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HomeMy WebLinkAboutRUTH CALLAN LT 18B I ' Municipality of Anchorage Page I of -7_ ~P/-~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 34.3-4744 On-Site Wastewater Disposal S~Ystem and/or Well Inspection Report Permit Number: E~uqNoIZ~ PID Number: Name: ~ ~, ~ ~ ~ ~u~ WastewaterSystem: ~New D Upgrade Address: ABSORPTION FIELD ~h~n~:~~.~ ~ ~~[N°'°~dr°°ms: ~ Deep Trench D Shallow Trench ~Bed D Mound ~ Other LEGAL DESCRIPTION so, Rating: ~. ~GPD/Sq. Ft. Total Depth from original, grade: Lot: ~ Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath p~pe /~ ~ ~~ Z,~Ft. ,~ Ft. Tcv:nch~;: ~angs: I Section: Fill added above original grade: Gravel length: WELL: D New C Upgrade Gravel width: Number of lines: Distance be~een lines: /~ Ft. ~ ~'~ Ft. Classification ~A,B,C): ~ Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Ft. Casing Height Ab°ye Or°u;;: TANK SEPARATION DISTANCES ~ Septic D Holding ~S.T.E.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~~ ~ Material: Number of Compadments: Sudace '+ ,+ LIFT STATION Lot Size in gallons: Manufacturer: "Pump on" level at: "Pump off" level at: High water alarm at: Cu~ain Pump Make & Model Electrical Inspections pedormed by: Location and Description: I As*umed Elevation: S & S ENGINEERING 17034 Eagle River Loop Road, No 204 ns~ect ons performed by' E~=~ mv;r.~laska ~ST~ Dates: 1st ~-~-~ Denartment of Health.nd Hum~e~ces approval 72-013 (Rev. 9/91) MOA 25 Permit. No.SW94O1.53 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report _ RUTH CALAN SUBDIVISION, LOT 18B Legal L)escription: PID No.: 05109147 }C02 C03 9.3~ ~Ti& ! r-10o.8' ..................................92.-~II__8'~'. ,' .......... 2000SySTEMS.T.E.p.;;~:i '~' ',:.li~' 92.6' ...................... '; .................... ','"' * ~ ~6~8~ ~,~/!/i ......... ~ .;~'ml~"r~'c'" ~'" >~T ,&~2.8 WATER MT4) 5/10/94i 100' WELL RADIUS GARAGE i f GRAVEL DRIVE EXIST WELL o :02 03 ~ A B F~O 27.5 '14.0 CQi 73.0 72.0 CO2 87.5 86.0 CO3 97.5 98.0 · M,~ 99,0- ,1.00:~ MT1 113.0 119.0 M~2 115.0: 123.C MT3 166.5 172.C Mi4 [ 168.0 171,C NEW DISTRIBUTION N zooo GA[,. -- i S.T.E.P. SYSTEM ! ,i or-- -sB _. Er MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOP~AGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940133 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DOUGLAS LOREN L & MARIAN V OWNER ADDRESS:3230 WESTMAN CO. ANCHORAGE, AK 99508-4336 DATE ISSUED: 5/19/94 EXPIRATION DATE: 5/19/95 PARCEL ID:05109147 LEGAL DESCRIPTION: RUTH CALLAN LT 18B LOT SIZE: 45058 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE BED WIDTH MUST NOT EXCEED 15 FT. THE POINT OF ENTRY INTO THE BED MUST BE AT ~.~POINT OF THE LENGTH OF THE BED. LOREN L. & MARIAN V. DOUGLAS 3230 WESTMAR CIRCLE ANCHORAGE, ALASKA 99508 Ph.: (907) 274-0994 Ph.: (907) 277-61S2 (Message) March 27, 1994 Mr. Ray Sharer S & S Engineering 17034 Eagle River Loop Road Eagle River, Alaska 99577 Re: land Use Pencil DOUGLAS SUNSk~I' ACRES (Lot 18B, Ruth Callm SubcL) Dear Mr. Shafer, This letter is in response to our telephone conversation of Friday, March 25, 1994. There are no plans to include a kitchen in the garage. The garage is intended to be used as a garage and typical miscellaneous storage. The residence that we would like to build next year will have the kitchen. Thank you for your interest and follow-up in our regard. Loren k Douglas DSA #1 < I ,OI om~ re. o oom~ 'dA-18 13SNnS NVqd 3ils 'II&Il ,OI- £14SM ~/'E !a'Ia,0g O-oo SYD ,0~ ~IIJ/1 ,0][ ~]~S2 .~/~ !41q'f,Og '(IA]8 13SNFIS NV'Id tills :::r3¥0S ROBERT SHAFER, P.E. ROGER SHAFER, P.E. March 21, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIl_ TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 MUNICIPALITY OF ANCHORAGE ~NvIRONMENTAI- SERVICES DIVISION , ~,~F, 2 2 1994 RECEIVED REFERENCE: RUTH CALLAN SUBDIVISION, Lot (18B) Rexltte~t yon isau~ a pegtmlt to inatall ct aept,~e a~6~J. .¢~ ,~e. cu~ ~ proposexl four bedroom house on the refotenced propectty. TeSt holeS were excavated and percolation teSts performed. The approximate location of the teSt holes are located on the attached site plan. This property has enough ar~a for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. The owner wishes to develop the existing well located on the referenced property. It is unknown exactly when the w~ll was drilled, there is no well log available. The well was probed and it has been d~termined tha~ the well is approximately 67' deep with 40'+ of 6" well casing. Once power is available to the property a well flow teSt will be performed to determine ~ts production. If you have any questions, or require additional information for your review, please contact us. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~T l~)~)~ 2 4 7 8 9 10 11 13 14 15 16 17 15 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? V~/ PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINi 72-008 (Rev. 4/85} SLOPE SITE PLAN S L iF YES, AT WHAT O DEPTH? , p <1,ol¢ Depth to Water Afterlt~ r '~ · ~.'~,, Monitoring? i: i~J4~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop '. '/o G,,,,-, ~," / 3;o0 ~ I PERCOLATION RATE '-~ (minutes/inch) PERC HOLE DIAMETER ~ TEST RUN BETWEEN~D ~P FT ENGINEERING  ERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: ENGtNEER'S LEGALDESCRIPTION:~T I~(~--'~> ~~wnship, Range, Section: SLOPE SITE PLAN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- YES, AT WHAT OL IF ' I~o~ilod~§? ;' '...Iv', ~I~: Gross Net Depth to Net Reading Date Time Time Water Drop I : - " PERCOLATION RATE ~ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ND ~'~ FI OOMMENTS X.L /  ¢~F/ON THIS DATE. DATE: $ & $ ENGINEERING ~7G$4 Eagle ~Jver Loop Road PERFORMED B~.a~le River AI=.L-. 99577 I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE 72-008 (Rev. 4/85) CERTIFY THAT THiS TEST WAS PERFORMED IN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. (]N-SIT~ WA~A'~A'£~ DISPOSAL O0~STRUC~ION PRACTICES MATERIAL SPMCIFICATIC~S CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLA'f[ON TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN RUTH CALLAN SUBDIVISON, LOT (18B) The scope of this project includes the installation of a 1500 gallon septic tank and two five foot wide drainfields to serve the proposed four bedroom residence for the referenced property. e Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. bl~l~IC ~ INSTALSATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORF~ION TRMICH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. e Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Se Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MA'£~w~AL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Page Three Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the 9200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPf~C~IONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 0 The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Page Four Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER EAGLE ELECTRIC INC. EAGLE ELECTRIC INCORPORATED June 2'~ S&S E Bob S~ · re: Lo1 The fc appro~ the wi termin If t_her, Todd ] Presid Constr~ 1995; gineer3ng haffer: ',n DoUglas residence lowing is to 9erify that the lift station wiring completed at lot 18B Ruth Callan Sub. on matelj March of 1995 was installed per the National Electrical Code specifications. All of ing rah underground was completed by others. The Junction box and control box was [ . led by Eagl,e Electric Incorporated. ~, are ariy further questions regarding the above, please feel at ease t6 contact me. touston mt ELECTRICAL CONTRACTING :tion · i Ma.intenance "Remodels · Code Upgrade ' Sta{ewide Se~ice · Licensed, Bonded and Insurec 7721Sch~o~n Street, Suite I · Anchorage, Alaska 99518-3038 · (907) 344-7121 ~ FAX (907) 344-0827 P.O. Box 871632 · Wasilla, Alaska 99687-1632 ° (907) 373-68~1 P.O1 00¢ ¢o. SULLIVAN WATER WELL P.O. BOX 670272, CHUGIAK, ALASKA9956? * TELEPHONE 688-2;'59 OWNER OF LAN~ Z ADDRESS DATE - Started Ended STATIC LEVEL OF WATER GALS, PER HR ,., KIND OF CAGING KIND OF FORMATION: From.~) F, to From._o~. Ft. Ptom._.~ Ft. From_t~ Ft. From ~ From~FL tO ~ Ft ~ FrOth ~ From EL to. Ft. From.~ From.~Ft. to~Ft.~ From From ~Ft. to ~Ft_ ~ From.~ From .F,. (o Ft. ~g/'~~Fr°m~Ft' to~ From ~Fi- (o --Ft ~ FL to dUI ~ 7 .From ~t. ~o From__,Ft. to__.Ft. ~ ~-u MtSCL INFORMATION: PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW950136 DESIGN ENGINEER:GILFILIAN ENGINEERS, INC. OWNER NAME:DOUGLAS LOREN L & MARIAN V OWNER ADDRESS:20935 SUNSET BLVD CHUGIAK,AK. 99567 DATE ISSUED: 6/29/95 EXPIRATION DATE: 6/29/96 PARCEL ID:05109147 LEGAL DESCRIPTION: RUTH CALLAN LT 18B LOT SIZE: 45058 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY:~ DATE: DATE: 1" : 50' 8CALE 50'BLM R/W ESMT 10' UTIL SITE PLAN SUNSET BLVD. I I I I ~,, 10' 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. 051-091-47 Expiration Date: q-3– Z V Z2- 1. GENERAL INFORMATION Complete legal description Ruth Callan Lot 18B Location (site address) 20935 Sunset Blvd, Chugiak, AK 99567 Current property owner(s)William H Sparrow Day phone (907)830-9278 Mailing address PO Box 671171, Chugiak, AK 99567 Real estate agent Oianointo Paoletti 2. TYPE OF DWELLING: ❑O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone ,9071414-0946 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑■ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -5-S0 Waiver Fee $ Date of Payment Date of Payment Receipt Number, Q1 6Z9 D Receipt Number COSA # (1 7, 1 Z % Waiver # 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. M. J. Date 12/30/21 6. DSD SIGNATURE System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved OF AC­kk�i1 ,rte.