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Home My WebLink AboutSKY RIDGE LT 7Sky Ridge Lot 7 #015-275-07 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: OSP 251014 Date of Issue 2/28/25 Parcel Identification Number: 01527507000 Legal Description Property Owner Name & Address Sky Ridge Lot 7 Hultquist Homes 11094 Red Sky Circle Anchorage, AK 99516 Pump Installation Date: 3/29/25 Pump Intake Depth Below Top of Well Casing: 193 feet Pump manufacturer’s Name: Grundfos Pump Model: 10SQE07-240 Pump Size: 3/4 hp Pitless Adapter Burial Depth: 12 feet Pitless Adapter Installer: Pitless Manufacturer: White Raven 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 Certified Drilling Log OWNER OF LAND: Hultquist Homes ADDRESS: LEGAL DESCRIPTION Sky Ridge Lot 7 DATE: 3/4/25 PERMIT NUMBER: OSP251041 DATE OF ISSUE: 2/28/25 TAX IDENTIFICATION NUMBER 01527507000 Is well located at approved permit location: Yes No Method of Drilling: air rotary cable tool Depth of Well: 202’ Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 202 feet Liner type Static Water Level: 76 feet Recovery Rate 20 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: Bore Hole Data Depth From To 0 2 Casing Stickup 2 4 Overburden 4 31 Silt & Gravel 31 64 Silt, Gravel, Some Clay 64 72 Clay, Some Gravel Wet 72 85 Clay & Gravel 85 98 Gravel, Some Clay Wet 98 122 Silt & Gravel Some Clay 122 169 Silt, Gravel & Clay 169 181 Silty Sand & Gravel Wet 181 202 Sand & Gravel Water Drillers Name: Cole Sullivan 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 System Permit Permit Number: OSP251041 Work Type: Well Initial Tax Code Number: 01527507000 Site Legal Address: SKY RIDGE LT 7 G:2634 Site Mailing Address: 11094 RED SKY CIR, Anchorage Owner: HULTQUIST HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 2/28/2025 2/28/2026 27386 Z 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 � ffII Received By: me I I --S Date: Issued By: Date: LL2�EZ S c 5 MUNICIPALITY OF ANCHORAGE AVE- Development Services Department -343-7904 On -Site Water & Wastewater Section -- ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015-275-07 Property owner(s) Hultquist Homes, INC Day phone Mailing address 12570 Old Seward Hwy Anchorage, AK 99515 Site address NHN Red Sky Circle Legal description Sky Ridge Lot 7 Number of Bedrooms 5 Engineering Firm Pannone Engineering Services, LLC Building Permit Number Not Applicable ❑ APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank ❑ Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Well 0 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment: Permit No. Cs -0 Waiver Fees: Date of Payment: Waiver No. Distance- 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 99519 Subject: Sky Ridge Lot 7 Initial Well Permit Request This is a design narrative for a permit to install a private well for this property. Currently the lot is undeveloped. This lot and the surrounding lots are to be served by AWWU sewer services. Currently there are no sewer mains or private septic systems within 100’ of the proposed well location. 1. Well Design. The well will be located: 100’+ from any sewer main and or sewer system manhole. 100’+ from any on-site septic system. 25’+ from any private sewer lines and or clean outs. 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, PE, F. ASCE Owner/Civil Engineer 20 February, 2025 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251041, Deb Wockenfuss, 02/28/25 SPECIAL PROVISIONS TO SPECIFICATIONS 1. GENERAL NOTES: 1.1 . ANY MODIFICATIONS TO THE ATTACHED PLANS NEED TO BE APPROVED BY PES AND THE OWNER OF THE PROPERTY. 1.2. PES SHALL BE NOTIFIED A MINIMUM OF 48 HOURS IN ADVANCE BEFORE CONSTRUCTION OF THE PROPOSED WASTEWATER TREATMENT SYSTEM. 1.3. PES SHALL BE NOTIFIED A MINIMUM OF 24 HOURS IN ADVANCE TO PERFORM A MINIMUM OF FOLLOWING INSPECTIONS: 1.3.1. A PRE CONSTRUCTION MEETING IS REQUIRED BY STATE AND MUNICIPAL REGULATIONS BEFORE A ONSITE WASTEWATER TREATMENT SYSTEM MAY BE INSTALLED. 