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Home My WebLink AboutTIMBER TRAIL TR 1C-2Onsite File To bim0 er Tems` TraciAm r Cam •t t Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181027 PID Number: 017-101-65 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: X New ❑ Upgrade Name ADRIAN JAMIE ABSORPTION FIELD 0 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address ❑ Other Phone Number of Bedrooms Soil-Rating Total depth from original grade 4 0.8 GPD/SF 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3:0 Ft. Gravel depth beneath pipe 7 Ft. Subdivision Block—Lot TIMBER TRAIL TR 1 C-2 Fill added above original grade 1 + Ft. Gravel length 56 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 784 Ft' Ft. Well 1001+ 100'+ 50,+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCH TANK 1250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ NA STEEL 2.0 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 112.4 ft Inspection 1st dates: r Location and description 4111 BASEMENT DOOR STOOP 3`d ON-SITE WATER AND WASTEWATER SECTION APPROVAL EQgin4bAStamp, ooe °ems 1 n :;! Conditional Approval: Date sua p O e e e o 0 0 0 e 0 e 0 e o s e e p o e •�� e o e e o 0 o s a e e e ........... °eoe°eeee• . � 'V1MICHAEL N. ANDLRSCN :- �) Septic System Approved CE-9469 •:,v', Date 10 30��gl(Ge �a�poa,SSn Note: this approval does not include well permit requirements. kmuv u0/uz/ 10) Permit No. OSP181027 Page 2 of 2 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 Legal Description: TIMBER TRAIL TR 1C-2 PID No.: 017-101-65 MARK A B j FCO 2 ( 15 col CO2 71 L .65. TC01 7 68 TCO2 18 75 03 87 181 '04 - __.._.-I 88 800 _... _ ., .. _,.__._ . _ _.._._ . .., ._ - /-.-. /.� �.... _, _..... ._ ._._. , _ ....._. 11 T1 13¢ 130 C06 1146 144 / WELL I\ BENCH / I / I \ I I — — NEW 1250 TANK I \\ WELL Co \ \ CO2 �\ ----� I \\ CO2 TC01 FCO \ I\ \ ®C05 l B \ DRIVEWAY \ �X / / ASBUILT I SCALE: 1"=50' y( -FCO COI tr CO2 //-TCOI Jr COi coz }(-Ccos ®®®®prp F I I / TC01 I ♦� I /-MT MT� ,M6.5 100 OG OF FINISH GRADE ®® `�•• /---FlLTER FABRIC .0 ORG V••• Y®®® Air � � ® 4 9 TTHH ®® 4 1.250 GALLON%/I+ STEEL TANK CM •.•�� Lf .................................... p 8. 7 7 9, n : ;MICHAEL N. ANDERSON. �® ® s,'. No. CE 9469 ® SEPTIC SECTION 92 ®®®E\ ®®®® N.T.S. DRY, OCT 2017 ® 4 Certified Drilling Log DOC CO dba BILL Sc COLE 1�►ULLIVAN PO. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Adrian Jaime ADDRESS: - LEGAL DESCRIPTION Timber Trail -Tr -1C2 - DATE: 5-15-18 PERMIT NUMBER: OSP181027 DATE OF ISSUE: 3/9/18 --TAX-IDENTIFICATION-NUMBER-0171015 000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 202' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 200 feet Liner type Static Water Level: 125 feet Recovery Rate 8 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Bore Hole Data Depth From To 0 2 Casing Stickup 2 4 Overburden 4 27 Silty Sand & Gravel 27 39 Tight Silty Sand & Gravel w/ Clay 39 51 Silt & Sand 51 101 Tight Silty Sand & Gravel w/ Clay 101 162 Hardpan w/ Cobbles 162 189 Silty Sand & Gravel w/ Clay 189 195 Silty Sand & Gravel Water 195 202 Tight Yellow Clay & Gravel Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. Parcel -Identification Number:_ _ _017101351000 t5 Legal Description Timber Trail Tr 1C2 Pump Installation Date: 9-26-18 Pump Intake Depth Below Top of Well Casing: 170 Pump manufacturer's Name: F&W Pump Model: 4F07P053015 Pump Size: 1/2 Pitless Adapter Burial Depth: 10 Property Owner Name & Address Adrian Jaime Pitless Adapter Installer: Mike Anderson — Anderson Engineering Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson Pump Installers Name: Sullivan Water Wells feet E feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 87*17'3E" E 63.71 BOBBYR BURNETT 2941 Carriage Drive Anchorage, Alaska 99507 (90 7) 350-5541 r SEPTIC f N 88°06'40 E. 166.47 r100' Well Rack S 87*17'3E" E 6 3.71 10' UTILITY EASEMENT 4 S 89°59'37" E 280.07 9/13/2018 1"=30' Grid SW 3037 AS–BUILT _EAST 14.._--AVENUE—._---N on LOT 1 C-2 TIMBER TRAIL SUBDIVISION Plat # 2018-19 WELL 52.51 z 0 0 O D D G Air,, BF O p Poa s GRAPHIC SCALE. • 1 Inch = 30 Feet 15 0 15 30 60 AV OF ALS / BOBBY F. BURNETT / /o � t\ ��SSIONAL 1' I hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other easements on said property except as shown. E J��IPPl/`y O� MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program f!�,,,E' PO Box 196650 4700 Elmore Road l Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r. .r / http:/lwww.muni.org/onsite l)cpar tmen t On-Site Water & Wastewater System Permit Permit Number: OSP181027 Effective Date: 3/9/2018 Work Type: WellSeptic Initial Expiration Date: 3/9/2019 Tax Code Number: 01710157000 Site Legal Address: TIMBER TRAIL TR 1C2.G:3037 Site Mailing Address: Owner: MGJ BUILDING GROUP INC Lot Size in Sq Ft: 90169 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: D Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: /1/1"-4' Date: 3(TV/V Issued By: l 1-€/e/ 0, Ca_)v(.,Ca Date: 3// /i MUNICIPALITY OF ANCHORAGE Community Development Department t5 ' Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-101-57 Property owner(s) MGJ I Day phone Mailing address 911 T loq s+Vee-ti i\nc4,orale! AK 9ctSO r7 Site address �J Legal description (Sub'd., Block& Lot) Timber Trail Tr 1C 2 Legal description (Township, Range & Section) Lot Size 90169 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field ❑x Initial ❑x Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑x Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well W- Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST_F-QR: 7 -- V Distance: ete I certify that the above information is correct. I further certify That tl is is in ac o "FTeT " ,fi h applicable Municipal Codes. I • • 1 4/14,A-- \<r. (Signature of property owner or authorized agent) ��. % 'i' Permit/Rush Fees: See ? rm‘} i. P Ill 3Waiver Fees: Date of Payment: /A/51//�9' Date of Payment: Receipt Number: yin o2l`73a9 Receipt Number: Permit No. osio18' /Qa 1 Waiver No. Permit App__-.• ::..,c March 7, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic & Well Permit Legal: Proposed Timber Trial S/D Tract 1C2 (S-12377) To Whom it may concern: This is a request for a septic and well permit on the two above referenced lots. A two test hole were excavated and found silty gravels GM, for the entire depth with no bedrock or water observed. The perc rate was 12 minutes per for each of the test holes. From the site plan the slopes are fairly flat (less than 5-10 percent) at the test hole locations. The lots are large (one acre plus) and the soils are good with no ground water or bedrock. This permit will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely l 2./c_ Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: MOUND OVER (TH#1) (TH#2) o I GRADE 4 BDRM X 150 =600 GPD ORG ORG1 c SOILS =600/0.8 = 750 GPD 1.0 1.0 FILTER FABRIC 750 GA/12 =63' GM GM 3-3 0\-_T- 4"ø PIPE (1)TRENCH ~SEWER ROCK 