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HomeMy WebLinkAboutT12N R3W SEC 15 LT 21Onsite File T12N R3W Section 15 Lot 21 #015-111-10 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number. OSP221155 PID Number: 015-111-10 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name RONALD ELLEDGE ABSORPTION FIELD Site Address* El Deep Trench A Wide Trench El Bed F1 Mound 4631 O MALLEY ROAD ANCHORAGE, AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-346-1050 1 1.0 GPD/SF 4 MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot SEE DWG. Ft. 0.52 Ft. Fill added above original grade Gravel length Township Range Section T12N R3W SECTION 15 LOT 21 SEE DWG. Ft. 51 Ft.Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 5 Ft. - - Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches Tank Field Lift Station Tank Line 250+ Ft2 1 From _ Ft. Well 100'+ 100'+25'+ TANK ASeptic ElS.T.E.P. ElHolding ElOther Manufacturer Capacity Surface Water 100'+ 100'+ GREER TANK 1000 Gal. Material Number of compartments Lot Line 5'+ 10'+ NA PLASTIC 2 Foundation 10'+1 Q'+ 1 0'.i.• LIFT STATION Manufacturer Capacity Remarks PFR r nNTPA!'TnP TWP nl n 1— 1— ­ (�I location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield A+ HOME SERVICES Drainfield D3034 CO/MTD3034 Inspector GEG AND MOA BENCHMARK (Assumed elevation) 100.27 ft Inspection es: 151 6/2/2022 2�a 6/3/2022 Location and description 3`d 6/3/2022 4th _ TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's St mp oo6�O :,onditional Approval: Date o �� • ' ' �50� Septic Syst�7_ Approve Date -17-_21?- Note: 17Note: this approval does not include well permit requirements. �v 05/02/18) o * �......... ................ ... ........ foey A. orness•: O 9; CE -79 3 d 40e�pro fes W"o' #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: OSP221155 RECORD DRAWING 015-111-10 A B DBL1 14.3 1 81.6 DBL2 14.7 82.1 MH1 14.8 83.1 STI 16.3 86.7 DBL3 16.9 87.4 DBL4 17.4 88.1 C01 42.7 90.2 MT1 42.6 92.1 CO2 90.2 104.1 MT2 90.7 103.8 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. HORSE CORRAL NEW 1000 NEW GREER T.H.#1 m \ CO21 Y 0 N i a EXISTING STRUCTURE WITH 1 BEDROOM RESIDENCE I GENERAL LOCATION OF WATER LINE PER LOCATE BY ARCTIC EFFLUENT (LOCATED PRIOR TO TESTHOLE EXCAVATION - RETAINED BY ARM SEPTIC SERVICES) �,/ .. 'i °• e - 4_ ° Ltd ENGINEERING - SALES - CONSULTING µ 3701 E. TUDOR ROAD. SUITE 101 *ANCHORAGE. AK 99507 • PHONE (W71337-6179 -FAX (007( 338-3246 • WEBSITE: wxw.pmessenpneerirp.com PREPARED FOR: PHONE NUMBER: 3L3& DB 1&� 907-346-1050 C',/ LEGAL DESCRIPTION: DRAWN BY: Tl 2N R3W SECTION 15 LOT 21 D.J.G. TYPE OF WORK: DATE: �SEPTIC SYSTEM RECORD DRAWINGS 01 e l .:'.. S e 'a o• °4 °. A A I GENERAL LOCATION OF WATER LINE PER LOCATE BY ARCTIC EFFLUENT (LOCATED PRIOR TO TESTHOLE EXCAVATION - RETAINED BY ARM SEPTIC SERVICES) �,/ .. 'i °• e - 4_ ° 4...emn.ea a. �..ti.uaaau ♦♦ Je y A. Zness ,® ♦ E- 953® jv LICENSE #AECC884 m Ltd ENGINEERING - SALES - CONSULTING µ 3701 E. TUDOR ROAD. SUITE 101 *ANCHORAGE. AK 99507 • PHONE (W71337-6179 -FAX (007( 338-3246 • WEBSITE: wxw.pmessenpneerirp.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: RONALD ELLEDGE 907-346-1050 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: Tl 2N R3W SECTION 15 LOT 21 D.J.G. TYPE OF WORK: DATE: �SEPTIC SYSTEM RECORD DRAWINGS 6/10/2022 4...emn.ea a. �..ti.uaaau ♦♦ Je y A. Zness ,® ♦ E- 953® jv LICENSE #AECC884 m PERMIT NUMBER: PARCEL ID NUMBER: OSP221155 RECORD DRAWING 015-111-10 TH TOP OF TANK AT INLET = 96.19 - INVERT OF BUNG AT INLET= 94.55 ORIGINAL GRADE AT HIGHEST POINT = 97.79 —TF MH = 100.27 MH �FINAL GRADE = 99.17-99.69 6 '- 2" INSULATION PER CONTRACTOR NEW 1000 GALLON H.D.P.E. GREER SEPTIC TANK 0.52 RELATIVE ELEVATION AT BOTTOM OF T.H. = 84.79 T.H. DRY ON 6/2/2022 TOP OF TANK AT OUTLET = 96.18 INVERT OF BUNG AT OUTLET = 95.35 MT CO FINAL GRADE = 97.39-98.12 i- FILTER FABRIC SOUTH 30' INSULATED PER CONTRACTOR BOTTOM OF TRENCH/TOP OF SAND= 93.79 INVERT OF PIPE= 94.31 5 �BOTTOM OF EXCAVATION =91.79 ®-- �1 y ®....'