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Home My WebLink AboutPOTTER CREEK TR 2Onsite Potter Creek TR 2 #020-271-02 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161352 PID Number: 020-271-02 Dwelling: Am Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade Name ROBERT TIERNEY ABSORPTION FIELD A Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 5.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.0 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot POTTER CREEK TR 2 Fill added above original grade 2.0 FL Gravel length 50 Ft. Township Range Section Gravel width 2.0 Ft Beds. Number of Lines 0 Distance between lines 0 Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 400 Ftp 1.0 0 Ft. Well 100'+ 100'+ 50'+ TANK ❑O Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer TANK Capacity 1000 Gal. Surface water 1001+ 1001+ANCH Material STEEL Number of compartments 2 Lot Line 10'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Curtain Drain LIN UN Remarks Pump on level at in Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 rank to drainfield 3034 Installer MIKE ANDERSON, P.E. Drainfield3034 Co/MT Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 103.8 ft Inspection 1" 12-20-16 12-20-16 Location and description 2`� das3'" 4'h GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Epg gQaY.s:Srampr Conditional Approval: Date d % MICHAEL N. ANDLRSON ; 41 �@ �2- Approved f Date Z Z . Y��+�i� Inspection Report _9-1-12.doc Permit No. OSP161352 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 Page 2 of 2 Legal Description: POTTER CREEK S/D , TR 2 MARK A B C01 75 71 TC01 80 75 MT 102 106 F W— \TH# MT1 II \ I I. • II I 1 I II I \ II II T'C I PID No.: 020-271-02 \ OLD CRIB DECOMMISSIONED PER UPC 1 BENCH, GARAGE SIAB DD EWAY V v \ I I NEW 1000 GALLON T 1 EXISTING ARTESION WELL \ WITH PACKER CONTAINED \ IN INSULATED WOOD BOX \ / 20' UTILIY EASEMENT ASBUILT ' _SCALE: =50' CO, VPos CVS 1 V a. rcm oaamoz �cZ riuisry canoEqC� �♦♦ ................ — .ow c. ixsuuno"-0 oac I !ER IPBRIC k iNSVUiiON V _ / •'�'. ♦. G. � � ; 49 rH � 1 ,PxR 04" 10 O'•aViICHAEL N. ANDERSON ,:'��iiN ♦ No E 9 59 'S♦ SEPTIC SECTION WATER ® 90 II/9/6 114 On -Site Wastewater Disposal System Permit ti�tenr MUNICIPALITY OF ANCHORAGE Development Services Department n ,, On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Department Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161352 Tax Code Number: 02027102000 Work Type: Septic Upgrade Permit Effective Dates: December 13, 2016 to December 13, 2017 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: POTTER CREEK Site Legal Address: POTTER CREEK TR 2 G:3640 Owner/Address: TIERNEY ROBERT L & CLAUDIA J 350 W FALLEN LEAF CIR WASILLAAK 996540000 Site Mailing Address: 7980 POTTER HEIGHTS DR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 217800 Total Bedrooms: 3 N Private Well N Water Storage 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received 154 Issued By: We e� 4M// Date: MUNICIPALITY OF Community Development Department Development Services Division 04 On -Site Water & Wastewater Program a: l .rfT Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-271-02 Property owner(s) ROBERT TIERNEY Day phone _ Mailina address 7980 POTTER HEIGHTS DIRT ANCHORAGE, ALASKA 99516 Site address SAME Legal description (Sub'd., Block & Lot) POTTER CREEK TR 2 Legal description (Township, Range & Section) Lot Size 217800 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank 0 Upgrade ❑X Duplex ElHolding (D) Tank F1Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ j -J = .,\\ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQU V ZT`f Distance: J i I certify that the above information is correct. I further certify that this is in'accordar applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -J(p� 34(r 1L) Date of Payment: 1?/121./ (r Receipt Numberilooq('k lgu Permit No. 0 S P 1ID I ZA92- Permit App_'- ::' - c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Dec 1. 