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Home My WebLink AboutSNOW CREST VIEW LT 26Onsite File i �� Municipality of Anchorage On -Site Water�and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191131 PID Number: 016-141-24 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: BURTON KRACKER & SHERRY CORLEY ABSORPTION FIELD — EXISTING - TO DOCUMENT ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 11220 LILLIAN LANE, ANCHORAGE ® Other 2 CRIB SYSTEM Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 10.6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.6 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot SNOW CREST VIEW 26 Fill added above original grade VARIES Ft. Gravel length 16+ Ft. Township Range Section Gravel width 16+ Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES ToTotal Septic Absorption Lift Station Holding Sewer absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 400+ Ft2 Ft. Well 100'+ 100'+ NA NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1 1000 Gal. Surface Water 100'+ 100'+ NA NA Material STEEL Number of compartments 2 Lot Line 10'+ 10'+ NA NA NA Foundation 10'+ 10'+ NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA UNK NA NA Remarks S.T. connected to existing cribs. Two Pump on level at in. Pump off level at in. High water alarm at in. 8'+ x 8'+ x 6'ED cribs with SW soils. MOA On -Site staff present at documentation. Pump make and model Electrical Inspections performed by Installer MIKE N. ANDERSON PIPE MATERIAL House to tank 3034 dank to 3034 Drainfield 3034 CO/MT 3034 Inspector FWCS / MNA BENCHMARK (Assumed elevation) 100 ft Inspection �s 6/6/19 6/6/2019 Location and description 2nd 3`d 4th BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL 0®� ®A 4 toConditional Approval: Date ®* .49TH *� MICHAEL N. ANDERSON.- NDERSON:No. CE 9469 w )00 N.. Approved 1&loQr Date axx 7 /q \ sslo�Pti s inspection Repon_!j i-iz.aoc SCALEi NTS PREPARED FOR: SUPPORT,SERVICES: --06_0k\ BURTON KRACKER & SHERRY CORLEY i�� F<9� 1 SNOW CREST VIEW SUBD, LOT 26 11220 LILLIAN LANE, ANCHORAGE, 99515 Michael N. Anderson P.. Anderson, 8/27/2019 MICHAEL N. ANDERSON / No. CE 9489 4661 Natrona Ave.DRAWN: FWCS 1 �� 8/27/19 Anchorage, Alaska 99516 1 � (907)727 8864/FAX: (907)345 1391 SCALE: 1�ssl0��•v i" = 30' \�`__� PI D: 016-141-24 SNOW CREST VIEW SUBD, LOT 26 PERMIT. OSP191131 F- F- N N �I 30' S 89 52'30" W 135.00' — — — — — — — — — —x—x—x—x—x—x—x—x—x—x x 9.7' z Z I EXISTING 2 O KS NEW 1000 -GAL -CHAMBER O O I SEPTIC TANK CRIB O8 CO I O 28.5' A O CO CO COs r F- C I� y FCO CO E MT O F- I r r 000 a N EXISTING HOUSE �, _ C C _ D O W N BM F Z OMT I� m � U, 28.5' B x x_x r - —x_ �x—x_x r D D x -4 Z d7 I GRAVEL m O 7. ' N CARPORT 0/W O O _i I cn O oLOT 26 U'l — —'58"2i3-(Y`W-x—x—x—x--1 13 .00' 0 • KEYBOX O -1 WELL (tYP) � ® N UT SCALE1 1' = 30' A -C=26,6' F0° co Co co C01 CO2 MT MT B -C=34.4' 98.54 98.52 97.7 FINAL GRADE 97.6 A -D=32.2' B -D=40.0' 94.42 A - E = 5 5.6 PER DATA REVIEWED & 93.84 3.67 EXISTING 93.0 +.000 GALLON DISCUSSED W/ B - E = 61.6' STEEL TANK MOA -AREA CRIBS SOILS SHOW A- F= 5 7 4' SANDY SW/SP B - F - 58.3' 87'0 CRIBS HAVE 87'0 SOILS & NO GROUNDWATER 6' ED ISSUES. SITE SOILS SHOWED SEPTIC SECTION PAM CONSTRUCT.D SW MATERIAL. SOME SLUDGE REMAINING. SCALEi NTS PREPARED FOR: SUPPORT,SERVICES: --06_0k\ BURTON KRACKER & SHERRY CORLEY i�� F<9� 1 SNOW CREST VIEW SUBD, LOT 26 11220 LILLIAN LANE, ANCHORAGE, 99515 Michael N. Anderson P.. Anderson, 8/27/2019 MICHAEL N. ANDERSON / No. CE 9489 4661 Natrona Ave.DRAWN: FWCS 1 �� 8/27/19 Anchorage, Alaska 99516 1 � (907)727 8864/FAX: (907)345 1391 SCALE: 1�ssl0��•v i" = 30' \�`__� Carroll, Rebecca M. From: Carroll, Rebecca M. Sent: Wednesday, May 15, 2019 10:58 AM To: Brent Subject: RE: Snow Crest View L26 Thanks Brent, I am comfortable with separations to groundwater and impermeables. For the sizing, it looks like surrounding lots that actually did perc tests ranged from <1 mpi to 5 mpi. Would you be able to do a perc? If not, I think we would have to assume <1 mpi and would need a sieve analysis showing that it is sand. Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 From: Brent <brentwestern@gmail.com> Sent: Wednesday, May 15, 2019 9:55 AM To: Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov> Subject: Re: Snow Crest View L26 10-11' from grade - looks like a little fill / landscaping material above original grade so more like 9-10'. Thanks- I meant to get back to you. Sent from my iPhone On May 15, 2019, at 9:42 AM, Carroll, Rebecca M.<rebecca.carroll(cDanchorageal<.gov> wrote: Hey Brent, What was the total depth of the existing seepage pit, so I can determine whether existing test holes are deep enough?11 CVVJ / _� `/' (_T/J Becca Carroll4iW-- Onsite Water and Waste1///`//J Municipality of AnchorSW — C{�j_ ' `"�i 'f�-.(�, V W 343-7908 F" 1Z i -.- _ZGUi L -p %ot to —! 2� s P <aTZ-71 V r — zoo ----sa,.� i 1 (�i6� . Ulm N. 17— 0 0 ---4 30' S 89*52'30" W 135.00 A A -A -X -X -X -X -X -X X -X-X X -X -X -X -X X 9. z z I N C 0 SHED 0 0X ' � � 28.51 72.1 1 C:) X r 0 a C:x BW so SEPTIC 0 r- 11 ---1 C VEN T f— r- 00 0i EX/S77NG ANT 0 N (typ) > X Ho(jSE 0j --- i C)4 1 N 0 z - M sw17— U) > 0) 28.5* r z > 0-) 0 rn M 6 --1 GRAVEL 00 CARPOR-r D/W 7. 00 0 L4 no I M 0 M X-X-x_i 135.00 0 -'bKEYBOX 0 WELL (typ) Ln ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: SNOW CREST VIEW SUBD LOT 26 PLAT P-512 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a .0.F. 4Z LAIVD physical survey of this property as shown on this drawing and that the• O 4S, improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should/ � 49TH•. � � a � � any information on this drawing be used for construction of fences, .... ........ • .. ........... structures, improvements, or for establishing bound ary lines. FrIA FA ? U V PA a EXCLUSION NOTES: It is the owners responsibility to determine Q1 • 0 It OHN L. SCHULLER. the existence of any easements,, covenants, or restrictions which do not appear on the recorded subdivision plat. LS -10408 1831 Talkeetna Street 'S� 0 WORK ORDER NUMBER: DAM SCALE. E -"U • eQ Ali* •, 0`p 6 4Af;W Anchorage, Alaska 99508 AUG 17, 2019 1 =30" MAWW BY: CliECI(ED BY GRID NUMBER: BOOK/PAM 'o-0 f (907) 227-1455 office lqlo�� 19-079 esSjon& JLS SW2630 190139 (907) 274-4992 fax 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:fiwvAv.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191131 Work Type: SepticTank Initial Tax Code Number: 01614124000 Site Legal Address: SNOW CREST VIEW LT 26 G:2630 Site Mailing Address: 11220 LILLIAN LN, Anchorage Owner: KRACKER BURTON P 50% & Design Engineer: fiNDERSDk) CONSTRUCT/oNj+5 J6/NEE121N6 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Date �mcnt C:I1F11'rtllCl)t 5!112019 Expiration Date: 4130/2020 Lot Size in Sq Ft: 8910 Total Bedrooms: 2 ❑ 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 (2417). 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: 1) Seepage pit shall be pumped to remove any solids and scum. 2) A test hole shall be provided to verify code required separations to groundwater and impermeables, as well as to verify that the seepage pit is adequately sized. Results shall be submitted with inspection report. If test hole determines that the seepage pit does not meet code requirements, a drainfield design shall be submitted to Onsite for review and approval. Received By: Issued By: JF Date: S , Date: 5 I M MHMPAUTY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 016-141-24 N 'E 1 ® �.f 9 f •' ON-SITE SEPTIC/WELL PERMIT APPLICATION ERIANS Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) BURTON KRACKER & SHERRY CORLEY Day phone 9076321591 Mailinq address 11220 LILLIAN LANE, ANCHORAGE, AK 99515 Site address 11220 LILLIAN LANE, ANCHORAGE, AK 99515 Legal description (Sub'd., Block & Lot) SNOW CREST VIEW LOT 26 Legal description (Township, Range & Section) Lot Size 8910 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ® Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ElDuplex ❑ (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ } THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS m Brent Wes -tern (Signature of property owner or authorized agent) Permit/Rush Fees: oC oZJ Waiver Fees: i Date of Payment: �� Date