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Home My WebLink AboutT12N R3W SEC 15 BLM LT 63ATI2N ction 15 Lo1- 63 S132' #015-052-36 Permit Number. SW020009 Name: KIRK DAVIDSON 6900 JOSEPH ANCH. 99518 Phorm: No, of Bedrooms: (907) 240-3855 4 LEGAL DESCRIPTION B Jack: Lot: Subdivtaion: - 63 SOUTH 132' Townlhip: T12N Rongo: R3W S,c~on: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wast°water Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage,ak.us (907) 343-7904 On-Site Wastewater Disposal System and/or Well Inspection Report PID Numben 015-052-36 WELL: · New [] Upgrade PRIVATE 224 ~ 222 ,t ALPINE DRILUNG 4/9/2002 Wastewater System: · New O Page I of 3 r"l Upgrade ABSORPTION FIELD ~Deep Trench DShallow Trench r'tBed nUound 15 -~DE 0.8 ~o/~... 12.1 MAX ~ 8.03 MAX ~ 4.08 15 r..~.~ ,~, .~.~ ....: ~,~ ~-w~ SEE DWG ~ 75 5 ~ 1 - 750 ~. ~ D 3034/ F-810 163 ~ DENALI ~VATION 4/18/02 ~,~lj UNKNOWN 5O SEPARATION DISTANCES Well 100'+ 100'+ -- -- 25'+ Sud'ece W=ter 100'+ 100'+ -- -- -- Lot Un° $'+ 10'-t- -- - - Foundotion 5'4- 10'+ -- -- -- Curtaln Dm~n NONE KNOWq .... ! Remarks: TANK · Sep~c 0 Holding ri S.T,r p. [3 Other ANCHORAGE TANK 1250 STEEL LIFT STATION BENCH MARK BO'I'rOM OF TANK Inspections performed by: AKWWC, INC. Dates: 1st 4/18/02 2nd 4/24/02 3rd 7/24/02 Development Sjervices Department Approval . . (.-,.R~viewed,~,) and approved by: ~'J~{-~/'~ Dote: I ///, P[RWff NUMBER: SW020019 AS-BUILT DRAWING pARCEL ID NLAIBER: 015-052-36 \ \ \ \ \ E. 97th AVENUE (UNDEV[LOP£D) ST1 43.67 47.14 ST2 49.52 54.05 DBL1 51.69 56.05 ~ DBL2 53.21 56.76 C01 93.91 98.78 MT1 91.41 97.65 C02 48.33 29,11 MT2 50.03 27,60 FCO 31.25 .32.93 ~T%/,4/2002 PR~ED FOR: PHONE NUMBS: P~E NUMBS: T12N, R3W, SECTION 15; LOT 63 U~$~"" -~ '"'~ AS-BUILT OF WELL AND SEPTIC SYSTEM LOCATION AS-BUILT DRAWING SW020009 01,5-052-56 TOP OF TANK AT--~ INLET ,- 92.94 ~. / INVERT OF BUNG J AT INLET ,- 92.45 FINAL NEW 1250 GALLON SEPTIC TANK GRADE ~ 98.54 - 98.99 ToOP OF TANK AT UTLET -, 92.89 ~.-INVERT OF BUN(; AT OUTLET - 92.21 ORIGINAL GRADE -- '-~ 91.9 - 98.52 BOTTOM OFj' TRENCH - 86.41 I~' ~ /FINAL GRADE - 94.70 - 98.97 /FILTER F'AB RIi. :"'"" '~ ~ I~ OF PIPE - 90.49 HOLE RELATIVE BOTTOM OF ¥ir..~¥ HOLE__ El. EVA'lION - 80.52 ALASI(A WATER & WASTEWATER CONSULTANTS, INC. PREPAREO FOR: PHONE NUMBER: KIRK DAVIDSON (907) 240-5,855 LEGN. DESCRIPTION: T12N, RSW, SECTION 15; LOT 65 TYPE OF WORK: AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 10/14/2002 DRAWN B.S.G. N.T.S. PAGE NUMB[R: 3OF5 LOT 64A NORTH ,33', LOT 63 LOT 63A ~ 39,633 ~.f. ~ TG.EC~Id & ~,.rC EM~]E)ff N 90~X)'OO°E LOT 65B I t~'C>d~6~'1) I,bY_,L~)~TIC ~T 96TH AVENUE Lon~ · Associates inc. 115~ Dali Avenue, ~ohorage, ~aska 99515 u . _ ' to07) 522?476 Phone Regl~ered ~n= =u~eyo~ ~907)522 4625 Fax MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jan 22, 2002 Expiration Date: Jan 22, 2003 Permit Number: SW020009 ~Legal Description: T12N R3W SEC 15 LT 63 S132' Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Kirk Davidson Owner Address: 6900 Joseph Dr. Anchorage, AK 99518-0000 Parcel ID: 015-052-36 Site Address: Lot Size: 22975 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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 closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: //22/02 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci,anchorage.ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number Properly owner(s) KIRK DAVIDSON Day phone 940-3833 Mailing address(1) 6900 JOSEPH DRIVE * ANCHORAGE. AK Mailing address (2) Legal description (Lot, Block & Sub'd.) LOT 63 ~ i~_~~ I Zip Code 99518 Legal description (Section, Township & Range) Lot Size ~)~ -~ ~ Acres/Sq. Ft. SECTION 15. T12N. R3W Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade 4 THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi [~] Water Softening Unit 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. ALASKA WATER &: WASTEWATER CONSULTANTS, INC, (Cigneturc of propody owncr or euthorizcd egcnt) Permit Fees: Date of Payment: Receipt Number:. Waiver Fees: Date of Payment: Receipt Number:. ALASIO WATER & WASTEWATER CONSULTANTS, INC. January 14, 2002 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Ak 99519-6650 Reft Proposed Well and Septic System Design for TI2N, R3W, Section 15; Lot 63 To whom it may concern: The proposed 4 bedroom house will be served by a community water system and a private septic system. Two test holes were excavated in the area of the proposed septic system. The septic system will be designed around the 30 foot radii of these test holes. We are proposing that a 1250 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs w. hich shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 0.8 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 2.85 & 24 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 (average) c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 750 ft2 f. Total Depth: 11 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.50 j. Minimum Length: 75 feet long k Effective absorption area = 750 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: The area for the proposed septic system is mostly fiat; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. It' you have any questions, please contact us at 337-6179. Thank you for your assistance. ~r.e)/~V~S.Sincerely, ~ Pres~d2nt~j ~j NOTE: Attached is a site plan drawing, a design drawing, two soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com LOT ~B T12N. R3W, SEC 15 ~ 57 T12N, R3W. SEC 15 j I // LOT 55 /! T12N, R,,~/, SEC 15 ! // [NOl.t: ~ PJOUS NFOr_DS 1~ ! lB[ FLAGGEO BY A SURV~'YORI / PRIOR TO CONSTR~ ~ t'Y' / \ WELL RADIUS NE,.~US T~ ........... ;"-'------'~ , ~,~ ~ ~,u~/" E. 97th AVENUE ~% ~ J_./ T12N, R~, S~ -, F4 PROPOS[D BEDROOM ~--LOT r SHOWN HOUSE/' ON ~ID MAP. X% .... 'N~-.'~'/--PROPOSEJ) I ,, '----'w" %, LOT 72 T12N, RoW. SEC 15 ALASI~ WATER & WASTEWATER CONSULTANTS, INC. PR~PA,RED FOR PHONE NUMBER: KIRK DAVIDSON (907) 240-3833 I rGAg. D~ORI~TION: T12N. R3W, SECTION 15; LOT 63 TYPE OF WORK: j\ ~/~4/2oo2 C.J.O./J.LM. 1" = 100' PAGE N U Idi~[.R: 1 OF'2 LOT54 T12N, R3W. SEC 15 LOT 59 T12N, R3W, SEC 15 LOT 62A T12N, R3W. SrO 15 LOT T12N, R3W. $1;'C 15 SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM LOT 70 T12N, R~W, SEC 15 lIN 'file V~CiN/TY OF' TH[' SEPT/C NOTE: THE CONTRACTOR SHALL HAVE ALL LOT UNES LBT A REGISTERED LAN SYSTEM FLAGGED ICONSTRUCTION. D SURVEYOR PRIOR TO ANY rELTi ISl1 ADD 4 KIRK DAVIDSON ~v,o~£ .uu~: u:c,~. O~:R~noN: 240--$835 P~E Nuua~: 2 OF2 T12N, RSW, SECTION 15: LOT 65 ~E OF WO~: DESIGN OF PROPOSED WE~ AND SEPTIC SYSTE~ LOCATION ! ALASKA WATEK & WASTEWA.~ CONSULTANTS, INC. ISmL LOG PERCO~TION TESTI g~,~ ~-~ LEGAL DESCRIPTION: T12N, RSW, SE~ION 15; LOT 6~, ~....~ ..... PERFORMED FOR: KIRK DA~DSON ~ -~' ML B.O.H. SOIL CLASSIFICATIONS i~ GW ---- ..... -- -- _- ORG :':=%,':.~, eL GP ML GM CL · , GC OL "o SW NH ': t':;' SP CH SM OH SC DEPTH TO DATE GROUNDWATER DRY 11/24/00 DRY 11/28/00 DRY 12/4/00 PROPOSED /-LOT UNE SHOWN /--~ BEDROOM ........ &- ........ .///, //,.. //~, //,, .. /,, //.% /,,, /, E. _.9_'LLh__AVE N U E BE VACATED. ; TEST ~O,r LOC~ONS ~ ~SITF PLANI ^~ ~o~ ua~. I I' = I00' I DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 11/28/00 1 2:47 6' 2 2:57 10 I 1/2' 4 I/2' 3 2:57 6' 4 3:07 10 1 3/4' 4 1/4' 5 5:07 6' 6 3:17 10 2" 4' 7 3:17 6" ~ 8 5:27 10 2 1/4' 3 3/4' 9 3:27 6' ~ 10 3:37 10 2 1/2" 3 1/2' 11 3:37 -- 6" ~ 12 3:47 10 2 1/2" 3 1/2' PERCOLATION RATE 2.85 (MIN./INCH) PERC. HOLE DIA. 6' ,(INCHES) 20 TEST RUN BETWEEN 7.5 FT. AND 8.0 FT. COMMENTS: PERC-HOLE WAS PRE-SOAKED FOR 4+ HOURS PERFORMED ny ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W~S JP'ERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEMNES IN EFFECT ON THIS DATE: /Z./~-'/~ PHONE (go7) ,3,37-6179 * Y~ (907) ~38-~246 ~ SOIL LOG-- PERCO~TION TEST~~' LEGAL DESCRIPTION: T12N, R3W, SE~ON 15; LOT 63,~ PERFORMED FOR: KIRK DA~DSON ~ DATE PERFORMED: 11/24/00 DEPT ~ (,.i~ =~ o.