Loading...
HomeMy WebLinkAboutMOUNTAIN AIR ESTATES BLK 3 LT 3AOnsite File mountain Per OSC231258, the record drawing profile is incorrect. The monitor tube does not go to the bottom of the sand. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201037 PID Number: 017-211-31 ling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: J01 New ❑ Upgrade Name ERIK HJELM ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed 9 Mound Site Address 14900 MOSSBERRY PL, ANCH AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.45 GPDJSFI 0.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0 Gravel depth beneath pipe 0.5 Subdivision Block Lot MOUNTAIN AIR EST. BLK 3, LOT 3A Ft. Ft. Fill added above original grade Gravavet length Township Range Section 3'+ Ft. 90 Ft. Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 6 SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Ft. Dist. between trenches From Tank Field :Lift Station I Tank Line 1350 Ft2 Ft. Well ,100'+ 1 100++ 50'+ TANK ❑ Septic 0 S.T.E.P. ❑ Hotding ❑ Other Manufacturer Capacity GREER TANK 1500 Gal. Surface Water100+ }. ' 100++ Material Number of compartments Lot Line 10++ 10++ NA PLASTIC 2 Foundation10++ T_ *� 0++ LIFT STATION Manufacturer Capacity — — - Remarks * DECK PILE >5' FROM TANK GREER 1 500 Gal. t duel alarms in garage and SW corner of Bldg. Alarm location **SW corner of bldg. Electrical installed by MOA PERMIT Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 105.2 ft Inspdeates:ctio 1�4 8/3/20 2w8/4/20 Location and description 3`d 4th GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's` Stamp Conditional Approval: Date � • �• • �f - + • 4.9TN 'F ''3 • MICHAEL N. RIcDERSCN -4 ,- . Septic Syste Approved Date /D // Z I - °�fr�•. c q ��*� ffZ2,�••;�� Note: this approval es not include well permit requirements. (Rev 05/02/18) Permit No. OSp201037 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES O|V1S|C]N P.O. Box 196650 Anohoroge, A|ooko 89518-6050 Telephone: 343-4744 On—Site VVoatavvoter Diopmou| System and/or Well Inspection Report Legal Description: MOUNTAIN AIR EST, 3UBD BLIK 3LOT 3A PID No.: 017-211-31 MARK /7- cof, 12 T 5j TCO2 23 24 MT1 77 6 53 MT4 43 55 190' WELL RADIUS BENCH, GARAGE�SLAB �IVEAWAY DRIVEWAY 41 MT 7Z �:�/�7 Al TCO 1500 GALLON' PLASTIC' STEP TANK DF TCO2 100. GO FINISH GRADE 4 C-3 All �7 MW FABRIC & INSULATION I FILL /-nLTER R4 .2 PLASTIC TANK MICHAEL N. ANDERSON N CE ML I. 9469 Ar AV 2 21 AW SEPTIC SEQ-110 J 7•" 0 L F - Z W w Q W W f- N d N 0 N O J o : 'yo v 0 mI M:g �gpQ I I J N• Q ,,� �► c(: o a to oitnZ0c J W 0 Z to •- D U L m O O L nLc� E `t O x U I L O I w E m �) > U -) U >W, N �IQta,tZ:c Wl aN N D1® I�totoo p D: O O C I of U L �i N I > w (f) L X1• O r J 0 J m (n o Q 10 1 8d -� 1 � V /4- c O O CL m D r� o Q M M p m am C m m L > 0'b L „F > DSC m D O+L D Q to D O I o Qt^ci O O �I �I JH3110d a m 0 Q.m= 06 /M 33N3Q DzEym I o m y m 1�i01S,0'8l CD �t c— E = j .- O ,, N U U i p ow�aaa x Wo T 0 sac D� -C wLm CN II 'D .12't L to o m O �0� O V ZQD O X N m A030 p Q `- spa ms o 0'8 L W CA- c 4 = (� D C TO D U��u�aD o v- m m O m .p c t wEco U) 0 Q m m> a F y 0 s CL m-rrEEm c m J 7•" 0 L F - Z W w Q W W f- N d N 0 N O J o : 'yo v 0 mI M:g �gpQ I I J N• Q ,,� �► c(: o a to oitnZ0c J W 0 Z to •- D U L m O O L nLc� E `t O x U I L O I w E m �) > U -) U >W, N �IQta,tZ:c Wl aN N D1® I�totoo p D: O O C I of U L �i N I > w (f) L X1• O r J 0 J m (n o Q 10 1 8d -� 1 � V /4- c O O CL m D D p Lr Q m � m p m am C m m L > Q „F > DSC m D O+L D Q to D O I o Qt^ci O O �I �I mem°cc M a m 0 Q.m= L N oat O c C i DzEym I o m y m I CD �t c— E = j .