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Home My WebLink AboutBREITZMAN LT 2Onsite File Breitzman Lot 2 #015-231-78 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201461 PID Number: 015-231-78 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name SCOTT & MIRIAM DOBBINS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7247 ALATNA AVENUE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot BREITZMAN 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well *95'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding E Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ __ NA Foundation 10'+ ILIFT STATION Manufacturer Capacity Gal. Remarks *MOA WAIVER. TANK INSULATED & CONNECTED TO EXISTING SYSTEM. Alarm location Electrical installed by Installer q+ PIPE MATERIAL House to tank 3034. Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection 1" 12/2/20 2nd 12/3/20 Location and description 3`d 4'h GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional �''••.t�',�� Approval: Date 'a'•• �¢ 7H jo •••••. ••••!•••••••:•• Septic System Approved - CSU �� •,. Curtis Huffman : 4 �c��l Date �� % ' • . of 228991 . a ��'' F ,. ��i��pROFESSI�� ,•� Note: this approval does not include well permit requirements. , 10' UTILITY ESMT. MUNICIPALITY OF ANCHORAGE on-Sde Water &Wastewater Rrcgrartl FO EWK 11%$�O 4700 Elm n Road Anchamps, AlasM99151 Phaw. (907) 343-7904 Far X907) 3A3JR7 hnp: dhr9AkWte On -Site Wastewater Disposal system Permit Perm it N urnber: 0SP201 d61 Work Ty p e: SepticTank Upgra& Tax C ode NuMber: 01 :5231 nOOO Site Legal Address: BREffzfdAtiN LT 2 G:2799 311a hailing Address: 7247 ALATNA AVE. Awborage Owner DOBBINS SCOTT A & M I REAM K Design Engineer., FIRST WATER CONSULTING This pormit is for the constrtrotion of 0 oi6poaal Field 0 Septic Tank ❑ Holding Tanks 0 Privy Effective Date: Expiration Date: Lot Size in Sq Ft; ep;netiltunt I MM024 I W EV2021 49400 Total Bedrooms: S ❑ Private Well I2 Water Star -age AIL onst rac Ilan shall be in accardartee with, 1, a attached approved deslgrr. 2, All r-squirarrnents Bperi ed in Anchorage MuTi iclpal code Chapters 1 ,55 and 16-86 and the Stats of Alaska Waste,rfater Diigpoml ReguilwiorLs (I 72) and DrlrMng Vaker Regrlliamions (1 B4AC80) 3, The k-rastevraler code requires iriepe ons during the Inslallaflon. The angineer shall noffy tha Devellopmerit Services Department per AMC 1 &06- Pmrnde riotificallon by calling (907) 34V?F J24)7)- 4. From October 15 Io April 15, o sl,bsuftoe roil ehcorpiion system under constr-uctian during free2in weather 0441 he either a. Opened and Closed on the same day, or b- Covered, sealed, and lrea#ed to prevent freemtrg Recelved By. Issued 63+;Zee.Az 11 Dame; 1012W 020 Diatom 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com October 23, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: BREITZMAN LOT 2 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank to serve the existing 5-bedroom residence. The lot and area are served by private water as shown on the design. The existing tank will removed, decommissioned and the new tank installed in the same location to maintain the 95'+ separation to the referenced property's well and in accordance with WR85- 056 as previously issued by the MOA. Continuance of this waiver is justified with a new improved tank (HDPE) and as outlined previously with the original waiver. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201461, Rebecca Carroll, 10/28/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201461, Rebecca Carroll, 10/28/20 MUNICIPALITY OF ANCHORAGE ~ , DF. ,:ITMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION Address~ WELL ~'0 Go-,¢ IOz 3~ 0 ~,~.~,. /~ i~ ~ TANK FIELD Phone(s) -- JP rm,, S~S INd. of Bedims _ J WELL " I0~ LEGAL DESCRIPTION LOT LINE _ I Subdivision Lot ~ Block ¢ I er, f~.