• •;9 {i *: 49 TH • * 9 . � r__41 Benjarr'rySchiller CE 12592 12/30/21 , �� pROFESSOk" Conditional approval for bedrooms, with the following stipulations: \�\s V\ -yam%i g ON-SITE By:(C", Original Certificate Date: /r3 - 2–OZ-7— The OZZ 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 X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other 91�_ Legal Description: Ruth Callan, Lot 18B If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 9 Well log is filed with Onsite (or attached) Date drilled 8/1995 Total depth 64 ft Cased to 64 ft Q Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 11/30/21 Parcel ID: 051-091-47 Structure served by this system Well production at time of test 1.6 gpm Water storage tank volume 3000 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L 0 Nitrate less than MRL (ND) Arsenic 22.8 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 11/30/21** Static water level at beginning of test 24 ft. Comments "Well and storage tank disinfected and new sample taken 12/29/21. B. TANK DATA Age of tank(s) 27 years Tank type/material Steel/S.T.E.P Measured operating fluid level in septic tank 50 ®❑ Standpipes/foundation.cleanout per record drawing Date of pumping JRs Septic 12/13/21 D. ABSORPTION FIELD DATA Absorption Bed Which system tested (date installed) 8/4/1994 0 ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station 27 years Lift station material Steel Comments: A+ Home Services 12/8/21 Adequacy test date 11/29/21 Results Q Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 812 gal New depth 0 in Elapsed time 1440 min fim� Code -required soil cover over field Final fluid depth 0 in Q System presoaked Absorption rate '750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 1054 gallons If yes, enter date Comments/Deficiencies:, 15(Width) x 62.5(Lenglh) x .5(Depth) = 468.75cu ft (468.75 x .3(Volume of Gravel) = 140.6225 1140.6225 x 7.4(Fluid Gallons) =-1052Gal COSA Checklist yellow sheet 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' ✓Q Yes if No ft M Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' 7✓ Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'✓Q Animal Containment > 50' Yes if No ft ED Yes if No ft ✓� Yes if No ft Water Service Line > 10' R✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' �✓ Yes if No ft —❑✓ 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' Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' ✓� Yes if No ft Water Service Line > 10' R✓ 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'�]✓ Yes if No ft If absorption field is under driveway comment below Property Line >.10'✓Q Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓0 Yes if No ft . Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION AW 1 certify that l have determined through field inspections and review �'fiy •' -9 of Municipal records that the above systems are in conformance with ; t TH MOA COSA guidelines in effect on this date. r • • ' Ben'a •' chiller • • • •, �¢� '"c�,•. CE 259212/30/21 pROfESS1©Nt`�"�.®�® COSA Checklist yellow sheet ��,�.���.d�"®' ANCHORAGE µ -y 1 Development Servicer Department 4 r � � t €� �..» Phone: 90,7 -34 ti -79,04 On -Site Water & Wast, °water Section Fax: 907 -3.V -79G Litt StabordPump Vault tt> Maintenance Log StreetAddress Phone. _ Legal Desc_� -Sludge level 44 inc Les, -Pumping,, requires -Pumping completed Ver t .. Lift salon; -Pu, mp basket cleaned - ft uant filter cleaned -:zntr cel #ants cleaner= -Primer goat sttinsnlat rc xl -Operation shit" ctor -Deli ated electrical a arm circuit� o -Audible arta visual alarm inside dwelling -Alarm system operatic M� `�d 4 C' not -..5 #i�I c Manhole Ris-or -Ground water intrusrc i at riser to tank, conn cn .Ground water intra issi, i around pipe penetrations -Maritc�l lid_ l* uncti )r�al Insulated Properly Secured' -All manufacturer regv:red inspections and maintenance cot-t-tpleted ye� It comms Technician iia ''l � Crate of maintenanc I_ ;A if companyA"-f- 4CtA1,L `X Signature www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC211741 Subdivision: Ruth Callan, Lot 18B A kvater sample revealed an arsenic concentration of 22.8 micrograms per liter (ug/L). The Environmental. Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells, information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 211741 Subdivision: Ruth Callan Lot 18B 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for - this property is 2-17 years old.. Typical replacement cost for a _)TEP tank could range from $11,000 to $14,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 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