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HARMANY RANCH - EAGLET AERIE LT 1
Onsite File :,,Ty� "; �, �, �,,,�� %� �n "� �x t� z ��� ,tip-`�'•x,a�.,, fi � „ ��",K�',�`�.` � �` '�.'���,: � � � 2, � z" ., 'StY `"_• ;ate a �-� � �a~ m Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201107 PID Number: 050-381-81 Dwelling: R Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: R New ❑ Upgrade Name Spinell Homes ABSORPTION FIELD Site Address � ��. ❑ Deep Trench ❑ Wide Trench ❑ Bed R Mound Fes-Harmany Ranch Rd Phone El Other Number of Bedrooms Soil Rating Total depth from original grade LEGAL DESCRIPTION yr"ror — Depth to pipe invert from original grade +0.5 Ft Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Harmany Ranch - Eaglet Aerie 1 Fill added above original grade 4.0+ Ft. 'EedNumber Gravel length 2 @ 90 Ft. Township Range Section Gravel width 5.0 Ft. of Lines n/a Distance between lines n/a SEPARATION DISTANCES Tol From SepticAbsorption Field Lift Station Holding Tank Sewer Line Total absorption area 900 Ftz Number of trenches 2 Ft. Dist. between trenches 6+ Ft. Well 1001+ 100'+ 100'+( n/a I 25'+ TANK EJ Septic 9 S.T.E.P. 171 Holding 171 Other Manufacturer Capacity Surface Water 1001+ 100'+ 100'+ ` n/a Anchorage Tank 3000 Gal. Material Number of cornpartments Lot Line 5'+ 5'+ 5'+ 1 n/a NA Steel 2 Foundation10'+ 10'+ ` 10'+ n/a LIFT STATION { Manufacturer Capacity Remarks Orenco 250 Gal. Alarm location on house Electrical installed by Solid Ground Installer Pomraning Excavation PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 field Drainfield 3034 Co4 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 90.0 ft Inspection v, 1/12/2021 2 , 1/13/2021 da:31° Location and description 1/13/2021 0' 2/10/2021 Top of foundation wall @ A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �� OF A�,,k � co . 9TH .... d �teverr i f'cnnone yea L,` 8149 9�`s�2.ti- Septic System Approved Date 3 rt'i o24 Note: this approval does not include well permit requirements. (Rev 05/02/18) < co�"y�o T(5�'K- -mm F- r yr T\ D --I-i �Qo 41 O Gz7�OD DD N _ U) Dx Sm�GzMx70fu N— CJ7 (0 N W Co Woo'. 00 O P xm U -1 m —0 (0 Cn 1 C Ut � D nO�OD X00 m (D (D z D O o z o r 0 H s D x-D� 0 rr*m O O I (0 —i C Z -t m (D W FTI CD O Z (n M;u �tr*m0 J (Jt J W m m> D o z Q1 r- m t ;7 O C U) m �A m P D D r -02 1+ C) c r*m _ \ O Km T(5�'K- -mm F- r yr T\ D --I-i �Qo 41 O Gz7�OD DD N Z Dx Sm�GzMx70fu N— CJ7 (0 N W Co Woo'. 00 0) —0 (0 Cn 0) Ut � D (O m (D (D N (0 00 D CO J (0 (D N (D W J J (Jt J W W W O Q1 00 W 90 W N co P -P — W N O 0N(C �C)M>'oM DO�� z(nrn-�\z0 -mm F- r yr T\ D m �Qo O Gz7�OD DD N Z Dx Sm�GzMx70fu CJ7 (0 N W Co Woo'. 00 cn �D —0 COoo O� O m OW O 0) <� M (n o �- m 9 c) O o o -1 CJt m m "D -D O D Z 0 D O S U) <a m X zn-" O O D Ln o x c ( n -i m 0 o I m / r ' � I ( o m ! A Ul / m \ — N S 0 1) > F- > / 0 i O / C 1 I O U)i n� 11 l L1 D I z �r I -n °'f co -, I o � l 171 1' o I ;a v \ zmNz\ ! t t ( m- 1 DODiD < C mmcor� / = I I� / mpOm n I R, ::E z K�X 0 co 7J O C1? xN� (O M D zU z / 0 1 -u v c mcn:�E- �p ADW DO .S SFC' X00 (n G' T ti F- / � 1 m I \ o x 0 0 m I I 3 O �. z cn I I 3 NOTES: PANNONE ENG SVC LLC (C.1. iO88� """"», REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALER, AK 99645 11/9/2021 PHONE (907) 745--8200 FAX (907) 745-8201 __��? ' "'gsir�, REV 1: 11/30/21 SCALE 1" = 50' HARMANY RANCH — EAGLET AERIE L1 P.I.D. NO DRAWN ACP SPINELL HOMES oso-381-81 �— Q.'$.C,` i, Steven Ponnane : 1 SITE:f c+� HARMANY RANCH ROAD% `E-8149 PEOSP201107 C1.0 SHEET EAGLE RIVER, AK «�....." 