..... 4 ....................... K ,� r 0 3701E TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 337.6179 -FAX (907) 338-3246 • WEBSITE: r .gamessengmeenng.wm .. .... ......• .. 0 d•� : 1.........,..a PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ®{r1 ey A. wess Lt! A RONALD ELLEDGE 907-346-1050 3 OF 3 E 7953 a PROJECT/LEGAL DESCRIPTION: Tl 2N R3W SECTION 15 LOT 21 DRAWN BY. ®O® F,p'•. l p� 22 •.•' '+ Fp•' ••••.....,...•••' D.J.G.. ®® TYPE OF WORK: DATE: ®t`%FESS\Oko�� LICENSE 411®TA'alk SEPTIC SYSTEM PROFILE RECORD DRAWING 6/10/2022 #AECC884 f0 'r1 o tO rt o cxD z (n I ID In 0 CD Q. 3 (D w : '06 OD n (D m S Ort j O rt RS o QJ O N n O C7 0�� O c -O oui Fr+ :3 rt CD R- K aCD:3=°o m fI � rt N N OfD�-0 0, O � � o Q. m — -am Ci ID aCD EO CDs -0 rn Cn N > cD o Q :E > o'0 v m�< a0O sN rt CD O �. N to O N � �rt�O�N•G -0 rt0 fp ,..'. O 0 6� D�� oaID OJ O 7r (D �rt CDO��I �1" � 10 10 -O U)ID A tO Q � 7O p OKtQ (D C (4 Co Q= 7O ::3 a 1 0 Z r CDa 0 (D Co 0 0 7 C- G g 0-D = (A g ° O 0 M i '06 OD n (D m a o N 3 rt a 0 CD fI � rt L 75' N C':- pQa�Itsnm 4. = o �r(bn U L p0 0-3 B. i aoa.3 4 �a C -)x 0 wNO'08'00"W 585.00' Pacer Place w 75' r— O N =`t'� MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program No Is, ' PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 n \ http://www.muni.org/onsite � IBh 4 'VCR OR AGf' pa 1' t 111 Cult On -Site Wastewater Disposal System Permit Permit Number: OSP221155 Effective Date: 5/27/2022 Work Type: Septic Upgrade Expiration Date: 5/27/2023 Tax Code Number: 01511110000 Site Legal Address: T1 2N R3W SEC 15 LT 21 G:2536 Site Mailing Address: 4631 O'MALLEY RD, APT, Anchorage Owner: MCQUEARY LINDA L Lot Size in Sq Ft: 169884 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 1 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shalt be in accordance with: I. 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 Received By: -L___Date: S1 2 -]-I Issued By: t Date: 5 a 7 �,? 2 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015+ 1-10 Property owner(s) RONALD ELLEDGE Day phone 907-346-1050 Mailing address 4631 O'MALLEY ROAD *ANCHORAGE, AK 99507 Site address 4631 O'MALLEY ROAD *ANCHROAGE, AK 99507 Legal description (Sub'd., Block & Lot) T1 2N R3W SECTION 15 LOT 21 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 1 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field 0 Initial ❑ Septic Tank jl Upgrade Q Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) (w/wo AD U) Duplex (D) Multiple Dwellings (SF and/or D) 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: t 5` 5 Waiver Fees: Date of Payment: 5 x 5/0- 0 Date of Payment: Receipt Number: � �' 0'/' G Receipt Number: Permit No. O� P a Q j( 5 5 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc aj �m Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221155, Rebecca Carroll, 05/27/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221155, Rebecca Carroll, 05/27/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221155, Rebecca Carroll, 05/27/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221155, Rebecca Carroll, 05/27/22 — - ---- -- _ - Alaska Testlab - Anchorage 4040 B Street, Suite 102 Anchorage, AK 99503 r, ATL -- Phone: 907-205-1987 Fax: 907-782-4409 info@alaskatestlab.com Material Test Re ort Report No: MAT:22-0841-S01 p Issue No: ,1 Client' Garness Engineering Group Ltd. Project Code: 220453 The results contained below pertain only to the items tested below. This report should not be reproduced, except in full, without the prior written approval of Alaska Testlab or the agency. 