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Home My WebLink AboutVALLEY VIEW ESTATES #1 BLK 1 LT 9 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address Valley View Estates #1 Block 1 Lot 9 Allen Denis McGee Pump Installation Date: 2-1-19 Pump Intake Depth Below Top of Well Casing: 300 feet Pump manufacturer’s Name: F&W Pump Model: 4F07G10301 Pump Size: 1 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Unknown Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Unknown Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,~t'dcigO~e,! PID Number: Name:Wastewater System: ~ New ~ Upgrade Address: ABSORPTION FIELD Phone: INo. of Bed~ms: B Deep Trench B Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION Sol, Rating: Total Depth from original grade: ~.~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to p~pe bottom from original grade: Gravel depth beneath pipe Township: J Range: J Section: Fill added above original gr de: / Gravel length: I I WELL: ~New ~ Upgrade Gravelwidth: Number of lines: IDistancebetweenlines: Olassification (Private, A,B,O): Total Depth: Oased To: Total absorption area: Pipe material: ~/~ Driller: Date Drilled: Static Water Level: Instal[er: Date installed: Yield: Casing Height Above Ground: IPump Set at: I /,~ Ft TANK ~ GPM ~O7 Ft. SEPARATION DISTANCES ~s..tio ~ Ho~din. ~S.T.S.~. To Septic Absorption LHt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Li~es ~ ~O~~ ~ ~ Material: Number of Compartments: Surface Water /¢¢~¢ /0¢'¢ /~0'¢ ~ LIFT STATION Lot Size in gallons: ~ Manufacturer: "Pump o~" I~vel at: I "Pump off" level at: I High water alarm at: Curtain Pump Make & Model ~ Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: ENGINEER'S SEAL Department of .ealth~.;H u~¢~ces approval Reviewed and approved b?~~~ ~ Date:/~.<~* .' 72-0t 3 (Rev. 9/91) MOA 25 Permit No.Sw950361 2 2 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report VALLEY VIEW ESTATES #1, BLOCK 1, LOT 9 05052160 Legal Description: PID No.: C01 MH A B P.P C01 16.10 29.0 C03 30.5 34.10 - C04 73.5 76J0 - MT1 37.0 42.10 - MT2 29.0 40.5 - MT3 89.0 93.5 - MT4 45.0 58.10 - MT5 93.0 99.i5 - 113,9' MT4 MT2 ' 103.0 ·97~ NO WATER FOUND GAL. S.T.E.P. PROP. HOUSE 1BDRM. NEW 75' 75' 44' CO2 1750 C02 ENGINEER'S SEAL 72-013 A (1/93) POWER POLE (P.P.) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-06§0 SOILS LOG -- PERCOLATION TEST Township, Range, Section: 4- 5- 6- 7- 8- 9- 10- 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE -- T T R BETWEEN PERFORMED BY: I ACCORDANCE 72-~8 (Rev. 4/~) Eagle Eiver, Alaska 99577 ETER /~ / ~_//~x~/-,.-, x~-------~-- 2~RTiFV T.^TT.iS TEST W^B pER~OR.EO,N CT ON THIS DATE. DATE: STATE OF ALASKA DEPA~TM~NT OF NATI~L ~.ESOUi~CES . DIVISION OF GEOLOGICAL AND GEOPHYSICAL SURVEYS WATER WELL RECORD LOCATION OF WELL BOROUGH SUBDIVISION LOT BLOCK SECTION QTRS TOWNSHIP RANGE MERIDIAN DIRECTIONS: p ]~ WEL,. OW~E: /~C73 ~' ~LL DEPTH: DATE OF CO~LETION: ~ground surface ~other: Depth of casing:.~.~ ft BO~HOLE DATA: Depth STATIC WA~R LEAL: / ~/' ft. Date Material type and color From TO METHOD OF DRILLING: ~r rotary p~ ~ C~//Ur~ ~ ~ ~cable tool ~other: ~O~ ~~ ~/ 3~ USE OF WELL: ~domestic ~irrlgation ~monltor ~publlc supply ~other: t CASING: St ~ok-up /'~. ft. Diam: ~ in WELL INTAKE: ~ open end ~screened gO, B fo=e' /aY 2~a ~ perforated ~en hole Depths of openings:__ to ft ~ r~~l-~~ ~.~~ Set Between and __ft · 1~%~ ~ 9 ~ Volume used: _Depth to top:__ oePt. He~th&HUman&~C~ Depth: from__ ft to __ft DE~LOPMENT METHOD: ~'~ Duration: ~ 1~, P~ING LEVEL ~D/YIELD: . ,/~ ~W~W~' ~%O ? ft after / hrs pumplng~~' gpm '0~* ~ay ~aP~ Of>% ~ INTAKE DEPTH: ~/~'ft Horsepower:___ Date P~p Installed CONT~CTOR INFO~TION: WATER CHEMISTRY S~PLE TAKEN? ~ yes ,~ ~/ ~_ ~ ~ .... ~ ~,// , f._ Well disinfected upon completion? ~yes ~no Registered Business Name Signature of Authorized Representative Date PLEASE MAIL WHITE COPY OF LOG WITHIN 45 DAYS TO: DGGS PO BOX 77-2116 EAGLE RIVER, AK. 99577 !!-09-93 ,,,.o _ ;.. 