2016 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic system Legal: Potter Creek TR 2 To Whom it may concern: This is a request for a new septic permit on the above referenced lot the old system is located inside the well radius and has failed. A new test hole was excavated in the backyard and found various types of sands and gravels, GM/SM. Damp soils were observed during the excavation at 12 feet but after the 7 day monitoring period the monitoring tube showed water at 10 feet. The pert rate was 2 minutes per inch at 4 feet below grade. A I -wide trench has been designed as a replacement trench. The tank will also be replaced due its location. Z The lot slopes to the west at about 4 to 5 percent, sec the drawing. This replacement system will not impact any of the neighboring properties due to the lot size. Please call me if you have any questions. Sincerely Mike Anderson, P.E. 4661 Natrona Ave. Anch, Ak 99516 DESIGN CRITERIA: MOUND OVER (TM#1) b RADE 3 BDRM X 150 = 450 GPDORG 2' INSULATION SOILS = 450/1.2 = 375 GPD FILTER FABRIC 375 GA/8 = 47' —1.0 4*0 PIPE 11GM/SM (1) TRENCH `SEWER ROCK 5.0' DEEP 4.0' EFFECTIVE —s.o 2.0' WIDE 12_o I 47' LONG 1,3 L f � � L)/D u / SEPTIC FIEL� TRACT 1 TRACT 1 Septic Design Prepared for .�pSILgII14 ROBERT TIERNEY .•�P�F"...� �S�•• POTTER CREEK TR 2 . 11;' Anch, Alaska 49 H • •......................................... ■ Michael N. Anderson, P.E. DATE: 12/4/2016 •� -MICHAEL CN. AOND6EORSON.' 4601 NATRONA AVEDRAWN: DJR ••: r ': ANCHORAGE, ALASKA 99516 • �•Z� S•� (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1"=100' EXISTING LOG CRIB TO BE DECOMMISSIONED PER THE UPC VACANT � op PROPOSED \� DRAINAGE FIELD \\ �� APPROX. LOCATION OF CREEK EASEMENT i PERTY UNE --,--..Q i - EXISTING WELLY 3XISTING 0 UTILITY\ 100' RADIUS �� BEDROOM EASEMENT -- —— ----- HOUSE 20 01;LRY EASEMENT — - — TRACT 2 VACANT VACANT NO OPEN WATER WITHIN 100' OR SLOPE GREATER THAN 25% WITHIN 50' OF THE PROPOSED RE TRACT 1 TRACT 1 Septic Design Prepared for .�pSILgII14 ROBERT TIERNEY .•�P�F"...� �S�•• POTTER CREEK TR 2 . 11;' Anch, Alaska 49 H • •......................................... ■ Michael N. Anderson, P.E. DATE: 12/4/2016 •� -MICHAEL CN. AOND6EORSON.' 4601 NATRONA AVEDRAWN: DJR ••: r ': ANCHORAGE, ALASKA 99516 • �•Z� S•� (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1"=100' 20' UTILITY EASEMENT EXISTING CRIB TO BE DECOMMISSIONED PER THE UPC PROPERTY LINE G 1 0� P�Py 4-5 % SLOPE _T1_ v . \ \ EXISTING WELL to l �� 100' RADIUS PROPOSED SEPTIC D oo T I II TCO / DRN EWAY \ I I II II L Ll ---�f EXISTING HOUSE \ r r r O 4-5 7. SLOPE i NEW 1000 � GALLON TANK I I I I I i ARTESIAN WELL ENCLOSED IN \ INSULATED BOX \ \ \ \ Septic Design Prepared for ...��\�11 ROBERT TIERNEY ��P�E OF �4. POTTER CREEK TR 2::` 49TH Anch, Alaska ... ..:................... ............ .... `:.....� 0 ........... .. ......................... i Michael N. Anderson' P.E. DATE: 12/4/2016 j ' MICHAEL N. ANDERSON." No. C69 4601 NATRONA AVE DRAWN: DJR •��; (z %F,9�b,•2: ANCHORAGE, ALASKA 99516 I r 1 • (907) 727-8864 /FAX: (907) 345-1391 SCALE: 1 "=30' i i 20' UTILITY EASEMENT EXISTING CRIB TO BE DECOMMISSIONED PER THE UPC PROPERTY LINE G 1 0� P�Py 4-5 % SLOPE _T1_ v . \ \ EXISTING WELL to l �� 100' RADIUS PROPOSED SEPTIC D oo T I II TCO / DRN EWAY \ I I II II L Ll ---�f EXISTING HOUSE \ r r r O 4-5 7. SLOPE i NEW 1000 � GALLON TANK I I I I I i ARTESIAN WELL ENCLOSED IN \ INSULATED BOX \ \ \ \ Septic Design Prepared for ...��\�11 ROBERT TIERNEY ��P�E OF �4. POTTER CREEK TR 2::` 49TH Anch, Alaska ... ..:................... ............ .... `:.....� 0 ........... .. ......................... i Michael N. Anderson' P.E. DATE: 12/4/2016 j ' MICHAEL N. ANDERSON." No. C69 4601 NATRONA AVE DRAWN: DJR •��; (z %F,9�b,•2: ANCHORAGE, ALASKA 99516 I r 1 • (907) 727-8864 /FAX: (907) 345-1391 SCALE: 1 "=30' Municipality of Anchorage d''�•' (E" E>' •� Development Services Departmentr 49?H Building Safety Division /• • • • • • • • • • • • •`� V On -Site Water and Wastewater Program Pt. • • • • • N • • • • • • • • • • P4 4196 Elmore Road •• MICHAEL N. ANDERSON •;•`= e" P.O. Box 196650 Anchorage, AK 99507 a, ; ,•".• www.cianchorage. ak.us ,! .-;, . CE -9469 (907) 343-7904 r a • . . •'•��,_i Soils Log - Percolation Test Performed For 1211 i Tvo r ,f� •7 Date Performed: /V moi! A, Legal Description: f9 f"'•V CV'+r Z Township, Range, Section. Depth (Feet) 11 14- 15- 16- 17- 18- 19- COMMENTS 0%rc� , 60 btu Site Plan WAS GROUND WATER Dale ENCOUNTERED? 