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Home My WebLink AboutNORTH WOODS PHASE 2 BLK 1 LT 12AMR PH S. S URN s v 0 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231226 PID Number: 051-801-05 Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name C/O JOHN SWIGART ORPTION FIELD rE01 De Trench ❑Wide Trench ❑Bed ound Site Address 22520 WHISPERING BIRCH CIRCLE, CHUGIAK, AK 99567 Other Phone Number of Bedrooms Soil RatingTotal depth fr original grade 316-621-9576 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Subdivision Block Lot NORTHWOODS PHASE 2 1 12 Ft. Fill added above original gr G-rNel length Ft, Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines - Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total a rption area Number of trenches Dist. between ches From Tank Field Tank Line Ft2 - - Well N/A - _ - 25'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer INFILTRATOR SYSTEM Capacity 1060 Gal. Surface Water 100'+ - _ _ Material Number of compartments Lot Line 5'+ _ _ - NA PLASTIC 2 Foundation *9.5' _ _ _ ATION Manufacturer Capacity Remarks *SEE PROFILE DRAWING Gal, Alarm location Elec r . tailed by Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 ARM SEPTIC SERVICES Drainfield EXIST. c0/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspection 151 12/7/2023 Location and description nd 2 3rd _ 4th BACK DOOR THRESHOLD ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date9Sd� . ...... .... ............ � Septic Syste Q J ey A. rness,, �d Approved Date q 9 '• CE-7953 e�Q� Note: this approval does not include well permit require ent #A EccEIE14°�OOpoo�� kmuv 71 1 2PARCEL ID NUMBER: RECORD DRAWING I 051-801-05 'Tr ,RE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. NEW IM -1060 INFILTRATOR PLASTIC SEPTIC TANK— INSTALLED DOUBLE CLEANOUTS (DBL1 & EXISTING DRAINFIELD (NOTE: EXACT PERMITER IS UNKNOWN)--,, NEW FOUNDATION CLEANOUT (FCO) - KEY BOX (APPROX. LOCATION) ASSUMED WATER LINE LOCATION- V NOTE: PER THE CONTRACTOR, THE OLD TANK WAS DECOMMISSIONED PER UPC AND NO DRAINROCK ENCOUNTERED WITH 6+ FEET OF NEW TANK NOTE: ELEVATIONS TAKEN ON 12/21/2023 AND 1/3/2024 Ti Ltd ENGINEERING 4 SALES -CONSULTING ��,,.. � � l _,, 0 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA `PHONE (907) 337.6179 • WEBSITE: www.gamessengineering•com r••�, .•• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ; I JOHN SWIGART - BUYER 316-621-9576 2 OF 3 �j��J,�i• PROJECT/LEGAL DESCRIPTION: DRAWN BY:#A( NORTHWOODS PHASE 2; BLOCK 1, LOT 12 J.L.M. v TYPE OF WORK: DATE: LICENSE RECORD DRAWING OF SEPTIC TANK UPGRADE 1/3/2024 #AECC884 U / c i !c IN Ar 00 HROFESS\�.'.', ' r•� NOTE: PER THE CONTRACTOR, THE OLD TANK WAS DECOMMISSIONED PER UPC AND NO DRAINROCK ENCOUNTERED WITH 6+ FEET OF NEW TANK NOTE: ELEVATIONS TAKEN ON 12/21/2023 AND 1/3/2024 Ti Ltd ENGINEERING 4 SALES -CONSULTING ��,,.. � � l _,, 0 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA `PHONE (907) 337.6179 • WEBSITE: www.gamessengineering•com r••�, .•• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ; I JOHN SWIGART - BUYER 316-621-9576 2 OF 3 �j��J,�i• PROJECT/LEGAL DESCRIPTION: DRAWN BY:#A( NORTHWOODS PHASE 2; BLOCK 1, LOT 12 J.L.M. v TYPE OF WORK: DATE: LICENSE RECORD DRAWING OF SEPTIC TANK UPGRADE 1/3/2024 #AECC884 U / c i !c IN Ar 00 HROFESS\�.'.', PERMIT NUMBER: PARCEL ID NUMBV. OSP231226 RECORD D RAW I N G 051-801-05` TOP OF TANK @ INLET = 95.70 - INLET \ INVERT OF PIPE @ / \ INLET= 95.16 \ 9.5'+/- \ I -BOTTOM OF \ \ FOOTER = 94.51 \ Qs \ 9'Y A. \°sem TOP OF MANHOLE LID = 98.31 =1NAL GRADE = 98.08-98.18 -2" OF INSULATION (PER CONTRACTOR) 1060 2 -COMPARTMENT INFILTRATOR SEPTIC TANK STI TOP OF TANK @ OUTLET = 95.68 INVERT OF PIPE @ OUTLET = 94.86 - M A. '�# ' 4 ENGINEERING � SALES --CONSULTING _,w. 01 0 .. _.,_ `=1 0 3701 E TUDOR ROAD, SUITE 107 'ANCHORAGE, ALASKA'PHONE (�7) 337-5779' NVEBSITE: wmv.gamessengmeenng.com ��*.