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Home My WebLink AboutPOTTER HIGHLANDS PH 2 BLK 2 LT 4Onsite File Potter Highlands Ph 2 Block 2 Lot 4 #020-281-64 tmev uo/uzi-io) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221150 PID Number: 020-281-64 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑Q New ❑ Upgrade Name John Hagmeier Homes LLC ABSORPTION FIELD El Deep Trench 9Wide Trench [:1 Bed F1 Mound SiteA Site Address POTTER Valley Rd ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 6.0 GPDISFI 4.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft.2 Gravel depth beneath pipe Ft. Subdivision Block Lot POTTER HIGHLANDS PHASE 2 2 4 Fill added above original grade 1.0 Ft. Gravel length 20 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines NA Distance between lines NA Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 142.8 Ftz 1 NA Ft. Well 1001+ 100'+ 100'+ NA 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 9 Other Manufacturer Orenco Capacity 1500 Gal. Surface Water 1001+ 100'+ 100'+ NA Material Number of compartments Lot Line 5'+ 51+ 5'+ NA NA HDPE 2 Foundation 10'+ 101+ 10'+ NA LIFT STATION Manufacturer Capacity Remarks Orenco 250 Gal. Alarm location House Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to3034 drainfield Red Dog Masonry, Inc. Drainfield 3034 Co/MT3034 Inspector PES BENCH MARK (Assumed elevation) 88.5 ft Inspdection 151 12/1/22 12/2/22 Location and description 3`d 1/17/22 2nd 4d' 1/18/22 Bottom House Trim @ A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date P,�GOF.••• ... .. ....... �•$}even anriope Septic System Approved L Date r ZOz CE 8149 .: 2° °5'0�'•• ERIOFESS�►�' Note: this approval does not include well permit requirements. tmev uo/uzi-io) PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) 1 SCALE: NTS SEPTIC SYSTEM PROFILE PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 020 281 64 POTTER HIGHLANDS PH 2 2 4 JOHN HAGMEIER HOMES LLC 2204 CLEVELAND AVENUE ANCHORAGE, AK 99517 03 23 2023 75 A.Y. MCDONALD 23075K3LB .75 15 MERRILL PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 10/13/2022 01:43 907-345-0202 ALPINE DRILLING PAGE 01/01 Alpine Drilling & Enterprises Well Log Permit Number: ASW221150 Date of Issue: 6-24-2022 Parcel Identification Number: 02028164000 Date Started: 1-15-2023 Date Completed: 1-15-23 Is well located at approved permit location? x Yes ❑ No Legal Description: Potter Highlands Phase 2 Block 2 LoN Property Owner Name & Address: Potter Creek Development, LLC Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling x air rotary ❑ cable tool Casing type: steel stick-up 0 2 Wall Thickness:.250 inches gravelly silt bedrock 2 28 28 106 Diameter: 6 inches Depth: 32 feet Liner Type: gvc Diameter: 44=5 inches Depth: 83 feet Casing stickup above round: 2 feet Static water level (from ground level): afeet B20 78 80 Pumping level: IQ#feet after 2 hours pumping 2 �2 gpm Recovery Rate: 2 Um Method of Testing: air di Well Intake Opening Type: ❑ Open End x Open Hole ❑ Screened Start feet Stopped fleet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 2 brs Depth: Start 0 feet Stopped 7 feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes ❑ No Method of Disinfection: Chlorinetablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 R415 tial- 3�a� ��9�- MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PoBox 1o6mnn 47onElmore Road Anchorage, Alaska ggo/V'0a5u Phone: 904 Fax: (e0r)34a-7gg7 hup://wwnwmuoi.onnk,nuite Permit Number OGP221150 Work Type: WellSeptic Initial Tax Code Number: 02028164000 Site Legal Address: POTTER HIGHLANDS PH28U< 2 L 4 G:3638 Site Mailing Address: 5884POTTER VALLEY RD, Anchorage Design Engineer: PANNONEENGINEERING SERVICES This permit hsfor the construction of: Effective Date Lot Size in Sq Ft: 8/24/2022 O124/2U23 R1 Disposal Field 0Septic Tank ElHolding Tank O.Privy RI Private Well 1_1 Water Storage . . . . All construction shall hsinaccordance with: 1. The attached approved design. 2. All requirements specified inAnchorage Municipal code Chapters 1555 and1585 andth State of Alaska RegulationsWastewater Disposal Regulations (18AAC72) and Drinking Water ` '3. The wastewater code requires i."pucbm/� during the installation. The engineer shall notify theueve|opment Services Department per AMC 15.G5.Provide notification by calling '' (24/7). 4. From October 15toApril 15. asubsurface soil absorption system v`var constructionduring freezing weather shall beeither: o. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Special Provisions: 1) Category III Nitrogen -reducing septic systems are required by Plat 15-10 in this subdivision. 2) Wetlands shown on site plan are per Plat 15-10. See updated US Army Corps of Engineers Jurisdictional Determination dated April 21, 2022 for updated wetlands boundaries on this lot. Received By: Issued By: _ Date: Date: u, I h) yh ' 02Q 19 MUNICIPALITY OF ANCHORAGE 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. 020-281-64 Property owner(s) Hagmeier Home Mailing address 2204 Cleviand Ave, Suite 201, Anchora Site address Day phone qe AK 99517 Legal description (Sub'd., Block & Lot) Potter Highlands Ph2 1321_4 Legal description (Township, Range & Section) Lot Size 143,424 Sq. Ft. - ..Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E] all that apply) Absorption Field MX Initial 0 Single Family (SF) Septic Tank N (w/wo AD U) Upgrade ❑ Holding Tank El Duplex (D) Renewal ❑ Privy El Multiple Dwellings (SF and/or D) Private Well Water Storage E] 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: 4' 2 0 Waiver Fees: Date of Payment: 51) 3 dog 2 Date of Payment: Receipt Number: 06q-3 S 61 Receipt Number: Permit No. () spd� 1 150 Waiver No. Permit App_-*- :- ._..:c: in] 1 0 N Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221150, Rebecca Carroll, 06/24/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221150, Rebecca Carroll, 06/24/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221150, Rebecca Carroll, 06/24/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221150, Rebecca Carroll, 06/24/22 Tank Bouyancy.Check PANNONE ENGINEERING SERVICES. LLC Job Name: POTTER HIGHLANDS PH2 62 L4 Subject: M1500 ADVANTEX Septic Tank Bouyancy Check Job Number: 2022.06.16 Originator: UC Checker: SRP Septic Tank ASSUMPTIONS SITE PARAMETERS 1. No angle of repose on backfill material Weight of Water 62.4 Ib/ft' 2. 100lb/ft' backfill material Weight of Soil 100 lb/ft' Tank Bury Depth �ft TANK DIMENSIONS Diameter of Tank 8.8 ft Radius of Tank 4.38 ft Length of Tank �ft Area of Tank 60.13 ft`' Volume of Tank 529.16 ft3 Weight of Tank �lb Manholes Yes Percentage of Tank in Groundwater 16% BOUYANT FORCES (weight of the displaced water) 5283 Ib UP RESISTING FORCES (weight of soil & tank) Volume of Manholes 17 ft3 Volume of Soil 194 ft (Volume of Soil over Tank minus Volume of Manholes) 19447 Ib DOWN NET FORCE ON TANK 1416a Ib Design OK Regulatory Division POA -2021-00454 DEPARTMENT OF THE ARMY ALASKA DISTRICT, U.S. ARMY CORPS OF ENGINEERS REGULATORY DIVISION P.O. BOX 6898 JBER,AK 99506-0898 April 21, 2022 Ms. Connie Yoshimura Potter Highland, LLC. 561 E. 36th Avenue Suite 200 Anchorage, Alaska 90503 Dear Ms. Yoshimura: This is in response to your October 18, 2122, request for an Approved Jurisdictional Determination fora 7.3 -acre parcel of land described as Potter Highlands Subdivision Block 2 Lots'4 & 5. It has been assigned number POA -2021-00454, Little Rabbit Creek, which should be referred to in all correspondence with us. The project site is located within Section 14, T. 11 N., R. 3 W., Seward Meridian; USGS Quad Map Anchorage A-8; Latitude 61.048270* N., Longitude 149.7706430 W.; Municipality of Anchorage, Potter Highlands Subdivision, Block 2, Lot 4-5; in Anchorage, Alaska Based on our review of the information you furnished and available to us and our September 27, 2021, site visit, we have determined the above property contains waters of the U.S., including wetlands, under the U.S. Army Corps of Engineers (Corps) regulatory jurisdiction. Specifically, there are: 0.036 acres of wetlands and 527 linear feet of stream channel below the ordinary high water mark on the site. These waters of the U.S. are shown on the enclosed drawings prepared by the Corps and dated February 2022, We have also determined that the subject parcel contains wetlands which are not waters of the U.S. under our regulatory jurisdiction. Wetland A and Wetland B on your property do not have a surface hydrologic connection to a traditional navigable water (TNW), and are therefore not considered to be waters of the U.S. Therefore, a Department of the Army (DA) permit is not required for any activities which may occur within Wetland A and Wetland B on your property. A copy of the Approved Jurisdictional Determination form is available under the above file number at the following address: hftps://www.poa.usace.army.mil/Missions/Regulatory/Jurisdictional- Determinations/Jurisdictional-Determination-Archivel. This jurisdictional determination does not establish any precedent with respect to any other jurisdictional determination under Section 404 of the Clean Water Act. _2_ The waters on your parcel were reviewed pursuant to Section 404 of the Clean Water Act which requires that a DA permit be obtained for the placement or discharge of dredged and/or fill material into waters of the U.S., including jurisdictional wetlands, prior to conducting the work (33 U.S.C. 1344). For regulatory purposes, the Corps of Engineers defines wetlands as those areas that are inundated or saturated by surface or groundwater at a frequency and duration sufficient to support, and under normal circumstances do support, a prevalence of vegetation typically adapted for life in saturated soil conditions. This approved jurisdictional determination is valid for five (5) years from the date of this letter, unless new information supporting a revision is provided to us before the expiration date. Enclosed is a Notification of Administrative Appeal Options and Process and Request for Appeal form (see section titled "Approved Jurisdictional Determination"). You can find a copy of the DA permit application online at the following address: www.poa.usace.army.mil/Missions/Regulatory. Please see the sample drawings on our website: wWw.poa-usace.ar.my-mil/Portals/:34/docs/regul6tory/guidetodrawings2012.pdf. Section 404 of the Clean Water Act requires that a DA permit