OF WORK: PROFILE AS-BUILT DRAWING 119 Permit Number: #SW Date of Issue Date Started: $11012010 Date Completed: 61~12010 Property Description HIGHLAND TERRACE ADDN NO.4 Lot 5A Block Property Owner Name & Address: ROY LEBLANC STEEPLE DR. EAGLE RIVER Borehole Data: Depth Soil Type, Thickness & Water Strata From To See Comments 0 190 Gray Bedrock 190 238 Gray & White Bedrock 238 266 Gray Bedrock Hard 266 274 Green Bedrock Hard 274 307 Gray Bedrock Hard 307 356 Gray & White Bedrock 356 400 Water Sample Results: Arsenic: ug/l Nitrates Total Coliform Bacteria co lonies/100mL Other bacteria: col/100mL Well Log Parcel Identification Number: Is well located at approved permit location? !X lYes Section: Town: Range: (lso AK 99577 Method of Drilling ~1 air rotary Iii cable tool Casing type: Wall thickness 0.25 inches Diameter 5 inches Total: 44 feet Liner type: Diameter inches Depth: feet Casing stick-up above ground: 2 feet Static Water Level (from top of casing) Pumping Level: feet after I hours pumping gpm Recovery Rate gpm Method of Testing: Air 41 feet Well Intake Opening Type [i~ Screened Start feet Stopped feet [7,1 Perforations Start feet Stopped feet Grout Type: Bentonite dry granular Volume: 750 Pounds Depth 44 Start 0 feet Stopped 44 feet Pump Intake Depth: feet Pump size: HP brand name Well disinfected upon Completion? !X~ Yes i ! No Method of disinfection CHLORINE 50 PPM Comments: EXISTING 190' WELL UPDATED TO CURRENT SHALLOW BEDROCK CODE AND DEEPENED TO 400'. FULL GROUT SEAL TO 42'. WELL PRODUCES 15 GPH. Well Driller: Cole Sullivan Sullivan Water Wells P.O. Box 670272 Chugiak, AK 99567 (907) 688-2759 Attention: The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion. Mark Begich Mayor Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Brogaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.rauni.orq/on$it¢ (907) 343-7904 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: Date of Issue: Legal Description ~1 .,,.~.~ k~.._ / Pump Installation Date: ~/~/jO Pump Intake Depth Below Top of Well Casing: ~ffS- feet Pump Manufacturer's Name: (,.~.,~1 ~') Pump Model: /~' ~3 },Y q/'~ Pump Size ~: ,~ hp Pitless Adapter Burial Depth: ~ feet Pitless Adapter Manufacturer's Name: C¢~?6&{ Pitless Adapter Installer: ~Ali'~,..~ L~q ~)e./l~, Well Disinfected Upon Completion? ~'Yes ~ No Method of Disinfection: Comments: Property Owner Name & Address: Pump Installer Name: Company Name Mailing Address city nK Zip Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Prograrn 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Renewal Date Issued: Jun 17, 2003 Expiration Date: Jun 16, 2004 Permit Number: SW030194 Legal Descdption-~,HIGHLAND TERRACE f/4 TR 5A~ Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Roy & Melissa LeBlanc OwnerAddress: 10021 Wildwood St. Eagle River, AK 99577- Parcel ID: 050-311-09 Site Address: Lot Size: 90750 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of:. [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Pdvate 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 ( 18AACS0 ). 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. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 A~chorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 ON-SITE SEWEF~ELI. PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0~0 3)/--~' Permit Number Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size Day phone Zip Code Acr~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] ~ Water Storage [] [] [] Jacuzzi [] [] Water Softening Unit [] [] I certify that the above information is correct, I fudher certify that this application is being made for a Single-r~amily Dwelling and is in accordance with applicable Municipal Codes. {$ign,ture o[ property owner or ,uthori:,ed egent) Date of Payment: /~llblO~ (Rev. 12/00) Waiver Fees: Date o~ Payment: Receipt Number: May 12, 2003 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Waste Water Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: On-Site Septic System for Tract SA; Highland Terrace Subdivision #4 To Whom it may concern: This letter is to advise you of my intention to install my on-site waste water system. This installation will be completed in accordance with the design engineered by Alaska