9.0' DEEP 6.0' EFFECTIVE -9.0 2.0'WIDE 2.0' 63' LONG 18.0 18.0 SEPTIC FIELD SECTION 7S5 I I I> _ l� I - E� *RO SEPTIC ' i w \\�I WELL Z _ POSED4 i •OM HOUSE— i I o i • WELL I I ‘ \ _ I i' PROPOSED WELL i\ / ,-N I I�-� ` �`(,�100'RADIUS \\ // SE�TIC�1 / t. 1 �.,1I �/\ •WELL I _ __ / II•1 Ih`, /, PROPOSED 1 11, / i • �1 —DRAINAGE FIELD } I y /��,_-,-' PROPERTY LINE I I 1 \ i� i _, , N,-,,'' I ._-'- J �SE�'TIC -E 142ND AVE- / \ � \ - - - - / -\ S - - - - - 1 I • WELL I -I- -. — II / IER-qc --------- I Ij II i [ 1 t II I II Septic Design Prepared for ..ovoiss�q it1 MGJ BUIDLING GROUP •��P-,v_OF / �!♦♦ TIMBER TRAIL TRACT 1C2, (S-12377) ;' 49 TH %\ .\ '' ♦j, Anchorage, Alaska ,• 144 • • Michael N. Anderson, P.E. DATE: 3/7/2018 W.!v1..!CHAEL N. ANDERSONI: No. CE 9469 A 4601 NATRONA AVE DRAWN: DJR ♦♦•� ••• •• .••' '-� ANCHORAGE, ALASKA 99516 • • (907) 727-8864/FAX: (907) 345-1391 ! SCALE: 1"=200' ♦444 ��t •� 1 \ \ , / \ \ / 1 \ , , \ \, , 1 / ' 1 , / \ \ \ 1 ' \ 1I / / I' ' X i I : 1 TIMBER TRAIL I I • ' EXISTING /ELL , TRACT 2 • • ' ' \ ' 1 I , \ \ I RAPTORS KNOLL \ I LOT 3 „ ' \ 1 , \ \ \ \ s 1 ' 4, .. ' • \ , / ------------r--- , . PROPOSED . , \ . -- SEPTIC SITE \ ., a <1 ‘\ • \ - III I / / 1 I tt • 1 I I t-1 / PROPERTY LINE I / i / PROPOSED t/VELL'ROPSOED {1,1BER TRAIL / I / TRACT'%C1 I / I \ I, RAPTORS KNOLL / , 'I I LOT 2 PROPOSED TIMBER-T.-04V-- TRACT 1C2 - -DIRECTION OF -- I ,..„- --- SLOPE,2' 1 , 0 CONTOURS ya.-- \ PROPOSED \ PROPC11ED WELL , i HOUSE \ I 1- , , 1-• /- .,------• CO z z . i i ui LI! XI M I \ TCO F / CP 7 01 // \\ , < ‘‘ 1 i r LLI w w /I-Fi#2 • IX 1 I Z1\ DC' 000 \ - - I =I 11 \ \\ L \----------Its- R- P \ -----44L\--y..\ \ . ........ - Li, D \ / \\ / I (/) b b 1.. .. ____AY I • \ 2 / ,- - / - 11 1 \ - •• I / \k (to ., \ , 1250 GALLON I , .2 , f.,..,,, . \ ,, . TANK,TYP. '\ .,\ - 1 -_ _ VH#1 / t-ir Us, \ \ \ \ .-\<- 1----- LLI 4 r I RAPTORS KNOLL \ / \ \ \ \ E 1 LOT 1 \ / .----------..._.... \ _ _ _ _ 1_ ___ L _ _ _ .....____=.,...eZ.. _ _/_c''..._:. —_ -- • , \ , , \ CI — _.., I I ,-' 10'111-11 [TY FASFMFNT ---., \ > 1 / z I N ,,-- / \ - / PROPERTY LINE 0 — / \/ / ENSTING WELL'> / c.D - /142NDAVE- \ _ _ _ _ _ — - / - - _ -\ \ - / \ 1 \ / • Septic Design Prepared for Imilisiivi it i z 7:74N... _ ..... MGJ BUIDLING GROUP 4-/\r-...4! 0F----- ----.. v,z57•A TIMBER TRAIL TRACT 1C2, (S-12377) .„ : --./ 49 TH .41:40c--- Anchorage, Alaska a : ; .7i47/4 : • • • .. . . .. .., ..10.. . .. .a Michael N. Anderson, P.E. DATE: 3/7/2018 Icle.A.MICHAEL N. ANDERSONi ar : s• •-.0 .... No. CE 9469 ...:!_ ‘: 4601 NATRONA AVE DRAWN: DJR v• '' 0°e.,0 . ..................- 4, ANCHORAGE,ALASKA 99516 (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 4 4. .,,..• '"Illims*" Municipality of Anchorage „�'E �INU S,WL.�‘ � Development Services Department ,","� ;••''• n } I_ — • \ Building Safety Division 6'! fin'yi-�• ' :r"1-`?� On-Site Water and Wastewater Program •-r:.' 9 �: .,` '• �; 4700 Elmore Road rr, •y t 0 ,orielf P.O.Box 196650 Anchorage,AK 99507 www.ci.anchoraoe.ak.us t4 -_� (907)343-7904 0 s^% MICHAEL N. ANDERSON : !'r iik'5:'-••. CE-9459 `,`'," Soils Log - Percolation Test ' ••. .t' . ' .•.....•`�K\u�, i.' •• � Performed For: /k4 T C'j Date Performed: j'( re! 3'.._, Legal Description: l' 1- 4 � p I l,�rt `, G✓ �'�� ( � �w-1 � (t�� Township.Range.Section: 14Slope Site Plan Depth (Feet) (909 , 1- 2- 4-,•e,--, Cvl 3- 4- 5- 6- 7- tel 8- WAS GROUND WATER 9- ENCOUNTERED? /49 S 10- IF YES.AT WHAT DEPTH? L Depth to Water After o P 11- Monitoring? 