HomeMy WebLinkAboutMEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 11Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211355 PID Number: 051-531-16
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
DANIEL HENEGAR C/O ARM SEPTIC SERVICES, LLC
AORPTION FIELD
❑ De Trench El Trench E] Bed ound
Site Address
25221 HOMESTEAD ROAD, CHUGIAK, AK 99567
Other
Phone
Number of Bedrooms
Soil RatingTotal
depth f original grade
688-9433
3
/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from origi
EXISTINGel
Z I L. N, T
depth beneath pipe
Ft.
Subdivision Block Lot
MEADOW RIDGE ESTATES NORTH 6 11
Fill added above original gr
Ft.
JGr I length
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 orption area
Number of trenches
Dist. between t ches
From
Tank
Field
Tank
Line
Ftz
-
-
Well
COMM.
EXIST.
-
_
_
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
INFILTRATOR
Capacity
1060 Gal.
Surface Water
1001+
EXIST.
-
_
Material
PLASTIC
Number of compartments
2
Lot Line
*Q'
EXIST.
-
-
NA
Foundation
10'
EXIST.
-
_
L AT10N
Manufacturer
Capacity
Remarks *LOT LINE WAIVER GRANTED (WR# OSV211058)
Gal.
ROW ENCROACHMENT PERMIT GRANTED.
Alarm. location lElectri
i alled by
PIPE MATERIAL House to tank Tank to
D3034 drainfield D3034
Installer
ARM SEPTIC SERVICES, LLC
Drainfield EXIST. CO/MTD3034
Inspector GEG CONSULTANT, JODY MAUS
BENCH MARK (Assumed elevation) 100.00 ft
Inspection151 8/25/2021 -
Location and description
dates: 2
DOOR THESHOLD
3'd _ 4,h _
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's §1tamp
Qo6�o� O
Conditional Approval: Date
TH
�.......�. .........
Q ,
Septic System
J re y A. Gorness:'
Q
lE 7 53
Approve- Date
_
`cQQO
F d
eo'
Note: this approval does not include well permit requirements.
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#AEcc ��obo
(Rev 05/02/18)
0A
PERMIT NUMBER:n / PARCEL ID NUMBER:
OSP211355 RECORD DRAWING 051-531-16
8
LU+ ( 17.8 1 43.8
C Z 30.9 69.6
MTI 1 30.7 69.2
Ye r 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.
WATER MAIN NOTE: AN AS -BUILT DRAWING OF THE WATER MAIN LOCATION WAS PROVIDED TO GEG BY
THE ADEC DRINKING WATER PROGRAM. THE WATER MAIN LOCATION WAS SHOWN ON THIS DRAWING IS
BASED ON THIS DRAWING; HOWEVER, THE AS -BUILT DRAWING IS OF POOR QUALITY. EVEN IF STANDARD
PRACTICE WAS USED FOR THIS INSTALLATION, WHICH IS 10 -FOOT OFFSET FROM CENTERLINE, IT
WOULD APPEAR THAT THERE IS 10+ FOOT SEPARATION FROM THE WATER MAIN TO THE DRAINFIELD.
NOTE: THE OLD TANK WAS
PUMPED, EXCAVATED,
REMOVED AND DISPOSED
OFFSITE PER CONTRACTOR.
1"=30'
4 FOOT WAIVER
EXISTING
3 -BEDROOM
.HOUSE
INSTALLED
DOUBLE
CLEANOUTS
(DBL3 8
j
OeQ /
INSTALLEV /
DOUBLE PQ /
CLEAVUTS
(DBLj,& DBL2)
R
WATER SERVICE LINE
LOCATION PER NUS LOCATES.
EDGES OF PAVEMENT
APPROXIMATE LOCATION OF WATER
MAIN LOCATION PER RECORD
DRAWING SUPPLIED BY ADEC
ELECTRIC L LINE LOCATE
(APP X. LOCATION)
NEW 1060 GALLON
INFILTRATOR PLASTIC
SEPTIC TANK.
EXISTING DRAINFIELD. PASSED
ADEQUACY TEST ON 6/18/2021.
NEW CLEANOUT AND 2" STEEL
MONITORING TUBE INSTALLED.
