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HomeMy WebLinkAboutHERITAGE HILLS BLK 4 LT 5Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP261180 PID Number: 015-221-31 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JEFFREY & ALLISON KARLIK ABSORPTION FIELD — ADVANTEX FAP 3.0 ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 12301 TRACY ROAD, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 2 GPD/SF 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 6.5 Ft. Subdivision Block Lot HERITAGE HILLS 4 5 Fill added above original grade 1.01 — 1.06 Ft. Gravel length 32 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To' Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Pump Basin; Tank Line 416 Ft2 1 -- Ft. Well 50'+ 50'+ 50'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. I Surface Water 50'+ 1 50'+ 50'+ Material PLASTIC Number of compartments 2 Lot Line 5'+ 5'+ 5'+ NACOMPOSITE Foundation 10'+ 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks DECOMMISSIONED/ REMOVED OLD SEPTIC TANK & INSTALLED NEW AX FAP3 & FIELD W/ DIVERTER. Alarm location Electrical installed by FIRST FLOOR BRICK'S ELECTRIC Installer Smith Co Construction & Equipment Tankto PIPE MATERIAL House to tank 3034 dra nffeld 3034 - --- Drainfield 3034 co/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 7/13/2026 2nd 7/14/26 Location and description 3'd 7/15/26 4'h 7/16/26 TOP OF MANHOLE MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL ..��~�•��t . Conditional Approval: Date �!�Q rr, .......... Septic -S, spm � q�RP Curtis Huffman ���`r6-"j''•.Co 10896,-- Date ----- ��'`��/ <` .... �llF�pROFESSIONP�'�-+ Note: this approval does not include well permit requirements. (Rev 05/02/18) FIRST WATER CONSULTING PID:015-221-31 PERMIT: OSP261180 HERITAGE HILLS BLOCK 4, LOT 5 1"=30' 30' 0 131st AVE 0 0�0 N 8 9 °5 9' 0 0" W 13q'.O-rX"``X--x % � o � 1� • SEPTIC VAULT PIPES (typ) MH • O � O 2Q o w Q 00 X, LOT 5 0 >— 0 �� J U 0 ���0 ° 0 0 <C C< 0 61.1' 0 0 0 2� o, X Z GRAVEL DEW 7. . �' x Q WELL U-) x x N A °5 9X_0", 0-____ fig : ��' x x x --_X X x 30' LOT 6 B LK 4 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE HILLS LOT 5 BLOCK 4 PLAT 63-41 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E-MAIL: JULY 21, 2026 1"=30' schullerakOgmail.com 26-077 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: JLS SW2737 260254 o F / •'TH '• tY' .� 49 ......... .... .. :... / F ?A .J(�EN L. SCHULLER.• 0 LS -10408 qj / kk 001 '�.'. , '�• d eAr O� •� \ O f e s n a� slo .� Abp SUR U P 1, L .A N Coll 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Permit Number:OSP261180 Tax Code Number:01522131000 Work Type:Septic Upgrade Effective Date: Design Engineer: Site Legal Address:HERITAGE HILLS BLK 4 LT 5 G:2737 Owner:KARLIK JEFFREY & ALLISON Site Mailing Address:12301 TRACY RD, Anchorage Lot Size in Sq Ft:15414 Total Bedrooms:3 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Non-Public Water Well Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Coodinate with On-Site staff regarding preferred method. 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 6/29/2026 6/29/2027 FIRST WATER CONSULTING Expiration Date: þ þ ¨¨¨¨ Issued To: Issued By: Date: Date: 6/29/2026 6/29/2026 FIRST WATER CONSULTING Isatou B Njie MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department �Ar Phone: 907-343-7904 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-221-31 Property owner(s) JEFFREY & ALLISON KARLIK Day phone Mailing address 12301 TRACY ROAD, ANCHORAGE, AK 99516 Site address 12301 TRACY ROAD, ANCHORAGE, AK 99516 Legal description HERITAGE HILLS B4, L5 Number of Bedrooms Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable❑ APPLICATION IS FOR: APPLICATION IS AN: ((Z all that apply) Disposal Field © Initial ❑ Septic Tank X❑ Upgrade X❑ Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: Waiver Fees: Date of Payment: �% L c� Date of Payment: Permit No. C) So 2 6 t i � Waiver No. May 2025 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! June 26, 2026 Municipality