HomeMy WebLinkAboutFOREST CREEK LT 6Forest Creek
Lot 6
#015-292-54
(-
Municipality of Anchorage
Development Services Department
`
Building Safety Division
OnHSite Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage. AK 99507 Page of
www.d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW080258
PID Number.. 015-292.54
Nn" The Dittrich Company
Wastewater System: Q New ❑ Upgrade
Aaoau
P.O. Box 90411 Anchorage, AK 99509
ABSORPTION FIELD
PhorM 632-8790
RMrbra aealooma 5
p Dew T. tl O Snail« Tmal O sea O Maw Clothe'"
LEGAL DESCRIPTION
Sri RaMq
1.2
TOW Depth awn Ongnal Qeee
10
GPose
Ft.
Blxr La �aMran 6 s
Forest Creek
Depth W p hottan hentO^g'ul a'eM
orna Cato Deman Me
3 FI.
7 FL
Townwp Ro"
se,xW
F.I aanee amve onynai yeas
Grew Lergn'
.5-1 Ft.
45 Ft.
Q New ❑ Upgrade
Grey an=
whor a wa
oetance wrwaan area,Well:
3 Ft.
1
FI
C:eernramn (Pnwa A. S. C)
Tsai Deptn
Caaap m
TaMI eoaprppon aiea
P" MaterW
Private
311
Fl.
310.2 F,
630 FIS
ASTM D3034 PVC
Dow
Data cnMO
SWoe WeW LevellnaWNr
Dale IMWNO
MW
10/1/04
266 FL
Glacier Excavating
416.7/2009
Yard
Pump sr at
arrq Nrgnt A 3m
TANK
10 CPM
fl.
>2 F4
SEPARATION DISTANCES
0 septic ❑ Holding ❑ S.T.E P. ❑ Other:
To
Septic
Absorption
Lift
Holding
uhlwPrrvaW
0aw
pa"T
Fmm
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,500 Gai
Ma1Mai
Nunnr aCanprtmenM
was
>100'
>100'
N/A
N/A
>25'
Steel
Two (2)
statacewrer
>100'
>100'
N/A
NIA
LIFT STATION
ve
w waar
Loltme
>5'
>10'
N/A
N/A
Gai
'Pump tri Mvr r
'Pump olr wvr el
1pn carr rrm N
Fa'"0'ti0n
>5'
>1V
NIA
N/A
n
n
in
Pump Mus 8 MOoai
Elu lnS,WO na prlanlN eY
cu,mor.n
None
Noted
Rainailts
BENCH MARK
l.wuon ra DeFuquan.
Bottom Level Finished Floor.
r,nW •vauan
100.0 FL
Inspections performed by: A. Harala
Dates: 1M 416/09
2"a 417/09
'
Development Services Department Approval
.OurA 4gIH
..N
Conditional Approval
Date:
N N ..•
.�
A . MIQIAR E ANDERSON; v
*`- I CE-4381
100, a.. as
•�� fpFB'��L
Reviewed and approved by:
Date:g"2y-
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KLINGLER STREET
(!t
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A
W
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO80258
N /N UU
1,500 Galton
Seotic Tank
Page 3 of 3
PID No. 015-292-54
97.0 98.0
Finished Grade
Existing Grade
Geotextile Fabric
93.8 Drainfield Rock
86.8
78.0 45' (Trench Length)
PROFILE AS -BUILT -
No Scale
93.8
r
49th ••E
..1. .... ..... .. z RA...
........................................
9, :, MICIUEL E. AN➢ERSnN j
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
((cep
1-
2
3
4
5
6
7
8
9
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 6, DITTRICH SUBDIVISION
PERFORMED FOR: THE DITTRIcH COMPANY
DATE: 4/06/09 PROJECT No.:
PARCEL ID#: TECHNICIAN: A. HARALA
TEST HOLE 3
OB/OG
n'
POORLY GRADED SAND
:' •' SP
d a
BOH @ 7'
SLOPE
E7
MICHAEL E. ANDERSON
No. CE -4381 .
SITE PAN
SEE SITE PLAN i
k
Y
i
10 WAS GROUND WATER EN�COL^PTERED° No
(.
