HomeMy WebLinkAboutSKY MANOR LT 3 SKY MANOR5
ky Manor
Lot 3
#051-193-42
Inspection Report _ -12. oe
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site water & Wastewater Program sl V N 92014
4700 Elmore St. - P.O.
Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141025
PID Number: 051-193-42 ® New E] Upgrade
Nome:
JOHN THOMSON
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound
Address:
11404 JESSIE MAE CIRCLE,
EAGLE RIVER, AK 99577
❑ Other
Phone:
No. of Bedrooms:
Soil Rating'
Total Depth from original grade:
(907) 240-2020
*6
0.7 GPD/Sa. Ft.
**9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
SEE DWG. Ft.
Gravel depth beneath pipe:
0.53 Ft.
Subdivision:
SKY MANOR
Block: Lot:
— 3
Fill added above original grade:
Gravel length:
SEE DWG. Ft.
65 Ft.
Township: Range:
— —
Section: _
Grovel width:
Beds Number of lines.
Distance between lines:
20 Ft.
4
5 Ft.
SEPARATION DISTANCES
Total absorption area:
1300
Number of trenahee:
—
Dist. between trenches:
—
To
Septic
Absorption
Lift
Holding
Public/Private
From
Tank
Field
Station
Tank
Sewer Lines
So. Ft.
FL
Well
200'+
200'+
—
—
25'+
TANK ®Septic ❑S.T.E.P. CHolding ❑Other
Manufacturer:
capacity:
Surface water
100'+
100'+
—
—
ANCHORAGE TANK
2000
Got.
Lot Line
5'+
10'+
-
-
N/A
Material:
STEEL
Number of compartments:
2
Foundation
5'+
10'+
—
—
LIFT STATION
Curtain Droin
NONE KNOWN
Manufacturer: c IY:
Gal.
Remarks: *THIS IS A DUPLEX.
"Pump an" level at:
rap off" I
High water alorm at:
*2 FEET OF MOA SAND FILTER
BELOW TOTAL DEPTH.
Pump Make &
Electrical Inspections performed by:
PIPE MATERIAL
House to tank D3034 Tank to D3034
drainfield
Installer
GREEN GENERAL
CONTRACTING
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd.
BENCHMARK (Assumed elevation)
100.00 Ft.
Inspection
Location and Description:
Dates: 1st 4/1/14
2nd 4/3/14
3rd 4/7/14
4th 4/14/14
DOOR THRESHOLD NEAR POINT "B"
Community Development Department Approval
ENGINEER'S SEAL
_Qob000p
(DF
A.�gS�O
Conditional approval:
Date:
��QO
T
oQpai�P•
..... ..................
�.� fey.......rness:...
QO " CE 753 ,•' mph
��4�e '•.bT6�lrf'•'�0000
Approved:
-/3
Date:
DIP no,
�40000��
Inspection Report _ -12. oe
Lot 2
PROPOSED
SEPTIC
SYSTEM
NEW
2000 GALLON
SEPTIC TANK
FCO
14'+
NEW GRAINFIELD
�— WATER LINE LOCATION PER CONTRACTOR.
FOURTEEN- FOOT SEPARATION TO
GRAINFIELD PER CONTRACTOR.
KEY BOXES
rEXISTING WATER MAIN
PARCEL ID NUMBER:
X051-19342
f -••.
Lot 4
PROPOSED
SEPTIC
SYSTEM
CONFIRMATION TEST
HOLE DUG PRIOR TO
CONSTRUCTION.
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E.TUWRR D, SMITE 101•ANGg E,MM0)'PI3W(SM M6179-IM(9pn 33632<9•WEB51E: wxn'gertaewglweM1gmn
'REPAIRED FOR: PHONE NUMBER: PAGE NUMBER• •,•••'
JOHN THOMSON (907) 240-2020 2 OF 3
.EGAL DESCRIPTION: - DRAWN BY:
SKY MANOR SUBDIVISION; LOT 3 J.L.M. •�4
YPE OF WORK: DATE:
. AS -BUILT OF NEW SEPTIC SYSTEM 6/5/2014
6BEDROOM
DUPLEX
(UNDER
CONSTRUCTION
ALTERNATE
A.
�7
b
PERMIT
PARCEL ID
OSPI41025: AS -BUILT DRAWING 051193-428ER.
