HomeMy WebLinkAboutPALATERRA ADDN 2 LT 9Onsite File
Palaterra Addn 2
Lot 9
PID# 017-151-33
Formerly Palaterra Block 2A
nnU ality of Anchorage
_ I)r.�rrlmenr j
P.O. Box 196650 ® 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#: OSV241012 COSA#: Permit#:OSP231084
PID#: 017-151-34
Legal Description: PALATERRA ADDN 2 LT 10
Engineer: Forge engineerinq
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field and septic tank on Lot 9 to the private well on Lot 10 has been approved. The
approved separation distance is 91.0 feet for the field and 88' for the tank.
This waiver approval applies to the existing absorption field and septic tank only. Any future
upgrade to the on-site wastewater disposal system will require all separation distances be met or
another approval from this department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Ar L1 /y /Z Li
Named vier
............................................................................ 1
**** VARIAN C E/WAIVER REVIEW ****
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211401
PID Number: 017-151-22
Dwelling: A Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 9 New ❑ Upgrade
Name
COLONY BUILDERS
ABSORPTION FIELD
9 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
13400 DEPALATIS CIR, ANCHORAGE, AK 99516
❑ Other
Phone
907-345-0371
Number of Bedrooms
5
Soil Rating
Total depth from original grade
0.8 GPD/SF
12.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
8.0 Ft.
Subdivision Block Lot
PALATERRA ADDN. #2 9
Fill added above original grade
2.6
Gravel length
60.0
Township Range Section
Ft.
Ft.
Gravel width
3 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
960 Ftz
1
N/A Ft.
Well
>100'
>100'
N/A
N/A
>25
TANK F21 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer_
GREER
_Capacity
1500 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
PLASTIC
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>1 0'
>10'
N/A
N/A
LIET STATION
Manufac
Capacity
Remarks
Gal.
Alarm location
Elec nstalled by
Installer
PIPE MATERIAL House to tank D3034. Tank to D3034
drainfield
Bronson Brother LLC
Drainfield D3034 CO/MT D3034
Inspector L.Tidwell/ J.Millette
BENCH MARK (Assumed elevation) 100 ft
Inspection151 11/17/21 11/19/21
Location and description
2�d
3rd 11/19/23 41111/19/26
TOP OF FOUNDATION AT SW CORNER OF HOUSE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp
Conditional Approval:
o
Date ���'c ®r-`����:
co
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Septic System
Benjam,� Schiller
¢� �F� •
Approve
CE 12592
Date Z� 2Z ��'srF9• s/2o/2?
��� PROFESSIONPa
Note: this does
approval not include well permit requirements.
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PROFILE AS-BUILT
(NO SCALE)
91.4
85.5
91.8
97.02CO1MH1 SV11500 GAL
SEPTIC TANK
97.6 FINISH GRADE
60'MT1P9 NGENO GROUNDWATER 6/25/21
83.1
91.0 CO1CO276.0
83.0
91.0
95.0 ORIGINAL GRADE MT22CO291.1
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A LENGINEER9/15/22
PERMIT # OSP211401 PID # 017-151-22
PALATERRA ADDN, LOT 9
DRAINFIELD ROCK
Northern Geotechnical Engineering, Inc.
Terra Firma Testing
11301 Olive Lane
Anchorage, AK 99515
(907)344-5934
Soils Log - Percolation Test
(ENGINES nityofA
Nkiwiter and
Project Name/No.: Proposed Lots 1-11, Palaterra Subd. / 5969-21 Date Performed: June 17 2021
Legal Description: Proposed Lot 9, Palaterra Subd. Test Performed For: Colony Builders, Inc.
Slope Site Plan
Depth Borehole ID: P9
P11
(feet) Drilled On: 6/16/21
OL
P10 _.
ss•?ss
3-
4-I�-
r=
�:�Im
mill
9-
10-
12-
-10-12- SM
13-
14- -
15- 16-
17-
18-
19-
20-
21-
22-
23-
24-
25-1
COMMENTS
6-17-18-19-20-
21-
22-
23-
24-
25-
COMMENTS
WAS GROUNDWATER
Date
Gross Time
Start/Stop
(HH:MM)
OBSERVED ATD?
