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Home My WebLink AboutGLASSING RIDGE LT 58BOnsite File Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191327 PID Number: 051-081-08-000 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project:❑ New ❑ Upgrade Name Moore Oliver & Venita Fam Trst ABSORPTION FIELD ❑t Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21902 Knik Vista St. Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-242-5089 3 0.45 GPD/SF 14.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 Ft. Gravel depth beneath pipe 9.0 Ft. Subdivision Block Lot LT 58 Fill added above original grade Gravel length 1.5 Ft. 57 Ft. Township Range Section T1 5N R1 W SEC 5 Gravel width Beds: Number of Lines Distance between lines 2.5 Ft. Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1026 Ft2 1 Ft. Well 116 145 TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1000 Gal. Surface Water 800'+ 800'+ Material Number of compartments Lot Line 95 59 NA Polypropylene 2 Foundation 10 44 LIFT STATION Manufacturer Capacity Remarks Extended TH #2 an additional 3 ft to verify Gal. no impermeable layer. Monitored for groundwater Alarm location Electrical installed by for 7 days; none found. Revised soils log attached. PIPE MATERIAL House to tank PVCTank to PVC drainfield Installer Fischer Bros. Excavation, LLC *All PVC ASTM D3034Drainfield PVC CO/MT PVC Inspector Scott Roelfs, PE (VEI Consultants) BENCH MARK (Assumed elevation) 524.7 ft Inspection v, 9/24/19 9/25/19 Location and description 2nd 31" 9/25/19 4`h 10/3/19 Finish Floor of House ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 4%-0 0, Conditional Approval: Date Q�.• / �`� 1 •rr .: � •• 9TH �� •'. 00131Scott Thackery Roelfa �: •C,-00 �: •, CE ! $ 4 .; �6AW Septic System 00--m-65 Approved Date a� ab s � F,'•.) �%v��' ,c.�� Note: this approval does not include well permit requirements. pP P q`j`,ESS''�tti .,, � k trcev uoiuzn o/ T I I I �< o — ��Ga N 72 100• WEl RADIUS 73A / 73B EPTIC YSTEMS / II z o F�� 59 58 SEPTIC SYSTEM • PLAN - Pg 2 PROFILE - Pg 3 So' ,00, 3 -BEDROOM HOUSE WELL • iH#1 TH#Z 0 �TM� \ EF— 72 100• WEl RADIUS 73A / 73B EPTIC YSTEMS / II y GRA SSER RD EXISTING SEPTIC SYSTEM 70, I 8A �G 5 RECORD DRAWINGS z o• So' ,00, y GRA SSER RD EXISTING SEPTIC SYSTEM 70, I 8A �G 5 RECORD DRAWINGS r/ I 511 moo Rqa uS \ NE HOUE ?��4 FOR 77�Wl O \ CO PROPOSED 3 -BEDROOM HOUSE FINISH FLOOR ELEV = 524.7 (BENCHMARK) �4, DESIGN CRITERIA No. OF BEDROOMS: 3 GALLONS PER DAY: 450 GPD PERCOLATION RATE: 35 MIN/INCH ALLOWABLE APPLICATION RATE: 0.45 GPD/SF MINIMUM EFFECTIVE ABSORPTION AREA: 1000 SF DEEP TRENCH MAXIMUM DEPTH: 15.5' WIDTH: 2.5' LENGTH: 57' DEPTH OF SEWER ROCK: 9.0' EFFECTIVE DEPTH: 9.0' EFFECTIVE ABSORPTION AREA: 1026 SF m#1 221' BEND so 4" PVC 10'. L 9 h+# — — — — —DEEP TRENCH — L' — — — — — — — — — — DOUBLE 571 x 2.5'W x 9' DEPTH BELO II CO POTENTIAL REPLACEMENT SYSTEM � / 1000 GALLON POLYETHYLENE SEPTIC TANK (INFILTRATOR) MANWAY RISER (20"0 MIN) SERVING FIRST COMPARTMENT 4"0 STANDPIPE TO OTHER COMPARTMENT 2" INSULATION IMMEDIATELY OVERTOP TANK NE GARAGE CORNER \ FOR SWING TIES LOT 58, SEC ION 5, T15N, R1 W, \II\ SEWARD MERIDIAN I � \ PRO OS \ ED DRIVE I _ 10' 20' h — co M T ERF PIPE 59.3 I TO IL'. RECORD DRAWINGS SWING TIE DISTANCES (FT) COMPONENT FROM NE HOUSE CORNER FROM NE GARAGE CORNER FOUNDATION CLEANOUT 3.1 35.6 TANK MANWAY 12.5 39.8 TANK STANDPIPE 17.1 42.1 DOUBLE CLEANOUT 31.6 49.1 WEST MONITORING TUBE 44.8 55.8 TRENCH CLEANOUT 100.1 99.8 EAST MONITORING TUBE 100.3 99.0 59.3 I TO IL'. RECORD DRAWINGS ............................................................................ Co IMT NO GRD WATER 10/3/19 ........................................................ MT .. ........... __ DOUBLE NO GRID WATER 10/3/19 CID 0 9 fl I /- FINISHED GRADE 525 0 MANW S ANDPIPE 525 FINISH FLOOR ELEV = 524.7 .(BENQJAMARK) TH,y - TOP OF HOLE = 523.1 ZEXISTING BTM OF HOLE = 502.1 NO'GRD WATER 7/29%19 AND 10/3/19 GROUND 520 11Z%I 1 11 111 1 1 lif 520 22 ' 4" PVC BEND 2% INVELEV = 519.50 ................................. .... oy,....... ........... ...... 4' PVC i =1= `fes, i�—_4_PERFQRA7ED_ P�C� _� = TANK INLET ELEV = 519.27// .... ........... INV ELEV .. ....... = 518.54.. .... � o. TANK OUTLET ELEV 519.020 o 1000 GALLON `. . . ....................... �. TANK 515 DEEP 515 ..