Loading...
HomeMy WebLinkAboutT12N R3W SEC 22 LT 28 LESS N375'T12N R3W Sec 22 Lot 28 Less N 375' #015-521 -33 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241347 PID Number: 015-521-33 Dwelling: Z Single Family (SF) El with ADU F-1 Duplex (D) El Two Single Family Project: n New 0 Upgrade Name MARCY RUTH TRUST... ABSORPTION FIELD Z Deep Trench F] Wide Trench E] Bed n Mound Site Address 11146 TOTEM ROAD, ANCHORAGE El Other Phone71 f Bedrooms Soil Rating Total depth from original grade 7� 3 0.45 GPD/SFI 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pip 6 Ft. Subdivision Block Lot 28 LESS Fill added above original grade Gravel length N375' VARIES 1.3'— 1.88 Ft. 1 90 Ft. Township Range Section 12N 3W 22 Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1080 Ft2 21 12 Ft. Well 100'+ 100'+ 100'+ 25'+ TANK 0 Septic ED S.T.E.P. El Holding El Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ 5'+ NA Foundation 10'+ 10'+ 10'+ LIFT STATION — S.T.E.P. Manufacturer ORENCO / GREER Capacity 1500 Gal. Remarks Deep-burial tank. Undocumented tank decommissioned & field abandoned. Alarm location LAUNDRY ROOM Electrical installed by RISING SON Tank to PIPE MATERIAL House to tank 3034 drainfield 3034 Installer MIKE N ANDERSON, PE. (MNA) Drainfield 3034 CO/MT 3034 Inspector FWC & MNA BENCH MARK (Assumed elevation) 100 ft Inspection 15' 11/14/24Location 11/15/24 and description dates: 211 31d 11/16/24 4"' 11/16/24 IMANHOLE TOP — 2ND MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL A4,4 Conditional Approval: Date 71H Septic System CuaisHuffman Al Approved Date CE 128991 •11/20/24. . PROFESSOO Note: this appy al does not include well permit requirements. r-o� NN 6%�;OiS_' (Rev 05102/18) 40 . 0 ' 24.0'14 . 5 ' 8.0' 3. 5 ' 13.0' 29 . 0 ' 45.0' LOT 28 FENCE CONC. 3-BR HOUSE WELL DE C K CHIMNEY GR A V E L DR I V E W A Y FENCE N 0 0 ° 0 4 ' 0 0 " W 2 8 5 . 0 0 ' 84.9' CON C . OV E R H E A D U T I L I T Y L I N E G R A V E L D R I V E W A Y LESS N375' PID:015-521-33 PERMIT:OSP241347 FIRST WATER CONSULTING T12N R3W SEC 22 LOT 28 LESS N375' —x— I SEPTIC MANHOLES CONC. CS, FENCE 45.0' 1 -STORY o FRAME of o HOUSE NI 8.0' io M 13.0' WELL 24.0' CHIMNEY GRAVEL DRIVEWAY BUILDING DETAIL 1" = 30' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT MAY NOT BE SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. JOB # 24235B I NO CORNERS SET THIS DATE I SCALE 1" = 60' 0 30' 60' OF AQTH ' ...... 22/2j .. . �'. B u Saliz o r G� • �i� s� •• LS -14837 F CJ = AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: GOVERNMENT LOT 28, EXCLUDING THE NORTH 375 FEET, SECTION 22, TOWNSHIP 12 NORTH, RANGE 3 WEST, SEWARD MERIDIAN ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS SHOWN IN RELATION TO THE PROPERTY LINES. DATED THIS 25th DAY OF NOVEMBER, 2024, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 LOT 28 1 REMAINDER o N 90000'00" E 329.50' --- A PORTION OF LOT 28 >. 93,908 sq. ft. SHED EAVE I. 0 I I =_ x--� ENCEII Z I x l O -O O CD SEPTIC (7) x + x I O m _1�il STANDPIPES J I .0., K LOT 27 O `l., — CD X O m 13 o 00 84.9' L N 00 0 SEE b - � C? BUILDING im o DETAIL to - UTILITY O° m -___ 33' PEDESTALS OVERHEAD UTILITY LINE p� EO_ EO_ EO_ EO_ LO_ EO_ EO_ EO_ EEO _ O-� -EO EO �O_ �6=�y�LO_ UTILITY 33' ROADWAYAND PUBLIC UTILITY mPOLe --_ RIGHT-OF-WAY 0- -- REBAR N 90000'00" W 329.50' 0 "' 112th AVENUE 0 "' —x— I SEPTIC MANHOLES CONC. CS, FENCE 45.0' 1 -STORY o FRAME of o HOUSE NI 8.0' io M 13.0' WELL 24.0' CHIMNEY GRAVEL DRIVEWAY BUILDING DETAIL 1" = 30' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT MAY NOT BE SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. JOB # 24235B I NO CORNERS SET THIS DATE I SCALE 1" = 60' 0 30' 60' OF AQTH ' ...... 