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HomeMy WebLinkAboutOVERLOOK ESTATES #2 LT 3Onsite File ON p 5 u � N" ' € x Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191310 PID Number: 068-041-35 Dwelling: ❑s Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project:❑ New ❑ Upgrade Name: Steve Letcher ABSORPTION FIELD ❑ Deep Trench NI Shallow Trench ❑ Bed ❑ Mound Address 8124 E. Leonora Street Mesa, AZ 85207 ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 602-525-8118 4 1.0 GPD/SF 3.9 / 3.1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.4/2.6 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Overlook Estates #2 3 Fill added above original grade 4.7/3.2 Ft. Gravel length 2 @ 60 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line z 600 Ft 2 >6 Ft. Well >100' >100' N/A N/A >25' TANK ❑e Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator/Ferguson Capacity 1530 Gal. Surface Water >100' >100' N/A N/A Material Number of compartments Lot Line >5' >10' N/A N/A Plastic 2 NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain DrainNone Noted Remarks 2 MOA sand filter below trenches. Pump on level at in. Pump off level at in. High water alarm at in. Tank is insulated. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Northern Excavation Drainfield D3034 CO/MT Inspector J. Millette / J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection 15 7/30/19 7/31/19 Location and description 2�d 3rd 4th Bottom of siding @ point B COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ���"'q( Conditional Approval: Date # e. •�'��� 47 • 49th van...nue..........................e ..... 4 -.MICHAEL E. ANDERSON e w 0C��'•• No. CE -4381 ,''�� 0 0%. 10/2/19 •e.•''•t���� Approved � � Qt;UL Date j j � T o®Fop .... ...... ®� inspection Keport_y-i-izxioc Municipality of Anchorage On -Site Water and Wastewater Program P.O. Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.orcl/onsite Review Comments Engineer: FORGE ENGINEERING Legal Description: EPLANS OVERLOOK ESTATES #2 LT 3 Parcel ID: 06804135000 Permit: OSP191310 WellSeptic Report Type: As Built Review De: p'ai-anent 10/21/2019 Completed By: R.Carroll The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: 1. The as -built survey shows the well less than 25 ft from the house foundation. Please confirm there are no curtain drains within 25 ft of the well. 2. Please submit water sample results. 1) Confirmed with contractor that a footing drain was not needed or installed due to the satisfactory drainage of the in-situ soils. 2) Request to submit water sample with the COSA. OVERLOOK ESTATES #2, LOT 3 PERMIT # OSP 191310 LOT 2 BLOCK 1 PID # 068-041-35 LOT 3 2-60' LONG x 5' WIDE x.5" EFFECTIVE DEPTH ABSORPTION TRENCHES wA2' MOA APPROVED SAND LINER 1,530 GALLON SEPTIC, TANK W/20" mANWAY CO2 MTJ MT2 Lij SV MH TH1 w 2CO C06C05,FCO B Av C04 CO3� MT4 MT3 4-BDRM HOME A. B c 6 FCO .4 MH 13.8 Ad `SV1 42.5 18 2C0 39.1 16.6 FS 40.4 "23.9 -,100'WELL RADIUS C05 49.2 4.2.6 C06 60.8 56.5 MT1 73.4 55.5 C01 73.8 66.74 EXISTING WELL — MT21 85.5 73.5 CO2, 84.6 72'. MT3 37.3 49.6 35.7 CO3 48.9 47.77T75U7 MT4 C04 49 1 59.8 LOT 4 0 50 100 ism m im FEET C17 !T 2 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH -MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE OVERLOOK ESTATES #2, LOT 3 PERMIT# OSP1 91310 PID # 068-041-35 01-- 2 0 85.5 85.0 2" INSULATION EAST TRENCH 1-0 93.6 FINISH GRADE 88.9 ORIGINAL GRADE 75 0 DRAI FIELD ROCK MOA APPROVED FILTER SAND 1 -9 83.0 60' 72.9 + NO GROUNDWATER 7/15/19 0�- 2 0 82.9 82.4 83.0 WEST TRENCH 88.7 FINISH GRADE 85.5 ORIGINAL GRADE DRAINFIELD ROCK MOA APPROVED FILTER SAND 80.4 60' 69.5 NO GROUNDWATER 7/15/19 PROFILE AS -BUILT (NO SCALE) 80.4 85.5 85.0 82.9 82.4 49th ................................... MICHAEL E. ANDERSON No CE -4381 1012/19 Certified Drilling log ® DOC CO dba BILL a. COLE ®N►OUILLIVAN WATER W CIRO. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Letcher Custom Homes ADDRESS: 27283 Vantage Ave Eagle River, AK 99577 Bore Hole Data Depth From To LEGAL DESCRIPTION Overlook Estates #2 Lot 3 DATE: 7-29-19 0 2 Casing Stickup PERMIT NUMBER: OSP191310 DATE OF ISSUE: 7-24-19 TAX IDENTIFICATION NUMBER 06804135000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 400' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 134 feet Liner type Static Water Level: 88 feet Recovery Rate 6 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ❑ open end ®open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ❑yes Ono Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 24 Silty Sand & Gravel w/ Cobbles 24 89 Hardpan & Boulderes 89 129 Silty Sand & Gravel w/ Cobbles 129 259 Bedrock Gray 259 305 Bedrock Green Hard 305 323 Bedrock Gray 323 389 Bedrock Gray w/ Quartz 389 400 Bedrock Gray NATER QUALITY TESTING Coliform Co 1 Nitrates tJp nKVL Arsenic r> /L � k 1°I Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. ROM • i •• ♦ f •Ma www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW OSP191310 Date of Issue 7-24-19 Parcel Identification Number: 06804135000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 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MLLJ W a [L0 x a O in Q QLd �Ld m U ON LLJ W 0 � U) z M z O WO~6R'W <-i C) O I-� (X U 0 M=w �Og90 azEo H O cp x _ HY- z Z � - N W WNQNH WOWC o U m�O oLU ujo�OZ�j- W> =z>g= �Oacn _ �I MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4.700 Elmore Road Anchorage, Alaska 99519-6650 Phone. (907) 343-7904 Fax. (907)343-7997 httpJlwww.tnuni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP191310 Work Type: WellSeptic Initial Tax Code Number: 06804135000 Site Legal Address: OVERLOOK ESTATES #2 LT 3 G:0465 Site Mailing Address: 27283 VANTAGE AVE, Eagle River Owner: ATOR KARLENE M FAMILY TRUST Design Engineer: FORGE ENGINEERING This permit is for the construction of: E'7 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective hate: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �11Cn( llep�t ctmeut 7/24/2019 7/23/2020 103924 RI 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 Date: 1 _ Date: 7/2z//;7 0 MUNICIPALITY OF ANCHORAGE r _J Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 068-041-35 Property owner(s) Steve Letcher Mailing address 8124 E. Leonora Street Mesa, AZ 85207 Site address 27283 Vantage Avenue Eagle River, AK Day phone 602-525-8118 Legal description (Sub'd., Block & Lot) Overlook Estates #2, Lot 3 Legal description (Township, Range & Section) Lot Size 103,924 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑X Initial 0 Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑ (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ..,::. a a"� (Signature of property owner or authorized agent) Permit/Rush Fees: SeR 6 , y 9 Z Waiver Fees: _ Date of Payment: iq jj"T/21/19Date of Payment: Receipt Number: Receipt Number: Permit No.y 5P 1 q 13 to Waiver No. Permit App_.;- : h J PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 19, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Overlook Estates #2, Lot 3 Dear On-Site Services Engineer: The owner of the above lot intends to build a 3-bedroom home on the property, but has requested the septic system be designed to serve 4-bedrooms. We are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home as well as the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes to the west, at an approximate 20% slope. There are no slopes steeper than 25% within 50’ down slope of the proposed absorption trenches. Ground contours are shown on the site plan showing the grade and direction of flow. Storm water drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Test holes on the lot and in the subdivision indicate very coarse gap graded gravel with very few fines. The absorption rate of effluent is much faster than 1 minute per inch. A 2’ sand liner is required and has been designed in to the system. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 16’ away. Please refer to the attached test hole logs, soils lab analysis, plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 7/19/19 7/18/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191310, Rebecca Carroll, 07/24/19 45044545546010050 0 FEET 1"=50' 4-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MT OVERLOOK ESTATES #2, LOT 3 7/23/1920' DRAINAGE EASEMENT2-60' LONG x 5' WIDE x .5' EFFECTIVE DEPTH ABSORPTION TRENCHES w/ 2' MOA APPROVED SAND LINER PROPOSED WELL 1,250 GALLON SEPTIC TANK w/20" MANWAY ALTERNATE SITE COCO CO CO SV 2COSVMH FCO MT T H 2 TH1 NOTE: WELL MUST BE MORE THAN 25' FROM ANY FOOTING DRAIN. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191310, Rebecca Carroll, 07/24/19 OVERLOOK ESTATES #2, LOT 3 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 1.0 GPD/SF 5' WIDE TRENCH SYSTEM 1,250 GALLON SEPTIC TANK TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 3' 6" NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 4.0' BELOW GRADE FLOW LINE ELEVATION: 3.5' BELOW GRADE TOP OF TRENCH: .5' ABOVE GRADE 600 GPD / 1.0 GPD/SF /5' WIDE *1.0 RED. FACTOR = 120 LF TRENCH REQUIRED (120 LF SPECIFIED) 7/23/19 2' MOA APPROVED SAND Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191310, Rebecca Carroll, 07/24/19 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TH #1 - SOUTH SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) OVERLOOK ESTATES #2 LOT 3 7/4/19 J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? NO - NONE <1 6 -- -- 068-041-35 STEVE LETCHER 1 2 3 4 5 6 1' OB GP( 3' MINUS COBBLY GRAVEL) 7/15/19 Professional Engineers Stamp: 7/18/19 *PERC RATE ESTIMATED TO BE MUCH FASTER THAN 1 MPI. LARGE BOULDERS MADE IT NEARLY IMPOSSIBLE TO DIG A PERC HOLE. GRAVEL WAS VERY POORLY GRADED. TESTHOLES ARE IDENTICAL TO THOSE COMPLETED DURING THE SUBDIVISION PHASE. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191310, Rebecca Carroll, 07/24/19 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TH #2 - NORTH SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) OVERLOOK ESTATES #2 LOT 3 7/4/19 J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? NO - NONE <1 6 -- -- 068-041-35 STEVE LETCHER 1 2 3 4 5 6 1' OB GP( 3' MINUS COBBLY GRAVEL) 7/15/19 Professional Engineers Stamp: 7/17/19 *PERC RATE ESTIMATED TO BE MUCH FASTER THAN 1 MPI. LARGE BOULDERS MADE IT NEARLY IMPOSSIBLE TO DIG A PERC HOLE. GRAVEL WAS VERY POORLY GRADED. SEE SUBDIVISION TEST HOLES. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191310, Rebecca Carroll, 07/24/19 b'Mfts MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 068-041-35 1. GENERAL INFORMATION Expiration Date: 5, 2_002 C� Complete legal description Overlook Estates #2, Lot 3 Location (site address) 27283 Vantage Avenue Chugiak, AK Current property owner(s) Karlene Morrie Ator Day phone _ Mailing address Real estate agent 8124 E Lenora Street, Mesa, AZ 85207 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $,-- 75,�,, Waiver Fee $ /I U Date of Payment — —�� n�= Date of Payment Receipt Number Receipt Number COSA # o5c�q Idr5 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 11/7/19 0 00o©oo❑qa � 4o P� �f ............... -gC�sa000 o 4-9th 00 6. DSD SIGNATURE o't1,�""� "("C' �; o o................................................ o System #1 Approved for bedrooms oa �, ;MICHAEL E. ANDERSON No. CE-438i O System #2 Approved for bedrooms °o®�F;••., 11ni19 ,..