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SKY MANOR SOUTH LT 10
Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water & Wastewater Program 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: OSP191332 PID Number: 051-193-50 E New ❑ Upgrade Name: C & T CONSTRUCTION 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: 240-2020 6 (DUPLEX) 0.7 7.5 (MAX.) GPD/Sq. Ft Fl. LEGAL DESCRIPTION Depth to pipe invert from original grade: Gravel depth beneath pipe: SEE DWG. Ft 0.5 Ft Subdivision: Block. Lot: Fill added above original grade: Gravel length: SKY MANOR SOUTH - 10 SEE DWG. 86 Ft. Ft. Township: flange: Section: Gravel width: Beds Number of lines: Distance between lines: 15 Ft. 3 5 Ft. SEPARATIONDISTANCES Total absorption area: 1290 Number of trenches: — Dist. between trenches: — To Septic Absorption Lift Holding Public(Privete From Tank Field Station Tank sewer Lines So. FIL Ft. Well 100'+PVT. 200'+ COMM. too'+PVTJ 200'+ COMM. - - 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holdin ❑ Other p 9 Manufacturer: Capacity Surface Water 100'+ 100'+ - - INFILTRATOR 1530/1060 Gal. Lot Line 5'+ 10'+ - - N/A Material: Number of compartments: HDPE PLASTIC 1 / **2 LIFT STATION Foundation *10'+ 10'+ - - Curtain Drain NONE KNOWN Manufacturer: ca Y: Gal. Remarks: *8 FEET FROM CLOSEST DECK PILE To EDGE OF TANK "Pump on' level at "Pump ofr•level at High water alarm at **OBTAINED VERBALAPPROVAL FROM DEB WOCKEN FUSS AT TH E Electrical Inspections performed by. MOA ONSITE DEPARTMENT TO USE 2 -COMPARTMENT SEPTIC TANK. 7771 PIPE MATERIAL House to tank D3034 Tank to D3034 drainffeld Installer GREEN GENERAL CONTRACTING Drainfield D3034 co/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 107.27 Ft. Inspection Location and Description: Dates: 1st 9/11/2019 2nd 9/12/2019 3rd 9/14/2019 4th 11/27/2019 BOTTOM OF SIDING NEAR FCO ENGINEER'S SEAL Community Development Department Approval OF'��'��� Conditional approval: Date: way �?•`�' _ADDITIONAL GRADING ALALIAS -BUILT SURVEY_T_O_BE_PERFORM EDJN THE SPRING OF 2020._ — �....x..... ,.. ................ 0 O .� . ... .......... ......:.. �'• fey ar, SS tv. �.G AV <v CE -79 3 :• Approved: Date: 2 ^ �� LICENs �pR�FESS����• t #AECC884 JUL Incnonfinn Rnnn./ 1.1.1�.1nr PERMIT NUMBER: OSP191332 B LOT 11; SKY MANOR SOUTH S/D INSTALLED DOUBLE CLEANOUTS (DBL3 & DBL4) NEW 1060 GALLON INFILTRATOR 2 -COMPARTMENT SEPTIC TANK - PROPOSED 6 BEDROOM DUPLEX 4 ---- ---_ =: ---------- .4 •'+ • • �15' UTIL. ESMT. RECORD DRAWINGPARCEL ID 051-193-50 NUMBER. INOTE: THE CONTRACTOR WHO INSTALLED THE 1 WATER SERVICE LINE IS THE SAME CONTRACTOR WHO INSTALLED SEPTIC SYSTEM. THE CONTRACTOR \ STAKED WATER LINE LOCATION AND GEG CONSULTANT, JODY MAUS, MEASURED 12'+ FROM i EDGE OF DRAINFIELD TO STAKED LOCATION. NEW WATER SERVICE LINE - LOCATION PER \ JOS CONTRACTOR RESERVE SITE \ i _ NEW DRAINFIELDLOT 9; SKY M NOR SOUTH S/D C#10 C& ' Cos CC4 -- _ �03 r -------- -__ --- CC2 I I COL ------------ J INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2) f--'---- ---------- ---_ sr3 NEW 1530 GALLON I ST1 MH1 INFILTRATOR 1 L 1 -COMPARTMENT /DECK SEE NOTE ON SEPTIC TANK NEW EXISTING 6 BED OOMI I I 6 DUPLEX BEDROOM DUPLEX •+:'•J• • 'ley-,• / z LL ------24-- •-4 •-:;- ~, -----mac ENGINEERING: SALES , CONSULTING = 3701 E TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 - PHONE (907) 337-6179 • FAX (907) 338-3246 - WEBSITE www.gamessengineei PREPARED FOR: PHONE NUMBER. PAGE NUMBER: C & T CONSTRUCTION 240-2020 2 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. TYPE OF WORK: DATE: �- RECORD DRAWING OF NEW SEPTIC SYSTEM 12/27/2019 to A B � �+� •'J: MTI 80.1 42.6 FOO 47.2 33.4 C01 81.4 42.4 MH1 52.5 41.4 CO2 84.9 46.8 ST1 45.0 48.8 ' 4 • CO3 88.5 51.3 DBL1 42.6 51.4 MT2 86.9 52.5 DBI -2 41.5 52.7 MT3 56.0 102.8 ST2 39.6 55.0 C04 57.3 105.2 ST3 1 36.0 59.5 1 C05 1 61.9 1107.2 DBI -3 1 37.8 60.8 1 C06 1 66.7 1109.3 DBL4 1 39.0 61.6 1 1 MT4 1 66.6 1107.7 LOT 11; SKY MANOR SOUTH S/D INSTALLED DOUBLE CLEANOUTS (DBL3 & DBL4) NEW 1060 GALLON INFILTRATOR 2 -COMPARTMENT SEPTIC TANK - PROPOSED 6 BEDROOM DUPLEX 4 ---- ---_ =: ---------- .4 •'+ • • �15' UTIL. ESMT. RECORD DRAWINGPARCEL ID 051-193-50 NUMBER. INOTE: THE CONTRACTOR WHO INSTALLED THE 1 WATER SERVICE LINE IS THE SAME CONTRACTOR WHO INSTALLED SEPTIC SYSTEM. THE CONTRACTOR \ STAKED WATER LINE LOCATION AND GEG CONSULTANT, JODY MAUS, MEASURED 12'+ FROM i EDGE OF DRAINFIELD TO STAKED LOCATION. NEW WATER SERVICE LINE - LOCATION PER \ JOS CONTRACTOR RESERVE SITE \ i _ NEW DRAINFIELDLOT 9; SKY M NOR SOUTH S/D C#10 C& ' Cos CC4 -- _ �03 r -------- -__ --- CC2 I I COL ------------ J INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2) f--'---- ---------- ---_ sr3 NEW 1530 GALLON I ST1 MH1 INFILTRATOR 1 L 1 -COMPARTMENT /DECK SEE NOTE ON SEPTIC TANK NEW EXISTING 6 BED OOMI I I 6 DUPLEX BEDROOM DUPLEX •+:'•J• • 'ley-,• / z LL ------24-- •-4 •-:;- ~, -----mac ENGINEERING: SALES , CONSULTING = 3701 E TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 - PHONE (907) 337-6179 • FAX (907) 338-3246 - WEBSITE www.gamessengineei PREPARED FOR: PHONE NUMBER. PAGE NUMBER: C & T CONSTRUCTION 240-2020 2 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. TYPE OF WORK: DATE: �- RECORD DRAWING OF NEW SEPTIC SYSTEM 12/27/2019 to \ � �+� •'J: N . • '. o a •"�A'•r LU SCALE: ;:. 00 1"=40' ' 4 • pp �,, .... .. .. ........... ................0 ♦ rn rey . arness c 8 r �1 E-7 53 _ .: 2 q �2� ••`���4W •`' ♦���j pROFESS��P+�� LICENSE ,tt\rr����� #AECC884 / PERMIT NUMBER: RECORD DRAWING PARCEL ID NUMBER: OSP 19133 - 051-193-50 FINAL GRADE= 103.5-103.7 NOTE: ADDITIONAL FINAL GRADING TO BE COMPLETE'. ST3 IN THE SPRING OF2020. TOP OFTANK@ INLET = 101.16 F 2" OF INSULATION TOP OF TANK@ PER CONTRACTOR) OUTLET = 101.16 INLET OUTLET INVERT OF PIPE@ INLET = 100.56 1060 2 -COMPARTMENT INVERT OF PIPE @ INFILTRATOR SEPTIC TANK OUTLET=100.35 N it OF � T TT !V !V T � T 11• T� TT T �� !V �� /� t T71 � � � : • n � ENGINEERING SALES t, CONSULTING 3701 E TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337.6179' FAX (907) 338-3246 • WEBSITE www.gemessengineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C & T CONSTRUCTION 240-2020 3 OF 4 PROJECT&EGAL DESCRIPTION: DRAWN BY: SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF NEW SEPTIC SYSTEM 12/27/2019 � T 55 .... ...J . ..,•................. 