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RECORD DRAWING
THIS RECORD DRAWING REPRESENTS THE AS -BUILT CONDITION OF THE PROPERTY IMPROVEMENTS DESCRIBED ABOVE.
THE DRAWING AND ANY OTHER SUBSEQUENT ATTACHED OR INCLUDED INFORMATION IS BASED ON PERIODIC VISUAL OBSERVATION
BY A REPRESENTATIVE OF PES ALONG WITH NOTES, PHOTOS, AND OTHER INFORMATION PROVIDED BY THE INSTALLER OF THE SYSTEM.
THE INFORMATION PROVIDED IN THE RECORD DRAWING APPEARS REASONABLE AND REPRESENTS THAT THE PROJECT WAS DESIGNED AND CONSTRUCTED IN
GENERAL CONFORMANCE OF 18 AAC 72, THE ADEC ONSITE WASTEWATER SYSTEM INSTALLATION MANUAL, AND AMC 15.65 WHERE APPLICABLE. PES SHALL
NOT BE HELD LIABLE FOR SYSTEM DEFICIENCIES WHICH FALL OUTSIDE THE SCOPE OF THE REQUIRED VISUAL OBSERVATIONS OR SUBSEQUENT
OBSERVATIONS IF REQUESTED BY THE INSTALLER. SEPTIC SYSTEM INSTALLERS ARE TRAINED AND APPROVED BY THE MUNICIPALITY OF ANCHORAGE AND OR
ADEC AS APPLICABLE. INSTALLERS ARE RESPONSIBLE FOR CONSTRUCTING THE SEPTIC SYSTEM AS DESIGNED AND ENSURING THEIR WORK CONFORMS TO
THE CODES AND POLICIES STATED ABOVE.
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PRIMARY(NEW)/RESERVE(P) DRAINFIELD'
(2EA) 50LF x 5.0'W x 4.0'ED x 9.0'TD M4
INSTALLED MONITOR TUBE AND CLEAN OUT
C4
AT EACH END
M3 /ss C2
/
s
C3 / ss M2
LOT VACANT 3.5
NO WELLS/SEPTICS C1 M1
/
' ES --I-C
TH-1
/ O
14DC2
\
SEPTIC AREA (E)
O
DROP T2
/CONNECT
�
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T1
/
' DC1 �M
NEW 1500g SEPTIC TANK M
/
INSTALLED DOUBLE CLEAN OUT BEFORE
INSTALLED DOUBLE CLEAN OUT AND PIVESi B
FLOW SPLITTER AFTER TANK
NEW
2�
A
I
HOUSE
\
106.3
/
I
/
A
B
ORAY
DC 1 37.1
51.30
T1 38.1
53.9
T2 40.8
57.6
DESIGN PARAMETERS
DC2 41.5
58.6
NEW/RESERVE SEPTIC SYSTEMejC NEW WELL
Mo�NTq/N
CONNECTROP43.4
60.7
gpd) \ J
1500RATE:
'
MP50
TANK SIZE: �R VE
o0�
10.8
108.6
5.1
CS-PERC 101 .6
109.6
SOIL RATING: 0.8 GPD/SF\��
AREA ROD: 937.5 SF
M1 102.8
108.2
C2 127.2
98.6
SYS. TYPE: WIDE TRENCH 4.0' ED O�
RF: 0.50 �2
M2 125.9
97.3
MIN LENGTH: 93.75 LF
C3 113.3
121.3
�O
NO WELLS/SEPTIC\
M3 116.1
122.4
USED:
(2EA) 50LFx5.0'Wx4.0'E.Dx9.0'TD WITHIN 200' W
-
C4 135.9
111.9
M4 136.3
113.5
TOTAL AREA: 1,000 SF W�
NOTES:
PANNONE ENG SVC, LLC�
Date
RECORD DRAWING
P.O. BOX 100217 ANCHORAGE, AK 99510
'• -"
5/7/2024
PHONE (907) 272-8218 FAX (907) 272-8211
P ' "y
Sc
.... . .. .......
P.I.D. NO
MOUNTAINSIDE VILLAGE #1, BLOCK 4, LOT 13
�ie,3even
020-172-56
DRAWN BY: DRM
HULTQUIST HOMES
7125 BIG MOUNTAIN DRIVE
annomeCE
814
PERMIT No.
OSP231194
PLAN
ANCHORAGE, AK
j
Sheet
1 OF 2
GARAGE FF: 100
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85.5
(S) FG: 65.9
TH-1
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FG: 65.4
(S) EG: 65.4 OR
—FOR
(N) EG: 64.9
80.8 _,
(S) 60.4
(S) 60.4
1500 GAL GREER (N) 59.9
POLY TANK
(N) 59.9
4.0' SEWER ROCK (50LF)
(S) 56.4_
(S) 56.4
(N) 55.9
_
(N) 55.9
IL -
50.4 (DRY)
NOTES:
PANNONE ENG SVC, LLC1
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
�
P'•-"
'� "y
. �*
.... .. .......
