HomeMy WebLinkAboutGINAMI HILLS LT 7CII
ANm i l \J 1.1-v V li 1\i: V 1LX" 11 I V it 1 V 1 1\ 1 l a) rX"I-V" 1ILI-L
AS -BUILT OF:
GINAMI HILLS SUBDIVISION
LOT 7C PLAT 74-57
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 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:
MAY 20, 2025 1 "=40' schullerakogmail.com
25— 050 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE:
JLS SW2741 250157
OF �\
�........AL
.• 4 NTH •. �' g
® ....... ......... .......
® r
�.............. ............:..`.,
•.J HN L. S CHULLER.-
'`¢ LS-10408 ; 10'
ell C
Ar pt`
°fes iono� �' 'aw
s �ow
P_D SUR V
L�r
1jD 1'
r
c' n
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
GREL,ER ANCHORAGE AREA BOk. dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS ?1~1
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL_
MANUFACTURER~-~J~_.
INSIDE LENGTH
INSIDE WIDTH
MATERIAL ~
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY/,~fl''(-~) GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION /0 I Jr-
DISTANCE BETWEEN LINES
DEPTH:
! TOTAL LENGTH
NEAREST LOT LINE /~ ~L OF LINES ~,-~J
SQ. FT. LENGTH OF EACH LINE ~_/~ /
MATERIAL BENEATH TILE /~' t~. ABOVE TILE / IN.
WELL:
BUILDING
FOUNDATION
CONSTRUCTION
NEAREST NEAREST SEPTIC
LOT LINE__ SEWER LINE TANK
DEPTH DISTANCE FROM:
SEEPAGE
SYSTEM
CESSPOOL
, OTHER SOURCES
APPROVED __ DISAPPROVED
REMARKS
DISTANCES:
i NSTALLED By: :~'~ ,~J,
SEWER LINE DEPTH:
PIPE MATERIAL:
LOTSLOPE: ~,/ t
REMARKS:
D' AG RAM O F SYS~TEM~--~~
G.A.A.B. ~)
Form EQ-032
HFt',:.:',IHLJH IqL.tH.F]E:F.'.' OF .E,'IEDI:~'.OOH:i'_:; = ,::1.
SOIL .i:'z.':I:::ITII",IG (Si;Ii:! 1:::7',/BI:~:)=: E',5
THE ~:E(~:!LI :[ RE[:, S I ;;i:.:E: 0t::' THE ;~;0 :[ L.. Rr:'.':tE;OP.t::'T I ON .?,"r'~;TEi"I :[ ~;:
THE L.ENGTH [':' I I"lE:i",!'.:ii; I O1'.,I I E; THE I..E..:NGTH ,:: ]: N I::EE~:T> OF THE "I"RE~]",iCH OR C, RFI ]: NI::':[ E]...[::,.
THFZ [:,E::F'T'H OF FI "I'I:~:I~t",ICH O1'7.: PIT IS THE C,].'STFti'.,!CE: E',ETI,.!E:E':N THE': :!SUF~'.F:Ft(i:Ii!!: OF '1"Ht:7
GF~'.OUI'..I[:, FIND THE: E:CFt"'TOH OF 'T'HE E',~'::CI::I","FI'I"ION ,:::[1",1 FEET::'.
THEF.:E: l':'ii; NO :~;[':-.T ,t,.II[.':,TH FOR':
THE GF. tI::I',,,'EL [:,EF'TH I S THE Iq
F'II",I[.':' THE: DO:t"TOH CIF THE: t.'.C::':',CFI'v'FITtOI",! ,.': i'N F'E:ET:).
H I N I HLIH D I '.E;TI::INC:E': BI.'i':TW[EIE]'-,I FI I.,.tEI_I.... F~i'.,II::." I:lN"r' Ot",t-S i TE '_:.;EIqF:I6i.E!: C, I '.i.~;F:'O:ii.:,F:lL. S"r':~;'T'E:I"'! i 'Z'!;
:'1..00 FEET F'OF.: la F'R'.I',,,'I'hTE WELL OR :201Z~ I::EEI" FOF'. F:I F:'LJE~LIC 1.4EL.L.