- O ,, N U U i p ow�aaa Q U p c I T sac D� -C wLm TO O �.W-X C Q to L a m O �0� O V ZQD O X N m ►- ..= O m y Z U c ►- L T p Q > i O aD spa ms o I CA- c 4 = (� D C TO D U��u�aD >. 0 0 a C v- m m O m .p c t wEco Lm 0 Q m m> a F y >`M p,t o y c 0V s CL m-rrEEm c m U to Q3cQ.m o IF Permit Number: #$ 4'201037 Date of Issue: 3-13-20 Parcel Identification Number: 01721131000 Date Started: 3-16-20 Date Completed: 3-07-20 Is well located at approved permit location? x Yes ❑ No Legal Description: Mountain Air Estates Block 3 Lot 3A Property Owner Name & Address: Erik Hjelm 14551 Golden View Drive Anchorage Alaska 99516 Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: e• steel stick up 0 2 Wall Thickness: .250 inches 4 Diameter: 6 inches Depth: 108 feet gravel fill 2 Liner Type: Silt 4 5 Diameter: inches Depth: feet silty gravel 5 36 Casing stickup above ground: 2 feet gravelly silt 36 41 Static water level (from ground level): 29 feet silty gravel 41 82 Pumping level: 105 feet after 2 hours pumping 20 gpm silt 82 86 Recovery Rate: 20 gpm silty gravel 86 102 Method of Testing: air li water sand & gravel 102 108 Well Intake Opening Type: x Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 22 bjzs Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name WeII Disinfected Upon Completion? x Yes [:].No Method of Disinfection: chlorine tablets Comments: WATER QUALITY TESTING Colllorm: a Col/100mL Well Driller: Alpine Drilling & Enterprises ' 1 ate$ N L PO Box 110496 i1f 0_ ug/L Anchorage AK 99511 Pump Installation Well Drilling Permit Number: 201037 Date of Issue: 3 _ 13_2020 Parcel Identification Number: 017211 «31000 Legal Description Mountain Air Estates - Block 3 Lot 3A Property Owner Name & Address: Erik Hjeim 14551 Golden View Dr. Anchorage, AK 99515 Pump Installation Date: 10 _23 _2020 Intake Depth Below Top Well Casing: 92 feet Plump of Pump Manufacturer's Name: G ru n dfos l0-SQE-07-240 Pump Model: 314 Pump size: hp Pitless Adapter Burial Depth: N/A feet Name: N/A Pitless Adapter Manufacturer's N/A Pitless Adapter Installer: Well Disinfected Upon Completion? , Yes ❑ No Zethod of Disinfection: chlorine tablet \ Comments: PLEASE SAVE FOR COSA Pump Installer Name: Company: Aarow Pump & Well Service, LLC Mailing Address: P . Q . Box 110496 City: Anchorage state: AK Zip: 99511 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 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: OSP201037 Work Type: WellSeptic Initial Tax Code Number: 01721131000 Site Legal Address: MOUNTAIN AIR ESTATES BLK 3 LT 3A G:3139 Site Mailing Address: 14900 Mossberry PL, Anchorage Owner: HJELM ERIK Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date llepartment 3/13/2020 3/13/2021 Lot Size in Sq Ft: 53100 Total Bedrooms: 112' 4�GC 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 Received By: - '' l�� Date: Issued By: ,C/ Date: 3 27A?