Date
RECORD DRAWING
Scale
NTS
P.I.D. NO
MOUNTAINSIDE VILLAGE #1, BLOCK 4, LOT 13
020-172-56
HULTQUIST HOMES
7125 BIG MOUNTAIN DRIVE
e,3a aneCE
814
PERMIT No.
OSP231194
Sheet
DESIGN DETAILS
ANCHORAGE, AK
�' 'j
2 OF 2
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Well Log
Permit Number: #__________ Date of Issue: ________ Parcel Identification Number: __________________
Date Started: _________ Date Completed: _________ Is well located at approved permit location? Yes No
Legal Description:_________________________________________________________________________
Property Owner Name & Address: _______________________________________
_______________________________________
_______________________________________
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Method of Drilling air rotary cable tool
Casing type: _________
Wall Thickness: inches
Diameter: inches Depth: feet
Liner Type: _________
Diameter: inches Depth: feet
Casing stickup above ground: feet
Static water level (from ground level): feet
Pumping level: feet after
hours pumping gpm
Recovery Rate: gpm
Method of Testing: _________
Well Intake Opening Type:
Open End Open Hole
Screened Start feet Stopped feet
Perforations Start feet Stopped feet
Grout Type: _________ Volume: _________
Depth: _________ Start feet Stopped feet
Well Disinfected Upon Completion? Yes No
Method of Disinfection: Comments:
Well Driller: _____________________________
Company: _____________________________
Mailing Address: _____________________________
Water Sample Results:
Arsenic: _________ ug/L
Nitrates: _________ mg/L
Total Coliform Bacteria:_________ colonies/100mL
Attention: The well driller shall provide a well log to the
On-site Water and Wastewater Section within 30 days of
completion.
231194 7-6-23
9-26-23 9-27-23
Mountainside Village #1 blk 4 lot 13 G: 3439
Hultquist Homes, Inc.
steel
.250
6 46
none
2
76
6
airlift
x
46 345
bentonite 2 bags
30 0 30
tabs
x
Johnny Kay
Hefty Drilling, Inc.
po box 112130 Anch AK 9951
casing stick up 0 2
overburden 2 6
silt & gravel 6 10
bedrock (hard)10 345
LAT: 61.3’36.4
LON: -149.44’54.5
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: ,)3 I i `/ Date of Issue• 7 G - S
Parcel Identification Number: - -
Legal Description Block Lot Property Owner Na e & JAddress:
ti 11 , .1 5 2e 14 1 C��I Vj 1 r�'✓h r
Pump Installation Date: �5
Pump Intake Depth Below Top of Well Casing: d ? U feet
Pump Manufacturer's Name: Gru,14a S
Pump Model: 5 S O F—o 3� C)
Pump Size: 75 hp
Pitless Adapter Burial Depth: ) V feet
Pitless Adapter Manufacturer's Name: B—' b
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection:yA 1)") n
Comments:
Pump Installer Name: I)vLq Iq VG
{t �-
Company: c- �,+ Ver I I t� : iC
Mailing Address: -%, 6 11 ) 13 o
City:
,410 -
State: 4, Zip: 7 e- 7 /I
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
���zcnr
On -Site Water & Wastewater Program
'61
PO
PO Box 196650 4700 Elmore Road i
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
t�(:I)81'LIIl(:llt
On -Site Water & Wastewater System Permit
Permit Number: OSP231194 Effective Date: 7/6/2023
Work Type: WellSeptic Initial Expiration Date: 7/5/2024
Tax Code Number: 02017256000
Site Legal Address: MOUNTAINSIDE VILLAGE #1 BLK 4 LT 13 G:3439
Site Mailing Address: 7135 Big Mountain DR, Anchorage
Owner: HULTQUIST HOMES INC Lot Size in Sq Ft: 82648
Design Engineer: PANNONE ENGINEERING SERVICES 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
Received By: 5 5 ul� 70 P L5 Date:
Issued By: �-- Date: C Z3
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D.
020-172-56 "'
VH
Property owner(s) Hultquist Homes Inc. Day phone
Mailing address 12570 Old Seward Highway, Ste. 204, Anchorage, AK 99515
Site address 7125 Big Mountain Drive
Legal description (Sub'd., Block & Lot) Mountainside Village #1, Block 4, Lot 13
Legal description (Township, Range & Section)
Lot Size 82,648 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❑
Duplex (D) El
Holding Tank
❑
Renewal ❑
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: `4 9 2 --Waiver Fees:
Date of Payment:
Receipt Number:
Permit No. o S e 2_3 1 I% i
Permit App_'- : :-'.,'c
Date of Payment:
Receipt Number:
Waiver No.
