HomeMy WebLinkAboutNORTH SLOPE #2 BLK 5 LT 15North Slope #2 Block 5 Lot 15 #050-581-19 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241382 PID Number; 050-581 -19 Dwelling: FE-1 Single Family (SF) ❑ with ADU ❑ Duplex (D) F-1 Two Single Family Project: El New 9 Upgrade Name C/O GORDON SLOANE (AGENT) A 'ORPTION FIELD Tr ound EEII D Trench F-1 Wide Trench n Bed Site Address 4039 KOGRU PLACE, EAGEL RIVER, AK 99577 ZPZ Other Phone Number of Bedrooms Soil Rating Total depth f original grade 907-244-3381 3 �ISF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Nkc i.."o ravel depth beneath pipe Ft. Subdivision Block Lot NORTH SLOPE #2; BLOCK 5, LOT 15 Fill added above original Ft. G?huel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Di between lines SNFt. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between ches From Tank Field Tank Line Ft' Well 100'+ EXIST. - 25'+ TANK 9 septic 0 S.T.E.P. [I Holding E] Other Manufacturer INFILTRATOR Capacity 1060 Gal. SurfaceWater 100'+ EXIST. - Material PLASTIC Number of compartments 2 Lot Line 5'+ EXIST. - NA Foundation 10'+ EXIST. tlff-_'�TATION Manufacturer Capacity Gal. Remarks Alarm location Elecr tailed by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer ARM SEPTIC SERVICES Drainfield EXIST. CO/MT D3034 Inspector GEG BENCH MARK (Assumed elevation) 100.00 ft Inspection Ist 12/13/2024 Location and description dates: 2 nd BACK DOOR THRESHOLD 3rd 41h ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Approval: Date �Conditional 49 .. ....... ............. . ... .......... Septic System Approved Date Go ness.- po —7 CE 53 <�1 1 4ffl Note; this approval does.not include well permit requirements. Aec rofe (Rev 05/02/18) PE�<MIT NUMBER: ID I OSP241382 RECORD D RA W I N G PARCEL 050-581 NUMBER: 1-19 I i NORTH SLOPE-EKLUND; LOT 1 NORTH SLOPE-EKLUND; LOT NV tNGHUAUHMtN I NO ENCROACHMENT CONCERNS. ( I I CONCERNS. WELL ON NORTH END OF PROPERTY WELL ON NORTHEAST END OFPROPERTY 10' UTILITY EASEMENT I / \ GRAVEL DRIVEWAY \ \ a ' a• I EXISTING INSTALLED \ p 1 3-BEDROOM FOUNDATION \ to I HOUSE CLEANOUT (FCO) INSTALLED DOUBLE A CLEANOUTS (DBL1 & DBL2) ' F 1 << RgOjUs I NORTH SLOPE#2; I _ BLOCK 5, LOT 16 i 100, WELL RADIUS GENERAL LOCATION 14 NOTE: PER THE CONTRACTOR, THE OLD TANK WAS DECOMMISSIONED IN PLACE PER UPC 1"=40' -INSTALLED NEW CM-1060 INFILTRATOR SEPTIC TANK —INSTALLED DOUBLE CLEANOUTS (DBL3 & DBL4) EXISTING DRAINFIELD NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. ` '•. ENGINEERINGGARNESS .....:.... ... ........... ........... * ... i ENGINEERING SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, ALASKA -PHONE (907) 337-6179' WEBSITE. mvw.games ngrnearing.ann •...4.. .............. ............ �y ..` PREPARED FOR: PHONE NUMBER: PAGE NUMBER: d Cn 1), Ga ness L ! F C/O GORDON SLOANE (AGENT) 907-244-3381 2 OF 3 ����5 CE- 3 PROJECTILEGAL DESCRIPTION: DRAWN BY: � Z�S- `• � NORTH SLOPE #2; BLOCK 5, LOT 15 J.L.M. A� .........••'�F.4b, TYPE OF WORK: DATE: rto"RmSS ®®® RECORD DRAWING OF SEPTIC TANK UPGRADE 1/3/2025 #AECC884 ®YA I PEIMIT NUMBER: �^► p pp //����// RR���-^+► PARCEL ID NUMBER: OSP241382 RECORD ®ftf'IVVING 050-581-19 INVE IN NK @ 34.39 INVERT OF PIPE @ OUTLET = 93.55 ••..`y®` Air GARNESS ENGINEERING GROUP, Ltd� ' - ®e0 .....:..... ........................0 ENGINEERING SALES CONSULTING s... 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, ALASKA * PHONE (907) 337 -6179 ' WESSITE. +r�m.��x35szr5puunuu�g.axn ' + .. . .. ....... .a............�. 