0 N E 12- Date. 10/! ( t 7- 13- Q/,rsd a k.." 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- /d(-z/j x 27. , CP ' f 1. 5 " 16- (/ /( 7,S tf 17- i) ?. fir/ 18,-- � �r ?••-t-" 130 )40w U N 19- 20- PERCOLATION RATE /7_- (minutes/inch) PERC HOLE DIAMETER (, TEST RUN BETWEEN Lil FT AND 47 FT COMMENTS PERFORMED BY: N( NI.--4\ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I?11(i/I .72 -,."CV s' ® . c: 0i- Lid 4; Municipality of Anchorage .•�•��1 'GINEER's•4EP );�?., • Development Services Department „'e G;• •a- ••••r,,; , Building Safety Division �1 L'}Q;(q .• •i C Q On-Site Water and Wastewater Program •:::•.:. •....• •.......... :• ,4700 Elmore Road ''•• P.O.Box 196650 Anchorage,AK 99507 • •°••°.......• °•••• • 04 fwww.ci.anchorage.ak.us MICHAEL A(907)343-7904 N ANDEscN ; ;A • • •• CE-9469 <�;'# Soils Log - Percolation Test d lgFo'•• ••,,,,.)• ' ke1�:i1 X11,_,',. .',.:: Performed For: MTA, Date Performed: )\.*'g ;a/7 Legal Description: .)'t rrt'1 cv' -N 6t 'Ivy 4 4' (CA., Township,Range,Section: Slope Site Plan Depth (Feet) 0 v,5 1- 2- c,e p(u y, 3- 4- 5- 7- (�-� 8- WAS GROUND WATER 9- ENCOUNTERED? o S 10- IF YES,AT WHAT DEPTH? L Depth to Water After o P 11- Monitoring? 9 f\1 E 12- Date: ity/Le/0._ Or 13- OrK4,v•k_, 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- /t7�(dr/.t. -"Sik,„ to it 2. S" 16- (D�� 2t S' 7 17- (D 't 2(K a 18— ----.(li 0�p►h ito, it -7r , 19- 20- PERCOLATION RATE ( 'L (minutes/inch) PERC HOLE DIAMETER (0 TEST RUN BETWEEN y FT AND c". FT COMMENTS PERFORMED BY: ni)\(A I CERTIFY THAT THIS TEST WA PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: i 4/e/2 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 OSC261017 Parcel ID 017 -101-65 Legal description TIMBER TRAIL TR 1C-2 Expiration Date: 7/12/2026 Site address 14170 GOLDEN VIEW DR Current property owner(s) TASH HEATHER A & CALEB M X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: Original Certificate Date: 1/29/2026 This Ceficate of On -Site Systems Approval (COSA) is intended to demonstrate the subject syst (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, D elopment Service Department (DSD) issues COSAs based upon representations provided by an Z professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other Age u - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: EJ AWWTS F� Bed A Deep Trench [] Wide Trench ED Seepage Pit Waiver request for: Distance: Expedited review requested: By applying for this entitlement, this property is subject to inspection by municipal On-site sti to verify the accuracy of the information provided. COSA Fee $ 19 Waiver Fee $ Date of Payment Date of Payment COSA Checklist_May2025 copy 2.docx COSA Checklist Legal Description: TIMBER TRAIL TR1C-2 Parcel ID: 017-101-65 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 5/15/2018 Total depth 202 ft Cased to 200 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA *7/12/2024 Static water level at beginning of test 133 ft. Well production at time of test 5+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 1/21/2026 Comments *Per MOA record docs, well flow test performed by Mike N Anderson, PE. B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 1/23/26 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 8/18/2018 ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 5 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) _N If yes, enter date Adequacy test date *7/12/2024 Results Pass Fluid depth prior to test 60 in Water added 600 gal New fluid depth 70 in Elapsed time 1440 min Final fluid depth 60 in Absorption rate 600+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in (MOA 7’ ED) Effective depth used 60 in (Final Fluid Depth) Effective depth remaining 24 in Comments/Deficiencies: Monitoring tube fluid level was measured at 7”, w/ no known treatment & vacant on 01/23/2026. *Per MOA record docs, adequacy test performed by Mike N Anderson, PE.. COSA Checklist_May2025 copy 2.