HomeMy WebLinkAboutDENALY ESTATES BLK 2 LT 5Onsite File
Denaly Estates
Block 2
Lot 5
#067-062-12
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191073
Dwelling: ❑■ Single Family (SF)
Name:
Troy Davis Homes
PID Number: 067-062-12
❑ Duplex (D) ❑ Multiple (SF and/or D) Project: F91 New ❑ Upgrade
1689 Knik Goose Bay Rd 400 Wasilla, AK 99654
Phone Number of Bedrooms
310-2501 4
LEGAL DESCRIPTION
Subdivision Block Lot
Denaly Estates 2 5
Township Range Section
SEPARATION
DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
well
97.5'
>100'
N/A
N/A
>25'
Surface water
>100'
>100'
N/A
N/A
Gravel length
Lot Line
>5'
>10'
N/A
N/A
Gravel width
►a_Z*Y91S2-9 IQ 0,
❑ Deep Trench Q Shallow Trench ❑ Bed ❑ Mound
❑ Other
Soil Rating
depth from original grade
JTotal
0.8 GPD/SF
3.0 / 2.9
Ft.
Depth to pipe invert from original grade
Gravel depth beneath pipe
2.5/2.4
Ft.
0.5 / 0.5
Ft.
Fill added above original grade
Gravel length
1.5/1.3
Ft.
2 @ 75
Ft.
Gravel width
Beds: Number of Lines
Distance between lines
5.0 Ft.
Ft.
Total absorption area
Number of trenches
Dist. between trenches
Ftz
2
>8
Ft.
TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Anchorage Tank
1250
Gal.
Material
Number of compartments
Steel
2
NA
Foundation >10' >10' N/A N/A ILIFT STATION
Manufacturer
Curtain Drain I None I Noted
Remarks Tank and septic line up to the north
trench are insulated.
Gall
Pump on level at (Pump off level at I High water alarm at
in.1 in.1 in.
Pump make and model JElectrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
Installer drainfield D3034
Ursa Minor Landscaping & Excavation Drainfield D3034 CO/MT
Inspector J. Millette BENCHMARK (Assumed elevation) 100 ft
Inspection X51 5/22/19 2nd 5/23/19 Location and description
3m 5/30/19 4'h Top of foundation block on SW corner of home.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL I Engineer's Stamp
Conditional Approval: Date
A 1 C��IJ V% o
pproved � C� � Date
mspecuon rcepori_y- i- i z.aoc
:'; i ��i `�
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development. Services Department
On -Site Water and Wastewater Section
�)l'�ef CI11C 11C
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV191096 COSA#: Permit#:OSP191073
PID#: 067-062-12
Legal Description: Denaly Estates Block 2 Lot 5
Engineer: Forge Engineering
Applicant: Troy Davis Homes
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 97.5 feet. See engineer's
waiver request for justifications.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
Waiver is Granted: X
Waiver is not Granted:
Date: f I/05/19 Approved by: /1" - CaAto&
Name of Reviewer
.............................................................................. 1
**** VARIAN C E/WAIVER REVIEW ****
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
November 26, 2019
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Denaly Estates, Block 2, Lot 5 – 25380 McIntyre Road
Well to Septic Tank Waiver
Dear On-Site Services Engineer:
The new septic tank on Lot 5, Block 2, Denaly Estates Subdivision was inadvertently placed 97.5’
from the new well on the lot at its closest point. A waiver is therefore required to allow the septic
tank to remain at this location less than 100’ from the well.
The new septic tank is constructed out of high grade steel and is located more than 15’ down slope
from the well. Septic effluent that might surface from the tank would flow away from the well.
The surface grade is 15% to 20% away from the well. Surface effluent contamination of the well
is virtually impossible from the septic tank.
Underlying soils on the lot are gravel with sand and silt with percolation rates slightly more than
5 minutes per inch based on test holes completed in the recent past. Groundwater levels were noted
at 9’ to 10’ below the surface. The well log indicates it is 145’ deep with steel casing the entire
depth. The static water level has been measured at the surface and the well is considered artesian
with an artesian plug in place. The well was drilled through silty sand and gravel material the full
depth with impermeable clay layers encountered near the bottom. We are confident based on the
location of the septic tank and the aforementioned characteristics of the lot surface along with the
well construction that the reduction in the protective radius of the well to 97.5’ will not impact the
quality of water from the water system.