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: � J reyA�. ( arness,;' � _ C/O GORDON SLOANE (AGENT) 907-244-3381 3 OF 3 ®# ' CE- 53 ` Za AV PROJECT/LEGAL DESCRIPTION: DRAWN BY: ��,��' NORTH SLOPE #2; BLOCK 5, LOT 15 J.L.M. TYPE OF WORK: DATE: LICENSE RECORD DRAWING OF SEPTIC TANK UPGRADE 1/3/2025 #AECCaea JK I N3kV3A V& -q 0 3,9 O"a 0"o No nHo - nHo nHO 0140 nNo Z ni4o. m 2?1 cu 0 0 CL 0 4-1 Ri CL .cn 4ci7 a) — Ems' in CD 0 D Z CD a) E E :5 w E >0. f E 2 CL 0 Q3 0-0 o s aj CL 0) cc M CL m c -0 417 CO 0.0 o Q) 0 a- > -0 -1.1 n 0 (U 3: o E -d E cc 4- Q E m >1 0 r- C 0 "1" co 0 >''Z6 4- W 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: OSP241382 Work Type: SepticTank Upgrade Tax Code Number: 05058119000 Site Legal Address: NORTH SLOPE #2 BLK 5 LT 15 G:0703 Site Mailing Address: 4039 KOGRU PL, Eagle River Owner: DIETZ HAROLD P & JENNIFER Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: L>cparnnent 11/22/2024 11/22/2025 ff-1- ❑ Disposal Field LSI 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 be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Issued By: Date:T 2�� IR M MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-581-19 Property owner(s) C/O GORDON SLOANE (AGENT) Day phone 907-244-3381 Mailing address 4039 KOGRU PLACE, EAGLE RIVER, AK 99577 Site address 4039 KOGRU PLACE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) NORTH SLOPE #2; BLOCK 5, LOT 15 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (9 all that apply) Absorption Field n Initial ❑ Single Family (SF) nX Septic Tank N Upgrade Q(w/wo ADU) Holding Tank D Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings El (SF and/or D) Private Well El Water Storage n 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: 2 25- Waiver Fees: Date of Payment: I % Date of Payment: Receipt Number: Receipt Number: Permit No. _0� 19'Z -y /_313 2 Waiver No. GADevelopment Services\Building Safet)AOn Site Water and WastewateAForms\Client FormsTennit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241382, Deb Wockenfuss, 11/22/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241382, Deb Wockenfuss, 11/22/24 m CL %F w off lw P� 0 w WAN w To a w V-.,Vw%rw v woo no o" 11-0000 . ............................. IN.9n.9A Vd �0� CL 0 03 LL 0 0 8 7� c .2 8 w 15 t �g Ev C3 C (0-0 CL 2:2 C CL 0. C 0 :3 r LD 4) (a .0. E LD z to PM rR w tko m tko t C*4 0 0 4-0 4-0 m 4-J -E 0 CL ho M -X3 c 00 V-4 Ln 0 0) m fuA E m 0 114 0 U<VE j w 0 0 _5 w 4 v ;> > = < W L12 4-0 00 r -I C: Ln ,4 0 c 0 L- LA U- to .0, E 0 wo Z Z 7S > CL 0 "2 CL >,MiE 02 0 Z. wo Lo C: 0 cc 44( F s 1 4-J > 11.02 V So E CL 0 0 2:1 R. C: y 44 CO cr r :3 ver 4$ Ln 4 4Y CL V rA • La w r • 4 PM rR w tko m tko t C*4 0 0 4-0 4-0 m 4-J -E 0 CL ho M -X3 c 00 V-4 Ln 0 0) m fuA E m 0 114 0 U<VE j w 0 0 _5 w 4 v ;> > = < W L12 4-0 00 r -I C: Ln ,4 0 c 0 L- LA U- to �y GREATER ANCHORAGE AREA BOROUGH cfl�� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 NAME LOCATION SEPTIC TANK: DISTANCE) �� � NUMBER OF i. FROM WELL/ MANUFACTURER / MATERIAL COMPARTMENTS. INSIDE LENGTH INSIDE WIDTH - LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE SEEPAGE 2i%e 715 ryy NUMBEROFPITS DIAM T�ER�OR WIDTH, LENGTH --, DEPT; / , AA__' - LINING MATERIAL RIB SIZE: DIAMETER -DEPTH _61DISTANCE FROM: - WELL /" O t TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 36 / SQ. FT ADDITIONAL ABSORPTION WELL - TYPE CONSTRUCTION_ BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: w N� 7 /'^'""'"- LOTSLOPE: REMARKS: REMA DISTANCE FROM: SEEPAGE SYSTEM DIAGRAM OF SYSTEM i APPROVED 6y DEPTH NEAREST SEPTIC SEWER LINE TANK_ REMA DISTANCE FROM: SEEPAGE SYSTEM DIAGRAM OF SYSTEM i APPROVED 6y TYPE OF =OIL ABSORBTUJN SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/SR)= 110 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: I_-° E F• -F A—A - - 7 L- E= "C33 T"- '::L °-1 12� A- : F=l V E= L_ E- A= F•'r H ._ _-i THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IE, THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �_Eo�9A._A I �'_'EG• '�EF'T I r: 'TRt-aF^;; , •_. I �E= ���€� r A=1LLs�or•.1°= BACKFILLING OF ANY 'SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC bdELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F°E=F_r^A ='I". S1 HL_ G° A= 1.1 Ft'Br-•f� Sr'E F�°�1 ri1�A.1� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENT_ FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY. THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNEC?: PLI dT JERRY KENDALL /,-) f71 P x / /% I=SSUED BYE__ ---------- -----------DATE---- 11,Y , � roT A=rrj®� Ate® o* A �®�E r lA_Ara I o yWEALTH C?EF'AF'TMEtdT HND ENVIRONMENTAL tTECTIOta q I 516, E. OR RD. , ANCHORAGE, AK. 99507 4. -VF= = E_ L•a E= eR: F• E= A='rl z -r PERMIT NO. ' 645E APPLICANT JERRY KENDALL. GENERAL DELIVERY EAGLE RIVER R 694-2880 LOCATION Ki_iGRU PLACE LEGAL L15 65 NORTH _LOPE SUED LOT SIZE 44000 SQUARE FEET TYPE OF =OIL ABSORBTUJN SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/SR)= 110 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: I_-° E F• -F A—A - - 7 L- E= "C33 T"- '::L °-1 12� A- : F=l V E= L_ E- A= F•'r H ._ _-i THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IE, THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �_Eo�9A._A I �'_'EG• '�EF'T I r: 'TRt-aF^;; , •_. I �E= ���€� r A=1LLs�or•.1°= BACKFILLING OF ANY 'SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC bdELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F°E=F_r^A ='I". S1 HL_ G° A= 1.1 Ft'Br-•f� Sr'E F�°�1 ri1�A.1� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENT_ FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY. THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNEC?: PLI dT JERRY KENDALL /,-) f71 P x / /% I=SSUED BYE__ ---------- -----------DATE---- 11,Y , . Et E • h c Russell Oyster 694-2774 Soils Er Foundations Performed for: GEACHNI CAL Et DEVELTfPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Elis 688-2280 Land Development Name: Tel. No.,b�l L�- �$$� Mailing Address: Legal Description Depth (feet) Soil Characteristics 1 �� ��,- �'oax�•�- uj/ 'r"Zoacs }� QZ"C,P�J�c_s 2 3 r - 5�� S4aMT7^j IjRP.�1�y 1vJ10 (ZS )'V 6 7 8 —2. Ao �� G ljti�a�y Gsuav2z wl CoBaus d. �1 ��1ry12 l G7— �a��alLl¢PpJiLv�JCO .' .�.e'SO O' 14 15 Ground Water Encountered: Yes No v If yes, what depth -Z7"a S37 ) '5 ®%,6- �Z�an�t3� Proposed Installation: Seepage Pit Drain Field ✓ Comments,- ti.2I-9 A7"V1e6x.N-Ptr* . f Z�-74, Performed by: Date: MUNICIPALITY OF ANCHORAGE DEPARTMED OF HEALTH AND ENVIRONMENT PROTECTION 825 I, Street, Anchorage, Alas#a 99501 279-2511, ext. 224 or 225 #1: Time Pn t # 2 : Time 1 Date (,,-�Ll- 7I Date InsP /_L5 Insp Date Received: June 23, 1977 #3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER WATER FACILITIES rn_v,,l ✓n P�o L o �� of� 'll 4l �su Lending Institution Request: Ho e Federal Savings and Loan o Joanne Mailing Address: 2. Property Owner: Mailing Address: 535 D Street 99501 Lowell A. Pollard Phone: 272-1451 Phone: Route #1 Box 211, Outlook Washington 98938 3. Legal Description: Lot 15 Block 5 North Slope Subdivision #2 4: Single Family Residence: (4 Multiple Family Residence: ( ) 5. Well System: Individual Well (i4 6. Number of Bedrooms: three Number of Bedrooms: Community/Public System ( ) Permit # Depth of Well 124' Well Log on File ( ) Construction