Water and Waste Water Consultants and the required inspections will be contracted through them as well. My personal abilities include general construction experience as well as familiarity operating heavy equipment. I have purchased an approved septic tank through Anchorage Tank and Welding, reserved an EX100 excavator for a week rental and made arrangements for drain rock to be delivered by ROK Services. I intend to conduct the septic system installation during the week of May 19th. If you have any questions I can be reached via phone at 694-8570 or cell 727-0446. Thankyou Roy LeBlanc Property Owner Tract SA, Highland Terrace Subdivision ltl "\ ~\~\ HIGHLAND T[RRAC[ (SEE DESrGN. P~E 2 OF 2~ Z4/11/2005 ~-~ /~ ~ '.' &VATER & W~TEWATER. PREPPED FOR P~NE NUMB[E: P~E N~BER: ,~ ROY · MEUSSA' LeB~NC 694-8570 I OF 2 [~. ~.~f~ ~ o~.,,,~.: ~,,%'/~. :~- 7~." ~ I HIGH.ND TERRACE SUBDIVISION ~4; TRACT 5A ~ '.. / ..." ~.~ , SITE P~N FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM MUNICIPALIT~ 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 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Renewal Date Issued: Jun 13, 2002 Expiration Date: Jun 13, 2003 Permit Number: SW020168 Legal Description: HIGHLAND TERRACE ~ TR 5A Design Engineer: 0003 S & S Engineering Owner Name: Roy & Melissa LeBlanc Owner Address: 10021 Wildwood St. Eagle River, AK 99577- Parcel ID: 050-311-09 Site Address: Lot Size: 90750 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. Date: Municipality of Anchorage Development serVices DePartment Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.a nchorage.ak.us (907) ~3-790~ ,Su50t O\ $ t ON-SITE SEWER/WELL PERHIT APPLICATION ' - FOR A SINGLE FAHILY DWELLING Parcel I.D. O50-311-O9 Permit Number Property owner(s) Mailing address (1) Mailing address (2) ROY ~ HF[ISS~, LeBLANC 10021 WILDWOOD STREET · FACLE' RIVER. AK Day phone §94-8570 Zip Code 99~77 Legal description (Lot, Block & Sub'd.) TRACT SA: HIGHLAND TERRACE SUBDIVISION ~/4 Legal description (Section, Township & Range) Lot Size Acres/Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only l~l sewer and Well Sewer Upgrade [] Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Jacuzzi p~] Water Softening Unit 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. ALASKA WATER & WASTE'WATER CONSULTANTS~ INC. · (Signature of properly owner or authorized agent) Permit Fees: Date of Payment: Receipt Number:.. Waiver Fees; Date of Payment: Receipt Number: Parcel I.D. Municipality of Auchorage 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 ~"~-~: X FOR A SINGLE FAMILY DWELLING ~0' 5JJ' O ~ PermitNumber~ Property owner(s) Mailing address (1) Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ;~ · ~/' 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 [] Well Only [] ,~ Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Si~-~m~~ and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12,'00) F /~0 ?C)~' ~A'P--''U'~c~a iv e r F e e s: ~ / ~'"/~O ~;),._ Date of Payment: ~- ~) ~::0~ Receipt Number'. ALASKA WATER & WASTEWATER CONSULTANTS, INC. April 11, 2003 Municipality of Anchorage Development Service Deparlment Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Well and Septic System for Tract SA; llighland Terrace Subdivision//4 To whom it may concern: The proposed 3 bedroom house is to be served by a private water and septic system. The septic system will consist of a 1000 gallon septic tank and a 5-wide type drainfield. Three test holes were excavated on the property. The drainfield will be designed around the 30 foot radius of test hole #3. The well is to be placed as shown on the site plan. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that the insitu sandy soils will act as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/fi c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 fl2 f. Total Depth: 5.5 feet (max.) g. Effective Depth: 3 h. Width: 5 feet i. Reduction Factor: 0.58 j. Minimum Length: 55 feet long k Effective absorption area = 474 fl~ 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: The average topography around the area of the proposed drainfield are 15-25 percent slopes running approximately north/northeast to south/southwest. There is a cut bank south of the proposed drainfield that will be 50+ feet away. In short, there are no slope concerns. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. NOTE: A site plan drawing, a design drawing, three soil logs, and a 7 page construction specification letter which are all part of the design paclcage for this septic system. 6901 Dcbarr Road, Suite 2B * Anchorage. AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Wcbsile: akwwc.com S/D J4; LOT 2A PROPOSED SEPTIC S~-TEM (SEE DESIGN. pAC4~ 2 OF' 2)--~ ~/~ ~/2oo~ --- ~w. ~= ~.,~.. z.~.=. ~+~'-' ~S~ ~TER & WASTE~TER ~: HIGH.ND ~ERRACE SUBDIVISION ~4; TRACT 5A ~, "' .~. ...... -" ~E OF WORK; SITE P~N FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM ~~~ / TRENCH THAT IS 5.5 FEET DE:E:P I '';o'o:~':'.'?:'~. '.- , MAX,MUU .5FEET WIDE: BY 5~-~ ~ / ~e~ '~- SEPTIC TANK _ / ~~ c,~o~ / TOP OF CUTBANK ~.~ ~ / i · CONSULTANT,S. INC. , I" -- ,40' ,~, "': ....... J' "/J ...... : ROY &: MELISSA LeBLANC 694-8570 2 or 2 LEGAL DESCRIPTION' HIGHLAND TERRACE SUBDIVISION l~4; TRACT 5A PROPOSED WELL AND SEPTIC SYSTEM LOCATION ALASKA '~VATER & ~VASTE~VATER ~ ""'/i.,~ ~ DESCRI~ON: H~CH~D ~R~E SUBDMSION ~4; ~ ~_ [' ~ *. .. ........ '~ (f ORGANICS ITEST HOLE ~1I r ............................. II~l~fll ML MIXED ~C ~ OL SH Oh I 1 BEDROCK , ~!~ DEPTH TO ' GROUNDWATER DATE D~ 8/22/2002 J [SITE J [ ~'-~oo' I 10 11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) 12 8/16/2002 1 2:42 - 6- - 2 ~:12 50 2' 4' 15 5 5:12 - 6- - 4 5:42 50 5' 14 5 5:42 - 6- - 6 4:12 50 ~' 15 17 18 PERCOLATION RATE 10 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 1.5 FT. ~D 2.0 FT. 2 A FO~ HOUR PRESOAK WAS PERFOEHED: ~ YES ~ NO SOILS LOGGED BY: ~ODY MAUS PERCOLATION TEST PERF~HED BY: ROB ~PB[LL COHHENTS: PERrOR~[g BY ~C, INC. I, JE~ ~ C~NESS, CE~ ~T ~IS W~ ~ERFOR~ED IN ACCORD~CE W~ ~ ~ATE AND MUNICIP~ GUIDEUNES IN E~CT ON ~IS DATE: ~hmlo~ DEPTH TO GROUNDWATER DATE DRY 8/9/2002 DRY 8/22/2002 ALAS~ '~ATER & WAS'rEPeATER !~'"~ CONSULTANTS, INC. ISOIL LOG - PERCO~IION TESTI . ~ DESCRI~ON: HICH~D ~E ~4; .,;~ PERFORMED FOR: R~ · U~ LeB~C DA~: 8,/9/2002 'rE-7955 '"'*~ f ORGANICS ITEST HOLE IIDItlf~ ML MIXED ~ GW m ORG r ............................. .... 1 GH CL  ~c OL : ",X BEDROCK SW ~ MH I ~sP CH SH OH I DEPIH TO ~ -' GROUNDWATER DATE D~ 8/9/2002 ~ --HI~ D~ 8/22/2002 t l ~"-~oo' I 10 11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) PERCOLATION RATE - (H[N./INCH) PERC. H~E DIA. - (INCHES) 19 lEST RUN BEIWEEN - FI. ~D - FT. 2 A FO~ HOUR PRESOAK WAS PERFORMED: D YES D NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFUMED BY: - COMMENTS: PERFORMED ~ ~C, INC. I, JE~ ~ ~NESS, CE~ T~T ~lS W~ P~RFORMED IN ACCORD~CE W~ ~ ~ATE ~D DUNIClP~ GUIDEUNES IN E~CT ON ~IS DATE: DEPTH TO GROUNDWATER DATE DRY 8/9/2002 DRY 8/22/2002 ALASKA WATER & '~VASTE~VATER ~'~."",~<~"Jlf ' '"".~l,,_. ~,,~....,, ,_._~...'--' '-' '""~'f- LEGAL DESCRIPTION: HIGHLAND TERRACE SUBDNI$10N t~4) TRACT 5A ORgANiCS TEST HOLE ~ Gw ~ ORG ............................. ,,, GM CL GC '~ OL i i sw M. ! ,, SP CH SM O. _ ~M/SM w/ SC , ML MIXED i .~.'r,~, THROUGHOUT DEPTH TO DATE GROUNDWATER DRY 8/9/2002 DRY 8/22/2002 I ~ PLAN1 I I l"=lOO' / ' 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (HINUTES) READING (INCHES) 12 8,/16{2002 I - - 6' - 2 - <1 O' 6' 13 3 - - 6- - 14 BEDROCK 4 - <1 O' 5 - - 6,, _ 6 - .41 O' 6' 16 18 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 3.0 FT. AND 3.5 FT, 2 A PRESOAK WAS PERFORMED: · YES [] NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER PERFORMED BY AKWWC, INC. I, JE~L-'Y A, C, ARNESS, CERTIFY THAT THIS W~/S P~ERFORMED IN ACCORDANCE wrm ALL STAT~ AND UUNICIPAL CUlDEUNES IN £F~CT ON TH~S DAT£: DEPTH TO DATE GROUNDWATER DRY 8/9/2002 DRY 8/22/2002 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 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jun 11, 2001 Expiration Date: Jun 11, 2002 Parcel ID: 050-311-09 Permit Number: SW010181 Legal Description: HIGHLAND TERRACE f~4 TR 5A Design Engineer: 0003 S & S Engineering Owner Name: WILLIAM K. & MARY L. DUNCAN Owner Address: NHN STEEPLE DRIVE ANCHORAGE, AK 99516/..~.b~.