��. OF ANG,,♦ 1�`P�� •�S♦•� 510 o� o� `oma o `0 0 0 `0 0 0 o I 510 i �'�' : J •� 0+00 BTM TRENCH ELEV = 509.5 •• AF�=� 49th �� .....:: .. .................cl:.....� 0+50.......................................... _ 1+00 SULTANTS ........ Lr•••••�••:• 13451 RUDN KOF CIRCLE ......::........1�....... SCOTT T. ROELFS w Aw 118 4,W SEPTIC SYSTEM RECORD DRAWINGS � VEI LOT 58, SECTION 5 *j FO ....... TOWNSHIP TOWNSHIP 15N, RANGE 1W, SEWARD MERIDIAN Consultants �NI ;��5�;..•' R E C 0 R D DRAWINGS VERT CALF 1:=2 DATE: 1/15/2D GRID: NWI457 Pg 3 OF 3 PERT SCALE: 1'=2' VEIConsultants Civil Engineering and Surveying Consultants Serving All of Alaska 1345 Rudakof Circle, Suite 201 Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Oliver and Venita Moore DATE PERFORMED: 6/26/19, extended 9/25/19 LEGAL DESCRIPTION: Lot 58, Sec 5, T15N, R1W, S.M. TOWNSHIP, RANGE, SECTION: T15N, R1W, Sec 5 PERFORMED BY: Scott Roelfs, P.E. TEST HOLE No. TH #2 DEPTH (FEET) 0 - Topsoil :.V SW 2- '�;.,: sand, some gravel 3 - SP 4 :*.; : fine sand, ; some gravel 5- '.: :::':. 6- 7- 8- 9- 10 - SP 11- fine sand 12- 13- 14- 15- 16-~_ 17- 18 - 6/26/19 19- 20- 21- 9/25/19 .•�� OF 14 tit •:�4 0 49th�0 I SCOTT T. 6ELF e •��i •• C 118 _AV �e pF0 ••........ SLOPE vi TOTAL DEPTH OF TESTHOLE 21.0 GROUNDWATER ENCOUNTERED: ® ❑ NO YES DEPTH TO GROUNDWATER: GROUNDWATER ENCOUNTERED: ® ❑ (After Monitoring) NO YES DEPTH TO GROUNDWATER: MONITORING DATE: 7/29/19 ,n /z Mn w a 0 En SITE PLAN I I I I I I I TH #1 TH #2 I ® ® I I TH #3 I II Date Reading Gross Time Net Time (min.) Depth to Water (inches) Net Drop (inches) 6/26/19 1 14:38 0 2 14:52 14 1 1/2 1 1/2 3 15:01 9 2 1/4 3/4 4 15:09 8 2 7/8 5/8 5 15:14 5 3 1/4 3/8 6 15:23 9 3 7/8 5/8 7 15:30 7 4 3/8 1/2 8 15:40 10 5 5/8 9 15:50 10 5 1/2 1/2 PERCOLATION RATE 13.1 (minutes/inch) PERC HOLE DIAMETER 6., TEST RUN BETWEEN 6.0 FT AND 7.0 FT COMMENTS: Pre—Soak 4hrs Extended from 18.0 to 21.0 on 9/25/19 PERFORMED BY VEI CONSULTANTS. I, SCOTT T. ROELFS , CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Wheaton Vater We, enc. 1190 N. Wasilla-Fish hook Road Wasilla, AK 99654 (907)376-2041 Name: Hall Quality Homes Address: PO Box 1987 City: Wasilla State: AK Zip Code: 99654 Well Site: T15 rJ KA -3 Sec 5 Lot/Block: rj g Additional: 21902 Knik Vista St., Chugiak, AK Well Depth: 77 ft From: To: Formation: 0 11 sand/silt Below Ground: 75 ft. 11 33 sand/gravel/silt Above Ground: 2 ft. 33 54 silt/gravel Gal/Min: 30 54 63 damp silty gravel 63 77 gravel/water Static Level: 57 ft. Casing: 77ft. of 6 in. x .25 in. steel Liner Pipe: N/A Screened: N/A Perforated: N/A Grouted: YES, Bentonite ` VAf ER QUALITY TESTING Coliform 10 t /900rt�L Depth: N/A Nitrates 3491A �L Develop. Method: Air Arsenic N D 1 z3 2020 Use of Well: Residential Drilling Method: Rotary Misc: Other: chlorinated to 50ppm The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 30. Date Drilled: 9/19/2019 Driller: Ben Mattson Development Services Department Building Safety Division GE 8U On -Site Water & Wastewater Program 4700 Elmore Road z. x P.O. Box 196650 Mark Begich Anchorage, AK 99507 s A E T Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW OSP191327 Date of Issue: 07/28/2019 Parcel Identification Number: 05108108000 Legal Description Property Owner Name & Address: Township 15N, Range 1W, Section 5, Lot 58 Oliver and Venita Moore PO Box 670732 Chugiak, AK 99567 Pump Installation Date: 12/06/2019 Pump Intake Depth Below Top of Well Casing: 70 Pump Manufacturer's Name: Meyers Pump Model: 1/2 hp 12 GPM Pump Size 1/2 hp Pitless Adapter Burial Depth: 16 feet Pitless Adapter Manufacturer's Name: Campbell Pitless Adapter Installer: Unknown Well Disinfected Upon Completion? ✓❑ Yes ❑ No Method of Disinfection: Sterilene Comments: Pump Installer Name: Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. el 133HS F71- -70 lj 0, ('06) 29566 " 29 10-1 VV19 �Dzlf,31")6!D s7uq7tnsuoj 17111 SV G/A L)rySDIV 5qtpJ0Xly -15D30tPUV 'UBT�Jafl PJDM--S *18 V911 ',r 0 -IS V.9 X7 AToTLd7MYU'-7v—o,y7 6102 'Ylfl ANW-ON PalalduIX 1(9-nS VDId ay/ uo Umoys SD p-aqsijppa -,o punoj U9aq aADY vaujM) j9/ JID ;DLI; PUD 111-19JJW UhlOYS aJD S6 quopq pun s.,ouDislip gyj IDY) PUD 'Pa1,9AJnS dljonpo SPUD/ jo UQqDJU.