of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: HERITAGE HILLS BLOCK 4, LOT 5 The property owner has requested we obtain a permit to upgrade the existing concrete failed septic system of the above referenced lot. The proposed design consists of an AdvanTex FAP 3.0 with a deep trench to serve the 3 -bedroom residence. The subdivision has small lots and other advanced wastewater systems (Advantex & Biocyle). The design is based from the recent test hole conducted in June, 2026. No groundwater was observed at excavation or subsequent monitoring. The slopes are moderate at 3 -8% at the proposed upgrade location. The lot and area are served by private water and “community” water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261180, Isatou Njie, 06/29/26 FIRST WATER CONSULTING HERITAGE HILLS BLOCK 4, LOT 5 DESIGN CALCS: NO SLOPES >25% WITHIN 50'OF PROPOSED FIELD. STAKE PROPERTY LINES, WELL RADII, ESMTS, OR OTHER SEPARATIONS... PRIOR TO CONST. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261180, Isatou Njie, 06/29/26 FIRST WATER CONSULTING NO PRIVATE WELLS W/IN 50' OF PROPOSED ADVANTEX SYSTEM. DESIGN DETAILS: HERITAGE HILLS BLOCK 4, LOT 5 LOT 3 BLK 4 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261180, Isatou Njie, 06/29/26 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: HERITAGE HILLS BLOCK 4, LOT 5 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 06/26/2026 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 7 8 SM/gm 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/24/26 30 min 6” 14/16” 30 min 6” 15/16” 30 min 6” 14/16” PERCOLATION RATE 34 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/26/2026 TESTHOLE # 26-1 DATE PERFORMED: 06/19/2026 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: JEFFREY & ALLISON KARLIK 06/26/26 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261180, Isatou Njie, 06/29/26 ATTENTION: Buyers and owners of a property served by an Advanced Wastewater Treatment System (AWWTS) ** TO AVOID SEWAGE BACKUPS" Prior to using the wastewater system, contact the service provider to ensure that regular maintenance is completed. Many of the systems require remote monitoring, the provider will tell you how to provide this capability. Who to contact: • AdvanTex: Anchorage Tank at 907-343-3704 • Quanics Aerocell: Garness Engineering at 907-337-6179 • Biocycle: Biocycle Alaska at 907-274-0314 • BioBarrier: Tim Ecklund at 907-250-0100 • Intermittent Dosing Sand Filter (IDSF): contact MOA onsite 907.343.7904 Please complete the attached document, Advanced Wastewater Treatn7ent System Maintenance and Repair Agreement. When signing this document, you acknowledge that you are required to provide regular maintenance for your A WWTS. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of T UAC., of 20 by and between 36 e�A }�C-C',, , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) HERITAGE HILLS BLOCK 4, LOT 5 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) J f-- Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This _V includes an annual maintenance fee (typically $400 to $600). J t— Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I. of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. V Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. U Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines'fd the'Constructiot, maintenance and repair of the Owner's AWWTS. Owner aAr8es .to" i'naintaisi remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Non`vaiver. The failure of the Municipality at any time to enforce a provision,of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any pant hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Lay. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the patties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement, (rev. 05/18/2018) Page 2 of 3 STATE OF ALASKA } )ss' THIRD JUDICIAL DISTRICT ) e) Date: The foregoing instrument was acknowledged before me this 1,q day of J r► t , NQTAR P C FOR ALAS A AiARii1 AUIRTtNEz M Commission expires: 3 '� 14t Notary Public Y p state of Alaska My Commission Expires Mar 2b, 2' Ey: (signature) Date: u ar.'o�(print name) Title: Akis X,1011,. 