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HomeMy WebLinkAboutBREITZMAN LT 4Breitzrnan Lot 4 #015-231-80 For a COSA, only the 5 bedroom system is to be tested. Municipality of Anchorage Community Development Department ,".1-JUC .2-A161 of 3 On-Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161120 PID Number: 015-231-80 ❑ New ■ Upgrade Name: THOMAS ROSELIUS ABSORPTION FIELD NORTH/SOUTH ❑ Deep Trench __ ■ Shallow Trench ❑ B_ed ❑ Mound Address: _ _ ,__ __ _-.-_ _-- 7301 ALATNA AVENUE *ANCHORAGE, AK ❑ Other Soil Rating: Total Depth from original grade: Phone: No. of Bedrooms: 229-4628 5 0.6 GPD/Sq.FL 9 MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: Gravel depth beneath pipe: SEE DWG. FL 4.01 & 4.01 Ft. Subdivision: Block: Lot: Fill added above original grade: Gravel length: BREITZMAN 4 SEE DWG. FL 65 & 68 Ft. Owns Ip: anger Section: _ Gravel width: Beds Number of lines: Distance between lines: 5 & 5 FL — — Ft. SEPARATIONDISTANCES Total absorption area: 1330 SQ. FL [lumber of trenches: 2 Dist. between trenches: 10+ Ft. To Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines From well EXISTING 100'+ 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑Holdin ther Manufacturer. Surface Water 100'+ ``v" XCa�pa`citt�`: \S Gal. Material: Number of compartments: Lot Line 10'+ N/A Foundation 10'+ LIFT STATION Curtain Drain NONE KNOWN Manufacturer. c y: Gal. Remarks: "Pump on" level at: -Pump off- level at: High water alarm at: BOTTOM OF TRENCH INSPECTED BY MOA ENGINEER TIM ECKLUND ON 6/23/16. 77e & M�Electrical Inspections performed by: PIPE MATERIAL House to tank EXISTING Tank to D3034 drainfield Installer A+ HOME SERVICES Drainfield 23034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Location and Description: Dates: 1 St 6/23/2016 2nd 6/24/2016 3rd - 4th - TOP OF GARAGE SLAB Community Development Department Approval4-4 ENGINEER'S SEAL �.•``�� `'��� OF . ,� q • •� Conditional approval: Date: � ��° Q ♦♦♦ AMW/*'�4, 0 ......................... .... ......... 0. ..�. .. ..... .� #. r / A. Ga ness = �Aw 0.,..�,! Approved: jQ'W' A lsyuc� �rn td Date: 11 a8 20 ►7 • LICEN�E,��1;;`S`.••• #AECC884 Inspection Report _1-1-12.doc !-1 : OSP16120DRAWING RECORD D RAW I N G PARCEL ID NUMBER: 015-231-80 0 SHED DURING THE EXCAVATION OF BOTH TRENCHES, THE 1979 TRENCH WAS ENCOUNTERED. IN SHORT, THE ORIENTATION OF THE 1979 TRENCH AS SHOWN ON THE 2008 INSPECTION REPORT IS NOT ACCURATE AND THE TRENCH HAD TO BE ABANDONED. IN ADDITION TO ABANDONING THE 1979 TRENCH, A 10 FOOT DIRT PLUG WAS INSTALLED ON THE WEST END OF BOTH TRENCHES TO MAINTAIN THE 10' SEPARATION DISTANCE BETWEEN THE NEW DRAINFIELD AND THE OLD DRAINFIELD. THE BOTTOM OF BOTH TRENCHES WERE INSPECTED BY MOA ENGINEER TIM EKLUND AT THE MOA ON 6/22/2016. BREITZMAN; LOT 3 EXISTING SEPTIC TANK GRN. HSE. ON STONE PATIO FS_ MT1 _ _ T.H.#1 C01�- e ALATNA AVENUE ® . -�'i I%%- V Ir — .0p7m a •• X.,EXISTING ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS E: BEDROOM HOUSE PREPARED FOR: THOMAS ROSELIUS PHONE NUMBER: (907)229-4628 PAGE NUMBER: 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: BREITZMAN; LOT 4 L.K.B. TYPE OF WORK: DATE: f•a. 11/27/2017 J, a ti • S� DURING THE EXCAVATION OF BOTH TRENCHES, THE 1979 TRENCH WAS ENCOUNTERED. IN SHORT, THE ORIENTATION OF THE 1979 TRENCH AS SHOWN ON THE 2008 INSPECTION REPORT IS NOT ACCURATE AND THE TRENCH HAD TO BE ABANDONED. IN ADDITION TO ABANDONING THE 1979 TRENCH, A 10 FOOT DIRT PLUG WAS INSTALLED ON THE WEST END OF BOTH TRENCHES TO MAINTAIN THE 10' SEPARATION DISTANCE BETWEEN THE NEW DRAINFIELD AND THE OLD DRAINFIELD. THE BOTTOM OF BOTH TRENCHES WERE INSPECTED BY MOA ENGINEER TIM EKLUND AT THE MOA ON 6/22/2016. BREITZMAN; LOT 3 EXISTING SEPTIC TANK GRN. HSE. ON STONE PATIO FS_ MT1 _ _ T.H.