22/2j .. . �'. B u Saliz o r G� • �i� s� •• LS -14837 F CJ = AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: GOVERNMENT LOT 28, EXCLUDING THE NORTH 375 FEET, SECTION 22, TOWNSHIP 12 NORTH, RANGE 3 WEST, SEWARD MERIDIAN ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS SHOWN IN RELATION TO THE PROPERTY LINES. DATED THIS 25th DAY OF NOVEMBER, 2024, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241347 Work Type: Septic Upgrade Tax Code Number: 01552133000 Site Legal Address: T12N R3W SEC 22 LT 28 LESS N375' G:2637 Site Mailing Address: 11146 TOTEM RD, Anchorage Owner: MARCY RUTH A TRUST AGREEMENT Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date r. r. n Uc�partmr�itr Lot Size in Sq Ft: Total Bedrooms: 10/16/2024 10/16/2025 93908 2 Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall er: - - -_-_ - Opened' osed on the ay, or Covered, s so pre led, and heated vent freezing Special Provisions: • The Record Drawing is to show the location of the existing field. I-eceNe48y: � 5 U elC� W,�,`i-e V- Date: Issued By: a/0/Date: i /'5; 2-u 3 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-521-33 Property owner(s) MARCY RUTH A TRUST AGREEMENT Day phone Mailinq address 11146 TOTEM ROAD, ANCHORAGE, ALASKA 99516 Site address 11146 TOTEM ROAD, ANCHORAGE, ALASKA 99516 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 2N R3W SEC 22 LOT 28 LESS N375' Lot Size 93,908 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field Initial F-1 Single Family (SF) Gi (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank 0 Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 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: 375 Waiver Fees: Date of Payment: %y Date of Payment: Receipt Number: 311/70 Receipt Number: Permit No. 0_5 /0a !j I -; 4 7 Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! October 14, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: T12N R3W SEC 22 LOT 28 LESS N375’ The property owner has requested we obtain a permit to upgrade the failed undocumented septic system of the above referenced lot. We propose to install two deep trenches and 1500-gallon deep-burial HDPE STEP tank to serve the existing 3-bedroom residence. It appears the undocumented septic field is as shown on the attached design and will be verified at construction. The design is based on the recent test hole conducted on October 8, 2024. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 3 -7% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241347, Deb Wockenfuss, 10/16/24 A PORTION OF LOT 28 93,908 sq. ft. FENCE 33' ROADWAY AND PUBLIC UTILITY RIGHT-OF-WAY CONC. UTILITY PEDESTALS UTILITY POLE 3-BR HOUSE 112th AVENUE 33' REBAR OVERHEAD UTILITY LINE WELL N 90°00'00" W 329.50' N 90°00'00" E 329.50' TO T E M RO A D DE CK CHIMNEY GRAVEL DRIVEWAY 30 ' 30 ' 33' LOT 27 LOT 28 REMAINDER C O N CRE T E FENCE EAVE AS P H A L T S 0 0 ° 0 4 ' 0 0 " E 2 8 5 . 0 0 ' N 0 0 ° 0 4 ' 0 0 " W 2 8 5 . 0 0 ' 84.9' 81 .6 ' CON C . GRAVEL DRIVEWAY OV E R H E A D U T I L I T Y L I N E APPROX. 