06 /Z'elc�-o26 (rev. 05/18/2018) Page 3 of 3 LL LL LL y LL C y LL L�y m c� (D �4 • L : tl °� m d = :0 m a ° v m v m� O x 0 • • 13 C), :V ���. •ate :N 3 m 2o L •ZLu-El Z c O O o c ICU0. .� -chc Ze L •`� •O 0 N v W oU S Z U W C O•• t _ ••-•\\�1�. LL LL O m o Z o co O M U Z a Q a, v M N E w o D 12 m z' z d. 2 N N aZ a N ti u� o LL LL❑ ca W J Q ¢ a=C C _O O Z N c ' c y a = ❑ z Y .1 m o U cn H CL _- a� a `s z Q V H = FW. F- u O 0 d 3 o a a o �a �w H m Q = a CL .. V) z O ;, Q- 'O O O Y Z W .c Q Ns •> a W V= .O ci. Q m �' 0 3 D a Q cn CL o ii m3 C7 �IL °- ia- O J a d z m a 0 zz 0 3 0 w' + co UX ` c�3 j E LO Z n m"aW Q c 2= `W c C A E]m J F �? a' = o cn T- Q Im 4) Y VO W C _ H Z CQ Z c7 m 76 c o N 3 O UJ W Q v, O z El U= ' Z Z Q 0 O ao 00(D Q F- O O N Q m o T- W a (n �' U) �' O C N E J Q ❑ Z d Z z O .v .yo LL W W w F- a a �' O -' a D O N Q - n FQ- N Y LL O N y. _M m (n i .F + f < Q W > V Q d' v J z �W O .- O �- T-- T- Z Z r �, ~ cn a N a� w w p Y Y Z O E :3 0N wr C V Q F N C = O C C C G 0 �j ° C (n Q) Z m Q$ Oca J wH a _ _ yy45 y a) co V o f, XX � y� 4 C Q d a) CL 3 J z< N fn O d J d W (!J S 3 fn 7 U- 4: y C - C C U Q Z FO- LL L MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241088 Work Type: SepticTank Upgrade Tax Code Number: 01522131000 Site Legal Address: HERITAGE HILLS BLK 4 LT 5 G:2737 Site Mailing Address: 12301 TRACY RD, Anchorage Owner: ALEXANDER MARSHALL Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ij yI1,11- I ) e 1) a I - t 111 e I I rI)epartment 5/29/2024 5/29/2025 15414 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ;' Special Provisions: • The edge of the crib is to be located to ensure that the required separation is met. Issued By: (�(/ Date: Date: 3 MUNICIPALITY CH Development Services Department p p `^� Phone: 907-343-7904 On -Site Water & Wastewater Section '— Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 015-221-31 Property owner(s) MARSHALL Mailing address 12301 TRACY RD ANCH Site address SAME Legal description (Sub'd., Block & Lot) HERITAGE HILLS Legal description (Township, Range & Section) Lot Size 15,414 Sq. Ft. Number of Bedrooms 3 Day phone BLK 4 LT 5 APPLICATION IS FOR: (N all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0 Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) El (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 3 �--o Waiver Fees: Date of Payment: s--Zg Date of Payment: Receipt Number: d/144ZO Receipt Number: Permit No. © f 2 Yl OV` Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc MAY 13, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: HERITAGE HILLS BLK 4 LT 5 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241088, Deb Wockenfuss, 05/29/24 L 1"=50' OLD TANK TO BE REMOVED EXISTING HOUSE INSTALL NEW 1,000 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, DOUBLE CO EACH SIDE. DECOM. OLD TANK PER UPC, MAINTAIN 5' FROM FIELD AND 10' FROM BLDG. SCALE: DJRDRAWN: DATE: HERITAGE HILLS BLK 4 LT 5 Anchorage, Alaska MARSHALL 5/13/2024 EXISTING CONCRETE SEEPAGE PIT WELL WELL WELL TR A C Y R D WELL WELL 150 & 100' COMM. WELL RADIUS FROM LOT 8A HERITAGE HILLS BLK 4, LOT 6 COMM WATER SERVICE FROM LOT 8A WELL WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241088, Deb Wockenfuss, 05/29/24 M 0 131st AVE 1"=30' 0 n 00 N89°59'00"w 130.00' I moo. 0 Uij i • SEPTIC PIPES (tyP) O 0 F-- 2g FUEL OIL (n 0 �' PIPES w Q 00 x � a LOT 5 B LK 4 Q Iz 0 61.1 17L o o, z Z GRAVEL D/W 7. x � WELL in X x 59 Q�_'xU��____�iQ:- �-'--x x x--- __X �X x 30' I 30' LOT 6 BLK 4 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE HILLS LOT 5 BLOCK 4 PLAT 63-41 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulc any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE. E-MAIL MAY 2, 2024 1 "=30' schullerakOgmail.com 24-034 DRAW BY: CHECKED BY GRID NUMBEM Baas AGE: JLS SW2737 240144 OF 'kNU&V �� ., L A / .....,A � SAL 'YD 1' 40� 0 �v/'/� , • • � ,yam �:1P�. 