/ NOTE: CO2 TO WATER SERVICE
s / LINE LOCATE WAS T-9" ON 8/30/21
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9........ ..............:
ENGINEERING =SALES ,CONSULTING '0
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE. ALASKA' PHONE (907)337-6179' WEBSITE: www.garnessengincering.rom
„•• ., ,
PREPARED FOR: DANIEL HENEGAR PHONE NUMBER: PAGE NUMBER: ,®� % .eye G mess.:' �,►
C/O ARM SEPTIC SERVICES, LLC 688-9433 2 OF 3 �� J,'• r CE�5*3 •;' �:
AV
PROJECT/LEGAL DESCRIPTION: DRAWN BY: �I �F • �� •
MEADOW RIDGE ESTATES NORTH; BLOCK 6, LOT 11 J.L.M. �1B Fp p' ••...,. •••''•P�, ��
TYPE OF WORK: DATE: LICENSE o, e 1!lOS0d*1 's
RECORD DRAWING OF SEPTIC TANK UPGRADE 8/30/2021 #AECC884
g1clf,2a
PERMIT NUMBER;R RECORD Q R D D RA � J I N G PARCEL 10 NUMBER:
OS P211355 V V 051-531-16
TOP OF TANK @
INLET= 94.61 -
TOP OF MANHOLE
LID = 99.21
FINAL GRADE
= 98.57-98.60
ST1
-2" OF INSULATION
(PER CONTRACTOR)
TOP OF TANK @
OUTLET = 94.55
INVERT OF PIPECad / ` (I !I f j_j,
INLET = 94.07
1060 2 -COMPARTMENT INVERT OF PIPE @
INFILTRATOR SEPTIC TANK OUTLET = 93.79
10N 'witulklmiqx t
nT Tp
ENGINEERING SALES CONSULTING 0 0
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, ALASKA' PHONE (907) 337-6179' WEBSITE: www.gamessangineenng.com ®•*• . s.+ ...........� ..... .
PREPARED FOR: DANIEL HENEGAR PHONE NUMBER: PAGE NUMBER: ®tom•%, S�fff@, ,A-GBf'Y1�SS wAr
C/O ARM SEPTIC SERVICES, LLC 688-9433 3 OF 3®�� (� C 79 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY: ��••. �j�� ( �•:•'����®
MEADOW RIDGE ESTATES NORTH; BLOCK 6, LOT 11 J.L.M. ®.......
�•''••� �®
TYPE OF WORK: DATE: LICENSE®4t, FESS\ �.
RECORD DRAWING OF SEPTIC TANK UPGRADE 8/30/2021 #AECC684 �lk us®'w
N
rA )
Scale 1" = 25'
, AL�
LOT9
DE', Electric Meter 0 Concrete
L
LT, Tel. Pedestal I;;i Septic Cover
A
LE % Elec. Pedestal
(S; Septic
Gas Meter
Deck
LOT 24
BLOCK 3
TONJESS ESTATES
PLAT #82-59
1. Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft.
2. This document is created by Frontier Surveys for the purpose of an
as -built survey for ARM Septic Services, only.
3. This document is based on Plat No. 74-133, Anchorage Recording
District.
Disclaimer
1. 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.
NOTE.
1. SUBJECT PROPERTY IS
SERVED BY COMMUNITY WELL.
2. D.E.C. RECORDS INDICATE
ACCEPTANCE OF SEPTIC
SYSTEM WITHIN R.O.W.
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2/8/2021
i
RIO 110FfSSIONA4
AN AS -BUILT SURVEY OF
LOT 11, BLOCK 6
MEADOW RIDGE ESTATES SUBD. NORTH ADDN.
25221 HOMESTEAD ROAD
CONTAINING: 20,056 Sq. Ft. i/- (RECORD)
RECORD PLAT: 74-133
FRONTIER SURVEYS, LLC
650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518
DRAWN BY: IS I DATE: 08130/2021 I DRAWING ID: 21-429
IE2IE613-461 L-4BU'/-91U3-FL) i8L)19463713
POST IN A CONSPICUOUS PLACE
ALL WORK MUST BE INSPECTED
Field Inspection Request required 2 working days in advance of starting work and 2 working
days in advance for final inspeciton. Call (907) 343-8206 (voice recorder) for scheduling.
Permit is not valid without the call-in and also must include the one -call ticket (utility locate)
number.
t-
�
MUNICIPALITY OF ANCHORAGE - RIGHT OF WAY DIVISION 1-� Tett i' i311 C. t1 t
4700 ELMORE ROAD
TELEPHONE (907) 343-8240 EMAIL: moarowrequests@muni.org
RIGHT OF WAY PERMIT 8212222
Type: Encrchmnt Status: Issued Grid: NW1462
Date Applied: 09/13/2021 Date Issued: 09/13/2021 Issued By: claudia.pinard
Construction Start Date: Last Updated: 09/14/2021 Last Updated By: claudia.pinard
Permittee: HENEGAR DANIEL N
Work Order:
Utility:
Contact Person: Daniel Henegar/ Sonya 337-6179 Primary Inspector: Jon Sauerbrey
Address/Loc: 25221 HOMESTEAD RD, Chugiak - @ Meadow Lake Drive.
Legal Description: MEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 11 G:1462
Original Work
Description: Septic pipes and holding tank encroach 7' into the 60' Homestead Road ROW, holding tank encroaches 5' into
the 10' Utility Easement, and deck encroaches 2' into the 10' Utility Easement.
Summarized Financial Transactions
Fee Description
Permit
Quantity Amount
1 $120.00
Total Fees: $120.00
See reverse for requirements/remarks.
I have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will comply with federal, state,
and municipal codes and regulations and the provisions of this permit.