~ This pe~it is for ~e construction of: ~ Disposal Field ~ SepticTank ~ Holding Tank ~ Pri~ ~ Private Well Site Address: Lot Size: 90750 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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: "~2 ~~-~ Date:~'-1~'-- d / Issued By: Z~~-~ ~. ~ 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.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWER~VELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. 050 - '~, -OC~ Permit Number Sw_~_O_.~..~_L Pr,opedy owner(s) -~ address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) "~ ,rxc~' Legal description (Section, Township & Range) Lot Size ~0}~0 ~ Lc b ct~C~l'3Day Ph°neLc[03c) ~,S'~ -$(0'~ Zip Code °tot 5 ~I~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] [] Water Storage [] [] Jacuzzi Water Softening Unit I cedify that the above Information is correct. I fudher cedify that this application Is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. $ & $ ENGINEERING '-~2 ~-/~-- 17034 Eag'. Rlver Loop Road No. 204 (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Dale of Payment: Receipt Number: May 17, 2001 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 894-2979 FAX (907) 694-1211 ONsrr( MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Tract 5A, Highland Terrace S/D #4 It is requested that you issue a permit to install a xvell & septic system (Intcrmittant Dosing Sand Filter) to serve the proposed 4 bedroom house on the referenced property. Test holes were excavated and percolation tests were performed. The approximate location ofthe test holes are located on the attached site plan. At the time of excavation on 4/16/01 water was not found and after monitoring ground water for seven days test hole # I and test hole #2 were found to be We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. cc/j -n Enclosure 17034 NORTH EAGLE RNER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577 SITE PLAN I DETAIL I ./ 1" = 60' / / / / ~o SITE PLAN DETAIL 1"=30' $CAI E Z I r'q I / / / / " N.T.S. PROFILE DETAIL $CA~ F DESIGN DETAIL II cornrn II N.T.S. SCAIF Munlclpallly of Anchorage ~..,,' DEPARTMENT OF tlEALTI'I & HUMAN SERVICES r 825 "L" Street. Anchorage. Alaska 99502-0650 .,_~.~.r~.,:,... PE"FO.MED FO"~~/..'~'~U~ __~ DATE PR"FO ', 2 3 4 5 6 7 8 g- 13- 14- 17- 18- 20- SLOPE SITE PLAN was cnouNo WATER .. ~ .~", ENCOUNTERED? S P/~¥ Date: PERCOLATION RA3E ~ · ~f Im,nules/inch) PERC HOLE DIAMETER __ 1 EST nUN BETWEEN / FT AND ~ FT COMMENTS $ & $ ENGINEERING PERFORMED BY: 17U34 Eagle River Loop Road No. 204 AcconoANCE CERTIFY TI-IAT ~JIS 1EST WAS PERFORMED tN DAte: 5-/! ¥/o / Municipality O! Anchorage ~_~.~,' ~...~/~"-.'~/~ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage. Alaska 99502-0650 sm~s ~o= - p~co~n~o~ ~s~ ~~.~ ~,~ ~o~., ~. ~"-'~ PERFORMED FOR:~~~~ DATE P E R FOR~ E~; ~ '~,//. ~'~ ~- t SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? Date: 4- 5- 6 7 8 g 10 !1 12 13 14 15 16 17 18 19- 20- Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (mmute~'mch) PERC HOLE DIAMETER COMMENTS TEST RUN BETWEEN __FTAND FT PERFORMED BY: ¶ ?~1~t1 Itm_~la ~iver [eep 2earl No. ~~ CERIIFY THAT ~HI$ TEST WAS PERFORMED IN r aska 99 ACCOROANCEWTH~t~MUNC~EOUOELNES "EFFECTONTHISDATE. OATE: ~/~ 72-008 (Rev. 4,85) Iq{OI)ERTY OWNER AGREEMENT FOR TIlE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM Tiffs agreement, dated e~.Q { ~Onl.~, is made betweeu the Municipality of Anchorage Department of llealth and lluman Sea:vices (DIIIIS) and the property owner(s) of: Tiffs agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to ll}e follow|ug: Submit lo Ibc Municipality of Aachorage, on an annual basis, an inspection and operatiou statement from a registered professional engineer. This inspection and operafioa statement shall verify that Ibc engineer bas inspected all effluent and air primps, timers, and alarms, m~d that aay deficiencies bare been repaired and that the system is functioning as designed. (Signature) (Printed Hame) (Printed l~me; (Notarize llere) MUNICIPALITY OF ANCHORAGE 4 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-311-09 1. GENERAL INFORMATION Expiration Date: 4'(q 5"-2-02-1 Complete legal description Highland Terrace #4 TR5A Location (site address) 11330 Steeple Drive Current property owner(s) Mailing address Day phone Real estate agent Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 