491H ................ i� �n ..... . .. .� .... r`. • ...� ••.J�6HN L. SCHULLER.• Q / s ��.. Ls 1040s ,.•• ..�...x, �°� ' • . , • , •' J� / 1831 Talkeetna street k�'°r • • • • 4� Anchorage, Alaska 99508 o fession a1 �- •.. (907) 227--1455 office ... ��\►`I\'�►:r►''�''�'` (907) 274-4992 fax 1 30' 30 ) 131st AVE N89*59'00"W 130.10' 0 CS < co LLJ 0 z 30' LOT 6 BLK 4 0 r1r) ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE HILLS LOT 5 BLOCK 4 PLAT 63-41 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no cnchroachments exist other than noted. Under no circumstance shout( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE:E—MAIL:JUNE 5., 2024 1 sp =30schullerak*gmail.com 24-034-2 DRAWN BY. ICHECKED BY: GRID NUMBER: B60KTPAGE- JLS SW2737 240212 .%411 SLJ)? t loop atmosAMF OF A%,� 00, C-:� 49TIl ? ?......... ...... ... . ....... A 0 0 It JOHN L. SCHULLER LS --10408 elf z 1831 Talkeetna Street AW ov Anchorage, Alaska 99508 Ar ®`\'d�\ MW ofessionlo\ 1~ (907) 227-1455 office (907) 274-4992 fax ~ ,~,.' HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N°. 142 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: LEGAL DESCRIPTION DISTANCE FROM WELL. Yf / LIQUID CAPACITY .,//~_~ ~.2 ~;) GALLONS. NUMBER OF MATERIAL L.5' 2~'-'''¢~'~-'~ COMPARTMENTS / ~-- ~- LIQUID INSIDE LENGTH ',,¢¢'"'~INSIDE WIDTH~DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: ~ , LENGTH .,.~3 . DEPTH .~' . NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH ,~:~/ / / /' LININO MATERIAL ~_~-~G2,/JL,/c:~..,~r~7~.~---./<'<'<~/'~/~4':-/. DISTANCE FROM WELL /'~C)/' / , BUILDING FOUNDATION .,;.~/ NEAREST LOT LINE..,,~'~-~' .~'~ .K'7 ~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,.~..~.D~ SQ. FT, TILE DRAIN FIELD: (.~-~oo TOTAL LENGTH · IN, T~O AL EFFECTIVE IN. ABOVE TILE DISTANCE FROM .,~-'-'/ WATER WELL: TYPE ~,-'~//~' , DEPTH , BUILDING FOUNDATION, SAMPLE_ , NEAREST LOT LINE ./~ /;Tz.... NEAREST /.../ SEPTIC .~ / SEEPAGE / , SEWER LINE , TANK , SYSTEM //~)/ , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE ~ /'.~'~ APPROVED .- HEALTH AUTHORITY GAAB-HD-2 ~' HEALTH DEPARTMENT ~: 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT CaseNo. (f ' ~ NAME OF APPLICANT ~5~./~/;~Y RESIDENCE ADDRESS ../y~./'.~.~,.,:C",,,_./2/y,r,z~' LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESU MAILING ADDRESS,-;9~D.-'2~/¢~2///-¢:/z~'oPHONE NO .2/// LO CAT I 0 N 0 F I N STA L LATI 0 N /'.,-d:~/~/~-~'~ ./:j//~z~__f ~'z~ ~SEEPAGE PiT ~DRAIN FIELD ,OTHER A~TI~IPATED DATE OF ~O~PL~TIO~'~:~:~:~ . BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS .//:/~ '~'~ z/..- 2/</~/~, , PERMIT TO INSTALL A ,~~ AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED ~ SEPTIC TANK SIZE /~s~ TYPE ~-~ SEEPAGE AREA DIAGRAM 0F SYSTEM HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. Depth /~' Location Sketch Was Ground Water Encountered?~ .... If Yes, At What Depth .... Besd[ng gate Gross i'ime Time Depth To '.q20 Nat Drop Star Rotate A Aucborage, Alaska 99502 jml~ 14th,73 weil~ /oN ~ f/Je~ $~.~ ~ ~ ~1~ ao~. ~ cost for ~~i~ of ~ . 'is ~ ~-f~t. ~ set at ~ f~t at a cost of No ~ge for ~ of ~p,t~ ~ptng, ~sc~~ of wat~ 1t~, taking omt pitle~s zdaptsr ~ inst~!l~ng the same. No charge fo~ additio~l ~lree~_dd~,~g a section to the water line, ooupl~ngs and ~tors a~ w~lding . as. wel~ as crmtting the hole in casing for pitless adapter. Also pressure gaug.e. D~: Bernie ~us of ~Pmmp~rt Drilling W~rks I'V06- 06106 ~ ~ 3 Said well producing 15 GPM, in a stable formation of fine and course gr~_.vel. Static recowery of 25 feet of wrater off bottom, original wate~ formatio~ may have i~een, ruptured by the h~gh pressure rotary drille~ well drtl!tnz +-bromgh the water formation 200 feet away. ~s ~ '" ,C~NTAL PR I0~" te~J~ FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION 305 FIFTH AVENUE * ANCHORAGE, ALASKA 99501 * PHONE 272-6401 October 3, 1972 Greater Anchorage Area Borough Department of Environmental Control 3500 Tudor Road Anchorage, Alaska 99500 LOT 5, BLOCK 4, HERITAGE HILLS SUBDIVISION Gentlemen: This is to