Signature: 'ba�- L'"�ta.r Date: 09-16-2021
uig»ign v eruiea: i rz i r -o i )-4o,r r_ -4n _ I-vr k_.3-run6u i y4oJ / o
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MUNICIPALITY OF ANCHORAGE 6"N '12
:�
m Development Services Department
Right of Way Section e3 �
Department
THIS AGREEMENT, made this 13th day of September, 2021, by and between DANIEL N.
HENEGAR and his heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the
Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the
laws of the State of Alaska, hereinafter called the "PERMITTER".
WITNESSETH:
WHEREAS, PERMITTEE is the owner of the following described real property:
MEADOW RIDGE ESTATES NORTH ADD, BLOCK 6, LOT 11, according to the
official records thereof, on file in the office of the District Recorder, Anchorage
Recording District, Alaska, and;
WHEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows:
The SIXTY FOOT RIGHT OF WAY OF HOMESTEAD ROAD AND THE TEN
FOOT UTILITY EASEMENT, immediately on the southeast side of PERMITTEES
property as shown on Plat No. 74-133, on file in the office of the District Recorder,
Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTEE has placed a septic pipes and holding tank upon the referenced real
property which encroaches 7.0 feet upon the PERMITTER'S 60.0 -foot Right of Way, a holding tank
which encroaches 5.0 feet and a deck upon the referenced real property which encroaches 2.0 feet upon
the PERMITTER'S 10.0 -foot Utility Easement.
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
The PERMITTER, acting through the Director of Development Services
Department, hereby grants to the PERMITTEE the privilege of allowing septic
pipes and holding tank to encroach 7.0 feet upon the PERMITTER'S 60.0 -foot
Right of Way, a holding tank to encroach 5.0 feet and a deck to encroach 2.0 feet
upon the PERMITTER's 10.0 -foot Utility Easement as shown on "Attachment
A," included herewith.
2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless,
the Municipality, its officers and employees, from any and all lawsuits, claims or
actions brought to any person for or on account of damage to property or injury,
d'i'sease, illness or death of persons, including all costs and expenses incident
thereto, arising wholly or in part from or in connection with the existence of,
alterations, maintenance, repair, renewal, reconstruction, operation, use or
removal of the encroaching septic pipes and holding tank, as placed upon the
PERMITTEWS 60.0 foot Right of Way and a holding tank and deck, as placed
upon the PERMITTER'S 10.0 -foot Utility Easement
DigiSign Verified: IE21E613-461'E-4BC7-9FC3-FDB8D1.94637B
3. The PERMITTEE shall not assign or transfer any of the rights granted herein to
another individual or company without first notifying and securing the approval
of the Director of Development Services Department.
4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S
real property whatsoever, except only the encroachment rights described herein.
5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days
written notice to the PERMITTEE. The PERMITTEE agrees upon such notice
of revocation, to move said encroachment(s) from the 60.0 -foot Right of Way
and/or 10.0 Utility Easement in which it is placed. Should the PERMITTEE
refuse or fail to comply with said written notice, the PERMITTER may, without
further notice to the PERMITTEE, remove or cause to be removed the
encroachment(s), and the PERMITTEE hereby agrees to reimburse the
PERMITTER for all costs incidental to the removal thereof.
In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a
one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of
$315.00.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day
and year first hereinabove written.
GRANTEE:
GRANTOR: MUNICIPALITY OF ANCHORAGE
September 14, 2021
Daniel N. Henegar Jacic L. Frost, Jr.
Owner Right of Way Supervisor
. MUNICIPALITY OF ANCHORAGE
On -Site Water& Wastewater Program
POBox 1B0Gsu 47QnElmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
C''1583INVI IF 111111, iiij
De pa rtmne-11r
Permit Number: OSP211365 Effective Date: 8124/2021
Work Type: SepdoTonkUpgrade Expiration Date: 8C24/2022
Tax Code Number: 05153118000
Site Legal Address: MEADOW RIDGE ESTATES NORTH ADD BLK 6 L 11 G:1482
Site Mailing Address: 25221 HOMESTEAD RD, Chugiak
Owner: HENEGARDANIEL N Lot Size inSqFt: 20056
Design Engineer: GARNESSENGINEERING GROUP LTD Total Bedrooms: 3
This permit imfor the construction of:
E1 Disposal Field 2 Septic Tank El Holding Tank 11 Privy El Private Well Water Storage
All construction shall beinaccordance 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 (18AAC73)and Drinking Water Regulations (18AAC8U)
3. The wastewater code requires inspections during the installation, The engineer shall notify the Development
Services 15.u5.Provide notification bycalling (9U7)543 -79O4(24/7).
4 From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall baeither:
a. Opened and Closed onthe same day, or
b. Covered, sealed, and heated koprevent freezing
25
Special Provisions:
Rp 1) A Right -of -Way Use permit is required prior (nany work being done within the right ofway.
Right -of -Way Encroachment permit is required for the system located in the utility easement and right -of -
copy ofthe encroachment permit shall beprovided toclose out this permit.