04?7. .u,.. /U.,i ED'S ELECTRIC INC. 3138 COMMERCIAL DRIVE ANCHORAGE, ALASKA 99501 VALDEZ ANCHORAGE (907) 272-4,591 Fax 274-62~5 November 9, 1993 Long Construction 19420 Upper Skyline Drive Eagle River, Alaska Electrical inspecuions on Lift: Station Dennis Allen Residence Valley View Esnates #1 Block 1 Lot 9 Eagle River, Alaska Dear Sir: The inspection of )¢ovember this time, 4, 1993 indicaLed Thank you, ED'S ELECTRIC, Ed Strout Operations Manager ES/der r.o code violations at PERMIT NUMBER:SW930361 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ALLEN DENIS MCGEE OWNER ADDRESS:HC 83 BOX 1762 EAGLE RIVER, AK 99577 PARCEL ID:05052160 -93 · MUNICIPALITY OF ANCHORAGE / , DEPARTMENT OF HEALTH AND HUMAN SERVICES " " 2 ' !'--' "'~ P.O. BOX 196650, 825 L STREET, ROOM 50 ANCHORAGE, ALAS 99519-6'650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT~~,~, DATE ISSUED: 9/14/93 EXPIRATION DATE: 9/14/94 LEGAL DESCRIPTION: VALLEY VIEW ESTATES #1 BLK 1 LT 9 LOT SIZE: 439803 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. THE DRAINFIELD FOR THIS SYSTEM SHALL BE INSTALLED UP- SLOPE OF TEST HOLES 1 AND 2. 2. AN ADDITIONAL TEST HOLE SHALL BE DUG AT THE TIME OF CONSTRUCTION TO VERIFY ~EDROCK DEPTH AT THE DRAIN FIELD MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 LOCATION. DEPTH AS PRACTICABLE. ISSUED BY: ~ · THE DRAINFIELD SHALL BE INSTALLED AT AS GREAT A DATE: DATE: PAGE 2 OF 2 HEALTH AUTHORRY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECT[ON & FLOW TEST SITE PLANS SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 18, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUI~LAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Valley View Estates Subdivision, Block 1, Lot 9 Re.est you issue a Dermit to drill a well and install a seDtic system to serve the Droposed four bedroom house and one bedroom Mother-in-law cabin on the referenced Droperty. Three test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the holes were checked and found to be dry. This property has enough area for a septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. AS/LSU/lsu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~," · - 50' SITE PLAN SCALE ~>1 o:~mo o~O z2:-q ~_~ _ o~ 8c8 o ~o~~ ~m . ~ ~ ~ o ~ ~o~Zo umo< Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: T~___::~¢~. I$ ~'~J.,-~f"J DATE PERFI LEGAL DESCRIPTION: ~/~./.E--~ //~/~J ~. ~7 ~,, ~:~ / Township, Range, SectiOn: / SLOPE SITE PLAN 6 7 8 g 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ~. ENCOUNTERED? s IF YES, AT WHAT ~ ~) DEPTH? P E I'donitoring? "'"' '~,7 . Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~.~T AND ~ A~O~DA~E WlTH ALL STATE AND MUNIGIPAL GUIDEL~I~EGT ON THIS DATE DATE; Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: b ~---/~'J I,~ E.A'OESCR,PT.ON: IJ .V 10 DATEPERFORMED: Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN 11 12 13 14 15 16 17 18 19- 20- IF YES, AT WHAT DEPTH? Depth t0 Water Aft, re' .,-~ 9"/'~ .--'-/~, Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ,,~3o3 (minutes/inch, PERC HOLE DIAMETER ~ /'' TEST RUN BETWEEN '~ FT AND ~/ FT COMMENTS -~ & ~ -..";C:,":.'~.A;NG ~ PERFORMED BY:~"I' "IV'", Alaska ~,~ .... -- , / ~/ERTIFY THAT THIS TEST WAS PERFORMED IN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES MATERIAL SPECIFICATIONS REFERENCE: Valley View Estates Subdivision, Block 1, Lot 9 GENERAL: 1. o The scope of this project includes the installation of a 1750 gallon septic tank effluent pumping (S.T.E.P.) system and five foot wide drainfields to serve the proposed four bedroom residence and existing one bedroom Mother-in-law cabin for the referenced property. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK iNSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. o The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Valley View Estates August 18, 1993 Subdivision, Block 1, Lot 9 Septic tanks installed with less than 4 ft· of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: o Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design· Page Three Valley View Estates Subdivision, August 18, 1993 Block 1, Lot 9 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank The following pipe materials septic system installations Anchorage: are approved for use in in the Municipality of Tvpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill· o Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Valley