0 e G messAV C- •• �� LICENSE j PERMIT NUMBER: PARCEL ID NUMBER: OSP191332 RECORD DRAWING 051-193-50 ORIGINAL GRADE @ LOWEST POINT =97.75 (APPROXIMATE) FILTER INVERT OF DISTRIBUTION LINES = 94.83 TOP OF SAND _ FILTER = 94.33 BOTTOM OF EXCAVATION = £ FINAL (3RAUE = 98.2-100.1. NOTE' ADDITIONAL COVER AND FINAL GRADING TO BE DONE IN THE SPRING OF 2020 MT2 CO3 CO2 C01 MT1 TH#10 MT4 C06 C005 C04 MT3 /�ORIGINALGRADE@ f9 f 1 I � I9MT",,'--HIGHEST POINT= 99.75 7.5' DEEP MAX AT ANY POINT —15 FEET WIDE RELATIVE ELEVATION OF BOTTOM OF TH#10= 83.75 (NO WATER) -- ENGINEERING SALES CONSULTING - 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 'PHONE (907)337-6179- FAX(907) 338-3246' WEBSITE: www.gemessengineeing.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C & T CONSTRUCTION 240-2020 4 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. TYPE OF WORK: DATE: �l RECORD DRAWING OF NEW SEPTIC SYSTEM 12/27/2019 ® ................. .. ........... .............. ♦ �,:• �J A. Gar, esstij- �1 S CE -79P3 a LICENSE ®0Bits IL;W%ll�® A® #AECC884 i 0.5' OF EFFECTIVE 2.08 FEET OF MOA "'�`` � �;., �"• ti :'ROVEDSANDFILTERY?. 2. 8' :per —15 FEET WIDE RELATIVE ELEVATION OF BOTTOM OF TH#10= 83.75 (NO WATER) -- ENGINEERING SALES CONSULTING - 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 'PHONE (907)337-6179- FAX(907) 338-3246' WEBSITE: www.gemessengineeing.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C & T CONSTRUCTION 240-2020 4 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. TYPE OF WORK: DATE: �l RECORD DRAWING OF NEW SEPTIC SYSTEM 12/27/2019 ® ................. .. ........... .............. ♦ �,:• �J A. Gar, esstij- �1 S CE -79P3 a LICENSE ®0Bits IL;W%ll�® A® #AECC884 i Pierce Blewett From: Pierce Blewett Sent: Wednesday, January 29, 2020 11:34 AM To: Jeff Garness; Jody Maus Subject: Fwd: Reminder from ADEC, Division of Water for NOI AKR1 OFM99 for Sky Manor South Sub Lots 8-12 — Project Over 60 Days Past Estimated End Date — Action Required 2�11IZ� J2 Sent from my iPhone V 617 Begin forwarded message: 4-A� From: "DEC.Water.WimTeam@Alaska.gov" <DEC.Water.WimTeam@Alaska.gov>� Date: January 29, 2020 at 11:26:32 AM AKST IA1 To: Pierce Blewett <Pierce@garnessengineering.com> `may Subject: Reminder from ADEC, Division of Water for NOI AKR10FM99 for Sky Manor South Sub Lots 8- 12 — Project Over 60 Days Past Estimated End Date — Action Required To C&T Construction, Attn: John Thomson or Whom it May Concern, The Estimated Project End Date (12/31/2017) for Sky Manor South Sub Lots 8-12 has passed. You were initially notified when your project end date was in the past by 1 day. If you are receiving this email, your project end date is more than 60 days in the past. If the project is ongoing and not completed, you will need to submit a Notice of Intent (N01) Modification to remain in compliance with the permit. If the project no longer requires coverage under the Construction General Permit (CGP, AKR100000), you will need to submit a Notice of Termination (NOT). This reminder is being sent to all known points of contact based on current data from the N01 and is intended to reach the appropriate responsible party for further action. Project Information: Authorization #: AKR10FM99 Project Name: Sky Manor South Sub Lots 8-12 Estimated Start Date: 01/20/2017 Estimated End Date: 12/31/2017 Area Disturbed (acres): 2.9 A copy of the current NOI can be accessed at: http://dec.alaska.gov/Applications/Water/WaterPermitSearch/Detail.aspx?id=16006&v=1 Required Action: • Submission of an NOT (Part 10 of the CGP) if the construction project is finished and final stabilization has been achieved on all portions of the site where ground disturbing construction activity occurred and -all -tern- ora b est_ rna nagemeAt-practices_(.BMP--s)_have_b=een-ream-oved,_or-if-a-new operator has assumed control over all areas of the site that have not been finally stabilized. Note, the new operator will need to file a separate N01. • Submission of a N01 modification (Part 2.7 of the CGP) if ground disturbing activities are continuing and/or the project is still awaiting to achieve final stabilization. N) How to Submit Forms: DEC highly encourages submission of the NO1 or NOT using the Water Online Application System (OPA) web page at http://dec.alaska.gov/water/wastewater/stormwater/apdesenoi and will result in faster processing than submitting via postal mail. For assistance in filing the eNO1 or eNOT, please contact Shonda Oderkirk at 907-451-2881 or via email at Shonda.Oderkirk@alaska.gov. For Additional information in regards to the CGP can be found at http://dec.alaska.gov/water/wastewater/stormwater/construction . If you have any questions regarding the above, please contact Angela Hunt at 907-269-7599 or via email Angela.Hunt@alaska.gov or myself at 907-334-2288 or via email James.Rypkema@alaska.gov. James Rypkema Program Manager, Storm Water and Wetlands C7/) July 14, 2016 THE S"1:�TE r t t :iOVERNoR BILL W, kLK_R Department of Environmental Conservation DIVISION OF ENVIRONMENTAL HEALTH Drinking Water Program 555 Cordova Street Anchorage, Alaska 99501 Main: 907.269.6064 Fax: 907.269.7650 Jeffery Garness P.E. File: Chugiak — Sky Manor Wellhouse Garness Engineering Group, Ltd. PWSID: 218807 3701 E. Tudor Road, Ste. 101 Class: Community Anchorage, AK 99507 Source: Groundwater Re: Sky Manor Wellhouse, Tundra Jewell Ranch Subdivision Distribution System Expansion — Conditional Approval to Construct Dear Mr. Garness: Thank you for the submittal on June 27, 2016 requesting approval to construct modifications of the Sky Manor Subdivision public water system to accommodate an expansion of the subdivision to include duplexes on six additional lots. Modification will include adding a third 1,000 gallon storage tank, replacement of the existing pump end for the Grundfos booster pump system with a CR 10-4 pump end and installation of 6 new service connections to the existing 3 -inch HDPE distribution main. This letter, along with the attached Construction and Operation Certificate, grants Construction Approval for these modifications, subject to conditions detailed below. System Description The Sky Manor Subdivision water system operates year round with an estimated population of 72 people