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HomeMy WebLinkAboutSPRUCE TERRACES LOT 9Onsite File WIN Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251163 PID Number: 020-044-14 Dwelling: X Single Family (SF) El with ADU El Duplex (D) F] Two Single Family Project: 9 New F1 Upgrade Name Spinell Homes Inc ABSORPTION FIELD nN Deep Trench n Wide Trench El Bed n Mound Site Address 6838 Avalanche Circle El Other Phone of Bedrooms Soil Rating depth from original grade 16 1.2 GPD/SF JTotal 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft. Gravel depth beneath pipe 6.0 Ft. Subdivision Block Lot Spruce Terraces 9 Fill added above original grade 2.4-2.6 Ft. Gravel length 65 Ft. Township Range Section Gravel width 2.5 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 780 F t2 1 n/a Ft. Well NA NA NA NA NA TANK 9 Septic [I S.T.E.P. ❑ Holding [:1 Other Manufacturer Anchorage Tank Capacity 2500 Gal. Surface Water 100'+ 100'+ NA NA Material Number of compartments Lot Line 5'+ 10'+ NA NA NA Steel 2 FoundationLIFT 10'+ 10'+ NA NA STATION Manufacturer Capacity Remarks Property Served by Community Well Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank F628 Tank to D3034 drainfield Installer Pomraning Excavation, LLC Drainfield D3034 CO/MT D3034 Inspector Pannone Engineering Services, LLC BENCH MARK (Assumed elevation) 100.3 ft Inspdates:ection v, 6/16/25 6/17/25 Location and description 2nd 3`d 6/17/25 4" 7/10/25 J 1st Compartment MH Lid ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 0k 0F At Conditional Approval: Date .k.k ..11I 49 T .ri ...... .. .. .. . ....... Steven R. 'annone CL Septic Syst C s1 49 1012912025. Approved Date 0 �OIFESIJO ote: this approval does not include well permit requirements. (Rev 05/2K8) 6BR SFD (N) TH-9 PES Avalanche C i r c l e APPROXIMATE WATER SERVICE BY OTHERS RESERVE AREA (NIC) BASED ON CAT III INSTALLED DRAIN FIELD (N) 65LF x 2.5'W x 6.0'ED x 10.0'TD INSTALLED CO AND MT AT EACH END 12.0' 11.0' INSTALLED 2500gal SEPTIC TANK (N) INSTALLED FC BEFORE & DCO AFTER DRIVEWAY A B MH1 C1 DECK OVER PATIO MH2 C2 C3 C4 M1 M2 C5 P. O . B O X 1 8 0 7 P A L M E R , A K 9 9 6 4 5 PA N N O N E E N G I N E E R I N G S E R V I C E S , L L C ( C . I . 1 0 8 8 ) PH O N E ( 9 0 7 ) 7 4 5 - 8 2 0 0 F A X ( 9 0 7 ) 7 4 5 - 8 2 0 1 DA T E SC A L E SH E E T P. I . D . N O PE R M I T N O . DR A W N RE V I S I O N S CH E C K E D AC P RE C O R D D R A W I N G SP R U C E T E R R A C E S L 9 SP I N E L L H O M E S I N C SI T E 6 8 3 8 A V A L A N C H E C I R C L E AN C H O R A G E , A K 10 / 2 9 / 2 0 2 5 02 0 - 0 4 4 - 1 4 OS P 2 5 1 1 6 3 SR P 10 / 2 9 / 2 0 2 5 ST E V E N R . P A N N O N E CE - 8 1 4 9 R E GI STEREDPROFES S I O N A L E N GINEER SI T E P L A N 1" = 6 0 ' 1 O F 2 ABBREVIATIONS TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. DCO DOUBLE CLEANOUT FC FOUNDATION CLEANOUT FS FLOW SPLITTER DV DIVERTER VALVE MT MONITOR TUBE NO. MH MANHOLE NO. TYP TYPICAL NEW SEPTIC DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 6(900 gpd) TANK SIZE: 2500gal SEPTIC TANK PERC RATE: 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 750 SF SYS. TYPE: DEEP TRENCH 6.0'ED MIN LENGTH: 62.5 LF USED: 65LF x 2.5'W x 6.0' E.D., 10.0' TD TOTAL AREA: 780 SF RESERVE SEPTIC SYSTEM NO. BEDROOM: 6(900 gpd) TANK SIZE: 3000gal ADVANTEX W/ 2es AX20 PODS PERC RATE: 1-5 MPI SOIL RATING: 6.0 GPD/SF AREA RQD: 150 SF SYS. TYPE: DEEP TRENCH 6.0'ED MIN LENGTH: 12.5 LF USE: 15LF x 2.5'W x 6.0' E.D., 10.0' TD TOTAL AREA: 180 SF WATER LINE / WELL RADIUS A B C1 7.0 MH1 22.0 31.1 MH2 33.6 44.2 C2 37.4 48.2 C3 38.8 49.5 C4 54.8 47.6 M1 52.6 46.8 C5 66.0 82.9 M2 65.8 82.4 ESMT/SETBACK STREAM/DRAINAGE WAY CENTERLINE FLOW PATH 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. DRAIN ROCK 6" ABOVE PIPE INV 4"Ø PERFORATED DRAIN PIPE OG: 98.0 FILTER FABRIC 6.0' DRAIN ROCK CL E A N O U T MO N I T O R T U B E CL E A N O U T MO N I T O R T U B E 94.0 94.0 2500-GALLON EPOXY COATED STEEL SEPTIC TANK 95.4 95.2 4.0' DO U B L E CL E A N O U T MA N H O L E MA N H O L E FO U N D A T I O N CL E A N O U T OG/FG: 100.0 FG: 100.4 FG: 100.6 P. O . B O X 1 8 0 7 P A L M E R , A K 9 9 6 4 5 PA N N O N E E N G I N E E R I N G S E R V I C E S , L L C ( C . I . 