¢~ FOUNDATION _ Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, property hnes, foundabon, ~ 6~ ~ .~ ~t '~ ~ Iz ~ dnveway, waterbod,es, etc.) TANKS ~ N I Manulacture~ Capacity ,n gallons I~- ~ . (~ "~aterial No. of Compadments o I~ I' TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~OTHER " ~ Depth t~' p~pe bottom from Total depth from original grade original grade ~ ' ~ FTI I ~ FTJ '~ Fdl added above original grade Gravel depth beneath p~pe 0 F1 ~ FTI ~ / Gravel length Gravel w~dth / Total absorpbon area ~' Distance between lines /, q O/ SQ FT /~ ~ ~lJ FT~/ Number o, hnesi j SOFT Pipe materia,~ ~0~ ~¢'' Installer Date installed ~ WELLS ~/, ~ PRIVATE ~ OTHER {Identify) Ol~ssIfic~bon (A,~,O) I ~otal Depth ~ Oase~ to FTI FT ~ *hstalleJ Date Installed: ~.~; REMARKS: - ,: ~:: : .,. Scale: '~: ' ,:::: ?:.~GINEER'S SEAL /~ ~) ~ ~C~ . '~~ Inspections Pedormed by: ,.~, Date: Municipal and State guidelines in effect 0n this date: / 0 .- L ~ -'~ 5~' Heallh Depadmenl Approval: ~ - Date: i, ~ f2-013 (3185) I;::'IEI'~M I T NO: DA]"IE ISSUED: LEON ROBINOVITCH I::'. 0. BOX 1()2380 ANCHORAGIE, AK 99510 SUBDIVISION: BRITZMAN SECTION: 23 'T'OWNSHIP: 56000 (SQ. F:'T. OR ACRES) 5 :L2N LIlT: ~:: RANGE: 3W BL[)(.;;K: NA l....isted below are 'Lhe options available to you ii"l designing your septic system. Choose 'Ll"'~e c~p'Lio-~ that best fits your site. DEF:'TH TO F'IPE BO'I"'T'OId (FrT.) 4..0 GI:~:AVIEI .... DE:F:'TH (FT.) 9. () TOTAL. DEF'TH eFT. ) :1.;$. 0 GRAVEl .... WID'TH (F'T.) 2.5 GRAVEL.. I....ENGTI'4 (FT.) 65.0 GRAVEl .... VOLUME (CU. YDS. ) 5'7.2 TANI< SIZE (GALS) 1,50().,0 *'* SOIl.,.. RATZIqG (SQ. I::"1". ?BR) 251 ',~"~' GRAVEL LE;NGTH >. ,~., FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 7'5 I:::'T. EACH) -~*' 'T'ANK I ILlS1 HAVE AT LEAST TWO COMPARTMENT'S I cer'L:LFy that: :L. I am Familiar with the requirements For on-.site sewens and' wells as set Forth by the Municipal:i. ty r.)¢ Anchonage (MOA) arid the State o¢ Alaska. 2. I will :i. nstalI the system in acco~dar~ce with all MOA codes and negulat:i, ons, and itl compliar~ce wi'Lb the design c:r'ite~ia oF th~i.s permit,, 3.,. I w:i.].l adhere to all MOA and State of Alaska requirements for the set back distances from any existing wel.1, wastewater disposal, system or public sewerage system on this on any adjacent or neanby lot. 4,, I. under'stand that 'Lhis per~mi?t is valid .for a maximur,.oF 5 bedrooms and any enlar'gement will require an additional permit. IF A I....IF:"I" S'I"AI"ZOIq IS ......II~IS'T'AI..,L. ED IN AN AREA COVERED'- BY MOA BUILDING CODE:~:~("', ' (2) AS-,E lILTS ':FHEN (1) AN EI_EC]'RICAL. F'ERMIT AND INSPECTION IdUST BE:. OBTAINED, .... WII....I .... Iq[;)':" BE API::'I:~OVED WITHOUT AN ELECTRICAL. INSPEC]":(ON REPORT.4 AND (3) THE AF:'I:::'L.. I CAN'1": I...IE(~N R~I3~[ NO,./I 'I"CH Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 5 DATE PERFORMED: PERFORMED BY: (ENGINEE Township, Range, Section: SLOPE SITE PLAN I bd 41 I WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Depth to Water Alter Moniloring? Date:. Gross Net Depth to Net Reading Date Time Time Water Drop Im. ~ II:l'f d~.'5'0 ...... it ~,: TEST RUN BETV~EEN PERCOLATION RATE¢-~'''~ (minutes/inch) PERC HOLE DIAMETER FTAND :,~-- FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMEDIN ) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IP_HONE . MAILING AD~S~ ~iq. ca~citg in flallons Inside length ~idth kiquid de~th ~ DISTANCE TO; W~ Of ~ac~ I~n~th of ~ Trench ~idth inches Distance be ;~Q Top of tile to finish grade. Material beneathtile '~ , ~ ~ ~' ag~o~ ~ ~_ To al effe tive'abson Length Width Depth PERMIT NO. N Typ ' epth ~ / Bu~~ Nearest lot line ~ DISTANCE TO: ~ ~ ~ ~ Depth Driller Distance to lot line PERMITNO~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS~~ SOIL TE INSTACLER~ REMARKS ~q / (Rev. 3/78) PERM I'¥ NCm. MIJNIm3 I F .LIT¥ OF At, CH( ~813E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L~ STREET, ANCHORAGE, AK. 99501 264-4?20 WELL 8N[~ CIa,--SITE SEWER AF'F'LICANT LO6ATILN LEGAL WILLIAM R. BRITZMAN HILLSIDE?ALANT8 LOT 2 BRITZMAN SUB TYF'E OF SOIL 8BSORBTION SYSTEM IS' MAXIMUM NUMBER OF BEDROOMS = ..