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HomeMy WebLinkAboutOVERLOOK ESTATES #2 LT 5Onsite File Overlook Estates #2 Lot 5 #068-041-37 (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211476 PID Number: 068-041-37 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade Name Hultquist Homes Inc ABSORPTION FIELD ❑Deep Trench ME Wide Trench El Bed E] Mound Site Address 27366 Vantage Ave, Eagle River ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 310-2501 4 JTotal 1.0 GPD/SF 6.3 / 6.1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.8/5.6 Ft. Gravel depth beneath pipe 0-5/0-5 Ft. Subdivision Block Lot Overlook Estates #2 5 Fill added above original grade 1.7/-1.0 Ft. Gravel length 60 / 60 Ft. Township Range Section Gravel width 5/5 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 2 Dist. between trenches From Tank Field Tank Line 600 Ft2 9.3 Ft. Well >100' > 100' N/A N/A >25' TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >100' >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >1 0' >10' N/A N/A LIFT STATION cturer Capacity Gal. Remarks Alarm location I installed by PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer Little Dipper Drainfield D3034 CO/MTD3034 Inspector J.Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15t 3/29/22 n 3/30/22 Location and description dates: 2 aro 3/31/22 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Approval: Date •�kConditional low, . • ' ' ` TH �F . Benja J rr re 12592i11er Septic System Approved w., '" Date Z Z 0'`�r • , 8/18/22 ..'�, pROFESSSSOW Note: this approval does not include well permit requirements. � (Rev 05/02/18) OVERLOOK ESTATES #2, LOT 5 PERMIT # OSP211476 PID # 068-041-37 84.9 84.4 84.9 84.4 of --1- o 92.4 FINISH GRADE ----- 90.7 ORIGINAL GRADE fill fill in DRAINFIELD ROCK MOA FILTER SAND ®� 82.4 82.4 -� 60' UPPER TRENCH NO GROUNDWATER 3/30/22 = 77.7 H M Co 0 � 90.5 ORIGINAL GRADE Fes— O U 5189.5 FINISH GRADE �� 11 fill fill DRAINFIELD ROCK, MOA FILTER SAND �- 82.4 82.4 —1" 60' LOWER TRENCH NO GROUNDWATER 3/30/22 77.5 PROFILE AS -BUILT (NO SCALE) 84.9 84.4 gw . 9 TH .......... • • • • . • • Benja'n Schiller ' 't�F��i%•. CE2592 2111M0222.•���� — mm Cil 0 RM T o m m =<�=cmi�nCN�p rn O O O m Z -i--0i�zO00m o S< 0O 0 � Z 003 Z O rn m oD m 0 mzz �--4o m0rn z ODZ m m O z O �C7�C)�C��C7-nNc/>�T • °° ®�,: CD •:c o•omi — mm Cil 0 RM T o m m =<�=cmi�nCN�p rn O O O m Z -i--0i�zO00m o S< 0O 0 � Z 003 Z O rn m oD m 0 mzz �--4o m0rn z ODZ m m O z O �C7�C)�C��C7-nNc/>�T F �� FFA•.: e._ .�.�1' — mm Cil 0 RM T o m m =<�=cmi�nCN�p rn O O O m Z -i--0i�zO00m o S< 0O 0 � Z 003 Z O rn m oD m 0 mzz �--4o m0rn z ODZ m m O z O �C7�C)�C��C7-nNc/>�T -10-IO�O-i0�n<=n -A .A W W NNS o O , � -O o v�»rnrn- ca.t�aorn�cflo->ooc..�o�' O-�OGo N—>m L—OOo CoO I -,1 --4 I O0 0�� V O� I) to !V V -P N CJ7 0') --4W co O N� N ". 6�-POO�OOOO W -Ii-Ill' MN1 m 0 cnN 4 07 1I TM, 6 SOILS LOG AND PERCOLATION TEST 2:33 <1 ENGINEERING 6 3 � • � •••.••... <1 0-6 6 4 Benja ' Schiller �� <1 LEGAL DESCRIPTION: OVERLOOK ESTATES #2, LOT 5 5 �'F•• CE 12592 • �� ��sj�'., onsnozz ,.•��� <1 PERFORMED FOR: HULTQUIST HOMES 6 klk�, PROFES®O.'