t I Waiver Fee $ Date of Payment I 1 0� 1 Date of Payment Receipt Number 0 (n 5 33 G Receipt Number COSA # OSC211008 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSD SIGNATURE 'j System #1 Approved for -J bedrooms System #2 Approved for bedrooms Disapproved Phone (907)745-8200 Date lay ... .. Steven R. f'annctae CE, 81A9 Conditional approval for bedrooms, with the following stipulations: k K vVtvl y+ , TY = r VVA rt7, WASTL� D oo DG�qA4 R `c. SRVI t� Original Certificate Datej__L� Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory __X Other COSA Checklist blue sheet COSH Checklist Legal Description: Highland Terrace #4 TR5A Parcel ID: 050-311-09 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 511"20'0 Total depth 400 ft Cased to 44 ft FE -11 Sanitary seal is functioning correctly FIR Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 1/72021 Static water level at beginning of test 70.7 ft. Comments B. TANK DATA Age of tank(s) 18 years Tank type/material Measured operating fluid level in septic tank 48 Q Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 5/22/2003 0 ALL standpipes present per record drawing Total measured depth from grade 6.5 ft (max) Measured depth to pipe invert from grade 3.33 ft (min) ❑ N/A - pressurized field ❑Q Monitor tubes go to bottom of effective. If not, state depth into effective R Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 0.50 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes n No ®❑ Coliform bacteria is Negative Nitrate 0.458 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Q Arsenic less than MRL (ND) Collected by Pannone Engineering Services Date of Sample 1212212020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 1171202' Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 180 min Final fluid depth 0 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F/1 Yes if No Community Sewer Manhole/Cleanout > 100' (v Yes if No ft . M Yes if No Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' M✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' El Yes if No M✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M✓ Yes if No ft✓] Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft 0 Yes if No ft Property Line > 5' F/1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F/� Yes if No ft Private Wells > 100' Yes if No Water Main > 10' P/ Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' E 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' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10' F/� Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓1 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' R✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Cali,[�31�►(��KY�l�:i�l�L*7_•rii[+Itl / certify that t 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. COSA Checklist yellow sheet "'Fd ft ft ft ft Well 'Water Advisory Certificate of On -Site Systems Approval # OSC211008 Subdivision: Highland Terrace #4 ,TR 5A This well's productivity was determined to be .5 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. Dept: Onsite Well and Septic V Status: Show All Response: Show All Search: Enter keyVorse Window Type: Show All V Cycle: Show All Time: Show All Refresh Learn how [Select One] Apply i (0 selected) Add Comment Add Library Comments Please enter your responses Onsite Type your response here. Ref.# 1 Changemark note #01 Well Tim1/11/21 2:19 PM Cycle 1 and Ecklund Septic Highland I,,( sokl Terrace 14 TR5A - chk.pdf Markup Please provide a septic pumper receipt and note on the checklist Responded by: Customer Service - 1/13/21 2:52 PM Pannone stuck the tank and determined there is less than 'Ift of solids in the bottom of the tank. We are asking for an exemption from the tank needing to be pumped prior to COSA approval. Parcel I.D. u 5 6 7 8 9 70 77 Municipality of Anchorage On -Site Water & Wastewater Program 907 343-7904 CL5A r;, AUG 0 7 2019 �Ld v CERTIFICATE OF ON-SITE SYSTEMS APPROV 050-311-09 1. GENERAL INFORMATION nr°os68L Expiration Date: 11— l 3 —j 7 Complete legal description HIGHLAND TERRACES/D #4; TRACT 5A Location (site address) 11330 STEEPLE DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Real Estate Agent ROY & MELISSA LEBLANC l