~~5~'' 8818 ABBOTT LF'. RD. SOIL RATING <SQ FTZBR)= THE REQUIRED SIZE OF THE SCmIL ABSORPTION _SSTEM IS [:~EF'TH---- :Jb0~0 =,I..!L.IMRE FEET LE~Jm'4TH= 125 D E P T H = THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). TH~ TRE~IISH WI D, TH IS ~ FEEl' THE GR. AVEL DEPTH IS THE MINIMUM DEPTH OF ~RAVE~I THE~TFALL PIPE AND THE BOTTOM OF THE EXCAVATION '::IN FEET.,. ~ 3-0/~.~i"}x~__ EIEIZ~LI I RED SEPT I C: TA~-IF~: S I ZE= .~~ L3ALL.~2I~IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION IN~FEL. TION_. F. IF ANY WELLS ADJACENT TI-I THIS ' ~ ' ' PROFERT5 AN[:. THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T&-]L-~ ,C 2 ::, I ~SF'EC:T I Of-dS PRE REmZ.~.LI I RE[;.-, BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION AN[:, APPROVAL BY THIS DEPARTMENT WILL BE SLIBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL~ OR i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST 8E RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY~ SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ER~I I T E×F' I RES DEC:Er. IBEE' _-~-t--1.. i979 I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. .. .... , I .... UED ~z' ...... DATE_ V~. ~ PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TES'F Pouch6-650, Anchorage, Alask, 99502 276-222'[ /~R ~ [~ ~ , ' ' '":~ SOILS LOG - PERCOLATION TEST RECEIVED LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Time J~ SOILS LOG MUhIICIPAt_ITY CF ' ~" I"')~^~: EFL'¢IR~.)f ,,l : 'lION ~'J PERCOLATION SITE PLAN Depth to Water Net Drop PERCOLATION RATE (minutes/inch) Net Time TEST RUN BE'FWEEN FT AND FT cOMM E N TS ~XPLORATION SiPPLY .AND EQUIPMENT, INC. ~ Dr,Il Sh,ft Report CONTRACTOR EQU~?MENT TYRE_ ~//~7-~' P~'~ / / PARTY DEPARTED CAMP _ TRAVEL TIME BREAKDOWN TIME DEPARTED FIELD MOVE TIME ARRIVED CAMP_ CHARGEABLE TIME LOCATION FORMATION FOOTAGE HELPER~ ~oc~ BITS / ~ ' ~'"'"/- iNSERT BITS MUD USED __ TIME TIME APPROVED BY COSA Checklist Legal Description: BREITZMAN LOT 2 Parcel ID: 015-231-78 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/14/1979 Total depth 80 ft Cased to 70 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10/16/2020 Static water level at beginning of test 38 ft. Well production at time of test 5.7 gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 7.17 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 2/24/2021 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) NEW 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping NA - NEW C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/4/1979 ALL standpipes present per record drawing Total measured depth from grade 9.4 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 5.6’ INTO THE 6’ ED Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 12/3/2020 Results Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 860 gal New depth 13 in Elapsed time 1290 min Final fluid depth 0 in Absorption rate 750 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies:.NEW MTs INSTALLED IN EACH TRENCH. FLUID LEVELS W/IN 1’ OF INVERT IN ’85 FIELD. 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 *95’+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *MOA WAIVER. G. ENGINEER’S CERTIFICATION I certify that I 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. 3/5/2021 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343- 7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC211067 Subdivision: Breitzman, Lot: 2 A water sample revealed a nitrate concentration of 7.17 milligrams per liter (mg/L). 