IF YES yRT IAT DEPHI"
DEPTH OF WATER AFTER MONITORING: VARIES
I I DATE OF MONITORING:
13
14
15
16
17
18
19
20
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
Dy ATERD
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
4/06
1
1:14/1:24
10
.75"/10.25"
8.5"
2
1:25/1:35
10
.68"/10.68"
9.0"
3
1:36/1:46
10
.63"/10.38"
8.75"
4
1:47/1:57
10
.68"/10.36"
8.68"
5
1:58/2:08
10
.75"/10.38"
8.63"
6
2:09/2:19
10
.68"/10.31
8.63"
PERCOLATION RATE* 1.2 (MIN/INCH) PERC. HOLE DIA g. 11 !INCHES)
TEST RUN BETWEEN. and 8 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
SOILS ARE THE SAME AS ENCOUNTERED IN TEST HOLES N0. I AND 2.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 9/21/09
M -W Drilling, Inc.
*P.O. Box 110378• Anchorage, AK 99511•
•907-345-4000 • 907-345-3287 Fax*
Job No.: "160 Parcel No.: 015-292-29 Permit No. SwO40210
Groundwater Well As -Built & Loi
•Well Owner: Di=. ch
•Legal Description: Dittrich Subdivi
Construction
•Use of Well.
Domestic
•lloleDepth: 311' •CasingSt:t: 6^ ♦Cased To: 31026' •Alaterial. AS3Steel
• Drul Alethod. Alr Rotary
— Perf.
♦ well completion- Open end X Screen Perforated Afetlood.
•Screen/Perforadondeseriptlon: None
•CtoutNotes. (I)Sad-No.8bentonitatmuies
♦ Notes:
• R erl Development: Method. Air surge Nara:
• Static water level (SWI) 266' (•"ve) (below) fop of cash: (TOG7.
•wellrleldfeslat 10 p1lonsperinhrute(GP.11)/tal;eq, eritewP4G )for 1 hours
with 10011. ofdrowdown(DD)ftomstaticlevel(SHI).
•.Nerhod: Airlift
• Date ofeomplerion: 01 October2004 • Pump install.
-
Well Loa
Depth In feet from
top ofeasin .
Details of formations penetrated,size
ofmaleriaLcolor and bardness.
0
TO
2.5
Casing stickup
2.5
TO
4
Organics
_ 4
TO
18
Silt: dry
18
TO
50
Silt: cobble gravel, wet
50
TO
66
Water ravel: slightly sandy,
5 gpm, static water level = 481
66
TO
128
Silt _gravel: dry
128
TO
190
Silty clay: wet, gravell
190
TO
212
Sandy silt: dry
212
TO
235
Silty le boulders
235
TO
268
Silt water gmvel (2 m)
268
TO
297
Boulder gravel: silty, damp
29.7
TO
310
'Vater gravel
•
E. % ES78EAG
resident; !.4—W-Dnuing; !
NGWA Oertifred CortYractp
Ct.rtilicalc.No9._$/,�
Contractors Lfccnse No. 1000
TOAYAF
TO
TO
TO
TO
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW080258
Legal Description: FOREST CREEK LOT 6
Design Engineer: 0014 ANDERSON ENGINEERING
Owner Name: THE DITTRICH COMPANY
Owner Address: PO BOX 90411
ANCHORAGE. AK 99509 -
Date Issued: Dec 29, 2008
Expiration Date: Dec 29, 2009
Parcel ID: 015-292-54
Site Address: NHN KLINGLER STREET
Lot Size: 40130 SO. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
A. THE ORIGINAL TEST HOLES CAN NOT BE LOCATED. THE ENGINEER SHALL PERFORM ADDITIONAL
PERCOLATION TESTS AS NEEDED PRIOR TO CONSTRUCTION OF AND WITHIN 30 FEET OF THE SEPTIC
FIELDS (PROPOSED ACTIVE AND RESERVE). PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE
AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE
SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL.
y/a/04 Des:�h r e v r� t:d 40 c"cco wio dA rd UcJe d Ae we , G��
Received
Issued
Date: _ H5 -0S
Date: /a ey
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: March 31, 2009
TO: Jay Crewdson, P.E.
FROM: Mike Anderson, P.E.
