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HomeMy WebLinkAboutEQUESTRIAN HEIGHTS BLK 2 LT 6Equestrian Heights Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251036 PID Number: 017-092-60 Dwelling: R Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: F* New ❑ Upgrade Name Hultquist Homes Inc ABSORPTION FIELD ❑ Deep Trench RN Wide Trench ❑Bed F] Mound Site Address 14377 Equestrian Circle ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907)745-8200 4 1.2 GPD/SFJ 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft. Gravel depth beneath pipe •0 Ft. Subdivision Block Lot Equestrian Heights 2 6 Fill added above original grade 2.4-2.0 Ft. Gravel length 50 Ft. Township Range Section Gravel width 5.0 Ft.n/a Beds: Number of Lines 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 500 Fe 1 n/a Ft. Well 100'+ 100'+ NA NA 25'+ TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ NA NA Material HDPE (Deep Bury) Number of compartments 2 NA Lot Line 51+ 10'+ NA NA Foundation 10'+ 10'+ NA NA LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer Hultquist Homes, Inc Draintield D3034 CO/MT D3034 Inspector Pannone Engineering Services, LLC BENCH MARK (Assumed elevation) 100.3 ft Inspectiond1s' 3/10/25 3/11/25 Location and description 2nd MH Lid 3'd 3/11/25 4" 9/10/25 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 4F A( qS��� Conditional Approval: Date o77AW ®...... P Steven R anncne .O Septic System --,--,I++ Approved 'ti Date t 01's ° CE 2149 Il6 09/11/2025 \�e Note: this approval does not include well permit requirements. (Rev 05/02/18) DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4(600 gpd) TANK SIZE: 1250g PERC RATE: <1 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 500 SF RF: 0.50 ADJ AREA: 250 SF SYS. TYPE: WIDE TRENCH 4.0'ED MIN LENGTH: 50 LF USE: 50LF x 5.0'W x 4.0'E.D., 8.0'TD TOTAL AREA: 500 SF DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 4(600 gpd) TANK SIZE: 1500gal ADVANTEX W/ AX -20 POD PERC RATE: <1 MPI SOIL RATING: 6.0 GPD/SF AREA ROD: 100 SF RF: 0.50 ADJ AREA: 50 SF SYS. TYPE: WIDE TRENCH 4.0'ED MIN LENGTH: 10 LF USE: 15LF x 5.0'W x 4.0'E.D., 8.0'TD TOTAL AREA: 150 SF _w _w -WATER LINE/ WELL RADIUS - ss - ss - NEW SEPTIC - - - - ESMT/SETBACK STREAM/DRAINAGE WAY CENTERLINE FLOW PATH 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 o ( \ I I SHEET NOTES: 1. NO DISTURBANCE /S ALLOWED WITHIN THE 15 -FOOT OFFSET OF THE WETLAND 1- 1B0UNDARY REMOVALT 0!F ORGANICS 1.2. TEMORARY STORAGE OF MATERIALS 1 3 PLACEMENT OF FINAL GRADE FILL MATERIALS py VACANT LOT I ,� \ \ I I I NO WELLS OR SEPTICSLOT 7 I I v \ APPROXIMATE FUTURE I I \ a - - WELL LOCATION FOR__j p I CCCJJJJJ REFERENCE ONLY = p ' - " - ' ' - ' - ' �i ' 15' WETLANDS `SETBACK PER AMC TITLE 21 WELL (N) s ' INSTALLED 10go! SEPTIC TANK (N) PH 25 \ B INSTALLED FC BEFORE & DCO AFTER HOUSE/ FC \ / ' J CLASS A WETLANDS f BOUNDARY PER � � r MOA cls A / DC01 j •1 \ W M �TH-1 PES C1 '.'� VACANT LOT 4 I \ NO WELLS OR SEPTICS w _ w 62 RESERVE AREA _ CAT 111 (NIC) �1 C2 M2 INSTALLED DRAIN FIELD (N) J' 5OLF x 5.0'W x 4.0'ED x S.O'TD g20 INSTALLED CO & MT AT EACH END / \ / 8j6 ! NO WEtoSA\OC44Rs's", S \ l \ N A B C FC 10.9 6.3 MH 48.6 24.9 T2 51.5 29.6 DC01 53.4 33.1 DCO2 54.1 34.5 Cl 73.6 55.1 M1 74.2 56.6 C2 45.3 58.7 M2 47.9 59.9 �1 C2 M2 INSTALLED DRAIN FIELD (N) J' 5OLF x 5.0'W x 4.0'ED x S.O'TD g20 INSTALLED CO & MT AT EACH END / \ / 8j6 ! NO WEtoSA\OC44Rs's", S \ l \ N � � o '. rr6.., a• ..pw: u 0o zr za O 0 z 0 rn 0 0 HE CONTRACTOR, AND OR THE PROPERTY OWNER RESPONSIBLE FOR THE INSTALLATION OF THE PROPOSED WASTEWATER TREATMENT SYSTEM HALL NOTIFY PES A MINIMUM OF 24 -HOURS IN ADVANCE MONDAY THROUGH FRIDAY OF THE REQUIRED PRE -CONSTRUCTION INSPECTION. AT HIS TIME A REPRESENTATIVE OF PES AND THE CONTRACTOR OR PROPERTY OWNER WILL Z 1. DISCUSS CONSTRUCTION PROCEDURES AND DESIGN REQUIREMENTS. z 2. VERIFY SITE CONDITIONS CONFORM TO THE DESIGN PLANS AND PERMIT. Q 3. VERIFY THE PROJECT LAYOUT CONFORMS TO THE DESIGN PLANS AND PERMIT. w O Ref: AMC 15.65) o LEASE REFER TO THE NOTES AND SPECIAL PROVISIONS PAGE FOR MORE INSPECTION INFORMATION. z ES SHALL NOT BE HELD LIABLE FOR INSTALLATIONS NOT MEETING THE REQUIREMENTS OF 18 AAC 72 AND/OR AMC 15.65 AND THE SPECIAL O ROVISIONS OF THIS PERMIT AS APPLICABLE IF THE CONTRACTOR AND OR PROPERTY OWNER FAIL TO GIVE PES PROPER NOTICE. PES WILL w TEMPT TO DOCUMENT THE SYSTEM AND OBTAIN ANY NECESSARY WAIVERS AT THE CONTRACTOR AND OR PROPERTY OWNERS EXPENSE. PES AKES NO GUARANTEES THAT ANY NEEDED SEPARATION DISTANCES WAIVERS WILL BE APPROVED BY ADEC OR THE MUNICIPALITY OF ANCHORAGE NSITE DEPARTMENT STAFF. W J (o v coZU iW- U�0 LLw = O W W ZI':)O Q =d = U M < W J a = li.i W I_ U] '. rr6.., a• ..pw: 0 0 HE CONTRACTOR, AND OR THE PROPERTY OWNER RESPONSIBLE FOR THE INSTALLATION OF THE PROPOSED WASTEWATER TREATMENT SYSTEM HALL NOTIFY PES A MINIMUM OF 24 -HOURS IN ADVANCE MONDAY THROUGH FRIDAY OF THE REQUIRED PRE -CONSTRUCTION INSPECTION. AT HIS TIME A REPRESENTATIVE OF PES AND THE CONTRACTOR OR PROPERTY OWNER WILL Z 1. DISCUSS CONSTRUCTION PROCEDURES AND DESIGN REQUIREMENTS. z 2. VERIFY SITE CONDITIONS CONFORM TO THE DESIGN PLANS AND PERMIT. Q 3. VERIFY THE PROJECT LAYOUT CONFORMS TO THE DESIGN PLANS AND PERMIT. w O Ref: AMC 15.65) o LEASE REFER TO THE NOTES AND SPECIAL PROVISIONS PAGE FOR MORE INSPECTION INFORMATION. z ES SHALL NOT BE HELD LIABLE FOR INSTALLATIONS NOT MEETING THE REQUIREMENTS OF 18 AAC 72 AND/OR AMC 15.65 AND THE SPECIAL O ROVISIONS OF THIS PERMIT AS APPLICABLE IF THE CONTRACTOR AND OR PROPERTY OWNER FAIL TO GIVE PES PROPER NOTICE. PES WILL w TEMPT TO DOCUMENT THE SYSTEM AND OBTAIN ANY NECESSARY WAIVERS AT THE CONTRACTOR AND OR PROPERTY OWNERS EXPENSE. PES AKES NO GUARANTEES THAT ANY NEEDED SEPARATION DISTANCES WAIVERS WILL BE APPROVED BY ADEC OR THE MUNICIPALITY OF ANCHORAGE NSITE DEPARTMENT STAFF. W J (o v coZU iW- U�0 LLw = O W W ZI':)O Q =d = U M < W J a = li.i W I_ U] c� O HO o Zn N Z" 11- LL p Qt WZ W O J Q p 0 t: U) s O rN W W Q U 0 in a Y a N z O w �•� 'k b33 Itt 0 O 8 o 1-1 z FC T2 DCO u FC: 98.4 z u �',j/�� MH FG: 98.0 a •. �l N a OG/FG: 700.0 4'0 SCHD 40 PVC OR SDR35 OG: 96 0 PERFORATED DRAIN PIPE 5.5' DRAIN ROCK 6' ABOVE PIPE INV FILTER FABRIC �. W r 93.9 93.7 92.0 (j�� N m Z_ U 92.0 1250 GAL GREER 4.0' DRAIN ROCK h a "'° V Y o V �%! Q Q POLY TANK j J x _ L IU-' LJ (n = so' a Z W (/1 ZO t9^� Q Cy S Za w U�MQ Wmo WASTEWATER SYSTEM PROFILE A Zo Daw Z SAEIrtS Z d Z a � a z () m Q. Q Lu < J_ w LL 0 z 0 O o WU Z Q W U a III- TITLERWIK � tr W U 25' 25' I LOT 7 N89"48'19"W 167,00' 0 to Ki Ln N M o 21.0' 15.0' o c0 2.0'o Ci 2.0' i. EXISTING HOUSE 25.0' Qs 28.0' LOT 6 22,027 SQ FT 10' TELECOM & ELEC. ESMT L _ IL_149'3p; Rzz� 117p pp, I - — D DRI VE Notes: 1. Lot 6 is zoned R-6 and is GRAPHIC SCALE Developed to Zone R-7 Standards 0 10 20' �,�----� 2. Zoning CE R-7 SL 1" = 20' Setbacks: Front 25' Side 10' Back 20 Lot Coverage Allowed 30% As -built Legal Description: Lot 6, Block 2, Equestrian Heights Subdivision Survey Certification: I hereby certify that a Mortgagee's Inspection was performed on the described property. Notes: It is the owner's responsibility to determine the existence of any easements, covenants, or restriction which are not on the recorded subdivision plot. It is the contractor's responsibility to check top of foundation grade & building setbacks in relation to property lines and easements Address: 14377 Equestrian Circle Parcel No. 01709260000 Drawn by. ZBB Checked by. SC Scale 1" = 20' Grid: SW3038 Job 2025-009 Plat 87-14 Field Book No: N/A ............ A.,. Steven Callaghan LS -12034 25 114^00, 111.. _ - Legend: Pavement Overhang Wood Deck P7/// Q0 00 Ln N N N O V) W H U Q Lot Line — Adjacent Lot Line - — - Road CL - — — — — — - Easement - - Wetland Limits ( Septic Standpipe ® Well ® Septic Tank MH/Lift Station Date: 7/15/2025 Sheet 1 of 1 DOC CO dba � OLLIVANBILL COLE INF' WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: OSP 251036 Date of Issue 2/28/25 Parcel Identification Number: 01709260000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Certified Drilling Log P DOC CO dba BILL & DOLOda E ;40t ULLIVAIN WATER" WELL'Si P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Hultquist Homes ADDRESS: 14377 Equestrian Circle Anchorage, AK 99516 Bore Hole Data Depth From To LEGAL DESCRIPTION Equestrian Heights Block 2 Lot 6 DATE: 2/27/25 0 2 Casing Stickup PERMIT NUMBER: OSP251036 DATE OF ISSUE: 2/28/25 TAX IDENTIFICATION NUMBER 01709260000 Is well located at approved permit location:®Yes EJNo Method of Drilling: ®air rotary Rcable tool Depth of Well: 400' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 100 feet Liner type 320' of 4.5" PVC liner Static Water Level: 80 feet Recovery Rate 2 ® gpm F] gph Method of Testing Air Well Intake Opening Type: ® open end Flopen hole Screened Start feet Stopped El Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes Ono Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 32 Silty sand and gravel 32 38 Silty sand and some gravel, wet 38 44 Silt, sand, and water 44 80 Silt, sand, some gravel, clay 80 90 Silt, sand, boulders 90 197 Loose bedrock, gray 197 400 Hard bedrock, black 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: OSP251036 Work Type: WellSeptic Initial Tax Code Number: 01709260000 Site Legal Address: EQUESTRIAN HEIGHTS BLK 2 LT 6 G:3038 Site Mailing Address: 14377 EQUESTRIAN CIR, Anchorage Owner: HULTQUIST 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: Uchartment 2/28/2025 2/28/2026 22027 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 2 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 $ecze►ved By S�iG� C tc� Issued By:y�— Date: Date: 4 MUNICIPALITY OF ANCHORAGE 77� Development Services Departmentwr Phone. 907-343-7904 On -Site Water & Wastewater Section ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 017-092-60 Property owner(s) Hultquist Homes Inc Day phone Mailing address 12570 Old Seward Highway Anchorage, AK Site address NHN Equestrian Circle Legal description Equestrian Heights 132 L6 Number of Bedrooms 4 Engineering Firm Pannone Engineering Services, LLC Building Permit Number R2 5 -)05 14 — Not Applicable R APPLICATION IS FOR: APPLICATION IS AN: (M all that apply) Absorption Field El Initial Septic Tank M Upgrade ❑ Holding Tank F-1 Renewal D Privy E] Well R THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: '2 - Date of Payment: Permit No. 05e251036 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 Subject:   Equestrian Heights B2 L6          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 installation will serve a proposed four (4) 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. The soils logs is attached, and the approximate location is shown on the attached site plan. Groundwater was not observed during the excavation of the test hole to a depth of 15.0’ BGS, 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 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.  