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HomeMy WebLinkAboutSIEFKER #3 TR 5 LT 10 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: N/A PID Number: 015-281-44 Dwelling: W Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name GAIL METHONEN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 3651 EAST 121 ST AVE *ANCHORAGE, AK ❑ Other Phone ber of Bedrooms Soil Rating Total depth original grade 907-350-5872 T3u GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SIEFKER #3; TRACT 5, LOT 10 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ 25'+ TANK 9 Septic [IS.T.E.P. 171 Holding El Other Manufacturer Capacity GREER 1000 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'+ NA STEEL 2 Foundation 10'+LIFT z STATION Manufacturer Capacity , Remarks DOCUMENTATION OF 2017 INSTALL THAT WAS Gal. COMPLETED WITHOUT A PERMIT Alarm location Electrical installed by NK Tank to PIPE MATERIAL House to tank Udrainfield UNK Installer DIRTY DEEDS DIRT WORKS Drainfield EXISTING CO/MTD3034 Inspector N/A BENCH MARK (Assumed elevation) 100.00 ft Inspection i5, _ _ Location and description dates: 2nd aro _ 4,„ _ BOTTOM OF HORIZONTAL WINDOW TRIM BY POINT B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp oo�op0 °`h Conditional Approval: Date 4 T Q� �.... .. ff Septic System / Approved // Date 6/7c� ...... D �1e rey A. Gorness.: QQ c _79 �Op ��� v ��e . _& �����o� No�ef this approval does not include well permit requirements. 4°OOOpO�o© #AECC884 krcev uoiuu ioj i 1 1\ENGINEERING 111 \ ENGINEERING- SALES � CONSULTING A4,4M Au -h ri.ed VQ&POF May 19t', 2023 Municipality of Anchorage Development Service Department 4n -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Documentation of existing septic tank at Siefker #3; Tract 5, To whom it may concern: Per conversations with the agent, the septic tank was replaced without a permit and/or engineering in 2017. Attached is a receipt for the work that was completed by Dirty Deeds Dirt Works dated 8/1/2017. Per the receipt, a 1000 -gallon Greer septic tank was installed and 90 feet of new drainpipe was installed in the drainfield. Attached are record drawings of the septic tank created by GEG. It is important to note that the information was obtained by GEG without excavation. In short, the drawings have been created with limited information. If you have any uestions, please contact us at 337-6179. Thank you for your assistance. SSS inerelyg 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.garnessengineering.com ATB FCO 1.4 37.3 ST1 45.9 70.4 ST2 52.0 74.6 DBL1 51.7 72.0 DBL2 51.6 70.6 C01 1080 91.9 r.�T; 103.5 88.3 WELL ON LOT 10 IS BELIEVED TO SERVE LOTS 3,4 AND LOT 10 AND STUBBED TO SERVE LOT 5 SIEFKER #3; TRACT 5, LOT 5 FVACANT] `-I 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, SIEFKER #3; TRACT 5, LOT 3 — — — — 10'UTILITY EASEMENT SIEFKER #3; — — — — — — —10' — — — — — — ---Z----_ ------ TRACT 5, LOT9 1 APPROXIMATE LOCATION& EXISTING SEPTIC TANK BELIEVED TO BE INSTA4ED IN AUGUST OF 2017. SEE ATTACHED RECEIPT/ROM DIRTY DEEDS DIRT WORK. ST DBLI ST1 BL2 WELL DOES NOT EXTEND ABOVE GRADE. LOCATION IS PER OWNER SHOUSE HOUSE 100''NeO EXISTING DRAINFIELD; EXACT ORIENTATION LL A • • HOUS AND LOCATION IS UNKNOWN; NEW CLEANOUT AND MONITORING TUBE WERE INSTALLED FOR SEPTIC ADEQUACY TEST -A x P,peaay- 0 Tl slij �22 CO SIEFKER #3; TR EAST 121 ST AVENUE - — — — — — — — — — — N SIEFKER #3; TRACT 6] SCALE: 40' # # I -11,'W Tp ING GROU Ltd GARNY ........... .. . ....... ......... . 