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Home My WebLink AboutKENO HILLS BLK 3 LT 1Onsite File #020-171-05 r Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181434 PID Number: 020-171-05 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: V New ❑ Upgrade Name Hultquist Homes ABSORPTION FIELD ❑ Deep Trench N Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 17131 Ashland Drive Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.45 GPD/SF 6.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot Keno Hills 3 1 Fill added above original grade 2 0_r Ft. Gravel length 2@ 85.0 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To From Septic Tank I Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 1700 Ftz Number of trenches 2 Dist. between trenches 8.0'}' Ft. Well 100'+ 1001+ 100'+ n/a 25'+ TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1500 Gal. Surface Water 100'+ 1004 100'+ n/a Material Number of compartments Lot Line 5'+ 10'+ I 5'+ n/a NA Steel 2 Foundation 101+ 10'+ 10'+ n/a LIFT STATION Manufacturer Capacity Remarks Orenco 250 Gal. Alarm location On House Electrical installed by Capstone Electric Installer A+ Home Services PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 inspector Pannone Engineering BENCH MARK (Assumed elevation) 100.0 ft Inspection is` 10/14/19 znd 10/14/19 3'd 10/16/19 4"' 2/12/2020 Location and description Bottom House Trim @ Point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date � OF ACgs�� 4.9TH� Steven R. Pannone �+ Fc . CE 8149 a� ,® Septic System Approved Date g �0 O,C� Note: this approval does not include well permit requirements. kmty uoiuu io/ ��-n-nac�^^-{ {cnc>oo_CQ m FT] r-� O C) 01 Ci O 4orooIn- x�mM cn c''Zc°z-�' r o' w D m O E O o —t G) r�nC mr- mm0z o m OZ I =jr m Z o Crri A > O D O Z m r- m Z —Sj O rm f+ m X r 4 D r-O 3 Q cnn0V zm -0K O� Z n Nm 6) N �E �7 Cn D (n -D v Z m z�cw E FT] r-� O C) 01 Ci O -i a Co M -P W N (n N C7 m mm� i C,0 c�n W cnn0V zm -0K O� D � 6) N N N - - O W 0� -P (J} Ui Ui N Cn -' D M W_ 0 W O rn tv - J O Cn - P A -A W -P O 0 N 00 V C) UCO CC) Ul O , - -' -' CJ{ W CO I �E �7 Cn D (n -D v Z m z�cw E FT] r-� m Q TF;00z� r0' D� C��p� D O a Co M mcxn OzjOv�->11 IDNO<n -t m pztTm0cnz 2 ,G.. m 0C)O 0�.. -I 00 vo m mm� i C,0 c�n �D cnn0V zm -0K O� D � O C70 "D Lo m r \ .0 >y Irl p L •1 m m O m (J} 0 co 0 oll j. r ,t rn / co IQ 9$ /' C / Z cD fn -- s_�C x�S>S / G T U m � z X Ln \ G m r O 00 \ \ cio G v \� Tm i / N m zi / co O r D h L J \ C p0 O C \ m A i / m A X05 \\ =o r, �\ �p m / N A _• r / O Z _ _ _ - O O N / I �o _ �1 Z \ \ 93 CLy \/ // / OL /• Or m \ i NOTES: Pit NONE ONG SVC LLC REVISIONS DATE RECORD DRAWING P.O. 80X 1807 PALMER, AK b9645 �aFACgt\i) 2/17/2020 PHONE (907) 745-8200 FAX (907) 745-8201 �r��P. •!?'9�tt SCALE 1 - 60' KENO HILLS B3 L1 '..1ti� - P.I.D. NO DRAWN ACP HULTQUIST HOMES "st .'f3annorae.� 020-171-05 SITE:17131 ASHLANDDRIVE CE i ,% SHEET EEP181434 SITE PLAN ANCHORAGE AK 4\�� 2 OF 2 Certified Drilling Log ® DOC CO dba BILL 8% COLE It ULLIVAN WATER WELLS" 00 P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Chris Swanson ADDRESS: 17131 Ashland Dr. Bore Hole Data LEGAL DESCRIPTION Keno Hills Block 3 Lot 1 DATE: 8-8-19 Depth From To PERMIT NUMBER: OSP181434 DATE OF ISSUE: 2-21-19 TAX IDENTIFICATION NUMBER 02017105000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: Mairrotary ❑cable tool Depth of Well: 184' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 44 feet Liner type Static Water Level: 10' 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: 250lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Shallow Bedrock Surface Seal per MOA Code sealed off water zone from 25' to 28'. 