#1 C01�- e ALATNA AVENUE ® . -�'i I%%- V Ir — .0p7m a NEW DRAINFIELD ?� N . m NEW DRAINFIELD MT2 MT4 '-, C04 NO SURFACE WATER WAS NOTED IN THE ROAD DITCH DURING GEG INSPECTIONS SCE 795 ��.. ' �AV LICENSE 1 N�ESS1 #AECC884 1 �„``' GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS E: 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 337-6179 • FAX (907) 338-3246' WEBSITE: www.garnessengineering.com PREPARED FOR: THOMAS ROSELIUS PHONE NUMBER: (907)229-4628 PAGE NUMBER: 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: BREITZMAN; LOT 4 L.K.B. TYPE OF WORK: DATE: 11.1 RECORD DRAWING 11/27/2017 NEW DRAINFIELD ?� N . m NEW DRAINFIELD MT2 MT4 '-, C04 NO SURFACE WATER WAS NOTED IN THE ROAD DITCH DURING GEG INSPECTIONS SCE 795 ��.. ' �AV LICENSE 1 N�ESS1 #AECC884 1 �„``' PERMIT NUMBER: RECORD DRAWING O 15 231 $0 BER: OSP161120 NORTH SOUTH FINAL GRADE = FINAL GRADE _ Mr co 98.77 - 99.90 Mr co 98,30 - 99.80 ORIGINAL GRADE @ ORIGINAL GRADE @ TH#1 HIGHEST POINT= 98.39 FILTER HIGHEST POINT = 98.39 FILTER FABRIC FABRIC T T 4.01' INVERT OF PIPE = 4.01' INVERT OF PIPE _ 93.4093.40 BOTTOM OF TRENCH 5' BOTTOM OF TRENCH = 89.39 = 89.39 10'+ RELATIVE ELEVATION OF BOTTOM OF TH#1 = 82.39 (TH#1 WAS DRY ON 6/23/2016) ��\\\lk 0 tit �P ,,,......... S ♦i All• c, •••: GARNESS ENGINEERING GROUP, Ltd ... g CIVIL & ENVIRONMENTAL ENGINEERS 0 0 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246 - WEBSITE: �.gamessengineedng.com % •• •• •...... • I.............�. 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER:, C� y A. Gayness �v THOMAS ROSELILIS (907)229-4628 3 OF 3 ♦ J,'• C 7953 :'•_�� PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦♦♦�F •••,.• ��a� �� 4,••• ���� TYPE OFEWOR : DATE: LOT 4L.K.B. LICENSE 4o, "���\ �ROFESS\'!t • RECORD DRAWING 7/22/2016 #AECC884 \\� POST IN A CONSPICUOUS PLACE 'JoA C n r ALL WORK MUST BE INSPECTEDI,R, t' Field Inspection Request required 2 working days in advance of starting work ^ f: and 2 working days in advance for final inspection. Call (907) 343-8206 (voice recorder) for scheduling. Permit is not valid without the call-in and also must include the one -call ticket (utility locate) number. -� _ epa r Cnie tt t MUNICIPALITY OF ANCHORAGE RIGHT OF WAY DIVISION 4700 ELMORE ROAD TELEPHONE (907) 343-8240 RIGHT OF WAY PERMIT R1 61978 Type: Encrchmnt Grid: SW2739 Date Issued: 7/29/2016 Construction Start: Last Update by: PWDEW Permittee: ROSELUIS THOMAS & BONNIE Contact Person: Sonja Blewett,;3,37-6179 Last Updated: 07/29/2016 343-8240 Site Address: 7301 ALATNA AVE, Anchorage - @ Hillside Drive Legal Description: BREITZMAN LT 4 G:2739 Original Work - Description: Encroachment of well approximately 4 feet into Utility Easement and deck encroaching approximately 6 feet into Utility Easement. Financial Summa Fee Description QTY Permit 1.00 Total Fees: P AMT 115.00 115.00 See reverse for requirements/remarks. have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will comply with federal, state, and municipal codes and regulations and the provisions of this permit. Signature:Date: / 42 8� I On -Site Wastewater Disposal System Permit Permit Number: OSP161120 Tax Code Number: 01523180000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: Septic Upgrade Permit Effective Dates: June 09, 2016 to June 09, 2017 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: BREITZMAN Site Legal Address: BREITZMAN LT 4 G:2739 Owner/Address: ROSELUIS THOMAS & BONNIE 7301 ALATNA AVE #A ANCHORAGE AK 995162426 Site Mailing Address: 7301 ALATNA AVE, Anchorage This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 49500 Total Bedrooms: 5 N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Prior to Inspection Report approval, a Letter of Non -objection from the ROW is required for the well in the Utility Easement. Received Issued By: MIN MUNICIPALITY OF Community Development Department Development Services On -Site Water & Wastewater Program ANCHO Mayor Dan Sullivan I ;y 4'J}S On -Site SewerNNell Permit Application For Single Family Dwelling Parcel 1. D. 01 S- 23 1 —?o Property owner(s) THOMAS ROSELIUS Day phone 907-229-4628 Mailing address 7301 ALATNA AVENUE *ANCHORAGE AK Site address 7301 ALATNA AVENUE *ANCHORAGE AK Legal description (Sub'd, Block & Lot) BREITZMAN; LOT 4 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (kali that apply) Initial ❑ Absorption Field ® Single Family (SF) Upgrade M (w/wo ADU) Septic Tank ❑ Renewal ❑ Duplex (D) ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 'C]�nCl —Waiver Fees: Date of Payment: 21 L°t l (�= Date of Payment: Receipt Number: 02t4g3(a Receipt Number: Permit No. 651?1(00 1120 Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd CIVIL &ENVIRONMENTAL ENGINEERS May 13, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Breitzman; Lot 4 To whom it may concern AdVJ1XVd T,cv&, r SYstm QffiE The existing 5 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and needs to be upgraded. We are proposing to re- utilize the existing 1500 gallon septic tank and install dual 5 -wide trenches. One testhole was excavated on the property and the drainfields are designed around the 30 foot radius of this testhole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached 2016 soil log which shows the soil classification, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications 3. SURFACE WATERS: There is a manmade pond on property (see page 2 of 2), but no natural surface water was noted. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography around the proposed drainfield is flat. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P. E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337.6179 * Fax: (907) 338.3246 * Website: www.garnessengineering.com NUMBER OF BEDROOMS: 5 GALLONS PER DAY (GPD): 750 PERCOLATION RATE/S: 20 MIN/INCH PROPOSED APPLICATION RATE: 0.6 MINIMUM DRAINFIELD SO.FT.: 1250 FT' A DEPTH OF EXCAVATION: 9 FEET 5 FEET 2 0 65 FEET EACH (130 TOTAL) ON FACTOR: 0.5 ✓E: 4 FEET SO.FT.: 1300 FT' NOTE: THE CONTRACTOR SHALL HAVE ALL WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. AVLNea ?0()b z No ouial\• w VLV, LW. LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND rnuninnuc nim ,urn ALL EXISTING SEWER LINES SHALL BE JETTED AND CLEANED DURING INSTALLATION. Vm) ; w, EXISTING 5 BEDROOM HOUSE"I C I „� , 1 I EXISTING TANK TO REN INSTALL DIVERTER VALV EXISITING DOUBLE CLEA CRN. \ HSE. ER OF BEDROOMS: 5 INS PER DAY (CPD): 750 )LATION RATE/S: 20 MIN/INCH )SED APPLICATION RATE: •2 JM DRAINFIELD SO.FT.: 375 Fr' II ADVANCED TREATMENT M DEPTH OF EXCAVATION: 9 FEET 5 FEET 65 FEET ION FACTOR: 0.5 VE: 4 FEET Sam: 650 FT'. IN PLACE: mado (�A� SHED i i i i i i i ALATNA AVENUE 6V APPROXIMATE LOCATION OF EXISTING TRENCH 1- e GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS r,n..r n. omo <."..m . armour.. Dose, .... rami n,_n,m .. icon .