••'���'Q Disapproved o© po%no©S©��©Q®oma© Conditional approval for bedrooms, with the following stipulations: ., t k M7 (((-t," i By: lV' /�i (��.. �9�9Ut c� �� Original Certificate Date: I ,� 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 yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 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. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No 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 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Overlook Estates #2, Lot 3 068-041-35 6 7/29/19 0 400 134 >24 FORGE ENGINEERING 7/29/19 88 11/1/19 <1 Septic/Plastic New Construction - 7/30/19 N/A 5' Wide Trench 7/30/19 New Construction 8.6/6.3 8.1/5.8 COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If 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 Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S 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. 11/23/19 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ New septic system constructed 7/30/19. ✔ Received Date/Time 11/01/2019 16:19 11/01/2019 15:00Collected Date/Time 1196593001 Matrix SGS Ref.# Client Sample ID OVERLOOK EST L3 Client Name Project Name/# Printed Date/Time 11/22/2019 16:12Forge Engineering Inc. Technical Director Stephen C. Ede OVERLOOK EST L3 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID EWW11/06/19SM21 2540Cmg/LTotal Dissolved Solids 226 10.0 (<500) A Metals by ICP/MS BMZ11/12/19SM21 2340Bmg/LHardness as CaCO3 11/08/191385.00 C Waters Department EWW11/05/19SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)D Microbiology Laboratory A.L11/01/19SM21 9223B100mLE. Coli Negative 1 B A.L11/01/19SM21 9223B100mLTotal Coliform Negative 1 B Private Individual Analysis DMM11/19/19EPA 300.0mg/LChloride 11/19/1933.0 1.00 (<250) A EWW11/08/19SM21 2510Bumhos/cmConductivity3991.00 A DMM11/19/19EPA 300.0mg/LFluoride 11/19/19ND0.200 (<2)A DMM11/19/19EPA 300.0mg/LSulfate 11/19/1922.0 1.00 (<250) A EWW11/08/19SM21 2320Bmg/LAlkalinity12810.0 A BMZ11/12/19EP200.8ug/LAluminum 11/08/19223020.0 C BMZ11/12/19EP200.8ug/LAntimony 11/08/191.19 1.00 (<6) C BMZ11/12/19EP200.8ug/LArsenic 11/08/19ND5.00 (<10)C BMZ11/12/19EP200.8ug/LBarium 11/08/191423.00 (<2000) C BMZ11/12/19EP200.8ug/LCadmium 11/08/19ND0.500 (<5)C BMZ11/12/19EP200.8ug/LCalcium 11/08/1935400500C BMZ11/12/19EP200.8ug/LChromium 11/08/195.04 2.00 (<100) C EWW11/08/19SM21 2320Bmg/LCO3 Alkalinity ND 10.0 A 2 Received Date/Time 11/01/2019 16:19 11/01/2019 15:00Collected Date/Time 1196593001 Matrix SGS Ref.# Client Sample ID OVERLOOK EST L3 Client Name Project Name/# Printed Date/Time 11/22/2019 16:12Forge Engineering Inc. Technical Director Stephen C. Ede OVERLOOK EST L3 Drinking Water Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Private Individual Analysis BMZ11/12/19EP200.8ug/LCopper 11/08/1991.3 1.00 (<1000) C EWW11/08/19SM21 2320Bmg/LHCO3 Alkalinity 128 10.0 A BMZ11/12/19EP200.8ug/LIron 11/08/197400250(<300)*C BMZ11/12/19EP200.8ug/LLead 11/08/194.10 0.200 (<15) C BMZ11/12/19EP200.8ug/LMagnesium 11/08/191200050.0 C BMZ11/12/19EP200.8ug/LManganese 11/08/191021.00 (<50)*C BMZ11/12/19EP200.8ug/LNickel 11/08/197.73 2.00 (<100) C EWW11/08/19SM21 2320Bmg/LOH Alkalinity ND 10.0 A EWW11/08/19SM21 4500-H BpH unitspH8.0 0.100 (6.5-8.5) A BMZ11/12/19EP200.8ug/LPotassium 11/08/191700500C BMZ11/12/19EP200.8ug/LSelenium 11/08/19ND5.00 (<50)C BMZ11/12/19EP200.8ug/LSilver 11/08/19ND1.00 (<100)C BMZ11/12/19EP200.8ug/LSodium 11/08/1929900500C BMZ11/12/19EP200.8ug/LThallium 11/08/19ND1.00 (<2)C BMZ11/12/19EP200.8ug/LZinc 11/08/1973110.0 (<5000) C 3