0 2 2 3 3 25 25 28 28 104 104 118 118 129 129 162 162 177 177 184 Casing Stickup Overburden Bedrock Large Fractures 10+ GPM Bedrock Gray Bedrock Gray w/ Quartz Bedrock Gray Bedrock Gray w/ Quartz Bedrock Green Hard Bedrock Gray 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. Well Drilling Permit Number: SW OSP181434 Date of Issue 2-21-19 Parcel Identification Number: 02017105000 Legal Description Keno Hills Block 3 Lot 1 Pump Installation Date: 3-5-20 Pump Intake Depth Below Top of Well Casing: 170 Pump manufacturer's Name: F&W Pump Model: 4F11P07301S Pump Size: 3/4 Pitless Adapter Burial Depth: 10 Pitless Adapter Installer: White Raven Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson 11 Pump Installers Name: Sullivan Water Wells Property Owner Name & Address Chris Swanson feet hp feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Amsu Test Lab, I Name: Mail ing Address Legal Description: Sample Site Location Pannone Engineering LLC P.O. Box 1807 Palmer, AK 99645 17131 Ashland Drive Outside Hose Bib Lab ID#: M200752 Date SamI.Ved: 08/10/2020 Tinge Sampled: 0833 Sampled By: ML Date Received. 08/10/2020 Time Received: 1014 Health Guard I Parameter Method Result Unit MRL MCL Date Total Coliforms Colilert A --- --- --- 08/11/2020 (SM 9223B) Colilert E. coli (SM 9223B A --_ --- --- 08/11/2020 TNTplus 835/836 Total Nitrate - N (Hach 10206) <MRL in -/L 0.200 10.0 08/14/2020 Arsenic by ASV Arsenic EPA 7063 <MRL µg/L 1.00 10 08/12/2020 Method Reporting Limit (AlRL): the lowest concentration that can be reported reliably Alaximrm Contaminant Level (AICL): highest acceptable level in public water systems as set by EPA nig/L: milligrams per liter; 1/100011' of a ;ram pg/L: micrograms per liter; 1/1,000,000" of a gram Absent (A): none of this type of bacteria was detected Present (P): one or more bacterial cells of this type were detected Results Reported By: Patience Lynch Laboratory Analyst Reviewed By: Signature: Iglrlre /fit/ Ly'Kw Hit( (Augs, )ozo IiG,: A T A;KDT Email: matsutestlab.office@gmail.com C� See Detail - \ U Vertical wood poles �� --\ �Lift Station00 10qjgned 3/23 Legend: - Set Rebor with Cap � Found Rebar 0 Well Septic Overhang Wood Deck Pavement Eowo --- -- 01 ix - OSP 65 Note: No pavement at time Tom HDreyer, P.L.S. 124�7thAvonue Inspectey ion hereby--certify—Mortgagee's opno was performed on the described property. Anchorage, Alaska 9S5O1 Notes: It in the vwme/a responsibility to determine the (907) 306-8104 existence of any easements, vovonovto, or restriction which nnmil@S4AK.com | are not on the recorded subdivision plat. Checked by. CB Scale 1 = 100' Drawn by. AR Grid 3438 Job 2018-19 Plat 71-150 Field Book: 142 Date: 3/23/2020 Legal Description: ��":l+ z-uou��z� Lot 1, Block - , K Hills Subdivision \' MUNICIPALITY OF ANCHORAGE t,te � On-Site Water&Wastewater Program ,o' S� ` PO Box 196650 4700 Elmore Road �• Anchorage.Alaska 99519.6650 Phone:(907)343-7904 Fax:(907)3434997 r ss htlp:/Iwnvw.muni.org/onsite ri .. Department \CCN011 f.4E On-Site Water & Wastewater System Permit Permit Number: OSP181434 Effective Date: 2/21/2019 Work Type: WellSeptic Initial Expiration Date: 2/21/2020 Tax Code Number: 02017105000 Site Legal Address: KENO HILLS BLK 3 LT 1 G:3438 Site Mailing Address: 17131 ASHLAND DR, Anchorage Owner: SWANSON CHRIS Lot Size in Sq Ft: 142877 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field 121 Septic Tank ❑ Holding Tank 0 Privy El 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 L....Special Provisions: f slopes within 50'of the proposed absorption fields are found to be 25% or greater, construction of the tem will stop pending On-site approval. or Inspection Report approval, a statement is to be made on the report stating that the cabin and any ociated septic system has been removed/decommissioned. r J Received By: - - ✓ Date: Issued By: j, - �� Date: Z EPLEMS 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. 020-171-05 Property owner(s) Chris Swanson Day phone Mailing address 3120 O'Malley Road, Anchorage, AK 99507 Site address 17131 Ashland Drive Legal description (Sub'd., Block & Lot) Keno Hills, Block 3, Lot 1 Legal description (Township, Range & Section) Lot Size 142,877 Sq. Ft. Number of Bedrooms 4 . 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial Single Family (SF) ❑X (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. 