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E‐mail: steve@panengak.com
Mailing: P.O.Box 1807, Palmer, AK 99645
Telephone: (907) 745‐8200 FAX: (907) 745‐8201
30 June 2023
Municipality of Anchorage
Development Services Department
On‐Site Water & Wastewater Program
4700 Elmore Road
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Mountainside Village #1, Block 4, Lot 13
Well and Septic Permit Request
Well and Septic System Design Narrative
This is a design narrative for a permit to install an initial septic system and well on the subject property. The
proposed system will serve a proposed five‐bedroom (5) house. This lot and surrounding lots are served by a private
wells. There are no wells within 200’ of the proposed system.
1. Soils:
A test hole was performed on this lot by Pannone Engineering Services, LLC on 6/20/2023. Groundwater was not
observed during the excavation of the test hole, and bedrock was not encountered. No groundwater was observed
in the test hole monitor tube after 7‐days. Based on the results of the percolation test and overall soils appearance
an application rate of 0.8 gpd/SF was used for the design of a conventional wastewater treatment system in the area
of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water:
There is no surface water within 100 feet of the proposed septic tank and drain field.
4. Topography:
See attached site plan for area topography. Slopes in the vicinity of the system are around 30%. The system will
meet all previsions of the steep slope portion of the code.
5. Drawing Markings: The Drawings are marked “For MOA Review Only”. When written notification that the
review is complete and no further comments are received from MoA On‐Site Department, the note will be removed
and “For Construction” drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at (907) 745‐8200.
Sincerely,
Steven R. Pannone, P.E. F. ASCE
Owner/Civil Engineer
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231194, Curtis Townsend, 07/07/23
CR— ite Water a1,d
REM OR COIF E r�on
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70
IT
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PRIMARY/RESERVE DRAINFIELD (P)
(2EA) 50LF x 5.0'W x 4.0'ED x 9.0'TD -60
INSTALL MONITOR TUBE AND CLEAN OUT
AT EACH END
6s
10.4
TH-1
_ — — — — — —
8.0
(TvP)
2
_ � � � � /• C
SS ss ��6 SEPTIC AREA (E) /
SO
ss
ss=ss
LOT VACANT M
NO WELLS/SEPTICS y — — — SA
(MIN) 1500g SEPTIC TANK (P) 5BR _ _ 9g Zl 777
-INSTALL FOUNDATION CLEAN OUT — — — HOUSE i i�
INSTALL DOUBLE CLEAN OUT AND (P) X00 \
FLOW SPLITTER
WELL (P),
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
_NO. BEDROOM: 5(750 gpd)O
MUNT
TANK SIZE: 1500gal__ 7
PERC RATE: 5 MPI — Al N
SOIL RATING: 0.8 GPD/SF.AREA ROD: 937.5 SF —
SYS. TYPE: WIDE TRENCH 4.0' ED—
RF: 0.50 —
MIN LENGTH: 93.75 LF _ _
USE: NO WELLS/SEPTICS
(2EA) 50LFx5.0'Wx4.0'E.Dx9.0'TD — WITHIN 200' W� W �— —
TOTAL AREA: 1,000 SFNOTFS-
— —
OR CONSTRUCTION PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510 P�G
PHONE (907) 272-8218 FAX (907) 272-8211 �.'•
*; •49
DRAWN BY: DRM MOUNTAINSIDE VILLAGE #1, BLOCK 4, LOT 13 ••�}eve
HULTQUIST HOMES
7125 BIG MOUNTAIN DRIVE '•.
PLAN ANCHORAGE, AK
07/07
Date
••
7/5/2023
Scale
m. :*
1..=50'
•••••
P.I.D. NO
020-172-56
n ann"o
CE 8149 .;�
,�'
PERMIT NO.
OsPxxxxxx
Sheet
1 OF 3
07/07
SPECIAL PROVISIONS TO SPECIFICATIONS On-site Water and Vvbstev at
1. SCOPE AND SPECIFICATIONS: RE%AEWED FOR CODE
p,� �yj
1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MOA COMPONENT PARTS AND MATERIALS USED INS TowTlsen ,
CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
1.2. CONTRACTED WORK WILL BE IN COMPLIANCE WITH MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) DIVISION 10 & DIVISION 20 AS
APPROPRIATE.
1.3. SCOPE OF WORK: INSTALL SEPTIC TANK, DRAIN FIELD, AND WELL
1.4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 15.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT
WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 15.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
1.5. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER: A PLOT PLAN
DEVELOPED BY RLS; OR A SURVEY AS—BUILT.