I.,.IELL. t....OC'i'B FtP:'.E I-~:ELT.!I...IIFi:IE[:, FIND HtJST BE: I':::E:TUF.:NE:I:.':' TO THE': I:::'[.E:F~FIF:'.THEI",I"t'' I.'.IITH]:N ]i:0 !i:'F:l"r"_"~;
OF THE: I.,JELL. COHF'I...ETION.
':Z,F'E'C I F" ): C:F:ITZ Ot",tS:'; FIND CON:iETF.:I..ICT :[ 01",t [:' :[ FI6iI:Z.'.FIH~E; F'IRE: FI',,,'F:I Z t...F:I.F_",I._E: '1"0 Z NSUF.:E: F'F;'.(]F:'E]:;;:
]: i",I?FFIL.L.FIT :t: Oi",1.
I IZ:EI:~:TII:::'"r~ '['HF~T
:L: I FtI"'t I:'I::IHII...II::IF:: I.,.ll'TH 'T'HE I:~:EQL.I]iREiHENTS F'OF.': Oht-:E;ITE '_:~;[i!:[,.tER:~; FIND I.,~EL..I...:~:J; Fl::i;
FCtR'.T'H B"r' THE: I"'tlJl",l :[ C ]: F'FIL I T"r' OF F:INCFIOF..'FIGE.
:2.: I 141'1_1._ Ii",ISTFtLI... THE ~:';"r':.'T,'T'I::.:.H I1",t I:::IC:COI:::'.E)FINCE' t.'-IITH "l"l"'il~E
i~:: .'t1 L.II",t[':'ERt'..E;'TI:at",II:.':' 'THFFI" THIE ON-!.:.;tTE' '.E;EiI.,.IER ':7"r'STEH t"'tl::t"r' F.'I'ZQL]IF~'.E I.T.'.NI...I:F'IF;:(:~ilEHENT 1[I:::'
Fi:E'JS.It.'.:'[:CI",tC:IE .'t.':.:.'.': R[L'I'"tOC'IFJL. E:[:' TO I i",IC:L. IJ[.':'E: I"IOI::~:E "r'FIFIN ,::i. t.:]E:.'I.':.',F:".OOHS.
,:::,: ........ .................................................................
~- T.I~ I)FII:~'.ELL H]:I...L
.................. ..........
May 11, 1977
R & M No. 751151
Darrell Hill
801 Airport Heights, Space 33
Anchorage, Alaska 99504
Subject: Soils Investigation for Sanitary Sewer System, Lot 7C,
Ginami Hills Subdivision; Anchorage, Alaska
Dear Mr. Hill:
At your request of May 2, 1977, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the
subject lot. The investigation complied with those procedures required
by the Municipality of Anchorage, Department of Health and Environmental
Protection.
This investigation, which was accomplished on May 3, 1977, consisted of
a test hole drilled to a depth of 19 feet below the existing ground
surface. The location of the test hole is shown in attached Drawing A-01.
The hole was drilled with a rotary drill rig using continuous flight
~olid-stem auger with an outside diameter of 6 inches. Samples were
taken at the depths shown on the soils log in attached Drawing A-01.
These samples will be held in storage at our lab for approximately six
months. In addition, all material brought to the surface by the augers
was continuously monitored by an experienced engineering geologist.
The topography at the drilling site is generally gently sloping to the
west. At the time of the investigation the site had been stripped of
original groundcover.
The soils encountered in the test hole are shown in the log in Drawing
A-01. Groundwater was not encountered in the test hole. Bedrock was
not encountered. Subsurface conditions may vary in other parts of the
lot.