0 - ENGINEERING a SALES CONSULTING 0 0 3701 EAST TUDOR ROAD SUITE 101 -MW-40RAGF- ALASKA • PHONE (907) 337-6179' WEBSITE: w .gamesseng . neemV-ccm 0 ........... .......... .............. u 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: /o e re mess GAIL METHONEN 907-350-5872 20F3 # # C)-79�3 Aw Ar PROJECT/LEGAL DESCRIPTION: DRAWN BY: 11 4w SIEFKER #3; TRACT 5, LOT 10 D.J.G. ..... ...... 4W TYPE OF WORK: DATE:ROF� LICENSE 4 lklklkL i SEPTIC TANK "RECORD DRAWING" 5/17/2023 #AECC884 YA was ARCEL ID PN/AT NUMBER: RECORD DRAWING P015-281 44 ER. G.E.G. WAS NOT PRESENT DURING THE INSTALLATION OF THE SEPTIC TANK. INLET/OUTLET ELEVATION WERE CALCULATED. FINAL GRADE = 89.63-90.29 STS TANK IS "DOUBLE INSULATED" PER TOP OF TANK ST2 CONTRACTOR RECEIPT AT INLET = 87.35 TOP OF TANK (CALCULATED) AT OUTLET = 8721 (CALCULATED) INVERT OF BUNG AT INLET = 86.60 (CALCULATED) INVERTOF BUNG AT OUTLET = 86.29 (CALCULATED) EXISTING 1000 GALLON SEPTIC TANK BOTOM OF TANK AT INLET = 82.35 BOTOM OF TANK AT OUTLET = 82.21 BENCHMARK IS BOTTOM OF HORIZONTAL WINDOW TRIM NEAR POINT B ♦ lli44 Ar 'Ir Tp z '. ♦ �� �rF ,w.y�: � x„�: �� � �� ,.� �.�w,� �a: � tea. "� , �:.' r._ r,x:a,..-��_��, � - k Asa _�, ,. � , ��... , :a "r' �.•• •� / ............. . ......... ................. . up ENGINEERING SALES � CONSULTING .. 0 3701 E. TUDOR ROAD, SUITE 101' ANCHORAGE, AK 99507 - PHONE (907) 337-6179FAX (907) 338-3246 * WEBSITE: -gem-glneenng.wm r „••tae .• .......................... ... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ' GAIL METHONEN 907-350-5872 3 OF 3 ��� ffre� ; 5ess •';=i LEGAL DESCRIPTION: DRAWN BY: q \AV .1 SIEFKER #3; TRACT 5, LOT 10 D.J.G. •�! p�/� �,�7•`••��” TYPE OF WORK: DATE: LIC ENSE t1?4 1Ur ESS SEPTIC TANK "RECORD" DRAWING 5/17/2023 #AECC884 ��\\���•� X X X X X X X X X 0  0 ' 0  0 ' LO7 11 LO7  LO7 LO7 LO7  OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU W S S S S S89° 59' 30"E 177.00 S0 0 ° 0 7 ' 4 0 " E 1 5 0 . 2 4 N89° 58' 43"W 177.00 N0 0 ° 0 7 ' 4 0 " W 1 5 0 . 2 0 E 11S7 A9E1UE 10' U7IL ES07 ED*E O) 3A9E0E17 *RA9EL DRI9EWA<SHED E 100 ' W E L L R A D I U S        1     0   11   1 11  0   11    1 11 10 1   LRW 10 7R  SLHINHU SXEGLYLVLRQ   ST )W  1 E 11VW AYHQHXH 1 SWRU\ 0RELOH HRPH PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. March 17th, 2023. Legend: Scale 1" = 30' Electric Meter/Outside Power DeckSeptic Telephone Pole Fence Overhead Utility Lot 10, TR. 5 Siefker Subdivision #3 General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Savanna Wiita 23-068 03/20/2023 70-90 2735 Water Well Concrete E S x W 0DU 0 0 R E GISTEREDPROFESSIO N A L L A N D S URVEYORPierre M. Stragier No. L.S. - 9812 5/16/23, 3:48 PM Dan Wolf Team Mail - (no subject) https://mail.google.com/mail/u/0/?ik=adlfbea344&view=pt&search=all&permthid=thread-f:1766096514439914505&simpl=msg-f:1766096514439914505 2/2 ~1I;tNN1N� 7711SS'�'cJ w�rJ `.?N IJVI O HS' NV -7 