1 0 8 8 ) PH O N E ( 9 0 7 ) 7 4 5 - 8 2 0 0 F A X ( 9 0 7 ) 7 4 5 - 8 2 0 1 DA T E SC A L E SH E E T P. I . D . N O PE R M I T N O . DR A W N RE V I S I O N S CH E C K E D AC P RE C O R D D R A W I N G SP R U C E T E R R A C E S L 9 SP I N E L L H O M E S I N C SI T E 6 8 3 8 A V A L A N C H E C I R C L E AN C H O R A G E , A K 10 / 2 9 / 2 0 2 5 02 0 - 0 4 4 - 1 4 OS P 2 5 1 1 6 3 SR P 10 / 2 9 / 2 0 2 5 ST E V E N R . P A N N O N E CE - 8 1 4 9 R E GI STEREDPROFES S I O N A L E N GINEER PR O F I L E NT S 2 O F 2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251163 Work Type: Septic Renewal Tax Code Number: 02004414000 Site Legal Address: SPRUCE TERRACES LOT 9 G:3239 Site Mailing Address: 6838 AVALANCHE CIR, Anchorage Owner: SPINELL HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: ly ell t- CIS, t)CI)artil1c,tit 5/29/2025 5/29/2026 54913 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing A Received By:� Date: Issued By: �--- Date: _ �S MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-044-14 Property owner(s) Spinell Homes, Inc. Mailing address ALBORN FAMILY TRUST Site address NHN Avalanche Cir Legal description Spruce Terraces L9 Number of Bedrooms 6 Engineering Firm PES Day phone Building Permit Number fZ- 1V - R3 ""J' Not Applicable ❑ APPLICATION IS FOR: APPLICATION IS AN: (N all that apply) Disposal Field El Initial 0 Septic Tank Upgrade ❑ Holding Tank ❑ Renewal Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: N�f Waiver Fees: Date of Payment: SIPIZ S Date of Payment: Permit No. os 2_9 Waiver No. May 2025 Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807, Palmer, AK 99645-1807 Telephone: (907) 745-8200 FAX: (907) 745-8201 DATE 5/28/2025 Subject: Expired On-Site Water and Wastewater Permit Permit Renewal Request Permit Number: OSP241105 Legal Description: Spruce Terraces L9 This is a request to renew the permit for the above mentioned lot. All site conditions remain the same. The construction still will not affect the health, safety, or development of the surrounding lots. Sincerely, SRP Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251163, Curtis Townsend, 05/29/25 MUNICIPALITY OF ANCHORAGE ,IANc„v On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road f Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Uel�arttnent r On -Site Wastewater Disposal System Permit Permit Number: OSP241105 Effective Date: 5/28/2024 Work Type: Septic Initial Expiration Date: 5/28/2025 Tax Code Number: 02004414000 Site Legal Address: SPRUCE TERRACES LOT 9 G:3239 Site Mailing Address: 6838 AVALANCHE CIR, Anchorage Owner: MISSION HILLS LLC Lot Size in Sq Ft: 54913 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 6 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 5 S ` D -70 Date: i Issued By: Date: 2 $ 2d 2 J4 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. 020-044-14 Property owner(s) Mission Hills, LLC Mailing address 1900 W. Northern Lights Blvd #200 Site address NHN Avalanche Circle Legal description (Sub'd., Block & Lot) Spruce Terraces L9 Day phone Legal description (Township, Range & Section) Lot Size 54,913 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial 0 Single Family (SF) Septic Tank x❑ Upgrade El(w/wo ADU) Holding Tank ElRenewal ElDuplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: l 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: g Z Waiver Fees: w Date of Payment: Z y 2 Date of Payment: Receipt Number: Receipt Number: Permit No. O SP ?