Because of the abrupt soil change found at 9.5 feet in the first test
hole, a second test hole was drilled to a depth of ~ feet and a percola-
tion test was performed within the bore hole at t~e~°~epth shown in the
attached Table 1. The second test hole was checked vis~ally to assure
that the soil~Were essentially the same as those in the first hole. No
graphic log is provided for the second hole. All depths were measured
ANCHORAGE FAIRBANKS JUNEAU VALDE~: WASILLA
May 11, 1977
Mr. Darrell Hill
Page -2-
from the top of the hole. The data in Table 1 show average infiltration
from the depths indicated to the bottom of the hole. The measured
percolation rate was 0.61 minutes per inch.
We appreciate this opportunity to be of service to you. Please contact
us if you have any questions concerning this letter.
Very truly yours,
R & M CONSULTANTS, INC.
Jeffrey M. Ayres
Staff Geologist
JMA/RLS:bb
Robert L. Schraeder
Associate
Attachments: Drawings A-01, B-01, B-02, Table 1
XC: Department of Health & Environmental Protection
TIME
PERCOLATION TEST
DARRELL HILL
R & M NO. 751151
TH-1
May 10, 1977
ELAPSED INCHES DROP IN
TIME INCHES
10:00 0 14.0 0.0
10:01, 1 19.0 5.0
10:02 2 22.0 3.0
10:03 3 24.0 2.0
10:04 4 26.6 2.5
10:05 5 28.5 2.0
10:06 6 30.0 1.5~
10:07~ 7 32.0 2.0
10:08 8 33.0 1.0
10:09 9 34.0 1.0
10:10 10 35.0 1.0
~0:15. 15 38.5 3.54
Test Hole Sloughing in
Refilled T.H. with water.
24.5. inches total drop
0.61 min/inch
10:20 0 15
10:25 5 27.5 12.5
10:30 5 34.0 6.5, o
Test Hole Sloughing in
19.0._inches total drop
0.54 min/inch
LOCATION SKETCH
Not To Scale
Lot 7C ~.Oc~a.~' ~ '~;
Upper Huffman
Ginami Hills Subdivision
Distances shown are approximate
and have not been measured by
surveying methods.
CONSULTANTS, INCo
LOG OF TEST-HOLE No. 1
Scale: 1"=3'
0.0~
SILTY SAND W/SOME GRAVEL
Occasional Cobbles
_D~ o_~D ,--Wet
SILT W/SOME SAND
Brown, wet
GRAVELLY SAND W/SO,CE
SILT
Occasional Cobbles
Brow~, Very Moist
__1.5'
®
SILTY SAND W/SOME GRAVEL
Gray, Slightly Moist
w~:
V~'~
JMA
E:see aboveJ
LOCATION SKETCH ~;D
TEST HOLE LOG
DARRELL HILL
See Drawings B-01 and B-02 for
explanation of. symbols.
This log depicts subsurface soils
observed within the test hole at the
location shown.
19'T.D
Groundwater was not encountered.
SOILS
CLASSIFICATION~ CONSISTENCY AND SYMBOLS
CLASSIFICATION: Identification and classification of the soil is accomplished in
accordance with the Unified Soil Classification System. Normally, the grain size
distribution determines classification of the soil. The soil is defined according to
major and minor constituents with the minor elements serving as modifiers of the
major elements. For cohesive soils, the clay becomes the principal noun with the
other major soil constituents used as modifier; i.e. silty clay, when the clay particles
are such that the clay dominates soil properties. Minor soil constituents may be
added to the classification breakdown in accordance with the particle size proportion
listed below; i.e. sandy silt w/some gravel, trace clay.
no call - 0 - 3% trace - 3 - 12% some - 13 - 30%
SOIL CONSISTENCY - CRITERIA: Soil consistency as defined below and determined
by normal field and laboratory methods applies only to non-frozen material. For
these materials, the influence of such factors as soil structure~ ioe. fissure
systems, shrinkage cracks, slickensides, etc., must be taken into consideration
in making any correlation with the consistency values listed below. In permafrost
zones, the consistency and strength of frozen soils may vary significantly and
unexplainably with ice content, thermal regime and soil type.
