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HomeMy WebLinkAboutTHUNDERBIRD FALLS #1 LT 5Thunderbird Falls #1 Lot 5 #051-411-23 Permit Number: Tax Code Number: Work Type: On-Site Water & Wastewater System Permit OSP161177 05141123000 WellSeptic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Initial Permit Effective Dates: July 15, 2016 to July 15, 2017 Design Engineer: ANDERSON ENGINEERING Subdivision: THUNDERBIRD FALLS #1 Site Legal Address: THUNDERBIRD FALLS #1 LT 5 G:1764 Owner/Address: KELLEY LEONARD T 821 N STREET #205 ANCHORAGE AK 995013285 Site Mailing Address: 24301 WHALEN CIR, Chugiak Lot Size in Sq Ft: 85813 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing, Special Provisions: Provide results of bedrock confirmation test holes. See Site Plan for location. Received By: L/ /t/~ t ,~/,I¢(¢,~(, J t ~ J ¢/J b,. Municipalityof Anchorage P.O. Box 196659 · 4700 Bmore Road Anchomqel Alaska 99519-6650 ® (907) 343-7904 · Fax (907) 343-7997 http:llwww.muni.orqlOnaite Development Services Division On-Site Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW ** ** Waive¢: OSV161079 COSA#: PID#: 051-411-23 Legal Description: Thunderfalls #1 Lot 5 Engineer: Anderson En.qineerin.q Permit#: OSP161177 Applicant: Troy Davis Homes Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The 'approved separation distance is 34.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. [] The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. [] Notarized letter(s) of nonobjection have been received fi'om the owner(s) of the affected adjacent property. [] Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: ~/[tq,~ Ap proved by:~)~ ~ ~rpr. ~¢¢~ Name of Review~ **** VARIANCE/WAIVER REVIEW **** Community Development Department Development Services Division On-Site Water & Wastewater Program MUN C PALiTY OF ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SiTE SEWERNVELL PERMIT APPLICATION Parcel I.D. 051-411-23 Property owner(s) Troy Davis Homes Day phone 310-2501 Mailing address I65 E. Parks Highway #200 Wasilla, AK 99654 Site address 24301 Whalen Circle Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Thunderbird Falls #1, Lot 5 Lot Size 85,813 .Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: ([~ all that apply) Absorption Field [] Initial [] Single Family (SF) [] (w/wo ADU) Septic Tank [] Upgrade [] Duplex (D) [] Holding Tank [] Renewal [] Multiple Dwellings [] Privy [] (SF and/or D) Pdvate Well [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Primary and Alternate Absorption Trench to Slope. Distance: 34'/0' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. ANDERSON ENGiNEERiNG P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 29,2016 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 5, Thunderbird Falls Subdivision No, 1 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 5, Thunderbird Subdivision No. 1 intends to construct a new four- bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to accommodate the home. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system along with the alternate site. No existing wells or septic systems are closer than 100' from the proposed well or septic system. Surface slopes and direction of flow are shown on the site plan. This information was taken from the subdivision information in the Municipal files. The drainage pattern will not be changed as a result of this project. The test hole placed on the lot in the area of the absorption trench and alternate site indicated silty sand with gravel (SM). The percolation rate of the soil was determined to be 60 minutes per inch. No groundwater was found during the placement of the test hole and none was noted during the monitoring period. Bedrock was found at 13' below the surface. An application rate of .45 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1250-gallon Septic Tank and 2 - 67' long by 5' wide by 4' effective depth absorption trenches to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trenches will be 3' below the existing surface and the total depth will be 7' to provide 6' of separation to the bedrock. Two bedrock verification test holes will be placed prior to construction to insure the separation distance is met. A minimum of 3' of fill will be placed over the absorption trench and 4' over the septic tank. A flow splitter valve be used to insure even flow to each trench. The ground surface on the lot in the area of the absorption trenches slopes to the Lot 5, Thunderbird Falls Subdivision No. 1 June 29, 2016 Page Two southeast at a grade approximating 20%. The new trenches will be constructed parallel with the contours of the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' from the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments -' " '"'-. UNSUBDIVIDED - 259.2 283.6 N 89'50'28"E 198.43' ___~__¥ .... > ...... ~- ..... _~ .