100' WELL RADIUS LATTA LOT 2 LATTA LOT 1 APPROX. 100' WELL RADIUS BO Y D L O T 1 FIRST WATER CONSULTING T12N R3W SEC 22 LOT 28 LESS N375' DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM & NO CONFLICTS W/ LOT TO THE NORTH. NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241347, Deb Wockenfuss, 10/16/24 40 .0' 24.0'14 . 5' 8.0' 3. 5 ' 13.0' 29 . 0' 45.0' A PORTION OF LOT 28 93,908 sq. ft. FENCE CONC. 3-BR HOUSE WELL DE C K CHIMNEY GRAVEL DRIVEWAY CON C R E T E FENCE EAVE 84.9' CON C . FIRST WATER CONSULTING DESIGN DETAILS: T12N R3W SEC 22 LOT 28 LESS N375' NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241347, Deb Wockenfuss, 10/16/24 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T12N R3W SEC 22 LOT 28 LESS N375’ PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/16/2024 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 7 8 SM/ML 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 10/09/24 30 min 6” 0 9/16” 30 min 6” 0 10/16” 30 min 6” 0 9/16” PERCOLATION RATE 54 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NO DEPTH TO WATER AT MONITORING: DRY DATE: 10/16/2024 TESTHOLE # 24-1 DATE PERFORMED: 10/08/24 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION & NOTE ON IR. PERFORMED FOR: MARCY RUTH TRUST 10/16/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241347, Deb Wockenfuss, 10/16/24 LOT 28 REMAINDER 0 N 90000'00" E 329.50' -_- 33' __0/ 4 RTI OFOLOT 208 SHED I SAVE I �_ El cf) 93,908 sq. ft. ENCS z O x -O O C) x�� .� m _ K J LOT 27 I II O m 13 _ D 00 SEE - 84.9' -oo BUILDING o DETAILIm o a �o UTILITY w _33' PEDESTALS OVERHEAD UTILITY LINE 0 2 � - - EO EO �O_ �6Y���EO_ �O_ EO _EO_ EO_ EO_ EO_ EO_ EO_ CfV EO OT UTILITY - 33' ROADWAYAND PUBLIC UTILITY POLE -_ RIGHT-OF-WAY ° REBAR - o N 90°00'00" W 329.50' -- 112th AVENUE 0 30' 60' SEPTIC CONI. STANDPIPE FENCE 45.0' OF ! I IPE ......�<��!l��i 1 -STORY v o FRAME o �•' - C:) Nt HOUSE N I : 49TH irk o O "moi 13.0' I ; 10/06/2 4 i G WELL .. 24.0' B u Saliz �o f LS -14837 CHIMNEY GRAVEL pROFESSI0NP\_�\���` DRIVEWAY BUILDING DETAIL 1" = 30' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: GOVERNMENT LOT 28, EXCLUDING THE NORTH 375 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE FEET, SECTION 22, TOWNSHIP 12 NORTH, RANGE 3 RECORDED SUBDIVISION PLAT MAY NOT BE SHOWN HEREON. WEST, SEWARD MERIDIAN THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS SURVEY MAY DISCLOSE. SHOWN IN RELATION TO THE PROPERTY LINES. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE DATED THIS 3rd DAY OF OCTOBER, 2024, AT USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ANCHORAGE, ALASKA. ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC HEIGHT, C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM JOB # 24235 1 NO CORNERS SET THIS DATE I SCALE 1" = 60' 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 03/24/2015 23: 46, 987-345-0282 ALPZNE DR_TLLING PAGE 82/82 Alpine Drilling & Enterprises Well Log P©rmit Number: #SW Date of Issue: ~ Date Started: 7-fl46 Date Completed: ~-8-q6 ][~.'d Descriptiom TI 2N H3W Sec 22 L~ 28 Les8 N 375' ~ ~e~ Nmne & Address: R~4~ Marcy 1~ lg6 Totem Borehele Data: Soil Type, Thick~ss & Water Stral~ ' -i N Parcel Idenfificat on ~ mnber, ~ well loe~ed a~ approved permit loeatio~l? x Yes [~ No exi~;t#tg *veil saty sandy grave! w/ b20 ~,ater s~td & g~l AnchorageA,taaka 995¢6 Depth fit) Metlmd e~Dtflling x air rotary [] eabl~ toot To 0 227 Wall Thickno~: ,2~0 it~ches 127 J34 Di~e~r: ~ inohes Dep~: 169 feet 134 147 155 Liner TYt : ]47 Diameter: .... i:whes Depth: .... feet !65 Caal~lg sfiekup above .gfoand.