4110 (Signature of property • ner or authorized agent) Permit/Rush Fees: 7-5'7 Waiver Fees: Date of Payment: /.21/0h2 Date of Payment: Receipt Number: 0.3q//6 Receipt Number: Permit No. o5P/Y/1-13c/ Waiver No. Permit App_ .,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181434, Deb Wockenfuss, 02/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181434, Deb Wockenfuss, 02/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181434, Deb Wockenfuss, 02/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181434, Deb Wockenfuss, 02/21/19 Rick Mystrom, Mayor Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 3, 1997 Kenneth N & Janelle Martinson 17920 SteamboattDrive Anchorage, Alaska 99516 5731 Subject: Lot 1 Block 3 Keno Hills Subdivision Permit #SW960336, PID #020-171-05 The subject permit, issued October 3, 1996 by this office for a single family well and/or on-site wastewater system, has expired as of October 3, 1997. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. W~nen applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; 9120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. On-site Services enc: Copy of Permit cc: Tobben Spurkland, P.E. PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960336 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:MARTINSON KENNETH N & OWNER ADDRESS:1600 A STREET ANCHORAGE, ALASKA 99501 DATE ISSUED:10/03/96 EXPIRATION DATE:10/03/97 PARCEL ID:02017105 LEGAL DESCRIPTION: KENO HILLS BLK 3 LT LOT SIZE: 142877 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST 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 (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: DATE: I0 - 3- T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 BLOCK 3 KENO HILLS/D KEN MARTINSON Grotmd Water at 12 fi. Use ORENCO Sand Filter with 2-wide absorption trench, 5 ft. of sewer rock Insulate all components. Soil Rating. From test 10/06/92 28 and 48 min/in = 2 gal/sq, ft Required Area per Bedroom: 150/2 = 75 sq.ft.. Number of Bedrooms 4 Length of Trench 4x75/2 x 5 = 30 [feet] SYSTEM CONFIGURATION ORENCO SAND FILTER 1500 GAL STEP STANDARD TRENCH TOTAL LENGTH 30 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 8 FT. ROCK DEPTH 5 FT. COVER 3 FT. The installation of this septic system will not prevent wells from be installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface nmoff will not result fi.om this installation. Septic System Design Lot I Block 3 Keno Hills TOBBEN SPURKLAND P.E, 205 W 15TH, AVENUE ANCH. AK. 99501 (907'~ 279-3916 ] LOT 1, BLOCK 3 KENO HILLS S/D ASHLAND DRIVE KEN IdARTINSON II SEPTIC SYSTEM DESIGN ,DATE: FEBRUARY 2, 1995 SHEET: IJ$ GRID: $455 N £5 50 75 £CALE; 1" -- 50 FT, PROP. RESIDENCE AIR LINE ABSORPtiON TRENCH 50 F~ LONG 8 F~ TOTAL DEPT~,, 5 FE SEWER~o~'K TOBBEN SPURKLAND P.E. Il 203 W 15TH. AVENUE II ANCH. AK. ggS01 (907/ 279-~916 LOT 1. BLOCK 3 KENO HILLS 5'/'1) ASHLAND DP/YE KEN IdARTINSON SEPTIC SYSTEM DESIGN DATE: FEBRUARY 2, 1995 SHEET: 2/5 GRID: $455 From STEP Air Line --~- 1!-~/4 JMoniPold ,yoJoa, , I SANPL[NG YELL (1 IfII~IIIIIIUII~IIJNIII~II~I~IIIIIIIIflJI~IIIIIIVIIIIIJlIII x~ ~ ~ // / o C~eon Du$ Access 30 M~{ PVE Liner ~ Insulo~/on oll sJdes, fop ond TOP VIEW ' PEA · 5' PEA - .~- 2: Cover _ GRA~ SL~E 5~1 ~ ~VEL n o ~ ..... , ................. £ Fi Iter Savd Ex[ST, 6ROUND 49th SIDE VIEW BBEN No, CE TOBBEN SPURKLAND P.E. Il 20,3 W 15TH. AVENUE II ANOH. AK. 99501 (~QT'~ 279-a916 18x20 SAND FILTER LOT I BLOCK J KENO HILLS KEN blA£TINSON J J SEPTIC SYSTEM DESIGN DATE: ktAY 7, 1995 SHEET: 9/4 GRID: 3438 1500 GAL STEP TANK WITH 2-INCHES OF INSULATION JO NO SCALE Sqmple Access. 8-Inch Sump DRAINFIELD 2 FT W/DE 50 FT LONG 5 FT OF ROCK 8 FT TOTAL DEPTH $ FT OF COVER 50.00 ff ~5 2 fl. Fin. Etev. 976~ -- $' Cover Topsoil ..~?~..'~",t~ ~ ~ 5 FT SEWER M ~ 49th ~' ~ ...... DT':", ...... ~....~...~. , ...... ~,~ No. cE-aaa~ ...'~ BOTTOM S/D/NV ~.~..... ....