which will increase to 156 people after expansion of the water system. The system classification is community water system (CWS) and the source classification is ground water. The Public Water System Identification Number (PWSID) for this system is 218807; all correspondences (including laboratory samples) to the Department regarding this water system should reference this number. Water supply design criteria is based on an estimated demand for 156 individuals and a water usage of 75 gallons per person per day for a design average daily total water usage of 11,700 gpd and a instantaneous peak demand of 66 gpm. Thy system includes the following components: • Source Water: A single 273 foot deep 6 -inch drinking water well, along with a well -house, is located in the southern part of Lot 7, Sky Manor S/D. The well is fitted with a Grundfos 25S20-11 2HP submersible pump, providing a flow of approximately 25 gpm; • Water storage and system pressure:_ There are currently two 1,000 gallon Norwesco storage tanks. This project will add a third identical tank. System supply and pressure are maintained with a Hydro MPC -E Boosterpaq variable frequency drive controller containing two Grundfos pumps, model CR5-9, and. an_Amtrol. WX-_102_hydropneumatic. pressure -tank. This -project will -replace- - — - - — th—CR5=9-pump headss w thCR10 4 hea s. • Distribution: 7 service connections are currently connected to a 720 foot long 3 -inch HDPE water distribution main. This project expands the system capacity so that 6 additional service lines may Jeffery Garness, P.E. July 15, 2016 be added to this water main. Upon completion of this project, this water system may serve up to 13 residential duplexes. Conditional Construction Approval The submitted engineering plans and supporting information have been reviewed and are approved in accordance with Alaska Drinking Water Regulations (18 AAC 80). The enclosed Construction and Operation Certificates, with the Approval to Construct section completed, constitutes written approval. Deviations from approved plans which affect capacity, flow, pressure, operation, compliance, materials of major system components (particularly any components which do not meet NSF Standard 61), must be approved by DEC prior to their construction or implementation. Issuance of this approval is contingent upon compliance with the below condition: 1. It appears that construction of these modifications my result in an interruption of water service to the existing customers. It is important to plan the timing of construction to minimize impact to these customers and to inform the customers of the upcoming outage. Prior to commencement of this work, the contractor shall communicate with the Drinking Water Program so that we may discuss timing of outages, customer outreach and conditions for resumption of service. We recommend that you prepare pamphlets that you distribute to customers describing the intended work, timing of the work and a recommendation that homeowners flush their taps prior to consuming drinking water upon resumption of service. Contact information is listed at the end of this letter. Interim Approval to Operate Conditions As part of your submittal requesting Interim Approval to Operate, please provide written verification of the following - 1 . ollowing 1. Construction of the water system has been completed under the direction of a professional engineer licensed to practice in the State of Alaska and in accordance with the engineering plans and specifications; 2. Wellhouse plumbing has been flushed, disinfected, and sampled for total coliform in accordance with current AWWA Standards C652 and C653. Provide the location in the system where each sample was take, the time and date of each sample, and the results for each sample. Requirements for Final Approval to Operate Final Approval to Operate should be requested within 180 days of receiving Interim Approval to Operate. As part of your submittal requesting Final Approval to Operate, please provide the following- 1. ollowing1. Record Drawings, stamped and signed by an engineer licensed in the state of Alaska, confirming that the system meets the requirements of 18 AAC 80. "Record Drawings" refers to the original plans prepared for construction and department approval, revised to reflect how the system was constructed or installed. 2. Verification that the water system is being operated by a person appropriately certified for this system in accordance with 18 AAC 74, Water & Wastewater Certification & Training. For further questions please contact Ken Smith with the Operator Certification and Training Program at 465-5136. Appeal Process ---—Any-person=who=disagrees=with-tbs=decision may requegt-by mail, e-mail; or facsimile an informal— --- --- review in accordance with 18 AAC 15.185 or an adjudicatory hearing in accordance with 18 AAC 15.195-15.340. Informal review requests must be delivered to the Division Director within 15 days of receipt of this decision. Adjudicatory hearing requests must be delivered to Commissioner Larry 160715_SkyManor 218807_CA.docx Page 2 of 3 nq/ Jeffery Gayness, P.E. July 15, 2016 Hartig within 30 days of this decision, otherwise, the right to appeal is waived. For more information, visit www.dec.state.ak.us/conunish/ReviewGuidance.htrn. If you have any questions regarding this plan review please do not hesitate to contact me at 269- 6064 or daniel.reichardt@alaska.gov. Sincerely, Daniel Reichardt, PE Engineer I, DEC Enclosures: Public Water System Construction and Operation Certificate cc: John Thomson C&T Construction 11404 Jessie Mae Circle Eagle River, AK 99577 Pierce Blewitt, Garness Engineering, email w/ enclosure John Goerner, Operator, Water at Work Consulting, email w/ enclosure Jessica Cahill, EPS, DEC, email w/ enclosure 160715_SkyManor 218807_CA.docx Page 3 of 3 � Alaska State of Alaska Department of Environmental Conservation 'DEC Drinking Water Program PUBLIC WATER SYSTEM CONSTRUCTION AND OPERATION CERTIFICATE Approvals listed below are for compliance with the requirements of the State of Alaska Drinking Water Regulations 18 AAC 80. Any approvals granted do not imply or grant any otherfederal, state or local authorizations that may be required. Water System Name: Sky Manor Wellhouse