1 OF 4 IN n y� iN I J21 Ell z� p j xx Icmxin i � - xx I xx N > m m o 0 z —4 o N o y //<� V/ " m v m OT m 9 9 I 4 i 1 Ijb" i Y dna « n NOTES: PANNONE ENG SVC �IFLLC (C.1. 1088) ""` i REVISIONS DATE RECORD DRAWING PHONE 9080 7458200 LfR. AK 9079975-8201 - �P�E. S4, REV 1: 11/30/21 11 /9/2021 t ) SCALE NTS HARMANY RANCH - EAGLET AERIE L1 .. P.I.D. NO DRAWN ACP SPINELL HOMES 050-381-81 % c, stewcER 149 � PERMIT N0. SITE: HARMANY RANCH ROAD e,.(/t - OSP201107 C1.1 EAGLE RIVER, AKSHEET ........ `' 2 OF 4 P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section Waiver#: OSV221003 COSA#: Permit#:OSP201107 PID#: 050-381-81 Legal Description: HarmanV Ranch - Eaglet Aerie Lot 1 Engineer: Pannone Engineering Services Applicant: Spinell Homes n�enr Department Your request for a waiver of the maximum 3 to 1 mound side slope for the absorption field has been approved. See engineer's waiver request and slope stability letter for justifications. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all code requirements be met or another approval from this department. mmmmmmmmmmmmmmmmmmmmmmmemmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm� Waiver is Granted: X Waiver is not Granted: Date: l7 /2 0,'?,,?, Approved by: 4" 0- // Name of Reviewer mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmammmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm� 1/2yJZ2_ ��� 023(07G Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenp-ak.com DATE: 3/17/22 Subject: Expired On -Site Water and Wastewater Permit Permit Renewal Request Permit Number: OSC221085 Legal Description: Harmany Ranch L1 This letter is to confirm that the mound system at Harmany Ranch L1 has been confirmed as stable and in fact, the entire area surrounding the mount has been filled in with topsoil, seeded, and has established vegetation to prevent erosion. Sincerely, Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer i!iailing: P.0, 3ox 1807, Palm—er, Al"K 90645-1307 Telephone: (907) 745-8200 ;=AV t,907i 71=5-3201 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 30 November 2021 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P O Box 196650 Anchorage, Alaska 99519-6650 Subject: Harmany Ranch — Eaglet Aerie L1 Mound Slope Waiver Request Ladies and Gentlemen: We are requesting a waiver to AMC 15.65.210.E.9. Due to area constants on the subject property a mound with 33% side slopes would encroach on the neighboring property. The mound is to be top soiled and seeded in the summer of 2022. The mound is protected by the house and driveway located upgradient of the drain fields, along with other final grading and existing vegetation most surface runoff will be diverted from the mound. Erosion of the mound is not likely. If you have any questions or concerns, please contact me at 907.745.8200. Sincerely, ®®SCE OF AL ®®�P ...(...... AV C Steven R. Pannone 8.1 1p® ESS®o®®o®® Steven R. Pannone, P.E. Owner/Civil Engineer l I n-: P.O. Box asc 'tPaInHer, AK 996z'11.5 Te e,7hne t 7) 745-8200 r 1 X, (90J; 745-3201, z A O N D m y o 0 0 o W 0 x O O U) O O O H O G O � Z 1 1 I I o p O � Z I I I I o A O � Z m I 1 i I Zm� z O O A Z y � m m n D O O z 'o fl cD� o rn cn a W ru o -'o z m 1> m m Z :)o T G m N -q 00 O m N f 9 fm0� -1Z� O _ m O ODO D Zn J X n� =0m n" rm�� O �. ODS o Mg D ZD Dzm 0- � m a -+Z� -oma c�ln o OCm < 0 x � C 0 n O � 1 x Z 0 m 0 O in in y D� j = p O l�A O _Z Z r i (> Z I ?J D Z O < C C D O e e -+ z z1 mm=m D O O C m mao Z N ➢ - m m� M> VZ ��O c m D i n { D =3- z to O G7 ro D n y NOTES: PANNONE ENG SVC LLC C.I. 1088) P.O. BOX 102954 ANCHORAGE, A 99510 """ ,, A ' = ��OF <�SFy'4 REVISIONS DATE 2021 RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 SCALE25 HARMANY RANCH - EAGLET AERIE L1 SPINELL HOMES SITE: NHN HARMANY RANCH ROAD L :- -= �'.S�' CEft 148 none ; NTS P.I.D. NO 050-381-81 DRAWN ACP PERMIT 01107 C1.2 EAGLE RIVER, AK `{`v SHEET " .......