-Sajdai joaj-101 PUD aag D sf 49-nS /07 S�lqj 10q; Ajryaa Aq;'Jay Op 'joAq-- puol 1DuQssvjo.1d TW -Y 7 uculaA 7 -umoqs asimj@q4o ssajun '9961 ql�[ XDN `uD'P!-JGN PJC)mE)S 'ML abul)�J 'N91 diqsumo_L 'q uoijo@S jDjd ;Dc)-jq puis A-iq LUOAJ Uol;E)W-10�ul P)03Gq S-ql0N Fdlkvm ofi 3-J V') s X 'A �07 J, IVYZ OZ__.. azz i L s --]/Vi V C', 1,99.69N Uhl -S8 'W 00'99 :J,, Z- 1, e q-. 6 N 3,0�-. 'Tr, .,--" N- f7T'ggl --? 1 :1, 0 ,IS .68N 3 A i Lr f T] A, fid, 3 4 f 1. 1 AJ 0 2 L ti "yl 9 3-3 D N 0 cl, 0 co CD -d 10 H N VIA SI Z Z ih ro 0 CD rTj C5 VR (5 7� 'U cS CO � < CO C> CIO i bvi 7.. C� '00,m� is3m vile (Z --V-66 '23) -VZ-*�6Z 3,,-V9,C9.62S ONPAV39 JO SlSV8 V �V&'- �9, 6 r� �.6 8 avow wgss�wo 0 03Z U —66) >l X0079 G,9-nS N-1-371,11 VIN>l tl 'ON ;Did 'PJODGH xx PAODaH (W SDO auoLjdaj@j_ i DIJ�Oaj] PD@qJ@A0-3/HO XDMaAfJ(]/PDOd— G,iod 4nn tZ 11GIM 4noUD@jo OljdaS 0 3d), qj!M ADq,9d "q/g punoj 0 }sod uo dD3 wanly J�� 'juawnuoyl punoj 01-6 }sod LunjV ,JZ uo dD:) wnIV 'juawnuoN punoj Fdlkvm ofi 3-J V') s X 'A �07 J, IVYZ OZ__.. azz i L s --]/Vi V C', 1,99.69N Uhl -S8 'W 00'99 :J,, Z- 1, e q-. 6 N 3,0�-. 'Tr, .,--" N- f7T'ggl --? 1 :1, 0 ,IS .68N 3 A i Lr f T] A, fid, 3 4 f 1. 1 AJ 0 2 L ti "yl 9 3-3 D N 0 cl, 0 co CD -d 10 H N VIA SI Z Z ih ro 0 CD rTj C5 VR (5 7� 'U cS CO � < CO C> CIO i bvi 7.. C� '00,m� is3m vile (Z --V-66 '23) -VZ-*�6Z 3,,-V9,C9.62S ONPAV39 JO SlSV8 V �V&'- �9, 6 r� �.6 8 avow wgss�wo 0 03Z U —66) >l X0079 G,9-nS N-1-371,11 VIN>l tl tooPAL: 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.orglonsite 411 :781, I cpartrncnt 4NCHONa<E On-Site Water & Wastewater System Permit Permit Number: OSP191327 Effective Date: 8/9/2019 Work Type: WellSeptic Initial Expiration Date: 8/8/2020 Tax Code Number: 05108108000 Site Legal Address: T15N R1 W SEC 5 LT 58 G:1457 Site Mailing Address: Owner: MOORE OLIVER & VENITA FAM TRST Lot Size in Sq Ft: 108900 Design Engineer: VEI CONSULTANTS Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy Q 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 Special Provisions: Proposed system too deep for soils information submitted. The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. Received By: Date: 8 Issued By: i6d 6!..1d-r Jt Date: MUNICIPALITY OF ANCHORAGE (7.P' . Development Services DepartmentR,`I Phone: 907-343-7904 On-Site Water & Wastewater Section Fa • 'f g' ° -7997 n)-001 1 41'4) N ON-SITE SEPTIC/WELL PERMIT APPLICATION n. JUL 3 U 2019 AA- 'V I6 w Parcel I.D. 05108108000 << 9�\ Oliver and Venita Moore o7-Z ! �� Property owner(s) Day phone a". Mailing address Fo t3c) Cod d- Z C NLG IAk- AK- c195(7 Site address Legal description (Sub'd., Block & Lot) Lot 58 Legal description (Township, Range & Section) Township 15N, Range 1W, Section 5 Lot Size 108900 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field x Initial n Single Family (SF) 0 (w/wo ADU) Septic Tank H Upgrade H Duplex (D) ❑ Holding Tank Ii Renewal ❑ Multiple Dwellings Privy (SF and/or D) Private Well x 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. ez - .. ,� 0'76 crZaM C (Signature of property owner or authorized agent) Permit/Rush Fees: 4 82O Waiver Fees: Date of Payment: "MON Date of Payment: Receipt Number: c1 nAt!070( Receipt Number: Permit No. Qvl''``Z/ /3,27 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc VE1 Consultants Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 August 6, 2019 Municipality of Anchorage Development Services On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Re: On-Site Sewer and Private Water Well for Lot 58, Section 5, Township 15N, Range 1W, S.M. (Grid NW 1457) Narrative and Permit Application To whom it may concern, VEI Consultants was contracted to design an onsite wastewater disposal system at the above referenced property. A new three(3) bedroom single family residence is being constructed on the property. The proposed house, well and septic system locations are shown on the attached Site Plan, Sheet 1. We request that you approve the attached permit application for construction of the wastewater disposal system and the drilling of a new private water well. Soils VEI conducted field investigations including surveying,digging test pits, performing percolation tests and groundwater monitoring. The Soils Log—Percolation Test for Test Holes#1, #2, and#3 are attached; all test holes are in the