Cohesionless
N*~lows/ft) Relative Density
Loose 0 - i0 0 to 40%
Medium Dense 10 - 30 40 to 70%
Dense 30 - 60 70 to 90%
Very Dense - 60 90 to 100%
*Standard Penetration "N": Blows per foot of
a 140-pound hammer falling 30 inches on a
2-inch OD split-spoon except where noted.
Cohesive
T- (tsf)
Very Soft
Soft
Stiff
Firm
Very Firm
Hard
0 - 0.25
0.25 - 0.5
0.5 -1.0
1.0 - 2.0
2.0 - 4.0
-4.0
DRILLING SYMBOLS
WO: Wash Out WD:
WL: Water Level BCR:
WCI: Wet Cave In ACR:
DCI: Dry Cave In AB:
WS: While Sampling TD:
While Drilling
Before Casing Removal
After Casing Removal
After Boring
Total Depth
Note: Water levels indicated on the boring logs are the levels measured in the
boring at the times indicated. In pervious unfrozen soils, the indicated elevations
are considered to represent actual ground water conditions. In impervious and
frozen soils~ accurate determinations of ground water elevations cannot be obtained
within a limited period of observation and other evidence on ground water elevations
and conditions are required.
L.D.S~
G.L.B.
: 3- 1-72
E: N/A
R&M COI~ISUI.TAIMTS, lIMO.
GENERAL NOTES
GRID: N/A
I PROd. NO GENERAL
I, OWG. NO. B-OI
STANDARD SYMBOLS
~ ORGANIC MATERIAL ~
COBBLES B BOULDERS
CONGLOMERATE
SANDSTONE
MUDSTONE
LIMESTONE
IGNEOUS ROCK
METAMORPHIC ROCK
ICE, MASSIVE
ICE-SILT
ORGANIC SILT
SANDY SILT
SILT GRADING TO
SANDY SILT
SANDY GRAVEL,
SCATTERED COBBLES
(ROCK FRAGMENTS)
INTERLAYERED SAND
8~ SANDY GRAVEL
SILTY CLAY w/TR. SAND
SAMPLER TYPE SYMBOLS
St ..... 1.4"
Ss ..... 1.4"
SI ..... 2.5"
Sh ..... 2.5"
Sx ..... 2.0"
Sz ..... L4"
Sp ..... 2.5"
Hs ..... 1.4"
SPLIT SPOON
SPLIT SPOON
SPLIT SPOON
SPLIT SPOON
SPLIT SPOON
SPLIT SPOON
SPLIT SPOON,
SPLIT SPOON
WITH 47# HAMMER
WITH 140# HAMMER
WITH 140~ HAMMER
WITH 340# HAMMER
WITH 140# HAMMER
WITH 340# HAMMER
PUSHED
DRIVEN WITH AIR HAMMER
Ts .... SHELBY TUBE
Tm .... MODIFIED SHELBY TUBE
Pb .... PITCHER BARREL
Cs .... CORE BARREL WITH SINGLE TUBE
Cd .... CORE BARREL WITH DOUBLE TUBE
Bs .... BULK SAMPLE
A ..... AUGER SAMPLE
G ..... GRAB SAMPLE
HI ..... 2.5" SPLIt SPOON DRIVEN WITH AIR HAMMER
NOTE: SAMPLER TYPES ARE EITHER NOTED ABOVE THE BORING LOG OR ADJACENT TO IT AT THE RESPECTIVE
SAMPLE DEPTH.