Modifications Water Source: Groundwater r- System Wide Approval PWS1D: 218807 Classification: Community 1; Modification Approval Project Description: The Sky Manor S/D water system is an untreated GW system. Modifications to the well -house are being made to expand capacity to 13 service connections. Modifications include replacement of the distribution pump heads and installation of a third 1,000 gallon storage tank A. APPROVAL TO CONSTRUCT Plans submitted in accordance with 18 AAC 80.205 by Jeffery Gamess, PE have been received and are �% W approved as submitted 1— conditionally approved; see attached letter t/ yL ��Q"� Engineer I, DEC July 15, 2016 Daniel A. Reichardt, PE (Title) (Date of Approval) If applicant fails to construct, alter, install, or modify the system within two years of the date of approval to construct, approval is void, and plans must be resubmitted for Department review and approval (as per 18 AAC 80.215 (a)). Approved Change Order Change (contract order number or description): (Reviewing Engineer) (Title) (Date of Approval) B. APPROVAL TO OPERATE This section must be completed and signed by the Department before any water is made available for public use. Interim Approval to Operate: This interim approval to operate expires on It is illegal to operate a public water system beyond the expiration date without Final Approval to Operate from the Department. (Reviewing Engineer) (Title) (Date of Approval) Interim Approval Extension: This interim approval to operate has been extended to (Reviewing Engineer) (Title) Interim Approval Extension: This interim approval to operate has been extended to (Reviewing Engineer) (Title) (Date of Approval) (Date of Approval) incl Approval to Operate Record drawings and other documents submitted to the Department, or an inspection by the Department, has confirmed that the public water system was constructed in substantial conformance to 18 AAC 80. (Reviewing Engineer) (Date of Approval) MUNICIPALITY OF ANCHORAGE' On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191332 Work Type: Septic Renewal Tax Code Number: 05119350000 Site Legal Address: SKY MANOR SOUTH LT 10 G:1159 Site Mailing Address: 22951 SHERMAN ST, COND, Chugiak Owner: C & T CONSTRUCTION INC Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft e�'i�ler�r � r llepa rtill ell t Total Bedrooms: 8/6/2019 8/5/2020 40112 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: //'�('ii�,G 1 Issued By: �.QX/�,7i7.L-tJ Date: Date: 0 f 0 UHjC�G� , v OF Development Services Department ? -7 On -Site Water & Wastewater Section Parcel I.D. 051-193-50 NCHO ON-SITE SEPTIC/WELL PERMIT APPLICATION Pqo. jb 7°r3-7904 ,AUL Fax: 90711"N73-7997 Property owner(s) C & T Construction, Inc Day phone 240-2020 Mailing address 11404 Jessie Mae Circle, Eagle River, AK 99577 Site address NHN Sherman Street, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Sky Manor South; Lot 10 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 1.1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo AD U) Septic Tank ❑ Upgrade ❑ Duplex (D) FX Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: tqJ` �1 Date of Payment: 21, ( Ig Receipt Number: Qa Qq Permit No. 15101q 1332 - Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FonnsTermit Application.doc GARNESS ENGINEERING GROUP, Ltd - ENGINEERING o SALES o CONSULTING = July 30, 2019 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 Attention: Rebecca Carroll Ref: Request for Reissuance On-site Wastewater Disposal System Permit for Sky Manor South Subdivision; Lot 10 Ms. Carroll: On November 14, 2017, a septic permit was issued for the referenced property (permit number OSP171350) by your department. The permit has expired, and the owner would like to get the permit reissued. We have revised the design drawing to show the septic tank 10+ feet from the foundation and to show an access manhole on the first compartment. Other than this noted change, the septic system design that we performed in 2017 is still valid. We request the permit be reissued. We are unawar f any adverse impacts this installation would have on adjacent wells or septic sys s. If yqu a e any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com A`'ry MUNICIPALITY OF ANCHORAGE ,",L„t On-Site Water& Wastewater Program 'S�^ ' PO Box 196650 4700 Elmore Road - Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite ,r Du lw r t ru.An t SNfyua n(•E On-Site Wastewater Disposal System Permit Permit Number: OSP171350 Effective Date: 11/14/2017 Work Type: Septic Initial Expiration Date: 11/14/2018 Tax Code Number: 05119350000 Site Legal Address: SKY MANOR SOUTH LT 10 G:1159 Site Mailing Address: Owner: C & T CONSTRUCTION INC Lot Size in Sq Ft: 40112 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 6 This permit is for the construction of: II Disposal Field I1 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: - ..-- — Date: if 4/ /7 Issued By: f it.t 4 Qk 3L?x& Date: 11111V 1 'j • Municipality ofAnchorageil1 � .., : P.O. Box 196650 s 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV171145 COSA#: Permit#. OSP171350 PID#: 051-193-50 Legal Description: Sky Manor South Lot 10 Engineer: Garness Engineering Group Applicant: C&T Construction Your request for a waiver of the requirement that the entire absorption field be within the 30 foot radius of a percolation test has been approved. Consistent soils have been demonstrated throughout this area. This waiver approval applies to the proposed absorption fields (primary and alternate) only. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 11 I �`�J 2 Approved by: ) I ��Ct.�1TtC Q12, Name of Reviewer **** VARIANCE/WAIVER REVIEW **** ifirfab MUNICIPALITY OF ANCHORAGE Community Development Department ' - Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 051-193-5U Property owner(s) C &T CONSTRUCTION Day phone 240-2020 Mailing address NHN SHERMAN STREET'EAGLE RIVER, AK 99567 Site address NHN SHERMAN STREET EAGLE RIVER. AK 99567 Legal description (Sub'd, Block & Lot ) SKY MANOR SOUTH; LOT 10 Legal description (Township, Section & Range) Lot Size Sq.Ft Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Mall that apply) Initial ® Single Family (SF) ❑ Absorption Field ® 11 (w/wo ADU) Upgrade Septic Tank ® Duplex (D) Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well n Water Storage n THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: PORTION OF DRAINFIELD OUTSIDE 30 FOOT RADIUS OF TEST HOLE Distance 20 FEET 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/Rush Fees: 5109 — Waiver Fees: A/5- - Date 5-Date of Payment ii f K3 ri? Date of Payment Nit3!0- Receipt Number: n 0'-f tri-6(167 Receipt Number: 647646 6 Permit No. 03PI X1356 Waiver No. OsVI i '5 (Rev.01111) i GARNESS ENGINEERING GROUP, Ltd CIVIL& ENVIRONMENTAL ENGINEERS - --- .