HomeMy WebLinkAboutT12N R3W SEC 15 NE4NE4NE4NE4T12N, R3W Section 15 NE4, NE4, NE4, NE4 #015-051-01 �utsnnITTAI Municipality of Anchorage MAY 0 3:2021 On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211104 PID Number: 015 051 01 Dwelling: ❑O Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name AKDOT ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5700 ABBOTT ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot T12N R3W SEC 15 NE4NE4NE4NE4 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 Ftz Ft. Well +100 - _ _ _ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water +100 _ _ Material Number of compartments Lot Line +5 - - NA PLASTIC 2 Foundation +10 _ _ LIFT STATION Manufacturer Capacity Remarks TANK ONLY - _ Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer J Rs Drainfield CO/MT 3034 Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspection151 4/20/21 Location and description dates: 2 top of tank lid 3m 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 2/19/21 x:-40 OF A/,,gkkl Conditional Approval: Date ��Q...•' .cS',� *: 49 TH •. . • • . Septic System CHARLES G BALZARI9I CE-13854 Approved �j(► .COQ Date (o 0 0011 11P • ,lll OPROFESSIOO Note: this approval does not include well permit requirements. trcev uoiuu-i u/ WELL 1 0 0 ' W E L L R A D I U S 1250 GAL MOA APPROVED GREER POLY TANK W/ MANHOLE RISER APPROX. EXIST DRAINFIELD NEW DUAL CLEANOUTS LINE IS ~ 8' DEEP UNDER DRIVEWAY HOUSE GARAGE DRIVEWAY T12N R3W SEC 15 NE4NE4NE4NE4 EXISTING FCO 1'-2' BLOCK RETAINING WALL 1 (IMG_20210418_121203.jpg)A B C DE F EXACT END OF FIELD IS UNKNOWN DUE TO DEPTH OF COVER, VEHICLE LOADS WILL NOT IMPACT FIELD 1 (IMG_20210425_110737.jpg)2 (IMG_20210425_110756.jpg) 3 (IMG_20210425_110831.jpg) 4 (IMG_20210425_110846.jpg) 5 (IMG_20210425_110928.jpg) 6 (IMG_20210425_110950.jpg) 7 (IMG_20210425_110959.jpg) 8 (IMG_20210425_111012.jpg) 9 (IMG_20210425_111030.jpg) +100.0' TOP OF TANK LID 98.61 7' COVER 1250 GAL POLY TANK 100 90.891.0 C&M ENGINEERING SERVICES 907-854-5558 SITE PLAN LEGAL DESCRIPTION:T12N R3W SEC 15 NE4NE4NE4NE4 OWNER:AKDOT DATE: 5/1/21 REV: 0 DRAWN: CB REF: SCALE: 1" = 30' CHARLES G BALZARINI CE-13854R E G I STEREDPROFE S S I O N A LENGINEERLEGEND CLEANOUT MONITOR TUBE 5/1/21 SCHEMATIC SETCION, NTS MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211104 Work Type: SepticTank Upgrade Tax Code Number: 01505101000 Site Legal Address: T12N R3W SEC 15 NE4NE4NE4NE4 G:2437 Site Mailing Address: 5700 ABBOTT RD, Anchorage Owner: STATE OF ALASKA Design Engineer: C & M Engineering This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: S� v. L eparrinent 4/13/2021 4/13/2022 78400 ❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Received By: Date: Issued By: 1nC' Date: 3 MUNICIPALITY F ANCHORAGE 'i Development Services Department `�� = .r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015 051 01 Property owner(s) State of Alaska Mailing address Site address 5700 ABBOTT Day phone Legal description (Sub'd., Block & Lot) T12N R3W SEC 15 NE4 NE4 NE4 NE4 Legal description (Township, Range & Section) Lot Size 78,400 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 ADU) Septic Tank 0 Upgrade ED(w/wo (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: ,# 02 S Waiver Fees: Date of Payment: y W,20,2 ,2 i Date of Payment: Receipt Number: 6 0'3 -7 -b Receipt Number: Permit No. bS A2 10c/ Waiver No. G1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System Modification for 5700 ABBOTT (T12N R3W SEC 15 NE4 NE4 NE4 NE4) Dear Reviewer, The above referenced property is currently served by a 3 bedroom septic system installed in 1980s. The Tank is over 30-years old and is need of immediate replacement. We are proposing that the existing tank be replaced with a new 1250 gallon moa approved septic tank. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 4/1/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211104, Rebecca Carroll, 04/13/21 i[ "~ ,~NICIPALITY (DF ANCHORAGE MUNICIPALITY OF ANCHORAGE ~"~' DEPT. O? t-~:.:.*,_*iH & ' ·" . -;~,VIRONMENT,\L F[:O ~r-CTION DEPARTI~ENT OF HEALTH & ENVIRONMENTAL PROTECt:lON ENVIRONMENTAL ENGINEERING DIVISION SEP :t 1979 825 L Street. Anchorage, Alaska 99501 Telephone 264-4720 - ~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECT~~~L~ NAME i ' ; David Bundy I~J,.-/,"~.. I ,T~-INEW MAILING ADDRESS I' [~''r''r- ~ 7 J' J' [ E] UPGRADE 3126 East 72nd. Ave, Anchorage, Ak. 99507 LEGAL DESCRIPTION Por. Sec 15 iTlZW R3W, S.N. ~¢4-~,~ LOCATION On Abbott Road oppisite Serv~hew Baseball Pield Manufacturer ~ D,STANCE TO: [We" er DISTANCE TO: 125' No. of lines Length of each line to finish grade Type of crib DISTANCE TO: Class DISTANCE TO: ILS Crib diameter tee~ Inside length Dwelling ~'otal length of lines.. Trench widlh, i beneath tile , :)th 72 in(~hes '1 Crib depth Well ~ ~ Building foundatio~ Depth ~" Driller Building foundatlon~ Sewer line OTHER Cast Iron & P.'V,.C. P.V.C. Perforated as i~equired SOIL TEST RATING 130 s.f./BedroolmI INSTALLER Schachle Excavatin~i REMARKS NO. OF BEDROOMS PERMIT NO. 790334 No. of compartments 2 ~pth PERMIT NO. Liquid capacity in gallons Distance between lines ~ effe~i~e~bsorption area ~tive absorption area :i Nearest lot line : Distance to lot line Septic tank ea(s) NO. an 1198-E APPROVED 72-013 (Rev. 3/78) iDATE LEGAL .~man, P E. 7/13/79 ~or. Sec.15 T12N R3W,· S.~. '1 MUNI¢IF~ ZLI OF DEPARTMENT OF'!'HEALTH AND ENVIRONMENTAL PROTEcTiON LOT SIZE J .~ ' '/825 '~L' STREET, ANCHORAGE, PK. 99501 PERMIT NO.~ (i 7903~4 ) ~ E SEWER PERM APPLICANT DAVID BUND~ ~l~ E. ~2ND LOCATION ~ TYPE OF SOIL flBSORBTION SYSTEM IS: TRENCH 74000 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH~ 15 LENO .:.TH= 44 ORA'~EL DEPTH: THE LENGTH DIMENSION IS THE L~NOTH <IN F~T) OF THE TRENCH OR DRRINFIELD. TH~ D~PTH OF ~ TRENCH OR PIT IS TH~ DISTANCE B~T~EEN THE SURFACE OF THE OROUND ~HD THE BOTTOM OF THE ~XC~V~TION <IN F~ET>. THERE IS', [NO SET WIDTH FOR)TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE'~BOTTOM OF THE EXCAVATION (IN FEET). RE~IJ I R'ED SEPT I C TANK S I ZE= 12Se GALLOt~5 PERMIT APPEIOANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION~ 'INSPECTIONS OF ANY WELLS ADJACENT TO THI~ PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ------ T~O ( 2 ) INSPECT I Otis ARE REQU I RED BACKFILLING {OF ANY SYSTEM WITHOUT' FINAL INSPECTION AND APPROVAL BY THIS DEPRRTMENT~{~iLL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND RN~ ON-SITE SEWAGE DISPOSAL SYSTEM 100 FEET FOR'.R PRIVATE WELL; OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE T~PE OF. PUBLIC WELL. OTHER REQUIREMENTS MAY RPPL~. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS PRE RVRILRBLE T0~ INSURE PROPER INSTALLATION. PERM 'I:~ EXP I RES DECE~IBER ~l.. I CERTIF~ THAT l: IRM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 8S SET FORTH BY THE ~MUNICIPRLIT~ OF ANCHORAGE, 2' I WILL ItJSTRLL THE S~STEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT ~HE ON-SITE SEWER S~STEM t~R~ REQUIRE ENLARGEMENT IF THE RESIDENCE ~REMODELED~O INCLUDE MORE THAN 4 BEDROOMS. 