HomeMy WebLinkAboutROCKHILL BLK 2 LT 9APockHill
Block 2
Lot
9 A
#015-362-:36
Department of Health and Human Services
Building Safety Diviston
On-Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of
www. ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
Permit Number: swSW030031 PID Number: 015-362-24
Name: Wastewater System: [] New [] Upgrade
K~_llv ~, i~nrr~n Tnlmndn~.
Address:
3060 Lore Rd.. Ant Fl. AnchoraGe. AK 99507 ABSORPTION FIELD
Phone: Number of Bedrooms:
332-2430 5 ~ DeepTtench n Shallow Trench I-I Bed I-I Mound I'1 Other:.
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION 0,6 ~,~:~ 9-10' F,.
Block: Lot: Subdivision: Depth Io pipe bottom from odginal grade: Gravel depth beneath pipe:
2 9 Rock Hills SID 4-5 F,. 6' F~,
Township: Range: Section: Fill added above odginal grade: Gravel Length:
0 F,. 105'
Well: [] New [] Upgrade G~av~dth: 3' Ft. Numberoflines:~ ~l Distance between lines:Fl.
Classification {Private. A. B. C): Total Depth: Cased Io: Total absorption area: Pipe Material:
P 82 n. 77 Ft. 1260 F~ 3034PVC
Ddller. Date Ddlled: Static Water Level: Installer:. Date Installed:
Alpine Drilling 411/2003 45 n. Beek Contracting 101812003
'~e,d: I ""mb set at:Cas,n..e,ght ~ove Ground:
TAN
K
40 cP.I F,. 2
SEPARATION DISTANCES [] Septic I~ Holding r-I S.T.E.P. [-I Other:
Septic Absorption Lift Holding =ublic/Pdvate Manufacturer: Capacity:
Tank Field Station Tank Sewer Une Anchorage Tank Steel 1500 c~.
Material: Number of Cornpadments:
we,, 131.6 t19.1 124 Steel 2
Su.a~Water 100+ 100+ ~ / LIFT STATION
Size: Manufacturer:
~ot Une 10 5,4 14,2 Gal.
· Pu,~ on' lava~ at: 'Pu.~ o,' ~eve~ at: I .,h ~ter.~ar~ at:
7
6
9
Foundation
In, In.I In,
ca,in ~,n 75+ 75+ Pu,~ Make & Model Electrical Inspections performed by:.
Ra""'~: BENCH MARK
Location and Description:
Garage Slab
Assumed Elevation:
100.0 R.
Engineer's Stamp
Inspections performed by: Pannone Eng. Svc Dates: 1'f101812003
2n~10/08/2003 .
Department of Health and Human Services approval
Z/~-f/o___ './
Reviewed
and
approved
by:
Date:
, ,
(rav..,~) ~
~,,,,._EX I S T'O
SEPTIC
PERMIT NO: SWD30031
AS-BUILT
WATER & WASTEWATER DISPOSAL SYSTEM
LOT 9, BLOCK 2 RDCK HILL S/D
\\\ ~ EXIST'OJ
,,, X WELL
· / \\
\EXIST G_/
EPTIC
M1
LE
PRIMARY FIELD
105LF x 6' EFTV· 9'
1
P.I.D. ND: 015-36B-24
I
I
/
/
/
/
/
LOT UNDEVELOPED.
NO WELLS OR
W/IN 200 FEET
LL RADIU
WELL
RESERVE
105LF x 6'EFTV, 9'
5 BR
'IC TANK
18
LOT UNDEVELOPED.
NO WELLS OR SEPTICS
W/IN 800 FEET
EXIST'G WELL
.~ .~ .~ .~ ~DI~
t
I
I
DESIGN: '
PERC RATE= 16-30 MIN/INCH
250 SF/BR, 5 BR HOUSE
1~50 SF REQUIRED
DEEP TRENCH SYS, 6' EFF.
105 LFx 6% 9.0' TOTAL DEPTH
T~TAL AREA=1~~O~
1500g SEPTIC TANK
PREPARED FOR:
Keity & Darren Tatmadge
3060 Lore Rood, Apt FI
Anchorage, AK 99507
344-2075
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE· ALASKA 99510
227-3522 P· 272-8218 Fox
DATE: 11-85-03
DESIGN
~C~ALE: 1°:60'
P.I.D. NO.