•••••• November 10, 2017 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 South Subdivision; Lot 10 To whom it may concern: The proposed 6 bedroom duplex is to be served by a community water system (PWSID# 218807) and a private septic system. We are proposing that a new 2000 gallon septic tank and a bed type drainfield be installed. One test hole was excavated on the property and the primary drainfield and reserve drainfield are designed around the 50 foot radius of TH#10. Comments regarding the design are summarized as follows: 1. SOILS AND WAIVER REQUEST FOR PORTION OF PROPOSED DRAINFIELD AND RESERVE SITE TO BE OUTSIDE 30 FOOT RADIUS OF TEST HOLE: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. As can be seen on the attached site plan and design drawings, we are proposing the drainfield be centered around TH#10. It should be noted that a portion of the proposed drainfield is located outside of the 30 foot radius. GEG has performed over 20 test holes in the near vicinity of this proposed drainfield in the Sky Manor SfD and Sky Manor South SID. The soils in these two (2) subdivisions have been very consistent with percolation rates of <1 minute/inch and no groundwater encountered to a depth over 16+ feet deep. It is our opinion that it is pointless to require additional test holes for this proposed drainfield since we have shown that soils are consistent throughout the subdivision. We are requesting that the proposed drainfield be installed within a 50 foot radius of TH#10 and that a waiver be granted. 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: The topography is shown on the attached site plan and design drawing. 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 if any adverse impacts this installation would have on adjacent wells or septic systems. If yo t e any questions. please contact us at 337-6179. Thank you for your assistance. Since el ,r ' 1 Jeffr 4. ; •ess, '.E., M.S. Presi e t 3701 E.Tudor Road. Suite 101 * Anchorage,AK 99507-1259 Ph: (907)337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com f I \ I / 1 . : I r; III I lr \I 1NOTE CONTOURS / I ""-- I � ARE 1 FOOT \\ // 1 ------ I : 1 I I EXISTING 6 BEIDROOM+EXSTING -14#6 �EXISTING� �' -~ 6 BEDROOM H#4 DUPLEX 6 BEDROOM . - g I I N. DUPLEX DUPLEX ♦TH#8 / 0 O X Z p-1 i \ \ J r N EXISTING co W 7 I I - n- F s+ / /'� 6 BEDROOM ,- W m DUPLEX t- is -- THOM+, i j ijiiir------- I `\ <. I #--------------- -A / LOT 7; I 11 SKY MANOR S I j 11 �/ 1 j I ,,SKY MANOR SD SKY MANOR S/D I I LOT 5;SKY MANOR S/D I SKY MLOANOIjT 6 1S/D I ,-.,._—_______!__11 " ~I 1 I y w E r `I 1 -r- -- -+��^ - _ _- - t 1- - yir ''N �` , PROPO I I •' [6T 11; LOT 1 '' /rl/I r ,'\ �i , 1 I, WATER I�•� SKY MANORSOI/THS1D-- SKYMANORSOUT-S/Q;1 ------tOT9; _Z--I �- 'LOTB'-._ �,p r . I. A. 1 ALINE I ' '-., --- ___--- I , SKY MANOR-SOU-TN I I L- SKY MANOR \ �t1 _�T/rrllrf `,1 �' .' RE§ER ------- ESE_R --- �DTlTF131�D/ `it_Irrl1l �yy 1(E ]��, r PROPO_SEQ_- �• r(r � j /' ITE I WATER - �' ��,, I///., r'/ ,s /• .1 "_� - _ LINE / - _IL {rrr�'r' 1c- f !i A ,,.- .-'� - -- *TI /c - _1_ _�,-mom, r R" I i f 1 i" PROPOSED - -- ----- - _` `▪ ':'./ '.� ep r�T%+" '+�-- • hN��" ^aEPTIC ----- }--N -!'*,.lues/ T+ ". -_1 - `\ \ --1 1'�ifi" L -SYST� II P--ROPOSED PROPOSED, f"'4" _� 1 I �, -1 - �613EDROOM----- --- _68EDROOM - /'E)(I$TING-- I _ --- iirr _2� 111# ' -J "�ROPIDEED-' / DUPLEX DUPLEX 6�ED� OOlrt- I~ /_ I'-r r f - --- ---- gg L8 i • /1. - .ii9EDROOM� i` .�, i. zn _ DUPLEX- - �_f _,7.... i--,cl1 ‘,1 "� I /,,'� - 11PLPX"- RLL•,\.,.yam _ ----- t;PA �4 11---'� :_ ice_ -`yy `t"rr/ -`.Il i - St �� - �. , ,' t„ ybs~wii �.� ,` `' as - _ - r ___45.5-- �` ti ., �- 1 _� ,, 4., ,11 I 0 1 I`f -„T- l_i// -- - - + -- ---_- ,.- a __t- 5i--........t:,.%.- '�_ -*.-• --....._;=1-1,,,__,, -- te 'T ”J" e.``----------Z- I"W?` _ ---,14,-*; .-L— --5--=_ --X=;,,,I _ I. M I I ( 1 1 1 1 I it� I - --I - 1 1,`' , 1 1 \ I / / 1 I \ I TUNDRA JE I TUNDRA JEWEL I TUNDRA JEWEL I TUNDRA JEWEL I I I ii \\ I RANCH S/Q(L� 7 1 RANCH SID;LOT 6 I RANCH S/D,LOT 5 I RANCH S/D;LOT 4 I I -1 SCALE --- 1 \ / `_�—��I III I \ I / 1 I 1"=100' I \, I ,/ L I .46��aaa■It v" �1'.-. ° GARNESS ENGINEERING GROUP, Ltd M. : '. ••ems . CIVIL&ENVIRONMENTAL ENGINEERS •• 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AX 99507'PHONE(9071337-6179'FAX 1907)338-3246'NEBSITE.V A►w9M 99$ifl MNnp tom Z't• •V� •• •• • PREPARED FOR PHONE NUMBER PAGE NUMBER: S e -y A. ss : • IN C &T CONSTRUCTION 240-2020 1 OF 3 Flo- C 79 3 •� PROJECT/LEGAL DESCRIPTION: •DRAWN BY: ♦• •�•• 1 I i SKY MANOR SOUTH; LOTS 10 AND 11 J.L.M. 1•f '•• 1^--lfl -- .4, TYPE OF WORK: DATE +•t ;;;' ♦�4 SITE PLAN FOR PROPOSED SEPTIC SYSTEM 11/10/2017 #AECC884 �� DESIGN CRITERIA: NUMBER OF BEDROOMS: 6 (DUPLEX) GALLONS PER DAY (GPD): 900 PERCOLATION RATE/S: <1 MIN/INCH PROPOSED APPLICATION RATE: 0.7 GPD/FT2 MINIMUM DRAINFIELD SQ.FT.: 1286 FT` DRAINFIELD DESIGN: MAXIMUM DEPTH: 10 FEET WIDTH: 15 FEET LENGTH: 86 FEET M.O.A. APPROVED SAND FILTER: 2 FEET EFFECTIVE: 0.5 FEET REDUCTION FACTOR: N/A ' ACTUAL SQ.FT.: 1290 FT' LOT 11 SKY MANOR SOUTH S/D ------==='—'t ==--------- _0TH#11 ______� - _----_------�- - 1 ________J_____—. PROPOSED ' DRAINFIELD__"l ----PROR4SED.2Q9Q GALLON STEEL SEPTIC TANK - WITH MANHOLE ACCESS ON 1 ST COMPARTMENT - GEG, Ltd. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. 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 CONDITIONS OUTLINED. HE CONTRACTOR SHALL THE WEST & EAST LOT LINE FLAGGED BY A 5 REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION PROPOSED WATER SERVICE LINE.— SITE INE SITE i \ LOT 9; SKY MANOR SOUTH S/D TH#9C� ............ CO�INSTALL -- �___,� --, DOUBLE s ` ___ ______- CLEANOL - MH INSTALL -- �OUNDATION ' --- 2!7; T " ------------- ---------- ---480----- -------------------------------- PROPOSED PROPOSED 6 BEDROOM --____ _ -- 6 BEDROOM DUPLEX --------- ----------- ----- DUPLEX r I. v •� •' '•s• :1, . • SEPTIC TANK NOTE: IN LIEU OF °� '•' '; • , .'