3701 East Tudor Rd. CC: david Gamess Anchorage, AK, 99507 Maria Kampsen Project: 2022 Testing i Reviewed By: Maria E Kampsen Title: Senior Engineer Date: 5/6/2022 Sample Details Other Test Results Sample ID 22-0841-S01 Description Method Result Limits Client Sample ID T12N R3W Group Code ASTM D2487 GP General Location Section 15 L21 Group Name Poorly graded gravel with sand mm Atterberg Limits Estimated Yes 100 Tested By Cindy Zickefoose Date Tested 5/6/2022 i Method ASTM D6913 A % Passing Limits Preparation Method Oven Dry Composite Sieving? Yes Separating Sieve(s) No. 4 f 2in Cu ASTM D2487 33.47 t - _-° -�- __ _- ; _ Cc 0.41 Particle Size Distribution Method: ASTM D6913 Diameter Drying By: Oven 100 60 20 6 2 600 200 100 50 Date Tested: 5/6/2022 mm m u—I Tested By: Cindy Zickefoose 100 � -� � i - 1 1 - ; - Sieve Size % Passing Limits 4 3in 100 { f 2in 100 t - _-° -�- __ _- ; _ ___ 1'/2in 79 lin 66 70 i 3/<in 60 E I %in 53 60 3/8in 49 NoA 38.8 m No.10 29 50 --- - , — - - - -- — No.20 16 $ j j No.40 5 2 40 i II, - j, No.60 2 i No.100 2 No,200 1 - 30 20 10 j 0 Jll L 1 Sieve Size 3" 2" 1" 1/2" #4 #10 #20 #40 #60 #100 #200 Comments Sample Size Does Not Meet ASTM Requirements Soil Classification of Fines (4200) in Sieve Analyses Assumed Unless Verified by Additional Testing Form No: 18909, Report No: MAT:22-0841-S01 © 2000-2022 QESTLab by SpeclraQEST.com Page 1 of e SGS Ref.# 1221356001 LOQ Units Client Name Garness Engineering Group, Ltd (GEG) Printed Date/Time 04/13/2022 10:26 Project Name/# T12N R3W Sec15 L21 Collected Date/Time 04/01/2022 14:00 Client Sample ID T12N R3W Sec15 L21 Received Date/Time 04/01/2022 15:31 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks Parameter Results LOQ Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 04/02/22 04/11/22 DSD Waters Department Total Nitrate/Nitrite-N 1.88 0.200 mg/L SM21 450ONO3-F C (<10) 04/05/22 EBH Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 04/01/22 M.A. Total Coliform Negative 1 100mL SM21 9223B A 04/01/22 M.A 2of5 ...... m Sen min Halms ram LS -118709 ppVV d 0ZO a v �ArOtessiono 4 33' U O L W U n Lot 12 S90'00'00"W 296.76' Quonset Hut N 0 d 3 ..4! Connex--LO-1-C-1 33' �I n O'Malley Road i. Legal Description: A sbui It T12N R3W Sec 15, S.M. I0 I Lot 21 Survey Certification: 1 hereby certify that a Mortgagees Inspection was performed on the described property. Notes: It is the owner's responsibility to determine the existence of any easements, covenants, or restriction which are not on the recorded subdivision plot. It is the contractor's responsibility to check top of foundation grade & building setbacks in relation to property lines and easements [o a 6 CV n Tract .A r 0 Sheet 1 of 2 Legend: Well Septic Pavement Overhang Wood Deck Gravel Fence Feld Book: 146 Drown by: AR Scale: 1" = 70' Grid: SW2536 Date: 4/6/2022 Checked by: BH Plat: 89-80 DEPT. OF ENVIRONMEN]TAL CONSERVATION ANCHORAGENVESTERN PUBLIC SI:-'RVICE AREA OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 TONY KNOWLES, GOVERNOR RECI!IVED AtJG ~ 5 1995 Municq~ahty ct Ancl~orage Dept. Health &Hurnan Services August 23, 1995 Linda L. McQueary 4631 O'Malley Road Anchorage, Alaska, 99516 Subject: Lots 12 & 21, Section 15, T. 12 N., R. 3 W., S.M., Diamond H Ranch, Anchorage, Alaska, Project Numbers cJ621-WW-234-081 and 9621-DW-234- 043, Review Dear Ms. McQueary: This is in response to your August 22, 1995 submittal which was a letter dated November 27, 1992 from S & S Engineering to you. This letter was in regards to the wastewater treatment and disposal system that was designed to serve a two bedroom trailer house and this office's concerns regarding the existing on site Class C Public Water System. I have completed my review of the submitted information and have the following comments. Wastewater Disposal Based on the submitted information, it appears that the existing wastewater disposal system was upgraded in accordance with State Wastewater Regulations and the approval issued on August 21, 1992, with one exception. Tile exception is