Received By:
MMNZ4.7,AI 011 WAFM ME
> �� ),_ / /�_
/
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development e ices Department
On -Site Water and Wastewater Section
went S
I)eparnucnt
?ICY. K xAT/
Waiver#: OSV211058 COSA#: Permit#:OSP211355
PID#: 051-531-16
Legal Description: Meadow Ridge Estates North Add Block 6 Lot 11
Engineer: Garness Engineering Group
Applicant: Daniel Henegar
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the water service line has been approved. The approved separation distance is 4.0 feet. In
addition; your request for a waiver of the required 5 feet horizontal separation from the septic
tank to the southeast property line has been approved. The approved separation distance is 0.0
feet. See engineer's waiver request for justifications. If at any time it is believed that the reduced
separation between the water service line and absorption field is a contamination risk to the
community water system, this waiver is void and the encroachment will need to be addressed.
This waiver approval applies to the existing absorption Meld and proposed septic tank only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
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Waiver is Granted: X Waiver is not Granted:
Date: �S o2 ��L.2 0 2 t Approved by: &a
Name of Reviewer
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EVAN �.IN 11 Aia
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Parcel I.D. 051-531-16
ANCHORAGE
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) DANIEL HENEGAR - C/O ARM SEPTIC SERVICES Day phone 688-9433
Mailing address 25221 HOMESTEAD ROAD, CHUGIAK, AK 99567
LJr1AAC0-rCAn or�Arn r'UI I1�IAII A nnca.-7
Site address
GJ LL I 11\JIVIL%J I L/"uU I\l/!1U '�[ miNo r,Lr\ r -%f\ J:JJV1
Legal description (Sub'd., Block & Lot) MEADOW RIDGE ESTATES NORTH; BLOCK 6, LOT 11
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)
...::,.;.aZ,�''r��----a,�S^ '�"eC'x::�'�::s-", •.��:'TL'�....��as.�,5�'.?w'�
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Development Services Department
Single Family (SF) 0
On -Site Water e Wastewater Section
Parcel I.D. 051-531-16
ANCHORAGE
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) DANIEL HENEGAR - C/O ARM SEPTIC SERVICES Day phone 688-9433
Mailing address 25221 HOMESTEAD ROAD, CHUGIAK, AK 99567
LJr1AAC0-rCAn or�Arn r'UI I1�IAII A nnca.-7
Site address
GJ LL I 11\JIVIL%J I L/"uU I\l/!1U '�[ miNo r,Lr\ r -%f\ J:JJV1
Legal description (Sub'd., Block & Lot) MEADOW RIDGE ESTATES NORTH; BLOCK 6, LOT 11
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) 0
(w/wo ADU)
Septic Tank
0
Upgrade M
(D) ❑
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
11-:....1.. \ A 1-11
Alva e vv�Ii
r�
U
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
DRAINFIELD TO WATER SERVICE LINE
Distance: 4'
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner
rized
Permit/Rush Fees: G),2 5t 13 6 Waiver Fees: t
Date of Payment: O40 40 a 1 Date of Payment:
jn
Receipt Number: 0 � L4 q (o Receipt Number:
Permit No. S P �,1 1355 Waiver No. 05V 2 A 105
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP' 11355Rebecca Carroll, 08/24/21
Quanics,
GARNESS ENGINEERING Ltd r .
ENGINEERING SALES CONSULTING GROUP, " .. Alaska Authorized Dealer
August 24, 2021
Municipality of Anchorage
Development Services
On -Site Water & Wastewater Program
4700 Elmore Roade
Anchorage, Alaska 99507
Phone: (907) 343-7904
Reference: Septic Tank Upgrade for Meadow Ridge Estates North; Block 6, Lot 11
To whom it may concern:
The 3 -bedroom house on the referenced property is served by the "Unified Alaskan Utilities —
Homestead (formerly Dawn Water) community water system and a private septic system. Per
MOA records, septic system consists of a 1000 -gallon steel septic tank a deep trench type
drainfield that were installed in 1983. The drainfield has recently passed a septic adequacy test
on 6/18/2021; however, the septic tank is over 38 years old. Instead of trying to verify the
integrity of the old septic tank, it will be replaced. We are proposing that a new 1000 -gallon, 2 -
compartment Greer plastic septic tank or Infiltrator IM -1060 plastic septic tank be installed, and
the old septic tank permanently decommissioned. We request a septic tank upgrade permit be
issued.
It should be noted that the existing septic tank and drainfield encroach on the MOA right-of-way
for Homestead Road. Letters of non -objection from the MOA Right of Way Department and the
utility companies were issued in 2004 for this encroachment. We are proposing the new tank be
installed in the near the same location as the existing tank. New letters of non -objections from
the utility companies have been issued and a ROW encroachment permit should be issued
shortly.