• - 3 OF 4 A N D m y o 0 0 o W 0 x O O O O O O H O G O � Z 1 1 I I o p O � Z I I I I o A O � Z m I 1 i I Zm� z O O A Z y � m z - O p m (T ? W N Fri Z O U) F 1! N m O D r O A N N (T (n Zfrn'm O O A z z C �c ^' O to �' m 0 A m y m mn ;oK mcmn O V u L1 m m -{ 200 co m O \� _ 01n �K O y A 2:N Z o f m W N 00 o \ O m � mm .. . rt m O N m N z O m O D o 11 Z (7 =X W nm --i 0 m a N � o < m o q9. a nZm a �' m -i Z -o v� �� D m m�• •� i 2 2 O C o*o=o v n 0 'S 0 ;0 Ay �, Z� Z D m 0 iH D Z1 JD r �Dr1 mmID, z 2 00 D N z r mm m Z- D rn I ➢ Z O< y C 1 Z tn z -1 rnm2 O m vy na n-' O r C O ~ O,o -�m-i Z :i7 O c ut Z � D 2. ;a - rn�N z 0M); -moo mZ c w D D 2�- z (n 3 O � N y� '11 v -i NOTES: PANNONE ENG SVC LLC (C.1. 9088) P.O. BOX 102954 ANCHORAGE, AK 99510 """`111, REVISIONS DATE 1/25/2021 RECORD DRAWING PHONE 907) 272-8218 FAX 907) 272-8211 _=��? sfy'', - n %- s .,' steveCE-8148 rwna ; _ HARMANY RANCH - EAGLET AERIE L1 SPINELL HOMES SITE: NHN HARMANY RANCH ROAD SCALE NTS P.I.D. NO 050-381-81 DRAWN ACP PERMIT N0. OSP201107 C1.3 EAGLE RIVER, AK �` ry.... '1111\......•• 4SHEET 4 OF 4 A p m (T ? W N Z O N m O A N N (T N Zfrn'm O A z m O V u W U Z o f o I o f � m W N � w i• t •a, s S r w w• xwnlymmmm•• • • i,'s OWNER OF LAND: Jerry Harman ADDRESS: 8251 Harmany Ranch Eagle River, AK 99577 Bore Hole Data Depth From To LEGAL DESCRIPTION Harmany Ranch Subdivision Lot 1 DATE: 8-3-17 0 2 Casing Stickup PERMIT NUMBER: OSP171188 DATE OF ISSUE: 7-26-17 TAX IDENTIFICATION NUMBER 05038102000 Is well located at approved permit location: ®Yes F]No Method of Drilling: ®air rotary cable tool Depth of Well: 65 Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 65 feet Liner type Static Water Level: 10 feet Recovery Rate 35 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end Ropen 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 Ono Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 59 Clay & Gravel 59 65 Sand & Gravel Drillers Name: Cole Sullivan ATTENTION: It istheresponsibility 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 Parcel Identification Number: t www.suilivanwaterwells.com Pump Installation Log OSP171188 Date of Issue 7-26-2017 05038102000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. VITMXWI�Z �1.110 F-91 Y1, i MAINTENANCE AND REPAIR AGREEMENT MUNICIPALITY ;�; , ANCHORAGE ► ii THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 1� Day of of 20 Z1, by and between 1 `�w ancoc , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater' Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Waage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.55 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations Installation and Removal of Additional E ui anent. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. By•��� (signature) Date: (print name) STATE OF ALASKA } ) ss. THIRD JUDICIAL DISTRICT } The foregoing instrument was acknowledged before me this15� day of rWgL br f , 20 �k by 5 W -J�/'6 C^ -J,_ N . RI UBLIC FOR ALASKA x My Commission expires: 12.1 k • 23 MUNICIPALITY: By: X(signature) (print name) OFFICIAL SEAL FARM EUSLIC-5TAIE OFALASM MY COAR Ewes December 14, 2023 Date: a 3 ao 1 Title: 188.7' ;P cn — — --------------- — O ao \ ON llz\ t 4,I, ------------- '\ as �: \ o � SEPTIC SYSTEM \ \ \ 1 \ 1 "= 0' S 89055'46"E 412.07' e 30' RIGHT—OF—WAY ESMT. o (BK 2684, PG 291) co — WELL 0 AS-BU I LT GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. ZOOO E. DOWLING RD., SUITE I! ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID SW0260 F.B. 21-01 DATE 1/25/2021 JOB NO. HRS1 BUILDING 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE OF AL AV • •e e ju 49TH ° e eee•ee s• •• e0eee • • e• esee e•eeeeeeee rn ® Jeffery A. Gastaldi : aAIF LS -6091 t� •. 1/25/2021 °•• `Jm eaA °•eomeeee•°e a�J r0fessional ve" ll limits MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program POBox 18VO5o 47UOElmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Permit Number: CSP201107 Work Type: Septic Initial Tax Code Number: 05038181000 Site Legal Address: HARK8ANYRANCH - EAGLET AERIE LT 1 G:0260 Site Mailing Address: Owner SPiNELL HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit hyfor the construction of: 2 Disposal Field Z Septic Tank [] Holding Tank 171 Privy Effective Date Expiration Date: 5/19/2020 5/19/2021 Lot Size in Sq Ft: 61021 Total Bedrooms: 171 Private Well 11 Water Storage All construction shall heinaccordance 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 VVaatevvab*r Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Gen/|maa Department per AMC 15.65. Provide notification by calling (007) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. A test hole and additional percolation test(s) shall be provided prior to construction, in locations shown on site plan. If results require a design change, construction of the septic system shall stop pending review and approval of a change order. Please submit results with inspection report (or change order, if required). To close out this permit, please submit pump install log and water sample results. 3. Foundation footing drains shall maintain 10 ft separation to the absorption fields, including the outfall pipe, _ ?102t' - 1� ��� ~ -�-V- {}0°-\ '- - � 151 Received Date: / � /,�_s MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Parcel I.D. 050-381-81 Property owner(s) Spinell Homes Inc. Mailing address 1900 W. Northern Lights, #200 Site address NSN Harmany Ranch Road Day phone Legal description (Sub'd., Block & Lot) Harmany Ranch - Eaglet Aerie, Lot 1 Legal description (Township, Range & Section) Lot Size 61,021 Sq. Ft. Number of Bedrooms 6 l cct" ) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial 0 Single Family (SF) ❑X (w/wo ADU) Septic Tank RUpgrade 1-1Duplex (D) ❑ Holding Tank ❑ Renewal EJMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ 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: 5q 5 _ L( Li & • 2 Waiver Fees: Date of Payment: 5-1 l I ! 2L 2-b Date of Payment: Receipt Number: 6 C1 3C - Receipt Number: Permit No. 0._5 P 20 110? Waiver No. COVID-19 Permit App_ :•:-'.,c; 252o' DISCOUNT APPLIED Col 1 Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com November 20, 2020 Subject: Harmany Ranch — Eaglet Aerie, Lot 1 Septic System Permit Request Design Narrative This is a design narrative for a permit to install a new septic system to be issued for this property. The proposed systems will serve a proposed SIX bedroom (6) bedroom house. Currently the lot is undeveloped, with the exception of an existing well. This lot and the surrounding developed lots are or will be served by private wells. Required separation distances to wells will be maintained. 