OSP141025
TOP OF TANK
AT INLET = 95.38
INVERT OF BUNG
AT INLET = 94.76
FILTER FABRIC
INVERT OF DISTRIBUTION
LINES= 94.39 -
TOP OF SAND
= 93.86
BOTTOM OF BED
= 91.83 -
2' INSULATION
� FINAL GRADE = 98.0-98.1
NEW 2000 GALLON
SEPTIC TANK
20 FEET WIDE
- TOP OF TANK
AT OUTLET = 95.39
INVERT OF BUNG
AT OUTLET = 94.59
GRADE = 98.30 -
100.90
ORIGINAL GRADE
101.33-102.83
MAX.
DINT
RELATIVE BOTTOM OF TEST HOLE N3 =87.33 (TEST HOLE DRY)
RELATIVE BOTTOM OF TEST HOLE #313 = 85.83 ( TEST HOLE DRY)
GARNESS ENGINEERING GROUP, Ltd�`
CIVIL & ENVIRONMENTAL ENGINEERS
3XI E.TNWRRDAD.SUIIE 101'ANWO E,A MOI'PH NE (907 3374178'FM(90n 33BJ349'WEB81TE:xwn.genwee�gYxeilg.am
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • '�
JOHN THOMSON (907) 240-2020 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY MANOR SUBDIVISION; LOT 3 J.L.M.
TYPE OF WORK: DATE:
AS -BUILT OF NEW SEPTIC SYSTEM 6/5/2014
THN3
AND
TWK1B
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701E. TUDOR MAR SUITE 101'AN(DiORUDRAN99M7'PFOM(9R MY 179'FM(90T 33Sa'NB•W£BSrtE: xxw.yemms,pFwrFpcwn
LEGAL DESCRIPTION: SKY MANOR SUBDIVISION; LOT 3
PERFORMED FOR: JOHN THOMSON DATE: 3/28/2014
DEPTH ----
(teeU ORGANICS ITEST HOLE #36
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
OA
.
DRY
•• •l
0
M
GW
GP
SW
P
�I
//�i
417/14
;YYY7`Y`IIGC
y�y//pp�i
'YN�SC
GP W/ SOME
SILT AND
COBBLE/
BOULDERS
DEPTH TO
GROUNDWATER
DATE
DRY
3/28/14
DRY
411/14
DRY
417/14
DATE
READING CLOCK
NET TIME WATER LEVEL
NET DROP
TIME
(MINUTES) READING
(INCHES)
OHO.
O
O�PS�PS,
,NPS
BSO¢SEO
d1�I1k
19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 11 FT. AND 12 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODYMAUS PERCOLATION TEST PERFORMED BY: JODYMAUS
rnMMFNITc• PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASP FO MED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: L Is /
On -Site Wastewater Disposal System Permit
Permit Number: OSP141025
Tax Code Number: 05119342000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Work Type: Septic Initial
Permit Effective Dates: February 27, 2014 to February 27, 2015
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: SKY MANOR
Site Legal Address: SKY MANOR LT 3 G:1159
Owner/Address: THOMSON JOHN E
11404 JESSIE MAE CIR EAGLE RIVER AK 995770000
Site Mailing Address:
This permit is for the construction of:
Y Disposal Field Y Septic Tank
y -/-I/O` 3:30
Lot Size in Sq Ft: 40000
Total Bedrooms: 6
N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation
test. The Engineer needs to do an additional percolation test prior to 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 On -Site review and
approval. AMC 15.65.060.6.3
III
3111 /14 GDi ep v+ses 4 ha clro�i.� �: end •
Received By:
Issued By: !/� Date: Z7
MUNICIPALITY OF ANCHORAGE
Community Development Department . Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan r
On -Site Sewer/Well Permit Application s RUSH!!
For A Single Family Dwelling
Parcel I.D. CSI— 1q�J—�a
Property owner(s) JOHN THOMSON W/ CT CONSTRUCTION Day phone 240-2020
Mailing address 11404 JESSIE MAE CIRCLE * EAGLE RIVER, AK 99577
Site address NEEDELS LOOP * CHUGIAK, AK 99567
Legal description (Sub'd, Block & Lot) SKY MANOR; LOT 3
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 6
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial ® Single Family (SF) ❑
Absorption Field ® Upgrade ❑ (w/wo ADU)
Septic Tank ® Renewal Duplex (D)
❑
Holding Tank ❑y `� ^y�� Multiple Dwellings El
Privy
El U B M I 1 ,'�
Private WellA115H
(SF and/or D)
❑ FEB 2 5 201
Water Storage F-1! J
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.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/RushFees: 56�1 ' 1, ORuS�) Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: dal U 0 G Receipt Number.