2. CONSTRUCTION SPECIFICATIONS:
2.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM
THOSE USED TO PREPARE THE DESIGN
2.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE AND END OF TRENCH
BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE
CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL.
2.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL
ROCK SURFACE TO t1" PRIOR TO INSTALLING THE PERFORATED PIPE.
2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4
FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER.
2.5. ALL INSULATION SHALL BE 2" THICK DOW HI -40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES.
2.6. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM.
2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL.
2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS.
2.9, SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN
FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING
INSTALLATION AS PER MOA CODE.
2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM.
2.11. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH.
2.12. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED.
3. CONTRACTOR RESPONSIBILITIES:
3.1. THE CONTRACTOR SHALL FAMILIARIZE THEMSELVES WITH THE SITE CONDITIONS AND LOCATIONS OF ALL LOT LINES, EASEMENTS, WELLS (E & P), SEPTIC
SYSTEMS (E & P) AND SHALL MEET MINIMUM SEPARATION DISTANCES OR AS NOTED.
3.2. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE
AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE
WORK.
3.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
3.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
3.5. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE
PRIOR TO NOTIFYING THE ENGINEER.
3.6. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS
POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
3.7. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE
PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS.
3.8. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS
AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
4. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WILL BE PERFORMED IN ACCORDANCE WITH THE APPROVED PERMIT, AND ANY AND
ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED.
CONTRACTOR: BY:
FOR CONSTRUCTION PANNONE ENG SVC, LLCDate6/30/2023P.O. BOX 100217 ANCHORAGE, AK 99510•...f••'• s Qo/2o23
PHONE (907) 272-8218 FAX (907) 272-8211 le
NTS.... .. ....... P.I.D. NO
MOUNTAINSIDE VILLAGE #1, BLOCK 4, LOT 13 020-172-56
••even rio�
HULTQUIST HOMES CE 8an149 e PERMIT N0.
7125 BIG MOUNTAIN DRIVEOSPXXXXXX
DESIGN DETAILS ANCHORAGE, AK �• Sheet
2OF3
07/071
TEST HOLE 1
1
2
OR
ORGANICS
WATERTIME
LEVEL
READING
3
GM/
SILTY GRAVEL
--
SM
AND SAND
4
2:42:30
17.5 MIN
5
6.00
3
6
-_
3.40
7
4
2:55
8
5.70
2.30
9
2:55
--
10
--
6
11
10 MIN
5.40
12
7
3:05
13
3.40
14
3:15
10 MIN 1
15
1.91
9
BOH
3.40
DATE PERFORMED:
6/20/23
3:25
SOILS LOG - PERCOLATION TEST
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH? -DRY
DEPTH TO WATER AFTER
MONITORING? -DRY
DATE: 6/29/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COM LIANC
OSP231194, Curtis rowns�n , 07107
READING
DATE CLOCK
NET TIME
WATERTIME
LEVEL
READING
NET DROP
1
6/20/23 2:25
--
3.40
--
2
2:42:30
17.5 MIN
9.40
6.00
3
2:45
-_
3.40
--
4
2:55
10 MIN
5.70
2.30
5
2:55
--
3.40
--
6
3:05
10 MIN
5.40
2.00
7
3:05
3.40
8
3:15
10 MIN 1
5.31
1.91
9
3:15
3.40
10
3:25
10 MIN
5.35
1.95
11
3:25
3.40
12
3:35
1 10 MIN
5.37
1.97
PEROLATION RATE 5.1 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3 FT AND 4 FT
COMMENTS: Test hole excavated by BROWNSON BROTHERS.
PERFORMED BY: PANNONE ENGINEERING. I CERTIFY THAT THIS TEST
WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL
GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
FOR CONSTRUCTION PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
MOUNTAINSIDE VILLAGE #1, BLOCK 4, LOT 13
HULTQUIST HOMES
7125 BIG MOUNTAIN DRIVE
SOILS LOG ANCHORAGE, AK
CE 8149
Date
5/30/2023
Scale
NTS
P.I.D. NO
020-172-56
PERMIT NO.
DSPXXXXXX
Sheet
3OF3
Lot 13, Block 4,
Mountainside Village Subdivision
Addition No. 1
Asbuilt
Land Surveying
Land Development Consultants
Subdivision Specialists
Construction Surveying
124 E 7th Avenue
Anchorage, Alaska 99501
(907) 306-8104
mail@S4AK.com
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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:
COSA Checklist_June 2022
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’
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
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’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to 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
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system
under the conditions encountered at the time of the test, and separation distances measured to readily identifiable
features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that
may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside
the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we
cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this
report is for the sole benefit of the owner listed above.
Name of Firm
Phone
Engineer’s Printed Name
Date 05/07/2024