Sincerely,
Michael E. Anderson, P.E.
11/26/19
Wheaton Water Well, Inc.
1190 N. Wasi I la -Fish hook Road
WEft silla., AK 99654
Name:
Troy Davis Homes
Address:
1689 Knil< Goose Bay Rd.
City:
Wasilla
State: AK
Zip Code: 99654
Well Site:
Denaly Estates
Lot/Block: 5/2
Additional:
Well Depth:
145 ft
From: To:
Formation:
0 4
silt/gravel
Below Ground:
143 ft
4 16
wet sand/silt
Above Ground:
2 ft.
16 22
wet silt
Gal/Min:•
60 gpm
22 48
silt/gravel
48 72
silt
Static Level:
0 ft
72 133
clay soft
133 144
clay hard
Casing:
145 ft. of 6" steel casing
144 145
gravel/water
Liner Pipe:
N/A
Screened:
N/A
Perforated:
N/A
WATER QUALITY TESTING
Grouted:
6 bags casing seal
Collfarm
Ntrates
Rlose,4 Col/100ml-
0c 0 2 3 mg/L
Depth:
N/A
-1
Arser-Ac
123119
S. �; 3 ug/L
Develop. Method:
Air
Use of Well:
Residential
Drilling Method:
Rotary
Misc:
Other:
well chlorinated to 50 ppm
The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 60 gom
Pate Drilled:
4/3/2019
Driller:
Ben Mattson
Development Services Department
Suff&N Safety bivislon
On -Site Water & Wastewater Program
4700 ElrnoreRocd
P.O. Box 196650
Anchorage, AK 99507
May- mm, rnu n Ir-rq / onvite
(i71 3431.7904
Pump Installation Log
WeH Drilling Permit Number, SWF
Pom-d Identification Numben—
U,gal'.Desetip 6011
Det€;5k4 Loo 5, Sldak, 2
Pump InstmHation Date: No [kimp,
Pump Int�alw Depth Relaw Top of Well Casing.
!In mp Ainufactorer's NiArtic
Pbmp Model -
Pump Size bp
Pidess Adapter Buriat Depth. 12 feet
Pitlemi Adaptor Natne. CtrtPbefl
Piflv4s kdapter Installer.
Well M'Vinfected Lipari. Contpletiou! Ej Yes. E] Na
Method GMisinfectiou:
4COmmen t9: Aft !ail t%,O, ,.let ownp higWN-ld in NLu,us,_,
feet
D -ate of Issue: —
Property Owner Name & Addrus:
Tray 0%1d&Hrj;n8� in r
162-A MR Gvj�e Bay Rd
Wasira., ", 99654
Attention- The pqjrjjp insl4ilter 03aJ] Provide a pump insiallation log, %o the DSD withij) 34 days of pump installation,
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60 D U
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP191073
Work Type: WellSeptic Initial
Tax Code Number: 06706212000
Site Legal Address: DENALY ESTATES BLK 2 LT 5 G:0362
Site Mailing Address: 25380 MC INTYRE RD, Eagle River
Owner: TROY DAVIS HOMES INC _
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
LotSizein Sq -Ft:
Total Bedrooms:
4/1/2019
3/31/2020
- 56603
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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
Special Provisions:
ii
1. The recorded plat for this subdivision notes that artesian wells are common and that special drilling methods
may be required to prevent waste of water via surface discharge.
N/The 7 -day groundwater reading shall be observed and. recorded prior to construction of the drainfield. If the
results require a design change, construction shall stop pending On-site review and approval of a change order.
CO # 1(y/ l %/l9� (JPP�PII �V haoecl 0"11 %—d a y G(t) ✓ieaca�� d'
a -n d PV4 21 /nof9 5a ld pe % &) � f ° q�if -- `v
1
Date: 6
- mal -M, =`1
//2-// q
Date: 1
W
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: c
Development Services Division Fax- 4
On -Site Water & Wastewater Program
L
ON-SITE SEWER/WELL PERMIT APPLICATION
X67 8 9 7\
5X�—
-34*Mbd 2019 f
X343-7997
ZZ
Parcel I.D.