1. Soils. One test hole monitor tube was found on the lot by PES and groundwater was measured at 3.0' below grade in May. Test holes were allegedly performed on this lot by Michael E. Anderson in October of 2013 and September of 2017 (on file at the MoA). See note on plan sheet 1. One existing test holes was located on the lot by PES and ground water was found at a depth of 3 feet. A system has been designed to the worse case scenario logged and groundwater found in the test hole monitor tube. A new test hole was not performed to avoid damaging the roadway or lot until construction on the lot begins. New test holes will be excavated before construction of the system and a change order will be submitted if any modifications of the design are necessary. Based on the results of the percolation tests and overall soils appearance as presented in the subdivision soils report and based on worst case scenario; an application rate of 1 gallon/day/square feet was used for a CAT III wastewater system. 2. Soil Absorption System Design. a. 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. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the northeast to the southwest in the area surrounding the septic system at approximately 5%-15%. There are no steep slopes downhill of the system. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Steven R. Pannone, P.E. Anchorage Id al!li��. P.O. L�GX lt.Jv%!.I, ,� nC(iGtcsge, , \��? +�l-iii 1 7 Palmer Mailing: P.O. Bo 1807, Palmer, AIS 99645 Telepihone: (907) 745-8200 'FAX: (907) 745-8201 m DESIGN PARAMETERS *NOTE: PRIMARY/ RESERVE SEPTIC SYSTEM TEST HOLE MONITOR TUBES FOUND IN THE FIELD NO. BEDROOM: 6(900 gpd) DO NOT MATCH TEST HOLE LOCATIONS ON SUBDIVISION TANK SIZE: 3000g ADVANTEX TANK SOILS REPORT. TEST HOLE LOCATIONS SHOWN ON THIS W/ (2EA) AX20 PODS SHEET ARE FROM iPHONE GPS AND ARE AT APPROXIMATELY AND AUX PUMP VAULT 110' ACCURACY. EXISTING TEST HOLES ARE NOT LABELED AS THE LOCATIONS ARE VERY DIFFERENT FROM THE PERC RATE: 61-90 MPI SUBDIVISION SOILS REPORT. SOIL RATING: 1 GPD/SF PERCOLATION TEST READINGS ON SUBDIVISION SOILS REPORT AREA RQD: 900 SF ARE SUSPICIOUS. GROUND TOPOGRAPHY FROM SOILS REPORT DOES NOT MATCH THE ACTUAL TOPOGRAPHY OF SYS. TYPE: WIDE TRENCH 0.5'ED THE SITE. DISCREPANCIES ARE SUCH THAT THE SUBDIVISION MIN LENGTH: 180 LF SOILS REPORT DOES NOT APPEAR TO BE USABLE IN THE DESIGN OF A SEPTIC SYSTEM. THE SYSTEM WAS DESIGNED USE: LOT VACANT _PER WORSE CASE FROM THE SOILS REPORT, ALTHOUGH _ � SOILS HAVE BEEN FOUND TO BE BETTER THAN LOGGED (2EA) 90LFx5'Wx0.5' E.D., 0.0' TD NO WELL OR SEPTIC IN AREAS OF THE SUBDIVISION WHERE PES HAS PERFORMED TOTAL AREA: 800 SF TEST HOLES. A NEW TEST HOLE WILL BE PERFORMED TO VERIFY SOILS AND A CHANGE ORDER WILL BE REQUESTED \ I/ IF NECESSARY. TH—?? —/�30' ROW EASEMENT WATER @ 3' 5/1/2020— �t \ � � WELL (E) I L \ DRIVEWAY \ 5 BR \ HOUSE P 7005.2� TH-2(P) — DECK 30009 ADVANTEX TANK (P) � \ _ WITH (2EA) AX20 PODS A 10.61 ® WITH AUXILIARY PUMP VAULT —v 2 TH-1 (P ) s INSTALL FOUNDATION CLEAN OUT \ BALLAST TANK WITH PCCCONCRETE C� ss ss 8$ A" G o s ss �� s ' �J �FQ�y�F>' Z � va \ ss (3 ss \ \ �`\�sss .2 1 \ X F _ J � /- za _ L T 2� �o �A \ PRIMARY FIELD P Q (2EA) 90LF x 5'W x 05ED x 0.O'TD o ,� CONNECT TO MIDPOINT OF LATERAL w \ \ REMOVE ORGANICS AND INSTALL U t 1 FOOT OF SAND INSTALL MONITOR TUBE AT EACH END DRAINFIELD COVER NOTE: _ APPROXIMATE LIMIT OF FILL 1 MINIMUM COVER OVER DRAIN FIELD SHALL BE 2.5' WITH` ID INSULATIONSHALL R 3MAX.ITHOUT INSULATION, SIDE SLOP ` NOTES: _ ����® PAMONE ENG SVC LLC Dote pF q ��q FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 �� • . Cq. 1/20/2020 CHANGE ORDER PHONE (907) 272-8218 FAX (907) 272-8211 �c,'Fy�pa Scale DRAWN BY: 49 TH 1"=50' '• '•"'• P.I.D. NO DRM 11\. HARMANY RANCH —EAGLET AERIE, LOT 1 050-381—Si r Steven R. Pannone SPINELL HOMES INC. ® PERMIT NO. NSN HARMANY RANCH ROAD �$ I I. CE 814 . <z' OSP201107 PLAN EAGLE RIVER, AK 99577 ���IL&jjy-FESS . v Sheet 1 OF 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201107, Rebecca Carroll, 05/19/20 MUNICIPALITY OF ANCHORAGE ��ti�cnt On-Site Water &Wastewater Program ��� S•; -awe Box 196650 4700 Elmore Road �. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 z. g http:llwww.muni.org/onsite ,. epartmen r 4ry CH ORp0' On-Site Water System Permit Permit Number: OSP171188 Effective Date: 7/26/2017 Work Type: Well Initial Expiration Date: 7/26/2018 Tax Code Number: 05038102000 Site Legal Address: T14N R1W SEC 22 NW4NW4 AND S2NW4 G:0260 Site Mailing Address: 8251 HARMANY RANCH RD, Eagle River Owner: HARMAN JERRY Lot Size in Sq Ft: 5227200 Design Engineer: Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑ 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 Special Provisions: When well testing is complete, the well driller shall place an approved sanitary seal on the well head and no pitless adapter or pump shall be installed until an approved wastewater disposal system has been constructed. i lm ����.' - Date: 7p-ye' 7 Received By: , Issued By: . VAT , ", ,« Date: 7://i-6/17 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/VVELL PERMIT APPLICATION Parcel I.D. 0 S —'381 - 0 5y, g) - 3 J&" Property owner(s) JIf IC('1/4.1 kl-e r o -v - Day phone Mailing address 'b 60-y . )41 1 - LU&S, II Iq (6 e(rj 1iS7 Site address GAG v' .r,..v`"� I2 c -4-Jig t 7/ Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T, C{ N e1 to See. Da. 1,Li N to y a►ld15,)ej )L' Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E Initial El Single Family (SF) rA Septic Tank (w/wo ADU) ❑ Upgrade ❑ Holding Tank E Renewal Duplex (D) El❑ Multiple Dwellings E Privy E (SF and/or D) Private Well 1 .1 Water Storage E THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: � , Mt) 94113 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: 4 Z I Waiver Fees: Date of Payment: 07-' 17--1 7 Date of Payment: Receipt Number: 526g24 Receipt Number: Permit No. OSP/1-01 Waiver No. Permit App_9-1-12.doc MOA CASE NO. S12058-1 HARMANY RANCH SUBDIVISION PROPOSED LOTS 1 - 12 Q„o ,ase w.e..(( CIC444,40 V 30' RIGHT-OF-WAY ESMT. (BK. 2684, PG. 291) �,��” t � �i�-11 S 89°55'46"E 475.08' 0.1..,, POWER POLES 3.01• �'00 '•" N 412.07' n SS w N 1� - -EXISTING ` - - - - '?SO.3649, /. \ SHOP .-� S F 4 / \ \ t, �,_ rS) 1 \ ..--- \ \` LOT 1 \c � 'ss�, s 4 \ `1,021 S.F. A, Vt)\ a fid'\ ,,.. ' a,. 5rT3 (9 sXJ moo•°B. \ `� ��; ��` EXIS TNG , E� .7.7., J err \ `0 \ -� ELL O I ° -1.c.a„- `'2 S 70 \ 6: \ ^ TRANSFORMER • S� 4.S (;',.1 .6 \d� \ C �rp0' 4:17s E PH(NJE 702 L16"'' LOT �0 •8 \ 67,060 S.F. A. `�C\ ?• F 03 \ �O \ 'V llr CP Rix• IP 4:3in * \ ert.ti, A r �0o 05. \ LOT 3 LOT 85,728 S.F. p �,is o �cP N 49,095 S.F. \ ot C� \ ory ' iNi \- Ga, \ , S a \ s?6'9 A) s`"S[e d 99 7�. a 9.7-.b, \c\s \ \ soh s�. 77'F 7 Z 9, \ LOT 4 s'4 �6e7D`� \ s tr �8jo\, 87,421 S.F. , >>S•• �• CO CO <V�, \'s• `i>> LOT 5 �h-,. LOT 11 �'o~ \ \ °\ ��� 73,029 S.F. 14, MUMUPAUTY OF ANCHORAGE Development Services Department" " On -Site Water &Wastewater Section Phone. 