C/ w Z Q W  MUNICIPALITY OF ANCHORAG~--:--'- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 QN-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT LOCATION - ~ . ~ ' Nd. OF BESeeMs ~ ~ Ma nu fa cturer ~ ~ ~ M at~~ i ~o. of co m oar tm on..ts ____ 0 ~ ~ Manufacturar Material ~iquid capacitg in ~allons No. of lines/ Trench3it ;~ .... T°p°ftilet°finishgradeLength Width ~ ~ Type of crib Crib diameter Crib depth Total effective absor~ion area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Buildin9 foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER SOl~ TEST RATIN~ ~ ~ ~NSTALLER APP~ DATE LEGAL 72-0131 ev. 3/78) I"IFfi:,:; ]: MUM NtJHE:IEI:~: OF F:..:EDROOM':~; = :'ii: 'l"t..hE:: fREI;ILl I F.'IE[:, :.:!; I ZE: lC:IF T'HE' :501L I::IE:~iEI[~".F'T I ON ::;h":!~TEH I ::5: 'I't-IE 1_.[:I"4GTH [:, t ME]',IS I ON ];':'.i; 'FI-]E: [..EI"4GTH ,:: I N F'EET ::, OF: TFIIZ 'I"IRENCH OR DRf::I I I'.,IF.- ]: THE: [:,EF'TH Eft= FI TRENCH OF.". PIT ]:'-:.:; THE I?, ]: S 'r FI N E: E BETHEEN THE '.:::,UF:FF~CE [)F' THIE GFROLINE:, FII'.,I[:, 'tHE E',OTTOf,1 Cfi= THE E,'.-':CI:::I'v'RT I ON ,:: ~ N F:'EET::,. THERE :f.S NO SET H:I:[:,TH F:OF: TI;:ENCI-..IES. THE GI:;;:FIVEL DEPTH 1:5 THE H :[ N.I MUH DEF'TH OF" Gi'RFI'¢EL 13ETHEF::N THE EII...ITF'FIL. L F';[ F'Fi: F~I'.,I[:, THE: Do"r'TOH OF THE E::.::CFI',,,'FI"I' :[ ON ,:: .~ N FEET .'.',. PERM :[ T Ffl:'l='l.... :[ [:::I::INT I-I1":12; THE RESF:'OI",I.'.2; I [':': ]: L ]~ T'ITI TO ~ r,IFORM TH :[ ~..: [:,EF'RFYIq',IENT C, UR I N[!i "Fl.'E: I Ni~!;TFIL. LFI'f':[ ON I I'.,tSPE(Z:TI' ON2.: OF' f:tN'9 I.,.IE:L.L.'Z, FI[:,J'FICENT TO TH ]."..'i!; F'ROF'EF-'.T'-/ FIND THE NUI"IE:ER Of= IRIESIf::,ENCE!:'/..!; THWF "fTE~: HIEL. L I.,.IILt... SIEI:~::'v'E. [31::tC:1<F: ILL ]~ IqG OF: RN"r' ::5'¢~.:;"['[EM I,.I :1: 'THOLrT' F I hlFIL ].' I'.,I':.:;PEE:T I ON FIN[::, FIF'F'F::O',,,'F]L~ E:'.r' TH i rE; [:,IEF'I::]F.:f'HEN"I' H I L.L. BE..: SUE:J'ECT T'O F:'I;.:Cv.';:iECUT ]: O1'4. H:[ N I i'fll.IH [:, 12;TF'g",ICE DE:Tf'I.,IE;EI'.,I f:~ 1.4ELI.. FIN[::, FIN"r' :~.O[~1 FEET FOR FI r.:'F;tI',,,'f.;O"E I...IELI_~ Ci[~,. :l.!5C~ TO 200 I:=EET I=l:~:Oi',l FI I='U[!!:L]:C t.4ELL [:,E:F>EN[:~]:I'.,IG UF'Oiq THE T'.?I::'E OF: PIJE;I...Z[:: I.,.lti!:l..I [)THIEF,'. I::.IEQU I R[£1','I[.ZNTS; I',lFl'.r' FIF'F'I._"r'. L'3F'EC ]: F: 1' CFI-['I: ON~J f]l"~[:, CON:".'i;TF.".UC:T I Oiq [:' ].' FIGI~:FII"'I:~; F:tRIE FI","I=I Z IM:::IDLE TO 1' f.4~51...If:~:[.:.' F'f:~tOF'E;[~'. I I",I:'.:.';TFILLI::IT ]: ON. I CE~f~t'l" I F'h" TI"IFtT :L: ]: FIH I::'FiHILIFIf~'. I.'.I]:"i"H THE F.*:.EL.:!LIII*;~EMENT:.E; FOR ON'"-SITE ::SEHEI:;b.: FIN[:, I.,.II::'.I...I.S RS SE"f' I:::OlRTH E':"r' THE: HI. JN): C :[ F'r:ll_ ]: T'./ OF FII'.,ICHOf~.ff:IGE. ':2: :[: H): LL. t Nff;TF:iLL THE :!:;"r'STEH .[ N ::::::::::::::::::::::::::::::::: H Z TH THE: CO[:'E::;. :::: :1: I. JN[:,[Cl:;i:$:?'ml'.,l[:, THFIT "I'HE: OI'.,I-E;ITE SE':.b. IEI;...' S'./'.:.i;TEH HFI"r' i::.':EE.!UIIRE ENLFff:.:[!iEHENT IF' 'TI"'II:: t';Z:E:!i!; :l: [:'IEI",tE:E I :'T:; [~.:.'I:HOD[.:.:LEI) TO ]:I",IC:L. LIC'E MOF. tE THFIi'.,I 3: BE:[:'F-'.OOH:!;. FIF:' F'[.. Z E: F:ti',l T t;IFII4:C:U: i'"lE T HC~NE I',t ]' ":~: 'i:.: I1:~[':, [::,* ........ L ............................................................... I..: I I f I:~ ........... i~.~ .................... ",";ii:. 2 ,il, "." -- ' ' ..... . ' ,' ' CONSTRUCTION TEST LAB "One Test is worth a Thousand Opinions" 2204 Cleveland Anchorage, Alaska 99503 277-0231 'erformed for ,egal Description: 'his Fo~..n reports: Mr. Methonen Lot 10 Block Tract 5 SOILS TEST . yes Date _er~._ormed 7/23/79 Subdivision Seifker Subdivision PERCOLATION TEST y~$ Depth Feet /1' Soil Characteristics Peat Brown Silt -ML- ¢'7 Perc Zone Brown Sandy Silt Damp -ML- .? // Bottom of Test Hole qas Ground Water Encountered no If YES, What depth? Reading,I Date I Gross T~ne i7/23/79 7,/,24,/,79 Percolation Rate 1"/60 Proposed Installation: Net TLme Saturation Depth to H20 Period I 0 5" 0 i 3,0 Hours ! 3.5 Hours 6.5" 4.0 Hours Minute SEEPAGE PIT Net Drainage 7.0" I 1/2" DKAIN FIELD Depth of Inlet Depth to Bottom of Pit or Trench EO2CMENTS: ,~0. Square feet drainage area required per bedroom. ~est Performed by D. Pa~"~ ..~ Data Certified By: Construction Test Lab ~' Date : 7/25/79 ]DEIt~T. (IF ENVIlIiON~iENTAL ~ ~N§EIlIVATION $OUTNCENTRAL REGIONAL OFFICE October 2, 1979 338 Denali Street MacKay Bldg., Room 1206 Anchorage, Alaska 99501 (907) 274.5527 P.O. Box 1207 Soldotna, Alaska 99669 (907) 262-5210 P.O. Box 1064 [] Wasllla, Alaska 99687 (907) 376-5038 Lynn Lindquist Dept. of Health and RECEIVED Environmental Protection 825 L Street Anchorage, Alaska 99501 Subject: Lot 10, Tract 5, Siefker Subdivision MUNICIPALITY OF DEPT, OF H~AL~H ENVIRONMENT- & ~ AL PROTkCTION OCT 2,3 1979 Dear Ms. Lindquist: This department has no objection to"the proposed sepa- ration of 111 feet between the well and upgraded onsite sewer system serving the subject lot. Sincerely, James O. Starr Environmental Engineer imc la-O6LH Ji~:% Start ]~]n:viron~l%enta 1 Conservation 338 Denali ~treet Anoho~3age ~ Alaska 99501 Lo% i0 ':~raot 5 ~:io.f~er su]~ivision· so~:li--pub].ic well serving the subject property has been operatin~ prior to ~ho passage of Titl~ l~] Alaska S'gatuh~s. t~ ,.,,.~11 is an ~xi~t]ng ,source and the s~,ject lot or(lered to ~p~jrade the o!?-.9it~ s~w~r~ this dopartnlent objections to the separation distance of 11I feet. At this time no other alternatives appear fea~ibl~ and in light of past overflo~ing se%,~aij~ problems, the distanc~ of !lt f~t soer~s the moa~ r¢~asonable approach. there are any further qu~stions~ please oontao%; this offi0e at 264~,4720. Sinc~rely~ L~s N. Buohholz~ R,,So Senior Y~nvironm~ntal ~pacialis¢~ 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 Parcel I.D. 015-281-44-000 Expiration Date: Legal description SIEFKER #3 TR 5 LT 10 Site address 3651 E 121 STAVE Anchorage AK 99516 Current property owner(s) METHONEN GAIL 9/7/2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Septic tank was installed without a permit or engineering in 2017 Original Certificate Date: 6/7/2023 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 Approva"une 2022 MUNICIPALITY OF ANCHORAGE AA& - Development Services Department = 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. 