Permit No. Osvlq loa-T_ Waiver No.
(Rev. 09/12)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS mm
February 21, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic System for Sky Manor Subdivision; Lot 3
To whom it may concern:
The proposed 6 bedroom duplex is to be served by a community water system (under
construction) and a private septic system. We are proposing to install a new 2000 gallon septic
tank and a bed type drainfield. Two test holes were excavated on the property. An additional
confirmation test hole is to be excavated prior to construction. The primary drainfield and
alternate site will be designed around the 30 foot radii of TH#3 and this new test holes.
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 WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: As can be seen on the attached site plan and design drawing, the
topography is shown. In short, there are no slope concerns with this installation and there are no
cutbanks such as road ditch with 50 feet that will impact the installation of the septic system.
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. .,
.E., M.S.
N071=: Attached is a site plan drawing, a design drawing, two soil logs, which are all part of the design
package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Lot 5
PO$E-0._..._ DUPE JP
6 BEDRgpM...... % .,
OUPXEz .... ._.. /. '` PROPOSE �.... ...�-.L_ _..�•' 1
SEPT1O PR OSE
"SYSTEM. ''� T SEPTIC
__- "
.... I •-- --' ..... H♦/3 __'_: _ ....I SYSTEM
_........._ PROP ED' .. _- �.
Lot 1 -sE Ic _ -. _ iNYP-!. 1- -- = • ::Hn
.. - ]
Lot
f ! /- ALTERNATEStTE ALTERNATE SITE
SUBDIVISION
1
tUNORF JEWEL
LOr I
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)
j 1
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E%15TH. I I
CHURCx Q
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1 I
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 8 GENERAL CONTRACTORS
370t E. TUDOR ROAD, SUITE 101 • ANCHORAGE, Ax 99507 • PHONE (RO7)337-6179 • FM (907)3N-3246 •WEBSITE: •.� PHOmaFFFn innr' can
PREPARED FOR: NE NUMBER: PAGE NUMBER:
JOHN THOMSON 907-240-2020 1 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY MANOR SUBDIVISION; LOT 3 J.L.M.
TYPE OF WORK: DATE:
SITE PLAN FOR PROPOSED SEPTIC SYSTEM 2/21/2014
FOOT
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510
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Lot 5
PO$E-0._..._ DUPE JP
6 BEDRgpM...... % .,
OUPXEz .... ._.. /. '` PROPOSE �.... ...�-.L_ _..�•' 1
SEPT1O PR OSE
"SYSTEM. ''� T SEPTIC
__- "
.... I •-- --' ..... H♦/3 __'_: _ ....I SYSTEM
_........._ PROP ED' .. _- �.
Lot 1 -sE Ic _ -. _ iNYP-!. 1- -- = • ::Hn
.. - ]
Lot
f ! /- ALTERNATEStTE ALTERNATE SITE
SUBDIVISION
1
tUNORF JEWEL
LOr I
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GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 8 GENERAL CONTRACTORS
370t E. TUDOR ROAD, SUITE 101 • ANCHORAGE, Ax 99507 • PHONE (RO7)337-6179 • FM (907)3N-3246 •WEBSITE: •.� PHOmaFFFn innr' can
PREPARED FOR: NE NUMBER: PAGE NUMBER:
JOHN THOMSON 907-240-2020 1 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY MANOR SUBDIVISION; LOT 3 J.L.M.
TYPE OF WORK: DATE:
SITE PLAN FOR PROPOSED SEPTIC SYSTEM 2/21/2014
FOOT
OF
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS S GENERAL CONTRACTORS+
01 E 11OOR ROiY, aI11E 101 N•']*RVF, W. OW) a fNeft T9b9j$')- In • i - '
DATE
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION:
TUNDRA JEWEL RANCH; LOT 20 — PROPOSED SKY MANOR, LOT 3
PERFORMED FOR:
JOHN THOMSON DATE: 6/5/2007
DEPTH
(feet)
____
39��
====_
ORGANICS
TEST HOLE #31
:•s ___
SP/LOAM
SOIL CLASSIFICATIONS
3
a:e GP
ML
l
GM
CL
4
?