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. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Fact Sheet 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 of fertilizer and wastewater. Often the nitrate is in the 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. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date /¢ '- GENERAL INFORMATION (a) Legal Description (inctude lot, block, subdivision, section, township, range) (b) (c) Location (address or direCtions) r .~- ~ :~- ,4 /~. '/-'"'* A vo. L,~I¢_~V-.~,.) ,~'~ :79. Applicant Name L~>,~ l~*(':""~'""f~ i~ Telephone: Home Business ~d' Applicant is (check one)' Lending Institution ~ · Owner/builder ~; Buyer~ Other ~ (explain); :~ LL_ (d) Lending Institution 7pr,,.-~ /'/1-, ~ l( c g,*-/ Telephone Address . /~ ~ ~."~" .~,,,~,,e,...'e (;~¢-. <~;~',r~.,~,'°/~ (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms ,,~-'"'~ Other WATER SUPPLY Individual Well~/ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAG_.~ ISPOSAL Onsite I.J ' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 {11/84) Page 1 of 2 ENGINEERING FIRM PROVIDh,~G INSPECTIONS, TESTS, FILE SEARCH, b,., I'A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 was. tewater disposal system is in compliance with all Municipal and State codes, ordinances, and regul,ations in effect on the date of this inspection. Name of Firm /¢,f ~'Z Telephone 5-E'I J~' d_) ¥-d._) Address /2. oo l,d j~, :~'-'"' /~,,./., /i K ,~ ~'-d) .~ Date //- ~- ¢~ 3- D HEP APPROVAL --'/<~'¢'~'~ ~'~- '~~&X~ '! / ~/~"""~ Approved for ff¢'~"~"' bedrooms by Date Approved /'""-' Disap~ved Cond, d,d~al Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) PUBLIC UTILITY 72-010 (Rev. 6/79) NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Application Date ~ 1. GENERAL INFORMATION (a) (b) Legal,/_.¢~.7~Descripti°n2 (inclu_ude~:~ V'-e~ i 'f'~ wt ZL R,/Iot' bloc,k_, .subdivision, section, township,~.,u~ ~:~ge). Location (address or directions) , Applicant Name o~/ ' ' Telephone: Home Business ~'~ /- ~'"~/] Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder n; Buyer~('; Other [] (explain); (d) Lending Institution Telephone Address (e) (f) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family D Number of Bedrooms Other WATER SUPPLY Individual Well~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank [] / - Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDli ,NSPECTIONS, TESTS, FILE ~,EARCH, D ~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval shows that the omsite water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, end regulations in effect on the date of this inspection. Name of Firm ~ T,~ele/phone/ ~ Address Date o . . ~_A~ :. ~;~ "~'..~'~A Engineer's Seal 6. DHEP APPROVAL ' -~"Y~'"A Approved for bedrooms by Date~,'~r~. Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) I~UNICIPAUTY (3t= ANQ4Oi~GE MUNICIPALITY OF ANCHORAGE (MOA/ ~Ff. QF HEALll-t & HEALTH AUTHORITY APPROVAL (HAA) ENVIRQNI~NTAL PROTECTION C.ECK.ST- FE=RU^RY S64 10¥ 0 6 264-4720 Legal Description: ~~-~,e.,,t~ WELL DATA ,i ~. ,~ ~ _ _'7-i~' ~-~~~ Total Depth ~./~Jo~. Cased to /.4 ~.4~.~4~. Depth of Grouting Static Water Level I//~ ....... Pump Set At Casing Height Above Ground ~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ct.,~v% Depression Around Wellhead Separation Distances from Well: ~ To Septic/Holding Tank on Lot j~OO I ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot [ 0 C:, I ; On Adjoining Lots To Nearest Public Sewer Line /t,/O ~.,'~ To Nearest Public Sewer Cleanout/Manhole /~'//¢r' To Nearest Sewer Service Lineon Lot WaterSemple Collected by /~(~.44,~L /'~.~.-~C~..Z~ ' Date Water Sample Test Results Comments ~.,1~// /:.~, c~.,¢12c/.,t~-,~"'J'/,4 /~c~_'~O~ I~ SEPTIC/HOLDING TANK DATA ~J Date Installed l~7 ¢ Size /~"'o c:, No. of Compartments Standpipes (Y/N) ~ ~ Air-tight Caps (Y/N) ~r~. Foundation Cleanout (Y/N) ~'~-~ Depression over Tank (Y/N) /'z//'¢ Date Last Pumped ~ ~'",~-~.