HomeMy WebLinkAboutBREITZMAN LT 1B rei*tzman
Lot 1
#015mw231�77
M
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark Begich Anchorage, AK 99507
Mayor wm.muni.org/ortsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description Property Owner Name & Address: —A
I,,,0ptR1L FPIerAgg_
Q J z !''l A /1l -7aol At,4sn)4 040t-
040a'61
auxKae'.1 t j ✓t q4S� G
Pump Installation Date. 3-D,
Pump Intake Depth Below Top of Well Casing: Ga feet
Pump Manufacturer's Name: /4% ✓"CPDA'02'
Pump Model: a 30 sV L/ 3 4 G
Pump Size Vy hp
Pitless Adapter Burial Depth: 8 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: f
Well Disinfected Upon Completion? E es ❑ No
Method of Disinfection: Cl-ptet.n t Qf tlBTs
Comments:
Pump Installer Name: 601040'"4'L ta.J E t% 3
Attention: The pump installer shall provide a pump installatii log to the DSD within 30 days of pump installation.
Municipality of Anchorage
Development Services Department
Building Safety Division E
On-Site Water & Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ok.us (907) 343-7904 Page 1 of 3
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW090025 PID Number: 015-231-77
Name VICTOR MITTASCH
Wastewater System: ❑ New ■ Upgrade
Address:
7201 ALATNA ST . ANCHORAGE, AK a 99516
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 345-3669 5
Deep Trench O Shallow Trench O Bed O Mound 0Other
LEGAL DESCRIPTION
sal RW^V:
0.6 apo/sq. R
Tota aopih ham anpinal owe:
12.51 MAX R
Block: Lot: Subdivision:
aePU b pile, bo f o agilwl pride:
arrow Myth b.n.ath pale:
— 1 BRIETZMAN
3.16 MAX R
9 R
Township: Range: Section: —
— —
FA od"d .bov. odpinal erode:
Gn vel I. Wh:
72
SEE DWG. R
FL
Gnnel .Idlh:
Number of prw:
a4tanc. mt.. Knee:
WELL: ❑ New ❑ Upgrade
3 rL
1
— R
Cwewlw.lwn (Pmol.. Xs.0): TO,,l a.0Coed To:
Tote) ob. pilon arw:
1296
plp. m.t.rlal:
D 3034/ F-810
R
so. R
Orwer: died: stalk Oldie, L.v.l:
kwtww:
GREYS CONSTRUCTION
pot. Inet d:
4/1-2/2009
R
Yield:Iunp
Set Al:
CeNnp N.ght FDo.. Glawld:
TANK
f p11
R
R
SEPARATION
DISTANCES
■septic OHotding OS.T.E.P. 0Other*
To
Septic
Absorption
Lift
Holdingut&/pdvote
bia'"'la`h1fe.
GREER
G v Ay ~
1500
From
Tank
Field
Station
Tank
Sewer W...
Well
100'+
100'+
—
—
25'+
NaterlW:
STEEL
Nwna.r of awnpalmente:
2
Surface water
100'+
100'+
—
—
—
LIFT STATION
Lot Line
5'+
10'+
—
—
—
Sn N pdbrl.:
4arxdoclurer.
i,mp en lee ol: .r^p ell level of
a er ol.rm al:
Foundation
5'+
10'+
—
—
—
paelp Yoe. •
IrkW kwp.caans ponied bF.
curtain Drain
NONE KNOWN
BENCH MARK
Remarks:
La:ooi,n ono Deecriptkn:
OLD TANK & TRENCH WERE ABANDONED PER UPC.
BOTTOM OF TANK
As.ar..d Er . 90.32
in.
ENGINEER'S SEA
Inspections performed by: GEG, Ltd. Dates: 1st 4/1/2009
2nd 4/2/2009
OF
; (� �F
3rd 4/2/2009
Development Services Department Approval
p;? 4 IH 9 0
Conditional approval: Date:
Go•• •• ....