-... warts ......,,,....,�s,wh„....,,, -.._ PREPARED FOR: PHONE NBER: PAGE NUMBER: THOMAS ROSELIUS (907 2M 29-46282 OF 2 LEGAL DESCRIPTION: DRAWN BY: BREITZMAN; LOT 4 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM DESIGN UPGRADE 6/8/2016 69 DRAINFIELD 104 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E. TUDO0.� SUITE 101' A HDSAGE,MSRIET' PX NE (Nn =9 178'M (W'D 33857 -MBSRE:x gemmsShmngmn LEGAL DESCRIPTION: BREITZMAN; LOT PERFORMED FOR: THOMAS ROSELIUS DEPTH (feeqORG TEST HOLE #1 GM/ML SOIL CLASSIFICATIONS DEPTH TO GROUNDWATER DATE 111111111 •• um 1111"11%O% 1:15 6" R*, 2 HNH 111111111 • 4.5" � 3 rM2 - 1111tH • VIM, 30 �I! 1.5" 5 DEPTH TO GROUNDWATER DATE 13.8' 4/2212016 13.25' 5/5/2016 1:15 6" 4/2112016 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 515/2016 1 1:15 6" 2 1:45 30 4.5" 1.5" 3 1:45 - 6" 4 2:15 30 4.5" 1.5" 5 2:15 6" " 6 2:45 30 4.5" 1.5" 19 PERCOLATION RATE 20 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5 FT. AND 6 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: DAVIDGARNESS PERCOLATION TEST PERFORMED BY: LANDON BRUCE COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P R R ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: (3 Municipality of Anchorage .. Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of w .ci.anClorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW070286 PID Number. 015.231.60 Rte" Thomas and Bonnie Roselius Wastewater System: ❑ New ® Upgrade 7301AtlatnaAvenue Anchorage, AK 99516 ABSORPTION FIELD Parr 345-3413 Faanw a e.uaxN 4 O Op•p Tla0 O Stwllon T,wrn Dated O Mane O Opwr: S&I Ptirtin' T"DOM 10D1n oito rWa• LEGAL DESCRIPTION Existing GPOIF? FI. aaac LM SupamPM. °ip°Ima°•0000A1 ran mPw O•a• Grrnl aspsp ppF Breitunan FI. Ft TOWWV. R&w SFrnon FM•d*id Fap'A aWrul Wow Gnwl L*Vn R. FI. Well: ❑ New ❑ Upgrade G WIT'. '. oftiiw. L FI. FL ckii tllpn (P"O, A a. CI Tar Dpm Cw to Taus •b.arpan rpa Pp Malrul Existing FI. FL F2 Dtw OFM DaIM, aupa WMr L•wl Irm D" wuwa FL John's Excavating 10/15/2007 Yr Pump SM Cwnal gm Apow Grwia. TANK cPM F1.1 FL SEPARATION DISTANCES O Septic [:]Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ublc?dnle 'O"•` " From Tank Field Station Tank Srw•r un• Anchorage Tank 1,500 Gr. MMs,w Nunoar s, ComDrxnraF car >100' >100' N/A WA >26 Steel Two s,.rww" >100' >100' N/A N/A LIFT STATION La LYr >T >10' N/A N/A Gd 'Pump on' 1Fwl r 'Pump air Mw r. Myt wMr rrm u F•uw.lwn >5' >10' N/A N/A n M h Rmp Mru a Mops, ElFcarai In.pFinaw prbnlb by C~D , None Noted RwnY4! rn. I�1 ). j:! ,,; -I Existing Septic Tank Pumped, Crushed and Back-filled. '. i.;:i .'.:: i BENCH MARK i '-I1 .1 , Laraam toa 00.01pom Locations Not Exact Drawings Completed Without Surveyed Garage Stab As Bulli FL 5S1000.00 Eng;;Xj It\mP Inspections performed by: A. Harala Dates: 1M ' 10/15/2007 ��� OF Ah 2^^ 10/1512007 : Q�.••"'•"'• , ••� Gi~' ��•4S���� Development Services Department Approval W 49� GV * •" Conditional Approval Date: ••• mc ... ...... ........ o-AUCHAEL E ANDERSON; v t Reviewed and approved by: ' Date:pBOfESswl,p�4 lR. owal 1�L1\\���� " ( «sL 3 \) £ f I- 2 2 | «z Jot,)\ 2 WL� 7 c I _ \ _s `k v CO\ iD Z �° § % 0§ A0. | §kk IE LLI° , Z t> w m � # [§)0 k/ fcn&& §q., Li < ><£ u {§�0 ! ' \ ƒ/k% I% < §kkL ' ci / o0 I{ � , j �o \2 ` � f2 , S k 20 (DX r ...... - | @ � . ---� -------------- -- : s ®%)w ƒ »et \ : {� .04%i Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Drive Anchorage, AK. 99519.6655 - 343-7904 Onsite Wastewater Disposal System or Well Inspection Report Permit Number. SW070286 Existing & [Finished Grade 98.7 N M U U 4Gallon 1Si.2.05 PID No. 015-231-80 Tank & 2 Post Tank Cleanouts Placed Under This Permit. Existing Tank