�;.: ; .� • •' INSTALLING A STEEL SET'PIC TANK, A •: "� -� OPTIONAL INSTALLATION OF A 1530 ' ' :•' '• r SINGLE COMPARTMENT INFILTRATOR ': Y• --" ` ;'. •r 1� TANK FOLLOWED BY A 1060 SINGLE Jl, : \ ' • :'` ',. '• " ' ``_�`•-•: '.;"� COMPARTMENT TANK CAN BE INSTALLED FOR THIS PROJECT. ' • >� •.: ------------------ - -----485------- -- .: --- --------------- .. = "�15' -------------1-- / • • • , ♦'.::�. %: UTIL. ESMT. ' ' + , •'.:; GARNESS ENGINEERING GROUP, Ltd --- ---� ENGINEERING o SALES a CONSULTING L= -- --- -- 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 -PHONE (907) 337-6179 • FAX (907)338-3246 * WEBSITE: www.gamessongineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C & T CONSTRUCTION 240-2020 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. TYPE OF WORK: DATE: REVISED �, DESIGN OF PROPOSED SEPTIC SYSTEM 7/31/2019 �m��rzr EXISTING 6 BEDROOM �4 w SC <..: ,,,..... �i .... 4 3H .....:. .............. ........:..... ...... . ... . .............. ........y...■ ♦ ff . Garn s w mr CE -795 ?i .p�....'7 I.3 i, 1�°�� 4 �lw 4 PROFESS\SPi* LICENSE . �� #AECC884 / c ROM SEPTIC TANK —.12' 2' C CI o O I 2.5 j •'SOLID PIPE i $ 5. 1 4'PERFORATED PIPE 1 1 1 0 o• i 15 e I I ,_...Li. Lt . -------- --------__---___------_---_ 2.5 • 82 FEET 86 FEET LONG FINAL GRADE INV MT CO CO CO MT 6 8 E 8 ORIGINAL GRADE 7_ FILTER FABRIC 10'DEEP MAX. AT ANY POINT . . . - . . . . . . . . ••. . . . . ._:_ .._.''' '''''''-' ''''-'''''-•''''-'�''' 0.5'OFEFFECTIVE 6. INVERT OF DISTRIBUTION V.:i N,:6."'%?x',.•14 t- ` N 'fir.r:r •-"G� mss? *.S.-`.1:1' .l Ye- �' ir" LINES (TYR) .tt .4,.....4,.::-:....:•:,,4,;;;,2 FEET OF MOA APPROVED_ y.�ti'' fir`'' <' FnY-�;:;:li-5 4':›44 SAND FILTER 4';.,.!+: t) -,.`. -.4..i die'-c.';t.�',•r'f 3�='•air.;���:i s:a"'a�i d�'}'r-:.j. . TOP OF SAND 's'r:.��a�ti�4�i�i.�s'{'i'r:'i-asa. cH±c r�?�i1 :tiC•;i•i ts�yZ;••�. . �. --15 FEET WIDE BOTTOM OF BED TEST HOLE DEPTH IS 16 FEET (NO WATER) 41. iou oF ic/iy IPA (FARNESS ENGINEERING GROUP, Ltd 4• " `.1:. •O. • -- CIVIL&ENVIRONMENTAL ENGINEERS i 3,CI E 70 DOR ROAD SJI-E,0' ANCHORAGE.AK 99607'PHONE (907: 3376179'FAIN ;907) 33&3246-WEBS1 It*wee garneeamsweernp corn • . II A PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C & T CONSTRUCTION 240-2020 3 OF 3 0 e • ss e�4/�i i LEGAL DESCRIPTION: DRAWN BY: ••.t!', C 7' 3 ••\� SKY MANOR SOUTH SUBDIVISION; LOT 10 J.L.M. . ...•...0 I d f.�'•�� .� TYPE OF WORK: DATE: LICENSE ESS\.. DETAIL DRAWING OF PROPOSED DRAINFIELD 11/6/2017 #AECC884 } i +,0,,,aaaall4 ��*+- � °F..... , 444♦1 tL .+.. A i CD rl V •♦1 GARNESS ENGINEERING GROUP, Ltd +; 4.,. ..4'`..'• '� - CIVIL&ENVIRONMENTAL ENGINEERS• . 0 1101E TUDOR ROAD.SUITE 101'ANCHORAGE.Art 99501''HONE (90T. 3]7-6179-FAX(9071 336-3246'WEBSITE9an wlp"waxx5(.0r, .... . •• . •�� r SOIL LOG - PERCOLATION TEST •♦m 1. : rey .. -- --ss `�: ♦ f s QE-7753 _ LEGAL DESCRIPTION: TUNDRA JEWEL RANCH;LOT 1 =PROPOSED SKY MANOR PHASE II,LOT 10 �♦ ' 1 'f i PERFORMED FOR: C8 T CONSTRUCTioN DATE: 712612015 ♦1/d..pa:,�,�,�_"" ''' P� •� DEPTH '--_- +,�`aaa1•011s- (feet) _^ ORGANICS TEST HOLE #10 1 l' LOAM (SM) SOIL CLASSIFICATIONS SITE PLAN 2 = :`� GW ORG ~ 3 —"fk.". GSM GP II~ ML tiIU!IIGM V . CL �. . : , 'cm: GC V . ' OL P -�q1` °o o559DD. SW I` MH 'CZS 5 --,;;..'-;-;.-z- .,♦- �z- '^4'IfSi� Sa CH ���Ci 4 `1+x,'•..! NKR SM ,, ///, OH 7 — -t-.- t DEPTH TO DATE le-I ' GROUNDWATER ��(iP N -.,:::.t.;`;;. .,: r. r 8 -- I; }, DRY 7/28/2015 iiies t` DRY 8/5/2015 SCALE. 9 —.. i iii GP POCKETSGE DRY 10/14/2015 1" 100' .t`,':+= LENSES OF SP 10 ; r44:ri. ti.I*t±i� CLOCK NET TIME WATER LEVEL NET DROP i.,.. :',.-.-...:: DATE READING ~ (MINUTES) READING (INCHES) 11 ,;�;y �� TIME • 'r % ;. 7/28/2015 1 - 6" - 12 � 2 - <1 0" 6" 13 -74� -`-: 4- c1 0" 6^ 14 —.414-114:44 5 _ - - 6" _-. '0 , a! 6 <1 0" 611 • 15N64 7< 1 0" 6" 16 $.b.lt 9 - - 6.. 17 — 10 - <1 0" 6" 11 - - 6" - 18 — - 12 - <1 0" 6" PERCOLATION RATE <1 (MIN-/INCH) PERC. HOLE DIA. 6 (INCHES) 19 — TEST RUN BETWEEN 6.0 FT. AND 7.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES U NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I,JEFFREY A.GARNESS,CERTIFY THAT THIS WAS PEFF�RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: {I ((10 /a / J MUNICIPALITY OF ANCHORAGE o Development Services Department_ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-193-50 Certificate of On -Site Systems Approval Expiration Date: 9-28-2023 Legal description Sky Manor South lot 10 Site address 22951 Sherman Street # 21 Chuqiak Alaska Current property owner(s) Karen Klzis X The On-site system(s) is/are approved for 6 bedrooms Conditional approval for Comments or advisories: L 0, ee�,-&J Ir bedrooms, with the following stipulations: r +^--J(- pow Pte► er1, BY Original Certificate Dater This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MUMUFA UTY OF LHC COR OC ods., Development Services Department `�' p p 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. 051-193-50 Complete legal description Sky Manor South Lot 10 Location (site address) 22951 Sherman Street #21, Chugiak AK Current property owner(s) Karen Kizis Day phone 2. ON-SITE SYSTEMS SIZED FOR 6 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 V Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 3 - 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 $ nSs� Waiver Fee $ Date of Payment `7 i 3�) �� Date of Payment COSA # OS Waiver # C 1 3210 COSA Application June 2022 COSA Checklist Legal Description: Skv Manor South Lot 10 Parcel ID: 051-193-50 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ELL DATA ❑ Well log d with Onsite (or attached) Date drilled al 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 B. TANK DATA Measured operating fluid level in septic tank 3 Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/11/19 - 11/27/19 ✓❑ ALL standpipes present per record drawing Total measured depth from grade 4.8 ft (max) Measured depth to pipe invert from grade 4.3 ft (min) ❑ N/A —pressurized field. ❑ Per record drawings, field is insulated. ✓❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test opm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative trate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L E] Arsenic less than MRL (ND) Collected by Date STATION ❑ Require 1?t ' tenance completed Age of lift station rs Lift station material Comments: Adequacy test date 9/28/22 Results ✓❑ Pass Fluid depth prior to test 0 in Water added 900 gal New fluid depth 0 in Elapsed time 1 min Final fluid depth 0 in Absorption rate 900+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES rivate Well on Lot to: (Please enter distances if less than required or if community well on lot) 7tic © Yes if No ft Tank/Li non Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft Water Service Line > 10' El Yes if No Neighboring Tank > 100' ❑ Yes if ft Private Sewer/Septic Line > 25' [:]Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Animal Contain�Excreta ❑ Yes if No ❑ Yes if No ft Manure/Animal Storage > 1 Community Sewer Main > 75' F-1 Yes if No ft ❑ Yes if No 0 N/A — Served by Community Well (not on lot) or Public Water ft ft ft ft From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' © Yes if No ft Field to Property Line > 10' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Water Service Line > 10' ❑ Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' FZI Yes if No ft © Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date C-1 /2-7— Engineer's -y Engineer`s Comments: This investigation was completed in compliance with ADEC and MOA regulations. A/ The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The `e `e' OF •� C- H.. now and absorption rates may change due to subsurface conditions that may not be observed from the .0�`'"� surface, changes inland use, local soil characteristics, groundwater levels that may IInctuate during the year and the water usage of the family being served by the system. The operational life of all well andseptic a i� ¢9 systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will 10 function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist rKEYNE TH M� 711 Vj, ♦�e,��QL��ti`m COSA Checklist June 2022 A+� e�yesoyev�4 From: Melissa Harmel info@melissaharmel.com Subject: HOA Septic information from PMSI Date: October 4, 2022 at 6:28 AM To: Angela Johnson yappcoordinator@gmail.com, Dea Duffus dea@arcterra.net, Dea Duffus arcterra@gmaii.com, Brita Horn brita.horn@gmail.com Good morning I went to PMSI yesterdday to see what they know about the septic systems and what information they have as to when they are pumped - The HOA voted to make sure that they are pumped every three years. 22951 Sherman was pumped in September 2021 (see the Arm Services, LLC invoice) The HOA takes money from the dues and puts it aside so they can hire a septic company to pump the septic tanks every three years. It is the sole responsibility of the owner to have a COSA done per the MOA when they sell their property. At this point, I think the best next step is to contact ARM Services and discuss pumping the septic for Lot 10. They will have to call PMSI for the code to the gate - according to PMSI - Brita did her own investigation yesterday and Dave Paul, one of the owners at South Manor might also be able to help - 907.229.7308 avatar Melissa Harmel Realtor eXp Realty, LLC Website: www.melissaharmel.com Email: info @ melissaharmel.com Phone: 907.227.2817 Thinking about a career in Real Estate? ARM Sepllc Sewvlcet,, LLC 17933 Old Glimn lt�way Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-193-50 1. GENERAL INFORMATION: Complete legal description SKY MANOR SOUTH S/D• LOT 10 Expiration Date: N10y at 7, o2 0� 1 Location (site address) 22953 SHERMAN STREET CHUGIAK AK 99567 Current Property owner(s) C & T CONSTRUCTION Day phone 907-240-2020 Mailing address Real Estate Agent 17349 N. JUANITA LOOP EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ® Multiple Dwellings (Single Family and/or Duplex) Day phone 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: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # 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 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 date/s of the 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, 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 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 the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in 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 right whatsoever. e/LIZ( ffc,arness .<.. . #AECC884 6. DSD SIGNATURE System #1 Approved for bedroomstOF t(iQ,���ij� System #2 Approved for bedrooms �'eP\- yO//rte Disapproved ` Z ON-SITE Conditional approval for bedrooms, with the followi�-Iipul~ WEER AND =- WASTEyVATER C) .moi r A P A f._ ���IIJLLT SEEy JNN By: Original Certificate Date: oZ0 a 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 sheer 10-10-12.doc COSA Checklist Legal Description: SKY MANOR SOUTH S/D; LOT 10 If more than 1 septic system on lot: COSA Checklist # 1 of 1 DATA COMMUNITY WELL) ❑ Well log d 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 C Static Ovate at beginning of test ft. Parcel ID: 051-193-50 Structure served by this system 1 Well production at time of test m Water storage tank volu gallons Well disinfect r coliform test? ❑ Yes ❑ No orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Al �c ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample B. TANK DATA . �IFI STATION Age of tank(s) `2 years ❑ Requl aintenance com Tank type/material HDPE Age of lift station ye Measured operating fluid level in septic tank N/A Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments - Date of pumping $/4/21 D. ABSORPTION FIELD DATA BED Which system tested (date installed) 9/11/19-11/27/19 Adequacy test date NEW ❑ ALL standpipes present per record drawing Results Q✓ Pass For 6 bedrooms Total measured depth from grade *6.2 ft (max) Fluid depth prior to test NEW in Measured depth to pipe invert from grade *3.6 ft (min) Water added NEW gal ❑ N/A — pressurized field NEW New depth In ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time NEW min depth into effective ❑ Code -required soil cover over field Final fluid depth NEW in ❑ System presoaked Absorption rate NEW gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: ALL MTS WERE DRY ON 8/4/21 COSA Checklist yellow sheet ?16 E. SEPARATION DISTANCES COMMUNITY WATER SYSTEM FtbiuZrivate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift n Lot > 100' if No ft Community Sewer Manhol nout > 100' QQ Yes if No ft Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if ft P ' ewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No t ng Tank > 100' ❑ Yes if No ft Neighboring Absorption Field 0 Yes if No Animal Contain 50' ❑ Yes if No ft Community Wells > 200' _ ❑ Yes if No ft Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > Co i y Sewer Main > 75' ❑ Yes if No ft ❑ Yes i ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No ft Surface Water > 100' QQ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: 21 Absorption Field > 5' 21 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' My Yes if No ft Water Service Line > 10' R 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' (� Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 21 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *8'+ TO DECK PILES ` WATER SERVICE LINE LOCATION WAS FLAGGED/STAKED BY DAN GREEN WITH GREEN GENERAL CONTRACTOR, THE CONTRACTOR THAT INSTALLED BOTH THE WATER SERVICE LINE AND THE SEPTIC SYSTEM. �a� OG. ENGINEER'S CERTIFICATION F V`UR I certify that l 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. ;.�........ ...... �O effrey ness., 9, r C 7 53 COSA Checklist yellow sheet �1O p &0 � ssio� o #AECC88. Parcel I.D. 051-193-50 tri CV Municipality of Anc o On -Site Water and Wastewater P (907) 343-7904 9 10 77 GE _ BU S AII ET YS Certificate of On -Site Systems Appro 61�, 1. GENERAL INFORMATION: Complete legal description SKY MANOR SOUTH S/D; LOT 10 Expiration Date: Z© 2Z 47 Location (site address) 22951 SHERMAN STREET, CHUGIAK, AK 99567 Current Property owner(s) C & T CONSTRUCTION Day phone 907-240-2020 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 Day phone 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: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ • 00 Waiver Fee $ Date of Payment << 102,0 Date of Payment Receipt Number 03F"6 Receipt Number COSA # NCEQ 04-1 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: Z 2 a 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 date/s of the 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, 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 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 the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in 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 right whatsoever. 6. DSD SIGNATURE -,2( System #1 Approved for J_� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following OF AC�S�4 4 T*I ......... ......... f r A. Gar ess,= CE -7 53 ��c G ��� pia Fe s sionoQo #AECC884 ATY OF �-M ®tv-SITES 4aticiWATE�� AN® I WA�TEU aTE -AM -� By: v Original Certificate Date: 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 Legal Description: SKY MANOR SOUTH S/D; LOT 10 Parcel ID: 051-193-50 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 / COMMUNITY WELL LL DATA ��r+�,a2�c ✓Cry LtJ ❑ Well log d with Onsite (or attached) Well production at time of test Date drilled Water storage tank volu gallons Total depth ft Well disinfect r coliform test? ❑ Yes ❑ No Cased to ft orm bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected A c ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) in. Collected by Date of flow test for C Date of Sample Static wate at beginning of test ft. ents B. TANK DATA IFT STATION Age of tank(S) NEW years ❑ R>aintenanceTank type/material HDPE Age Measured operating fluid level in septic tank NEW Lift sStandpipes/foundation cleanout per record drawing ComDate of pumping NEW D. ABSORPTION FIELD DATA BED Which system tested (date installed) 9/11/19-11/27/19 Adequacy test date NEW ALL standpipes present per record drawing Results [DPass For 6 bedrooms Total measured depth from grade *5.7 ft (max) Fluid depth prior to test NEW in Measured depth to pipe invert from grade *3.4 ft (min) Water added NEW gal ❑ N/A — pressurized field NEW New depth In ❑® Monitor tubes go to bottom of effective. If not, state Elapsed time NEW min depth into effective �Final fluid depth NEW in ❑ Code -required soil cover over field ❑ System presoaked Absorption rate NEW gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) If yes, enter date Gallons introduced gallons — - -Comments/Def ciencieS: 'ADDTIONAL FINAL -GRADING AND COVER TO -BE -ADDED TO TANKS AND DRAINFIELD`IN-THE-SPRING -- OF 2020. f i COSA Checklist yellow sheet E. SEPARATION DISTANCES ✓❑ Yes if No COMMUNITY WATER SYSTEM Surface Water > 100' 1 -?C rivate Well on Lot to: (Please enter distances if less than required or if community well) Property Line > 5' Septic Tank/Lift n Lot > 100' Yes if No Community Sewer Manhol nout > 100' Yes if No ft Yes ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if ft P ' ewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No t ng Tank > 100' ❑ Yes if No ft Neighboring Absorption Field _ Water Service Line > 10' ❑✓ Animal Contain 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > ' Co I y Sewer Main > 75' ❑ Yes if No ft ❑ Yes I 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' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' U Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' 0 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' ❑✓ 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' 0 Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS " WATER SERVICE LINE LOCATION WAS FLAGGED/STAKED BY DAN GREEN WITH GREEN GENERAL CONTRACTOR, THE CONTRACTOR THAT INSTALLED BOTH THE WATER SERVICE LINE AND THE SEPTIC SYSTEM. G. ENGINEER'S CERTIFICATION / certify that / 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 OF �zF 01 ..... ................. •.J f Gar ess.- •'• E-793 •'� �;� f/ Z (\ p 0 ���F'�ofessio� o #AECC884 ASBUI LT SEHARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE.."/ FOLLOWING DESCRIBED PROPERTY: At DATE,�� AND THAT NO ENCROACHMEW- S EXIST EXCEPT AS I , •'-. - —1ND-IC-A I EDIT-i'S-THE`RESPONStIITL`I I Y O f.••.. ... •aeeeoe OWNER TO DETERMINE THE E:tiSTENCE OF ANY GRID f � •� EASEMENTS COVENANTS OR RESTRICTIONSWHICH DO NOT APPEAR ON THE PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ED SUBDI-�i� C '_ Dve LS — j9 3 VISION Sj ANY DATA HEREON BE USED FOR CONSTRUCTION y6 `A: •/. 5, OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DtZAWN•���a.��`