It should also be noted that the existing community water main location is unknown. Northern
Utility Services (NUS) has attempted to locate this water main and has been unsuccessful (see
attached statement). We contacted Roy Robertson with the ADEC Drinking Water Program and
he provided us an as -built drawing (poor quality) of the water main. Based upon this drawing,
the water main is approximately located on the centerline of the ROW. Standard practice would
be for the water main to be constructed 10 feet off the centerline. If that is the case, there should
be 10 -foot plus separation between the water main and the drainfield and the proposed septic
tank. Attached is our correspondence with Roy Robertson for your review.
Water Service Line to Drainfield Waiver Request: NUS has located the water service line
that serves this house and we have shown the location on the design. The existing sump (at the
end of the drainfield) is approximately 6 feet from the water service line locate mark. UPC only
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com 0 - �?
Page 2 of 2
requires 5 -foot separation; however, we are requesting a 4 -foot waiver from the water service
line to existing drainfield to account for the trench width. Justification for this waiver is as follows:
• It is that it is believed that the water service line is comprised of copper. We observed
that it the water line entering the house is made of copper. Given the likelihood the
entire water service line is made of copper, it is reasonable to believe that the service
line is not compromised.
• We recently performed a septic adequacy on the 38 -year-old drainfield. Based upon our
testing data, there is good absorption in the drainfield which indicates the soil must be
porous, allowing for rapid downward migration of effluent and moderate lateral
migration.
• We are only requesting a 1 -foot variance to the UPC code.
Based upon these factors, there appears to be minimal risk with granting this waiver.
Lot Line Waiver to New Septic Tank: We request a 0 -foot lot line waiver from the southeast lot
line to the new septic tank. We have already addressed that the existing tank was off property,
but the new tank will mostly if not completely be on property as designed. The new septic tank
will be in the utility easement and letters of non -objection have already been issued for this
upgrade. We are unaware of any adverse effects on adjacent properties with this installation.
Please do not h sitate to call us at 337-6179 if you require further information. Thank you for
your assistance,!
Sincere
s, P/E., M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211355, Rebecca Carroll, 08/24/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211355, Rebecca Carroll, 08/24/21
Jeff Garness
From: Robertson, Roy A (DEC) <roy.robertson@alaska.gov>
Sent: Thursday, August 19, 2021 10:22 AM
To: Jeff Garness; Jody Maus
Subject: RE: Question regarding Unified Alaskan - Homestead Division CWS (formerly Dawn
water system) water main to septic system
Jeff,
I am sorry for the delay. You are correct, if the water main is 10 -ft or greater from the drain field system then it meets
the ADEC Drinking water regulations 18 AAC 80 and no wavier is required. I will defer to your engineering judgment and
your determination whether this system has the required 10 -ft of separation. The DEC drinking water program doesn't
regulate the water service lines, and that would be covered by the muni/our wastewater program/the UPC. When
making a determination on the separation between the aging water service connection and the drain field you should
keep in mind that this system has had pressure and coliform problems in the past and that pressure losses can allow
contamination around the water service to infiltrate. This email is not an approval and does not imply the granting of
any authorizations or waivers.
-Roy Robertson
From: Jeff Garness <Jeff@garnessengineering.com>
Sent: Thursday, August 19, 20218:53 AM
To: Robertson, Roy A (DEC) <roy.robertson@alaska.gov>; jody <jody@garnessengineering.com>
Subject: FW: Question regarding Unified Alaskan - Homestead Division CWS (formerly Dawn water system) water main
to septic system
Roy, I did not see a response from you yet. Can you respond so we can proceed with applying for the MOA permit.
Thanks .......................jeff
From: Jeff Garness
Sent: Monday, August 16, 202111:17 AM
To: 'Robertson, Roy A (DEC)' <roy.rohertsonPalaska.gov>
Cc: Jody Maus <J dILl-,°,arnessengineering.com>
Subject: Question regarding Unified Alaskan - Homestead Division CWS (formerly Dawn water system) water main to
septic system
Roy,
Thank you for sending us the as -built drawing of the water main for the subject water system. Attached is a draft of our
design drawing (revised 8/16/21) which shows the assumed location of the water main, If this assumption is correct,
there appears to be 10+ foot separation between the water main and the existing drainfield serving Lot 11, Block 6,
Meadow Ridge Estates North. Short of excavating/exposing the main (which could compromise it), I see no other path
forward other than to assume that the water main is 10 feet from the road center line. It is also my understanding that
the water service line is not regulated by ADEC's drinking water regulations, so the MOA Onsite Department has the
authority to issue any waiver associated with the separation distance between the water service line and the
N(,ORTH ERN
UTILITY SERVICES
P.O. Box 233368 Anchorage, AK 99523 Phone: (907) 222-4084 1nfo,,,0NusA1aska.corn Web, NusAlaska.corn
Monday August 2nd, 2021
Jana Littlewood
Anchorage Well & Pump
7640 King St
Anchorage, AK 99518
25221 Homestead Rd, Water Main Locate Report
Dear Jana,
Per your request, I attempted to complete the 811 locate ticket for the water main in front of 25221 Homestead
Rd. Due to the lack of available keyboxes, valves, hydrants or similar connection points to the distribution
system near the requested locate ticket location, my only available method for connecting our line locating
equipment was using the exterior hose spigots on the nearby homes. This lack of connection point options in
addition to the maze of communication, electric, and gas lines which my
locator wanted ed t . 0 PICK up much easier
than the water line made it impossible to determine the location of the water main.