TYPICAL BORING LOG
BORING IVUMBER...j,.-E H. 50- 15
DATE DRILLED-..~,,iO_ 21. 70
SAMPLER TYPE~,Ss
WATER TABLE
GRADATIONAL
Ss
FROZEN
Cd
Elev. 274.6 ,,~--ELEP'AT/ON/,4/FEET
All Samples Ss'~'-''SAMPLER TYPE
O'
ORGANIC MATERIAL I'
Consid. Visible Ice 0'-7' ICE+ML
ICE -SILT
Estimate 65% Visible Ice
C) 90, 56.2%
7'
SANDY SI LT
~,.,..APPROXIMATE STRATA CHANGE
Little toNoVisible Ice I$L30' Vx -- ICE, DESCRIPTION B CLASSIFICATION
(~7 2~ 5ZI °/o~ 85 9 pcf~ 28°, GP (CORPS OF ENGINEERS METHOD)
~ '~ ' ~. ~. ~"UNITIED ORFAA CL,~SS/FICAT/ON
'~ -~ ~ ~'TEMPERATUR~ OF
\ ~ -- DRY DENSITY
\--kVATER CONTENT
--BLOWS/FOOT
~SAMPLE NUMBER
SANDY GRAVEL
26'
95 SCHIST ~ GENERAL/ZED SOIL OR ROCK DESCRIPTION
LOCATION 30 ' .~ DRILL DEPTH
~ ~O,-WHILE DRILLING, AB-AFTER BORING
[j W N: L.D.S.
KD: G.L.B,
ATE: FEB. 1972
CALE:NONE
I~NSULTANTS, INC.
EXPLANATION
OF
SELECTED SYMBOLS
J GRID: N/A
il, Owe. NO.
SIX 'INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED at THE RATE Of
PER FOOT.
PrOPERtY OWNER ;~',~P*-----.~- ~ -
DRILLER Berate L~a~ of l~apa~_~ l~llkL~n~;_ Workso
WELL LOG:
~'~e~, Tet~ 21e~ ~h~ sh~ a ~ssible ~ 0~o
[9~20~e $~t~y rook, Tot~ footage, 205 feet.
Indicating 100% improvement
Hill of ~80 feet: ~0,00
D~,tJ. ling Cost°
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PaYaBLE TO RAMPART DRILLING works For ThE sum OF $32~0'00
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART.DRILLING WORKS
SERVICE CHAROEOF I~% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE
555 CORDOVA ST.
ANCHORAGE, ALASKA 99501
Ms. Rudy Hill
Bonnie's Bed & Breakfast
8501 Upper Huffman
Anchorage, Alaska 99516
TONY KNOWLES, GOVERNOR
(907) 269-7505
December 16, 1996
Subject:
Lot 7C, G_..i~3Ft[~-~iJls Subdivision, Class C Public Water System, PWSID #
216847; Alaska ADEC Project Numbers 9121-WA-009; Review
Dear Ms. Hill:
I apologize for the delay in responding to your request on decreasing the monitoring
requirements that were placed on your Class C Public Water System at the time of
approval. We were waiting for the results of the Hillside Well Head study before any work
on reducing monitoring requirements for public water systems were completed. Since the
study has been completed, we are now reviewing reduced monitoring requests.
Based on the results of the study and the results that you have provided, it is apparent that
your public water system is a candidate for reduce monitoring. After reviewing this office's
file on the above-referenced facility, the monitoring requirements have been changed from ·
semi-annual to annual for nitrate (as nitrogen) and total coliform bacteria during the month
of February.
Please remember to place the PWSID Number (# 216847) on all analytical data submitted
to this office. I have also attached copies of the original approval letter and Final Operation
Certificate for your files.
Thank you for your coordination with this Department. If you have any questions, please
do not hesitate to contact me.
S~cerely,/,///~
Keven K Kleweno, ~.E.
Environmental fin9ineer
KKK/ka
Enclosures: As Stated
cc: Lynn Johnston, ADEC/E/DW, w.o Enc.
"Jim Cross, P.E., MONDHHS, w/o Enc.