SUBJECT: Lot 6, Forest Creek Subdivision
Septic System Construction Permit
Well and Septic System Permit No. SW080258
We have modified the location of the septic system absorption trench to the north
side of the proposed house location. The monitor tube and test pit location are still
at the site and can be found. A percolation test will be performed at the time of
construction to verify the soil material at the west end of the proposed trench meets
design criteria as the entire trench does not fall within 30' of the existing test hole.
The ground slope at the north side of the new house is much shallower than other
areas and more conducive to construction of the new trench. The new location is
shown on the attached drawings and does not conflict with wells in the area. Please
modify the permit to allow placement of the new trench at the revised location.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-292-54
Property owner(s) The Dittrich Company Day phone 632-8790
Mailing address P.O. Brox 90411 Anchorage, AK Zip Code 99509
Site address W"a Klingler Street Zip Code 99516
Legal description (Sub'd., Block & Lot) Forest Creek, Lot 6
Legal description (Township, Range & Section)
Lot Size 40,130 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
ID
Septic Tank
ll
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms Five (5)
THIS APPLICATION IS AN:
Initial
0
Upgrade
❑
Renewal
❑
I certify that the above Information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Date of Payment:
Date of Payment:
Receipt Number. tell v'J Receipt Number.
(Rev. 11105)
ANDERSON ENGINEERING
P.O. sox 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
December 12, 2008
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 6, Forest Creek Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 6, Forest Creek Subdivision intends to construct a new five -bedroom
home on the lot. We are therefore requesting a permit be issued for the construction of
a new septic system to accommodate the home. The attached Site Plan and backup
documentation identify the location and configuration of the existing well and septic
system along with the alternate site. Also identified on the plans are the existing wells
and septic systems on surrounding lots. No conflicts exist between the proposed well
and septic system and wells or septic systems on adjacent lots. Drainage arrows are
shown on the site plan showing the grade and direction of flow on the lot. The drainage
pattern will not be changed as a result of this project.
The test holes were placed on the lot in the area of the absorption trench and alternate
site during the subdivision phase. The logs indicate well graded sand (SP/SW) to
depths of 18'. The percolation rate of the soil was determined to be between 1 and 5
minutes per inch. No groundwater was found during the placement of the test hole and
none was noted during the monitoring period. An application rate of 1.2 gallons per day
per square foot was used in the design of the absorption system. We are proposing to
place a new 1,500 -gallon septic tank and a 45' long by 3' wide by 7' effective depth
absorption trench to treat and dispose of the effluent generated in the house. The
elevation of the distribution line in the absorption trench will be 3' below the surface and
the total depth will be 11'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be
placed over the absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the northwest.
The new trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. The new septic system will be constructed a
Lot 6, Forest Creek Subdivision
December 12, 2008
Page Two
minimum of 100' from all wells and any surface water and 10' the proposed and existing
water services in the area. The system will be constructed outside the Class B Wetland
Boundary shown on the Site Plan.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely, /�
:� z:
Michael E. Anderson, P.E.
Attachments
u# 49:n'�
V -'-A-' L A%CEaSC%
FtF_
TRACT A
(VACANT)
i O LOT 3 LOT 4 '
a
c
LOT 2 1 LOT 5
(VACANT) i
I =
LOT 1�
1 _
� � ter.
LO 6
IL: o
• r 49th
�Nu�-
f -u�
t^ y MIONEI E IINOERSW C �
SCALE I' = 100' •����. No. tc aer f ��
••p•�FESS;�.••
LOT 6, FOREST CREEK SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System
Perc. Rate: 1.2 Min./Inch 1,500 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 7' Drainfield Rock
5 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 625 SF Absorption Area
625 SF/14 SF/ LF = 44.6 LF Trench Length
THEREFORE: Construct a 45' Long x 3' Wide x 7' Effective Depth Absorption Trench at the Location
Shown. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be
11' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
Natural
2'6" Backfill
Geotextile
Fabric
6" O 4" Perforated
PVC (Holes Down)
TO"
3'
Drainfield Rock
TYPICAL DEEP TRENCH SECTION •••. riot*
(NO SCALE) �.�P(E......, 4
tom.''
NOTE: Grade Area Over Trench to Drain Away. ,y
Minimum 6' Separation From Bedrock. ',... ,'. 49..'