that no verification that the contaminated soils were properly disinfected was submitted to this office under the stamp of a Professional Engineer. If the disinfection was not completed, as requested, the freeze-thaw actions over the last two years should have completed the disinfection. Therefore, final operation approval for the wastewater treatment and disposal system is being granted in accordance with the provisions of State Wastewater Disposal Regulations, 18 AAC 72. The Approval of On-site Residential Water and Sewer System Certificate, constituting this approval for the On-Site Wastewater Disposal System is enclosed. This approval does not imply the granting of additional authorizations, nor obligate any federal, state, or local regulatory body to grant required authorizations. Linda L. McQueary 2 August 23, 1995 DrinkinR Water The existing Class C Public Water System has not been approved to operate. The November 27, 1992 letter to you from S & S Engineering covers items that needed to be submitted to this office under the stamp of a Professional Engineer. Due to the length of time that has expired (three years) since the submittal of the analtyical results for total coliform bacteria and nitrates (as nitrogen), current results (no older than 30 days) will need to be provided to this office along with the above noted information. Solid Waste. Please note that the only approved methods for the disposal of solid waste generated at your facility is the Anchorage Regional Landfill or the Anchorage Regional Composting Facility. If you are landspreading the waste on site, you are doing so in violation of the State Solid Waste Management Regulations. Contaminated Sites As noted in the numerous copies of the "Compliance Order By Consent" that was being reviewed in the spring of '1992, there has been hydrocarbon contaminated sites noted during site inspections. However, no information on if the sites were properly cleaned up. Please provide verification that all contaminated sites were properly cleaned to this office. Thank you for your coordination with this Department. If you have any other concerns please do not hesitate to contact me. Sincerely, Keven K Kleweno, P.E. Environmental Engineer KKK/cf Enclosure: As Stated cc: Jim Cross, P.E., MOAJDHHS, w/o Enc. • `� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D.015-111-10 Expiration Date: 1. GENERAL INFORMATION: Complete legal description T12N R3W SECTION 15 LOT 21 Location (site address) 4631 O'MALLEY ROAD *ANCHORAGE AK 99507 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 1 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: WdwadUal_VVetl' Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2 Date of Payment 15 90 Receipt Number COSA# O SC,2D 1 ag(� Waiver Fee $ Date of Payment Receipt Number Waiver # MIR 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: %11 VZ2 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 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend 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 adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fol �,Q0000p��� u.:...I.. ............. y A CA. c ;ess `G !•� s • cLG �1 e #AECC884 r p1.IT Y(pF \ Ory_,3j o Fj bND m T ,,vvYlg n PR0(;� . PER J JJ J�9,9 SERVICESv��� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other ME COSA Checklist Legal Description: T12N R3W SECTION 15 LOT 21 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4124186 Total depth 325 ft Cased to 325 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/1/22 Static water level at beginning of test 213.2 ft: Comments B. TANK DATA Age of tank(s) NEW years Tank type/material 1111DI Measured operating fluid level in septic tank " ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 2022 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.33 ft (max) Measured depth to pipe invert from