advise you that we are aware of and concur with Mr. Jerry Bruton's request to place a sepage pit closer than twenty feet from the lot line of Lot 5, Block 4, Heritage Hills Subdivision. First Federal Savings & Loan Association is entitle on this property cur- rently. We will advise future purchasers that this concession has been made. Thank you. Your~ truly ~ ~ ,..,' /' . ' '/ ~ ii3$y Star Route A .AWAM alllLING WMS W —7714 Anchorage, Alaska 7)502 July Oth,73 and drLd' ent to 2P8_fest, '�" C`ij of or').,,vj One sis inch caned water w)1 deepenedwell 5 $50().0() 5 .00 min3ss= on drilling cost. gy cost for installation of P=P [Eli III lit It zx+; foot .t . oo:c or s177.60 Ho oharge for pulling Of purip,test Pmaping, disconnecting of water line, taking nit pit, adapter _Md inatallln6 the saws. No charge for addon itial wirs,adding a erotica to the water line,couplings and connectors and welding as wall as cutting the hole in casing for pitless adaptor. Also pressure gauge. II ...iy vm w�,„ h Y Driller, gcrnis Cl .nt of Y�rpPs t milling Forks c , 12 ry, R 3 w rvi Drilling Site, Lt. S 31L. Lf Subdivisions Ne r, t^ SH s NCE - c 6 06 36 3 T2s- 9'r6-5.7 Clmeri tax,,.l Jensen Ph. }VI -.0160 Sdd well p>roduaing 15 GP!( in far=t tUn Of fires MA &7W',9.0 VrA7e1. Statio recovery of 25 fent of water off boElam. This wile original water formation may have been ruptured by the high pressure rotes drilled well drLUaag through the water formation 200 feet away. 'thir. .i has happcad.many Liars In the Past. ueoete check payahle to Rampart Drilling }forks for the sum of $677. I:...�:: All -i o� AN p•„E�E�VVol �Q pq T104 or^ gerale Claus of Rampart Drilling Works n•vK c•, t ' d, rg CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CT&E Environmental Services Inc. 991334001 S & S Engineering Lot 5 Blk 4 Heritage Hills Lot 5 Blk 4 Heritage Hills Drinking Water Parameter Results Total Coliform-, Nitrate -N 01 Client PO# Printed Date/Time 04/07/99 14:04 Collected Date/Time 03/31/99 18:00 Received Date/Time 04/01/99 09:15 Technical Director: Stephen C. Ede Released By POL Units Method 0 col/100mL SM18 9222B 1.99 0.500 mg/L EPA 300.0 ALlouable Prep Analysis Limits Date Date Init 04/01/99 KAP 10 max 04/01/99 04/01/99 SCL 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 OSC261271 Parcel ID 015 -221-31 Expiration Date: Legal description HERITAGE HILLS BLK 4 LT 5 Site address 12301 TRACY RD Current property owner(s) KARLIK JEFFREY & ALLISON X The On-site system(s) is/are approved for 3 bedrooms By: 6/3/2027 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date: 7/23/2026 This ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sy em(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, evelopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section film -11M Bit A Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-221-31 Complete legal description HERITAGE HILLS BLOCK 4 LOT 5 Location (site address) 12301 TRACY READ ANCHORAGE, ALASKA 9516 Current property owner(s) KARLIK JEFFREY & ALLISON Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: X Private Well serving # 1 dwelling units El Other Non-public well as regulated by MOA El Water Storage F-1 Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: * Private Septic ❑ Private Septic serving 2 dwelling units F-1 Holding Tank Fj Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel FM -1 Plastic F1 Concrete ❑ Fiberglass Age NEW _See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ME AWWTS F-1Bed FM]Deep Trench MWide Trench F]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 $ 340. Date of Payment COSA# OSCQ-(-, 12—+ 1 Waiver Fee $ Date of Payment Waiver # COSA App1icafion_Apr2025.doc COSA Checklist.docx COSA Checklist Legal Description: HERITAGE HILLS BLOCK 4 LOT 5 Parcel ID: 015-221-31 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 attached) Date drilled 7/14/1973 Total depth 228 ft Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 28 in. Date of flow test for COSA 6/3/26 Static water level at beginning of test 170 ft. Well production at time of test 2.5+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 5.21 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 6/3/26 Comments: See attached Sullivan scoping letter. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA – ADVANTEX <1YR Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) NA - NEW ALL standpipes present per record drawing Total measured depth from grad 10.1 ft (max) Measured depth to pipe invert from grade 3.5 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) N If yes, enter date Adequacy test date NA - NEW FIELD Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY – NOT TESTED Effective depth (per record drawings) 78 in (6.5’ MOA IR) Effective depth used 0 in Effective depth (ED) remaining 78 in Comments/Deficiencies: COSA Checklist.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No *50+ ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5+ ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below. F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII/II SEPARATION DISTANCE REQUIREMENTS. 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 07/22/2026 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 07/22/26 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT TiilS MAINTENANCE AND REP AIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 9? Q Day of J t::? ::3/. of 20 ~ by and between -:::Fk?_......---...~,, /~ , herein the "OWNER," and the Municipality of Anchorage, herein the " CIP ALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (A WWTS), described as AN ADVANTEX located at (legal description) HERITAGE HILLS BLOCK 4 LOT 5 2. Maintenance, Repairs and Alterations. /f.Owner is required to read, understand and initial each section) .!/lj Throughout the term of this Agreement, the Owner shall enter into a service agreement with an A WWTS service and maintenance provider approved by the Municipality or the man1Jfacturer' s representative. The A WWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in M accordance with the equipment's approval for operation in the Municipality. ~ It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). pwner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an A WWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of3 ~~ Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. ~ Owner acknowledges that the fine for failing to maintain and repair an A WWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the A WWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. Owner agrees that the A WWTS installation and maintenance requirements as provided by the A WWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's A WWTS. Owner agrees to maintain remote monitoring of the A WWTS as required by the A WWTS approval. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the A WWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an 1mauthoriud representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 1 • Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of3 OWNER: 14 By: _(signature) Date: % --.r (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me thud y of �, 20.n; , by J3ae-ph ti' ?Mor�� LIC FOR ALASKA MIKE KENNETH CHAN n expires: Notary Public P �`� iS ° ��� state of Alaska My Commission Expires Mar 15, 2023 M"l \l�'� TY: ' .- 7 .� By (signature) Date: 7v (print name) Title: (rev. 05/18/2018) Page 3 of 3 Date: 6/22/26 P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 Brent Western First Water Consulting Services RE: 12301 Tracy Rd., Anchorage Well Camera Inspection Well was inspected to 70’. All welded joints look good with no leaks. The Casing is in good condition with no holes, cracks or leaks. The pitless area appears to be sealed and in good condition. There is no indication of surface water contamination. Nitrate Advisory Certificate of On -Site Systems Approval # OSC261271 Subdivision: Heritage Hills, Block: 4, Lot: 5 A water sample revealed a nitrate concentration of 5.21 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. i Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org I Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org C) V/ m CD r- r- cy')m I? M ti r 0 0 0') CD 0- 0 o > u) a) c M w L O 0 0 M i N N u / CD r U d co LO rn rn LO v J Q Y � J O m U J Q J Q W U U Q Q _H LU C) cY) c N O Q U) U U) L J in LU Ral 0 O a) M x 0 0 0 - OL m C O c 0 O A 'a L O N 4-1C E 0 f N 0 c a a U) O U %I.