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area. """"""'"""""" ""
MKAUEL EAN;;7G: `7
Minimum 100' Separation From Surface Water or Streams.•��i�� :_ No. m4mt
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT
ARTMENT
4700 SOUTH BRAGAW STREET SERVICES ANCHORAGE. ALASKA 99519-6650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Jamie Dittrich DATE PERFORMED: 2r/2DD4
LEGAL DESCRIPTION: Proposed Lot 6 Dittrich Subdivision
TEST HOLE # 1 SLOPE SITE PLAN
goOG/OL I
I .
d
2
c '
4 �• w
N
5
d
n
6 SMlSP
Silty Sand to Poorly
7 Graded Sand
.o
a
8
WAS GROUNDWATER
9 ENCOUNTERED? No
10 Some Gravel IF YES, WHAT DEPTH?
II DEPTH OF WATER None
AFTER MONITORING:
12 DATE: 224/2004
S 7slzooy�
114 E
Lt 0.
tl 10C/NEI GAIIDFR9M
16 �L��L No. CE4MI F+� J
17 ° . 1) 1111k.... mai
BOH @ 19'
S
L
0
P
E
SEE SITE PLAN
FOR TEST HOLE LOCATION
Varies
PERC RATE: 1_3 MIN./INCH PERC. HOLE DIAMETER:8.
TEST RUN BETWEEN 4.5 FT. AND 5.5 T.
COMMENTS: Test Hole Pre Soaked Prior to Test
TEST PERFORMED BY: ALAN HARALA 1, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2242004
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650
SOILS LOG - PERCOLATION TEST
49th
A
d �..y9.�..�MICKcAMERSON
. �t
17J .d O
BOH @ 20'
PERC RATE: 1_3 MIN./INCH PERC. HOLE DIAMETER:80
_
TEST RUN BETWEEN 4.5 FT. AND 5.5 T.
COMMENTS: Test Hole Pre Soaked Prior to Test
TEST PERFORMED BY: ALAN HARALA I, MICHAFL F. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORCANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/24/2004
PERFORMED FOR: Jamie Dittrich
DATE PERFORMED 2nn0D4
LEGAL DESCRIPTION: Proposed Lot 6. Dittrich Subdivision
TEST HOLE # 2
SLOPE
SITE PLAN
I
OG/OL
2
0
3
SEE SITE PLAN
4
°
FOR TEST HOLE LOCATION
z
m
m
5
a
6
a
SwSP
Silty Sand to Poorly
7Graded
Sand
v Gray
8
WAS GROUNDWATER
9
ENCOUNTERED?
No
S
L
10
Some Gravel IF YES, WHAT DEPTH?
0
Varies
II
DEPTH OF WATER
None
P
• AFTER MONITORING:
E
12
o DATE:
2124/2004
S 15 T.°0'F
49th
A
d �..y9.�..�MICKcAMERSON
. �t
17J .d O
BOH @ 20'
PERC RATE: 1_3 MIN./INCH PERC. HOLE DIAMETER:80
_
TEST RUN BETWEEN 4.5 FT. AND 5.5 T.
COMMENTS: Test Hole Pre Soaked Prior to Test
TEST PERFORMED BY: ALAN HARALA I, MICHAFL F. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORCANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/24/2004
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 6, FOREST CREEK SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a new
1,500 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 45' long X 3' wide X 7' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 3' below the existing ground
surface. Total depth of the trench will be 11' below the existing ground
surface. The new absorption trench and septic tank must be placed a
minimum of 100' from all private wells and any surface water in the area and
10' from the water service line proposed for the lot. A minimum of 3' of cover
is required over the absorption trench and 4' of cover over the septic tank.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Building Safety On -Site Water and Wastewater
Program for system installations. Owners installing their own systems must
receive prior approval from the On -Site Water and Wastewater Program
before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,500 -gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 6, Forest Creek
December 12, 2008
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 1 00'away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
Lot 6, Forest Creek
December 12, 2008
Page 3 of 3
MATERIAL SPECIFICATIONS:
Septic tanks must be constructed by a municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
189
®Municipality ®i Ach®rag r"
On -Site Water and Wastewater Program a SES Zol� >`
(907) 343-7904�d s • F e T�
CERTIFICATE OF ON-SITE SYSTEMS APP _ 4�
Parcel I.D. 015-292-54 Expiration Date: 1 Z '--12— -�9
1. GENERAL INFORMATION
Complete legal description Forest Creek Lot 6
Location (site address) 10160 Klingler Street
Current Property owner(s) Peter and Dawn Harriman Day phone
Mailing address 10160 Klingler Street
Real Estate Agent Herington & Company. Day phone 263-9333
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
Individual Well
®
Holding Tank
❑
Individual Water Storage
❑
Community
❑
Community Class _ Well
❑
Public Sewer
❑
Public Water System
❑
WaiverNariance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number
COSA# lLil?-
Date:
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date y_J/�
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assess/ment 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen AM, 0 a.L\ \
encroachments, deficiencies or discrepancies exist.