It is possible that with several hours more effort and some as -built drawings in hand, the water main could be
located, however we can't guarantee that getting a good locate is possible in this location.
Sincerely,
Daniel Kranich
Northem Utility Services
agnelgoL
L _L _
(907) 242-9820
MATANUSKA ELECTRIC ASSOCIATION, INC.
LETTER OF NON -OBJECTION
August 19, 2021
Daniel Henegar
25221 Homestead Road
Chugiak, AK 99567
Re: Lot 11 Block 6 Meadow Ridge Estates Subdivision North (Plat 74-133, Anchorage Recording District)
Dear Daniel Henegar:
MEA has no objection to the encroachment of a septic tank and drainfield located in the utility easement as
depicted on the attached as -built survey drawing dated August 18, 2021, subject to the following conditions:
1. The improvement will in no way restrict or limit the current or future ability of MER to fully enjoy the
benefits of the easement for any and all utility purposes that it presently enjoys under the easement.
2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any
person or property that may result from the existing and future use of the easement by MEA, its
contractors, or assigns.
3. MEA will be held harmless by the landowner for any and all liability arising out of or relating to any use
of the easement by others under a Letter of Non -Objection.
4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the
easement.
5. The landowner will be responsible for any special construction costs incurred by MEA due to the
improvement in the easement.
6. The landowner will assure compliance with all applicable safety codes relating to the improvement in
the easement.
7. Use of this letter by the landowner, their successors or assigns will constitute acceptance of these
conditions.
8. Alteration of these conditions shall invalidate this letter.
9. This letter is not effective unless it is recorded in the Palmer Recording District before ownership of the
referenced property is changed from the above named landowner.
Sincerely,, '
Land
STATE OF
THIS IS TO CERTIFY that on this 19 day of August, 2021 before me, the undersigned, a Notary Public in
and for the State of Alaska, duly commissioned and sworn as such, personally appeared
Manny Lopez
Known to me and to me known to be the individual(s) named in and who executed the foregoing instrument
and acknowledged to me that helshe/they signed and sealed the same as a voluntary act and deed for the
uses and purposes therein mentioned.
INWITNES 'REOF, I have hereunto set my hand and official seal the day and year first above written
SEua«..,vU�
Notary Public in and of Alaska My commission expiresFri
�pg-',z
Return to: MEA, PO Box 2929, Palmer, AK 99645 f j
k».,• OF'pL
DocuSign Envelope ID: AB3D4866-31DE-4597-A5D0-C56CC8EE175E
August 4, 2021
25221 Homestead Road
Chugiak, AK 99567
To whom it may concern,
Subject to your agreement to indemnify the company as set forth below, GCI
Communication Corp has no objection to the tank and drainfield encroaching into
the utility easement and right of way of Meadow Ridge Estates North Add. 86
L11, also known as 25221 Homestead Road, city grid NW1462, GCI WO# 21-
0340-22.
This letter of non -objection in no way precludes GCI Communication Corp from
full use and enjoyment of any rights it may have within any portion of the utility
easement and or the right-of-way, including unlimited access for servicing its
facilities. Also, any additional and extraordinary costs incurred during any future
required construction, repair or reconstruction of GCI's facilities to accommodate
any or all the encroachments shall be paid by the property owner.
By signing below, you agree to indemnify and hold GCI Communication Corp
harmless, now and forever, for any damage, costs, expense (including
reasonable attorney's fees), liabilities and injury to any person or property
occurring as a result of the encroachment.
Please indicate your acceptance by signing and returning this letter to me at the
address below.
Sincerely,
ba.k�_Lzg Aekycfa}-
00C ed
Signature
CSI
08-16-2021
t 4EA42871 F7741 C._
Date
MARKUS KOFOID
GCI I Mgr. Sr, Operations & Constuction
907-868-6168
NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT
By this document Matanuska Telecom Association, Inc. (MTA) declares that it has no objection to the existing
encroachment of the septic tank within the utility easement located at Lot L11, Block 6 of Meadow Ridge
Estates Subdivision North Addition, filed as Plat No. 74-133 in the Anchorage Recording District.
Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use
of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace
buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the
encroachment as a result of utility construction will be borne by the property owner of record. This document
does not authorize the placement of any additional encroachments within the easement area. Property owners
are required to obtain utility locates before doing any kind of work in the utility easements and will be liable
for any damages caused by their construction work in the easements.
This document is in no way an agreement to vacate any_portion of the utility easement and should not be
interpreted as such
Issued for Matanuska Telecom Association, Inc. this l Oth day of August 2021 by,
Jessica Burnett, Real Estate & Properties Supervisor
Matanuska Telecom, Association, Inc.