2 �• Depth to Water S IF YES, AT WHAT DEPTH? /0,15 L Depth to Water After, O ` P Monitoring? Q E Date / /I Sr /GP Reading Dale Gross Time Net Time Depth to Water Net Drop U tt 5 .r (n " 43 CIO ri S rt ro /t S -n PERCOLATION RATE Z (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN SFT AND _ if FT PERFORMED BY. t./t M 4.1 CERTIFY THAT THIS TES WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / t� 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 Parcel I.D. 020-271-02-000 Leqal description POTTER CREEK TR 2 Expiration Date: 10/14/2025 Site address 7980 POTTER HEIGHTS DR Anchorage AK 99516 Current property owner(s) KEOWN GERALD W JR X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 10/31/2024 his 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 Services 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 work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAG [Fe—ve-ro—pment bervices Uepartment Pone: 907-343-7904 On -Site Water & Wastewater Section \� Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-271-02 Complete legal description POTTER CREEK TR 2 Location (site address) 7980 POTTER HEIGHTS DR Current property owner(s) KEOWN 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑N Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 8 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ g '6D Waiver Fee $ Date of Payment COSA # 05 C-,2." 19 Z Date of Payment Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: POTTER CREEK TR 2 Parcel ID: 020-271-02 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 UN Total depth UN ft Cased to LN ft ❑ Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 10/14/24 Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes A No N Coliform bacteria is Negative Nitrate mg/L N Nitrate less than MRL (ND) Arsenic ug/L N Arsenic less than MRL (ND) Collected by MNA Static water level at beginning of test ft. Date 10/14/24 Comments WELL IS ARTESIAN, HAS A PACKER INSTALLED B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 10/14/24 ❑ Required maintenance completed, ifAWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/17/16 M ALL standpipes present per record drawing Total measured depth from grade 1—ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field. Q Per record drawings, field is insulated. Q Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 10/11/24 date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 10/14/24 Results QPass Fluid depth prior to test 24 in Water added 450 gal New fluid depth 32 in Elapsed time 1440 min Final fluid depth 24 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 24 in Effective depth remaining 24 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' QYes ifNo_ft Neighboring Tank > 100' ❑i Yes if No _ It Absorption Field on Lot > 100' EK Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑0 Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' QYes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑o Yes if No_ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' s❑ Yes if No _ ft f]i 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' 0 Yes if No _ ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' Q Yes if No _ ft Field to Property Line > 10' QYes if No ft Water Main > 10' Yes if No _ ft Water Service Line > 10' Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Eil Yes if No ft 0 Yes if No It If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm PPhone �. 727-8864 Engineer's Printed Name sem] _ Date rJ 1-2 A4 COSA Checklist June 2022 %... 1...... Ill. • MICHAEL N. ANDLR5C;'1J r CE -949 'v O�oo��z 1'1I G f V li • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 2 sn.fT. n CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 020-271-02 1. GENERAL INFORMATION Complete legal description POTTER CREEK TR 2 Expiration Date: S-2-1` Location (site address) 7980 POTTER CREEK HEIGHTS DR. ANCH , AK Current Property owner(s) ROBERT TIERNEY Day phone Mailing address Real Estate Agent 350 W FALLEN LEAF CIR,WASILLA , AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: Received by: 3 Day phone TYPE OF WAS" Individual Holding Tank Community Public Sewer COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 41g. OD Date of Payment o-1 �(p Receipt Number a0 903 COSA# OSGILpIwt�1 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # DISPOSAL: 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 12/20/16 By: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 1040-12. doc - °J �. Ci Tib 1' °a •.1 Ai' DSD SIGNATURE'^ i,r rslcHaerN.