- y / / O5- Waiver No. Permit App__- :• ,_.,:c 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 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Spruce Terraces L9 Septic System Permit Request This is a design narrative for a permit to install an initial septic system on the subject property. The proposed installation will serve a proposed six-bedroom (6) house. This lot and surrounding lots are served by a community water system. Currently there are no wells within 200 feet of the proposed installation. 1. Soils: A test hole was performed on this lot by Pannone Engineering Services, LLC on 10/13/2020. 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 1.2 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: 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. There are slopes exceeding 25% less than 50ft from the proposed drain field. The proposed installation will conform to the steep slope provisions of AMC 15.65. The slope down gradient will be seeded and erosion control device installed if slope is disturbed. Please see attached section which shows how all other requirements of the steep slope provision will be met. 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, SRP Steven R. Pannone, P.E. F. ASCE Owner/Civil Engineer 28 May 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241105, Curtis Townsend, 05/28/24 PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) · · · · Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241105, Curtis Townsend, 05/28/24 PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) A SCALE: 1"=5' SLOPE SECTION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241105, Curtis Townsend, 05/28/24 PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) 2.2. SCOPE OF WORK: INSTALL SYSTEM IN ACCORDANCE WITH THE ATTACHED DESIGN AND SPECIFICATIONS. 16 FEET 16 FEET Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241105, Curtis Townsend, 05/28/24 READING SOILS LOG — PERCOLATION TEST NET TIME WATER LEVEL READING SLOPE RATE MPI) 1 10/73/20 TEST HOLE 9 2 1 O R O RG AN ICS 10.000 6.000 1.7 MPI 2 4.000 3 z 10 MIN 10.000 6.000 Q 5 4.000 6 4 0 5.650 1.8 MPI 7 5 4.000 SEE SITE PLAN 8 n 10 MIN 9.580 5.580 6 LUU- 1 4.000 10 10 MIN 7 5.512 1.8 MPI 11 8 GP/ SM SAN D & 12 GRAVEL 9.487 5.487 1.8 MPI 9 4.000 1 0 74 10 MIN 9.465 11 1.8 MPI 1 2 SLO PE 1 3 SEE SITE PLAN 1 4 WAS GROUND WATER ENCOUNTERED? Y1 5 IF YES, AT WHAT16 BOH DEPTH? 1 6 ' DATE PERFORMED: 13O CT2020 DEPTH TO WATER AFTER M ONITORING? DRY DATE: 2 7 0 C T2 0 2 0 SOIL TEST RESULTS / ANALYSIS PERCOLATION RATE 1. 8 ( m in inch) Hydrologic Soils Group: HSG A) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 3 FT AND 4 FT. COMMENTS: Test hole excavated by POM RAN ING EXCAVATION PERFORMED BY: Pannone Engineering Services. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. N O TE S :P AN N O N E ENG SVC LLC ( C. I. 1 0 8 8 ) P. O. BOX 1807 PALVER, AK 99645 PHONE 907) 745- 8200 FAX 907) 745- 8201 REVISIONS Off, DATE 01/ 14/ 2021SOILS REPORT SCALE SPRUCE TERRACE L9 SPINELL HOMES LLC 1 9 0 0 W.NORTHERN LIGHTS BLVD STE# 200 AN CH O RAG E, AK 9 9 5 1 7 P. I. D. CE 8148 , N TS NO x x x - x x x - x x D RAW N SOIL LOG PERMIT N 0. O S P x x x x x x SHEET 9 OF 2 7 READING GATE NET TIME WATER LEVEL READING NET DROP RATE MPI) 1 10/ 73/ 20 4 .0 0 0 2 1 0 MIN 10. 000 6. 000 1. 7 MPI 3 4. 000 4 10 MIN 10. 000 6. 000 1. 7 MPI 5 4. 000 6 1 0 M IN 9. 6 5 0 5. 650 1. 8 MPI 7 4. 000 8 10 MIN 9. 580 5. 580 1. 8 M PI 9 4. 000 10 10 MIN 9. 5 1 2 5. 512 1. 8 MPI 11 4 . 0 0 0 12 1 0 MIN 9. 487 5. 487 1. 8 MPI 1 3 4. 000 74 10 MIN 9. 465 5. 4 6 5 1. 