vicinity of the proposed disposal field. No groundwater has been observed in these test holes/monitoring pipes and soils logs from surrounding properties led us to believe that groundwater is not an issue in this area. Still, we are requiring the contractor to extend all three test holes(if necessary)to verify there is no groundwater or impermeable strata within 6 feet of the bottom of the proposed trench once the bottom elevation has been set in the field. We anticipate our test holes will need to be extended 1 to 2 feet. Unfortunately,the percolation tests were not performed using the procedure outlined in AMC Chapter 15.65.210. However,the tests were performed using a falling head method (never exceeding the 8" of head outlined in code)and the percolation rate was calculated using the entire test(total minutes/total inches). We performed the tests multiple times throughout the day and we witnessed repeatable results. Only the last test of the day on each hole was provided on the soils log. Therefore, we are confident that we calculated conservative percolation rates. On-Site Wastewater Disposal System—Specifications,Lot 58,Section 5, Township 15N, Range 1 W,S.M. August 6,2019 Page 2 of 2 Additionally, we have chosen a conservative application rate of 0.45 gpd/sf in the design of the trench. Test Hole#1 had a slower percolation rate than the others, so we decided to locate our trench closer to the other two test holes. Surface Water & Topography There are no surface waters within 100 feet of the proposed system. Additionally,no seasonal surface water has been observed collecting anywhere on the property. The general slope of the lot is from southeast to northwest at a grade ranging from 2%-10%. An embankment,with a height of 50 feet and slopes between 40%to 70%, runs down the center of the property from the southwest to the northeast. The proposed absorption trench is greater than 50 feet from the top of the embankment. Trench Design See the attached design drawings and specifications for the proposed deep trench absorption system design. The proposed system will not alter the existing site topography or drainage patterns. The ground surface above the disposal field will be filled up to 1 foot above existing to ensure that surface water does not collect above the trenches. The area will be graded to ensure positive drainage across the absorption trench. There are no adjacent private wells within 100 feet or community wells within 200 feet of the proposed system. We do not expect there to be any adverse effect on adjacent lots by the construction of this system. Water Well The well will be sited,drilled and completed in accordance with standards and provisions in AMC Chapters 15.55 and 15.65. The proposed well location exceeds all minimum separation distances. If you have any questions, please contact me at 337-3330. Sincerely, VEI CONSULTANTS Scott T. Roelfs,, • Attachments: Overall Site Plan 1"=100' (Revised) Proposed Septic System Plan(Revised) Construction and Material Specifications(Revised) T / N r 1 c � ..„.., I o j ,, z .„. ..i 2 �� o• so' goo' GRASSER RD Fb• sS� A�,POAq0' _41 4. 59 58 '°o\, • i y EXISTING SEPTIC PROPOSED SEPTIC SYSTEM SYSTEM SEE DESIGN PAGE 2 . ,,,,,,,14, -‘, ` PROPOSED 0 . 3-BEDROOM • • HOUSE . PROPOSED 0.4 WELL • T HM1 TH#2 1 RA°,Gs • ) • ® ® I 9 0 / T"+® '''T \ 8A ;:PROPOSED DRIVEtl p� /I 0 . o ,,, . _ 72 l9 ....... r O \///, 73A / 73B o O / m � ,a 5v8 AIPP F., ' T I , , 0m _____ — _..,...r.,,,,, oN ._ , / ... 41P41,P' EXISTING .10�\\\\111 SEPTIC / I = N .�• OF , 4.. SYSTEMS •••1 ' '........ . ..**1.677. .: 9th �:: 1% • i��7 • f,,,,,,:, ,: VEI CONSULTANTS j s� SCOTT T. R9ELFS 1345 RUDAKOF CIRCLE ♦♦., CE- •' '�,=i SITE PLAN FOR SEPTIC SYSTEM DESIGN VE1•AF� $�6 I..�.�Z�� LOT 58, SECTION 5 w.�e.D pROFESSIO1\`�P:�•. TOWNSHIP 15N, RANGE 1W, SEWARD MERIDIAN Consultants ,11�\\\illi.• HORZ SCALE:1'.100' DATE: 5/6/19 GRID: 5*1457 P9 1 OF 2 e �a / / DESIGN CRITERIA No. OF BEDROOMS: 3 / / / GALLONS PER DAY: 450 GPO f/ V // PERCOLATION RATE: 35 MIN/INCH 'a.2 /'/" e` 522 ALLOWABLE APPLICATION RATE: 0.45 GPD/SF � 7 / fJ��,►� if-'',"5,..� M NIMUM EFFECTIVE ABSORPTION AREA: 1000 SF lic �/ f/� A14, DEEP TRENCH DESIGN �� - /4,oe S c",I,C MAXIMUM DEPTH: '3.5' y WIDTH: 3' .. 