No
Net Drop
(inches)
)
1
6/17/21
08:37 / 09:07
IF YES, AT WHAT DEPTH?
NIA
L
2
O
MEASURED DEPTH TO
None
1 10/16
GROUNDWATER
E
E
DATE OF MEASUREMENT 6125/21
Reading
No.
Date
Gross Time
Start/Stop
(HH:MM)
Net Time
Minutes
( )
Dp
Depth to Water
Start/Stop
(feet BTOC)
Net Drop
(inches)
)
1
6/17/21
08:37 / 09:07
30
12.560 / 12.965
414/16
2
09:11 / 09:21
10
12.560 / 12.695
1 10/16
3
09:23 / 09:33
10
12.560 / 12.690
19/16
4
09:34 / 09:44
10
12.560 / 12.690
19/16
5
09:45 / 09:55
10
12.560 / 12.695
1 10/16
6
09:58 / 10:08
10
12.560 / 12.695
110/16
7
10:10 / 10:20
10
12.560 / 12.690
19/16
FINAL PERCOLATION RATE 6 (minutes/inch) PERC HOLE/CASING DIAMETER 6 in./4 in.
TEST RUN BETWEEN 10.60 FT AND 11.10 FT BGS CASING S/U 1.96
PERFORMED BY: Andrew C. Smith CPG I Keith F. Mobley, P.E. CERTIFY THAT THIS TEST WAS
DGD1=(IDPAE=n 11\1 Ar`(`nDr)AK1( G UI1TW AI I QTATI= AKIII RAI 1K11!'`IDA1 !3I iinr-i INFQ IN GGGFr'T nhl TI-IIQ r14TG nATG- 7/9/91
:.. U i w
�490
Pump Installation
Well Drilling Permit Number: Bate of Issue:
Parcel Identification Number: - -
Legal Description Block . Lot Property Owner Name & Address:
COLONY BUILDERS
FBO THAYNE & SHEVAUN HACKING
PALATERA ADDITION 2 r 9 13400 DEPALATIS CIRCLE
ANCHORAGE, AK 99516
Pump Installation Date: 06 _ 23 _ 2022
Pump Intake Depth Below Top of Well Casing: 280 feet
Pump Manufacturer's Name: "' `_L_
Pump Model: 100C31318S21
Pump Size: 1.0 hp
Pitless Adapter Burial Depth: 12 feet
Pitless Adapter Manufacturer's Name: BAKER
Pitless Adapter Installer• ANCHORAGE WELL & PUMP SERVICE
Well Disinfected Upon Completion?Yes ❑ No
Method of Disinfection: PELLETS
Comments:
Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
Company: ANCHORAGE, AK 99518
Mailing Address: 907-243-0740
City: State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Alpine Drilling & Enterprises
Permit Number: #SW211401 Date of Issue: 9-22-21 Parcel Identification Number: 01715122000
Date Started: 4-10-22 Date Completed: 4-15-22 Is well located at approved permit location?'x Yes ❑ No
Legal Description: Palaterra Block 2A Lot 9
Property Owner Name & Address: Colony Builders
9420 Vanguard Drive
Anchoraae. Alaska 99507
Borehole Data: Depth (ft)
Soil Type, Thickness &Water Strata From To
Method of Drilling x air rotary ❑cable tool
Casing type: steel
stick-up
0
2
Wall Thickness: .250 inches
Gravelly silt
sandy- salt _
2
13
13
21
Diameter: 6 inches Depth: 293 feet
Liner Type:
Diameter: inches Depth: feet
silt
21
128
Casing stickup above ground: 2 feet
Static water level (from ground level): 219 feet
silty sandy gravel small amt water 128 134
gravelly silt
134
176
Pumping level: 290 feet after
silt
silty gravel small amt water
176
180
180
184
2 hours pumping 6 gpm
-Recovery te: _6 _gpmMethod of Testing: air li
gravelly silt
184
221
Well Intake Opening Type:
silt
221
230
x Open End ❑ Open Hole
gravelly silt
silty water sand& gravel
230
284
284
291
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: hentonite granules Volume: I hg
De the Start 0 feet Sto ed ? feet
gravelly silt
291
293
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? x Yes ❑ No
.WATER. 06Ty TCoU100 L ESTING--
Cofform --
Method of Disinfection: chlorine tablets
Comments:
Wrates 3
mg/L
u9/L
Well Driller: Alpine Drilling & Enterprises
Arswic
PO Box 110496
�! 3 d I Z2
Anchorage AK 99511
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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 Water & Wastewater System Permit