O15-36P-E4
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 9 BLOCK E ROCK HILL S/D
SWING-TIES
CO A B C D
FC1 5.0 11.7
FC2 5.4 12.0
T1 9.4 1E.5
T;3 19.4 19.4
PT1 ;38.5 ;38.7
PTP ;39.4 ;39.8
C1 1;36.0 131.0
M1 1;~4.6 1;39.1
M;3 86.7 77.4
C;3 86.8 7%;3
~ WELL 68.9 45.2
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PREPARED FOR:
Kelly & Dopren Tntn~dge
3060 Lore Ro~d, Apt F1
Anchor(~ge, AK 99507
344-2075
PERMIT ND. SW030031
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PANNDNE ENG. SVC.
P. O. BDX 148025
ANCHDRAGE, ALASKA 99514
274-0308, 272-8218 FAX
DATE: 11/25/03 I
NOT TO SCALE RECORD
· ~ ""~Rb~: IL.PINE DRILLING Ft:~ ND. : .~7 245 02~2 Nov. 26 2~03 10:25Atl P2
Municipality of Anchorage
Department o! H:~a~t. th' sa~n~tHuman Servioes
P.O. B~x 19~50 An~o~ge. ~a~ 99519~550
R~ Myst~m ~./~.¢l~n~o~e.~.~
Permit Numbe~ ~SW 03~3~ Date of~sue: ~ Parcel Id~tifi~fion Number: 0f~362-24
Date $~: 4-~-Q3 Date Com~e~: ~3 ~ well l~ at ~pmv~ p~t l~afion~ ~-~ ~ No
Legal Deseripflou:
Property Owner Name. & Address:
~or~7~h///B/k 2 Lt 9
Kelly & Darren Talmadge
3060 Lore Road
Depth (it)
99507 ,,
Method of Drillh~S [] airrotary [] cable tool
Soil Type, Thld~c-~ & Wazer Strata From To
stick-up 0 2
organics & zilt w/ bldr$ 2 27
si~ gmvel 21 55
g~v~ ~ 65 76
si~ water ~nd & grovel 76 82
Casing type:
Wall Thiel~ness: .250 ineh~
Di~netcr: ti inches Depth: 7__7
Liner Type:
Diameter: , inches Depth: feet
Casing sfickup above ground: ~, feet
Static water level (from ground lex, el): 45 feet
Pumping level: ~ feet n.Rer
g hours pumping aO gpm
Recovery Rate: 40 gpm
Method of Te~ttng: air I~
Well Intake Opening Type:
[] Open End [] 09ca Hole
[] Screened Start _ feet Slopped, , feet
[] Perforations Start ~ feet Stopped 8~ fi:et
Grout Type: ,{?¢r~oohe ~ Volume: 1
Depth: Start t~ fc~t Stopped .9 feet
Pump: Intake Depth _ feet
Pur~!_p size. _ _ ...,_hp Brand Name
Well Disinfected Upon Completion.'/[] Yes [~] No
Method ofDi.~infeetlon: r. hlqrlne tablets
Comments:
Well Driller.
Alpine Drilling & Enterprlae$
PO Box f10496
Anchorage Alaska
Attention: The well driller $halI provid~ a welt log to the property owner within 30 days of completion and the property
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Mar 04, 2003
Expiration Date: Mar 03, 2004
Permit Number: SW030031
[_L'_e~! a-'l '. D~'~:?Jl5 ti°-ff.'7.R O.~ ..K. ~[L_L~B L_.K~'f 2 'LT.5.9.1 ~/
Design Engineer: 0062 Pannone Engineering Services
Owner Name: Kelly & Darren Talmadge
Owner Address: 3060 Lore Rd. Apt F-1
Anchorage, AK 99507-
Parcel ID: 015-362-24
Site Address:
Lot Size: 49518 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
E~ Disposal Field E~ septic Tank
F'-] Holding Tank E~ Privy
Private Well
Water Storage
Ail 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 ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Parcel I,D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
wWW.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Property owner(s) Kelly & Darren Talmadqe
Mailing address (1) 3060 Lore Road, Apt F-1
Mailing address (2) Anchorage, AK
Legal description (Lot, Block & Sub'd.) Lot 9, Block 2 Rock Hill SID
Legal description (Section, Township & Range)
Lot Size 49,518 Acres/Sq. Ft.
Day phone 644.2450
Number of Bedrooms 4
Zip Code 99507
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTYCONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Fees:
Date of Payment:
Receipt Number:
Pannone Engineering Services, I, LC
Consultin§ Engineers
(907) 272-8218
P.O. Box 102954
Anchorage, Alaska, 99510
January 19, 2003
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Lot 9, Block 2 Rock Hill S/D
Well & Septic System Pei-mlt Request
Gentlemen:
My firm was contacted to investigate the possibility of installing a new well and septic system on
the above referenced lot. The record was researched to find the location of the surrounding wells
and septic system. Two test holes were excavated on December 21, 2002 on the lot. The soils
report and a percolation test resuRs are attached. Ground water was monitored for greater than
seven days. No bedrock or ground water was encountered in the test hole. The proposed upgrade
and reserve area are located greater than 100 feet from any surface water.
The lot is approximately49,518 square feet in size. Lot 9 slopes to the north at approximately 2
percent in the area of the test holea The proposed systemwill be located on the northern portion
of the lot. The lot will be served by a private well. The proposed septic system is greater than 100
feet away from proposed and neighboring wells and 25 feet from the proposed water service lines.
The surrounding x~ells are located greater than 100 feet from the proposed installation. The
proposed installation will not affect the future development of the surrounding or existing lots.
See the attached design.
If you have any questions or concerns, please contactme at 227-3522 or 272-8218.
Steven R. Pannone, P.E.
Civil Engineer
Attachments:
C: \Work\Letters\9-2Rock Hill.001.doc
PERMIT NO~ SW03
~,,,_EXIST'G
SEPTIC
PRDPDSED RESERVE FIELD
105LF x 6' EFTV, 9' T.D;
DESIGN DRAWING
WASTEWATER I)ISPBSAL SYSTEM
LOT 9, I)LOCK P ROCK HILL S/])
EXIST'GY
WELL
\\\ '
P.I.D. NB,
I
I
/
/
/
/
/
LOT UND ED.
ND WELLS BR )TICS
W/IN 200 FEET
2BPBSED WELL
PRBPBSED PRIMARY FIE
105LF x G'EFTV, 9'
PROPB,~
NB WELLS BR SEPTICS
W/IN 200 FEET
EXIST'O ~/ELL
//' SEPTIC]
NOTE,~ /
1) ALd, ZWORK WILL ~E PERFORMED
IN ACCBRDANCE ~ITH, & ALL METER
DE INSTALLED AT TIME BF INSTALLATIBN.
'PREPARE]) FOR'
Kerry & Dc~rren T(xtm(xdge
3060 Lore Ro(xd, Ap't FI
Anchorage, AK 99507
344-2075
HOUSE
· ~e~e &
/
/
/
~ I
~ t
~50 SF/BR, 5 BR HBUSE
1850 SF REQUIRED
DEEP TRENCH SYS, 6' EFF.
105 LFx 6'~ ~,0' TBTAL DEPTH
TBTAL AREA=3OaO SF
1500g SEPTIC TANK
IPANNDNE ENG. SVC, LLC
P. 0. I)DX 102954
ANCHDRAGE, ALASKA 99510
227-3522 P, P72-8218 F(lx
sATE, 1-19-03
I
I) ESIGN
CALE. 1'=60' I
PI,D, NO,
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 9 BLOCK 2 RnCK HILL S/D
PERMIT ND. SW03
ldZ
~-
PREPARED FOR,
3060 Lore Road, Ap~ F1
Anchorage, AK 99507
344-2075
I,I
PANNDNE ENG. SVC.
P. O. BOX 142025
ANCHDRAGE, ALASKA 99514
274-0308, 272-8218 FAX
BATE, 1-19-02 I
INDT TO SCALEI DESIGN
PERMIT NO, S~/03 P.I.D. Nn,
~",~_EXIST'G
SEPTIC
DESIGN DRA /ING
~/ASTE~/ATER DISPOSAL SYSTEM
LOT 9, BLOCK 2 ROCK HILL
CC:~~~ J~ [\\\\ \ o
EXIST'GY
~tELL
\
\
\
PROPBSED RESERVE FIELD
BSLF x 6' EFTV, 9'
/
/
/
/
/
/
/
/
LOT
NO ~/ELLS BR ~TICS
~//IN 200 FEET
~DPBSED WELL
PROPOSED PRIMARY FIE
BSLF x 6'EFTV, 9'
PRBPO,~
LOT UN])EVELDPED.
ND ~/ELLS DR SEPTICS
~I/IN 200 FEET
TANK
L%
EXIST'G ~/ELL
I
z~ ..../- EPTIC'7 // SEPTIC-] //
1) AtdZ~ORK ~/ILL BE PERFORMED
IN ~CCDRDANCE ~/ITH, & ALL METER
PRDPDSE']~4
hOUSE
2) ADD A MINIMUM DF 1' DF FILL OVER
ENTIRE TRENCH.
