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Home My WebLink AboutFOUR SEASONS CHALET LT 2AFour Seasons Chalet Lot 2A #075-031-24 \ Municipality of Anchorage Development Services Department 1 - Building Safety Division— On-Site Water 8 Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW060098 PID Number. 075-031-24 Nome: RICHARD EVANS Wastewater System: O New' ■ Upgrade Address: 2239 SUSITNA DRIVE a ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 230-7266 4 i] Deep Trench ■ Shallot Trench O Bed 0Mound Gather LEGAL DESCRIPTION Sod Roteq: 1.2 rota Depth Dam a" goal.: 8.5 MAX cm/sq. R R Block: Lot: Subdivision: Depth to pipe settee, Van original gra..: Gravel depth beneoth pipe. — 2A FOUR SEASONS CHALET SEE DWG. R 2.95 R Tcenship: Range: Section: !M spew aright god Grovel length: — — — SEE DWG. R 60 R WELL: 0 New p Upgrade Ga of eiallHe 5 Number otdere: 1 Petarc. O.t...n save: — R R CY,wlrotrn priest.. 40.0; Taal Depth: Loeeal To iota obooroon ores:awe patent D 3034/ F-810 R 50 8 So.R Dn .. wleal: Stade Motor Level:Mader. REDMOND EXC. Gate Yet 5�1-6/1/2006 R yNW: pump set At: caW,p Height Abovo Growrk: TANK Dpi„ R R SEPARATION DISTANCES ■Septic 0Holding aS.T.E.P. anther To Septic Absorption Lift Holding /Pnvats Manutaotaer: GREER TANK Copor,ty In goaahc 1250 From Tank Field Station Tank see« Lines Well too'+ too'+ — — 25'+ torten": STEEL lJ,enb.r at caeYathrse: 2 Surface water too'+ too'+ — — — LIFT STATION Lot Line 5'+ et'+ — — — Sig. In gasar: Ma ufactwer. Foundation 5'+ 10'+ — — — an Hovel al p ell eve aL or slam aL pump IlaYe ! Vkol Mperbor, penamed by: Curtain Groin NONE KNOWN BENCH MARK Remarks: Location orW Deecripto "LOT LINE WAIVER GRANTED BOTTOM OF SIDING NEAR FCO OLD SEPTIC TANK PUMPED CRUSHED AND COMPLETELY ABANDONED. 100.00 R ENGINEEA•„EAL 4odo40 oA' of �4 . Inspections performed by: GEG, Ltd. Dates: 1st 5/31/2006 9 .'• 37 ........... . 2nd 5/31/2006 0 3rd 6/1/2006 �Q r y A. Corness: Development Services Department Approval 00 CE -79153 Reviewed and approved by: Date: (o - l S DG 404p°prate„fa°Oo�� (ale.. 12/01) PERMrrNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 - SW060098 075-031-24 NEW 1 � f L / / / /ALTEIRNATE SITE WILL REQUIRE \US / THE USE OF AN ADVANCED WASTEWATER SYSTEM NEW 1250 GALLON / SEPOC TANK GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS 5101 L TL'M 0DW 1111[ 101 . MCHMAM M 00501 • RIOIL (.05)S.T) l" . FY (.0»]. " PREPARED FOR: PHONE NUMBER: PACE NUMBER: RICHARD EVANS 230-7266 (AGENT) 2 OF 3 LEGAL OESCRIPT)ON: DRAWN BY: FOUR SEASONS CHALET SUBDIVISION; LOT 2A. C.J.G. TYPE OF WORK: DATE:_ (R... 01105) A B STI 63.34 41.50 ST2 66.62 48.76 DBL1 69.41 54.24 DBL2 70.21 55.68 C01 77.79 73.63 MT1 73.80 72.15 20235.83 59.75 MT2 33.86 62.80 NEW 1250 GALLON / SEPOC TANK GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS 5101 L TL'M 0DW 1111[ 101 . MCHMAM M 00501 • RIOIL (.05)S.T) l" . FY (.0»]. " PREPARED FOR: PHONE NUMBER: PACE NUMBER: RICHARD EVANS 230-7266 (AGENT) 2 OF 3 LEGAL OESCRIPT)ON: DRAWN BY: FOUR SEASONS CHALET SUBDIVISION; LOT 2A. C.J.G. TYPE OF WORK: DATE:_ (R... 01105) PERMMNUMBER: PARCEL ID NUMBER: SW0 AS—BUILT DRAWING I SW060098 075-031-24 TH# I TOP OF TANK Al INLET - 93.61 INVERT OF BUN( AT INLET - 93.1 OF FINAL GRADE ORIGINAL -100. GRADE / 99.73-101.28 (00.28 A / HIGHEST POINT rFlLTER FABRIC 00 TION OF 87.26 BOTTOM IRLNCH 91.76 (A] OF BOTTOM 63.76 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS t GENERAL CONTRACTORS . lAl L TUDM 1410. ]III[ 101 • XCmDW4L 711 "W7 11UIS (W7)177 In • FM Mn]] 0 emRl[ e.e.rery�ew PREPARED FOR: PHONE NUMBER: PACE NUMBER: RICHARD EVANS 230-7266 (AGENT) 3 OF 3 0 LEGAL DESCRIPTION: DRAWN BY: OQaO J FOUR SEASONS CHALET SUBDIVISION; LOT 2A, C.J.G. e TYPE OF WORK: DATE: PROFILE AS—BUILT OF SEPTIC SYSTEM UPGRADE 6/5/2006 Rev. cim5) TANK AT 95.58 OF BUNG AT ET - 94.90 A. GGT ss: �1 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW060098 Legal Description: FOUR SEASONS CHALET LT 2A Design Engineer: 0855 Gamess Engineering Group, LTD Owner Name: RICHARD EVANS Owner Address: 2239 SUSITNA DR ANCHORAGE, AK 99516 - Date Issued: May 18, 2006 Expiration Date: May 18, 2007 Parcel ID: 075-031-24 Site Address: Lot Size: 25439 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit Is for the construction of. ❑✓ Disposal Field [D Septic Tank E] Holding Tank ❑ Privy Private Well Water Storage All construction must 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 (1 BAAC72 ) and Drinking Water Regulations (18AAC80 ). 3_ The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. 1. The subsurface disposal field is not within a 30 foot radius of a test hole. The Engineer needs to do an additional lest hole during the construction of the septic field. 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 Onsite review and approval. 2. Please submit well documentation with the inspection report. Received By. Issued By. Date: —/ el, 'd c Date: -5- Is -O(-; Municipality of Anchorage Development Services Department / Building Safety Division ' On -Site Water & Wastewater Program ' 4700 South Bragaw St. n' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.sk.us (907) 343-7904 ON—SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. -- - DW -031 - Property owner(s) RICHARD EVANS c/o ERIN EKER Day phone 230-7266 Mailing address _ 2239 SUSITNA DRIVE a ANCHORAGE. AK Site address Zip Code 99516 Legal description (Sub'd, Block & Lot) FOUR SEASONS CHALET SUBDIVISION: LOT 2A. Legal description (Township, Section & Range) N/A Lot Size c7? -5V39 Acres/Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR( ®all that apply): Absorption Field ❑ Septic Tank 123 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: 0_ Date of Payment: S-&C,to& Receipt Number. 33 (Y, t (Rev. 11/05) Waiver Fees: Date of Payment: -1-71b6D6 Receipt Number. 33! 11 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS May 15, 2006 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Four Seasons Chalet Subdivision; Lot 2A, To whom it may concern: The existing 4 bedroom house is served by a private well and an undocumented septic system. We are proposing to install a new 1250 gallon septic tank and 5 -wide trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE RATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography around the proposed drainfield is relatively flat. In short there are no slope concerns. 5. LOT LINE RAIVER: We request a 1 foot lot line waiver from the proposed drainfield to the north and west lot line. We are unaware of any adverse impacts with the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. NOTE. -Attached is a site plan drawing, a design drawing, one soil log, which are all part ofthe design package for this septic system. (Contact C.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com / / / I I AI�IIC�4Tu IIV � � i / \ O C\ FW R SCAS0 LAS S16;Lor rc ' SAolis ) LOT CZANT C 7953 1..11ASY"1 USS 3045 LOT 47 r SEWER SERVICE L AWWU HEMLOCK S/0; / T 1. /�Si1ER�C \\ EA/ / If PROPOSED SEPTIC UPGRADE / 1 (SEE DESIGN PACE 2 OF 2) / Q 1/ \HEMLOCK S/D; / Ljj / LOT 2. —� C j3. % \ O C\ FW R SCAS0 LAS S16;Lor rc ' SAolis ) LOT CZANT GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS E GENERAL CONTRACTORS fMl L IIIOCM Nlb, fl[I[ 101 � fMdORY[ AI( N501 fllbi ,U] -[1T fiVl b 1L -5]N � 1�50[mow. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: RICHARD EVANS 230-7266 (AGENT) 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: FOUR SEASONS CHALET SUBDIVISION; LOT 2A. I C.J.G. C OF WORK: SITE PLAN FOR SEPTIC SYSTEM (KO,. OlN5) 5/15/2006 �...