+ . . ..................,,uu. •,� PREPARED FOR: F3016-621-9576 NE NUMBER: PAGE NUMBER. 0 tom^ = e amess .• JOHN SWIGART - BUYER 3 OF 3 �# ;,, I. C 79 � PROJECTILEGAL DESCRIPTION: DRAWN BY. �j`�� •'. l 2 ��2 3 NORTHWOODS PHASE 2; BLOCK 1, LOT 12 J.L.M. +1��FQ �`''•....•..•,'� , ;��►�` TYPE OF WORK: DATE= LICENSE RECORD DRAWING OF SEPTIC TANK UPGRADE 12/21/2023 #AECC884 �rr�rrr NY AS-BU/L T SURVEY I" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT12 BLOCK I NORTHWOODSPHASE2 A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENIS SITUATED THEREON ARE WITHIN THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATEDATANCHORAGE,ALASKA THIS 207-H DAYOF DECEMBER , 2023 15830 232-27 235 86 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 MUNICIPALITY OF ANCHORAGE 1lcnt On -Site Water & Wastewater Program �o�' PO Box 196650 4700 Elmore Road i Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Department On -Site Wastewater Disposal System Permit Permit Number: OSP231226 Effective Date: 7/31/2023 Work Type: SepticTank Upgrade Expiration Date: 7/30/2024 Tax Code Number: 05180105000 Site Legal Address: NORTH WOODS PHASE 2 BLK 1 LT 12 G:1559 Site Mailing Address: 22520 WHISPERING BIRCH CIR, Chugiak Owner: WILMINTON SAVINS FUND AOCIETY Lot Size in Sq Ft: 35001 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q 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 r� Received By: t I .X, J - CjDate: Issued By: Date: i 3 MUNICIPALITY OF ANCHORAGE Development Set -vices Department`� ` j. Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-801-05 Property owner(s) C/O JOHN SWIGART (BUYER) - FORECLOSURE Day phone 316-621-9576 Mailing address 22520 WHISPERING BIRCH CIRCLE, CHUGIAK, AK 99567 Site address 22520 WHISPERING BIRCH CIRCLE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTHWOODS PHASE 2; BLOCK 1, LOT 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo AD U) Septic Tank Q Upgrade Z Duplex (D) ElHolding Tank ❑ Renewal El 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: AzZZS Waiver Fees: Date of Payment: %72�j Date of Payment: Receipt Number: n r6 `{ �7 G Receipt Number: Permit No. 0519 e3 /226 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc �A) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231226, Curtis Townsend, 07/31/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231226, Curtis Townsend, 07/31/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231226, Curtis Townsend, 07/31/23 I NY AS-BUILTSURVEY I" =30' NO CORNERS SET THIS DATE /HEREBY CERTIFY THA T / HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 12 BLOCK 1 NOR THWOOD SUB PHA SE2 A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENIS SITUATED THEREON ARE WITHIN THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 26 TH DAYOF UNE 2022 15830 232-27 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 /'"'x MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS ~J LEGAL DESCRIPTION LOCATION ~U D STANCE TO /'~ Manufacturer ILiq. capacity in gallons I /~O~ F HOMEMADE DISTANCE TO' Well Manufacturer IWell DISTANCE TO' No. of lines Length of each line Top of tile to finish ~rade Length ~ . Width 5¢' ~7 Tvpe o~ e~ib Crib DISTANCE TO: ~" ~ 0 CI e ~h ~ISTA~CfiTO: ~ Buddmflfoundat~on PHONE ] [~4~E W ,~/S--3~9 ( [] UPGRADE Absorption[,2-! area Mate?ial ?