~,cs J TEST HOLE ~2 J 2-- ML SOIL C~SSIFICATIONS SM B.O.H. ~ GW -- ..... ---- -_-- ORG ~ ~P qTITIT~ ML GM CL GC OL SW MH SP CH , SM OH SC DEPTH TO GROUNDWATER DATE DRY 11/24/00 DRY 11/28/00 DRY 12/4/00 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (HINUTES) READING (INCHES) 11/28/00 1 2:45 6# 2 3:15 30 4 3/4' I 1/4' 3 3:15 ... 6' 4 3:45 30 4 3/4' I 1/4' 5 3:45 6' 6 4:15 30 4 3/4' 1 1/4' 19-- PERCOLATION RATE 24 (HIN./INCH) PERC. HOLE DIA. 6" (INCHES) 2O TEST RUN BETWEEN 7.5 FT. AND 8.0 FT. COMMENTS: PERC-HOLE WAS PRE-SOAKED FOR 4+ HOURS PERFORMED BY ALASKA WATER & WASTEWATER I. JEFFREY A. GARNESS, CERT]~' THAT THIS W~SkERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: IZ-[~/Oi) ° Municipality of Anchorage Department of Health and Human Services . ' - 825 'L" Street . P.O. Box 196650 Anchoraoe. Alaska 99519-6650 Rick Myatrom h~ p~/w~v.cl.anc~ea~.ak.u~ Mayor Permit Number:. #SW 020009 Date of I~sue: 1-22..02 Date Started: 4-9-0~. Date Completed: ~.9-0~ Parcel Identification Number:. 015-052-36 well located at approv~ permk location? ~ Ye~ [] No Method orDrilling [] air rotan7 [] c~ble tool Casing type: Wall Thickness: .250 inches Dhsmeter: _6 inches D~th: ~22 feet Liner Type:, Diameter: inches Depth: feet Casing atickup above ground: ~ feet Static water level (from ground level): 163 feet Pumping level: 220 feet after ~ hours pumping 50 gpm Recovery Rate: 50 gpm Method of Tenting: airlift Well Intake Opening Type: [] Open End [] Operi Hole [] Screened Start feet Stopped. fc~t [] Perforations Start fce~ Stopped fc~t Grout Type: Bentonite granules Volume: l~bg Depth: Start0 feet Stopped: feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: chlorine tablets Comments: Well Driller: A/o/r~ Ddllh'~ & Entorgtise$ ~ Box 110496 Anchorage Alaska 9951 L~gal D~cription: Tf2N R3W ,~C 15 LT 63 $132 l*rol~rty Owner Name & Address: K/t~ Davfdson 6900 do~eph Dc. Anchorage, Alas~ 99518 Borehole Data: Depth (fi) SoU Type, Thickness & Water S~am From To st/ck~up 0 2 g/ty cobb/y gm vel 2 7 sandy si/t 7 21 Silt 21 43 silty cobbly gm vel 43 142 gravelly silt 142 178 silty cobbty gm vel 178 190 gravelly silt 190 215 weter sand & gravel 215 224 Attention: The welt driller shall provide a well log to thc prol~'tty owner within 30 days of'complc'tlon and the pr~crty erGE Q` • Municipality of Anchorage On -Site Water and Wastewater Program =Y" (907) 343-7904 Certificate of 4n -Site Systems Approval �3 Parcel I.D. 015-052 1. GENERAL INFORMATION: Expiration Date: 1— -7 — 2.0-2 Z Complete legal description T12N R3W SECTION 15 BLM: LOT 63A Location (site address) 9580 Carlson Road *Anchorage Current Property owner(s) Kirk Davidson Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 240-3833 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Pq Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 50Waiver Fee $ _ Date of Payment 5 a ao n Date of Payment Receipt Number Q 00 1S G Receipt Number COSA # o S C a a f a 9 3 Waiver # .-A 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: - 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: S 12, Z In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the 0 F evaluation. Separation distances were measured to readily identifiable features. Hidden defects or� c ... • encroachments may exist that were not identified during the evaluation. The operational life of all wells O� T•• �� j S� r� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, (/)., T n Q T. groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), .......... .. 