P.O. Box 3550 1 Palmer, Alaska 99645 1 mtasolutions.conr 1907.761.2510
MEMO
Electric Meter Concrete
A
LT� Tel. Pedestal
Elec. Pedestal
Septic
Gas Meter
Deck
General Notes
1. Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft.
2. This document is created by Frontier Surveys for the purpose of an
as -built survey for ARM Septic Services, only.
3. This document is based on Plat No. 74-133, Anchorage Recording
District.
Disclaimer
1. 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.
0 12.5 25 50
Scale in Feet
OF .44 it
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7VA Pierr,- M. Strigier
N8 LS 12
7/8/2021
ti
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I
i~ 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 ,,. IPHONE [ /~NEW
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well ~ Absorption erea~ / Dwelling / PERMIT NO.
DISTANCE TO: ~V~/r~I ~ /b
~<~ Z Manufacturer ~/~ Material~ No. of compartment~
~ M Liq. capacity in gallons Inside length Width Liquid depth
/ ~O IF HOMEMADE:
~ DISTANCE TO: Well ~/~ Dwelling PERMIT NO.
~ ~ ~ Manufacturer~ Matorial ~iquid capacity in flallons
~ DiSTA~C ~ TO: ~~~ell Foundation it ~ ~ ~ ~earest lot h
~~ ~Z No. of lines / LengthO~°~e~h }ina Total lengt~o~,li~s.>_r. Trench width~o.~ inct, es Distance between lines~/~/
~ ~ Top of til~f~ish grade / Material beneath tile Total effective absolBtion area
~ ~ / ~O inches
Width ! Depth PERMIT NO.
Length
~ ~ Type of crib Crib diamet Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth ~riller Distance to lot line PERMIT NO.
~ - Buildin~ ~oundation Sewer line Septic tank : Absorption area(s)
~ DISTANCE TO:
OTHER ,. /~
PIPE MATERIALS
SOIL TEST RATIN~ VC ~ /
INSTALLER
REMARKS
..... ~ ',~,~ ~ /
/,.-z W ,
APPe~VEU///// ~ / DATE LE'GAL ~ ~ ~
72-01: (Rev. 3/78)
MUNi~IFALIIY U~
Department f Health and Environmenta~ ?rotection
825 ~ Street, Anchorage, AK. ~9501
264-4720
//~4 * * * HANDWRITTEN PERMIT * * *
. ON-SITE SEWER PERMIT ~>~ ~ /
:Applicant:~ ~ ~-~"~' Mailing Addres
/
Location: Phone Number: ~.~
Legal Description: ~//~ ~/~f~[~ ~~ ~ Lot Size:
Type of Soil ~sorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tan~~
Maximum N~ber of Bedrooms:~ Soil Rating(sq.ft/br)
The Required Size of the Soil ~sorption System Is: '//
GRAVEL DEPTH --~ WIDTH
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minim~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = ///~ GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that th~ well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will b~ subject to prosBcution.
~inimum distance between a well and any on-si~e sewage disposal system is 100 ~e~t
for ~ private well or 150 to 200 fB~t from a public well de~nding upon the type
of public well. ~inima distance from a privets well to a privat~ sewer line
is 25 feet and to a co.unity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and constr~ction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 1 9 B * * *
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers and wells as
set forth by the Municipality of ~chorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more t~~
Signe~: ~ _~/~ Issued by:
Appli~nt Date: ~/~
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: ~ (~)~-I~
LEGAL DESCRIPTION: ~--'~7" // ~"~',
SLOPE SITE PLAN
10
11
12
13
14
15-
16-
172
18-
19-
2O
COMMENTS
I~ o-tTo,-~n oF
P
E
IF YES, AT WHAT
Gross Net Depth to Net
Reading Date Time Time Water Drop
i ~,~-t-~ ~; ~,¢ pn 8 ~ ........
'2_ l~ :4.~ ~J :~ m ~. / O ~
PERCOLATION RATE '~O (minutes/inch)
CERTIF~~
o~
/
G 8V
• Municipality of Anchorage
U '
On -Site Water and Wastewater Program
(907) 343-7904 s F E T P
Certificate of On -Site Systems Approval
Parcel I.D. 051-531-16
1. GENERAL INFORMATION:
Expiration Date: 12 -1 (a r U"
Complete legal description MEADOW RIDGE ESTATES NORTH ADDITION; BLOCK 6, LOT 11
Location (site address) 25221 HOMESTEAD ROAD, CHUGIAK, AK 99567
Current Property owner(s) DANIEL HENEGAR C/O ARM SEPTIC SRV. Day phone 688-9433
Mailing address 17933 OLD GLENN HIGHWAY, CHUGIAK, AK 99567
Real Estate Agent SWITZER TEAM
Day phone 602-3799
2. TY-PEOF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual
Individual Water Storage ❑
Holding Tank ❑
Community Class A Well ®
Community ❑
Public Water System ❑
Public Sewer ❑
Waiver/Variance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 0�5�
Date of Payment
Receipt Number "t n G
COSA #
Waiver Fee $
Date of Payment
Receipt Number
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.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 I
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 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, G
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 eventeither of the current systems fail to perform adequately in
the future. The content of this report is for_ the sole -benefit of the pe-rsonlparfy that—retained GEG-fo -
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
#AECC884
SERVICES��
w 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
COSA blue sheet 10-10-12.doc
J
)�
ey A. G , ness.- �O
4 ns
CE -79.3 D
c� D
4��(p"
f e s s-10 oma
#AECC884
SERVICES��
w 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
COSA blue sheet 10-10-12.doc
COSA Checklist
Legal Description: MEADOW RIDGE ESTATES NORTH ADDN; BLOCK 6, LOT 11 parcel ID: 051-531-16
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
ELL DATA SERVED BY UNIFIED ALASKAN -HOMESTEAD DIVISION COMMUNITY WATER SYSTEM
❑ Well log d with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for C
Staticwater at beginning of test ft.