Pumped, Crushed and Backfilled. PRDEILE AS -BUILT No Scale MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 995196650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW070286 Legal Description: BREITZMAN LT 4 Design Engineer: 0014 ANDERSON ENGINEERING Owner Name: THOMAS & BONNIE ROSELIUS Owner Address: 7301 ATLATNA AVENUE ANCHORAGE. AK 99516 - %6P 01 Date Issued: Oct 15, 2007 Expiration Date: Oct 14, 2008 Parcel ID: 015-231-80 Site Address: 007301 ALATNA AVE Lot Size: 49500 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. Received By: Issued By: B. Covered, sealed, and heated to prevent freezing. i SK i,4 Date: I C) —1 5-C)1 N1 Nl/ Date: /° 11401 o1 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 995196650 www.muni.orglonsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.231-60 Property owner(s) Thomas 6 Bonnie Roselius Day phone 345-3413 Mailing address 7301 Alatna Avenue Anchorage, AK Zip Code 99516 Site address 7301 Alatna Avenue Anchorage, AK Zip Code 99516 Legal description (Sub'd., Block & Lot) Lot 4, Breitzman Subdivision Legal description (township, Range & Section) Lot Size 49,500 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms F2u2) THIS APPLICATION IS AN: Initial ❑ Upgrade El Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or autnoru:ea agent) Permit/Rush Fees: ` oo Waiver Fees: Date of Payment: D I t 1Jri Date of Payment: Receipt Number. 1X21 Z Receipt Number. (Rev. 11105) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX September 30, 2007 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Breitzman Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The septic tank on Lot 4, Breitzman Subdivision is failing and must be replaced. We are proposing to replace the tank with a new 1,500 -gallon steel tank to serve the five - bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic tank to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system and the location of the new tank. Also identified on the plans is the existing well on the lot. The new tank will be placed in the same location as the existing tank approximately 20' from the foundation. The existing tank will be properly disposed on the property or removed from site. The drainage patterns will be maintained after construction. The ground surface on the lot slopes at shallow grades. The new septic tank will be constructed near the location of the existing tank and as parallel with the slope of the land as possible in conformance with Municipal requirements. The new septic tank will be constructed a minimum of 100' from the existing well on the lot and those on the adjacent lots and will not conflict with other facilities in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing Lot 4, Breitzman September 30, 2006 Page 2 of 2 septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 4 SEPTIC RESERVE AM D � i � 4 W 0 _J S ALATNA AVENUE A-2 •• E OF �b .......... 49th'.,'•, AREA MAP .,..//�f .�.�.�.�.�.��..%. ..•�� MICHAEL E. umERSQI i SCALE 1' = 100' •�• N�. EE-4381-4381 ��� ♦ ...