�.y............. rey A. Gorness.: C 7953 1..11ASY"1 USS 3045 LOT 47 r SEWER SERVICE L AWWU GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS E GENERAL CONTRACTORS fMl L IIIOCM Nlb, fl[I[ 101 � fMdORY[ AI( N501 fllbi ,U] -[1T fiVl b 1L -5]N � 1�50[mow. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: RICHARD EVANS 230-7266 (AGENT) 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: FOUR SEASONS CHALET SUBDIVISION; LOT 2A. I C.J.G. C OF WORK: SITE PLAN FOR SEPTIC SYSTEM (KO,. OlN5) 5/15/2006 �...�.y............. rey A. Gorness.: C 7953 :g' TO OBTAIN A COPY OF THE LETTER CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER. WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND PROPOSED DRAINFIELD 1' LOT LINE M REOUESTE NOTE: THE CONTRACTOR SHALL HAVE THE 100' WELL RADIUS AND THE NORTH AND WEST LOT LINES FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. V LOT LINE WAIVER REQUESTED )NFIRMATION TESTHOLE TO BE DUG WRING CONSTRUCTION NUMBER OF BEDROOMS:4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: <1 MIN./INCH PROPOSED APPLICATION RATE: 1.0 MINIMUM DRAINFIELD SO.FT.: 600 MAXIMUM DEPTH:8.5 FEET mOTH:5 FEET LENGTH:70 FEET M.O.A. APPROVED SAND FILTER: N/A EFFECTIVE:3 FEET REDUCTION FACTOR: .58 ACTUAL SO.FT.: 603 —PROPOSED 1250 GALLON SEPTIC TANK / EXISTING SEPTIC SYST BE PUMPED, CRUSHEI COMPLETELY ABAND( / a INSTALL FOUNDATION CLEANOUT I QA0 0�� GARNESS ENGINEERING GROUP, Ltd. gr ....... • •• •••••• ......••••• ]AI C TA'M A'YD. 1UR 101 • II.O.[A.0( Wf •p0) • I..S[ (001I31]MIT • /N (M1J3Y-]tN • OEKIL �w.pwr•/wM1p••.• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •• •••• ••• •••••• RICHARD EVANS 230-7266 (AGENT) 2 OF 2 OQ v '•• fT Ga ness.: LEGAL DESCRIPTION: DRAWN BY: QO r CE -7 .�Fo FOUR SEASONS CHALET SUBDIVISION; LOT 2A. C.J.G. TYPE oWORK: DATE: proie;'Io�o4�0 0 DESIGN FOR PROPOSED SEPTIC UPGRADE 5/17/2006 ��Oppp000 IRw. OLDS) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS C 4 A, E T.00N MMD, SuIE 101 • MKaMnOC. NC iY•A) • P1LV4: i07 ],(Y r (.Y: 907 -]1N • WYIG V>^•••q+••M tan SOIL LOG — PERCOLATION TEST ....... LEGAL DESCRIPTION: FOUR SEASONS CHALET SUBDMSION; LOT 2A, r y CE_ 79/5grness. Qp PERFORMED FOR: RICHARD EVANS DATE: 5 a 2006 o e'• c�Fop� 7/ iS14.6' DEPTHO�0O'Pofessio"°oma (feet) _=== ORGANICS TEST HOLE # 1 r �Do fesslo LOAM SOIL CLASSIFICATIONS GW ==== ORG --- 3 L+'+�Z GP ML GM CL A a +, », G a GC OL ••.• SW MH / Og 0.•'0 '0, SP CH SM ; OH / _ — 6 �S SC i a� A 8» 9 '+ MORE SILT sc LE. c •» w/ DEPTH 11 '` . L•qL 12 Lwt 14 R { • L•M_ �• .L 16 >w': R• 17 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.5 FT. AND 4.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: THE INSITU SILTY SOILS WILL ACT AS A SAND FILTER PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE Z WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: / O4 DEPTH TO GROUNDWATER DATE 13' 5/4/2006 13' 5/13/2006 • aaaaa • aaaaa ��aaaa� ��aaaaa ��aaaa� ��aaaaa ��aaaaa Municipality of Anchorage •. •• �`,� CO. IMx� 19(iGiO • Al. 1i19fiGiO •Telephone (907) 31.1 )ii01 •1'u� 370(1 ISmgnw S:ncl • :lnehnmgc, :Uackn 99507 atm munLorg Mayor Dlark Ilcgich Building Safety Division May 18, 2006 Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Subject: Waiver Request for Four Seasons Chalet Lot2A Waiver Request WR#: 060019 Parcel ID # 075-031-24 SW060098 Dear Jeffrey Garness, P.E.: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the propertyline has been approved. The approved separation distance is 1.0 foot. The 1 foot horizontal separation applies for septic absorbtion field to north and west property line waiver. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there arc any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, J e oodall Civil Engineer On -Site Water & Wastewater Program Community, Security, Prospeiity Municipality of Anchorage Development Services Department • +� Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:060019 PiD#:075-031-24 HAIPermit# SW060098 Date Received: May 18, 2006 Legal Description: Four Seasons Chalet Lot2A Engineer. Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Applicant: Richard Evans & Erin Eker Waiver Requested: l foot horizontal separation from septic absorbtion field to north and west property line waiver. Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver Is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date: 4/18106 By: Joe Goodall Name of Reviewer .°...°..°...°°.°..........a............................................... Rec#: 33181 Amount: $M Date Paid: 5/18/2006 Municipality of Anchorage Development Services Department • '� Building Safety Division : `a Onsite Water and Wastewater Program =. _ 4700 South Bragaw St. s r P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Jeff Gorness Legal description: Four Seasons Chalet. Lot 2A The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on ® Calculation error in design. 1.0 6PD should be used when existing soils act es a sand filter ® Additional soils information needed. Provide perculation tests so that the system is within a 30' radius. Tests may be done during system excavation and installation ❑ Water monitoring results Inadequate. ❑ Discrepancy in Information submitted. _ ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. ® Well log required. Provide well log for existing well. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. Please note on the plans that the existing system will be abandoned per code Name of reviewer. Deb Wockenfuss Date: 05/17/06 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK NUMBER OF BEDROOMS:4 TO OBTAIN A COPY CE THE LEITER NOTE: THE CONTRACTOR SHALL CONTACT GEC. BY PROCEEDING FORWARD HAVE THE 100* WELL RADIUS GALLONS PER DAY (CPD1 800 WITH THIS INSTALLATION, THE ENGINEER, PERCOLATION RATE/S: <1 MIN./INCH WELL DRILLER. CONTRACTOR AND AND THE NORTH AND WEST PROPOSED APPLICATION RATE: 1.2 PROPERTY OWNER AGREE THAT THEY LOT LINES FLAGGED BY A MINIMUM DRAINFIELD SO.FT.: 500 HAVE READ THESE SPECIFICATIONS AND REGISTERED LAND SURVEYOR AGREE TO ACCEPT THE TERMS AND PRIOR TO CONSTRUCTION. DRAINFIELD DESIGN: CONDITIONS OUTLINED. MAXIMUM DEPTH:8.5 FEET WIDTH: S FEET LENGTH:58 FEET W.O.A. APPROVED SAND FILTER: N/A EFFECTIVE:3 FEET PROPOSED REDUCTION FACTOR: .58 DRAINFIELD ACTUAL SO.FT.: 500 INSTALL DOUBLE — - CLEANOUTS PROPOSED 1250 GALLON SEPTIC TANK (CO 1' RNATE SITE WILL REQUIRE E USE OF AN ADVANCED TREATEMENT SYSTEM EXISTI BE CL INSTALL FOUNDATION CLEANOUT is Ail GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS&GENERAL CONTRACTORS ......• • •••••• ............•• 3T31 L TCM 11010. Ill 101 • NICIILVUI! W MSO) • Ill (ill • fm (fOY)S.Y-JON • Anil w .0AFmn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••• ••• ••.••.......•. RICHARD EVANS 230-7266 (AGENT) 2 OF 2 QQ P hey Carl LEGAL DESCRIPTION: DRAWN BY: O�'P, •.•�7—� .• • F`a FOUR SEASONS CHALET SUBDIVISION; LOT 2A, C.J.G. ��'�..• 4ed TYPE OF WORK: DATE: QOO4Op�QOProfessloo&oa DESIGN FOR PROPOSED SEPTIC UPGRADE 5/15/2006 nay. OlNal • Municipality of Anchorage U3 G On -Site Water and Wastewater Program - (907)343-7904 sa ETY Certificate of On -Site Systems Approval Parcel I.D. 075-031-24 Expiration Date: 6P ` 2- Z 2 z 1. GENERAL INFORMATION: Complete legal description FOUR SEASONS CHALET; LOT 2A Location (site address) 150 Snowmass Circle *Girdwood 99587 Current Property owner(s) Kristina Fritz Mailing address Day phone 382-0750 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5 O Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number, COSA # O S C a-'1 1 1 O 1 Waiver # 10 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. Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: _ 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: -2-1 Z 7 - In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the datels of the r)� evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ` encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Cl) groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and j ""' (/ are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty' • • • • • • • • • • • • • (express or implied) regarding the future performance of ..(1 • • • • •�/ the well or septic system. GEG makes no representation whether an alternative well or septic system (r efl y can be installed on the property in the event either of the current systems fail to perform adequately in CE- 795 `C the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal rightrzss+ t°o 6. 7IGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the fol #AECC884 ON-SITE -mom WATER AND _ r0"tip I�n91rs_v'ATER01 o PROGRAM 6 SE?\\J . 1, �/✓�V Vq-d Original Certificate Date: -2 % 7 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: FOUR SEASONS CHALET; LOT 2A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1172(?) Total depth *68+ ft Cased to *50+ ft ❑ Sanitary seal is functioning correctly On Wires are properly protected Parcel ID: 075-031-24 Structure served by this system _ Well production at time of test 6.7+ gpm Water storage tank volume N/A gallons Weydisinfected for coliform test? ❑ Yes MM No `�� qk ® Coliform bacteria is Negative Nitrate _— 6/1- ❑ Nitrate less than MRL (ND) Arsenic ug/L & Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG, LTD. Date of flow test for COSA 2/22/22 Date of Sample 2/23/22 Static water level at beginning of test 55.2 ft. Comments *PER ARROW WELL &.PUMP SERVICE CAMERA INSPECTION IN 2012 B. TANK DATA Age of tank(s) 16 years Tank type/material STEEL Measured operating fluid level in septic tank 50" ❑ Standpipes/foundation cleanout per record drawing Date of pumping _ ! I i D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 8/1/06 ❑ ALL standpipes present per record drawing Total measured depth from grade *8.75 ft (max) Measured depth to pipe invert from grade *6.75 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.41' C. LIFT STATION ❑ Required maintenance Age of lift station Lift station materi� Adequacy test date 2/22/22 Results MV Pass For 4 bedrooms Fluid depth prior to test 6 in Water added 616 gal New depth 19 in Elapsed time 120 min ❑ Code -required soil cover over field Final fluid depth 13 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: 'FOR NORTH SIDE OF TRENCH -C/O a MT ON SOUTH SIDE OF TRENCH NOT FOUND rJ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 21 Yes if No Community Sewer Manhole/Cleanout > 100' E] Yes if No ft Q 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' 0 Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No ft [D Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 21 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 21 Yes if No ft Wells on Adjacent Lots: R Yes Absorption Field > 5' R Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' 21 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 *1'+ ft Wells on Adjacent Lots: Water Main > 10' R Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' F-11 Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *WR#060019 F.C.O. IS PRESENT, BUT NOT SHOWN ON AS -BUILT SURVEY 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. COSA Checklist yellow sheet Volt I x -N isx-N IV .. j. J ff ess. QQ49. —79 3 n �4 dPr0fessio�o\c� #AECC884 8 Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us 343-7ge.