8PPE~ICRNT DAVID BUND~ ISSUED B~ ..... ~2_ DATE__ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 0°5° 2 3 4 5 6 7 8 9 10 11 12 13 51r.& ~rs. David Bundy NE~ NE~ ME½ NE~ Sec.15 _~9E659~S Silt USCS "~L" Poorly Graded~ Sndy Gravel USCS "GP" .(to 19.0') DATE PERFORMED:. 6/2 7/79 T12N R3W S.M. SITE PLAN SLOPE · 14 ~15 16 17 18 19 20 PERFORMED BY: 72-O08 (7/76) WAS GROUND WATER S ENCOUNTERED;:' . NO P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~-~ "'%',~ _ '-" (minutes/inch) ,~'_~(~, .O.~Fo.A~p %t~EST RUN BE~EEN FT AND FT COMMENTS ~mend ~.~ ~. Ft. Per Bedroom ..... CERTIFIED B ATE:, , i F.!;_9 ,mss III 111111111111� s� 6 Development Services Department On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 015 051 01 1. GENERAL INFORMATION Complete legal description Location (site address) Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: T12N R3W SEC 15 NE4 NE4 NE4 NE4 5700 ABBOTT Current property owner(s) STAE OF AK Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S 50 Waiver Fee $ Date of Payment 5&61.20-2 I Date of Payment Receipt Number. Q E 411 1-b Receipt Number COSA # ©S C- ), 11 '1 8 5 Waiver # X 9- 3. NUMBER OF BEDROOMS: 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: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S 50 Waiver Fee $ Date of Payment 5&61.20-2 I Date of Payment Receipt Number. Q E 411 1-b Receipt Number COSA # ©S C- ), 11 '1 8 5 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. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 5/20/21 oF A1,q �\ 49 TH '• �� 6. DSD SIGNATURE 0 System #1 Approved for bedrooms CHARLES G BALZARIU1 System #2 Approved for bedrooms ����F�.�.. • CE -13854 Disapproved�� TF�Fpp • • ' ' • �� Conditional approval for bedrooms, with the following stipulations: C' X n ci S "' J-2 Vli D �Ve (o C/��`OF ` 0�_r� a Q_C"mak 4 O_ML\o_n- J Wo,o,,J�e.cl +o c,Q ,ATE iluvebud �i� Cru1d be_ (oCD (�Sed, vvAST`'V� �-: Cb sz JJJJI At SE J)I J � ,-Tr�rr1111� By: LixtUl oa-rutb, Original Certificate Date: _� 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 is Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: 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 Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 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 Results Pass For 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 Comments/Deficiencies: 3/$67,& T12N R3W SEC 15 NE4 NE4 NE4 NE4 015 051 01 11 1 +5.0 8/1979 - 48 48 6.83 +18 C.BALZARINI 3/4/21 26 5/4/21 0 SEPTIC NA NEW TANK TRENCH 1979 3/4/21 4 10.5 0 NA 750 0 <1440 ~2' 0 600 NA 2000 NA NO CLEANOUT TO MEASURE PIPE INVERT DEPTH AT ✔ 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’ Yes if No 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 ft F. ENGINEER’S COMMENTS 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.5/10/21 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ HOME WAS VACANT FOR AN EXTENDED PERIOD PRIOR TO TESTING NEW TANK INSTALLED. DRAINFIELD MAY BE PARTIALLY UNDER DRIVEWAY. DUE TO DEPTH, PIPE CRUSHING IS NOT A CONCERN SEE ATTACHED CALC. ✔ PROJECT:5700 ABBOTT Determine if drainfield distribution pipe in driveway is acceptable Use Plastic Pipe Design Manual by Vylon Pipe http://www.primeconduit.com/Brochures/Vylon/Plastic_Pipe_Design_Manual.pd A Calculate pipe load B Calculate deflection C Check buckling D Check crushing A Pipe Loading Py=DL+LL DL=yXH y=150 pcf soil weight H=8 ft burial depth DL=8.333333 psi LL=0.69 psi based on Table 1, H20 Truck Py=9.023333 psi B Pipe Deflection deflection=Dl*K*Py*100 (.149*PS)+(.061*E') Dl=1 Lag Factor taken as 1. K=0.1 