~ Dwelling Inside length Wi_ NO. OF BEDROOMS P E R IV~T NO. , ~d.2./b:25- No, of compartments Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation Nearest lot line PERMIT NO, Total length of lines Trench w dth inches Distance between lines Material beneath tile Total effective absorption area inches Oepth crib dcpth Building foundation Driller PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Sewer line Septic tank PERMIT NO, Absorpt on area(s) OTHER PIPE MATERIALS b 303¢ SOIL TEST RATING INSTALLER REMARK~ (~-7' APPROVED DATE LEGAL 72-013 (Rev. 3~78) PERMIT NO. APPLICANT LOCATION LEGAL MI_Ir~ I C: I F~LIT"~ OF F~r~CH~:AGE DEPRRTMENT L. rHEALTH RND ENVIRONMENTAL ,..OTECTION 825 gL' STREET, RNCHORRGE, AK. 99501 264-4720 m3~--SlTE L~EL4ER PERf4IT ( 82102~ ) LIFESTYLE IND SR8 i452-T 99502 Li2 Bi NORTHWOODS PHASE II ]:45-]:891 LOT SIZE 999999 S.F~UARE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD MAXIMUM NUMBER OF BBDROOMS = ~ SOIL RAT-ING (SQ FT?BR)= 2~8 THE REQUIRED SIZE OF'-;THE SOIL,ABSORPTION SYSTEM DEPTH= 7 L'EhlOTH= ."~4 ,3RP, V'Ei. , DFPTH - ~ THE LENGTH DIMENS~FJN IS THE LENGTH (IN FEET>i'OF;THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE, BEtWEEN THE SURFACE OF THE GROUND AND THE BOTTOM.OF THE E×CAVRTION~(IN.FEET). THE TREN~OH '~J-IDT~: IS 5. 000 FEFT. THE GRAVEL DEPTH'I%"~HE MINIMUM'.DEPTH OF GRAVEE BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REI21J I RED SEPT I C: T,"-~NI-( $ I 7E I £~C40 CiFILLL-,I'...IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECT{ONS OF ANY WELLS RDJRCENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T L~C, (~-'> I F~SF'ECTICm~4S ARE REC(IJ I 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 i00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE AVAILABLE TO INSURE PROPER INSTALL8TION. F'EF~:I-I I T E}::P I RES DEC:EI'IBER _?.::1... I CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. S I GNED: APPLICANT LIFESTYLE IND ISSUE[.', ................ ~ ~-~7 ......... Y- - V4. 0 PERMIT EXPIRES DEOEMER )~ ~i)Q~ [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST LEGAL DESCR,PT,ON: LoT t ;)- G~k I 1 2-- 3 4 5 6 7 8 9 oIr~O.~ i4- SoT- L$ SLOPE DATE PERFORMED: SITE PLAN 10- 11 12 13 WAS GROUND WATER 7,~ ,.~ SL ENCOUNTERED? 0 P ! E DEPTH? Gross Net Depth to Net ReadingDate Time Time Water Drop - -- ~ /, /~.. ~o ~,'~ /o ~ / ~" ~ ,, /~.,~o /~ ~,~ /o ~ ~//~" ~ [~ /0.' ~0 {0 ~i~ I/ ~" '~b" 14 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: 72-008 (6/79) PERCOLATION RATE 27 (minutes/inch) TESTRUN BETWEEN y FTAND ~ FT DATE:Z ~c~(~~'~' ApPLj¢~NT'~FILLS OUT UPPER HAL~''~ ONLY Property Owner ~..~ ~:~.. ~ T~ ~ /~/~ Phone MailingAddre~ ~ ~' ~ ~['/C~. A~ ZipC°de ~'~ Buyer Address Zip Code Lending lnstitution ~'SK~) ~.~p/~ ~. ~:~ ~ ~ /~ Phone Realty Co. & A~nt ~ ..... ~ Phone Address Zip Code S~r~ ~oca.~ ~,~ ~ ~:~ C ~ Type of Resi~nce ingle Family ultiple Family No. of Bedroo~ .,~ ~ Other Water Supply ~ Individual A~ACH WELL LOG, A w~l log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available), Community Public Utility Sewer Disposal Yearlndiv~uallnstalled: ~'~ ~ ~'~ ~'~, ~ Individual -- · '~' Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspector Field Notes: DFpT ~'~ ENVIRO; ~t,' ~1',. A.: ,0 ECTION RECEIVED (3 ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3182) mwm MUNICIPALITY OF ANCHORAGE c .t Development Services Department ° =w' Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-801-05-000 Expiration Date: 1/4/2025 Legal description NORTH WOODS PHASE 2 BLK 1 LT 12 Site address 22520 WHISPERING BIRCH CIR Chugiak AK 99567 Current property owner(s) SWIGART JOHN C X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1/4/2024 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 ApprovaLJune 2022 MUNIUPAUTY OF ANCHORA GE Development Services Departmentparr �'�` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-801-05 Complete legal description NORTHWOODS PHASE 2; BLOCK 1, LOT 12 Location (site address) 22520 WHISPERING BIRCH CIRCLE, CHUGIAK, AK 99567 Current property owner(s) JOHN SWIGART 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 316-621-9576 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units X Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS Q 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 $ 56-0 Date of Payment I AA �I COSA # Waiver Fee $ Date of Payment Waiver # COSA AppllcaUon_June 2022 IVA COSA Checklist Legal Description: NORTHWOODS PHASE 2; BLOCK 1, LOT 12 Parcel ID: 051-801-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 LL DATA ❑ Well log i with Onsite (or attached) Well drilled depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow, test for COS Static water I eginning of test ft. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/21/1982 ❑■ ALL standpipes present per record drawing Total measured depth from grade 5.2 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. R Monitor tubes go to bottom of effective. If not, state depth into effective R Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 1458 gallons 9/12/2023 date Any rejuvenation treatment (past 12 months) NIA If yes, enter date Well production at time of test m Water storage tank vol gallons Well disinfg;or coliform test? ❑ Yes O No Arsenic Collected by Date bacteria is Negative _ mg/L ❑ Nitrate less than MRL (ND) ug/L ❑ Arsenic less than MRL (ND) ❑ Require Age of lift station Lift station niaW Adequacy test date 9/12/2023 Results Q Pass Fluid depth prior to test 0 in Water added 1058 gal New fluid depth 5.5 in Elapsed time 925 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: PRESOAK AND SEPTIC TEST PERFORMED ON SAME DAY. COSA Checklist 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' accordance with the guidelines and regulations established by the Municipality of Anchorage and industry Community Sewer Manhole/Cleanout > 100' MYes if No ft ❑Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' F� Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑Yes if No ft Neighboring Absorption Fields > 100' .......... ..... . .. or septic system can be installed on the property in the event either of the current systems fail to perform Animal Containment > 50' Yes if No ft Yes if No ft perform evaluation. upon provided person party legal QQ 1 �� ? (including subsequent property purchasers) is not authorized, nor will it confer any right whatsoever. re • �n`�fl fl Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft r]Yes if No ft 0 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 *9.5 ft Surface Water > 100' ❑� Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' Q Yes if No ft Q Yes if No ft no Yes if No ft n Yes if No ft F. ENGINEER'S COMMENTS *SEE RECORD DRAWING. Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' [11 Yes if No ft Yes if No ft If tank or field is under driveway comment below 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 Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 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 o060��0� practices. The reported results describe the condition of the system/s on the date/s of the evaluation. o Separation distances were measured to readily identifiable features. Hidden defects or encroachments may......fl The life systems depend 0 7 exist that were not identified during the evaluation. operational of all wells and septic levels fluctuate ' 01 upon a variety of variables, including (but not limited to) soil conditions, groundwater (that may p%� during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing * = 4 T -7 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 �Q r, A. Gar ess.= adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to the Reliance the information in this report by any other or 9 k CE fieG perform evaluation. upon provided person party legal QQ 1 �� ? (including subsequent property purchasers) is not authorized, nor will it confer any right whatsoever. re • �n`�fl fl LICENSE OR., Fr o (e s slonoq COSA Checklist June 2022 #AEccaea