~_ _.~__,.__ ,."_ _ p __; _~,__~ .... ~__. .............. ___2___¢__~_~2_~%__ '__&__2_2?__~22__& ~_ _.2 ...... k--2---~ .......... , ,~ ,w,,,/ ,' ~ / ,,:/ .' t ~", ::" ~' ~ ~33'SECTIONLINE~SEMENT " ; " " i " .; ~-:/" ,' ~ , ~A - , ~ , ' ', . . , - :' : .-' x " i'/ 7~."' ",, ~. "~ , .. , · J/ .." THUNDERBIRD,, FALLS -NO. 1 .. / ~ .: : ~ ,' .. .. :,. ; : ', ., / . ,' .... :,' ,, .,?' :' .~// ,." ~,:, /: ,. ~.. ,, ',, ~ '~. . . ...,, : ~ .. ..-~ , ~ ~ : ',. , . . -..........~ . . ....... ..., .... ........ . ....... :~ ~%. NO. CE-4381 Z~-~,., O T T ~ ~ I A ~1 Advontex Treotment,x LOT 5, THUNDERBIRD FALLS SUBDIVISION NO. 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home 5' Wide Trench System Perc. Rate: 60 Min./Inch 1,250 Gallon Septic Tank Application Rate: .45 GPD/SF 4' Drainfietd Rock 4 Bedrooms * 150 GPD/Bedroom =.600 GPD Design Flow 600 GPDL45 GPD/SF/5 SF (Width) ~5 (Red. Factor) = 133.3 LF Trench Length THEREFORE: Construct 2-67' Long x 5' Wide x 4' Effective Depth Absorption Trenches at the Location Shown on the Site Plan. Flow Line Elevation in the Trenches to be 3' Below Original Ground Level. Total Depth to be 7' Below Existing Ground. Provide 3' of Cover over the Trenches. Place 4' of Cover Over the Septic Tank. Place 6" of Topsoil and Revegetate Exposed Slopes. Place 6" Topsoil and Revegetate~ Exposed Slopes. ~ , Fabric Geotex ~ 4" Perforated PVC (Holes Down) -- Drainfield Rock YPICAL 5 WIDE TRENCH SECTION NOTE: Grade Area Over Trench to Drain Away. ~:'"' Minimum 4 Separat on From Groundwater ~..~.~.-~,~-,~.,~ lmum 100, Separation From Private Wells in the Area. ~t Minimum 100 Separation From Sudace Water or Streams.-~%. No. c~4~,~ ~700 DEPTH (~et) 1 2 3 4 5 6 7 8 9 11 20¸ MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT [~RAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST ] LEGAL DESCRIPTION: LOT 5, THUNDERBIRD FALLS NO. I PERFORMED FOR: DATE: $/r9/£Ol6 PARCEL ID#: TROY DAVIS HOMES PROJECT No.: TECHNICIAN: OB/OG SILTY SAND WiTH GRAVEL SN BEDROCK W. ROBERTS SLOPE SITE PLAN SEE SITE PLAN WAS GROUND WATER ENCOUNTEKED? NO IF YES ~ WHAT DEPTH'~__ LS DEPTH OF WATER AFTER MONITOPdNG: NONE 50/0 DATE OF MONITORING: 6/U2016 ~ DEPTH TO DATE READING SROSS TINE NET TINE WATER NET DROF (MINUTES) (MINUTES) (INCHES) (INCHES) TEST'HOLE PRESOAKED PRIOR TO TESTING: 5/19 1 3:16 1.50" 2 3:46 30 2.13" 0.63" 3 3:47 1.50" 4 4:17 30 2.00" 0.50" 5 4:48 1.50" 6 2:I5 30 2.00" 0.50" PERCOLATION RATE: 60 (MIN/1NCH) PERC, HOLE DIA. 6" .(INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 7/I/2016 Performed for: Leonard T. Kelley Date Performed: 10;~0~'~ Project:. NWl/4, NWl/4, NWl/4, Sec36, T16N, RlW, SM TEST HOLE # 00-5 Depth (Feet) Org SEE ATTACHED SITE PLAN FOR HOLE LOCATION 2- Was Ground water encountered? NO What depth? NA GM - gray, mod. dense 3- Depth to water after mor~toring? DRY Date? 10/17/00 · Reading Date Gross Net Depth to Net Time Time Water Drop 6- I 10/13/00 1:30 9" B.O.H. Bedrock 7- 2 2:00 30 rain 8' 1' 8- 3 2:00 8" 9- 4 2:30 30 rain 7" 1' 10- 5 2:30 7" 11- 6 3:00 30 mtn 6" 1' 12- 13- 24- 15- 16- 17- 18- * Water Added 19- HOLE PRESOAKED Percolation Rate .20 (min/in) Perc Hole Diameter 6" 20- PRIOR TO TEST Test Run Between 1.5 feet and 2.5 feet I, Kenneth M. Duff-us, certify that this test was performed in accordance with all State and Munidpal guidelin~ irt effect on this date. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 1, 2016 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 5, Thunderbird Falls Subdivision No. 1 Absorption Trench to Slope Waiver Dear Onsite Services Engineer: The large house, driveway, presence of bedrock and well location planned for the subject lot reduce the amount of area available for the septic system. We have located an area with acceptable soils for the absorption trenches, but the southerly trench is located 34' from a break in grade greater than 25%. The alternate site is located on a slope greater than 25%. The slope flattens however approximately 6' from the edge of the trench. We are therefore applying for a waiver allowing placement of the absorption trenches and the alternate site at the designated sites. The attached drawing shows the absorption trenches in relation to the slope. The imaginary 25% slope when extended downward from 2.5' above the flow line does not daylight other than at the area directly above the trenches for 35' for neither the primary nor the alternate trench. We therefore request a waiver be issued allowing placement of the new absorption trenches within 34' and 0' of a slope greater than 25%. Sincerely, Michael E. Anderson, P.E. .\~., ........... ~. a,7 ~9.'' A Z Primo~ Site Site ~k~~ .,.