grade *3.08 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: 'SOUTH 30 FEET INSULATED PER CONTRACTOR COSA Checklist yellow sheet Parcel ID: 015-111-10 of Structure served by this system Well production at time of test 14+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Al No ❑ Coliform bacteria is Negative Nitrate 1.88 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 4/1/22 C. LIFT STATION ❑ Required maintenance Age of lift station years Lift station maWial Adequacy test date NEW Results ❑✓ Pass For 1 bedrooms Fluid depth prior to test in Water added - gal New depth in Elapsed time - min Final fluid depth - in Absorption rate 150+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date NIA E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft M Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' n Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' 0 Yes if No * ft 21 Yes if No ft 0 Yes if No ft Water Service Line > 10' F1 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' M Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' r-vl Yes if No ft Wells on Adjacent Lots: [] Absorption Field > 5' Fv Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' El Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' F1 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' [j Yes if No ft Wells on Adjacent Lots: Water Main > 10' [] Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' R Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *HORSE CORRAUTRAINING AREA LESS THAN 100 FEET FROM EXISTING WELL. **SEE ATTACHED ADEC GIS MAPPING THE 200' RADIUS OF THE COMMUNITY WATER SYSTEMS ON THE LOT TO THE EAST DO NOT ENCHROACH ON SUBJECT LOT G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet oFAv��4 7 TH P� ...... ... . ... .............. ... ........ f y A. Gar ess: Vo , CE— 79 . P1jA• �o Pro f e s sio�°ao #AECC884 Ind 1201 RN101M St. 99515 ANCORA AES, AILASKA -7714 SIX INCH WATER WELL DRILLED -----------OUT TO THE DEPTH OF 325 Tee-. DRILLED AT THE RATE OF 323.00 PER FOOT. PROPERTY OWNER Dta and If Ranch & Tack Shop.. (Ik. Thank, lllcQueatuk) LOCATION OF WELL SITE TA. 21 Btk, Su.G Sec. 15 T 12J2 c30 S Re t tdi_an DRILLER Be4n le Untt4 a- Raapa>rt j)&tt tag lk&k-4. WELL LOG: 0----24'- -S i,t �andt� �.ine q/iaare L. 25°� ct aiy tru�de�i. 24---68' Sand wZU-L 35:0 f lae q tweL. 10i.' cLat,,t. 68---147' Ita zdpan. R team ted cvtatre . Seue2at imatt bou,Ldet4. 747-22.5' Came gltatreL. 3054 c (.atp &,Ladet. 225-274' Tb -Le g,)tweL wLth 255' cLaV. Seuezn.L -dmatt baso 274-295' -SZt ti, water. be_aA ina �. e gAave.L. Satzdtk clruk Z& -the ?tray e� lrear.t r, ry mut .fi i a L. 295-378' 1Ug1Ien qufl- bj- �ine wateA bea& ng q zaue.L. Somewhat jZUip & aandtj gtet.d. 378-325' road coa-t4e wat z t beaA,&Lg q zauet atLaurtng the-,Piaet jan.do dont ,the upped . o&mat,Lo" ,to be. 41,te& d awa.V. The 4e.ue&a L Peet o-� good come gnavet aV-ota4 the wate,zc to f,Lot:r .th totwA the water beevz, f-o&mattoa at a high pAoduc t.i.on.. Thence .ems a-tjo a g&ea-t atn.aun t o� pryceo ju ce 4A -the water bear ing jt,=taa, (Rgut�-e&) 4howtag. A -n ttk tg"f'tlt a.- wa tec td i,e t.d. Lra teA &ecaueh� .ice .!rack up. to 80 Peet o4 bottom. H i4h . pnaduc -.Loa Su (rrtte i,lrl e /'u&A nhou W be in�.fatted f We deet o4 bot tam. 9t .ice h 4h-bj. -jat.wj)j tn.g to .lin ing in. such a h,i.gh gut, & h,t c,1h c}uat i ttk tdatez De.t,L. S -tee -L ca4-1 t d-t,iuen ,to 325 fie" Tota -l- coat- o�- DAtiL{ r4. x2-3.00 peli X 325 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. (7475) WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF _it747(;-00 (.Le44 12 aon Jw Sta to dee & 4&v -pp ing fee.) s THANK YO`U1 VEqY MUCH..� z--,' 'I'—f– I �� BERNIE CLAUS OF RAMPA4T DRILLING WORKS DATE f2p&ZL 24th, 7986 SERVICE CHARGE O F i Ya% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS, W'LL pum/ 4t �GCi Resat � (( rr cs� N6 1�RfAwi) awry