1• . .11 . .......... p), and the water usage of the family utilizing the system/s. These conditions can vary, and _ �� are outside the corifrol orvEG. Satisfactory test results do not guarantee future performance of the :X systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of • • • • . • • • • • • • . • . • • • the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in v() ' q CE 1I5' j:�/� the future. The content of this report is for the sole benefit of the person/party that retained GEG to 1 perform the evaluation. Reliance upon the information provided in this report by any other person or ��,''e; ,;"""' party including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. !rIGNATURE System#1 Approved forbedrooms System #2 Approved for bedrooms Disapproved `!F - Jp O�, S/ W, T TE Conditional approval for bedrooms, with the following 8 la ' o: E ,�STf: RAND rn qM .off By: 1 1,-, J) Original Certificate Date: b — —7— Z_6 Z27_ 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 engineers work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other_5� d — Tl C � �e A J VtS i 0vti. � Legal Description: T1 2N R3W SECTION 15 BLM; LOT 63A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 419102 Total depth ..224 ft Cased to 222 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 514122 Static water level at beginning of test 160.6 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 50" ❑ Standpipes/foundation cleanout per record drawing Date of pumping 9/27/21 D. ABSORPTION FIELD DATA TRENCH .�_'3 Parcel ID: 015-052-�!IQ Structure served by this system _ Well production at time of test 7.9+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes No t'Coliform bacteria is Negative Nitrate mg/L (Q Nitrate less than MRL (ND) Arsenic ug/L nj Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 5/4/22 C. LIFT STATION ❑ Required maintenance corn Age of lift station s Lift station materi Commen Which system tested (date installed) 7/24/02 Adequacy test date 5/4/22 ❑ ALL standpipes present per record drawing Results R Pass For 4 bedrooms Total measured depth from grade 13.0 ft (max) Fluid depth prior to test 34 in Measured depth to pipe invert from grade 3.91 ft (min) Water added 720 gal ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state New depth 41 in depth into effective Elapsed time 135 min ❑ Code -required soil cover over field Final fluid depth 37 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: COSA Checklist yellow sheet 7" 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 *5'+ ft Community Sewer Manhole/Cleanout > 100' QQ Yes if No ft R Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Cj✓ Yes if No ft Absorption Field on Lot > 100' Q Yes If No ft Holding Tank > 100' LR Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10'0 Yes Animal Containment > 50' P✓ Yes if No ft 0 Yes if No ft Water Service Line > 10' E] Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' From Absorption Field on Lot to: (Please enter distances if Community Sewer Main > 75' Q Yes if No ft My Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' [✓ Yes if No ft Property Line > 5' Q✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' [✓ Yes if No ft Water Main > 10'0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' E] 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' ✓Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' [] Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL 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. COSA Checklist yellow sheet moo'` •• ••'••:9s�4 *, G Q .J ^ f A. QO�arness,- G � CE-- 3 �G e 0 0 o f e s sioro-\zigg #AECC884 �d O CA w w :-T ., • CARLSON ROAD a,., DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite 907-343-7904 t Fax: 343-7997 Septic Tank Advisory Certificate of On -Site Systems Approval #OSC221243 Subdivision: T12N R3W Sec15 BLM lot 68A Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA i property is 20 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced.