HomeMy WebLinkAboutEQUESTRIAN HEIGHTS BLK 2 LT 10HEIGH 5
Block 2
017-092-64
(Rev 05/02/18) l
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241369
PID Number: 017-092-64
Dwelling: 0 Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: X New ❑ Upgrade
Name
Hultquist Homes
ABSORPTION FIELD
❑ Deep Trench X Wide Trench ❑Bed El Mound
Site Address
14241 Equestrian Circle
❑ Other
Phone
of Bedrooms
Soil Rating
depth from original grade
7Number
5
1.2 GPD/SF
JTotal
4.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.0 Ft.
Gravel depth beneath pipe
3.0 Ft.
Subdivision
Block Lot
Equestrian Heights
2 10
Fill added above original grade
(W)4.8 / (E) 4.0 Ft.
Gravel length
2@38 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
NA
Distance between lines
NA Ft,
SEPARATION
DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
655.2 Ft,
2
6.3 Ft.
Well
100'+
100'+
NA
NA
251+
TANK [9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1,500 Gal.
Surface Water
100'+
100'+
NA
NA
i
Material
Plastic (deep bury)
Number of compartments
2
Lot Line
5'+
10'+
NA
NA
NA
Foundation
10'+
10'+
NA
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer
Hultquist Homes
Drainfield 3034 CO/MT 3034
Inspector PES
BENCH MARK (Assumed elevation) 100 ft
Inspection
1m 11/21/24
12/16/24
Location and description
es:
V 12/17/24
2nd
1h 1/16125
Bottom of window sill between A&B
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
!
! !
Septic System t,
Approved
Date
annome
CE 8149 !•'
ff! 07/01/25 !'
N/o- t!!
No : this approval does not include well permit require ents.
(Rev 05/02/18) l
� I I
/ � I
7elecT om &yF\ Esmt ISM S Telec
�
/ LOT 10 A/
ESMT AS MAPPED PER / B
S4SURVEY 2024.10. 11 / / NEW
5BR i
1-1 � HOUSE
NEW
VACANT LOT WELL
NO WELLS OR SEPTICS /
I � � DRIVEWAY
/
0
0 0 5
A
w Z J O
m
m Q
17.3
J W J
U
U 0
H
� U
Z O�
27.7
Z. z
DCO
0
U
89 8'
�,POL
50OG GREE)
Y TANK
NOTES:
RECORD DRAWING
704.4
I W W W W
I W W W w
z'I I W W W W
INSTALLED NEW 1500gol
INSTALLED W/FC BEFORE & DCO AFTER
=c Esm s 1-� -1-r
Itl
�/ I I I W W W
DCO W W W w
FS I / I �W W W W oW
CZ W
M31 0
T1 M1 I 6.3 NI I I I I W W W W z WW
T2 C1 " �V I W W W F a W
I II1 6.o MiN.I RESERVE AREA CAT 111 (NIC) W W Y
I N It I! W W W W W
(PES) N I ' W CLASS A W W W
tC2 I M 4 WETLANDS w W
I M2 I C4 ,,1 W W W W W
I I INSTALLED NEW ABSORPTION FIELDS W W
•/ (2EA) 38LF x 5.0'W x 3.0 "E. D., 4.0'T D. W
I �5� INSTALLED W/FS BEFORE & CO/MT AT
EACH END. w W
/ � \µ , I w •v •v •v W W
� I � I W •1r1• 1 W W W W W
I I
I I DESIGN PARAMETERS
I I 1 NEW PRIMARY SEPTIC SYSTEM
I I NO. BEDROOM: 5(750 gpd)
WTANK SIZE: 1500gal
PERC RATE: <1 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 625 SF
SYS. TYPE: WIDE TRENCH 3.0'ED
RF: 0.58
0 o MIN LENGTH: 73.0 LF
FG (W) 93.8 g USED:
�FG: (E) 92.0 (2 EA)
EG: (W) 89.0 38LF x 5.0'W x 3.0'E.D. x 4.0'TD
EG: (E) 88.0 TOTAL AREA: 655.2 SF
-FILTER FABRIC
DRAIN ROCK 6" ABOVE PIPE INV TH-1
C RECORD DRAWING
4" 4 DRAIN PIPE 900-
(w)8"
0 0-
(w) aa.o�
A
B
FC
0.0
17.3
T1
22.3
32.9
T2
27.7
37.6
DCO
32.2
42.1
C1
45.1
50.1
M 1
40.7
45.8
C2
60.5
50.7
M2
62.7
53.5
C3
56.0
61.4
M3
52.3
57.4
C4
71.7
64.5
M4
72.8
66.1
NOTES:
RECORD DRAWING
704.4
I W W W W
I W W W w
z'I I W W W W
INSTALLED NEW 1500gol
INSTALLED W/FC BEFORE & DCO AFTER
=c Esm s 1-� -1-r
Itl
�/ I I I W W W
DCO W W W w
FS I / I �W W W W oW
CZ W
M31 0
T1 M1 I 6.3 NI I I I I W W W W z WW
T2 C1 " �V I W W W F a W
I II1 6.o MiN.I RESERVE AREA CAT 111 (NIC) W W Y
I N It I! W W W W W
(PES) N I ' W CLASS A W W W
tC2 I M 4 WETLANDS w W
I M2 I C4 ,,1 W W W W W
I I INSTALLED NEW ABSORPTION FIELDS W W
•/ (2EA) 38LF x 5.0'W x 3.0 "E. D., 4.0'T D. W
I �5� INSTALLED W/FS BEFORE & CO/MT AT
EACH END. w W
/ � \µ , I w •v •v •v W W
� I � I W •1r1• 1 W W W W W
I I
I I DESIGN PARAMETERS
I I 1 NEW PRIMARY SEPTIC SYSTEM
I I NO. BEDROOM: 5(750 gpd)
WTANK SIZE: 1500gal
PERC RATE: <1 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 625 SF
SYS. TYPE: WIDE TRENCH 3.0'ED
RF: 0.58
0 o MIN LENGTH: 73.0 LF
FG (W) 93.8 g USED:
�FG: (E) 92.0 (2 EA)
EG: (W) 89.0 38LF x 5.0'W x 3.0'E.D. x 4.0'TD
EG: (E) 88.0 TOTAL AREA: 655.2 SF
-FILTER FABRIC
DRAIN ROCK 6" ABOVE PIPE INV TH-1
C RECORD DRAWING
4" 4 DRAIN PIPE 900-
(w)8"
0 0-
(w) aa.o�
DESIGNED AND CONSTRUCTED IN GENERAL
DATE PERFORMED:
NO. BEDROOM: 5 750 10/16/2024
( gp O' /
THIS RECORD DRAWING REPRESENTS THE
_
(E)7.0
SP/
W/2(EA) AX -20 PODS
AS -BUILT CONDITION OF THE PROPERTY
3.0' sEwER ROCK
sw
IMPROVEMENTS DESCRIBED ABOVE.
(w) 85.0
VISUAL OBSERVATIONS OR SUBSEQUENT
AREA ROD: 125 SF
THE DRAWING AND ANY OTHER SUBSEQUENT
(E) 84.0-
INSTALLER. SEPTIC SYSTEM INSTALLERS ARE
TRAINED AND APPROVED BY THE
-MIN LENGTH: 14.5 LF
ATTACHED OR INCLUDED INFORMATION IS
AS APPLICABLE. INSTALLERS ARE
BASED ON PERIODIC VISUAL OBSERVATION
SCALE: NTS
-s.o
BY A REPRESENTATIVE OF PES ALONG WITH
THEIR WORK CONFORMS TO THE CODES AND
SP/
NOTES, PHOTOS, AND OTHER INFORMATION
SM
PROVIDED BY THE INSTALLER OF THE
PROFILE
SYSTEM.
THE INFORMATION PROVIDED IN THE RECORD
78.0
DRAWING APPEARS REASONABLE AND
(DRY 10/24/24)
-12.0
REPRESENTS THAT THE PROJECT WAS
RESERVE SEPTIC SYSTEM
DESIGNED AND CONSTRUCTED IN GENERAL
DATE PERFORMED:
NO. BEDROOM: 5 750 10/16/2024
( gp O' /
CONFORMANCE OF 18 AAC 72, THE ADEC
TANK SIZE: 2500gd1 ADVANTEX
ONSITE WASTEWATER SYSTEM INSTALLATION
MANUAL, AND AMC 15.65 WHERE
W/2(EA) AX -20 PODS
APPLICABLE. PES SHALL NOT BE HELD
FERC RATE: <1 MPI
LIABLE FOR SYSTEM DEFICIENCIES WHICH
FALL OUTSIDE THE SCOPE OF THE REQUIRED
SOIL RATING: 6.0 GPD/SF
VISUAL OBSERVATIONS OR SUBSEQUENT
AREA ROD: 125 SF
OBSERVATIONS IF REQUESTED BY THE
SYS. TYPE: WIDE TRENCH 3.0E. D.
INSTALLER. SEPTIC SYSTEM INSTALLERS ARE
TRAINED AND APPROVED BY THE
-MIN LENGTH: 14.5 LF
MUNICIPALITY OF ANCHORAGE AND OR ADEC
AS APPLICABLE. INSTALLERS ARE
RESPONSIBLE FOR CONSTRUCTING THE
USE:
SEPTIC SYSTEM AS DESIGNED AND ENSURING
15LF x 5.0'W x 3.0'E.D., 4.0'T.D.
THEIR WORK CONFORMS TO THE CODES AND
POLICIES STATED ABOVE.
TOTAL AREA: 129.3 SF
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
DRAWN BY: DRM EQUESTRIAN HEIGHTS, BLOCK 2, LOT 10
HULTQUIST HOMES INC
14274 EQUESTRIAN CIRCLE
PLAN ANCHORAGE, AK
Date
6/30/2025
Scale
1"=50'
.... . .. ....... P.I.D. NO
017-092-64
even annome PERMIT NO.
CE 8149 OSP241369
Sheet
2 OF 2
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: OSP 241369 Date of Issue 10/30/244
Parcel Identification Number: 01709264000
Legal Description Property Owner Name & Address
EQUESTRIAN HEIGHTS BLK 2 LT 10 Hultquist Homes
14241 Equestrian Circle
Anchorage, AK 99516
Pump Installation Date:
12/12/24
Pump Intake Depth Below Top of Well Casing:
50 feet
Pump manufacturer’s Name:
Grundfos
Pump Model:
10SQE05-160
Pump Size:
1/2 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
Pitless Manufacturer:
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Merrill
White Raven
Certified Drilling Log
OWNER OF LAND: Hultquist Homes
ADDRESS: 14241 Equestrian Circle Anchorage, AK 99516
LEGAL DESCRIPTION Equestrian Heights Block 2 Lot 10
DATE: 11-13-24
PERMIT NUMBER: OSP241369 DATE OF ISSUE: 10/30/24
TAX IDENTIFICATION NUMBER 01709264000
Is well located at approved permit location: Yes No
Method of Drilling: air rotary cable tool
Depth of Well: 64’
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 55 feet
Liner type
Static Water Level: 35 feet
Recovery Rate 12 gpm gph
Method of Testing Air
Well Intake Opening Type: open end open hole
Screened Start feet Stopped
Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 lbs
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: yes no
Method of Disinfection: Chlorine 50 PPM
Comments:
Drilled to 64’ in silty formation. Pulled back to 55’ where
the best gravel was.
Bore Hole Data
Depth
From To
0 2 Casing Stickup
2 4 Overburden
4 17 Silty Sand & Gravel w/ Clay
17 48 Silty Sand & Gravel Tight
48 56 Silty Sand & Gravel w/ Yellow Clay
56 62 Silty Sand
62 64 Gray Clay w/ Gravel
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP241369
Work Type: WellSeptic Initial
Tax Code Number: 01709264000
Site Legal Address: EQUESTRIAN HEIGHTS BLK 2 LT 10 G:3038
Site Mailing Address: 14241 EQUESTRIAN CIR, Anchorage
Owner: DIME DEVELOPERS LLC
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
K0 "f(f
�x
L)�•hartr�i��e�r
10/30/2024
10/30/2025
22797
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: S�'�-5 Date: _
Issued By: Date: 3 0� %`
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. 017-092-64
Property owner(s) Hultquist Homes, Inc. Day phone
Mailina address 12570 Old Seward Highway Anchorage, AK
Site address NHN Equestrian Circle
Legal description (Sub'd., Block & Lot) Equestrian Heights B2 L10
Legal description (Township, Range & Section)
Lot Size 22,797 Sq. Ft. Number of Bedrooms _
5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial n
Single Family (SF)
nX
(w/wo ADU)
Septic Tank
❑X
Upgrade ❑
Duplex (D)
❑
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:
Date of Payment:
Receipt Number: _
Permit No. US P I Y 11
Waiver Fees: _
Date of Payment:
Receipt Number:
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: Equestrian Heights B2 L10
Well and Septic System Permit Request
This is a design narrative for a permit to install an initial well and septic system on the subject property. The systems
will serve a proposed five (5) bedroom house. This lot and surrounding lots are served by private wells. Currently
there are no wells within 100ft of the proposed installation.
1. Soils: A test hole was performed on this lot by Pannone Engineering Services, LLC on 10/16/2024. The soils log is
attached, and approximate locations are shown on the site plan. Groundwater was not observed during the
excavation of the test hole, and bedrock was not encountered. Groundwater was not observed in the test hole
monitor tube after 7-days. Based on the results of the percolation test, overall soils appearance, and the
attached sieve analysis; 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.
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
25 October 2024
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241369, Curtis Townsend, 10/30/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241369, Curtis Townsend, 10/30/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241369, Curtis Townsend, 10/30/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241369, Curtis Townsend, 10/30/24
040.002 Crowther Associates
1632 Bellevue Circle / Anchorage, Alaska 99515
Telephone (907) 349-2198 / E mail: 907crowther@gmail.com
Date:October 28, 2024
Client:Pannone Engineering Services, Dan
Project:Equestrian Heights Block 2 Lot 10
Anchorage, Alaska
Particle Size Distribution Table
(percent passing subject sieve size)
Sample Source --
Moisture
Content
xx%
Sieve Size Percent Finer Percent Finer Percent Finer Percent Finer
3 inch 100
1-1/2 inch 100
¾ inch 100
#4 100
#10 99
#40 27
#100 25
#200 25
0.02 mm xx
Classification Silty Gravelly
Sand (SM)
Invoice 229
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251262
Parcel ID 017 -092-64 Expiration Date: 5/28/2026
Legal description EQUESTRIAN HEIGHTS BLK 2 LT 10
Site address 14241 EQUESTRIAN CIR
Current property owner(s) HULTQUIST HOMES INC
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By:
Original Certificate Date: 7/2/2025
This Cert' cate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
syste s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Dv
opment Service Department (DSD) issues COSAs based upon representations provided by an
in ependent 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
MUNN= 0 1
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-092-64_
Complete legal description
Location (site address)
Equestrian Heights B2 L10
14241 Equestrian Cir
Current property owner(s) Hultquist Homes, Inc. Day phone
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
3. TYPE OF WATER SUPPLY: Fj Private Well serving # 1 dwelling units
E] Other Non-public well as regulated by MOA El Water Storage
F-1 Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: X Private Septic E] Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: F] Steel nN Plastic n Concrete n Fiberglass
Age new - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: EJ AWWTS E] Bed E] Deep Trench Wil 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 $ -7� ^ Waiver Fee $
Date of Payment 7AS— Date of Payment
n -
COSA # (0 _Sr U Waiver #
COSA Application—Apr2025.doc
COSA Checklist_May2025.docx
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.DISPOSAL 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 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’ 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 ft
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
Field to Foundation > 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/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
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
Phone Name of Firm
Engineer’s Printed Name
COSA Checklist_May2025.docx
Date
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 years, and
the water usage of the people 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 if the system, nor do they guarantee that
there are no hidden defects of encroachments. Therefore, we cannot provide any
warranty of future performance, nor can we estimate the remaining life of the system.
The content of this report is for the sole benefit of the owner listed above.
06/30/25
Lot 10, Block 2,
Equestrian Heights Subdivision
As Built
Land Surveying
Land Development Consultants
Subdivision Specialists
Construction Surveying
AEC# 173042
S4
Group
124 E 7th Avenue
Anchorage, Alaska 99501
(907) 306-8104
mail@S4AK.com
04/29/2025