bilkklt_6 Bacterial Analysis Sewage Disposal System: On-site System (39 Public Utility ( ) Permit # �� Installed 1976 Installer 'Vt0' Septic Tank Size (` oo Manufacturer I LAJ Absorption Area ko �A Soils Rate Material�j�9�^{�` t 7. Distances: Well to Septic Tank �`� to Absorption Area f r to Sewer Line rA Nearest Lot line a'f Absorption Area t to Nearest Lot Line C-3 Page Two ' � • Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 15 Block 5 North Slope Subdivision #2 Comments: _ Affadavit Attached: ( ) Letter Attached: ( ) Approved: Date: 311,171 Disapproved: Date: Department Worksheet: 1 �_ ,Ai, If Individual, date of installation July 1976 (Approximate) 3�j Municipality of Anchorage .fid' Environmental Protection 825 L Street Anchorage, Alaska 99501 REQUEST FOR APPROVAL Of INDIVIDUAL SEWER & WATER FACILITIES j. Type of Inspection: CJIRO VA FHA CONV AHFC 2. Property Oti•tner: Lowell A. Pollard ou a V1, Box Mailing Address: Outlook, WA 98938 Day Phone Out of State 3. Name of Buyer: Harold P, Dietz Box 2238 Mailing Address: Anchorage, AK 99510 Day Phone 279-1324 , ;vane of Lending Institution. Home Federal Savings & Loan ATTN: Joanne 535 D Str Mailing Address: Anchorage, AK 99501 Phone 272-1451 5. Name of Realtor or Agent: Myrna Johnston AREA, Inc., Realtors, P1,0. Box 249 Mailing Address:. Eagle River, AK 99577 Phone 694-9555 6. Legal Description: North Slope Subd #2, Blk 5, Lot 15 Location• Agent -will accompany 7. Bdrrms. 3 Type of Facility to be inspected:Single Family No. 8_ Water Supply Type of Supply: Public Utility Individual xx If Individual, number of dwellings. presently served 1 If Individual, depth of well 124' 9. Sewage Disposal -System Tyae.of System: Public Utility Individual (on-site) xx If Individual, date of installation July 1976 (Approximate) 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 OSC251005 Parcel ID 050-581-19 Expiration Date Legal description NORTH SLOPE #2 BLK 5 LT 15 Site address 4039 KOGRU PL Current property owner(s) DIETZ HAROLD P & JENNIFER X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: 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 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 submittal. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory X Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-581-19 Complete legal description NORTH SLOPE #2; BLOCK 5, LOT 15 Location (site address) 4039 KOGRU PLACE, EAGLE RIVER, AK 99577 Current property owner(s) C/O GORDON SLOANE (AGENT) Day phone 907-244-3381 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: RN Private Well E] Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units Fj Community Well or Public F] Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic E] Private Septic serving 2 dwelling units F71 Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: F71 Steel Q Plastic [] Concrete 171 Fiberglass Age NEW _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS M Bed X Deep Trench E] Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: R 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 $ Ty 0 Date of Payment Waiver Fee $ q-0 ?, 5- Date of Payment COSA # 0 S' C- 'L';- / CC, S_ waiver # COSA ApplicaUon—June 2022 COSA Checklist Legal Description: NORTH SLOPE #2; BLOCK 5,LOT 15 Parcel ID: 050-581'19 ifmore than 1well and/or septic system on lot, provide separate checklist- Structure served by this system A. WELL DATA XWell log hyfiled with Onmdm(or attached) Date drilled 1976(?) Total depth *124 ft Cased to UNPi ft ��Sanitary seal hsfunctioning correctly RE wires properly protected Casing height (above ground) 12+ in. Date nfflow test for C{]S/\ 10/17/2024 Static water level atbeginning oftest 1014 ft Comments *PER KXOARECORDS B. TANK DATA Measured operating fluid level inseptic tank NBN Date of pumping NEW FlRequired maintenance completed, ifAVVVVTG Comments: C. ABSORPTION FIELD DATA Which system tested (date installed) 7/29/1976 FfALLmban� 'paapreour�perrecorddro�ing . � Total measured depth from grade 101 ft (max)-� Measured depth topipe invert from grade 53 ft (min) �lN/A - pressurized field. �l Per record drawings, field is insulated. FlMonitor tubes gotobottom ofeffective. If not, state depth into effective 57" ��Presoaked required if (Required ifhouse vacant orfield not used for more than 3Odays prior todate oftest) Gallons introduced °1940gaUuna 10/22/24 date Any rejuvenation treatment (past 12months) N/A |fyes, enter date NONE KNOWN Well production st time oftest 2.5 ~"m �� VVatarstorage tank vo|unne_���__gallons Well disinfected for no)ifnrm test? FlYes No 17Co|ifonnbacteria ioNegative Nitrate 0.479 mg/L Fl Nitrate less than N|RL (NO) Arsenic _uo/L ��Arsenic less than yWRL(ND) Collected by GEG, LTD. Omba 10/17/2024 STATION Age of lift station Lift station rnaW Adequacy test date 10/22/2024 Results ns Pass Fluid depth prior to test 3-75in Water added 146 go/ New fluid depth °7J5in Elapsed time 10 min Final fluid depth *0 in Absorption rate 450+ gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) 78-96 in Gffed�21+�depthmmad in Effective depth remaining z'+ in *1 940-GALLON PRESOAK ADDED TO DRAINFIELD USING FLOW FROM WELL AND WATER HAULS WHICH CAUSED A LIQUID LEVEL RISE OF 3.75". ADDITIONAL 546 GALLONS ADDED WHICH CAUSED LL TO RISE TO 7.75" °°NEVV2"STEEL K4TAND 4"CLEANOUTINSTALLED ATEND OFTRENCH. NEW MTEXTENDS 57"BELOW INVERT. CLEANOUT IN CRAWLSPACE WILL ACT AS FOUNDATION CLEANOUT (SEE PHOTO). COS8Checklist-June 2022 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' Community Sewer Manhole/Cleanout > 100' 1 Yes if No ft © Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' W Yes if No ft Holding Tank > 100' FE] Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MN Yes if No ft Q 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' Q Yes if No ft Surface Water > 100' 0 Yes if No * ft Tank to Property Line > 5' [] Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' [E Yes if No ft Private Wells > 100' FO-1 Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *NO H2O OBSERVED IN DRAINAGE EASEMENT ON 10/17/2024. 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. Na.rne of Firm _ Garness Engineering Group, LTD. (GEG) Phone 9107-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date 1 ! �l S" 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 Municipality of Anchorage and industry Q 0 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. F Separation distances were measured to readily identifiable features. Hidden defects or encroachments may identified during exist that were not the evaluation. The operational life of all wells and septic systems depend upon 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 system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not • . • • :. • .:. • .. - • .........:... guarantee future performance of the system/s; 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 to perform ! f y . warn ess.- �a adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG CE—? to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent is not authorized, nor will it any legal right property purchasers) confer whatsoever. COSA Checklist —June 2022 raeea���4ao���o a Ecv