Bedding co taken as 0.1 Py=9.023333 Prism load PS=46 Pipe stiffness F/Y E'=200 Soil modulus for loose, coarse grained soil (conservative f deflection=4.735664 % deflection limit of 5% C Pipe Buckling Pb=1.15* sqrt(Pcr*E')confined pipe buckling Pcr=0.447*PS/(1-V*V)unconfined pipe buckling v=0.38 poissons ratio for pvc pipe Pcr=25.64516 psi Pb=82.35985 psi F.S.9.127431 factor of safety D Pipe Crushing comp stress T/A allowable compressive stress T=Py*D/2 wall thrust (psi) D=4.5 OD of pipe T=20.3025 lb/inch A=D/dr Area of Pipe Wall (in*in/in) dr 35 (for 3034 sewer pipe) A=0.128571 in/in 157.9083 psi F.S.17.5 factor of safety Conclusion:Deflection controls, but is within 5% limit. So pipe is ok structurally 6/1/2021 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 # OSC211285  Subdivision: T12N R3W Section 15 NE4NE4NE4NE4  A water sample revealed a nitrate concentration of 6.83 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 medi a 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 & HUMAN SERVICES Division of Environmental Services On-Sit6 services Section r . P.O. BOX 196650 AnChorage, Alaska 99519-6650 343-4744 · CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O~5"'-O~'1'" Ol 1, GENERAL INFORMATION Complete legal description NE 1/4, NE 1/4;'NE '1/,4, Section 15, T12N, R3W Location (sit? address or directions) .?.. '. ; . . ~. · .~. 5700 Abbott Road ~? Property owner John Repasky "M~iiing address PO .Box · Lending agency., ' :Mailing address.". · 210163, Anchorage, Dayphon~46-5466 AK 99521 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: '~ 3. TYPE OF WATER supply: NOTE: Individual well Community well-.' Public water If community well system, provide written confirmation from State ADEC attest- ing to the legalitY and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site ~ Holding tank Community on-site XXX Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Re~.1/91) Front MOAe21 sTATEMENT OF INSPECTION BY ENGINEER As Certified by my ~eal affixed 'hereto and as of the validation date Shown below, I verify that my investigation of this Health Authority APprovAl application Shows that the on-site water supply and/or wastewater disposal system is safe, fur~ctional 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, and regulations in effect on the date of this inspection. S & s ENG. INEERING -- Phone ~-c~ ~) ~ ;~--9 -7 ~ Name of Firm ,vu,~, I=a~;e River Loop Road No. 204 Eagle River, Algska 9~577 Address 'Engineer, s-signatUre ,~,~Z/~-~ /r/.~'-- , :~':Date !.'! /:~'~/) O0 6. DHHS SIGNATURE .... ~,~. Approved for Disapproved. bedrooms. 'Conditional approval for ~ Additional Comments ~ Note= The well for this property meets existtn§ State andMunicipal Codes". There are ntt~ p~ T~ ~ ~ .... o~ ~ ~'~- t~cting be performed to insure the wells continued suitability. Current nitrate ... .~ concentration'~ ~ '~ ,_~/~ .'~ . .. . · More information on nitrates is available from th~ On-site Services.Pro~ram,, ~-~¢' -~ "t ,~o-c-'-~, Da~e /-7/-oo The Municipality of Anchorage Department of 'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Rev. l~91) Back MOA~CZl MunicipalitY of Anchorage . i DEPARTMENT OF HEALTH & HUMAN.SERVIC S Environmental Services Division ' 825 L Street, Room. . .502 · Anchorage, Alaska 99501 · (907) i Health Authority APproval Checklist Legal Descri'Ptibn:. ~A. WELL DATA Well typ6. Date of test ;I - Static water level Well production If A, B, or C, attach'ADEC letter. ADEC water system hdmber '""- · Date completed ~; [ If'/'7~ !