067-062-12
Property owner(s) Troy Davis Homes Day phone 310-2501
Mailing address 1689 Knik Goose Bay Rd #400, Wasilla, AK 99654
Site address 25380 McIntyre Road Chugiak, AK
Legal description (Sub'd., Block & Lot) Denaly Estates, Block 2, Lot 5
Legal description (Township, Range & Section)
Lot Size 56,603 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑X
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank
19Upgrade
ElDuplex
Duplex{D) El
Holding Tank
1-1
Renewal El
Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
19
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 11S 2.Oy
Date of Payment: 0324 J(a
Receipt Number: 012-uD
Permit No. 63 P 1 q,1013
Permit App_.:- :
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
March 29, 2019
MOA Development Services Dept, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Denaly Estates, Block 2, Lot 5 – 25380 McIntyre Rd.
Septic System Design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 4-bedroom home on the property. We are submitting
this permit application for the construction of a new well and septic system. The attached site plan
identifies the location of the home and the proposed well, septic location and alternate site. No
conflicts exist between this proposed system and any other well or septic system on this lot or
adjacent lots.
The ground surface on the lot slopes gently to the southwest at grades approximating 10%. There
are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site.
Drainage arrows are shown on the site plan indicating the grade and direction of flow. Stormwater
drainage will not impact this septic system. The new trenches will be constructed parallel to the
slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank.
Please refer to the attached test hole logs, soils lab analysis, plan and profile pages for the septic
design. If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
3/29/19
ALTERNATE SITE
FCO
100500
FEET
1"=50'
EXISTING WELL
4-BDRM HOME
1250-GAL SEPTIC TANK
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
CO
MT
TH#1
DENALY ESTATES, BLOCK 2, LOT 5
MC
I
N
T
Y
R
E
R
O
A
D
3/28/19
15' T&E EASEMENT
25' BUILDING SET-BACK25' BUILDING SET-BACK2 x 75' LONG x 5' WIDE x
0.5' EFFECTIVE DEPTH
ABSORPTION TRENCH
TH#2
MT
MT
MT
CO
CO
CO FS
CO
2CO
PROPOSED WELL
100' WELL RADII
ADJACENT LOT
SEPTIC AREA
12.5' BUILDING SETBACK
10' BUILDING SETBACK15-20%15-20%
DENALY ESTATES, BLOCK 2, LOT 5 CO* I
F��c�|/�MJ ����- �����T�N7 �J�/�U\���y���JT�'
�^�_^^.`�." FACTORS- ``^ . `,. ^`^^^ . `' . ^_.". REQUIREMENTS:
`�_.".^_." . ~�.
6OOGPD PEAK FLOW SHALLOW TRENCH SYSTEM
PERK RATE: 6-15M|N/|N 125O-GALSEPTIC TANK
APPLICATION RATE: O.8GPD/SF
8OOGPD /O.8GPD/SF /5'VNDE^1.ORED =15OLFTRENCH REQUIRED (15OLFSPECIFIED)
BOTTOM OFTRENCH: 4'-G'BELOW GRADE
FLOW LINE ELEVATION: 4'-O'BELOW GRADE
TOP OFTRENCH: O'-O"ABOVE GRADE
��
5'
TYPICAL TRENCH SECTION
(NO SCALE)
��T��'
' —�--'
1. GRADE AREA OVER TRENCH TODRAIN AWAY
2. PROVIDE 3'DFCOVER OVER TRENCHES AND 4'OVERSEPTIC TANK, DR2'
WITH 2"{}FINSULATION
1 CHECK GROUNDWATER ATTIME OFCONSTRUCTION. |FLEVEL |GHIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
TED PVC
OWN)
OVED SAND
'.MICHAEL E. ANDERSON
No. CE -4381
13, d
SOILS LOG AND PERCOLATION TEST
E N G I H E E R I N G
LEGAL DESCRIPTION: DENALY ESTATES 132 L5
PERFORMED FOR: T D H
DATE: 3/25/19 PROJECT No.:
PARCELID#- 067-062-12 TECHNICIAN: J. MILLETTE
DEPTH TEST HOLE I
(feet)
1 11 OB SLOPE
GP (SANDY GRAVEL)
2
CL (CLAY)
5
6
7
GM (SANDY SILTY GRAVEL)
8
9
'\7
SITE PLAN
SEE SITE PLAN
13-
14
15-
16
17
is-
19 -
20
COMMENTS:
DATE
READING
GROSS TIME
(MINUTES)
WAS GROUND WATER ENCOUNTERED?