- 6 3,/,�/w ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-211-31 Property owner(s) ERIK HJELM Mailing address 14551 GOLDENVIEW DR ANCH AK 99516 Site address SAME Day phone 947-1110 Legal description (Sub'd., Block & Lot) MOUNTAIN AIR ESTATES BLK 3 LT 3A Legal description (Township, Range & Section) Lot Size 53,100 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial 0 Single Family (SF) 0 (w/wo ADU) Septic Tank Fx� Upgrade ❑ Duplex ElHolding (D) Tank ❑ Renewal 1-1� ❑ ellings Privy ❑ s ) Private Well Water Storage ❑ 6 SAN 0 ' 2D a 20 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR. a 3 0Z ti 6 8 L 9 '- tance: 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: U 2- I0 0-0 Waiver Fees: Date of Payment: 3 ��� I Z021��� Date of Payment: Receipt Number: 2- Z-7-7 Receipt Number: Permit No. O Sp20-i 6 3 7 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc March 11, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Well and Septic Permit, REVISED Legal: MOUNTAIN AIR ESTATES BLK 3 LT 3A. To Whom it may concern: This is a request for a septic and well permit on the above referenced lot. Two test holes were excavated on the west end of the lot and found SM/GM with water at 6.5 feet after the 7 day monitoring period. Both perc tests were Jean 30 mintite r inch but for longevity an application rate will be slower at 0.45 gpd/sf. A bed system has been designed with a pressure distribution system to evenly cover the field. The secondary system will be the Advantex system. The ML layer is per permeable, top was very loose. The lot has a very shallow slope running from the east side to the west side and has no cut banks with slopes greater than 25 percent, see the drawing. This new system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely 11A Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS = 600/0.45 = 1333 GPD 1333 GA/15 = 90' (1) BED 1.0'DEEP 3oNuv„ o(—Smv)C, 0.5' EFFECTIVE 15.0' WIDE 90' LONG TEST HOLE #1 1.0 4.0 10.0 3:1 SLOPE TOPSOIL AND SEEDING 3.0 ::� TEST HOLE #2 XIS GRADE ORG 0.5 FILTER FABRIC 1.0 1.0 & INSULATION 1.25"0 PIPE /v SEPTIC FIELD SECTION ------------ I I I I I I I I _ I I WELL Witt I PROPOSED WELL ORG SM/GM WELL SM/GM 1 i ! \�� Wl! PROPOSED I \� 4.0 PROPOSED FIELD I /� �, x j� HOUSE /DRAINAGE VACANT\�� I '=: ML _ ' OP7 ML ISE WELL - I /v SEPTIC FIELD SECTION ------------ I I I I I I I I _ I I WELL Witt I PROPOSED WELL � o II < m I Septic Design Prepared for ERIK HJELM i -6" OF DRAIN ROCK -6" MOA FILTER SAND MOUNTAIN AIR ESTATES BLK 3 LT 3A Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: Air®; 49TH %:' Oo ® .............................. ®m s........................... *............ MICHAEL N. ANDERSON 3/2/2020 oG� • oNo. E 469Ar o \® DJ R ®®AV 1"=200' WELL PROPERTY LINE i i ! \�� Wl! PROPOSED I \� PROPOSED FIELD I /� �, x j� HOUSE /DRAINAGE VACANT\�� I '=: _ ' OP7 / E� PROPOSED ISE WELL - I 19 I VACANT `"E IC WELL � i WELL• I Cn I03 VACANT I �` m --� _ � o II < m I Septic Design Prepared for ERIK HJELM i -6" OF DRAIN ROCK -6" MOA FILTER SAND MOUNTAIN AIR ESTATES BLK 3 LT 3A Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: Air®; 49TH %:' Oo ® .............................. ®m s........................... *............ MICHAEL N. ANDERSON 3/2/2020 oG� • oNo. E 469Ar o \® DJ R ®®AV 1"=200' SEPTIC! SHALLOW OPEN CHANNEL DRAINAGE I / ITCH, NO SURFACE TER L PROPERTY LINE 20' /DRAINAGE EASEMENT — — — — — — — — — — NEW 15 X 90 BED SYSTEM i 2' CONTOURS PROPOSED WELL `8 100' RADIUS f%DRAINAGE ( 1 \ r d' AN VA /PROPOSED HO ITCO C CO PROPERTY LINE I'l 250 PLASTIC TANK AND vPUMP BASIN ✓ SECONDARY SITE T SECONDARY SYSTEM TO BE 1,500 GALLON ADVANTEX TANK AND POD, 1<#2 APPLICATION RATE OF 2.0 GPD/SF, BED SIZE 20 X 15 TYP. DRAINAGE SEPTIC VAU-4T Ix/ WELL\ Septic Design Prepared for ERIK HJELIVI MOUNTAIN AIR ESTATES BILK 3 LT 3A Anchorage, Alaska 1"Alichael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: SEPTIC DF 14............ -1 -4 % 49 TH or ................ A ............................... 0...... / ....... ...... 08" -MICHAEL N. ANDERSON..-gAff 3/2/2020 No CE 469 DJR �0• AV 1 "=50' Performed For: Legal Description: f 4 � 9.s A h, Date Performed: p/TUttvt �k)vi �a 7 S Township, Range, Section: Slope m --moi✓_ 7 I I Depth � (Feet) 2- / 3- 5- 6- 7- 8 - ,b•�„b"�`�`�.? `fig Municipality of Anchorage ,fie, y Eloi�aNe�Rs:s>o�c),? Development Services Department �� :°° On -Site Water and Wastewater SectionoT F1 4700 Elmore St. a•, „°,aa°°e°°°>°Fs P.O. Box 196650 Anchorage, AK 99519-6650 S www.muni.org/onsite 1°°°° ° °•<°o°°°.••° (907)343-7904 r° ��} 0 MICHAEL N. ANDERSONCE[914 9 Jf•.� � 7V°• \�.. Soils Log - Percolation Test �l ©PArarrrct Monitoring? Performed For: Legal Description: f 4 � 9.s A h, Date Performed: p/TUttvt �k)vi �a 7 S Township, Range, Section: Slope m --moi✓_ 7 I I Depth � (Feet) 2- / 3- 5- 6- 7- 8 - Date Gross Time Net Time Depth to Water WAS GROUND WATER 9- ENCOUNTERED? r ' U!/ S IF YES, AT WHAT DEPTH? L 11- rr Depth to Water After d� Monitoring? i�10 L/ 12- Date: Z 7, !0 2 13- 14- 15- 16- 17- 18- 19- 20 - N Site Plan G Reading Date Gross Time Net Time Depth to Water Net Drop U!/ 3;/ PERCOLATION RATE (minuteslnch) PERC HOLE DIAMETER (-p TEST RUN BETWEEN L FT AND Z VI, FT COMMENTS A. V-CCL4,r PERFORMED BY: CERTIFY THAT THIS TEST W S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Zi7 Municipality of Anchorage Date (ENG.INEER'S,SEA.5),�, Development Services Department Depth to Water On -Site Water and Wastewater Section 0 IF YES, AT WHAT DEPTH? 4700 Elmore St. Depth to Water After Monitoring? P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904S'.<< °a :°��o°oo°o°> o. 0 1,10CHAEL N. AIDLP_Cjm Soils Log - Percolation Test Performed For: ej ky1 Date Performed: Legal Description: "Ailm),11, , Ar C. L' Township, Range, Section: Slope Site Plan 1 1 1 1 1 1- 2- 3- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS --t- W4 -, C)%r, C=1 , WAS GROUND WATER Date ENCOUNTERED? Net Time Depth to Water s 0 IF YES, AT WHAT DEPTH? L Depth to Water After Monitoring? 0 PE // Date: 0 Reading Date Gross Time Net Time Depth to Water Net Drop Z qlZo W A, '\"t // 3 h �2 PERCOLATION RATE '_ZVP(minutes/inch) PERC HOLE DIAMETER LP It TEST RUN BETWEEN � FT AND 2-1 t) FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE Development Services Department" Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 017-211-31 Certificate of On -Site Systems Approval Expiration Date: Legal description MOUNTAIN AIR ESTATES BLK 3 LT 3A Site address 14900 MOSSBERRY PL Current property owner(s) HJELM ERIK G & NICOLE A 7/12/24 XThe On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 2/7/24 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUHMPAUTY OF A IMC HORQOC Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-211-31 Complete legal description MOUNTAIN AIR EST BLK 3, LOT 3A Location (site address) 14900 MOSSBERRY PL Current property owner(s) ERIK HJELM 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑® Plastic ❑ Concrete ❑ Fiberglass Age 2020 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ S Sb Waiver Fee $ Date of Payment %1ZUlZ 3 COSA # 05G 231-2 5S Date of Payment Waiver # COSA Appliration_June 2022 COSA Checklist Legal Description: MOUNTAIN AIR EST BLK 3, LOT 3A Parcel ID: 017-211-31 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 3/7/20 Total depth 108 ft Cased to 108 It ❑0 Sanitary seal is functioning correctly H Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/12/23 Static water level at beginning of test 29 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 33 Date of pumping 7/12/23 ❑ Required maintenance completed, if AWWTS Comments: STEP TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 8/4/20 X ALL standpipes present per record drawing Total measured depth from grade 3.5 It (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑� Per record drawings, field is insulated. Q Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑, Yes No ❑ Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by MNA Date 7/10/23 C. LIFT STATION H Required maintenance completed Age of lift station 4 years Lift station material PLASTIC Comments: Adequacy test date 7/12/23 Results QPass Fluid depth prior to test 0 in Water added 600 gal New fluid depth Q in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: NOTE: MT DOESN'T GO TO BOTTOM OF THE SAND, RD PROFILE IS INCORRECT BOTTOM OF MT IS BOTTOM OF ROCK NOT SAND. COSA Checklist June 2022 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' Community Sewer Manhole/Cleanout ?: 100' Q Yes if No _ ft 0 Yes if No _ ft Neighboring Tank > 100' g Yes if No_ ft Absorption Field on Lot > 100' ❑� Yes if No ft Neighboring Absorption Fields > 100' Fol Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' ri❑ Yes if No ft Animal Containment > 50' Q Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Q Yes if No _ ft �o 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' Q Yes if No_ ft Surface Water > 100' ❑� Yes if No ft Tank to Property Line > 5' ❑i Yes if No _ ft Field to Property Line > 10' Q Yes if No _ ft Water Main > 10' ❑i 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' E Yes if No ft 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 Mr_ h G A, 1 -&4'4014 %PC G, Phone 727-8864 Engineer's Printed Name s., M, COSA Checklist June 2022 Date �` Z4 Qr=y r 7tEtae�ilhr,� X 7t .. �O MICHAEL N ANCCRSCL of ��c=•, CE 46', �. 4' ' 4 la�'k LJ97 l,J � � MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner Street Address��� Septic Tank: -Sludge level inches -Pumping: required es o -Pumping completed yes no Lift station: *Pump basket cleaned s no *Effluent filter cleaned s no -Control floats cleaned ten o •Proper float settings confirmed es no •Operation satisfactoryno Alarm System: -Dedicated electrical alarm circuit (a no -Audible and visual alarm inside dwelling es no .Alarm system operation satisfacto not satisfactory Manhole Riser .Ground water intrusion at riser to tank connection yes no •Ground water intrusion around pipe penetrations es no -Manhole lid: Functional es no Insulated es no Other -Weep hole functional es no Properly Secured Qg no -All manufacturer required inspections and maintenance completed Comments: Qualified Maintenance Provider: Technician I o.ccy V1 11 :dL J{ Company �_ ^E S Signature Date of maintenance 3n I Date - h 1