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Home My WebLink AboutSTOLLE BLK 3 LT 7Stoll Block Lot 7 #020-021 - 19 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Renewal Date Issued: Oct 31,2007 Expiration Date: Oct 30, 2008 Permit Number: SW070302 Legal Description: STOLLE BLOCK 3 LOT 7 Design Engineer: 0060 DHI ENGINEERING Owner Name: JACOB & YVETTE DEMPSEY Owner Address: 10900 FOREST DRIVE ANCHORAGE, AK 99516- Parcel ID: 020-021-19 Site Address: 16040 HONEY BEAR CIRCLE Lot Size: 47091 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] 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 ( 18AAC72 ) 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. Received By: Issued By: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www. muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) ~(1 [>~ ¢ ~ ~£,~ ~/'~¢~/~Z/'Day phone -,-_~ :~L~'f - ~ ~<'~ ~ ~ ' , /.. ~ / ~-- Mailingaddress ][~.~ p {~.~ /,~ ~/~5[..- ~/~ ~]~? Zip Code Legal description (Sub'd., Block & Lot) ~//~_ '~,~ ~ ~ Legal description (Township, Range & Section) Lot Size L?/~ ii ¢? / Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR ([~ all that apply): Absorption Field Septic Tank 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. (Signature of property own'er or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewaler Program 4700 South Bragaw Street P.O. Box lg6650, Anchorage, AK g9519-6650 (gO7) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Nov 01, 2006 Expiration Date: Nov 01, 2007 Permit Number: SW060357 Legal Description: STOLLE BLOCK 3 LOT 7 Design Engineer: 0060 DHI ENGINEERING Owner Name: JACOB & YVt::I I E DEMPSEY Owner Address: 10900 FOREST DRIVE ANCHORAGE, AK 99516- Parcel ID: 020-021-19 Site Address: 16040 HONEY BEAR CIRCLE Lot Size: 47091 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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 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. Issued By;, Date: ////0~/~ 0'''' / Date: Municipality o.f Anchorage Development Serv,ces Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www. muni.org/onsite (907) 343-79O4 ON-SITE SEWER/VVELL PERMIT APPLiCATiON FOR a SINGLE FAMILY DWELLING Parcel I.D. 020-021-1 9-, · Property owner(s)3acob & Yvet:te Dempsey Mailing address 10900 ~'orest: Drive Site address 16040 t~one¥ aear CJ. rcle Day phone 529-5078 Zip Code 99516 Zip Code 9951 6 Legal description (Sub'd., Block & Lot) [,ol: 7t B].ock 3~ Sto].le Subd:l.v.ts:rLon Legal description (Township, Range & Section) $B1 /4 t N~.I /4 t Sect. J. on 6, '1' 1 1 N, R214, $. M., ,~,].as ka Lot Size 4 7 t 091 . Sq. Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR (~;~ all that apply): Absorption Field [] Septic Tank [] Holding Tank D Pdvy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ($igdature of property owner or a/ut~t~ed agent) Waiver Fees: Date of Payment: Receipt Number. Permit No. Legal Description: Municipality of Anehorage Department of Developmental ON-SITE SERVICES Services Page I of 6 W.O. 06762 Date 10/20/06 P.O. Box 196650' Anchorage, AK 99519-6650' Tel: 343-4744 Well & On-Site Wastewater Disposal System LOT 7, BLOCK 3, STOI.I.~. SUBDMSION PID No. 020-021-19-000-1-0 SYSTEM DESIGN CALCULATIONS 1. NO. BEDROOMS = 5 2. USE WIDE TRENCH SYSTEM (W=5') L.