3) CONTRACTOR SHALL STACK LOT LINES
AND ~/ELL RADIUS ]~EFDRE CDNSTRUCTIDN
4) I)DTH PRIMARY & RESERVE SYSTEM MAY
DE INSTALLED AT TIME DF INSTALLATION.
PREPARED F'DR~
Ket[y & Dc~rren Tc~[mc~dge
3060 Lore Roc~d, Ap't F1
Anchor(zge, AK 99507
344-~075
PANNDNE ENG, SVC, LLC
P, D, BOX 10~954
ANCHORAGE, ALASKA 99510
~7-35~ P, ~7~-8~18 F~x
])ATE, ~-19-03 I DESIGN
SCALE, 1'=60'
I
DESIGN, '
PERC RATE= 16-30 MIN/INCH
~50 SF/DR, 4 DR HOUSE
1000 SF REQUIRED
DEEP TRENCH SYS, 6~ EFF.
85 LFx 6', 9.0' TOTAL DEPTH
TDTAL AREA=lO80 SF
12509 SEPTIC TANK
14
/
/
/
\ /
\ /
\ /
\ I
\ I
P,I,D. ND. PERHIT NB. 8;/03
DESIGN DETAILS
WASTEWATER ABSBRPTIBN SYSTEH
LOT 9 BLOCK 2 ROCK HILL S/D
wZ
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wry
C.\Work\])r~wlng$\9-PRockhlils.dwg
PREPARED FBRI
Kel, ty & I)~rren T~tmctdge
3060 Lore Ro~d, Ap'l; F1
Anchor(~ge, AK 99507
344-2075
I,I
PANNDNE ENG. SVC.
P. 0. BOX 142025
ANCHDRAGE, ALASKA 99514
274-0308/ 272-8218 FAX
I)ATE, 1-19-03 I
NOT TO SCALE: AS-BUILT
IJMIAL DESCRN'HON:
l'gST HOLg I
P.O. BOX 102954
ANCHORAGE, AK 99510
Lot9~ Block 2 Rock ]~I1
I~ht Bemm ~.T
DATE PI~FORMED: 12-21-02
IF YE8~ AT WHAT
DKPIli? -4).0-
DB:PTH TO WATER AFl'ER
MONrI~RING? DRY
hATE: '~-18-03
1/8' ! 7/8'
3/8'
1/2' 1 7/8'
1/4' -
~/8' ! 7/8'
RATE ,16 .u,~/tneb} ~ HOL~ DL~'r~ 6 fnc~e~
TEST~~ 6~7~
PERFO]~,t~.r~ BY: Steven R. p~,,e,~,% P.E. I CER'IYNY THAT THIS TF, ST WAS ~RMED IN ACCORDANCE
ALL STATE AND MUNI~.~-'AL OUTLINES IN ~ra~"r ON TI-Is DATE OF ~ TEST.
~y.~ ~. ~~ ~
PANNO~ F.,NGII~G SRRVICJ~
P.O. BOX 10'2954
ANCHORAGR, AK 99510
('207) 272-8218
Fm~ORm:D FOR: w,,~, & Derr~n ~
~ DESCRIPFION:
Lot 9,13~cJc 2 Rock Hm 8/D
8m2do & fliLT8
Uam o,,,eur
WA~ GROUND WATER
mO0~
DATE PKlU~~ 1221-02
NO
I~ ~, AT WHAT
DI{IP'II~ -0-
DI{IPllt TO WAI1{IR AMII{IR
MONITORINGP Dr~
DATR: 1-18-03
~HOL~
PERla'O~n BY: 5teven R. pA,,.,.,m~,,,~ P.E. I CEI/'IIFY THAT THIS TEST WAS PERFOIi, um~r~ IN ACCORDANCE
ALL STATE AND MUh-itPdt,AL OU--~LDiT!;8 IN ~,lqq!;t~ ON THE DATI!; OF THVIS ~lt;8T.
Municipality of'Anchorage
Department of Health and Human Services
825 "L" St~.eet
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom http:/N,,ww, ci.a nchorage.ak.us
Mayor
Permit Number: #SW ,030031 Date of Issue: 3-4-03 Parcel Identification Number: 015-362-24
Date Started: 4-1-03 Date Completed: 4-1-03 Is well located at approved permit location? [] Yes [] No
Legal Description: Rockhill Bik 2 LI 9
Property Owner Name & Address: Kelly & Darren Talrnadge
3060 Lore Road
Anchoa~le, Alaska 99507
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
stick-up 0 2
organics .& silt w/ b/dm
silty gravel 21 55
gravelly silt 55 76
silty water sand & gravel 76 82
RECEIVED
bt Y 2 3 200
Per..c:2: ......
