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Home My WebLink AboutT12N R3W SEC 33 LTS 92A & 92B0 ,, • • NO • MOO s _{ ,. CL 4— Iq rT- C] V/ A� VT/ 1 co c7 co M I'- I -- CD 0 CY) CA O X VU O C O O d •� � c^B '� O L N O Ncn 'a i 4+ cn p V Q U U U) Ln U) L i cu O cn cu O 'y O O - L Q Q U) tc � N o Ov 3 � i G > p cC �. N -a = O L O JJJo Q. EQ% L Q L ) v R _ r- •{J v U) -0 M A d.i O L O O ^ O /O V (j ,^ = N E �� E @ > o -0 i- OL N L It N O N N O 6 ca n C O .Q X W r LO 0') CY) m Y N Q Cll 0) Q NT Tp VJ U) U J Q M Z C`7 J fw Q U)7> /7> iY . O Z OCN J [— Q LO O � Q U N N -p _0 _0 ca � m .�. J CO r • G 1 `l WA 0 X Q > O CL C- CU C6 0 15 c O M 1+ L) O O= O U) O CU •� � c^B '� O L N O Ncn 'a i 4+ cn p V Q U U U) Ln U) L i cu O cn cu O 'y O O - L Q Q U) tc � N o Ov 3 � a- '7) N > p cC �. N -a = O L O Q Q. EQ% Q L � E (n V! v R _ r- •{J v U) -0 M A d.i O L O O ^ O /O V (j ,^ = N E �� E @ > o -0 i- OL N 0 L cn o N .c I— ON >, cn t c Q O L Q i t i Q X Ll O T) Q L � � o Y > ^U` LL WQ C: N U 1c� a 0) f Q Q L... 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C > M (1) < CL 0 — co U) (.) 0 M 0 (n E 0 ❑IL CL m in U - WD El < N a. uj0 0 z D) U) Cl) C/) >4- 0 5". w I I a) UJ (D :3 W L) wLU I --a) ❑FL 0- < 3: z 0 o U 0 u Cf) < Q I-- (n 4- M ui U- 0 LL 0 C-0 a) > a) cri 0) a U) w U-1 P 2i (L fL (1) 0) U) _0 0 LU < M < a) CL M cu 0- x > C4 vi ch V5 (6 3: Lu m .0. a) a) LL S. - a) cu 3: U!) - a) (1) LL U) 0 0 >, cu n 4- 0 0 (1) cu 0 CO 0 0 .2 0 COSA Checklist Legal Description: T12N R3W SEC 33 LTS 92A & 92B Parcel ID: 018-261-32 it 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 UN Total depth UN ft Cased to >40+ ft H Sanitary seal is functioning correctly On Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 10/20/023 Static water level at beginning of test 80 ft. Comments B. TANK DATA Measured operating fluid level in septic tank `30 Date of pumping 10/2/23 N Required maintenance completed, if AWWTS Comments: * PRE-SET FLOATS D. ABSORPTION FIELD DATA Which system tested (date installed) 12/10/84 ❑E ALL standpipes present per record drawing Total measured depth from grade 3.0 it (max) Measured depth to pipe invert from grade it (min) ❑ N/A — pressurized field. IN Per record drawings, field is insulated. ❑ul Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes M No R Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Date 10/20/23 C. LIFT STATION H Required maintenance completed Age of lift station 117 years Lift station material STEEL Comments: Adequacy test date 10/20/23 Results Q Pass Fluid depth prior to test in Water added 450 gal New fluid depth 0 in Elapsed time 1440 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 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' if No _ ft ❑� Yes Community Sewer Manhole/Cleanout > 100' Qi Yes if No _ ft Q Yes if No _ ft Neighboring Tank > 100' ❑m Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Absorption Field on Lot > 100' 0 Yes if No _ It Holding Tank > 100' Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No _ It Di Yes if No ft _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑a Yes if No _ ft 2] 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' [j] Yes if No _ ft Surface Water > 100' E Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ❑� Yes if No _ ft ❑� Yes if No _ ft QYes ifNo_ft Q Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 0 Yes if No _ ft Q 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 t A kc & fiat tl ,rv60fi 1"( Phone 727-8864 Engineer's Printed Name 4, a W *—, Date q OP 4i hip'•• �'�'i"3Ps '..m tP "CHAd K ANDI(ag(„yN r '• %L'• CE -94M COSA Checklist June 2022 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received~/~z_~.. Time of Inspection Date of Inspection __~// ~/~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: /~'/ ~.~<c~_~.~.~_~Z~ Mailing Address: /?/A.c, Phone: _, >';~ :/[6"o~/ Property Owner: ~_ ~(./~_~/~ mhone: 7~':-'-~ / ~ Mailing Address: ~/~ ~. ~/X/ ~' 3. Legal Description: ~z ~i ,~Z~x~/~ ~?'~_~.,_ ~/~.~kY~ :L ~ Lx] 4. Location: __ <~ ~.'~',~'-~-~<[- ~.~. 5. Type of facility to be inspected ~Y'~,[J~,~_~z~:,~/E~No. of bedrooms E. Disposal Distances: Well Data: A. Type __~ ~,c<..:- B. Depth _ //~ / C. Construction ~?..~/£/_2~ D. Bacterial Analysis Sewage Dl'sposal, System: ~/-~LC, ~ c/-- A. Installed_ --/,~/~'x~.~.. . B Instal]er:/}/~__ /-/~/~-~-~'~ C. Septic Tank: 1. Size /~ ~:~.',~2. Manufacturer :~/c/__,~_, D. Seepage Pit: 1. Absorption Area ~ 2, Material Field: Total length of lines ~./_~{/~/~/~*~__/~l~z~-~)×~/ A. Well to: Septic tank b~-? ' _, Absorption area .//.~ ' , Sewer Lines /~__,>/-- Nearest lot line __/~ t~Z__, Other contamination B. Foundation to septic tank .~ ~ , Absorption area /~/~ ~. /~ C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req~.st for Approval of Individual S~,er & Water Facilities Legal Description Comments ¢-'- ~ ~';' Disapproved Approved __ ~_ .._ Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM · ,v 1: ~ '&~: ~'-'-- ' certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. EQ-034 (1/74) Date 3330 GREATER ANCltORAGE ARI.,', BOROUGH Department of Environmental Qual~.t~ "C" St., Anchorage, Alaska 99503 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: Nailing Address: CMRO VA X7~ FHA CONV Alfred E, Hatton Box 481E SRA Anchorage Da.,~ Phone 344-0840 McCoy_b- Bi. tly __D. 3919 Merrill p_r_iv__e__ 99__5_0_3____ Phone 277-7373 4. Name of Lending Institution: First National Bank of Anchorage Mailing Address: P.O. Box 720 99510 Phone 279-4481- ext 234 5. Name of Realtor or Agent: Alaska Associated Realty---Cloyd Moser Mailing Address: 831 B St, Anchorage P[ione 279-0904 Real Est. Off. Work 6. Legal Description: Location: BLM Lot 92B Lochloman Lane & Rabbit Creek Rd. 7. Type of Facility 8. Water Supply Type of Supply: If Individual, If Individual, 9. Sewage Disposal System Type of System: If Individual, date of to be inspected: Residence No. Bdrms. 3 Public [Jtili'ky Individual number of dwellings presently served depth of well Unknown Public Ul:ility Individual i FI s t a l 1 a t i o n Unkn own ( o n - s ite )XXXXX