YES
NET DROP
(INCHES)
3/27
TEST HOLE PRESOAKED PRIOR TO TESTING:
IF YES ,@ WHAT DEPTH?
91
6
2
DEPTH OF WATER AFTER MONITORING:
9.51
0
5
3
6:16
DATE OF MONITORING:
4/15/19
p
4
6:46
30
4
1 16
4 L2
16
E
5
12
6
6
13-
14
15-
16
17
is-
19 -
20
COMMENTS:
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO WATER
(INCHES)
NET DROP
(INCHES)
3/27
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
5:45
6
2
6:15
30
1
5
3
6:16
6
4
6:46
30
4
1 16
4 L2
16
5
6:47
6
6
7:17
30
1 -!L
16
412
PERCOLATION RATE: 6.3 (MIN/INCH) PERC. HOLE DIA. --.§--(INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
DEPTH
(feet)
1 -
2—
J -
4—
5—
6—
7—
8—
9—
10—
11—
12—
13—
14—
15—
16—
17—
18—
19—
20—
SOILS LOG AND PERCOLATION TEST
ENGINEERING
LEGAL DESCRIPTION: DENALY ESTATES B2 L5
PERFORMED FOR: T D H
DATE: 3/27/19 PROJECT No.:
PARCEL ID#: 067-062-12 TECHNICIAN: J. MILLETTE
TEST HOLE
1' OB
GP (SANDY GRAVEL)
----- CL (CLAY)
f
GM (SANDY SILTY GRAVEL)
SLOPE
WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH? - L
' DEPTH OF WATER AFTER MONITORING: 10' 0
DATE OF MONITORING: 4/ 15/ 19 P
i
COMMENTS:
49th
%.n.n.u..nn.......,nu..nneeee ..nee
MICHAEL E. ANDERSON : 4
4.
No. CE -4381 °,•°
4116119
®e m
%4ESS
\0- �
Professional Engineers Stamp:
SITE PLAN
c
SEE SITE PLAN
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
3/27
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
6:31
6
2
7:01
30
0
6
3
7:02
6
4
7:32
30
0
6
5
7:33
6
6
8:03
30
0
6
PERCOLATION RATE: 5 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
Certificate of On -Site Systems Approval
Parcel 1. D. 067-062-12
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: rte yJ a l0 , c 01�0
Complete legal description Denaly Estates, Block 2, Lot 5
Location (site address) 25380 MC Int:yre Road, 1e- R+VzC; AK
Current property owner(s) Troy Davis Homes Day phone 907-357-9394
Mailing address
Real estate agent
1689 S. Knik Goose Bay Road, Wasilla, AK 99654
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: W Q -u, Distance: 9ri• 5
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 15
Date of Payment I v 5 6 -
Receipt
Number 0 �0 18 5b
COSA# 6SCA9155`3
Date:
Waiver Fee $ 1
Date of Payment I I
Receipt Number 01 05 OD
Waiver # O Sy 19 109 (0
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 11/14/19
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6. DSD SIGNATURE _ - , 49th •
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System #1 Approved for bedrooms •• fi; MICHAEL E. ANDERSON ,; i2� 0
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System #2 Approved for bedrooms p F'°•.,,.11/14/19
Disapproved ®o� of,f'RO�®Sjsftwx�®�®®
Conditional approval for bedrooms, with the following stipulations:
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ON-SITE
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WATER ANWASTEWATEMD
PROGRAM
ll1
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.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume 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 of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade 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
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
Denaly Estates, Block 2, Lot 5 067-062-12
60
4/3/19 0
145
143
.028
3.53
>18 Wheaton Water Well
4/3/19
Artesian
10/23/19
<1
SEPTIC/STEEL
New Construction - 5/22/19
5' Wide Trench
5/22/19 New Construction
4.5/4.2
4.0/3.7
COSA Checklist yellow sheet
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
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Property Line > 5’Yes if No ft
Absorption Field > 5’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to:(Please enter distances if less than required)
Building Foundation > 10’Yes if No ft
Property Line > 10’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
F. ENGINEER’S 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.
11/26/19
97.5 ✔
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See well to septic tank waiver.
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