of Payment: Receipt Number: 0 0 7'�131b Receipt Number: Permit No. 0,5016 I I q/ Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 April 24, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SNOW CREST VIEW LOT 26 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to install a septic tank on the subject lot. We are in the process of documenting this system and would like to have the tank permit on hand to install at time of investigative excavation. From observations of the existing cesspool seepage pit and area sandy soils, it appears the absorption pit will meet code parameters for 2-3 bedrooms and with the installation of the proposed septic tank we will be able to complete documentation of this system. In the event that the pit does not meet code criteria, an updated design will then be submitted. The lot and adjacent lots are served by a private class C water well and the installation of this tank will not impact any of the neighboring properties due to the lot layout. Please contact me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191131, Rebecca Carroll, 05/01/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191131, Rebecca Carroll, 05/01/19 �' Zlp �f93 Sn.a,aCSLtssr JIE�J rJc�4N C ST. lLuN - etaFi.1L, O'MALLEY RD. I I 1 11 a I II PENINSULA CIR. 3Ec im1 u Jho I I 11151 .Fp -0 GPS To C) �R I •11200 I G��({.l(i%/ 19p 11205 1J z1 11'A1 b112 1 N A2 n 112111 11210 1N p2" 3 11245 11220 j1221 a 0220 1122 1224 11$5! 11231 • 1230 11230 0231 W 1304 6 11343 112413 x11240 1120 �13W 11301 1614 11315 11310 113014 1300 Z 11301' 1z4 -J J 11300 FC tOT z J 11311 3 11324 m 11325 JI13 1311 13p 11303 2 11321 < 11321 W n G 1330 11331 1634 S 11335 ST. S QO 11323 n 11403 '1111400 11401 \pp 1331 9 3 11330 j J 0341 Q 11300 N L 4W1 415 \\4\0 T\\ 11125 1 1 11001 113.0 11400 Z 3a. 111 �O q ? • w Q 0411 r 114p -3 YS . 121 1430 9 MQ p 9 6 , I > A s 11421 '7 JOAN CL 114b 9 MI11551 11511 IM31� 11430 O0 � 0 IK 11450 11321 IN41 ,r CJI IKO 16Z 13e- 130- y.r G6 MASEIIT 501 1 1 s 11160 p'\Q 1531 IISOI lr 0 1641 , 11511 Ir ro 1•E P D' \\ I KSL VEFLE 6 1 1 1''S 11C 2r Lptt I rwr 0551 HpEi�K 1 E IT MI 141 I KLATT RD. vF. KL -ATT RD. -___ __________________________ "A4.R1------- 1.1F01 ____--__—JOHNS L013MAIff 1 GR, 2630- NW 114 SEC. 19, T12N R3W 280 296 295+ 297 SEE OVERVIEW MAP "L" cavrRKart MJ9T JMt 3u rr OF I SN,. DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER AND WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 http://www.state.ak.us/dec/home/htm] April 11, 2001 Snowcrest View North Charles and/or Korin Homestead 11240 Latta Circle Anchorage AK 99516 TONY KNOWLES, GOVERNOR FILE L Telephone: (907) 269-7624 Fax: (907) 269-7655 RE: Reclassification of Snowcrest View [North] Public Water System (Public Water System ID #210493) Mr./Mrs. Homestead, This is to confirm our conversation this date on the reclassification of the referenced public water system (PWS). This Department received a letter from Mr. Donald Fritz on January 21, 2001 (attached) identifying that the homeowners association supports such a reclassification. Finding the residential population serviced by this public water system to be less than 25, with fewer than 15 service connections, this system meets the definition of a "Class C" PWS. Per your request, this water system has been reclassified from a "Class A" to a "Class C" PWS. Although Class C public water systems are not required to conduct routine monitoring, this Department strongly recommends that bacteriological sampling be completed at least quarterly and nitrates annually. Lastly, please continue to monitor the residential population. Should the population increase to 25 or more, the system would be required to be returned back to a Class A PWS and be held to the standards as such. If I can of further assistance, please contact me at (907) 269- 7624. Thank you. Sincerely, Thomas C. Tiley Environmental Specialist Atch: Snowcrest/Fritz Letter (1/11/01) CC: Snowcrest View North HOA (D.Fritz) to: Thomas Tiley Division of Environmental Health 555 Cordova St. Anchorage 99501 Dear Mr Tiley, p ECEOVE jolt = D AOEC/ANCHORAGE