~RENCH APPLICA~ON RATE TRENCH ~D~ (W) X REDUCTION FACTOR ** IF GRAVEL DEPTH = 3.0' REDUCTION FACTOR = 0.58** THEN LENGTH OF TRENCH = 5' X .58 = 72.5' USE 7Y PERCOLATION RATE *1 MIN/INCH 0-1 1-5 6-15 16-30 31-60 GREATER THAN 60 FILTER LAYER PIT & TRENCH APPLICATION RATE WIDE TRENCH REDUCTION FACTOR GPD/$F DEPTH OF GRAVEL NOT SUITABLE 12' 1.2 I ~s' 0.8 24" 0.6 30" 0.45 ** 136' NOT SUITABLE 42" 1.0 48" Permit No, Municipality of Anchorage Department of HealLh and Human Services ENVIRONMENTAL SERVICES DMSION P.O. Box 196650' Anchorage, AK 99519-6650' Tel: 343-4744 Page 2 of 6 W.O. 06762 Date 10/20/06 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 7, BLOCK 3, STO~.I.I~ SUBDMSIOI~ PID No. 020-021-19-000-1-0 UNSUBDN~DED ' ' '11 LOT 6 ~00' ' PROPOSED SEPTIC SEE SHEET ~ ! ~. v~,.OW LOT 5 UND~LOPED LOT 12 UNDEVELOPED LOT 7 47.091.28 S.~ 1.08 ELEV.-15s.go I LOT 11 · · UNDEVELOPED EXIS~NG SEPTIC ~ II STUD PIPES ~.. ~--~.. Permit No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DMSION P.O. Box 196650 ° Anchorage, AK 99519-6650 ° Tel: 84-~-4744 Page 3 of 6 W.O. 06762 Date 10/20/06 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 7, BLOCK 3, STOt'.I,~ SUBDMSION PID No.020-021-19-000-1-0 NT' ..-.~ :.~ ~-, ~:~...~ DATE Permlf No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DMSION P.O. Box 196650 ° Anchorage, AK 99519-6660' Tel: 343-4744 Page 4 of 6 W.O. 06762 Dale 10/20/06 Proposed Well & On-Site Wastewater Disposal System Legal Oescriptlon: LOT 7, BI,OCK 3, STO!.l.~. SUBDIVISION PID No. 020-021-19-000-1-0 REDDISH BROWN SANDY SILT BROWN GEAVELY SAND TRACE SILT, ROCK TO OCCASIONAL BOULDER ~-- MONITORING TUBE FINISH GRADE /SEE HOT[ 11, SHEET 5. BACKFILL II I . l e~4' PERFORATED PIPE SEE '' ~ { ~ ~GEOT~I~ F~RIC. SEE ~ I~ ~sip~c R~. SEE NO~ I0, SHEET 5 I.5.o, .I TO SEASONAL HIGH WATER LEVEL Permit No. Legal Description: DHI CONSULTING ENGINEEES LOT 7, BLOCK 3, ~'TOT.T.~- SUBDMSION NOTES: Page 5 of 6 I W.O. 06762 I Date Io/2o/o61 AU. CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULAr'IONS OF ~HE MUNICIPAL CODE, AND MOA STANDARD SPECIFICATIONS FOR STREETS, DRAINAGE, UTIUTIES AND PARKS (MASS) 1994 AS CURREN~.Y AMENDED, AND AU. APPUCABLE STATE AND FEDERAL REGULATIONS. INSTALL 1,500 GALLON, 2 COMPARTMENT STEEL SEPTIC TANK. SiTE TOPOGRAPHIC SURVEY CONDUCTED BY DHI ON 10/12/06. EXISTING STRUCTURES, WELLS, SEPTIC SYSTEMS OBSERVED WITHIN 200 FT. OF ~HE PROPOSED SYSTEM SITE ARE SHOWN ON DESIGN DRAWINGS. ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION INTO THE SYSTEM. CONTRACTOR TO LOCATE AU- UNDERGROUND UTIUTIES, PROPERTY UNES, EXISTING ~E:LLS, WATERWAYS, SURFACE AND SUBSURFACE DRAINAGE FACIUTIES, LAKES, PONDS, AND OTHER FACIUTIES REQUIRING SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. CONTRACTOR TO STAKE PROPOSED SYSTEM & NOTIFY THE ENGINEER O~ ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION. STAKE LOCATION OF EACH TRENCH END. NOTE DEPTH OF CUT ON LATH. CONTRACTOR SHALL HAVE SURVEY LEVEL AND ROD SET UP ON SITE DURING CONSTRUCTION. CONTRACTOR TO NOTIFY THE ENGINEER 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF THREE SITE VISITS ARE REQUIRED. THE FIRST V~SIT SHALL BE OF THE SUBGRADE PRIOR TO PLACING THE SEWER ROCK. THE SECOND VISIT SHALL BE AFTER THE PLACEMENT OF SEWER ROCK, DISTRIBUTION PIPING, STANDPIPES, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD VISIT SHALL BE AFTER THE WORK IS COMPLETED. 7 CONTRACTOR SHALL DEUVER TO THE ENGINEER A SET OF RED-UNED, AS-BUILT DRAWINGS SHOWING AU. DATA AS SPECIFIED IN SEC. 15.65.F.2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF THE FINAL VISIT. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE AS-BUlLTS SHALL BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWINGS TO DHHS. 8 ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN. 9 BOTTOM OF TRENCH EXCAVATION SHAM. BE LEVEL. SIDEWALLS &: BOTTOM SHALL BE SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE, AND END OF TRENCH BOTTOM. 10 PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK. LEVEL ROCK SURFACE TO · 0.1' PRIOR TO INSTALLING THE PERFORATED PIPE. 11 AU- PIPE SHALL BE PVC CONFORMING TO ASTM D5034. AU- JOINTS SHALL BE SEALED WITH APPROVED GLUE. CLEANOUTS SHALL BE INSTA))Kn AT THE END(S) OF THE TRENCH(S). 4' MONITORING TUBE(S) SHALL BE INSTALLED AT THE END OF THE TRENCH, WHERE SHOWN ON PLANS, PERFORATE ONLY THE BOTTOM 3' OF THE MONITORING TUBE AS SHOWN ON THE PLANS. 12 COVER THE DISTRIBUTION PIPE WITH YIN 2' SEWER ROCK, BEFORE PLACING INSULATION AND/OR GEOTEXTILE, FILL, AND TOPSOIL. 15 MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SO~L COVER, BUT THERE MUST BE A MINIMUM O~ 2' OF SOIL COVER OVER THE INSULATION. AU- INSULATION BOARD SHAM. BE 2' THICK POLYST~ENE, DOW H1-35 OR ENGINEER-APPROVED EQUAL. CENTER BOARD WIDTH OVER PIPE. 14 AN APPROVED GEOTEXTILE FABRIC SHALL BE INSTALLED BE~EN THE SEWER ROCK AND THE BACKFILL. 15 MATERIAL USED AS FILL SHAU- BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 16 SLOPE AU. FlU. MATERIAL AND TOPSOIL TO DRAIN AT 2% MIN. SLOPE, AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT 6' HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. THE TOP 4' OF COVER SHALL BE TOPSOIl- SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MUNICIPAL SPECS. 17 CONTRACTOR TO BE RESPONSIBLE FOR THE REMOVAL AND DISPOSAL OF CONTAMINATED MATERIAL FROM THE EXISTING TRENCHES, IF ENCOUNTERED. Permlt No. Legal Description: t/ttnicipalAty of Anchorage Department of Developmental Services ON-SITE SERVICES P.O. Box t96650 ° Anchorage, AK 995t9-66§0 ° Tel: 343-4?44 Well & On-Si[e Was[ewaLer Disposal System LOT 7, BLOCK 3, ST0~.t.~ SUBDt~ISION Page 6 of 6 W.O. 06762 Date 10/20/06 PID No. 020-021-19-000-I-0 50' ORIGINAL GROUND ! ! ! ! ! ! ! / / / / / / / / / / / 5' WIDE TRENCH TOP OF' DRAIN FIELD GROUND SLOPE FROM TOP OF' SEPTIC FIELD / / / **. ~._",",,'"'" ~ ,"!_ ~,% I / ~ .~. ~ -.~.** I ,' I ~-'j~.,?...~..~..~'?,*,.':~ I / # I , I~~~.:.1 I / ,=,-.,,, ..--,.,,.~. ,...,~, I ~.-,,-. o.....-~2 I 9~=t"l I '~ rm"l' DATE DHI CONSULTING ENGINEERS 800 ~. ~MOND BLVD. so, P~F~ r~: JACOB DEMPSEY ~ D~IP~:LOT 7, BLOCK 3, STOLLE SUBDI~SION ~ ~GANICS ,..~.~:~' REDDISH BRO~ SANDY SILT 2 ~ 3 / BRO~ GRAYLY SAND -- f.~** .. ~CA~0NAL BOU~ 9 4.'/.~ ~' · '...:.~'* w~s ~D w~ 10 ~,/~ ~C~N~ ~ ~0 O~ ? 12 ~'"~ D~ OF WA~ B.O.H. 13.5' (HARD DIGGING) I Io~i~ POSSIB~ BEDROCK ~ST RUN BE~: ~M~:CAT ~B BA~H~. S~LS ~RE PRE~ PRI~ TO RUNNING ~ STA~ ~D MUNIOP~ ~I~N~ IN ~ ~ ~IS DA~ DA~ 10/18/06 DHI CONSULTING ENGINEERS .oo z. muo. o ScvD. Sunz a-~4S ,*. t~....""...~6,~,~, so, s Lo -P .co TION EST ~ST HO~ LOG ~2 P~F~M~ F~: JACOB DEMPSEY n~ =~u~ ~nl~ln~ % ~. % .. ~o~, ..-~ ~o~ OEs~pn~.LOT 7, BLOCK 3r STOLLE SUBDI~SION T.H.~2 ~GANICS 1 · ~.~=~ REDDISH BRO~ SANDY SILT ~.~.~ SOME ROOTS ~E I 4 .. ~ " R~. GRA~LY SAND J _~. 7" - MOIST, MORE ROCKY ~ ~v ~ DEP~ 8 I g I 10 -~ WAS ~ND WA~ S ~.. ~N~ ? ~O L O 11 ~ * IF ~S. AT ~AT p DEP~ ? E 12 ' * 24' BOMBER ~ M~IT~ING ? ,N~E DA~: 1~ ~ 15.2' B.O.H. (B~ ROCK) ~ ~ ~ 3 I0~1~ I ~ K I' ~ 1,42 · ,o~ J ~ ~ e' ~ j ,.~ ~ I I I I I I I ~ST RUN BE~: ~.0 ~. ~D. 5.5 .