~-i " 'Cased to: ~!:~ ~' Casing ·height (abo, ve ground) - Wires ProPerly protected, ~N) · - AT INSPECTION' Log present~)'N) 'yE..5' Total depth Sanitaryiseal(~N) : :. : ' - FROM WELL LOG.?; WATER'AMPLE RESuLTsi" -' "' ': Coliform . O . · Nitrate :1/ ' ' Date of sample:" ! co ' ,' ,:~ B~HOi-I~ING TANK DATA ' '- Date installed ::-7 / 1 3/~ff - Tank siZe } ;),',~O Foundatioh ~:leanout {~N) Date of Pumping );/t~ 1 0 ~ C. ABSORPTION FIELD DATA Date installed ;, ~/t' . ' g.p.m. . ,,,C', _3 '4.3 ": O Other bacteria ' t, ..... S & S ENGINEERING 'Collected by: . , · ,7c,.~4 E,;.,:,,.. ~;,,~, L,,,.,~, R,,.,d ,',~,;, 204 Eagle River~ Alaska ~9577 Number of Compartments "~)--[ Cleanouts(~N) '"/~ $' ' DepreSsion (y~). z~O High water alarm (Y~. /'v' (2 ":' PumPer: I !.~ ,,~-c.-; 'r~. · . ' ' ' i , ~!: Soil rating: (~;p.d./ft~ o·~ '1 3 0 SySt,em type TR £ ~' c././ g.p.m. Length ' i;L/q Width 'J / :' .;i; ' - .' · ; G~:a~,el thickness below pipe ~o ' ! Total depth I! Effecbve.,.:absorpbon.. area.·. ~'~- ~' ~'r ~' Monitorin~ Tube present (~N) ~/~3 'Depressmon over field (Y~ ~ Date of a~equacy test I//1~ co :'ROsuI~~ , ~ ' ail)" P~ For ~ ~ bedrooms Fluid de~t~ ,,'~bs°rption field before test' (in.); O ..' ,immediately after ~0rgal..W~ter added (in.); 3 -Fluid del~t6 !iO (ins) Minutes later: !.3 ': Absorption rate = · Peroxide't~eatment (past 12 months) (Y/N) ~ ' 4 . #~,,,~.~:.. :x.-,vo,,,~ .:. If yes,'give date i :. 72-026 (Rev. 3~96)* " ' · - '~: g.p.d. Date installed" .~ ~- Manhole/Access (Y/N) High water alarm level at* Cycles.~ "P u...~j33p-en~Tevel at* ' ' *Datum "Pump off" level at* Septic/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES SEPARATION DISTANCES FROM WELLON LOT.TO: . . · IOO -i' Sewer/septic service line ~ ~' ''} SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 10 --Y- , Property line J0 .-/- Absorption field Water main/service line lO ~J Surfacewater/drainage On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~ 30 -'[-' I0 4- Property line I 0 .'~'.' ....Bbilding foundation Water main/service line Surface water .I 00 -e.. Driveway, parking/vehicle storage area .-O Curtain drain jul 0 .v ~ ~c ~ ~ ~., Wells on.adjacent lots / O 0 r-F- ', cedify that lhave determined thru field inspections and review of MuniciPal, ~~a~~~stems are in conformance with MOA ~A ouidelines in effect on this date ~ ~.~' ' ~'"'.~..~ ~ HAA Fee" $ ~..~j.~ .~O~D Waiver Fee $ Date of Payment I I ~ OI ~-_~--'~ Date of Payment Receipt Number /~"--(~::)~'~ ( ~~ ~ Receipt Number 72-026 (Rev. 3/96)*  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ ' DiviSi°n of Environmental Services On?Site Services Section · P.O. Box 196650 Anchorage,':Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner C)c~u,~' ~ .7'~-~/~ ~"/'"~/2 Day phone ~- Mailing address ~700 ~ ~b~F R~.~ ~c~oco~ ~ Lending agency ~,~ ~¢ ~r~ Day phone ESZ-E¢~ Mailingaddress 1199 ~. D,~o~ ~/~ ~ ~o3 ~C4 Agent .. No~ ~ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from .~+,, ,~ '"'-'"" lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-Site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and Status of system. 72-4325 (Rev. 1/91) Front MOA #21 Se STATEMENT OF INSPECTION BY ENGINEER' , As certified by my Seal affixed hereto and as of the validation date ~hown below', I verify that my investigation of this Health Authority ApproVal application shows ~hat 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. ! 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 wastewa~er disPosal syStem is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm /='/'~/"/'r-'r '7'~,~'A~;¢~'! ,¢~ru'~¢¢ Address 19~-30 ~EcA,~ ..g'tt~ ~c~or~.