�' 2:41 DATE: 3/30/22 PROJECT No.: 6 PARCEL ID#: 068-041-37 TECHNICIAN: J.MILI_ETTE Professional Engineers Stamp: DEPTH TEST HOLE A� (feet) _ 1106 SLOPE SITE PLAN 2 3 4 5 (GW) LOOSE CLEAN 6 r SANDY GRAVEL 7 8 re 9 1 O WAS GROUND WATER ENCOUNTERED? IF YES a WHAT DEPTH? NO - L 11 DEPTH TO WATER AFTER MONITORING: DRY O = DATE OF MONITORING: 4/7/22 P 5 E 12 k 13 DATE READING GROSS TIME NET TIME DEPTH To NET DROP WATER (MINUTES) (MINUTES) (INCHES) (INCHES) 14 3/30 15 1 2:31 <1 0-6 16 17 18 19 20 PERCOLATION RATE: <1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3 FT. and 4 FT. COMMENTS: 6 2 2:33 <1 0-6 6 3 2:35 <1 0-6 6 4 2:37 <1 0-6 6 5 2:39 <1 0-6 6 6 2:41 <1 0-6 6 Wasilla, AK 99654 (907)376-2041 Name: Hultquist Homes Address: City: Anchorage State: AK Zip Code: 99654 Well Site: Overlook #2 Lot/Block: 5 Additional: Well Depth: 125 ft. From: To: Formation: 0 2 stick up Below Ground: 123 ft. 2 24 cobble/gravel/sand Above Ground: 2 ft. 24 76 damp cobble/gravel/sand Gal/Min: 9 76 92 cobble/gravel/sand 92 95 boulder Static Level: 109 ft. 95 110 cobble/gravel 110 125 gravel/water/sand Casing: 125 ft. of 6 in. x.25 in. steel Liner Pipe: N/A Screened: N/A Perforated: N/A Grouted: Yes WATER Depth: O®liirsr+� _e_!� i'ESTINO Nitrates Oo!/1 OOML ,� Develop. Method: Air Arsenic L ' tag/L Use of Well: Residential Drilling Method: Rotary Misc: Other: The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 9gpm . Date Drilled: 5.17.22 Driller: Seth Moore Development Services Department Building Safety Division E e I On -Site Water & Wastewater Program o �G o 4700 Elmore Road z "Z P.O. Box 196650 Q Mark Begieh Anchorage, AK 99507 SA ETY Mayor www.muni.org/onsite (907) 343-7904 Pump Isallati®n L® Well Drilling Permit Number: SW OSP211476 Date of Issue: 11/23/2021 Parcel Identification Number: 068-041-37 Legal Description Property Owner Name & Address: Overlook Estates #2 L.t5 Hultquist Homes 27366 Vantage Ave, Eagle River, AK 99577 12570 Old Seward Hwy #204 Pump Installation Date: 10/03/2022 Pump Intake Depth Below Top of Well Casing: 103 Pump Manufacturer's Name: Meyer Pump Model: 3/4hp 10gpm Pump Size 3/4 hp Pitless Adapter Burial Depth: 13 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 Anchorage, AK 99515 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. £960034 -}Did uolslnlpgns papaoosa e4} UO lDeddo }ou op 4014M SUOIJOIa}SOJ Jo 's}uouenoo oc�QQOO�O 'S}uewesDe AUD }O aousl.slxa e41 aulwae}ap 04 aeumO 841 }O r(}Illglsuodsej 941 sl }I �o IVNOISSZ�y v ON ao�� Olsold 'a6DJo40uy to }o AnQ 041 s144 patn0 YP Qpp •uoe,tey pe}nolpul so }deoxe Apedoad plus uo s4uawesDe ~ �QO ONVI 9 13NN311 VQ elglSIA ae4}o JO SeUII uolsslwsuni} 's�(DMpooa ou aaD 8JO44 }D4} pun seslu.waad Q. • I -0 • ...... .. •' . �. Q pe%aAans 941 uo y000 tOue OIOJ044 4ue0OjpD 6uIAI L{.tedoid ay} uO s}uaweAoadwl ou QQ .1041 '04eaa41 }ueoojpo Apado3d e41 o}uo 4000aOua 40u op puD seuli Apadoid ay} ul44IM ..... aaD uosIe4} pa}Dn4ls S}Us�,Ueno,adwl 841 4044 puD 'D�IsnIV '}ol.t}s!0 6ulpaooe8 e6Dao4oub 4 p (Z£-61OZ 'ON ld'Id) Z N0111GOV - S31d1S3 )100�83AO 'S 101 a� Gi '• R16V ;' �QQ :Apedoid pegposap 6uIMOIIo} 041 poAeAjns eAD4 I }D44 rcppeo Aga.te4 1 p� woo•,(enans6UDIOUDy}DUot ..O o woo•r(eA.ins6uni®ue� s.i o A a na n S p u o� j r) u o I s s 8 j oa d XDj 5Z9V—ZZS (L06) c ` au04d 9L'P9-ZZS (1.06) O u I S a� o I� O S S d )R�? u O1 \ \ o eit \ 6't'0£-51966 D)IsOIV e6Dao4ouv lenuiDAV JbDO 009 L l *ON }oe oad 99to MS 0180 Oi� _ „ L 31VOS X 111(18 St+ NVId 101d 1N3W3SV3 381 ,0 L B �\ oti-„t 31vos 4 (j \ \ SV969 N \\ 0ot os sZ 01 0 kQ �3Nn moVe13s \ \ o ,0•Sz� — \ tic. Ar � J 'Z£ o A N030 �! 9 101 w ; Zzsse, ino>i-lvm \ \ /M 30N341S38 w \ � \ -;t 1,8019 l `D S1Iwn 0NI8V310 CD 0.01o > N030 / �a ,0.6t t �` S�rON Z LL ' `310HNVH 0�Q 0 > 3'S 9 LL't,9 113M :. S 103 \ \\ tiZ•tis' = NoldA313 ; C0 �3�y��• 8V838 „1? 30 d01 — V481 \ \ 1N3W3SV3 381 ,O t : \ —�--- / ,b8'L9£ 3„L5,6tr.68 S '00'0gt�� \ Ci 19-6al . .