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Home My WebLink AboutNULUKATAK LT 3 G'--~,TER ANCHORAGE AREA BORO' b~PABT~IENT OF EN¥1RONMENTAL 3500 TUDOI"~ ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELl LIQUID CAPACI]Y GALLONS. MAI'ERtAL. t/'~':/Z"( ~X :'z: ''~/ INSIDE LENGTH NUMBER OE COMPARTMENTS ~/,~/.///"z"t 2: ,/~) LIQUID INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PlI: NUMBER OF PlI'S / OUTSIDE DIAMETER_ L,N,NO MATER,A ' - NEAREST LOT LINE___ . .... OR W DTH___/(; , LENGTH~/~~ ' , DEPTH_ D~STANCE EROM WELL /,¢'F~"" BUILDING FOUNDATION TO~AL EFFECTIVE ABSORPTION AREA (WALL AREA) ,~.': ~ SQ. FT. TILE DRAIN FIELD: _.:~ : -~ ' .... -~. TOTAL LENGTH DISTANCE FROM WELL ___~,?' , FOUNDATION ~"~-, , NEAREST IO1 LINE .... OF LINES NUMBER OF LINES ..... -" DISTANCE BETWEEN LINES_ TRENCH WIDIH 1131f-(OTAL EFFECTIVE ABSORPTION AREAL SQ. FT. LENGTH OF EACH LINE "~-~ ~'~ DEPTH: TOP OF TII E TO FINISH GRADE DEPTH OF FILTER MATERIAL BFNEATH TILE IN. ABOVE TILE___ WELL: -~ .-- DISIANCE FROM 7-' / WATER , TYPE /~'~,~,/~,/-/~ __, DEPTH , BUILDING FOUNDATION _._~ ~ SAMPLE.,r'/L;('/~'';~' ' , NEAREST NEAREST ~.. SEPTIC / SEEPAGE ,' ~_ OTHER LOT LINE ~ , SEWER LINE __,TANK ,//~ , SYSTEM ,~("(~ , CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM DISTANCES: DATE GREATER ANCHORAGE AREA BOi--,:OUGH DEPARTMENT OF ENVIRONMENTAL OUALITY 3800 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCR]PTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD , OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS '~'~ /~- ,~_~/?~f¢/.2~ /~?.~' NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEB'l' FINAL INSPECTION: 24 HOIJR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK .SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER. LAKE, STREAM. ., DRAIN FIELD , DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY Or LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, DATE APPLICANT'S SIGNATURE LOCATION OF WELL (Pleale complete either la, tb or lc.) WATER WELl.. RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical SBrveys Orilling Permit No. A.D.L. No. lc.il DISTANCE ANO DIRECTIO~R~OAO INTERSECTIONS 3. OWNER OF WILL: JJ Address: Street Address and Area o~ Well Location Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION 2. WELL LOG Surface Malerl~l Type Top Bottom ~..1~ ¢ ~C{/C ~ ~ 6. ~Cable ,ool OR°tory ~Driven ~ Dug 9. FINIS~ OF WELL; Type: Dlameler: ~ m. STeTro WATER LEVEL: ~ ~ Above or surface ~ Equipment used: I~. PUMPING LEVEL below land surface and YIELD -- /~ ft. after ~hrs. pumping ~ 1~.GROUTI~6 W~ll Grouted: ~ Vo* ~ No Material: ~ Ne~t Cement ~ Other: ~3, PUMP: (if available) HP -- Length of Drop Pipe fl. capocily ~g.p.m. 14. REMARKS: co~T~cro~'s WATER WELL OERTIFICATION; 15, Waist T~mperolure ~o ~ F ~ C Address: Authorized Representolive Fnrm 02'WWR (11/81) COpy Oistribution; WHITE-Stole DGGS~ PINK-Driller, CANARY-Cuslomer MUMCh"PAUTY OF ANCHORAGE Development Services Department ----� ��'� =� -� �~ V T- _ p p/ Phone: 907 343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-013-43 1. GENERAL INFORMATION Complete legal description Location (site address) Nulukatak Lot 3 12900 Patrick Road Current property owner(s) John Jenson Mailing address Expiration Date: Day phone Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic 0 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. COSA Fee $---'D -5d/ 6 Date of Payment 9 C2 0a a Receipt Number OQ 7 3 q G Waiver Fee $ Date of Payment Receipt Number COSA # 0-5 e 2-2 12�; -j 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 Phone (907) 745-8200 Date 20220609 Conditional approval for bedrooms, with the following stipulations: YO�� .`� 0A1�z � � grFR rF o Ro �r B Original Certificate Date: L 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: Nulukatak Lot 3 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Parcel ID: 017-013-43 Structure served by this system 1 A. WELL DATA 44,3 ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled 6/1/1970 Water storage tank volume NA gallons Total depth 185 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to Ukn. ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 3.73 - mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12 in. Collected by PES Date of flow test for COSA 516222 Date of Sample 5`27'22 Static water level at beginning of test 23.3 ft Comments FIELD TEST CONDUCTED PRIOR TO WELL 5/09%2022 B. TANK DATA Age of tank(s) °"""' years Tank type/material CONCRETE Measured operating fluid level in septic tank NA ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/3/2022 D. ABSORPTION FIELD DATA SEEPAGE PIT C. LIFT STATION ❑ Required maintenance completed Age of lift station. years Lift station material Comments: Which system tested (date installed) 1971 Adequacy test date 5/9/2022 ❑ ALL standpipes present per record drawing Results [V Pass For 3 bedrooms Total measured depth from grade 12 ft (max) Fluid depth prior to test 7.5 in Measured depth to pipe invert from grade NA ft (min) Water added #500 gal ❑ N/A — pressurized field 26.5 ❑ Monitor tubes go to bottom of effective. If not, state New depth in 31 depth into effective sEEcOU Elapsed time min ❑ Code -required soil cover over field Final fluid depth 7.5 in H System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 09 allons If yes, enter date Comments/Deficiencies: CRIB ONLY CONTAINS CLEANOUT COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) L!J Septic Tank/Lift Station on Lot > 100' 75 ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft �j✓ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'[D Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100'✓Q Yes if No ft Neighboring Absorption Fields > 100' ft If septic tank is under driveway comment below Animal Containment > 50' Q Yes if No ft 121 Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft Cj✓ 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' QQ Yes if No ft Property Line > 5 L!J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100' M Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' E] 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10'[]✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS SYSTEM INSTALLED UNDER 1971 CODE G. ENGINEER'S CERTIFICATION 1 certify that 1 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. 20220609 COSA Checklist yellow sheet ft ft LO LU Q rn x 11 Z Q 0) C7 �P.•'' �s 11 z 0 U' o m W N co� � p CD C) (.5 t- � vvi� > CO QW0- o iO' z co TI ~U< < CO:Q- Wa O �6QW N C) o :EGA`' fit (q > z w ::i < Y o �m >Ww (D U) ° } Y OOWU Q V Z`` WU Q Uwd� p — (nu i I }-w I ��zw a W 0) 1cli w 0 — M C • O m ZLa z m~ Q ~ o 0-zQ W w 1- ❑ I �JW -i M =>S� �Ui ON S 00013'30" E 300.61' _° ° Q� w¢ XN Il.. J N z co _ ( Z Q� m cc O �to� V' O F- I:.: w O W> -p 0LLO U ��pWw 11 LL w ! , VM WW» }J a ww { W 0 w }> = iY w>O0 LL W > .::... 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