4T� 1'��
6. DSD SIGNATURE
L . DUFFUS
System #1 Approved for bedrooms. NNETH , 16
System #2 Approved for bedrooms. IC/
Disapproved.\.��►�
Conditional approval for bedrooms, with the following stipulations:
Q0.
L ��
O)V-
r
T
R Afyp Mr
OGRA 4.
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet 10-10-12.doc
X Nitrate Advisory
Arsenic Advisory
Other
Legal Description:
Forest creek Lot 6
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 10/1/04
Total depth 311 ft
Cased to 310.2 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 30 in.
Date of flow test for COSA 8/30/19
Static water level at beginning of test 267 ft.
Comments
B. TANK DATA
Age of tank(s) 10 years
Tank type/material Septic/Steel
49"
Measured operating fluid level in septic tank
11 Standpipes/foundation cleanout per record drawing
Date of pumping 8/29/19
D. ABSORPTION FIELD DATA
Which system tested (date installed) 4/7/09
ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 3 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 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-292-54
of Structure served by this system 1
Well production at time of test 3.8 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes No
`Coliform bacteria is Negative
Nitrate (-79 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 8/30/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/30/19
Results Q Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 10 in
Elapsed time 158 min
Final fluid depth 0 in
Absorption rate 600+ ond
Any rejuvenation treatment (past 12 months)
If yes, enter date
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 if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
rO Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25'k] Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
0 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'
® Yes if No ft
Private Wells > 100' Yes if No
Water Main > 10'
® Yes if No ft
Community Wells > 200' Yes if No.
Water Service Line > 10'
® 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' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft Private Wells > 100' 0 Yes if No
Water Service Line > 10'
® Yes
if No
ft Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that 1 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
ft
10
M
ft
F ♦.
<`,-
*ECTION BY ENGINEER
ffuced hereto and as of the validation date shown belowl verify that my, investigation,
Wined in the Certificate of On-Site Systems Approval Guidelines for this application,
star supply and/or wastewater disposal system is (are), safe, functional and adequate
ims and type of structure indicated herein. I further verify that based on the information
1palty of Anchorage files and from: my investigation and inspection, the on-site water
x disposal system is(are) in compliance with all applicable Municipal and State codes,
ms in effect at the time of installation.
on Engineering Phone 522-7773
10723 Anchorage, AK 99524
ne Michael E. Anderson,.P.E. Date 11/23/15
®®®®f OF ®BBeB
:P �
ff more than 1 septic system Is on the lot:
COSA Checklist # of _
Structure served by this system
CertifiCe1e of On -Site Systems Approval, Checklist
Legal Description: Forest Creek, Lot 6
A. WELL DATA
Wen type Private If A, B, or C provide PWSID #
Date completed 10/1/04 Sanitary seal (Y/N) Y
Total depth 311 fL Cased to 310:2 ft
FROM WELL LOG
Date of test
10/1/04
Static water level 266 It
Well production 10 g.p.m.
Parcel ID- 015-292-54
Well Log (Y/N) , Y
Wires Properly protected (Y/N)
Casing height (above ground) >18 in.
AT INSPECTION
11/18/15
-
2516 ft
4.7 — — 9 -pm.
WATER SAMPLE.(4ESULTS:
fr,
Coliform 0 _ colonies/100 mL Nitrate "j� mgLvlf
Arsenic D �g/L Date of sample: 11/17/2015 Collected by: Andersdril Ettgrg.