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �1 Parcell.D. 075-031-24 COSA# ose,la1.1-act 1. GENERAL INFORMATION Expiration Date: Complete legal description FOUR SEASONS CHALET LOT 2A Location {site address) 150_SNOWMASS CIRCLE *GIRDWOOD, AK 99587 Current Propertyowner(s) KELLER & MICHELE LAGING Day phone C/O AGENT Mailing address Lending agency Mailing address Real Estate bent Mailing address 150 SNOWMASS CIRCLE *GIRDWOOD, AK 99587 Day phone BRYAN EPLEY W/ REMAX OF ALYESKA Day phone 783-2010 PO BOX 1029 *GIRDWOOD, AK 99587 Unless otherwise requested, COSA wilt be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community -Class Well Public Water System' 4 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or 13 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or 13 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA - DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that -there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following 337-6179 Date 2 S 2 ON-SITE Attachments: / COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitr Advisory Other 8y: fry Original Certificate Date: .� (Rev. 11M) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FOUR SEASONS CHALET LOT 2A Parcel ID: 075-031-24 *PER ARROW PUMP & WELL SERVICES A. WELL DATA (WELL CAMERA'D) Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed -1972 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth * b& ft. Cased to *50 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test NO WELL LOG 4/12/12 Static water level ft. 56 ft. Well production g.p.m. 4.8 g.p.m. WATER SAMPLE RESULTS: Coliform —0—colonies/100 ml. Nitrate 0- 4 mg./L. Collected by: GEG. Ltd. Arsenic: 00 ug./L. Date of sample: 4/12/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Date installed 5/31-6/1/2006 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression overtank(Y/N) NO High water alarm (Y/N) N/A Date of pumping i a Pumper /V `e Oe n a /,J -y /:�L AN '0' C. ABSORPTION FIELD DATA Date installed 5/31-6/1/2006 Soil rating (g.p.d./ft2or /bdrm 1_2 System type SHALLOW TRENCH Length 60 ft. Width 5 ft. Gravel below pipe 2.95 ft. Total depth *8.5 ft. Eff. absorption area 508 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/12/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 2 in. Water added 600 gal. New depth 3_5 in. Elapsed Time: 10 min. Final fluid depth E in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date COZ& MTZAT SOUTH END OF TRENCH COULD NOT BE LOCATED DUE TO SNOW. TEST WAS PERFORMED USING CO & MT AT NORTH END OF TRENCH. PER JEFF POET CO & MT AT SOUTH END OF TRENCH DID NOT HAVE TO BE LOCATED. D. LIFT STATION Date installed Size in gallons Manhole/Access Q /N "Pump on" level at in. "Pump oft' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *1' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS i�1 G. ENGINEER'S CERTIFICATION o OF..A I ceftify that t have determined through field inspections and * N review of Municipal records that the above systems are in """""' ... """"""' conformance with MOA COSA guidelines in effect on this date. ....... ....... Q f r A. ess. Engineer's Printed Name JEFFREY A. GARNESS QQ @ E—J79513 m� �0 lZ�i Date �f �ZS j Z d n ofessio0 40''e l— �° o COSA Fee $ (JqL)/. W Date of Payment Receipt Number U q (Rev. 11105) Waiver Fee $ Date of Receipt Number AAROW PUMP & WE[[ SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 • Fax (907) 333-8976 Eagle River: (907) 622-9335 CUSTOMER rQ�9 L 7�F '�-/- -I No. 9344 JOB SITE A- L J INVOICE DAATEWELL �2 DEPTH b SWL 5-c CHLORINATED PUMP DEPTH SALESPERSON / QU ITY DESCRIPTION PRICE AMOUNT / S /A.5, G Z2��3J J- LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTALLABOR WORK ORDERED BT DATE COMP. TOTAL LABOR f PAY THIS AMOUNT y�G Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. Municipality of Anchorage 1 Development Services Department — i Building Safety Division Onsite Water & Wastewater Program \ 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 06-6,51-94 COSA# 1. GENERAL INFORMATION Expiration Date: 9 0 G Complete legal description FOUR SEASONS CHALET: LOT 2A. Location (site address) 15� NOWMASS CIRCLE • GIRDWOOD. AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RICHARD EVANS Day phone C/O AGENT 2239 SUSITNA DRIVE Day phone ERIN EKER w/ DYNAMIC PROPERTIES Day phone 230-7266 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 riles 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance oflhe system under the conditions encountered at the time of the lost, and separation distances measured to readily identifiable features. The operational filo of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden detects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE VGNApproved for bedrooms. Disapproved. Phone 337-6179 Date Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory. Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other p nN•cITF ••: Nr_ ii WATER AND ; m= PROGRAM By: &C -,t Original Certificate Date: S- O 1R.v 111 1 Municipality of Anchorage , ' Development Services Department ' Budding Safety Division . On -Site water & Wastewater Program 47W Bragaw street P.O. Box 1966W Androrege, AK 995198650 www.muni.arg/onafte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FOUR SEASONS CHALET: LOT 2A Parcel ID: 0 7.r - 031 ' 2 it - A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Data completed � 1972 Sanitary seal (Y/N) YES Total depth 75 ft. Cased to 40+ ft. FROM WELL LOG Date of test pG Static water level _ �� ft. Well production N� g.p.m. WATER SAMPLE RESULTS: Web Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 5/4/2006 47 ft, 5.5 g.p.m. Colffor 0_ colonies/100 ml. Nitrate 0,536 mgJL. Other bacteria 0 colonies/100 mi. Arsenic: _ ND ug./L. Date of sample: 5/4./2006 Collected by: GEG Ltd. B. SEPTICfHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Data installed 5/31-6/l/2006 Tank sae 1230 9ht, Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alar (Y/N) N/A Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed 5/41-e/1/200e Sob rating 4EOWft9bdr) 1_2 Length 60 ft. Width S ft. System type SHALLOW TRENCH Gravel below pipe 2.95 ft. Total depth 074-9.5 ft. Eff. absorption area 508 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth = in. Absorption rate >_ - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed "Pump on" level at _in. Datum - E. SEPARATION DISTANCES Size In gallons "Pump ofP High water alarm level at Cycles tested Meets alar 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100,+ On adjacent lots 1 Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line '1' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 060019 G. ENGINEER'S CERTIFICATION I cerdYy that I have determined through fleld inspections and V0,90 review of Municipal records that the above systems are in conformance with MOA COSA guidelinesin effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date 6 2 06 COSA Fee S /?a . O O Date of Payment 6 j .i - n C Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number rn eas.� CE—i79 4,s. .OL 0 s tit •8� % CID I-�_ .� Go a I{pp,5 mcuo AV CV Ij LI Owl / COmPl,1 R 6a.75lReal S p•E 68. /00-06-7 $1 S. oo'OSsb djJd�, l °c 16 any y � 0 eo —. bo P0p'"'pgnsu �0 86L �.0pg0.bLIV 2 n w L&'Le TO 39Vd OSSV B V>LLV-IVM G38J 180L PUM 6T-91 9001/60/90