1.3.2. TOP OF SEPTIC AND OR HOLDING TANK (TANK IS SET IN PLACE LEVEL WITH ALL PIPING ATTACHED (CLEANOUTS, MANHOLES, INLET AND OUTLET PIPING). 1.3.3. BOTTOM OF EXCAVATION OF THE DRAIN FIELD/S. 1.3.4. AFTER PLACEMENT OF FILTER SAND (IF NEEDED). 1.3.5. AFTER INSTALLATION OF THE DRAIN ROCK WITH ALL ASSOCIATED PIPING IN PLACE INCLUDING DISTRIBUTION LINES CLEANOUTS AND MONITOR TUBES PRIOR TO INSTALLATION OF FILTER FABRIC AND INSULATION (IF NEEDED). 1.3.6. FINAL GRADE INSPECTION. ENTIRE SYSTEM IS INSTALLED AND BACKFILLED. 1.4. THE ENGINEER (PES) HAS NO CONTRACTUAL RELATIONSHIP WITH THE CONTRACTOR (THE INSTALLER OF THE SYSTEM) AND, THEREFORE, HAS NO AUTHORITY, CONTROL OR RESPONSIBILITY FOR THE CONTRACTOR'S EMPLOYEES, THE QUALITY OF WORK, THEIR COMPLIANCE WITH THE DESIGN DRAWINGS/SPECIFICATIONS OR THEIR MEANS/METHODS OF CONSTRUCTION. AT APPROPRIATE INTERVALS, THE ENGINEER WILL VISIT THE WORKSITE TO OBSERVE THE QUALITY OF THE CONSTRUCTION AND TO DETERMINE IN GENERAL IF THE CONSTRUCTION IS PROCEEDING IN ACCORDANCE WITH THE DESIGN DRAWINGS/SPECIFICATIONS.THE ENGINEER WILL NOTIFY THE OWNER IF DEFICIENCIES ARE OBSERVED; HOWEVER, THE FAILURE OF THE ENGINEER TO OBSERVE A DEFICIENCY WILL NOT RELIEVE THE CONTRACTOR OF THE RESPONSIBILITY FOR CORRECTING ANY SUCH DEFICIENCY. THE ENGINEER WILL PREPARE RECORD DRAWINGS AND SUBMIT THEM TO THE REGULATORY AGENCY HAVING JURISDICTION OVER THE WASTEWATER TREATMENT SYSTEM (ADEC OR MOA). FINAL APPROVAL OF THE WORK AND CORRECTION OF ANY DEFICIENCIES IS BETWEEN THE OWNER, THE CONTRACTOR, AND THE REGULATORY AGENCY HAVING JURISDICTION OVER THE WASTEWATER TREATMENT SYSTEM (ADEC OR MOA). 2. SCOPE AND SPECIF!CAJIONS· 2.1. ALL CONSTRUCTION SHALL BE AS SPECIFIED IN THE ATTACHED PLANS. CONSTRUCTION ACTIVITIES SHALL ALSO BE IN ACCORDANCE WITH THE MOST CURRENT EDITION OF THE FOLLOWING CODES AND POLICIES AS APPLICABLE. 2.1.1. 18 MC 72 2.1.2. AMC 15.65 2.1.3. MOA STANDARD SPECIFICATION FOR COMPONENTS PARTS AND MATERIALS. 2.1.4. ADEC ONSITE WASTEWATER SYSTEMS INSTALLATION MANUAL (OWSIM). 2.1.5. MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS). 2.2. SCOPE OF WORK: INSTALL PRIVATE WELL IN ACCORDANCE WITH THE ATTACHED DESIGN AND SPECIFICATIONS. 2.3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF·· FEET BELOW EXISTING GRADE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN·· FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 2.4. 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. 3. CONSTRUCTION SPECIF!CAJIONS· 3.1. 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 3.2. 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 NON-COMPACTED MATERIAL. 3.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO ±1" PRIOR TO INSTALLING THE PERFORATED PIPE. 3.4. ALL PIPE SHALL BE SCHEDULE 40 ABS AND OR PVC CONFORMING TO ASTM F628 AND ASTM D3034 AS APPLICABLE OR ENGINEER APPROVED EQUAL. 3.4.1. ALL PRESSURIZED SEWER LINES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC CONFORMING TO ASTM D1785 OR ENGINEER APPROVED EQUAL 3.5. FOR MOA PROJECTS THE MINIMUM SOIL COVER SHALL BE 3 FEET OVER SEWER LINES AND DRAIN FIELDS AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. 3.6. FOR STATE OF ALASKA (ADEC) PROJECTS THE REQUIRED SOIL COVER IF 4 FEET FOR ALL WASTEWATER SYSTEM COMPONENTS. 3.7. THE MINIMUM ALLOWABLE SOIL COVER SHALL OVER ANY WASTEWATER SYSTEM COMPONENT SHALL BE 2 FEET WITH 2 INCHES OF APPROVED INSULATION. 3.8. ALL INSULATION SHALL BE 2" THICK DOW Hl-40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK, DRAIN FIELD, OR SEWER LINES. 3.9. GEOTECHNICAL FABRIC SHALL BE TYPAR 3401 OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. GEOTECHNICAL FABRIC SHALL CONFORM TO MSHTO M288 CLASS 3 AND HAVE THE FOLLOWING CHARACTERISTICS: 3.9.1. MINIMUM PERMITTIVITY (ASTM D4491) -0.5/sec 3.9.2. MAXIMUM APPARENT OPENING SIZE (ASTM D4751) - 0.20 TO 0.21mm (US SIEVE #70) 3.10. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. 3.11. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 3.12. 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. 3.13. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM. 3.14. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. 3.15. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED. 4. CONTRACTOR RESPONSIBIUTIES: 4.1. 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. 4.2. 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. 4.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 4.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 4.5. 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. 4.6. 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. 4.7. 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. 4.8. 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. 5. THE CONTRACTOR SHALL 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. BY ACCEPTANCE AND CONSTRUCTION OF THE ATTACHED PLANS THE OWNER, CONTRACTOR AND APPLICABLE REGULATORY AGENCY AGREE TO THE PROVISIONS SET FORTH ON THIS PAGE AS APPLICABLE AND ANY SUBSEQUENT SPECIFICATIONS (IF ATTACHED). PANNONE ENG SVC, LLC DoteNOTES: FOR CON STRUCTION �9':�--�2/20/2025P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ,� - Di�··· ...• Scale N TS P.I.D. N O···· �·.·d······ SKY RIDGE, LOT 7 015-275-07 HULTQUIST H OM ES, INC •• �\ewrf'•R.�ai'irie>Re•PERMIT N O. NSN RED SKY CIRCLE \�\ .__ er. 814�.... ' OSPXXXXXX DESIGN DETAILS ANCH ORAGE, AK ,,�� Sheet 2 OF 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251041, Deb Wockenfuss, 02/28/25 iE � WELL NOTES: 1. FINAL WELL LOCATION TO MAINTAIN AT LEAST 25 FEET FROM ANY SEWER SERVICE LINE AND FOUNDATION CLEANOUT. 2. FINAL WELL LOCATION TO MAINTAIN AT LEAST 700 FEET FROM THE AWWU SEWER MAIN AND ANY SEWER SYSTEM MANHOLE LOCATED ON RED SKY CIRCLE. 3. THE APPROXIMATE LOCATION OF THESE FEATURES IS SHOWN ON THIS DRAWING AS REPRESENTED BY THE RECORD DRAWING FOR THE PROJECT. THE EXACT LOCATION OF THESE FEATURES MAY VARY AND PES RECOMMENDS HAVING THEM PHYSICALLY LOCATED PRIOR TO DRILLING THE WELL. I NOTES: FOR CONSTRUCTION DRAWN BY: DRM PLAN PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SKY RIDGE, LOT 7 HULTQUIST H OM ES, INC NSN RED SKY CIRCLE ANCHORAGE, AK I I I I=-� ss __if Date 2/20/2025 Scale 1"=50' P.I.D. N O 015-275-07 PERMIT NO. OSPXXXXXX Sheet 1 OF 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251041, Deb Wockenfuss, 02/28/25 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 OSC251431 Parcel ID 015 -275-07 Expiration Date: Legal description SKY RIDGE LT 7 site address 11094 RED SKY CIR Current propertyowner(s) HULTQUIST HOMES INC X The On-site system(s) is/are approved for 5 bedrooms 9/8/2026 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: r Original Certificate Date: 9/22/2025 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, D elopment 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 M MUNICIPALITY r ANCHORAGE 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. 01527507 Complete legal description Sky Ridge L7 Location (site address) 11094 Red Sky Cir Current property owner(s) Hultquist Homes 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: R Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank FO -1 Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ 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 $ Date of Payment 7 ( lwg COSA # USC 2,51111 Waiver Fee $ Date of Payment 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 09/18/2025 Lot 7, Sky Ridge Subdivision Land Surveying Land Development Consultants Subdivision Specialists Construction Surveying 124 E 7th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com AKCAN 173042 Group S4 As Built 09/16/2025