907-343-7904Fax: 907-343-7997 Parcel I.D. 050-381-81 Certificate of On -Site Systems Approval Expiration Date: (� — 17-2,©z Z, 1. GENERAL INFORMATION Complete legal description Harmany Ranch - Eaglet Aerie Lot 1 Location (site address) 5:--3,5-3 Harmany Ranch Road Current property owner(s) Spinell Homes Day phone Mailing address 1900 W. Northern Lights Blvd, #200 Anchorage, AK Real estate agent Day phone 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $,j Waiver Fee $ Date of Payment Cv 2C9 Date of Payment Receipt Number ��nn VZ Receipt Number COSA # VS� _ 22.S Waiver # 5. 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 for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA 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 year, and the water usage of the family being 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 of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date 6. DSD SIGNATD; E , ,i System #1 Approved forbedrooms "steven' r'anncne•� System #2 Approved for bedrooms �����c CE 8149 E� 6 Disapproved _ -Conditional approval for bedrooms, with the following stipula I ll�i«Mrrrr�r OF q�Cc���i�_ a e _ - azo By: I ,',-''� Original Certificate Date: 2, The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet J_(\_� a e _ - azo By: I ,',-''� Original Certificate Date: 2, The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Harmany Ranch - Eaglet Aerie L1 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA W Well log is filed with Onsite (or attached) Date drilled 8/3/17 Total depth 65 ft Cased to 65 ft 0 Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA fif- Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material STEP1Stcd Measured operating fluid level in septic tank n/a Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Mound Which system tested (date installed) 7131202' H ALL standpipes present per record drawing Total measured depth from grade 4.0 ft (max) Measured depth to pipe invert from grade ft (min) MR N/A — pressurized field Q Monitor tubes go to bottom of effective. If not, state depth into effective R Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced n/a gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-381-81 Structure served by this system 1 r Well production at time of test I gpm Water storage tank volume ''_ gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ID Coliform bacteria is Negative Nitrate mg/L �t Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by pl� 5 Date of Sample '3a -a C. LIFT STATION W Required maintenance completed Age of lift station 0 years Lift station material F,bw9!ass Comments: Adequacy test date n/a Results ❑✓ Pass For 6 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'[Z] Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft M Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage? 100' Community Sewer Main > 75' Q✓ Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5[]✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ❑✓ Yes if No _ Water Main > 10' Yes . if No ft Community Wells > 200' Q Yes " if No Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No 5.9* ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *AWWTS 5.0' G. ENGINEER'S CERTIFICATION OF I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with: ! MOA COSA guidelines in effect on this date. 22fJ j� .. - _ Steven R. Pannone -CE 8149 �Fp��OfESS10:•A�- COSA Checklist yellow sheet ft ft. ft MUNUPAUTY OF ANCHORAGE Development Services Department _' On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-381-81 1. GENERAL INFORMATION Expiration Date: - Complete legal description Harmany Ranch - Eaglet Aerie Lot 1 Location (site address) 