View Estates Subdivision, August 18, 1993 Block 1, Lot 9 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. MUNICIPALITY OF ANCHORAGE 61\1�__L Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 050-521-60 1 Certificate of On -Site Systems Approval Expiration Dat . GENERAL INFORMATION Complete legal description Valley View Estates #1, Block 1, Lot 9 Location (site address) 26115 Wildflower Circle Eagle River, AK Current property owner(s) Troy Davis Homes Inc Day phone (907) 357-9394 Mailing address 1689 S Knik Goose Bay Road #400, Wasilla, AK 99654 Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ , Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑■ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 5 COSA Fee $7 . Waiver Fee $ Date of Payment 7& �0�0 Date of Payment Receipt Number iJ �3G% 7 Receipt Number COSA # Q S �' c2 0 1301 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/6/20 �'�P%OF ,,..... q�qs�®gym 49th •'�®m� 6. DSD SIGNATURE �....._. ... . System #1 Approved for bedrooms 4� �, : htICHAEL E. ANDERSON; c ® No. CE -4381 :' System #2 Approved for bedrooms p®A.•"7i6i2o °®� Disapproved ®®+® pROFESS��`��®®� Conditional approval for bedrooms, with the following stipulations: I Gc 2 cf-(4L��erj CjVl &, 06 i{�' �e �C 1 OLVL 4 Wt 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 registertRd in the S to of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. dow-j 0 7. ATTACHMENTS: �_�Vl_ i COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Othe�+ k_. -z -yr Legal Description: Valley View Estates #1, Block 1, Lot 9 If more than 1 septic system on lot: COSA Checklist 4 of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/30/93 Total depth 308 ft Cased to 35 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '24 in. Date of flow test for COSA 6/10/20 Static water level at beginning of test 133 ft. Comments B. TANK DATA Age of tank(s) 27 years Tank type/material S.T.E.P/STEEL Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/24/20 - Alaska Quality Septic D. ABSORPTION FIELD DATA Shallow 5' Wide Which system tested (date installed) 10/9/93 ❑ ALL standpipes present per record drawing Total measured depth from grade 9/7.1/6'3 ft (max) Measured depth to pipe invert from grade 6* ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced NA gallons Comments/Deficiencies: Parcel ID: 050-521-60 Structure served by this system Well production at time of test 4 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate •484 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 6/19/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station 27 years Lift station material Steel Comments: Adequacy test date 6/10/20 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 0/18/2 in Water added 790 gal New depth 0/21/7 in Elapsed time 1440 min Final fluid depth 0/18/3 in Absorption rate >750 gpd Any rejuvenation treatment (past 12 months) No If yes, enter date Only one of the trenches has cleanouts in accordance with original Inspection Report. All cleanouts on the report were found. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' ✓0 Yes if No ft Private Sewer/Septic Line > 25' F� Yes if No ft Absorption Field on Lot > 100' 0✓ Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' R Yes if No ft F✓ Yes if No ft ✓0 Yes if No ft Water Service Line > 10' 0✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ✓0 Yes if No ft E] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes 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' ✓0 Yes if No ft Water Service Line > 10' 0✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' p Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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. COSA Checklist yellow sheet CSF r YYY ;« 49th +: �n MICHAEL E. ANDERSON .` No, CE -4381 �T(`�''•.,,.i 8/6/20 .......... F��4 6 Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201301 Subdivision: Valley View Estates #1 Block 1 Lot 9 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 27 years old. Typical replacement costs range from $9,000 to $14,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 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