Method of Drilling [] air rotary [] cable tool
Casing type: steel
Wall Thickness: .250 inches
Diameter:/5 inches Depth: 77 feet
Liner Type: ~
Diameter: __ inches Depth: __
Casing stickup above ground: _2 feet
feet
Static water level (from ground level): 45,feet
Pumping level: 82,,feet after
_2 hours pumping 40 gpm
Recovery Rate: 40 gpm
Method of Testing: airlift
Well Intake Opening Type:
[] Open End [] Open Hole
[] Screened Start feet Stopped ~ feet
[] Perforations Start 79 feet Stopped 82 feet
Grout Type: Bentonite #8 Volume: I bg
Depth: Start 0 feet Stopped .9 feet
Pump: Intake Depth __ feet
Pump size hp Brand Name
Well Disinfected Upon Completion? [~ Yes [-'1 No
Method of Disinfection: chlorine tablets
Comments:
Well Driller:
Alpine Drilling & Enterprises
PO Box 110496
Anchorage Alaska 99511
Attention: The well driller shall provide a well log to ~e property owner within 30 days of completion and the pr,operty
Parcel I.D. IJ
Certificate of On -Site Systems Approval
Expiration Date:
Legal description ROCKHILL BLK 2 LT 9A
Site address 6420 SHALE CIR Anchorage AK 99507
Current property owner(s) TALMADGE
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
M
Original Certificate Date:/ I -.VZ.
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 Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovMjune 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department I� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application 1
1.- GENERAL INFORMATION
Parcel I.D. 015-362-. 3 �o
Complete legal description Rockhill B2 L9A
Location (site address) 6420 Shale Cir ANC
Current property ,-% Darren and Kelly Talmadge
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑Q Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age _ - See advisory if steel 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 $ 1C)
Date of Payment ea 3 2 3
COSA# 0 S C Z 3 (z �0
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: Rockhill B2 L9A
Parcel ID: 015-362-24
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 04/01/03 Total depth 82 ft
Cased to 77 ft
❑N Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) 24" in.
Date of flow test for COSA 06/28/23
Static water level at beginning of test 45.1 ft
Comments
B. TANK DATA
Measured operating fluid level in septic tank 5
Date of pumping 07/06/2023
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/08/2003
❑■ ALL standpipes present per record drawing
Total measured depth from grade 5.08 ft (max)
Measured depth to pipe invert from grade 3.33 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 1.2-1.5
❑ 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:
COSA Checklist June 2022
Well production at time of test 4.9 gpm
Water storage tank volumena gallons
Well disinfected for coliform test? ❑ Yes 0 No
9 Coliform bacteria is Negative
Nitrate 6.04 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L *]Arsenic less than MRL (ND)
Collected by PES
Date 06/28/23
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 06/28/23
Results ❑■ Pass
Fluid depth prior to test 0
Water added 600 gal
New fluid depth 0 in
Elapsed time 123 min
Final fluid depth 0 in
a
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 72 in
Effective depth used 57.6 in
Effective depth remaining 14.4 in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
QYes if No ft Fol Yes if No ft
Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft
Absorption Field on Lot > 100' W Yes if No ft Holding Tank > 100' ❑■ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft
Yes if No ft
—Manure/Animal-Excreta-Storage->-1 00' —
Community Sewer Main > 75' RYes 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 Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0 Yes
if No
ft
Surface Water > 100'
❑■ Yes if No ft
Tank to Property Line > 5'
❑■ Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑E Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
❑N Yes
if No
ft
Community Wells > 200'
■❑ Yes if No ft
Water Service Line > 10'
Q Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
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 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.��
Name of Firm Pannone Engineering Services *~'40X ':*'
.. ....
Engineer's Printed Name Steven R Pannone P.E., F. ASCE
Phone 907-745-8200
COSA Checklist—June 2022 Date 08/04/23
CE 8149
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC231280
Subdivision: Rockhill, Block: 2, Lot: 9A
A water sample revealed a nitrate concentration of 6.04 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
k } Y r
Mailing Address P O Bax 196650 *Anchorage, Alaska�99519 6650 *www morn org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component offertilizer"and wastewater. Often the nitrate is inthe -form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P D Box X96650 *Anchorage, Alaska 99519 6650 *www muni org
SHALE CIRCLE
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Taylor L. Dosch
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