B. SEPTICINOLDING TANK.DATA
Tank.Type/Material Septic/Steel Date installed 4/612009-
Tank
/6%2009-Tank size 1,500 �. Number of Compartments : t Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 7/17115 pumper A Plus Home Services
C. ABSORPTION FIELD..DATA
Date installed 4/7/09 Soil rating (g.p.d.e orje/bdrm) 1.2 GPD System type Deep Trench
Length 45 ft. Width 3 ft. Gravel below p' ft.
Total depth 10-19ft off. absorption area 630 ftz . Monitoring tube ,Y Dep
r ion Direr field
11/1$!15 Pass`"" ,45" pp.ry
Date ofdequacy test Results (Pass/Fail) Fol bedrooms
Fluid depth in absorption field before test 0 in. Water added 794 "" gal. New depth "a 5'
Elapsed Time: 70 min. Finai fluid depth _ 0. in. Absorption rate �' p.d.
Any rejuvenation -treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION '
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tankIflift station on lot
Aminal Containment areas
>100,
On adjacent lots >
Absorption field on lot
5-100
On adjacent lots' >100`
Public sewer main
r`
>100
�;:. .
Public sewer manhoWdeanout >100
Sewer /septic service line>2_
5
Holding tank r >5'
>50,.
&A —I- -->100'
excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5
Water main >1 Water service line >
Weiss on,edjacent,lots .>100'
ABSORPTION FIELD ON LOT TO:
Absorption field >5'
Surface water >400'
Property line >10' ' Building foundation > Water main > -
Water Service 114- >10' Surface water >100' Driveway. paridrglvAide storage '10'
Curtain.drain. None Noted , ;Wells on adjacent lots -.,.>l 00'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I c¢Xtffy that f have determined through field inspections and +aao�aiaa�a
revrew=l6f Munioal t000rds_Mat.the:abova systems are in. :.,�E �F a,!�
cohformarke witty MOA COSA guidelines imeflect on this date. St��� X00 b '•
Engineefs Printed Name Michael E. Anderson,"P.E. s 49tHle
+
_. ��?/15 _ _ _
Date 1 1 F r MICHAEL E. ANDERSON tt j
-C -4381
COSA broom sheet_10-10-12doc
Parcell.D. 015-292-54
Municipality of Anchorage o
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: / C) "/ 6 " / �
FOREST CREEK LOT 6
10160 KLINGLER RD., ANCHORAGE, AK 99516
Current Property owner(s) HARVEY RICHARD
Mailing address
Real Estate Agent MARY STEPHENS
2. TYPE OF DWELLING:
lx Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone 273-7706
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual 0
Individual Water Storage
❑
Holding Tank ❑
Community Class Well
❑
Community ❑
Public water System
❑
Pubiic Sewer ❑
WaiverNariance request for: NONE
Distance: ---
-1116V(3
Received by: L_
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ 010
Date of Payment
Receipt Number Ogcr) 46
COSA# OSZ 1'Qw5N
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Phone 279-3916
Engineer's Printed Name LARS SPURKLAND Date 10/16/12
6. DSD SIGNATURE
e�.4
�p
1/ System #1 Approved for bedrooms 1r E. SPURKLA,%'D.•a 1;0
System #2 Approved for _ bedrooms i+ . �J91500
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: IL) � �� Original Certificate Date: :7 - / i0 — /
Th unicipality o nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineef's work.
ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
OOSA blue sheet f c
Nitrate Advisory
Arsenic Advisory _
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: FOREST CREEK LOT 6
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # ---
Date
Date completed 10/1/04 Sanitary seal (Y/N) Y
Total depth 311 ft. Cased to 310 ft
Date of test
Static water level
Well production
FROM WELL LOG
10/1104
266
10
WATER SAMPLE RESULTS
ft.
9 -
p.m -
Coliform NEG colonies/100 mL Nitrate 1.45 mg/L
Arsenic ND ug/L Date of sample: 6/18/13
Parcel ID: 015-292-54
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION
6/18/13
262
4.4
ft.