114 ,'' LENGTH: 56' �,`�� r DEPTH OF SEWER ROCK: 9' EFFECTIVE DEPTH: 9' / -••-•-7 EFFECTIVE ABSORPTION AREA: 1008 SF 2" INSULATION IF COVER <3' 0' 10' 20' ALWAYS M/d,U+1TAIN 2' OF COVER MIN / hip 114#2 iINSTALL 1231 ISI FOUNDATION r'"... CLEANOUT WITHIN 4 FEET..- .._ _ 22} MT PROPOSED DEEP TRENCH • BEND 2R TO TRENCH -, T O DOUBLE CO 56'L x 3'W x 9' DEPTH BELOW PERF PIPE MT,_,,, 1„„ �' SEE DESIGN CRITERIA. Rgp`i' i ' TA KEET OF 5904 Gs + 1,to,o \ Y --0.4 POTENTIAL REPLACEMENT SYSTEM PROPOSED TH j3 181 3—BEDROOM \ HOUSE --- \ INSTALL 1000 GALLON POLYETHYLENE SEPTIC TANK MAN WAY RISER (20"0 MIN) SERVING FIRST COMPARTMENT 4"0 STANDPIPE TO OTHER COMPARTMENT MAX 4 FEET OF COVER — USE 2" INSULATION IMMEDIATELY OVERTOP TANK ALWAYS MAINTAIN 2 FEET OF COVER MIN N. 1 L � � \ \ 1 6K, LOT 58, SEC'i1 ON 5, T1'5N, R1 W, s4 SEWARD MERIO}IAN ` ` 1 N - - - - _ - ‘ I1t \ � _� PROPOSED DRIVE '/' 40011111_,11%ii li. • Ar `�'.,flk 1, *SIS 0,,C" .t ~ ~"" 'L"��r ��_ VE CONSULTANTS 0 SC6TT T. Eg.S-"' : L., 345 RUDAKOF CIRCLE IF ♦+ ..... 2E-8 ':G- � SEPTIC SYSTEM DESIGN 17S". VE'I *� 'OFESSIQ\A4�� TOWNSH;P 15N, RANGE 1W, SEWARD MERIDIAN Consultants 'II•auttf>> NORZ SCALE 1'.20' DAR:wig ,coq: NWI457 { Pg 2 OF 2 VE1 Consultants Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 August 6,2019 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: Lot 58, Section 5,Township 15N, Range 1W, S.M. GENERAL: 1. The scope of this project includes the installation of a new onsite wastewater disposal system to serve a new 3 bedroom single family residence being constructed on the referenced property. 2. Upon determining the bottom elevation of the trench,the contractor shall extend the three test holes (if necessary)to verify the water table is greater than 6 feet from the bottom of the proposed trench. Verify there is no bedrock or impermeable soil layer within 6 feet of the bottom of the proposed trench. Monitor groundwater for an additional 8 days after extending test holes. 3. Construction shall be in accordance with the approved site plan and design drawings,municipal permit with any special provisions or conditions,and all applicable Municipal Wastewater Disposal Regulations. Any deviation from the site plan and design drawings requires engineer approval. 4. The contractor shall be responsible for obtaining any necessary underground utility locates. 5. Groundwater monitoring test pipes shall remain in place and functional until construction of the disposal field has begun. If the test holes are required to be extended when the bottom elevation of the trench is determined, groundwater monitoring will be performed for an additional 8 days. After construction of the disposal field has begun, or 8 days after test holes are extended(whichever timeframe is later)test-hole excavations shall be filled and the monitoring tubes removed. 6. Contractors installing wastewater disposal systems must be certified by the Municipal Onsite Water and Wastewater Section for systems installations. Owners installing their own systems must also receive prior approval from the Municipal Onsite Water and Wastewater Section. SEPTIC TANK INSTALLATION: 1. Septic Tank shall be a minimum of 1,000 gallon. The tank shall be constructed of polyethylene and shall be pre-approved by MOA for installation. The contractor shall ensure that the fill over the tank does not exceed the burial depth rating (typically 4 feet for polyethylene). On-Site Wastewater Disposal System—Specifications,Lot 58,Section 5, Township 15N, Range 1W,S.M. August 6,2019 Page 2 of 4 2. Septic Tanks installed with less than 4 feet of cover shall be insulated. Minimum cover with insulation shall be 2 feet. Insulation shall be placed immediately above the top of the tank. 3. The sewer piping from the foundation cleanout to the septic tank shall be 4 inches laid at a 2%slope. If cover is less than 3 feet, insulate with 2 inches insulation. Always maintain 2 feet of cover. 