GC
OL
% SW
MH
5
t.;
i•.: SP
CH
'=:h
SM
'
OH
¢ T
.... .........
a f y ess,:
° CE77J5, i eG
sc SEE ATTACHED DRAWINGS
6
10rl<<::,':
,
DEPTH TO
GROUNDWATER
DATE
DRY
6/5/2007
DRY
6/12/2007
DRY
2/6/13
19� PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4 FT. AND 5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
PERFORMED BY GEG, Ltd.1, JEFFREY A. GARNESS, CERTIFY THAT THISWA P RFORMED IN ACCORDANCE
G l
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3
• • • aaa��a
��aaa�a
19� PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4 FT. AND 5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
PERFORMED BY GEG, Ltd.1, JEFFREY A. GARNESS, CERTIFY THAT THISWA P RFORMED IN ACCORDANCE
G l
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3
6 BEDROOM
DUPLEX
(UNDER
CONSTRUCTIONr _P
/ TH#2
, y
/ y
r /
A
_ Lot 3 '
_ PROPOSED
- - - 6 BEDROOM
DUPLEX
Lot 2
LMSTEM
ALTERNATE
SITE
I
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
N, \ i—
(
-
1 r
INSTALL
L
DOUBLE
CLEANOUTS
.�
CO
15 T,4 ESMT / NUMBER OF BEDROOMS: 6
GALLONS PER DAY (GPD): 900
PERCOLATION RATE/S: <1 MIN/INCH
PROPOSED APPLICATION RATE: 0.7
MINIMUM DRAINFIELD SO.FT.: 1286
'l DRAINFIELD DESIGN:
/ MAXIMUM DEPTH: 1/ FEET
WIDTH: 20 FEET
/ LENGTH: 65 FEET
M.D.A. APPROVED SAND FILTER: 2 FEET
_ EFFECTIVE: 0.5 FEET
REDUCTION FACTOR: N/A
/ ACTUAL SO.FT.: 1300
/
/ \
PROPOSED
6 BEDROOM
-N,I,�- \ DUPLEX
T TH#q (\ \
/
PROPOSED �n
2000 GALLON LOt 4
/
SEPTIC TANK
MZ
rO
�GO
T 113
OSED
(FIELD
J / /
/
/
-_J
-CONFIRMATION TEST HOLE.
DUG PRIOR TO
CONSTRUCTION.
NOTE THE CONTRACTOR
_
ALTERNATE SITE SHALL HAVE THE EAST
AND WEST PROPERTY
/-� - LINES FLAGGED PRIOR TO
/ WATER LINE /�CONSTRUCTION.
y LOCATION PER
CONTRACTOR _
EXISTING KEY /6SXES - --//
/ EXISTING WATER MAIN
17
20' SMTP y,-•17
GARNESSIENGINEERING GROUP, Lt �
CONSULTANTS & GENERAL CONTRACTORS G
5701 E. IUWR B . SUM 101 • oMCH'JR . M 99N7 • PHUNS (8(_)399-6!n - EP% (907)3]8-SN6 • W SRE ymnexcrvpmsn,p.csn Yn
PREPARED FOR:I F i UNE `IIIMBER: PAGE NUMB'
JOHN THOMSON 907-240-2020 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY MANOR SUBDIVISION; LOT 3 J.L.M. _
TYPE OF WORK: - o DATE: REVISED
DESIGN OF PROPOSED SEPTIC SYSTEM 1 3/31/2014
.... ... .......
i A. ..ar essr
P"
1 ` o� e
I v
ROM SEPTIC TANK'
r - O ,2.5•.
4" PERFORATED PIPE SOLID PIPE
2
O - _-----___ O 1 25.
I FEET
5 FEET LONG
FILTER FA
INVERT OF DISTRIBUTION
LINES (TYP.)—
TOP OF SAND
BOTTOM OF
GRADE
AT
ORIGINAL GRADE
11' DEEP MAX.