£0'.bZ 3„ ££,£Z.00 N 3nN3AV 30ViNVA � 88« MUNICIPALITY OF ANCHORAGE lY,cnr On -Site Water & Wastewater Program PD Bax 195650 4700 Elmore Road r_ Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 l=ax: (907) 343-7997 `' n http:llwww. muni.org/onsite v r ollr�t'tmcnr 0n Site -Walter & WastewateT-S}'stem Permit Permit Number: OSP211476 Work Type: WellSeptic Initial Tax Code Number: 06804137000 Site Legal Address: OVERLOOK ESTATES #2 LT 5 G:0465 Site Mailing Address: Owner: EKLUTNA INC Design Engineer: FORGE ENGINEERING This permit is for the construction of: Q Disposal Field RI Septic Tank ❑ Holding Tank ❑ Privy Effective Date: 11/23/2021 Expiration Date: 11/23/2022 Lot Size in Sq Ft: 64716 Total Bedrooms: 4 0 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: A confirmation test hole shall be provided (in location shown on site pian) prior to construction of absorption field to confirm design depth and sizing. If results require a design change, construction shall stop pending review and approval of a change order. Please submit results with the inspection report (or change order, if required). Veronica Pope GE 2021.11.23 Received By: 14:13:42 -09'00' Date. Issued By: Date: it /-20� MUNICIPALITY OF ANCHORAGE Community Development Department Develoament Services nivisinn On -Site Water & Wastewater Program Phone: 907-343-7904 Fax-907-343-799-7- --ON-SITE-SEWER/WELL PERM ax: 907-343-7997 --ON-SITE-SEWER/WELL-PERM IT APPLICATION Parcel I.D. 068-041-37 Property owner(s) Eklutna Inc Day phone 310-2501 Mailing address 16515 Centerfield Drive #100, Eagle River, AK 99577 Site address NHN Vantage Ave Legal description (Sub'd., Block & Lot) Overlook Estates #2, Lot 5 Legal description (Township, Range & Section) Lot Size 64,716 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial 0 Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑ (w/wo AD U) Holding Tank E] Renewal Renewal ❑ (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑X 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: -$520 Waiver Fees: � Date of Payment: , 7A I Date of Payment: Receipt Number: 0 2 531 D Receipt Number: Permit No. OS1021 I ct 7 6 Waiver No. Perm it App_::- ;-.,:c November 15, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 11/15/21 Subject: Overlook Estates #2, Lot 5 – Vantage Ave Septic system design Dear On-Site Services Engineer: The owner of the above lot intends to build a 4-bedroom home on the property, so 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 as well as the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes toward the south between 20-30%. There are no slopes greater than 46% within 100 feet downslope of either the primary or alternate site. The current design meets steep slope provisions for slopes between 25-46%. Contours and elevations are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Proposed 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. The alternate site is located more than 6’ away. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211476, Rebecca Carroll, 11/23/21 LO O J 1� 1 z I LU O U z 3� / O Z / LNL Qz Q Q LU LU CO CO O U� ' v � W OZ 0 U LU r < WLzu Q w \ w ~2 0 Q 0z 2F - ZH \ od � � H o � o_ N Lo w O z Z d LU 3 U) = o �= LLZ`� w w LL, C) U0 LL j O a W 0 H Q L \ �U)W� L x m Z \ \ z Z 2 oz W(LQ J in w Q N c N HD V � U ��, / / o O Z H W W f /U / U � W cn C, LU O 0- 0 O CL wL 2 L O O o �z 0O J W U m Z wOH CAH U z Z w W Q J LU — j J J O? Z U) Z Z U O O W O O O Q O 0 w U L U H U O O O = H j C.) 