~. ~M~;CAT 436B BA~H~. S~LS ~RE PRE~ PRI~ TO RUNNING P~C~A~ON ~ STA~ ~D MUNIQP~ ~N~ IN ~CT ~ ~IS DA~ DA~ 10/18/~ 762CSSBD MUMOF L U TYO F HCHO RA G Development Services Department 4 _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-021-19-000 Expiration Date: 1/30/2025 Legal description STOLLE BLK 3 LT 7 Site address 16040 HONEY BEAR CIR Anchorage AK 99516 Current property owner(s) REINHARDT RONALD JR & BRANDI X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Tank to be pumped in the Spring of 2024 on or before 6/15/2024 by One Stop Pumping. Original Certificate Date: 1/16/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject systems) 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 Approva"une 2022 MUNICIPALITY OF ANCHORAGE 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. 020-021-19 Complete legal description STOLLE BLOCK 3, LOT 7 Location (site address) 16040 HONEY BEAR CIRCLE, ANCHORAGE AK 99516 Current property owner(s) RONALD JR & BRANDI REINHARDT Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 15 - 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 $ '55-0 Waiver Fee $ Date of Payment Date of Payment COSA # OSC 2 y IOZ7 Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: STOLLE BLOCK 3, LOT 7 Parcel ID: 020-021-19 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 10/22/2008 Total depth 306 ft Cased to 43 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 2/7/2024 Static water level at beginning of test 53 ft. Well production at time of test 1.4 gpm Water storage tank volume 900 gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.13 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 1/30/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping SPRING 2024 by 6/15/24 Required maintenance completed, if AWWTS Comments: Pumping w/ site visit prepaid. Remote site inaccessible with winter conditions. C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/11/2006 ALL standpipes present per record drawing Total measured depth from grade 6.6 ft (max) Measured depth to pipe invert from grade 3.4 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) 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) N If yes, enter date Adequacy test date 2/7/24 Results Pass Fluid depth prior to test 0 in Water added 800 gal New fluid depth 1 in Elapsed time <5 min Final fluid depth 0 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 36 in (MOA 3’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 36 in Comments/Deficiencies: Approximate total measured depths from existing grade with winter conditions. ED per elevation measured shots & appears approximate with 3’+ ED. COSA Checklist.docx 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft 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’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 2/8/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 02/08/24 Thank you for your business!Invoice 26510122 Invoice Date 2/9/2024 Payment Term Due Upon Receipt Billing Address First Water 13021 Montego Circle Anchorage, AK 99516 USA Job Address 16040 Honey Bear Lane 16040 Honey Bear Lane Anchorage, AK 99516 USA Task #Description Quantity Your Price Total SEPTIC Pumped out the septic tank 1.00 $225.00 $225.00 Sub-Total $225.00 Tax $0.00 Total $225.00 Payment $0.00 Balance Due $225.00 Please call us with any questions or concerns at 907-561-7669. If you enjoyed our service, please leave us a review on Google. TO BE PUMPED IN THE SPRING OF 2024 PRIORTO 6/15/24 DUE TO ACCESSIBILITY - SNOW & SITE LOCATION.