~, printed on recycled paper
,,,, ,, ,~n~, \\ I - I IlJJMUNICIP~LI'W OF ANCHO,~GI~
NTAL PROTE~ION
DE~. OF ENVIRONMENTAL CONSERVATION /DEC 4 1990
/
ANCHO~GE WESTERN DISTRICT OFFICE RECEIVED 563-6775
3601 C ST~ET, SUITE 322
ANCHO~GE, ALASKA 99503
December 3, 1990
Mr. Bruce J. Corwin, P.E.
Corwin & Associates, Inc.
P.O. Box 230608
~nchorage, Alaska 99523-0608
Lot 7C, Ginami Hills Subdivision, Class C Public Water System
and Wastewater Disposal System, ADEC Project Number 9121-WA-
009; Review
Dear Mr. Corwin:
This is in response to your submittal, received in this office on
November 1, 1990, in which you requested the Department waive the
minimum 150 foot separation distance between a Class C Public Water
System Source Well and a wastewater disposal system to 80 feet
between the source well and the septic tank and 95 feet between
source well and soil absorption system. I have reviewed the
submitted information and find that I can not agree with your
conclusion that the requested waivers should be granted. The
request submittal did not provide sufficient information to justify
the waivers under 18 AAC 72.035 of the Wastewater Disposal
Regulations.
For a second evaluation, additional information on the slope of the
bedrock and the direction Of fractures within a three lot area
around the subject lot will need to be submitted to this office.
It appears that water being used by the public is being withdrawn
from the fractures in the bedrock and the contact zone between the
bedrock and the unconsolidated material. In addition, a copy of
your October 29, 1990 letter requesting the waivers will need to
be submitted to this office sealed with your stamp as a
Professional Engineer.
If you have any questions, please do not hesitate to contact me.
Keven K. Kleweno
Environmental Engineer
cc: John Smith, DHHS
KKK/pf
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
OSC251194
Parcel ID 015-461-32
Legal description GINAMI HILLS LT 7C
Expiration Date:
Site address 8501 UPPER HUFFMAN RD
Current property owner(s) HILL DARRELL & RUBY
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
Z o z,
By: ( 9 k Original Certificate Date: 5/23/2025
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development 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
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF
0
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-461-32
Complete legal description
Location (site address)
GINAMI HILLS LOT 7C
8501 UPPER HUFFMAN ROAD ANCHORAGE, AK 99516
Current property owner(s) DARRELL & RUBY HILL
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: RM Private Well serving # ' dwelling units
F] Other Non-public well as regulated by MOA r_1 Water Storage
n Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: � Private Septic n Private Septic serving 2 dwelling units
R Holding Tank R Community Septic or Public Sewer
5. SEPTIC TANK: nN Steel n Plastic n Concrete n Fiberglass
Age 11 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: F-1 AWWTS 0 Bed FO-1 Deep Trench R Wide Trench R Seepage Pit
Waiver request for:
Expedited review requested: n
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $_ S—U Waiver Fee $
Date of Payment 2- 1 / -z' 'z_ Date of Payment
COSA # U
C_ Waiver #
5
COSA Application_Apr2025.doc
COSA Checklist.docx
COSA Checklist
Legal Description: GINAMI HILLS LOT 7C Parcel ID: 015-461-32
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 6/6/1977 Total depth 205 ft
Cased to 200 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 4/16/25
Static water level at beginning of test 17 ft.
Well production at time of test 1.3 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.336 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 4/16/25
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 49”
Date of pumping 4/14/25
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/7/14
ALL standpipes present per record drawing
Total measured depth from existing grade 13.1 ft (max)
Measured depth to pipe invert from grade 4.5 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
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 4/15/25 date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 4/16/25
Results Pass
Fluid depth prior to test 15 in
Water added 600 gal
New fluid depth 24 in
Elapsed time 1440 min
Final fluid depth 9 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 84 in (MOA 7’ ED)
Effective depth used 9 in (Final Fluid Depth)
Effective depth (ED) remaining 75 in
Comments/Deficiencies:
COSA Checklist.docx
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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 Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
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 05/15/2025
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 &
05/15/25