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IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 5' 2' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 1.0 GPD/SF SHALLOW TRENCH SYSTEM w/ SAND LINER 1250-GAL SEPTIC TANK w/ 20" MANWAY BOTTOM OF TRENCH: 6' BELOW GRADE FLOW LINE ELEVATION: 5' 6" BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE 600 GPD / 1.0 GPD/SF /5' WIDE * 1.0 RED FACTOR (0.5' EFF) = 120 LF TRENCH REQUIRED (120 LF SPECIFIED) November 15, 2021 GEOTEXTILE FABRIC MOA APPROVED FILTER SAND 6" Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211476, Rebecca Carroll, 11/23/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211476, Rebecca Carroll, 11/23/21 MUNICIPALITY OF ANCHORAGE fl 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. 068-041-37 Legal description Overlook Estates #2 Lot 5 Site address 27366 Vantage Ave Eagle River Current property owner(s) HUlquist Homes Expiration Date: 1-26-2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: By: Original Certificate Date: 10-26-22 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 ITVXC*qm mHORAGE . 7 Development Services Department Phone: 907-343-7904 � On -Site Water & Wastewater Section �'!Fax: 907-343-7997 Certificate of On -Site Systems Approval Application Q 1 GENERAL INFORMATION Parcel I.D. 068-041-37 Complete legal description Overlook Estates #2, Lot 5 Location (site address) 27366 Vantage Ave, Eagle River, AK 99577 Current property owner(s) HUItquist Homes Day phone (907) 522-3204 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 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: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 6. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age < l yr - 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 $ �() Waiver Fee $ Date of Payment i a f l Q l aa COSA # CSC ap 157.2 �V-o Y� C/? D Date of Payment Waiver # COSA Application_ June 2022 Legal Description: Overlook Estates #2, Lot 5 Parcel ID: 068-041-37 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA HE Well log is filed with Onsite (or attached) Date drilled 5/17/22 Total depth 125 ft Cased to 125 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 5/17/22 Static water level at beginning of test 109 ft. Comments B. TANK DATA Measured operating fluid level in septic tank N/A Date of pumping NEW INSTALLATION ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/30/22 ❑ ALL standpipes present per record drawing Total measured depth from grade 8.0/5.1 ft (max) Measured depth to pipe invert from grade 7'5/4'6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 9 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 2.13 mg/L ❑ Nitrate less than MRL (ND) Arsenic 34.8 ug/L ❑ Arsenic less than MRL (ND) Collected by Wheaton Water Well Date 10/13/22 C. LIFT STATION A fired maintenance completed geof lige of lift station years Lift station material Comments: Adequacy test date _ Results F] Pass Flul depth prior to tes NEW Water ded gal New fluid th in Elapsed time min Final fluid depth in in Absorption rate > pd FIELD STATUS — POST COVERY Effective depth (per record dr'd sings) in Effective depth used in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Fm-] Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft Fn� Yes if No ft Neighboring Tank > 100' g Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft FmJ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft rml 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' Fm-] Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' Fm� Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. COSA Checklist—June 2022 Phone (907) 522-7773 Date 10/18/22 TH .. .�..:-:STM.... , .... t� BenjarnLn/Schiller CE 12592ARW ����;0 PROFESStOW Arsenic Advisory Certificate of On -Site Systems Approval # OSC221512 Subdivision: Overlook Estates #2 Lot 5 A water sample revealed an arsenic concentration of 34.8 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P fl Box 196650 *Anchorage, Alaska 99519 6650 * wuvw muni org