Permit Number: OSP211401
Work Type: WellSeptic Initial
Effective Date:
Expiration Date
Tax Code Number: 01715122000 1
Site Legal Address: PALATERRA BLK 2A G:2939 (Propose -d Lo+ 9)
Site Mailing Address:
en t7
o
llcparmient
9/22/2021
9/22/2022
Owner: COLONY BUILDERS INC - - - - Lot Size in Sq Ft: 648826
Design Engineer: FORGE ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q 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
Veronica Pope
GE 2021.09.22
Received By: 13:27:41 -08'00' Date:
Issued By: Date: •2 2 0�0
MUMUPALITY OF ANCHORAGE
Community Development Department y 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. 017-151-22
Property owner(s) Colony Builders Day phone 907-345-0371
Mailing address 9420 Vanguard Dr, Anchorage, AK 99507
Site address NHN Depalatis Circle 1
Legal description (Sub'd., Block & Lot) PalaterraO 181 k 2 A CProyo.5,J- L,1 91
Legal description (Township, Range & Section)
Lot Size 45,853 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑X
Single Family (SF)
❑X
(w/wo AD U)
Septic Tank
❑X
Upgrade ❑
(D)
❑
Holding Tank
ElRenewal
ElDuplex
Multiple
Multiple Dwellings
❑
Privy
El
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: -#/
Date of Payment: 4 20 a4? l
Receipt Number: C1191 b
Permit No.
Permit App_'-'-:.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
September 20, 2021
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
9/20/21
Subject: Palaterra B2A (Proposed Lot 9) – Depalatis Circle
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 5-bedroom home on the property, so 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 is mildly sloped at less than 10%. There are no slopes greater than
25% within 50 feet downslope of either the primary or alternate site. Contours are shown on the
site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic
system. The new trench will be constructed parallel to the slope as much as possible.
Wells on 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 pages for the septic
design. If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211401, Rebecca Carroll, 09/22/21
NOTE:
NO SLOPES >25% ARE WITHIN 50' OF THE PROPOSED SEPTIC SYSTEM. NO SURFACE WATER WITHIN 100' OF
THE 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
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
1"=40'
5-BDRM HOME
FCO
PALATERRA SUB, B2A (PROPOSED LOT 9)
FEET
0 40 80
September 21, 2021 DEPALATIS CIRCLEP9 NGE 2021
1,500 GALLON
SEPTIC TANK w/
20" MANWAY
PROPOSED WELLS w/
100' RADII
2CO
CO
MT
CO
60' LONG x 3' WIDE x 8'
EFFECTIVE DEPTH
ABSORPTION TRENCH
ALTERNATE SITE
896
900
905
908
904
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211401, Rebecca Carroll, 09/22/21
PALATERRA SUB, B2A (PROPOSED LOT 9)
TYPICAL TRENCH SECTION
(NO SCALE)
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
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
6"
3'-6"
8'
DESIGN FACTORS:SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW
PERK RATE: 6 MIN/IN
APPLICATION RATE: 0.8 GPD/SF
8' DEEP TRENCH SYSTEM
1,500-GAL SEPTIC TANK w/ 20" MANWAY
BOTTOM OF TRENCH: 12' BELOW GRADE
FLOW LINE ELEVATION: 4' BELOW GRADE
TOP OF TRENCH: 6" ABOVE GRADE
750 GPD / 0.8 GPD/SF / 8 DEEP / 2 SIDES = 58.6 LF TRENCH REQUIRED (60 LF SPECIFIED)
September 20, 2021
GEOTEXTILE FABRIC
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211401, Rebecca Carroll, 09/22/21
Proposed Lot , Palaterra Subd.