4. Construction shall include a 20 inch(minimum)diameter watertight manway riser serving the first compartment of the tank. The riser, including the cover, shall be insulated with 4 inches(minimum) insulation extending to 48 inches below grade, or to the tank insulation. The insultation shall be of a MOA approved type suitable for below grade applications. Exposed insulation above grade shall be protected from UV damage. The riser lid shall be secured(lockable)to prevent unintended access. The riser lid shall match the final grade. Use a 4 inch (minimum)diameter standpipe with airtight cap to provide effective access to each of the remaining compartments. All standpipes on the septic tank shall extend to a minimum of 12 inches above final grade 5. All septic tanks shall be fitted with watertight couplings,approved by MOA, at the pump out attachments and on the inlet and outlet of tank. 6. In the line between the tank and the absorption system there shall be two opposing cleanouts (double cleanout). The cleanouts shall be located on undisturbed soil not more than ten feet from the tank. The first cleanout in the line shall be to clean the line toward the absorption system and the second cleanout will be oriented to allow cleaning toward the septic tank. 7. The septic tank shall be sufficiently bedded with proper material and compacting to prevent settling or shifting of the tank. 8. The sewer piping from the septic tank to the absorption trench shall be 4 inches laid at a 2% slope. If cover is less than 3 feet, insulate with 2 inches insulation. Always maintain 2 feet of cover. 9. Insulation shall be placed over any wastewater line or pipe over which a driveway, parking, or vehicle storage area may be constructed. ABSORPTION TRENCH INSTALLATION: 1. Excavate the proposed deep trench to the dimensions shown on the design. The bottom of the trench shall be within 4 inches of level. Smeared trench sidewalls shall be raked or scarified before sewer rock placement. 2. Once the sewer rock is installed,the distribution pipe is to be installed level with perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A permeable nontoxic geotextile silt barrier must be installed between the final gravel layer and native backfill. Ensure that the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of 4 inch diameter, installed approximately in the locations shown on the design, and extended a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distributing pipe. On-Site Wastewater Disposal System—Specifications,Lot 58,Section 5, Township 15N,Range I W,S.M. August 6,2019 Page 3 of 4 5. Backfill over the final sewer rock layer must not be less than 24 inches. Insulation shall be installed when the backfill depth is less than 36 inches. The finish grade over the trench shall be mounded to prevent formation of depression after settling. 6. Insulation shall be placed over any wastewater line or pipe over which a driveway, parking, or vehicle storage area may be constructed. 7. Contractor shall verify the absorption system is minimum 100' away from any private wells in the area. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. Insulation shall be at least 2 inch thick extruded direct burial polystyrene(Dow Chemical Company Styrofoam HI, Insulfoam R-Tech IV, or equal) 3. Septic tank inlets and outlets shall be fitted with watertight couplings(Caulder, Fernco,or equal) 4. A permeable nontoxic geotextile silt barrier(Typar 3401, Mirafi 140N,or equal) shall be installed between the final sewer rock layer and the native soil backfill. 5. All leachfield gravel (sewer rock) shall be 0.5"-2.0"screened gravel with less than 1%passing the#200 sieve. 6. The following pipe materials are MOA approved for use in septic system installations: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 or F789 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes ASTM D2751 (ABS) Yes No **Use of a type of pipe other than listed above must be approved by the inspecting engineer. INSPECTIONS: Typically there will be several inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. A preconstruction site meeting. 2. An inspection must be conducted after the excavation of all native material for the trench has been completed, but prior to placement of sewer rock. 3. An inspection must be conducted after the placement of the sewer rock, and installation of distribution lines, cleanouts, and monitoring tubes, but prior to placement of insulation, silt barrier,or backfill. 4. An inspection must be conducted after the tank has been set in place with distribution piping and cleanouts installed,but prior to backfill. 