015-281-44 Complete legal description SIEFKER S/D; TRACT 5, LOT 10 Location (site address) 3651 EAST 121 ST *ANCHORAGE, AK Current property owner(s) GAIL METHONEN 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 907-350-5872 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units 0 Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 6(?) - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 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 $ S S-0 Waiver Fee $ Date of Payment �l3U/Z3 COSH # ( S �— 2 31 j g Date of Payment Waiver # COSAApplication—June 2022 COSA Checklist Legal Description: SIEFKER #3; TRACT 5, LOT 10 Parcel ID: 015-281-44 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 attac Date drilled Total de ft Well production at time of test ' gpm Water storage tank volume - gallons Cased to ft Well disinfected for coliform test? ❑ Yes IN No ❑ Sanitary seal is fun ' ning correctly Coliform bacteria is Negative ❑ Wires are pro y protected Nitrate 4.54 mg/L ❑ Nitrate less than MRL (ND) Casing hei above ground) in. Arsenic ug/L X Arsenic less than MRL (ND) Date ow test for COSA Collected by FIRST WATER CONSULTING is water level at beginning of test ft. Date 4/11/2023 Comments ALTHOUTH NOT REQUIRE FOR A COSA; IT IS RECOMMENDED THAT THE WELL HEAD AND COMPONENTS BE SERVICED BY A PROFESSIONAL B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping j 0 / 11 1 ) ).- ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1979 X ALL standpipes present per record drawing Total measured depth from grade 11.8 ft (max) Measured depth to pipe invert from grade 4.3 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑■ 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) NO If yes, enter date - C. LIFT STATION ❑ Required maintenance Age of lift station years Lift stati aterial Adequacy test date 5/17/2023 Results Q Pass Fluid depth prior to test 0 in Water added 500 gal New fluid depth 4.5 in Elapsed time 218 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 0 in Effective depth remaining 84 in Comments/Deficiencies:_ FIELD IS INSULATED PER 2017 RECEIPT BY CONTRACTOR (DIRTY DEEDS DIRT WORK) COSA Checklist June 2022 rill 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 > MYes if No ft es if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Se Ic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft olding Tank > 100' ❑Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft s if No ft Manure/Animal Excreta Storage > 100' Community ain > 75' ❑ Yes if No ft ❑ 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' 0 Yes if No ft Surface Water > 100' M Yes if No ft Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑I■ Yes if No ft Private Wells > 100' 5_1 Yes if No ft Water Main > 10' Water Service Line > 10' ❑ Yes if No ft El Yes if No ft Community Wells > 200' [E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS®� —(-Q LA.1-��a-. 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 Garness 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 practices. The reported results describe the condition of the systems 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 systems. 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. COSA Checklist June 2022 T �* A. Garness., ev LICENSEE%, Pr°fess}°n°< #AECC884dO`��d�'�'