Because of soil <1 mpi a sample was taken for sieve analysis and is expected back from Alaska Testlab within 3 days.  Due to the expedited nature of the permit we request that the permit be approved with the condition that a sieve showing USCS sand be provided before construction. 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 26 February 2025 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251036, Deb Wockenfuss, 02/28/25 FOR CONSTRUCTION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251036, Deb Wockenfuss, 02/28/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251036, Deb Wockenfuss, 02/28/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251036, Deb Wockenfuss, 02/28/25 Sample Details 25-00435-S01Sample ID 1001in 99¾in 99½in 1001½in 1003in 1002in % PassingSieve Size Particle Size Distribution Result Cu ASTM D2487 Other Test Results Method Description Limits 98No.16 97No.30 92No.50 98No.8 993/8in 99No.4 66No.100 36No.200 Chart Limits Cc Procedure ASTM C117 Group Code ASTM D2487 Group Name Liquid Limit Plasticity Index Gravel (%) Sand (%) Fines (%) ASTM D2487 Tested By Date Tested Equestrian HTS BLK 3, Lot ll TH-1Field Sample ID A SM Silty sand 0 0 1 63 36 Desirae Pascale 2/27/2025 Method: ASTM C136 Drying By: Oven Date Tested: 2/27/2025 Tested By: Shara Diamond The results contained below pertain only to the items tested below. This report should not be reproduced, except in full, without the prior written approval of Alaska Testlab or the agency. Report No: MAT:25-00435-S01 Issue No: 1 Dan Moran Kim Johnson Maria Kampsen Material Test Report 1020 W International Airport Rd Anchorage, AK 99518 Phone: 907-205-1987 info@alaskatestlab.com 2/27/2025Date: CC: Fax: 907-782-4409 Project: Lab Testing N/A Client: Pannone Engineering Palmer, AK, 99645 PO Box 1807 Senior EngineerTitle: Maria E KampsenReviewed By: N/A Alaska Testlab - Anchorage Project Code: 241431 Page 1 of 1© 2000-2025 QESTLab by SpectraQEST.com Form No: 18909, Report No: MAT:25-00435-S01 No Plasticity Index Test Performed Soil Classification of Fines (-#200) in Sieve Analyses Assumed Unless Verified by Additional Testing Comments mm µm 100 60 20 6 2 600 200 100 50 3" 2" 1" 3/4" 1/2"#4 #8 #16 #30 #50 #100 #200Sieve Size Diameter mm µm 100 60 20 6 2 600 200 100 50 3" 2" 1" 3/4" 1/2" #4 #8 #16 #30 #50 #100 #200Sieve Size 0 10 20 30 40 50 60 70 80 90 100 % P a s s i n g ( b y m a s s ) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251036, 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 OSC251418 Parcel ID 017 -092-60 Expiration Date: Legal description EQUESTRIAN HEIGHTS BLK 2 LT 6 Site address 14377 EQUESTRIAN CIR Current property owner(s) HULTQUIST HOMES INC X The On-site system(s) is/are approved for 4 bedrooms 7/3/2026 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: �i�_ —� By: � ,..: � Original Certificate Date: 9/17/2025 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development 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 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 Application 1. GENERAL INFORMATION Parcel I.D. 017-092-60 Complete legal description Equestrian Heights 132 L6 Location (site address) 14377 Equestrian Circle Current property owner(s) Hultquist Homes Inc 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: FN� Private