5. The final inspection is to occur upon backfill and final grading of the property. On-Site Wastewater Disposal System—Specifications,Lot 58,Section 5, Township 15N,Range I W,S.M. August 6,2019 Page 4 of 4 The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. The engineer shall be notified ''A day prior to a required inspection. "=.1qs4,14,57 w = 49th I�. i --- • 0.» w .r DI s s scow T. "2 FS v fi• ESSt4 • e VE1Consultants Civil Engineering(Ind Surveying('oneculhuntc 1345 Rudakof Circle,Suite 201 .Serving;111 oj;Iluckn Anchorage,Alaska 99508 FAX: (907)338-5386 Phone:(907)337-3330 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Oliver and Venita Moore DATE PERFORMED: 6/26/19 LEGAL DESCRIPTION: Lot 58, Sec 5, T15N, R1W, S.M. TOWNSHIP, RANGE, SECTION: T15N, R1W, Sec 5 PERFORMED BY: Scott Roelfs, P.E. TEST HOLE No. TH #1 SLOPE SITE PLAN DEPTH T- - (FEET) I I 0- - - a0�/ I I _- Topsoil i 1- +� . • 2- •• . I ' •. SP I I 3- ,, ••, fine sand, • • some gravel i1`i' 4 • ••.� TH#1 TH#2 5- � I ® ® 6_ 4 .,:4. 7-' 'ti.,�� TH#3 • 10- •• •,:., SM t'+'ti',° TOTAL DEPTH OF TESTHOLE: 19.0 11-' :.,.� silty 0.5%• ...---\___ - ••R► sand GROUNDWATER ENCOUNTERED: ❑ ❑ - 12- •....,, NO YES w 4�a _. DEPTH TO GROUNDWATER: a 13- • ' __J • ' GROUNDWATER ENCOUNTERED: El 14- •' • (After Monitoring) NO YES . +•�•'' DEPTH TO GROUNDWATER: 15- <r;�. MONITORING DATE: 7/29/19 16-.•x ., . Date Reading Gross Time Net Time Depth to Water Net Drop 17-:" '1.:;:.:t, (min.) (inches) (inches) 18-;I'�.'s.;, 6/26/19 1 14:31 0 19- ..•;:: ' 2 14:49 18 1/4 1/4 • 20- 3 15:04 15 9/16 5/16 • 4 15:19 15 13/16 1/4 ..��\\\\111, 5 15:43 24 1 1/4 7/16 x\P�E OF q<,•3 r, .. 6 16:21 38 2 3/4 4.Mr`J.•... •''•' �. 7 16:47 26 2 3/8 3/8 a 49th '\ • * °O 8 17:30 43 3 3/16 13/16 / �/ •r..../ 9 17:50 20 3 3/8 3/16 Or". Q-111 : SCOTT T. R FS : AM 0.� ;• C 24 •';;Z� PERCOLATION RATE 59.0 (minutes/inch) PERC HOLE DIAMETER 6" J.:2,,. � •. q o Ci 0 TEST RUN BETWEEN 6.0 FT AND 7-0 FT #.<4'/)pROF SS��NP��•• COMMENTS: Pre—Soak 4hrs 111111111,111011). PERFORMED BY VEI CONSULTANTS. I, SCOTT T. ROELFS , CERTIFY THAT THIS WAS P FORM IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: -7 Z6l7`1 t /// / VE1Consultants (711l Engineeriio,and Surveying('on.sultnnts 1345 Rudakof Circle,Suite 201 Serving.1l/ofAlaska Anchorage,Alaska 99508 FAX: (907)338-5386 1'hone:(907)337-3330 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Oliver and Venita Moore DATE PERFORMED: 6/26/19 LEGAL DESCRIPTION: Lot 58, Sec 5, T15N, R1W, S.M. TOWNSHIP, RANGE, SECTION: T15N, R1W, Sec 5 PERFORMED BY: Scott Roelfs, P.E. TEST HOLE No. TH #2 SLOPE SITE PLAN DEPTH F — (FEET) 0- �O� I I Topsoil i 1- SW • •• 2- ' •• • sand, I I some gravel I I 3- •i'~ SP 4 • .•' fine sand, • . some gravel r.5 I TH#1 TH#2 5 • ID ® 6- ▪ • r7 � . . TH#3 8- .• L- - - - - - - - - _I 10- • • SP • fine TOTAL DEPTH OF TESTHOLE: 18.0 11 0.5% ...--% , sand GROUNDWATER ENCOUNTERED: ❑ ❑ 12- •• • NO YES w 00 ' DEPTH TO GROUNDWATER: -j 13- J • • GROUNDWATER ENCOUNTERED: El to • • 14- • • (After Monitorirg) NO YES • DEPTH TO GROUNDWATER: 15 •;• • MONITORING DATE: 7/29/19 16- • • • Date Reading Gross Time Net Time Depth to Water Net Drop 17- (min.) (inches) (inches) 18- 6/26/19 1 14:38 0 19- 2 14:52 14 1 1/2 1 1/2 20- 3 15:01 9 2 1/4 3/4 4 15:09 8 2 7/8 5/8 ..��\SSII\,1,1 5 15:14 5 3 1/4 3/8 • OF q< 4 �•^^��• q� ♦. 6 15:23 9 3 7/8 5/8 J,• ••,'' •� .. 7 15:30 7 4 3/8 1/2 w o ;S 4•th ' ' '•• 0 8 15:40 10 5 5/8 • 0 9 15:50 10 5 1/2 1/2 • . • • SCOTT T. •e, LFS �`' 13.1 6" �.� CE 824 Z� PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER .°>' _T Z� �g,.•��C�� TEST RUN BETWEEN 6.0 FT AND 7.0 FT ♦��P"OFESS��... 4. COMMENTS: Pre—Soak 4hrs PERFORMED BY VEI CONSULTANTS. I, SCOTT T. ROELFS , CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: -f . •.-7- 1, ,.--,-1! VE1Consultants Civil Engineering and Surveying(•un%ultmmns 1345 Rudakof Circle,Suite 201 Serving.411 of Alaska Anchorage,Alaska 99508 FAX: (907)338-5386 Phone:(907)337-3330 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Oliver and Venita Moore DATE PERFORMED: 6/26/19 LEGAL DESCRIPTION: Lot 58, Sec 5, T15N, R1W, S.M. TOWNSHIP, RANGE, SECTION: T15N, R1W, Sec 5 PERFORMED BY: Scott Roelfs, P.E. TEST HOLE No. TH #3 SLOPE SITE PLAN DEPTH I- - - - - - - —I (FEET) 0- (1° in Topsoil 1- • •• 2- • .Z.... • 3- ;...