~5 Engineer's signature .... 6:-* -DHHS SIGNATURE ' ' '~'~APproved for ........ DisaPProved. -,~_. bedroomS. Conditional approval for bedrooms, with the f°lloWi~g stipulations: Additional Comments Date /- The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraPh 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025(Rev. 1/91) Back MOA#21 -' Legal Description: A. Well Data'" Municipality of Anchorage Department of Health' and Human Services HEALTH AUTHORITY APPROVAL' CHECKLIST /V E '/4 ~N~' V~/,/Z= y~,/..~:/J,-.Parcel I.D. i ~ r : [ : : Well type (~v-;~, ~ ~'~ Log present (Y/N) ~ . Total depth /"/~ ' Sanitary seal (Y/N) Y' If A, B, or C, attach ADEC*Iett~)r~'ADEC water system number" ' ; Date completed ~ y, --,r~) ;.: ' Driller ~ Date of test Static water i~vel Well flow Pump level1 ,Cased tO FROM WELL LOG SEPARATION DISTANCES FROM .WELL TO: S~)pficYholding.tank.o~ lot Absoi'ption field on lot Public sewer main Sewer service lin~ WATER SAMPLE RESULTS: Coliform 0 co[ / Date of sample: '7 / "I'Z-.F' * ~' .... Casing height .Wires properly protected (Y/N) . _ ..... g.P.m: ' ,~ r. ! ' g.p.m. c. o'. .... , ;'On'adjacentlo!s, ,- ";> ~oo, .... · ; On adjacent lots ;> too, [=~blic sewe~ manhole/cleanout ;>*r i .Petroleum tank /Vo~¢ .~-~ Nitrate ~, 6'5" ~,,~ /",.~ Collected by: Tank size Foundation cleanout (Y/N) B. SEPTIC/HOLDING TANK DATA Date installed '7 ! "7~ Cleanouts (Y/N) Y (~ I~ High water alarm (Y/N) ~. A, Date of PumPing~.," *[o /,?-/ [ 'f ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '~ I ?' ' ' On adjacent lots ..To property line ~ '~o f Absorption field Surface water/drainage '> ~ oo' ~. · 72.4326 (~33)' Front - Other bacteria I ~"C~.. ,,~,~,! Compartments Y' Depression (WN) Alar, m tested (Y/N) Pumper-~ ~'"j- c~,= ~;> I 00~ Foundation 'P_ 3' ~ Water maintservice line ~' ~o ~ '"CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons .... vent (Y/N) Manufacturer Manhole/A~ess ~) High water alarm level "Pump on" level at - ..... ",Pump,off",Lev, el at ~, · x" Cycles tested Meets MOA electrical codes (,Y~) SEPARATION DISTANCE FROM LIFT STATION -- Well on lot ..... ' .......... ':' ':~ ~; ;"~ '' - On adjacent lots" ~:~ i. :. =., Surface water D. ABSOR~ON FIELD DATA ' ~ '~ w-~'~ ~h Gravel {hi~' ' ' ~ Total depth I ,~-'Total ~mtion area ~-[~ clean~-present (YIN)' Y ' D~r~'ss~n over tield (Y~) ,; Date of adequacy test ~/fl I 9 ¥ Results (pass/f;;il)' .... ?,~ ~, ............ tO'r-' ~ Bedrooms C-.,~ ......................... ~'~' Water level ifi"absorption field before test O ' - Peroxide treatment (past 12 months) (Y/N) I~1o^~ ..... ~'E-p~RATic~NDISTANOE FROM 'ABSORPTION FIELD~'O:.5:~ r'~e' ' Well on lot . t ~ ..q- ~ On adiace~ lots To buildin~ foundation ~ ~ ..~ ' To existin~ or abandoned system on lot ~, ,4, On adjacent lots ';> too Cutbank ^~. ,4. Water main/service line ~ '7 o ' 8udace water ~. t oo, Driveway, parkingNehicle storage area .... Curtaindrain 'N on'~ $ e~ '"- ......................... .................... i.!."! ..... ~ _;;'~ .~ _ T~ '~:"":~ ~ \'~::' . ','~ ~;:.~:- ............................................................ E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA g~idelines in effect on the date of this inspecObn. ~'.~.i: ..... :~:?.> Oo:~.oo .:: : .~: "~' ' ' .... ' ':..:, ~ .... ~Waiver Fee $' ~ "~ '-:.' '~ '''? "~'~' '~ "' HM Fee Date of Payment ~...~z_/_-- ~cS'""- ................ Date of Payme'nt ' Rec~ipt'Numbe'r' .:, .//3 / "("/TDZ/~ Receipt Number / 72-o28 (3~3)'