• �� x i S%♦ 150.00 •••• .. i ' A ••• i �1 ;� • z e :�o i ::• to' u- e-- e roOEs pi-----------� ---------------- �� no ,���� I o o 3 I �a I T 1 I � D W I � w ,^ D o VJ D �o w N H m 1 o r > Z �D z r- m mrl I e Ln n C u T 1P co O I a3 a O Nw2� I �b• � s�� � Z .00 I LgoS� mi no I rf O F O r I zg 3 o S °c " O 150.00 m m n ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 4, BREITZMAN SUBDIVISION GENERAL: The scope of this project includes the pumping, crushing and backfilling of the existing septic tank on the property and the procurement and placement of a new 1,500 -gallon septic tank at the location shown on the Site Plan. Work also includes the placement of a foundation cleanout, two post tank cleanouts and tieing the new tank into the existing absorption trench. The new septic tank must be placed 100' from the existing well on the lot and 100' from all private wells and any surface water in the area and 10' from the water service line from the well. A minimum of 4' of cover is required over the septic tank. The foundation cleanout must be replaced if one is not found on the property. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On -Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On -Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,500 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 4, Breitzman September 30, 2007 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: - EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. All pockets of unacceptable materials must be removed and replaced. Lot 4; Breitzman September 30, 2007 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5' to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Municipality of Anchorage j Development Services Department Building Safety Division Onsite Water and Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: ANDERSON ENGINEERING Legal description: BREITZMAN LOT4 ®Permit OC.O.S.A.Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: 1. -EXISTING ABSORPTION SYSTEM ON RECORD IS ONLY APPROVED FOR A 4 BEDROOM HOME. ENGINEER NEEDS TO PROVIDE DATA TO ESTABLISH EXISTING ABSORPTION SYSTEM IS ADEQUATE FOR A 5 BEDROOM HOME, OR RESUBMIT APPLICATION FOR A 4 BEDROOM HOME SEPTIC TANK UPGRADE. Name of reviewer. JOE Date: October 5, 2007 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK 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 NAMEPHONE W;C61EQjZ;7-7_4qAk) NEW O UPGRADE MAILING JSS • 03 LEGAL DESCRIPTION M A Q LOCATION i NO. OF BEDROOMS VY DISTANCE TO: Well/� �v�� Absor ion ar?e Dwelling PER 0. LU ZQ Manufacturers A Materi�L7.p�./ No, of compar ents Li q/apac't igallons IF HOMEMADE: Inside length Width Liquid depth 6 Y J � Z DISTANCE TO: Well Dwelling PERMIT NO. 0ZI< Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Well. Foundation . Nearest lot 'n Q PERMIT NO.? 10 J LL Z Z W No. of lines ,� Le gth of each line, � - :2b Total I n th of ines ) Trench th inches;R Distance betwee0 7n s /t/ ' cc O Top of tile to finish grade Materia beneath tile inches Total eff=ive�bsorption area 'S ©© C7 Length Width Depth PERMIT NO. a H Wa Type of crib Crib diameter Crib depth Total effective absorption area W ti DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO, W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ALL PIPE MATERIALS SOI L TEST RATI NG ZZs INSTAL R � _ REMARKS S t i t APPROD DATE LEGAL 72-013 (fir. 3/78) 14 117 R.. fL . low Of p 71 1:1 Rq 0 --- "TV 1 0- K 00 057 b 1 KHT two F" K lot rw! 11 -7- PERMIT NO. ( 790620 ) ' � HPPLICnbmT WILLIAM BREITZMHN P 8 BOX i0 1901 ZIP 99511 . /l�] ^~�~�, LOCATION HILLSIDE TYPE OF SO1L ABSORPTION SYSTEM IS� TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL FARTING (SO FI/BR)- 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS ( [l � K21 K wo� -1- 1-1= �� �������= �������� �����= ' _�=' � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE 6RO11,11:) HND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) F40 K fitKA :1 lot EE E> 13 E77 Foy I - I TO 0- FA 14 PC 55 1�Z E�= IL WE 55 CA CA F1 k . L. CA 4 A 0�u PERMIT APPLICANT HAS; THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE NELL WILL SERVE. 