• SP 4^C 4 • ..• fine sand, co •• , some gravel y I TH#1 TH#2 5 • • ® ® 6- • •• • `{ •• • Q7 TH#3 8-� '• s ` - - - - � 10- • • SP • fine sand TOTAL DEPTH OF TESTHOLE: 18.0 11- 0.5% is„. • GROUNDWATER ENCOUNTERED: ® ❑ ▪ • e 12- • •• NO YES w �4 • • DEPTH TO GROUNDWATER: a. 0 13- • • • GROUNDWATER ENCOUNTERED: ® ❑ 14- (After Monitoring) NO YES • • DEPTH TO GROUNDWATER: 15 • MONITORING DATE: 7/29/19 • + •.• 16- • Date Reading Gross Time Net lime Depth to Water Net Drop 17- • (min.) (inches) (inches) 18- 6/26/19 1 14:45 0 19- 2 14:56 11 1/4 1/4 20- 3 15:11 15 7/8 5/8 4 15:25 14 1 1/4 3/8 '.10001%-11\i...4 5 16:19 54 3 1 3/4 "'�� Or �<.9 •it. 6 16:49 30 3 7/8 7/8 �1"J��•••••' • '••••� ... 7 17:25 36 4 3/4 7/8 • v. AV :•• 49th i1 �O. 8 17:44 19 51/8 3/8 •i MUNICIPALITY OF ANCHORAGE And Development Services Department t 4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-081-08-000 1. GENERAL INFORMATION Expiration Date: Complete legal description LT 58, T1 5N, R1 W, SEC 5 Location (site address) 21902 Knik Vista St. Current property owner(s) Selway Corp DBA Hall Quality Homes Day phone 907-746-2757 Mailing address PO Box 1987, Palmer, AK 99645 Real estate agent Day phone g70 2. TYPE OF DWELLING: rbv 7,7 ❑ Single Family (w/wo ADU) OV ❑ Duplex a FEB o5 -,202.o n F-1MultipleDwellings (Single Family and/or Duplex) 3 a. 3. NUMBER OF BEDROOMS: 3 << 'IN CV 01 g 8 L95 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ '79A Waiver Fee $ Date of Payment Al(0( P -6Z Date of Payment Receipt Number. 101ul+,s93 Receipt Number COSA # QSC �z d 165� Waiver # Distance: 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 VEI Consultants Phone 907-337-3330 Address 1345 Rudakof Cir., Suite 201, Anchorage, AK 99508 Engineer's Printed Name Scott T. Roelfs 6. DSD/SIGNATURE J System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 1 /2`/.�`@,a:� y S r7i . 4Gr Conditional approval for bedrooms, with the following stipulations: l�lllll({ltl((f�� ON-SITErri 14f ATER AND m.- WASTEV aTER Jt� PROG!, AM By:Cayu-coua o y Original Certificate Date.: o� 0 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 Legal Description: LT 58, T15N, R1 W, SEC 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9"9121119 Total depth 75 ft Cased to 75 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 9119/2019 Static water level at beginning of test 57 ft. Comments B. TANK DATA Age of tank(s) New years Tank type/material P"Y" Measured operating fluid level in septic tank New FOR Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA Which system tested (date installed) 9/25/19 ❑ ALL standpipes present per record drawing Total measured depth from grade 15.5 ft (max) Measured depth to pipe invert from grade 6.5 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective OR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: New COSA Checklist yellow sheet Parcel ID: 051-081-08-000 Structure served by this system Well production at time of test 30 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.96 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Erdman & Assoc Date of Sample 1123/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date New 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 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' ✓v Yes Community Sewer Manhole/Cleanout > 100' r Yes if No ft M Yes if No ft Neighboring Tank > 100'✓] Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ✓V Yes if No ft ✓❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E] Yes if No ft r/ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ✓v Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Main > 10' Yes if No ft Community Wells > 200' ✓v Yes if No. Water Service Line > 10' 0✓ 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' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' E✓ Yes if No Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' ✓� Yes if No ft F. ENGINEER'S COMMENTS New Construction %7�z _Z, G. ENGINEER'S CERTIFICATION � � OF A r',41p I certify that 1 have determined through field inspections and review '�� of Municipal records that the above systems are in conformance with N n ~ °. T� MOA COSA guidelines in effect on this date. "I w' V� n7+�jT�oZ'G� r, COSA Checklist yellow sheet ft ft ft ft