6 in.
1
/21
June , 2021
6/ /21
/21
Proposed Lots 1-11, Palaterra Subd. / 5969-21
Colony Builders, Inc.
No
N/A
None
1
Andrew C. Smith, CPG Keith F. Mobley, P.E.
2
6 1
7 10
1
10
10
10
10
10
/16
/16
/16
/16
/16
/16
/16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211401, Rebecca Carroll, 09/22/21
Certificate of On -Site Systems Approval
Parcel I.D. 017-151-22
Legal description Palaterra Addn @2 Lot 9
Site address 13400 De Palatis Circle , Anchorage
Current property owner(s) Colony
Expiration Date: 12-21-22
X The On-site system(s) is/are approved for 5 bedrooms
_ Conditional_approval_for_ bedrooms, with--the--following-stipulations:
Comments or advisories:
MI
Itl
Original Certificate Date:_2 —21-22-
This
2-22.
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 ApprovaIjune 2022
Development Services Department i 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. 017-151-22
Complete legal description Palaterra Addn #2, Lot 9
Location (site address)
13400 De Palatis Circle, Anchorage, AK 99516
Current property owner(s) Colony Builders, Inc Day phone (907) 345-0371
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
T-YPE-OF-WA-T-ER SUPPLY: 0 Private Well -O-Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass
Age < 1 yr - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑i
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 $ 75 + (Zd Waiver Fee $
Date of Payment !q 1.22- 0?T?7 C,) Date of Payment
COSA # 0 Z2 / V& S-_ Waiver #
COSA Application_ June 2022
Legal Description:
Palaterra Addn #2, Lot 9
Parcel ID: 017-151-22
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 4/10/22 Total depth 293 ft
Cased to 293 ft
OR Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 4/15/22
Static water level at beginning of test 219 ft.
Comments
B. TANK DATA
_Measured_ operating..fluid.level in_septic.tank
--- --
Date of pumping
❑ Required maintenance completed, if AWWTS
Comments: New Installation
D. ABSORPTION FIELD DATA
Which system tested (date installed) 11/17/21
❑ ALL standpipes present per record drawing
Total measured depth from grade 14.6 ft (max)
Measured depth to pipe invert from grade 6.6 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 N/A gallons N/A date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
Well production at time of test 6 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 1.39 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date 8/30/22 & 9/13/22
C. LIFT STATION
nce completed _
Age of lift station
Lift station material
Comments:
Adequacy test date NEW
Results ❑ Pass
id depth prior to test in
Watadded gal
New flui epth in
Elapsed time min
Final fluid depth in
Absorption rate � gpd
FIELD STATUS — POST ECOVERY
Effective depth (per record wings)
Effective depth used in
Effective depth remaining in
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
Yes if No ft 0 Yes if No ft
Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Q Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft
Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes if No ft Q Yes if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Fm -1 Yes if No ft Surface Water > 100' [j] Yes if No ft
Tank to Property Line > 5' [E Yes if No ft Wells on Adjacent Lots:
Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' Fe -1 Yes if No ft
Water Main > 10' Yes if No ft Community -Wells >_200' ___ .Yes, _if.No ft
Water Service Line > 10' Fm_1 Yes if No ft
F. ENGINEER'S COMMENTS
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 Forge Engineering
Engineer's Printed Name Benjamin Schiller, P. E.
COSA Checklist—June 2022
Prone (907) 522-7773
Date 9/15/22
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