~ Pumping/Maintenance Contract on File (Y/N) /~ ; for Holding Tank High-Water Alarm (Y/N) /t///~- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: ~,,~'~'"~ To Water-Supply Well ~- t~ To Building Foundation ;~¢ / To Disposal Field ~' / To Property Line /~' ¢ To Water Main/Service Line 74~ / Course Comments ¢~'l,Oe~ 11 /~ c~;o~ (0o I To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata J ~'~' Date Installed` Width of Field ' '~ (-"~J~,~o~.,~ "7~ / Type of System Design Length of Field ~ Z''/ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~, Depression over Field (Y/N) /1,,/~ Date of Last Adequacy Test Results of Last Adequacy Test A/O 7" Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /t/O To Water Main/Service Line 7 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on On Adjoining Lots //O~ / "~ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On'' Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify thaJ, I hay~checked, v~erifj~, or conformed to all MOA an.d HAA guidelines in Sig nJ~"'~'~'~ Date / ~//~'/~" :~- Company ,~ ~MOANo.~~--~'~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) effect on the date of this inspection. ]Viunicipality Anchorage P.O. BOX 6650 ANCHORAGE, A/.ASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES November 25, 1985 Darcy Bevens Alaska Environmental Control Services, Inc. 1200 West 33 Avenue, Suite B Anchorage, Alaska 99503 Subject: Lot 2 Breitzman Subdivision Waiver Request WR85-056 Dear Ms. Bevens: This Department has approved your request for a waiver of the 100 foot separation required between the septic tank and well on the subject lot. The separation distance requirement has been waived to 95 feet. This waiver is valid for the existing septic system only. Future upgrades must meet separation distance requirements. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw 440 W. Benson Blvd. State 206 PENINSULA ENGINEERING Anchorage, Alaska 09808 (907) 561-5107 October 16, 1985 Leon Robinovitch P.O. 102380 Anchorage, AK 99510 RE: Lot 2 Breitzman Subdivision 7247 Alatna Ave. (Sleeper) Adequacy Sewer Test Dear Mr. Robinovitch: At your request we have performed the adequacy test on the absorption system on the above referenced lot. The system consists of a 1,500 gallon septic tank and 52 feet of deep trench (6' deep). The system was tested by adding water to the drainfield at 5 gpm and monitoring the levels in the field and septic tank for three consecutive days. The test results are as follows: Start End Time Septic of of Date (Min.) Tank Trench Trench 10/14 0 31" 9" 56" 10 33" 12" 60" 20 36" 25" -- 30 59" 30" 80" 40 45" 20" 70" 50 40" 15" 67" 60 38" 14" 66" Total Rate Volume (gpm) Added 0 0 5 5O 5 100 5 150-Stopped flow 0 150 0 150 0 150 lo/J5 0 32" 9" 59" 0 0 5 34" 9" -- 5 25 10 35" 11" 62" 5 50 20 42" 26" 71" 5 100 25 56" 31" 81" 5 125-Stopped flow 35 44" 19" 70" 0 125 45 39" 14" 66" '0 125 55 36" 13" 66" 0 125 10/16 0 37" 9" 62.5" 0 0 A review and analysis of the test data indicates that the absorption system is not functioning adequately for a five bedroom home. The system was found to accept 125 gallons over a 24 hour period which is far below the required 750 gallons per day for a five bedroom home. Page ~2 Peninsula Engineering 10/16/85 The system should be upgraded to provide the required absorption in accordance with M.O.A. requirements. We were unable to inspect the well head and sanitary seal because it is apparently buried below grade. The well will have to be raised a minimum of 12" above finish grade and the driveway realigned as needed to provide access to the garage area.