0- 1"j C3 In so 74 :1 141 NO to" Ell K0 K 1: 17) 14 ST rIFIEE FT FE &I ki I FQ K LA BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. �K F& iwl X -T- K Kc 104 1: F?E23 c> FE co Ez rl E3 FE FQ !OIL, 1- to 7� 0:;; SIGNED: .................................................. ..... - HPPLICHNT WILLIAM BREITZMHN Ju 1SSUED BY___-_____-___--____-_-________DHY].2 C:: H o=o F: Hoa E- DEPARTh T OF HEALTH AND ENV I RONML ,'AL PROTECTION 825''L' STREET., ANCHORAGE, AK. 99501 h4-4720 Lam! E L _ L t=t r-4 C`= ID t-4 _.. I T' E =_• E Ls! E F` F' L =:1=' r--) I T" PERMIT NO. C APPLICANT , LOCAT ION / ��/S�qE Sziu l �- y LEGAL ( �7' 13 4 1, !r •� gni TYPE OF SOIL AESORPT I ON SYSTEM I S : l 7Le vc ,4 LOT SIZE 2700001 SQUARE FEE MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT,, BR:, = /2 S= THE REQUIRED SIZE OF THE SOIL ABi ►RFT I ON SYSTEM I S : CS L= F' 'T' H = 12 L_ L: r-41:3 -r _S iD F< F=i '..-I E L CN L= F' -T- THE LENGTH DIMENSION I S THE LENGTH < I N FEET? OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM, OF THE EXCAVATION (IN FEET). ~ THERE IS NO SET WIDTH FOB; TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IC•! FEET). F'E+ 1L -t I F'EC= EF"T I C: TF= t•.it *z. I zE-= oanl_L_C=tr-.J. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -T•WID < ^ ? I t -d =.F="L:11T I IZit.i =• HF: L= F'ECtL_t I L �'L�C1 _. BACKFILLING OF ANY SYSTEM WITHOUT FINAL I NSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION.. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I ;100 FEET FOR A PRIVATE WELL: OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. .OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'E:F-Zri I T E:','-< F' I F'E - E-sE: cL= rel F:E1*' .==--1 .• :I_• ._'_=+ I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWER..: AND WELL= AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM I1.4 ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO I NCLGDE MORE THAN 8 BEDROOMS. I GNE ISSUED 64' �/ DATE v 3. 'ONSTRUCTION TEST LkB "One Test is worth a Thousand Opinions" 2204 Cleveland Anchorage, Alaska 99503 277-0231 Performed for d11-11;AW ire- i f4,w&,,A Date Performed /1-.40 Legal Description: Lot y Block Subdivision �r`c.Tf-�yyla,v� 5V tCj This For_n reports: SOILS TEST V& -!G PERCOLATION TEST Depth Soil Characteristics Feet — 14o1�4vl— 04=- A7% -- Has Ground Water Encountered L� J If YES, What depth? !d le ■■■■■■ ■■■■■ Reading I Date 1 Gross Time I Net Time , Depth to H2O I Net Drainage Percolation Rate Minute Proposed Installation: SEEPAGE PIT DR,AIN FIELD Depth of Inlet Depth to Bottom of Pit or Tre h_ �0-, LENTS : ��� S/i !J ril.i, ��� �...- - n r5P_r� a t) i r ,�� Vest Performed by Data Certified Bv_: Date RETURN TO: Division of Geological and l ysical Surveys (DGGS) 3001 Porcupine Drive (Telep.,one: 277-6615) Anchorage, Alaska 99501 W A T E R W E L L R E C O R D Drilling Company Name _ 11V' inraTtnN nF WELL I Please complete either la, lb, or lc. U.S.G.S. Local No. Drilling Permit No. A.D.L. No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES la. Borough Subdivision Lot Block jib. Fraction Section No. Township N/S Range E/W Meridian lc. Distance and Direction from Road Intersections Street Address and Area of Well Location 3. OWNER OF WELL: Address: 2. WELL LOG Feet Below Surface Material Type Top Bottom 4• WELL DEPTH: (completed) ft. Surface Elevationj Date of Completion f. '4 5. 0 Cable tool Rotary Driven Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: '` t 6. USE: ❑ Domestic Public Supply Industry Irrigation ❑ Recharge ❑ Commercial Test Well Other: i.. _ 7 i- i r - _ 7. CASING: Threaded Welded in. to ft. Depth Weight lbs/f t. in, to ft. Depth rF' - j 8. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: t 9. STATIC WATER LEVEL: ft. Above Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pump -ng g.p.m. ft. after hrs. pumping g.p.m. i1. WELL HEAD COMPLETION: In Approved Pit Pitless Adapter inches above grade 12. GROUTING: Well Grouted: Yes [3No Material: []Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9 -P - Type: Q Submersible ❑ Reciprocating ❑ Jet []Other: 14. REMARKS: 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this Registered Business Name Address Signed: / �f est -,sic y Authorized Representative Form 02-WWR Copy Distribution: report is true to the best of my knowledge and belief: Contract License Number Date: WHITE - State DGGS, PINK - Driller, CANARY - Customer 5. LEGAL DESCR PTION DATE RECEIVED 1WEMION APPOINTMENTS — - §TRE`T LOCATION TIME G� wGr TIME(� TIME \ nl)VIQJ`4 SINGLE FAMILY L A.� (��cl j .lirJ DATE ❑ MULTIPLE FAMILY DATE DATE x . INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY INSPE T ❑ PUBLIC UTILITY INSPECTO INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT. of t ALTH & ; fl.`TECTION YEAR ON-SITE SYSTEM WAS INSTALLED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONIRONMENT,, 825 L Street - Anchorage, Alaska 99501 0* FEB 2 6 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED E C E I �/ 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. PRO E TY OWNER PHONE << /�3 MAILING A RESS AeG PROPERTY RESIDENT (Zigrent from above) PHONE �O 2. BUYER PHONE r MAILIN ADDRREE S 3. LENDING STI�ION PHONE MAI NG ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDR S 5. LEGAL DESCR PTION §TRE`T LOCATION G� wGr 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY 1:1 One Four 1:1 Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY . INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8.- SEWAGE DISPOSAL SYSTEM ,f5�' INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. i1-uiu lriev. o/ia) - 1 1 �! 4' �J—T{ '�h U7� 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED y —� INSTALLER p ' ❑Septic Tank or ❑ Holding Tank Size: I Z11 %3 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Se tic /Holding Tank SOD Absorption Area �I0o Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 1 -'APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accom tificate) ❑ DISAPPROVED DATE A .5rk,—%-.# V B 11c'?, 0 — - YA4C�4 I 72-010 (Rev. 6/79) CHEMICAL & Gj9t,4j OGICA1, LABORATORIES tis ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER �. 274-3364 5633 B Street u.ORA=ES Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: FA I I I I I Analysis shows this Water SAMPLE to be: I.D. NO. ❑; f Water System Name f Phone No. Mailing Address City State SAMPLE DATE: C LTL—J Mo. Day Year Zip Code ` SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. no. ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 3 4 5 Sates actory ❑ Unsatisfactory ❑, .Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result* Analyst Is ( F i m m *No. of colonies/ 100 ml. or No of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source READ INSTRUCTIONS a.m. Date Raceived Time Received p.m. Lab. No. Presumptive 10ml l oml 10ml 1 oml I l oml l.oml 0.1 ml 24 Hours BEFORE 48 Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 20ml Portions Membrane Filter: Direct Count Coliform/loom) Verification: LTB BGB Final Membrane Filter'Rasults Coliform/loom) Reported By Date Time: - a.m. p.m.