Collected by: ANSON MOXNESS
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/ STEEL Date installed 4/6/09
Tank size 1500 gal. Number of Compartments Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 7/XX/13 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed 4/7/09 Soil rating (g.p.d./fe orfe/bdrm) 1.2 System type TRENCH
Length 45 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth 10.2 ft. Eff. absorption area 630 fe Monitoring tube Y Depression over field N
Date of adequacy test 6/18/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 610 gal. New depth 17 in.
Elapsed Time: 10 min. Final fluid depth 6 in. Absorption rate >= 600 9 p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date
D. LIFT STATION
Date installed — Size in gallons _
"Pump on" level at in. "Pump off' level at
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested --
Septic
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main »5
Sewer /septic service line >25
Animal containment areas >50
Manhole/Access (Y/N) _
in. High water alarm level at —
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout >100,
Holding tank NA
Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Properly line >5
Water main NA Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10'
Water Service line >10 Surface water >100'(N.O.)
>50' (N.O.) >100'
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i certify that t 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.
Engineer's Printed Name LARS SPURKAND
Date 7/8/13
COSA brown sheet_10-10-12.doc
Absorption field >5
Surface water >100' (N.O.)
Water main NA
Driveway, parking/vehicle storage 25
in.
A4." 1�t
RS .SPURKLAND. r
11 00
,,1��PIi0F�S50NP��-C'~
Parcel I.D. 01 -292-54
1. GENERAL INFORMATION
COSA # Q!2 D '; 3 7
Expiration Date: _J.2 — �z .Z — 0 ci
Complete legal description Lot 6, Forest Creek Subdivision
Location (site address) 10160 lCingler Street
Current Property owners) The Dittrich Company Day phone 632-6970
Mailing address P.O. Box 90411 Anchorage, AK 99509
Lending agency Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
2. NUMBER OF BEDROOMS:
Municipality of Anchorage
Development Services Department
3. TYPE OF WATER SUPPLY:
Building Safety Division
Onsite Water and Wastewater Program
TYPE OF WASTEWATER DISPOSAL:
4700 Bragaw Street
P.O. Box 196650
�,
0•
S
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Vk
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Individual Water Storage
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01 -292-54
1. GENERAL INFORMATION
COSA # Q!2 D '; 3 7
Expiration Date: _J.2 — �z .Z — 0 ci
Complete legal description Lot 6, Forest Creek Subdivision
Location (site address) 10160 lCingler Street
Current Property owners) The Dittrich Company Day phone 632-6970
Mailing address P.O. Box 90411 Anchorage, AK 99509
Lending agency Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
2. NUMBER OF BEDROOMS:
Five (5)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation. '.
Name of Finn Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
b. DSD SIGNATURE
V IGApproved for L bedrooms.
Phone 522-7773
Date 9121/09
P�E...�..1. I
v O q Lqos�,'
'1 49MIf
SNI IN 1� •(N/I�N�,.{///y*
._MKXA.EL E ANDERSON
Disapproved. 9411 ;`
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: //U c Original Certificate Date: 9—.2
(R.. 11W)
Municipality of Anchorage .>
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program • ' • "
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 6. Forest CreekSubdwision Parcel ID: 015-292-54
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed 1on104 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 311 ft. Cased to 310.2 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 10/1104
Static water level 266
Well production 10 9.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform --E—colonies/1 00 mL Nitrate 1.29 mg/L Other bacteria 0 colonies/100 mL
Arsenic: N/D mg/l Date of sample: 9/6109 Collected by: MEA
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/steel Date installed 4/6/09
Tank size .1,500 gal. Number of Compartments Two Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date lnstalled 417109 Soil rating (g.p.d./ft2 or ft2/bdrn)12 GPD/SF System type Deep Trench
Length 45 ft. Width 3 ft. Gravel below pipe 7 ft.
i
Total depth 10-11 ft. Eff. absorption area 630 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results(Pass/Fail) For bedrooms
Fluid depth In absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
i
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
'Pump on' level at_In. 'Pump off level at —in.
High water alarm level at In.
Datum Cycles tested
Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100•
Public sewer main NIA
Public sewer manhole/cleanout NIA
Sewer /septic service line >2T
Holding tank N/A
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line>5_
Absorption field >5'
Water main >70, Water service line
>10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property fine >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100'
Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review.of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date M2109
COSA Fee $ -F— "V 3 lle"J
Date of Payment
Receipt Number f y
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
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