*~ ASSUMED ELEV. I00.00 FT TOBBEN SPURKLAND P.E~ J --' LOT 1 BLOCK 3 KENO HILLS IISEPTIC SYSTE~ DESISN 20~ W15ih Ave ~1 ASHLAND DRIVE ~ ~ DATE: ~AY 7, ~995 Anchoro e Ak 9950~ _ KEN ~ARTINSON SHEET: 4 ~ GRID: ~8 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~'EN LEGAL DESCRIPTION: LoT t W At~"f'~ sa rq 7 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT DEPTH? J ~ - pO E ..,th to Wotnr A,ot~/o/¢ Monitoring?I J hate: -~ Gross Net Depth to Net Reading Date Time Time Water Drop IO'k"tz' ~Z: q~ $~ ~ PERCOLATION RATE /'"/,~ (minutes/inch) PERC HOLE DIAMETER PERFORMED BY: ~ -""~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) I 1'1 ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED POR: ~EI, I DATE PERFORMED: COMMENTS Township, Range, Section: SLOPE WAS GROUND WATER y ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop 10.(~-?Z- ~:~(~ ~-~ PERCOLATION RATE ~*~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN .~-.--- FT AND ~7 ~-'- FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED ~N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate nfOn-Site Systems Approval 0�O1710� Parcel I.D. ~^-~ ' ' '~~ Complete legal description Keno Hills 3~ L1 Location (site address) 17131 Ashland Drive � Cunontpmp��a�Chris ��VV�RSUD m) ~"' ~ Mailing address Real estate agent 2. TYPE OFDWELLING: Day phone Day phone [3 Single Family (w1wnADU 0 Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OFBEDROOMS: 5 4. TYPE OFWATER SUPPLY: TYPE OFWASTEWATER DISPOSAL: Private Well F-1 Private Septic E I Water Storage 1771 Ho|d`ngTonk El Community Well R ConornVndv Public Water System El Public Sewer �l Waiver request for: Diotonne:________ Received by: Date: COSA to be released to the engineer. unless otherwise requested by the engineer. Date of Payment 1 no Receipt Number /�S�� ~7�� CO�A# Date nfPayment Receipt Number VVaivar# 5. $TATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my invesligation, based on proceduresoullined in the Certificate of On-Sile Systems Approval Guidelines for this application, snows tnat the 6n-site water supply and/orwastewater disposal system is (arei safe, functional and adequate for lhe'number of bedrooms and type of structure indicatedherein' I further verify that based on the infonnation obtained fiom the Municipality of Anchorage files and irom my investigation andinspection, the on-site water supply and/or utastewater disposal system is (are) in iompliance uiittr "tt applicable Municipal and Statecodes, ordinances, and regulations in effect at the time of installation. ln_conducting an adequacy test, I attempt to provide a thorough, conscientiqus engineering analysis of the system in accsrdance with MoACO$A guidelines and regulations. The reported results describe the performance oithe sysiem unOer the conditions encountered at the timeof the test. and separation distances measured to readily identifrable features. The operaiional life of all wells and septic systems depend onlhe local soil condition, ground water levels that may fluctuate during the yeal and the water usage of the family being served by the sysrem.These conditions are oulside the control of the evaluator of this system. All systems eventutly fail and sitistaciory test results do notguarantee future pertormance of the system, nor do they guarantee that there are ns hidden defects or encroachments. Therefore we cannotprovide any waffanty for fulure performance, nor can we estimate remaining life of the system. The content of this report is far the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk, Pannone Engineerlng Services LLC highly recommends buyers hire their own engineer to evaluate lhis report. Name of Firm Pannone Engineering Services phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99S45 Engineer's Printed Name Steven R. Pannone P.E.9s1g 20200831 6.SIGNATUREDSD System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms, with the following stipulations: bedrooms bedrooms .s\W-oir-s|T,+ ., ler(ruu &^4 Original Ce*ificaie Date: The Municipality of Anchorage Development Services Division (OSD) issues Cerliiicates of On-Site Systems Approval {COSA) basect only upon lhe representaiions given in paragraph 5 by an independent profes$ional eivil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeCs work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Welt Flow Advisory COSA Checklisl blue sheet Nitrate Advisory Arsenic Advisory Other