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 01/28/2026 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 01/28//26 Cm) �TT G) Vl cocy') co'IT IT co ti ti CD C:) rn rn LU c ca / n O LL V � Q LL O 2 U Z Q `O J Q� o O U E CO V ^L^`` _ Q W Z o� U� U �/�06 ul L c � E O >CO O c ❑O .0, N O N N ti 0 0 LO CO i O vl- A� 1 r Q U (6 a_ N U J LU Coo G c 0 .2- L) U cn O c0 O O J Q0 T11 - LO LO CD O') Q O M L- 0 O U C LU z W 0 0 O ti d' N 0 cv O CO I ow IrA i U cn E O 0 (D CH X IA cn2 O N c� L O N C O E O Lai M o 0 0 a� ^1^ �l.i + Q �� Y CL O 3 _Q a C O c O a U L O � N d � C 6 CL Q > o C E = t ¢ > D N E N U CO O O E Q w 'a O >i �= CL 0 0 CL .Q ami C. 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(B Vi U O /r /^� N R a d O U) a) V J w+ 0 in O c W N a m ❑ .2 = a Cn m cn o a m >, W W W N ~ m N U) Y Zo a ° U) U) w a a F -a m a� a) H O O U 0- L c Fn a a O H� W m a) Q L O H to Q a > '- Q T > m N M L6 CO > W m 40 T a) a) LL a) 69 a) W LL a U) O � � c� a o Q 0 L COSA Checklist Legal Description: TIMBER TRAIL TR IC -2 Parcel ID: 017-101-65 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 5/15/18 Total depth 202 ft Cased to 200 ft ❑� Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/12/24 Static water level at beginning of test 133 ft Comments — B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 7/18/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/18/18 0 ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 5—ft (min) ❑ N/A – pressurized field. ❑ Per record drawings, field is insulated. 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 gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑fi No H Coliform bacteria is Negative Nitrate 0.461 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by Date 7/12/24 MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 7/12/24 Results QPass Fluid depth prior to test 60 in Water added 600 gal New fluid depth 70 in Elapsed time 1440 min Final fluid depth 60 in Absorption rate 600+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 60 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' Qi Yes if No _ it Neighboring Tank > 100' Q Yes if No Absorption Field on Lot > 100' a' Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑� Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ it Holding Tank > 100'❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft Fs Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No _ ft Q 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' g Yes if No _ it Surface Water > 100' 9 Yes if No ft Tank to Property Line > 5' Di Yes if No _ ft Field to Property Line > 10' Yes if No _ ft Water Main > 10' ❑� Yes if No_ ft Water Service Line > 10' ❑� Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑� Yes if No it Q Yes if No _ ft 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 /\n(l�Lt✓��PYf(✓j Engineer's Printed Name Owe, COSA Checklist June 2022 Phone 727-8864 Date 2 Z,_ a OF AC gs�� r A • MICHAEL N. ANDERSON ;'�' rol �.•. E •:'tri