8 MPI Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241105, Curtis Townsend, 05/28/24 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 020 -044-14 Certificate of On -Site Systems Approval OSC251512 Expiration Date: 6/17/2026 Legal description SPRUCE TERRACES LOT 9 site address 6838 AVALANCHE CIR Current property owner(s) SPINELL HOMES INC The On-site system(s) is/are approved for bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: ' �— Original Certificate Date: This C ificate of On -Site Systems Approval (COSA) is intended to demonstrate the subje t sy m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, evelopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other ` 1. GENERAL INFORMATION Parcel I.D. 050-091-08 Complete legal description SPRING BROOK VISTA #1 BLOCK 3 LOT 7 Location (site address) 12221 E PRINCE OF PEACE DRIVE EAGLE RIVER, AK. 99567 Current property owner(s) YANCEY AK LIVING TRUST Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: F� Private Well serving # dwelling units F� Other Non-public well as regulated by MOA F� Water Storage AN Community Well or Public F-1 Holding Tank F-1 Community Septic or Public Sewer 6. SEPTIC TANK: MN Steel M Plastic E] Concrete M Fiberglass Age 8 _ See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: M AWWTS M Bed ME Deep Trench M Wide Trench M Seepage Pit Waiver request for: Distance: Expedited review requested: 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 Date of Payment COSA Checklist Legal Description: Spruce Terraces L9 Parcel ID: 020-044-14 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 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. Comments Community Well B. TANK DATA Measured operating fluid level in septic tank new Date of pumping new ❑ Required maintenance completed, if AWWfS Comments: New Tank D. DISPOSAL FIELD DATA Which system tested (date installed) 6/17/2025 ❑■ ALL standpipes present per record drawing Total measured depth from grade 12.6 ft (max) Measured depth to pipe invert from grade 6.4 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) no If yes, enter date Comments/Deficiencies: New drain field COSA Checklist_May2025.docx Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/17/2025 Results Q Pass Fluid depth prior to test 0 in Water added -- gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate 900 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 0 in Effective depth remaining 72 in E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' -❑ Yes if No ft Neighboring Tank > 100' F-1 Yes if No ft Disposal Field on Lot > 100' ❑ Yes if No ft Neighboring Disposal Fields > 100' ❑ Yes if No ft Sewer Line/Main > 100' ❑Yes if No ft Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Sewer Service/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 ❑✓ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No Field to Foundation > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Tank to Property Line > 5' Z Yes if No ft Wells > 100' ❑✓ Yes if No Field to Property Line > 10' ❑✓ Yes if No ft Community Wells > 200' Z Yes if No Water Main/Service Line > 10' ❑✓ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER ft ft ft ft 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 QF A regulations. The reported results describe the performance of the system under the ��� C,4S'�lil+ conditions encountered at the time of the test, and separation distances measured to //Cj, y I readily identifiable features. The operational life of all wells and septic systems depend *: 49 TH t :* on the local soil condition, ground water levels that may fluctuate during the years, and the water usage of the people served by the system. These conditions are outside the 'ar n;;ne control of the evaluator of this system. All systems eventually fail, and satisfactory test �i �,,. -F_ 81 L9 results do not guarantee future performance of the system, nor do they guarantee, ./oi2srzo2s. �, that there are no hidden defects or encroachments. Therefore, we cannot provide ,1�6?69 �OFESS�0��4AW � any warranty of future performance, nor can we estimate the remaining life of the �1j�®®"e.. system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services, LLC. Engineer's Printed Name Steven R. Pannone COSA Checklist_May2025.docx Phone (907)745-8200 Date 10/29/2025 Av a l a n c h e C i r c l e AsBuilt 10/30/25 Feet 0 60 120