AT ANY POINT
FEET WIDE —
TEST HOLE DEPTH IS 15.5 FEET (NO WATER)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
3701 E. TUDOR ROM. SUITE. 101 • ANCIIOWGE. M 99507 • PRDWE (907)337-61X • ME (907}136-3106 • WE6511E:....9amuangnevrinp.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOHN THOMSON 907-240-2020 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY MANOR SUBDIVISION; LOT 3 J.L.M.
TYPE OF WORK: DATE: REVIS
DESIGN OF PROPOSED SEPTIC SYSTEM 3/31/i
14
• 11
awn 1
.���
ey -+r-c orness:
CE -195 d�
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS +.�+
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: TUNDRA JEWEL RANCH; LOT 20 — PROPOSED SKY MANOR. LOT
PERFORMED FOR: JOHN THOMSON DA
TEST HOLE 4
SOIL CLASSIFICATIONS
GW zz= ORG
GP ML
GM CL
GC OL
° • S SW MH
' •� SP CH
sM OH
sc
DEPTH TO
GROUNDWATER
DATE
DRY
6/5/2007
DRY
6/12/2007
DRY
2/6/13
Fd IN
10
SEE ATTACHED DRAWINGS
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
-- A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS E FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
READI
• � � aaa��a
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
-- A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS E FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
MUNICIPALITY OF
t•
Development Services Department �' r
On -Site Water & Wastewater Section
Parcel I.D. 051-193-42
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: - 7_0? 2 -
Complete
Complete legal description Sky Manor, Lot 3
Location (site address) 22692 Needels Loop Chugiak, AK
Current property owner(s) Michele Bennett Day phone (907) 831-1605
Mailing address P.O. Box 671996, Chugiak, AK 99567
Real estate agent
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
0 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
6
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
0
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ I'i I2, ►50 C'6 10-1
Date of Payment I 5J0 0� U
Receipt Number. OWE 2 b
cosA# O5G201 >ZA
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 7/14/2020
6. DSD SIGNATURE
System #1 Approved for C� bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
9400 V4 PIP, OFESS
bedrooms, with the following stipulations:
-Iit(tttfW/"
Original Certificate Date: 7 3-Z�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Sky Manor, Lot 3 Parcel ID: 051-193-42
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments COMMUNITY WELL PWSID #218807
B. TANK DATA
Age of tank(s) 6 years
Tank type/material SEPTIC/STEEL
Measured operating fluid level in septic tank 50
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 7/15/20 - JRs Septic Pumping
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
D. ABSORPTION FIELD DATA Absorption Bed
Which system tested (date installed) 4/1/14
Adequacy test date 6/09/20
❑ ALL standpipes present per record drawing ***
Results ❑✓ Pass For 6 bedrooms
Total measured depth from grade 8 ft.(max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 7.5 ft (min)
Water added 918 gal
❑ N/A — pressurized field
0
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
0
depth into effective
Elapsed time min
All Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate '900 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) None
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies:
***One of the four monitor tubes cannot be located. Swing ties were used to attempt locating the
missing tube to no avail. The septic vents and
post tank cleanouts are at grade and were located.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES - Property served by a Community Water System
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑✓
Yes
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
❑✓ Yes if No ft
Water Main > 10'
Animal Containment? 50' ❑ Yes
if No ft
❑ Yes
if No
ft
® Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' ❑ 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'✓❑
❑✓
Yes
if No
ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
✓❑
Yes
if No
ft
Wells on Adjacent Lots:
❑✓
Absorption Field > 5'
❑
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'
71
Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Water Service Line > 10'
❑✓
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' El Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No
ft
Private Wells > 100'
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200'
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
Property is served by PWSID No. 218807.
G. ENGINEER'S CERTIFICATION
I certify that 1 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
F Yes if No ft
❑✓ Yes if No ft
OF
�S•• 9th
es...........
at
MICHAEL E. ANDERSON c j 9
tv ,a
No. CE -4381
7/16/20 ,••' • ti�'�4'
`E0
--,11c Municipality of Anchorage 0,1 9 10 777
f
On-Site Water and Wastewater Program (Nvre-
in 343-7904 (N, SAFETY
'm JUL 27 2017
Certificate of On-Site Systems Ap oval
cv
tt J
Parcel I.D. 051-193-42 Expiration :01 C";)
1. GENERAL INFORMATION:
Complete legal description SKY MANOR; LOT 3
Location (site address) 22692 Needles Loop*Chugiak 99567
Current Property owner(s) Greg Endom Day phone 925-550-8082
Mailing address
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: 6
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well ® Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
•
` f
j ,� �
Received by. �/� Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment 1 IP-77)11 Date of Payment
Receipt Number 1]afr Receipt Number
COSA#, 0C-rt Waiver#
•
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: Garness 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: q , 1 / .