~ 2.~ ]0 S~tie ~r lcvd (~om ground level): Paining I~el;~f~t a~er Recove~~ Rate: 20+ Meth~ ofT~fing: ~ Well [make Ope~ng Type: x Open ~nd ~ ~m Hole ~ Screened Start ~. ~ct S~p~d_~. feet ~ PeEormions Start ~ ~t S~pped Grout Type: b~ntte~anules Volu~ue: Pump: I~t~* Depth 2~ g~p si~ ~.~ hp Brand Name ~eflt~ ~Disinfec~ioa: chlorine mb~ Comments: Well Driller: Alpine DNlli~g & PO Box 110496 Anchorage AK 99511 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 OSC241463 Parcel ID 015-521-33 Expiration Date: Legal description T1 2N R3W SEC 22 LT 28 LESS N375' Site address 11146 TOTEM RD Current property owner(s) MARCY RUTH A TRUST AGREEMENT X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: 1 Original Certificate Date: 12/2/2024 This Certificate of O�Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in. u ' ' ebstantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 Development Services Department -343-7904 Phone: On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-521-33 Complete legal description T12N R3WSEC 22 LOT 28 LESS N375' Location (site address) 11146 TOTEM ROAD, ANCHORAGE, ALASKA 99516 Current property owner(s) MARCY RUTH A TRUST AGREEMENT Dayphone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well F-1 Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units E] Community Well or Public M water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic F-1 Private Septic serving 2 dwelling units F-1 Holding Tank F-1 Community Septic or Public Sewer 5. SEPTIC TANK: r_1 Steel Z Plastic r_J Concrete R Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: R AWWTS E] Bed Z Deep Trench R Wide Trench El Seepage Pit Waiver request for: Expedited review requested: Z 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 $ IL/ Waiver Fee $ Date of Payment 'Zo -Z, Date of Payment COSA # IS C'71- Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: T12N R3W SEC 22 LOT 28 LESS N375’ Parcel ID: 015-521-33 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 7/8/16 Total depth 169 ft Cased to 169 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 9/26/2024 Static water level at beginning of test 57 ft. Well production at time of test 5 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.715 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/26/24 Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA – NEW SEPTIC TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station NEW years Lift station material HDPE – NEW 1500-STEP Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ALL standpipes present per record drawing Total measured depth from grade 9.9 ft (max) Measured depth to pipe invert from grade NA 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 NEW SYSTEM Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – NEW SYSTEM – NOT TESTED Effective depth (per record drawings) 72 in (MOA 6’ ED) Effective depth used 0 in Effective depth (ED) remaining 72 in Comments/Deficiencies: Approximate total measured depths from existing grade. 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) 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 11/20/2024 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 & 11/20/24