535_3 Harmany Ranch Road Current property owner(s) Spinell Homes Day phone Mailing address 1900 W. Northern Lights Blvd, #200 Anchorage, AK Real estate agent Day phone 2. TYPE OF DWELLING: [] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well j] Private Septic [i Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: - _ — - Distance: Received by: Date: COSA to be released to the engineer. unless otherwise requested by the engineer. Date of PaymentVd z Receipt Number m 8 , COSA#_ r ZZA'S� Waiver Fee $ Date of Payment Receipt Number Waiver # 5. 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 for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA 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 year, and the water usage of the family being 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 of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved ;Conditional approval for Phone (907) 745-8200 Date y OF 0 Steven RPan 'annone CE 8149 bedrooms, with the following Stipul I OF � _s' nt.t CITE n !a 6:fi JJi Oi�e G �J 1� BY j 1 f't't �",n A!!57 Vl Original Certificate Date: -11 2, dt>_z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet c - 1`t�lvf�1 (.ii tly:. IF` Legal Description: Harmany Ranch - Eaglet Aerie L1 Parcel ID: 050-381-81 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA R Well log is filed with Onsite (or attached) Date drilled 813/17 Total depth 65 ft Cased to 65 ft Q Sanitary seal is functioning correctly RRI Wires are properly protected Casing height (above ground) 24 Jn. Date of flow test for COSA 7 Static water level at beginning of test 'Cft. Comments B. TANK DATA' Age of tank(s) 0 years Tank type/material VERS1.11 Measured operating fluid level in septic tank n/a Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Mound Which system tested (date installed) ...3"' 0 ALL standpipes present per record drawing Total measured depth from grade 4.0 ft (max) Measured depth to pipe invert from grade ft (min) N N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test �;6 gpm Water storage tank volume f gallons Well disinfected for coliform test? ❑ Yes Q No Q Coliform bacteria is Negative Nitrate mg/L (y Nitrate less than MRL (ND) Arsenic ug/L �4 Arsenic less than MRL (ND) Collected by p<2 5 Date of Sample � 4a C. LIFT STATION ®❑ Required maintenance completed Age of lift station 0 years Lift station material FC0'9`'55 Comments: Adequacy test date n/a Results j]✓ Pass For 6 Fluid depth prior to test — Water added gal New depth in Elapsed time min - bedrooms in * Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced n/a gallons If yes, enter date COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ✓�D Yes if No ft �✓ Yes if No fl Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25'El Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50'[]✓ Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100'® Community Sewer Main > 75' ElYes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' n 'ves ' if No ft Community Wells > 200' Q Yes - if No ft Water Service Line > 10' Q Yes • if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation.> 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 5.9* ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft. Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *AWWTS 5.G' G. ENGINEER'S CERTIFICATION 1 certify that I have detennined through field inspections and review of Municipal records that the above systems are in conformance with COSA Checklist yellow sheet Stsi%en t?. F'onnone CE 8149