°'°`° m AND' S'9 System #1 Approved for Y PP bedrooms. S" • e c a�. ,? t O4^..•r� 9 System #2 Approved for bedrooms. nn,a, Disapproved. " Conditional approval for bedrooms, with the following stipulations: By: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 1040-12. doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: POTTER CREEK TR 2 Parcel ID: 020-271-02 A. WELL DATA Well type Private Date completed UNKNOWN Total depth * UN ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Well Log (Y/N) Sanitary seal (Y/N) Y Cased to UN ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. gp. m. Wires properly protected (Y/N) Y Casing height (above ground) 18 AT INSPECTION 1212/2016 ARTESION ft. 5+ g.p.m. Coliform NEG colonies/100 mL Nitrate 0.741 mg/L Arsenic:. NO ug/L Date of sample: 121112016 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 12/1712016 Tank size 1000 gala Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping. NEW Pumper NEW C. ABSORPTION FIELD DATA - 1985 SYSTEM TESTED Date installed 1 211 712 01 6 Soil rating (g.p.d./ftz) 1.2 System type DEEP TRENCH Length 50- ft. Width 2 ft. Gravel below pipe 4.0 ft. Total depth 6 ft.. -Eff. absorption area 400 ft Monitoring tube Y Depression over field N Date of.adequacy test NEW Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test NEW in. Water added NEW gal. New depth NEW in. Elapsed Time: NEW min. Final fluid depth NEW in. Absorption rate >= NEW g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at In.High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 50'+ Animal containment areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 1004 Manure/animal excrete storage areas 1004 Building foundation 5'+ Property line 5'+ Absorption field 54 Water main 1001+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line Building foundation 104 Water main Water Service line 10'+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS WELL WAS CHECKED OUT BY 907 WATER WELLS (JOHN NETHERTON), SEE INSPECTION G. ENGINEER'S CERTIFICATION 1 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. Engineer's Printed Name MIKE N. ANDERSON, PE Date 1212012016 COSA canary sheet_2-6-15.doc �d • ..... • MICHAELN. ANDERSCN CE w I94 lk coi RESIDENTIAL & COMMERCIAL WATER AND WELL SERVICES 24HR AND EMERGENCY SERVICES AVAILABLE FREE ESTIMATES John Netherton 6630 Eest 8^ Ave RnUrorage Alaska 950a X30-1S6S 12/20/2016 In regards to 7980 Potter Heights Drive, Anchorage, Alaska. An inspection of the well system was conducted and the findings are as follows. The property has an artesian water well. There is a submersible well pump down hole. The well head is sealed from flowing water my means of a sanitary seal. The drop pipe comes out the top of the well. There is a sealed structure (Arctic Box) around the well. The water line and box are heavily insulated from the environment and heat trace is on the water line and is actively working. The water line makes a gradual slope inside the structure entering the ground and goes to the building. The well, wires, heat trace, and water line are all protected by the arctic box as a means of warmth and conduit from any potential hazards. There is no access to enter the box without intent and tool usage. I find the system to be in a safe and reliable condition. John Netherton TRACT 1 q 20' Tempoary Roadway Easement to be automatically vacated at such time 8448D when an alternate dedicated R.O.W. is accepted by the platting authority. 11� Zp Z N63014'00"W 248.90 Approximate location EAST 330.00 20' stream Maintenance Easement rev nve Septic vents s ^o N10°41'53"E 93.85 Septic vents N73050'37"W 18.14 o V oc mh 3 4 uel lank Well in Frame Box \ \ \ -------- --- N ----y--------- -— — — — — 20' Utility Easement TRACT 2 0 0 Oo 0 m 0 0 � 2 = O z o TRACT 1 Z TRACT 1 SCALE: 1 "= 60' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. EAST 330.00 OF • qC '\ i *: 49th '*,i ,• �go .......... 00 � ,'.Fred Walatka: ff / ss� 3255-S V' FB '' 1 ��FESSIONA�•�`� FB 16-12, pg 24 0 TRACT 1 RECERTIFIED 12.20-16 AS -BUILT NO CORNERS SET THIS DATE