.-
�oQ,ao44
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system OF ,� t
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 date/s of the �p4 1,,• *T.I.S4_1P0n
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 9- _, 0fn)encroachments may exist that were not identified during the evaluation. The operational life of all wells * ••.Je v
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, f�' V�
groundwater levels (that may fluctuate during the year), quality of construction (materials and 0 I D
workmanship), and the water usage of the family utilizing the system's. These conditions can vary,and 'r .. .
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Pd Jf ,S A, Gar ess.
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of V0' %. _T� . �,
the well or septic system. GEG makes no representation whether an alternative well or septic system �nn s • 1: �c4
can be installed on the property in the event either of the current systems fail to perform adequately in u� �, ) •'1 c°o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to ��Q'Pro fess�o,O\
•
perform the evaluation. Reliance upon the information provided in this report by any other person or ���pO�o�
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for (C: , bedrooms
System #2 Approved for bedrooms J���,'i OF H;,V�h
Disapproved ''' U
ON-SITE
Conditional approval for bedrooms, with the followinl•stil i ffpAND m
l
T; WASTEWATER
C.
`n PROGRAM
r�
'Trr-------T—k— ---
- Original Certificate Date: r.-- - 17
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
COSA blue sheet 10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of_
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: SKY MANOR; LOT 3 Parcel ID: 051-193-42
A. WELL DATA
Well type COMMUNITY If A, B, or C provide PWSID#218807 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (YIN
Total depth ft. Cased to ft. Casing height(abo - around) in.
FROM WELL LOG AT I CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RES :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 4/1-14/14
Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping 02 6,/'i Pumper Spm ciwst-y PuM Ls
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE AT MT
Date installed 4/1-14/14 Soil rating •.p.d./''or ft2/bdrm) 0.7 System type BED
Length 65 ft. Width 20 ft. Gravel below pipe 0.53 ft.
Total depth *5.2+ ft. Eff. absorption area 1300 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 4/26/17 Results (Pass/Fail) PASS For 6 bedrooms
Fluid depth in absorption field before test 0 in. Water added 926 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 900+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at • wa er alarm level at in.
- . Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main '.• ' sewer manhole/cleanout
Sewer/septic service line Holding tank
- - containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line '10'+ Surface water 100'+
Wells on adjacent lots 100'+PRIVATE&200'+COMMUNITY
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line *10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots100'+PRIVATE&200'+COMMUNITY
F. COMMENTS
'PER CONTRACTOR THAT INSTALLED BOTH THE SEPTIC SYSTEM AND THE WATER SERVICE LINE-SEE ATTACHED
STATEMENT.
•'� OF i
G. ENGINEER'S CERTIFICATION
4 :• 49�
!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 _. •• •
�I • ?'
date. ♦r^: �.r , A. - s r
Engineer's Printed Name JEFFREY A. GARNESS •1>: E 7795 4 rtic
Date 5Z-(a-971O LICENSE,t II�DFESS\ 4 4
#AECC884 w,i
(Rev.10112/12)
John and Jackie Thomson 907-695-5072 p.5
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.______ _______
L ,...,6,-,,.. .....4..e.....,7_ ,.,___er.„,:s,...i...2.
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SEWARD & ASSOCIATES LAND SURVEYING 694-0829
BY CERTIFY THAT I HAVE SURVEYED THESCALE:
YING DESCRIBED PROPERTY: /�wo .����4t�
. �4�mar 3 _--- -:- OF A L 1 4 tt
kT NO ENCROACHMENTS EXIST t"XCEPT AS DATE; ..- •_. -q e
ED- IT 1S THE RESPONSIBIi1 TY OF THE 9' /'S� -.-. _r s`f 3
f0 DETERMINE THE E(/STEN CE OF ANY GRID ..(1)..., 4° ��r �.,
NTS, COVENANTS, OR RESTRICTIONS ,."1".- --•'./. -5,1. o
b NOT APPEAR ON THE RECORDED SUBD1-
PLAT. UNDER NO CIRCUMSTANCES SHOULD FaVuari Nark Sewer _• $
11 WPWAA1 QC fr .. ........-.•-..-_.
eel% .. T' .16 �� �. �. �S-. � •�v�
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Contractors Statement for Water Main and Water Service Lines
October 6, 2014
To whom it may concern:
1, Dan Green, Owner of Green General Contracting, hereby certify that all water mains
and water service lines for Sky Manor Water System that were installed by Green
General Contracting, are ten (10) feet away from all septic tanks and drainfields.