~.,.. ,9~ ~ ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 5, THUNDERBIRD FALLS SUBDIVISION NO. '1 GENERAL: The scope of this project includes the procurement and placement of a new 1,250-gallon septic tank at the location shown on the Site Plan. Work also includes the construction of 2 new 67' long X 5' wide X 4' effective depth absorption trenches at the location also shown on the Site Plan. The distribution line in the trench will be placed 3' below the existing ground surface. Total depth of the trench will be 7' below the existing ground surface to remove the organic material to the underlying soil. The new absorption trenches and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line on the lot. Two test holes must be placed at each end of the trenches to verify the depth of the bedrock in the area. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. A flow splitter valve is required to assure even flow to each trench. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250-gallon septic tank must be procured from an approved source and installed at the location shown. The cover over the tank shall not exceed 4' unless approved by the tank manufacturer. Lot 5, Thunderbird Falls Subdivision No. 1 June 29, 2016 Page 2 of 3 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below the distribution line must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. J Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. Lot 5, Thunderbird Falls Subdivision No. 1 June 29, 2016 Page 3 of 3 A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. MUNICIPALITY OF ANCHORAGE Development Services Department p p - =' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-411-23 Legal description THUNDERBIRD FALLS #1 LT 5 Site address 24301 Whalen Cir Chugiak Current property owner(s) Kevan Katkus Expiration Date: 2- -7 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 4/5/2023 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 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-411-23 Complete legal description Thunderbird Falls #1 Lot 5 Location (site address) 24301 Whalen Cir. Chugiak, AK Current property owner(s) Kevan Katkus 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 6 - 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 $ / S SV Waiver Fee $ Date of Payment �/ 2 3 / z4 Z 3 Date of Payment COSA # 0 s c 2 3 t 0 5 g Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Thunderbird Falls #1 Lot 5 Parcel ID: 051-411-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑./ Well log is filed with Onsite (or attached) Date drilled S/12/16—Total depth 300 ft Cased to 40 ft F/-1 Sanitary seal is functioning correctly ✓❑ Wires are properly protected Casing height (above ground) 26 in. Date of flow test for COSA 3/14/23 Static water level at beginning of test 30 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping Za ZA 23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/1/16 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 12.5" ft (max) Measured depth to pipe invert from grade 6* ft (min) ❑ N/A - pressurized field. ❑ Per record drawings, field is insulated. ❑✓ Monitor tubes go to bottom of effective. 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) If yes, enter date Well production at time of test 1.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ✓❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ✓❑ Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by Areterra Consulting Date 3/7/23 T STATION ❑ Require h Age of lift station . Lift station material Comments: nce completed Adequacy test date 3/14/23 Results ✓❑ Pass Fluid depth prior to test 0 in Water added 650 gal New fluid depth _0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 0 in Effective depth remaining 48 in Comments/Deficiencies:*measurements from separate fields, both fields measured 48" ED COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if fess than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' nYes if No ft FV] Yes if No ft Neighboring Tank > 100' F./I Yes if No ft Private Sewer/Septic Line > 25'2] Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft n Yes if No _ ft — Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' © Yes if No ft 0 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' F,/-] Yes if No 5'+xx ft Surface Water > 100' 7 Yes if No Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS 0 Yes if No ft F/]Yes if No ft %/❑ Yes if No ft R Yes if No ft Wells on Adjacent Lots: Private Wells > 100' © Yes if No Community Wells > 200' © Yes if No If tank or field is under driveway comment below xx Tank to foundation 5'+ per 2017 IR and met code at time of install. Tank standpipe to foundation measured at 12'6" during site inspection. ft ft ft 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 Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date .V_a2�-Z.3 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 oral[ 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 encroachments, deficiencies or discrepancies exist COSA Checklist June 2022