Day phone 11330 STEEPLE )RIVE, EAGLE RIVER, AK 99577 BETHANY WISER OR BONNIE MEHNER Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 727-0446/240-3294 223-1632 / 223-0545 WaiverNariance request for. N/A Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $-667D 67D Waiver Fee $ Date of Payments s/Z Date of Payment Receipt Number (1� Receipt Number COSA # 95e jq j 3& y — Waiver # TYPE OF WASTEWATER DISPOSAL: Individual On-site In ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ WaiverNariance request for. N/A Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $-667D 67D Waiver Fee $ Date of Payments s/Z Date of Payment Receipt Number (1� Receipt Number COSA # 95e jq j 3& y — 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. 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 provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipally of Anchorage and industry practices. The reported results describe the condition of the systems on the datels of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms. Phone 337-6179 Date / P q ♦�•'`C� OF 1�0 AV ]. AN dA �.......... . b ............................ dim D7IDnr3331XErr= /J6 A. Garnegs AW 74P 4W LICENSE,` 111'PRO\\S\••A #AECC884 System #2 Approved for bedrooms. `r' Disapproved. �`G0LITYpt ii�� Conditional approval for bedrooms, with the following sti_f`ons: p y S/ o ►g U1, -TFR ^TF By:l- iii "CRVICES v•s\N ��%11)►►1i��111��1 Original Certificate Date: The Municipality 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 Septic System Advisory Well Flow Advisory (Rev. 10112/12) Nitrate Advisory Arsenic Advisory Other Legal Description: HIGHLAND TERRACE S/D #4; TRACT 5A If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled '6/11/10 Total depth 400 ft Cased to 44 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/24/19 Parcel ID: 050-311-09 Structure served by this system 1 Well production at time of test 0.5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No Coliform bacteria is Negative Nitrate 24 `1r&ng/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 7/29/19 Static water level at beginning of test 61 ft. Comments *ORGINAL WELL DRILLED ON 8/2/2003 - WELL DEEPEND ON 6/11/2010. B. TANK DATA Age of tank(s) 16 years Tank type/material STEEL * Measured operating fluid level in septic tank ❑ Standpipes/found tion cleanout per record drawing Date of pumping (_A -C'\ D. ABSORPTION FIELD DATA 5 -WIDE C. LIFT STATION ❑ Req aintenance complet Age of lift station Li n material Comments: `46.25" L.D. IN ST1 AND 47.75" L.D. IN ST2 Which system tested (date installed) 5/22/03 Adequacy test date 7/24/19 ❑ ALL standpipes present per record drawing Results [D Pass For 3 bedrooms Total measured depth from grade 6.4 ft (max) Fluid depth prior to test 0 / 0 in Measured depth to pipe invert from grade 3.2 ft (min) Water added 658+ gal ❑ N/A — pressurized field New depth 1 / 6 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 81 min depth into effective * ❑ Code -required soil cover over field Final fluid depth 0/0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: 'MT1 / MT2. MT1 EXTENDS -1' BELOW BOTTOM OF DRAINFEILD AND MT2 EXTENDS -$" BELOW BOTTOM OF DRAINFIELD. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25'E Yes if No ft Absorption Field on Lot > 100'✓❑ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft ✓❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Z Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Z✓ Yes if No ft Surface Water > 100' B Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 21 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓Q 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' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' S Yes if No ft Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION o� Q� Vv�p� I 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. :,, .. ,,,,,,,,, ,,,,,;,,, OJ f ey ess: Q 9; CE -79 3 �� p �j COSA Checklist yellow sheet ed 1 r o f e s soon& #AECC884 .d Well Water Advisory Certificate of On -Site Systems Approval # OSC191368 Subdivision: Highland Terraces #4 Tract 5A This well's productivity was determined to be .5 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. 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