(-4 /0
Signature of Owner Date
Dan Green, Owner
Green General Contracting
15939 Division Street
Chugiak, AK 99567
Phone: (907) 696-1805
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-193-42 Expiration Date:
1. GENERAL INFORMATION
Complete legal description SKY MANOR SUBDIVISION; LOT 3
Location (site address) 22690,NEEDELS LOOP, CHUGIAK, AK 99567
Current Property owner(s) JOHN THOMSON W/ CT CONSTRUCTION Day phone 240-2020
Mailing address
Real Estate Agent
11404 JESSIE MAE CIRCLE, EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
® Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 6
4. TYPE OF WATER SUPPLY:
Day phone
,,SUPPMITTAI
OCT u') �, 014;,
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Indiviriiial lNater Sfnraga_
❑
Individual Holding tank
❑
Community Class "A" Well
®
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request For: N/A Distance_
Received by: /— ® J Date:
COSA to be released t the engineer, unless otherwise requested by the engineer,
COSA Fee $ t �� 1 �, (• �o Waiver Fee $
Date of Payment lob /w Date of Payment
Receipt Numberd[ `�J�°�"y Receipt Number
COSA# o`yllI, `2 l Waiver#
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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date t 112,/i V
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 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.
6. DSD SIGNATURE
System #1 Approved for f ' bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
k� T6 7.
6, rness:'
CE -7953 �
iG-1! ( �./fit-
ON-SITE
=� WATER AND
oSTEWATER oz^
GWP--,mAtA j 3
Original Certificate Date: / t% '._.?` /l>
The Municipality orAde(orage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist �� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(R< wns
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: _
A. WELL DATA
Well type COMMUNITY
Date completed
Total depth -
SKY MANOR SUBDIVISION; LOT 3
Parcel ID: 051-193-42
COMMUNITY WATER SYSTEM
If A, B, or C provide PWSID# A Well Log (YIN) _
Sanitary seal (Y/N) Wires properly protected
Cased to ft. CasZl�
eight (abo n
FROM WELL LOG AT CTION
in.
Date of test
Static water level ft.
ft.
Well production g.p.m.
g.p.m.
WATER SAMPLE RESUL
Coliform colonies/100 ml. Nitrate mg./L.
Collected by:
A c: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed 4/1-14/2014
Tank size 2000 gal. Number of Compartments 6
Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO
High water alarm (YIN) N/A
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE
Date installed 411-14/2014 Soil rating 4H/ft r 0bdrm) 0_7
System type BED
Length 65 ft. Width 20 ft.
Gravel below pipe 0.5 ft.
Total depth '4.4-7 ft. Eff. absorption area 1300 ft2 Monitoring tube
YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) -
For 6 bedrooms
Fluid depth in absorption field before test = in. Water added
=gal. New depth in.
Elapsed Time: = min. Final fluid depth in.
Absorption rate >= 900 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off" level
Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
Public sewer main
Sewer /septic service
level at in.
Meets alar & circuit requirements?
COMMUNITY WATER SYSTEM
On adjacent
On
sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main
10'+
Water service line 10'+ Surface water 1001+
Wells on adjacent lots 100'+ PRNATE/209+ TO COMMUNITY WELL
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 101+
Water service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/200'+TO COMMUNITY WELL
F. COMMENTS
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.
Engineer's Printed Name JEFFREY A. GARNESS
Date JC> Lz h y
(Rev. 10112J12)
John and Jackie Thomson
a
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ASSUiLT
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907-696-5072 p.5
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1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
ISCALE:
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO EhfCROACHMENTS EXIST EXCEPT AS
INDICATED_ 1T
DATE -
9��y
IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID=
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI—
/vuijZs{
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
F3:
ANY DATA HEREON RE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING SOUND-
-
ARY LINES.
DRAWN;
OF At ya
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