~ A health authority approval cannot be issued until these corrections have been made. Please contact the M.O.A. health department for the necessary corrective action. If we can be of any further assistance in this matter please call. Sincerely, Attachments: M.O.A. checklist WH:kr ALASKA eI1UIROIlmeilTAL COI1TROL SeRUICe$, I[1C. (~nclineerin§ f., ~nuironmentaJ Studies John Lynn Department of Health and Environmental Protection 825 L Street Anchorage, Alaska November 19, 1985 MUNICIPALITY OF ANCl'-IORAQ~ DEPT. OF HEALTH I!iNVlRONMENTAL PRCf~'E,C'~IO'~ 'NOV 't RECEIVED Re: Breitzman Subdivision - Lot 2 Dear John: This is in regards to Breitzman Subdivision - Lot 2. On September 4, 1979, a septic system was installed. At that time, no well had yet been drilled. Recently, a Health Authority Approval was performed by another engineering firm, in which the Engineer noted that the well was below ground level and needed to be raised up. This Engineer apparently did not know the exact location of the well. Since the existing septic system failed an adequacy test performed by this Engineer, the Health Authority Approval was submitted with two conditionals: (1) That the well casing be extended above ground. (2) That the septic system be upgraded. I performed an inspection on this upgrade. Since the permit didn't say anything about examining the existing septic tank, I figured it must be approved already by the Municipality of Anchorage, so I only considered the trench in my inspection. However, you recently requested that the distance between the septic tank and well be measured. The distance from the cleanout of the tank to the well is 95 feet. Ground level at the septic tank is about the same as ground level at the well, so there probably won't be any flow from the tank towards the well. A soils log done near the tank showed no water encountered in a 17.5 foot deep hole. Therefore, no migration of gray water along a groundwater conduit towards the well is likely. 1200 LUest 33rd Aucnue, Suite J~ · Anchorage, Alaska 99503 ·(907) 561-5040 A copy of the well log is enclosed. As you can see, the well is 80 feet deep and cased to 70 feet. A strata with clay layers was encountered from 10 to 42 feet. The clay layers should prevent any potential graywater from getting down into the water supply. Therefore, we are asking for a waiver of the distance between the septic tank (as represented by the cleanout) and the well to be 95 feet. If you have any questions, please feel free to call the office at 561-5040. Sincerely, Engineering Geologist Approved By: Leroy C. Reid Jr., PhD, P.E. President _--.,.,' OF ~. ~ · ALASKA ENVIRON' *'NTAL CONTROL SERVIC,.,,, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CALCULATED BY "[~r*~ DATE I CHECKED BY DATE I~' SCALE ~' DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHOI~AGE L)t:FT. OF H~ALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL P~OTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStreet-Anchorage. Aleska99501 DEC 1 ? 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264..4720 R E C E i V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE ,~AI LIN {~'A'D'D R ESS PROPERT~ RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRE~/~--'~- ' 3. LENDING INSTITUTION . MAILI'NG ADDRESS.~_.._~ ~ 4. REALTOR/AGENT I PHONE' I MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION TYPE oF RESIDENCE ~FAMI LY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY ¢{~;]"~TN~I'V I D U A L* [] COMMUNITY [] PUBLIC UTILI ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM -~::{;~"-'//~DIV I DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or i-[Holding Tank Size: /.~;-~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank NUMBER OFBEDROOMS [] THREE [] FIVE [] FOUR [] SiX IAbsorption Area ISewer Line [] .OTHER INearest Lot Line 5. COMMENTS ~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE I BY ~ 72-010 (Rev. 6/79)