C ents
Well production at time of test pm
Water storage tank Volu gallons
Well disinfec r coliform test? ❑ Yes Al No
orm bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Ars'b , _ ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
PWS ID # 211431
----- _-B.-TANK-DATA- __---- .._-_ _._ ____ __-
(
N
_C>station
Age of tank(s) NEW y rs
❑tenance complete
Tank type/material PI`" 'c 7:
AyeMeasured
operating fluid level in septic tank NEWLal0
Standpipes/foundation cleanout per record drawing
C
Date of pumping NEW
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 6/9/83
Adequacy test date 6/19/21
X ALL standpipes present per record drawing
Results [DPass For 3 bedrooms
Total measured depth from grade *13.8 ft (max)
Fluid depth prior to test **0 in
Measured depth to pipe invert from grade *5.9' ft (min)
Water added 1243 gal
❑ N/A - pressurized field
"12.75
New depth In
❑ Monitor tubes go to bottom of effective. If not, state
5
depth into effective *5.8'
Elapsed time min
❑E Code -required soil cover over field
Final fluid depth *0 in
Al System presoaked
Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced `"`16s2 gallons
If yes, enter date N/A
Comments/Deficiencies: 'A NEW 2" STEEL MT WAS INSTALLED AT TIME OF SEPTIC TANK UPGRADE. EFFECTIVE DEPTH WAS SUPPOSED TO BE 120".
A NEW MT DRIVEN TO RESISTANCE. MT EXTENDS 5.8 FEET INTO EFFECTIVE DISCUSSED WITH TIM EKLUND WITH MOA ONSITE DEPARTMENT ON
6/27/21 AND HE STATED THIS WAS ACCEPTABLE. "MEASUREMENTS ARE SHOWN IN OLD SUMP TEST PERFORMED PRIOR TO NEW MT BEING
INSTALLED. BOTTOM OF SUMP WAS APPROX. 2.5 FEET BELOW INVERT. AFTER INTRODUCING THE FIRST 555 GALLONS THE LIQUID DEPTH WAS 12.75'
DEEP, AND REMAINED AT THAT LEVEL THORUGHOUT THE REST OF THE TEST NEW MT INSTALLED ON 8/27/2021 NEW MT FOUND DRY ON 8/30/2021
""'PRESOAK PERFORMED ON 6/18/2021.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES SERVED BY COMMUNITY WATER SYSTEM
rrof4,Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift n Lot > 100' Community Sewer Manhole/ ut > 100'
�` of > Yes if No ft ❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes if No
Absorption Field on Lot > 100' ❑ Yes if No
Neighboring Absorption Field g
U Yes if No
Sewer Main > 75' ❑ Yes if No
ft P • ewer/Septic Line > 25' ❑ Yes
if No ft
Tank > 100' ❑ Yes
if No ft
Animal Containment _ ❑ Yes
if No ft
ft
if No
Manure/Animal Excreta Storage > 10
Wells on Adjacent Lots:
ft ❑ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft
-Nater Service- Line > _10'_____ __ Fv� 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'
❑ Yes
if No
0 ft
Wells on Adjacent Lots:
Water Main > 10'
Rl Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
❑ Yes
if No
4 ft
Community Wells > 200' [] Yes if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS
'WAIVERS GRANTED - SEE WAIVER # OSV211058. RIGHT OF WAY ENCROACHMENT PERMIT FOR TANK AND DRAINFIELD GRANTED.
"WATER MAIN LOCATION DEPICTED ON THE 812021 SEPTIC TANK UPGRADE RECORD DRAWING IS APPROXIMATE AND BASED UPON A POOR
QUALITY RECORD (ASBUILT) DRAWING OF THE WATER SYSTEM SUPPLIED BY ADEC. SEE NOTE ON NEW SEPTIC TANK RECORD DRAWING.
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.
�..
... .... ..............
J fl e13
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3.�
COSA Checklist yellow sheet Pro f e s s�o�°oma
#AECC884