Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
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)'