- 0 0 -0 Q. L O 3 EL O L c �, U) a a% r- 0 ~ O E U L N a) O ❑ 0 O O a) c N (D Ni ca .5 70 O `� > U c N p -0 Q f!1 q 'N c N U c LL O U) ° o O °� L z Q O a) a .N U E �, N j C Q. -0O O m 0 cL Q. CL 0 - Or a o �_ E X Rf O N +' N LN cn m E -0 O Q 2:1 IL O O. ° > Q. 0 (D cn 0 — cn m '> °O> a) c. L -he o IL O Q O c �iz CD • � f w O cLc U (p Q I— O U O N O = N U a :E ;, a a c F- N 0 c a a U) O U o rn CA 0') CY)cy� I i` 00 (3) 0') (1) x LU c M r � oil n V O P� V z Lie O � U ®- a) /— E C/)V L Q � z ❑ W NU) U (13 ^>' W06 U E O � 0 c� U Q Q Q 0 L Q U -I.- C/) A C= O ^0 W U a) A Z O P: M CV � N 0 L LL •- Z C) J Q ❑ W Z U w C� a TMI J Y J = m z J Q J 0 LU Q w = o C'7 c CV o O L U) U N U N m -0 0) a) a) a) c 0 Q ca O U U 5i a) a) U- C J 1 ca o 3: c 0 69� E 0 cu LL 0 O m O U ❑ U U_ U w � •C "� N O O a) d a) a0) N a) O — N _ o a) O a) cn N U Q_. _>1 c L ■ O +- _ E a) �_ _ E � +' Q U ❑ 3 U U U a) >+ � ❑ a) ) N c O O C a) E > > �+ v :3 El CL a) O U to g N El 1:1m 2) _rZ c C O m ++ a) a ~ v cv > + M a) c c6 ❑ cn d C) 0) a) o ❑ a) C: a) N O C ) ❑ N a) — w 0) 0- 2 c c CL OL m O a) U J ❑ a ❑ 0. O > U O U N r o -O n m E CL m a) ¢ ❑ lJJ J❑ t 0 NE n- a) a) Fn Q.r ❑ W W r W ,F,^- 'a) VJ L a) ^�^,, N Rf U Q VJ Q Y Z o ` 0 Q > C% > ~a) n > `- M LU LL O LL O F- H U z cr _ vi a a O a) a) 21 F_ IL (1) cn a •— O H Q CO > N Q Q >� N M 14 ui CO > W m � a) a) U- C J 1 ca o 3: c 0 69� E 0 cu LL 0 O m O U ❑ U COSA Checklist Legal Description: HERITAGE HILLS BLK 4 LT 5 ParcellD: 015-221-31 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 attached) Date drilled '7/14/73 Total depth 228 ft Cased to UN ft A Sanitary seal is functioning correctly ❑fi Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 5/24/24 Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No 9 Coliform bacteria is Negative Nitrate 0.519 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Static water level at beginning of test 177 ft. Date 6/3/24 Comments " NO LOG FROM ORIGINAL WELL. WELL DEEPEDED JULY 1973 B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWfS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/1/1970 0 ALL standpipes present per record drawing Total measured depth from grade 14.3 ft (max) Measured depth to pipe invert from grade 5.3 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 2000 gallons 5/5/24 date Any rejuvenation treatment (past 12 months) NO If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station _years Lift station material Comments: Adequacy test date 5/24/24 Results Q Pass Fluid depth prior to test 44 in Water added 500+ gal New fluid depth 62 in Elapsed time 1440 min Final fluid depth 44 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 108 in Effective depth used 44 in Effective depth remaining 64 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Fi Yes if No ft E Yes if No _ It Neighboring Tank > 100' 7a Yes if No _ It Absorption Field on Lot > 100' ❑� Yes if No _ ft Private Sewer/Septic Line > 25' 0 Yes if No _ It Holding Tank > 100' ❑ Yes if No _ It Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ It Qo Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No _ ft Q Yes if No _ It ❑ 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' ❑E Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS [i Yes if No _ ft E Yes if No _ ft ❑� Yes if No _ It ❑� Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 2 Yes if No _ It g Yes if No _ It If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm ___ /�/i! N ,�nc� cJ6L✓( Y. Engineer's Printed Name Glvrnc� COSA Checklist June 2022 Phone 6/14/24 Date Q Q 7 H %. I�CiIPY ei�R. . ,• ... • .... r. k, •1. .. • •Y II.I IYS{'' �• MICHAEL N. ANN R3P.N �•, CE -9