be obtained for the placement or discharge of dredged and/or fill material into waters of the U.S., including jurisdictional wetlands (33 U.S.C. 1344). The Corps defines wetlands as those areas that are inundated or saturated by surface or groundwater at a frequency and duration sufficient to support, and under normal circumstances do support, a prevalence of vegetation typically adapted for life in saturated soil conditions. Nothing in this letter excuses you from compliance with other Federal, State, or local statutes, ordinances, or regulations. Please contact me via email at Eric. J.White@usace.army. m il, by mail at the address above, by phone at (907) 753-5693, or toll free from within Alaska at (800) 478-2712, if you have questions. For more information about the Regulatory Program, please visit our website at www.poa.usace.army.mil/Missions/Regulatory. Sincerely, Eric White Regulatory Specialist Enclosures POA -2021-00454 AJD Figures I of 5 Febuary 2022 Color copy of POA‐2021‐00454 AJD Figure 1 of 5 (from ACOE website) Ln � A PPA 2021-0(f464 AJD i;lgx s 4 of 5 Fohs"y 2022 lam 2125/2022, 5:32:07 PM 1:4,514 Image o 0.03 0.05 0,1 nil WMS Wetlands _ I D - Undesignated 1 Property Information 500 Scale Gdd Streams OpenChannel 0 D.04 0.08 0.15 km MUnFtl)'atlty of AWAO-ge, Slate of AJ -5!u,, ® OpenSbeotfAap, 'Al—sok Esil, HERE, Gennhr, Sofeer ph, METIIUASA. USGS, EPA, NPS, US Census Doreou, USDA, S.rcos: Eed, Aktws DS, USGS. NGA, NASA, MAR, N Robins, n, NCEAS, frig, OS, MCA, MUNCpatAy ei Ancharago, State ofAlaska. G OpenSNo6LM09. ki&roscft. E>ri, HERE. Gam:!n, SeteCrophi, ME7tINASA!AOA GDIC , USGS, EPA. NPS, US COMMS UUmaa, USDA I ap y N to 4� O N 0 2 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 16th Day of Kate and David Slyker of 20 22 , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AdvanTex located at (legal description) Potter Highlands Lot 4 Elk 2 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically 5400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 �0, C)S Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. V- DS Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. 'Perm. The tern of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of tire Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the "third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this .Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of OWNER: � f : % _(signature) Date: G 4t zc2.Z —c��'l/ �sa�:c�Si��(print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing_, instrument was acknowledged before me this day of 20 _Zg, ICY �.- '� �v�e� tA� go 0 NOTARY PUBLICPORASKA :Notary ENGEtOCH PublicMy Commission expires:1i`�`� e of AlaskaMy CoExpires Jan 21, 2023 MUNICIPALITY BY: vL 1(signature) Date: r 2-0 L 3 C��" (1 S t (print name) Title: C 1 v I L- C,,— (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE Development Services Departments -1 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 020-281-64 Certificate of On -Site Systems Approval Expiration Date: Legal description POTTER HIGHLANDS PH 2 BLK 2 LT 4 Site address 5884 POTTER VALLEY RD Anchorage AK Current property owner(s) JOHN HAGMEIER HOMES X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 5/11/2023 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 Approval_June 2022 IM UJMU DAUTY OF Development Services Department On -Site Water & Wastewater Section AHCHORAGE Au5rr Phone: 907-343-7904 Fax. 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-281-64 Complete legal description Potter Highlands Ph2 132 L4 Location (site address) 5884 Potter Valley Rd Current property owner(s) John Hagmeier Homes LLC 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age new - See advisory if steel older than 20 years 6. ABSORPTION FIELD: X 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 $ Waiver Fee $ Date of Payment Z 3 Date of Payment COSA # 625G 2.2, ) J 3:!:� Waiver # - COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: 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 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 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: 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. 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 Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: 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' QYes if No ft FE Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' [E Yes if No ft Absorption Field on Lot > 100' [E Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' n Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ❑Yes if No ft ❑ NIA — 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' 0 Yes if No ft Surface Water > 100' n Yes if No ft Tank to Property Line > 5' no Yes Field to Property Line > 10' 0 Yes Water Main > 10' n Yes Water Service Line > 10' 2 Yes F. ENGINEER'S COMMENTS if No ft Wells on Adjacent Lots: if No ft Private Wells > 100' if No ft if No ft Community Wells > 200' 0 Yes if No ft Q 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 Finn Pannone Engineering Services Phone 907-745-8200 Engineer's Printed Name Steven R Pannone P.E., F. ASCE Date COSA Checklist June 2022 AsBuilt 5/1/2023 Building Detail Feet 0 100 200