Well serving # 1 dwelling units El Other Non-public well as regulated by MOA El Water Storage F-1 Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: � Private Septic F-1 Private Septic serving 2 dwelling units [:] Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: F-1 Steel 0 Plastic R Concrete ❑ Fiberglass Age <1 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑ Deep Trench Fm� Wide Trench 0 Seepage Pit Waiver request for: Expedited review requested: 0 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 $ 7S Waiver Fee $ Date of Payment 9Nw-F Date of Payment COSA # W ) 5/44 Waiver # COSA Application—Apr2025.doc COSA Checklist Legal Description: Equestrian Heights B2 L6 Parcel ID: 017-092-60 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA FN -1 Well log is filed with Onsite (or attached) Date drilled 2/27/25 Total depth 400 ft Cased to 100 ft FN Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 2/27/25 Static water level at beginning of test 80 ft. Comments B. TANK DATA Measured operating fluid level in septic tank n/a Date of pumping n/a ❑ Required maintenance completed, if AWWTS Comments: New septic tank D. DISPOSAL FIELD DATA Which system tested (date installed) 3/11/25 FE -1 ALL standpipes present per record drawing Total measured depth from grade 10.4 ft (max) Measured depth to pipe invert from grade 6.0 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 2 gpm Water storage tank volume none gallons Well disinfected for coliform test? W Yes ❑ Nc 0 Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic 5.25 ug/L ❑ Arsenic less than MRL (ND) Collected by Sullivan Water Wells nnto 7/3/25 & 9/8/25 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/11/25 Results Q Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 0 in Effective depth remaining 48 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' F71 Yes if No ft Disposal Field on Lot > 100' ❑✓ Yes if No ft Sewer Manhole/Cleanout > 100' R/ Yes if No ft Sewer Service/Septic Line > 25'R✓ Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Disposal Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft Z Yes if No ft Manure/Animal Excreta Storage > 100' Sewer Line/Main > 100' ❑✓ Yes if No ft Q 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' M Yes if No ft Surface Water > 100' ✓Q Yes if No ft Field to Foundation > 10' n Yes if No ft Tank to Property Line > 5' M Yes if No ft Field to Property Line > 10' ElYes if No ft Water Main/Service Line > 10' FD Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Wells > 100' Community Wells > 200' Q Yes if No ft 0 Yes if No ft If tank or field is under driveway comment below 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 OF A ®d regulations. The reported results describe the performance of the system under the "t� . • •C"4S���I conditions encountered at the time of the test, and separation distances measured to ®co • •-V readily identifiable features. The operational life of all wells and septic systems depend : 49 Di ��� 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 _ • • • • • • • • • annone po control of the evaluator of this system. All systems eventually fail, and satisfactory test • CE 8149•Q -f results do not guarantee future performance if the system, nor do they guarantee that �� `GsT . • 09/11/2025 . there are no hidden defects of encroachments. Therefore, we cannot provide anyF�Fp ' • • • g warranty of future performance, nor can we estimate the remaining life of the system. kk0 �oFESSN0,�-.. 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 09/11/2025