ENVIRONMENTAL HEALTH My name is Donald Fritz and I am the owner of a lot located on Lillian ! ane ui Showe rest View Subdivision North, and which is connected to the communally shared well operated by us in the subdivision. I actually hold no position, but am simply one of the owners, but I do speak for other owners in this matter and have volunteered to write this communication. To Wit: We, the owners of the lots located in Snowerest View Subdivision North, hereby bring to your attention the legal fact that we are a class C public water system as defined by the State of Alaska in title: 18 AAC 80.1990; (a) (12), (a) (13), (a) (14). We have fewer than 15 connections year-round. (we have 13). �We serve fewer than 25 individuals year-round (we serve about 20) c) We serve the same number of individuals year-round, with no seasonal changes in water consumers Perforce, as defined in the above reference, we are not a Class A, nor are we a Class B public water system. And therefore, we are by definition a Class C public water system, Therefore, we request that our classil cation it *' c*^*_'� records and rolls be reclassified from Class A to Class C. I.r OS/ /� Thank You for your attention to this matter. Our functional_ address for notice of this Reclassification may be: JnowCrest View Subdivision, North c/o Dee Marx 11300 Lilian Lane Anchorage AK 99515 A copy of Reclassification notice may also go to our interim record -keeper: Korin Homestead 11240 Latta Cir. Anchorage AK_ 99515 1 am including a copy of a "plat map" which may help you locate our lots and their location. in Anchorage. Thank You, again Sincerely, Donald Fritz , owner lot 27, Snowcrest View S/D, North i¢. 21 U 8C1 Snxx., CQVT VILL,) SiUTN M NW 114 SEC, 19.712N R3W GR. 2630 280 296v 295+ 297 SEE OVERVIEW MAP "L.. 311 COPYP 1997 JM1 A Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 016-141-24 1. GENERAL INFORMATION Complete legal description SNOW CREST VIEW LOT 26 Expiration Date: N O V c I c 0 11 Location (site address) 11220 LILLIAN LANE, ANCHORAGE, AK 99515 Current property owner(s) BURTON KRACKER & SHERRY CORLEY Day phone Mailing address Real estate agent 11220 LILLIAN LANE, ANCHORAGE, AK 99515 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well "C" PRVT. ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -- Date of Payment I2� �� Receipt Number (5-o450 COSA # O CNI� I1;�qo Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 8/16/2019 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 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 FWCS and Anderson Construction & Engineering. DSD/ SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms ..ft-ft,q1"k i i ��. OF � �* 49XH� *� I01. I '.MICHAEL N. ANDMRSON:' 1 No. CE 9489 Atf ''••8/1.6/1.9•''•.'/ bedrooms, with the following stipulations: j ON-SITE 61 WATER AND By: Original Certificate Date: a 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.docx COSA Checklist Legal Description: SNOW CREST VIEW LOT 26 Parcel ID: 016-141-24 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA - CLASS C PRIVATE 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 NA 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 8/7/2019 Comments B. TANK DATA – 6/6/2019 - 1000-gal Age of tank(s) 0 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping NA - NEW C. LIFT STATION - NA Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA – TWO 8’+ X 8’ x 6’ED CRIBS – 1.2 GPD/SF = 400+ SF Which system tested (date installed) CIRCA 1970 ALL standpipes present per record drawing Total measured depth from grade 10.6 ft (max) Measured depth to pipe invert from grade 4.6 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 6’ Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2100 gallons Adequacy test date 6/11/2019 Results Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 550 gal New depth 1 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: NO WELL ON LOT (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 Documentation of existing cribs with new steel tank installed. 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. 8/27/19