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
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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
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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
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94.0
94.0
2500-GALLON
EPOXY COATED STEEL
SEPTIC TANK
95.4 95.2
4.0'
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FG: 100.4 FG: 100.6
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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 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
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·
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241105, Curtis Townsend, 05/28/24
PA
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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
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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
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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
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