QQ ' •• ...
f r rn ss.: Q
P
Q o CE-7
Reviewed and approved by:Date:�Z-210A
4�Qd Professlonoo�
(Rev. 4/06)
QO�O��pO
PERMITNUMBER:
—
AS—BUILT DRAWING
PARCEL ID NUMBER:
015-231-77
SW090025
SWO
I
I A I B
I C
FCO 33.011 3.7
1 17.8
\
STI 58.14 35.34
35.17
\
\
ST2 62.95 44.29
45.36
\
DELI 66.56 50.88
52.96
I
OBL2 70.94 51.66
53.82
\
COI 68.57 68.51
76.51
WTI 69.72 69.85
77.86
CO2 106.03 125.50 138.45
�\ ALTERNATE SITE//
TM'4,
MT2 104.74 124.37 137.39
/
IBORING
WELL
MTI
COl /
/
DBL2
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DBL1
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NEW 1500 GALLON
SEPTIC40
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B EXISTING
5 BEDROOM
C HOUSE
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PREPARED FOR: PHONE NUMBER; PAGE NUMBER: 0 "• •.. "' O
A. orness: 0
VICTOR MITTASCH 345-3669 2 OF 3 0e
LEGAL DESCRIPTION: DRAWN BY: OD,e� FFG
BREITZMAN, LOT 1 A.J.G.
TYPE OF WORK: DATE: pOQO4Opesslo '
AS—BUILT DRAWING OF NEW SEPTIC SYSTEM 4/3/2009
(Rev 01N5)
PERMITNUMBER: PARCEL ID NUMBER:
SWO AS—BUILT DRAWING I
SW090025 015-231-77
FINAL GRADE - 99.13-99.32
STI ST2
TOP OF TANK / TOP Of TANK
AT INLET - 95.15 AT OUTLET - 95.13
NEW 1500 GALLON
INVERT OF BUNG SEPTIC TANK INVERT OF BUNG
AT INLET - 94.75 AT OUTLET . 94.40
FINAL GRADE -
98.73-99.03ORIGINAL GRADE
O HIGHEST
PoINT- 97.21
FILTER FABRIC
INVERT OF PIPE
- 93.70
BOTTOM OF
TRENCH
84.70
rIVE ELEVATION OF BOTTOM OF
TESTHOLE - 77.21 (DRY)
RELATIVE ELEVATION OF BOTTOM j
OF TESTHOLE - JQ3.21 (DRY)
GARNESS ENGINEERING
GROUP, Ltd
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:EPAREO FOR: PHONE NUMBER:
PAGE NUMBER:
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•• ••• ......••
fr y Go ess:
VICTOR MITTASCH 345-3669
3 OF 3
0
GAL DESCRIPTION:
DRAWN AY J.G.
�O�n
ewe ' ' O�T.•�,o°`�G
BREITZMAN, LOT 1
4
PE OF WORK:
DATE:
004pOO�OO000
PROFILE AS—BUILT DRAWING OF NEW SEPTIC
SYSTEM 4/3/2009
[Rev 01N )
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Date Issued: Mar 31, 2009
Expiration Date: Mar 31, 2010
Permit Number: SWO90025 Parcel ID: 015-231-77
Legal Description: BREITZMAN LT 1
Design Engineer: 0855 GARNESS ENGINEERING GROW Site Address: 007201 ALATNA AVE
Owner Name: VICTOR MITTASCH Lot Size: 0 SO. FT.
Owner Address: 7201 ALATNA STREET Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516 -
This permit is for the construction of:
❑/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 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.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By.
Date: I6 0 1
Date:
Municipality of Anchorage
• -• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015--93>1
Property
1$ -a31
Property owner(s) VICTOR MITTASCH Day phone 345-3669
Mailing address 7201 ALATNA AVENUE • ANCHORAGE- AK
Site address Zip Code 99516
Legal description (Sub'd, Block & Lot) BRIETZMAN LOT 1
Legal description (Township, Section & Range) N/A
Lot Size
Sq.Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
❑
Upgrade
❑
Renewal
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.
GARNESS ENGINEERING GROUP Ltd.
Permit/Rush Fees: 3 L) q
Date of Payment: 31=S/ o I
Receipt Number: Q I �a
(Rev. 11/05)
Waiver Fees:
Dale of Payment:
Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
March 24, 2009
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650,
Anchorage,Ak 99519-6650
(907)343-7904
Ref: Proposed Septic System Upgrade for Breitzman; Lot 1,
To whom it may concern:
A permit (SW070307) was issued for this property on 11/13/2007 and has since expired. The property
owner is requesting that your department issue a new permit. The design has not changed since the last
permit was issued.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any qqestions, please contact us at 337-6179. Thank you for your assistance.
P.E.,
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: www.gamessengincering.com
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 13, 2007
Expiration Date: Nov 12, 2008
Permit Number: SW070307 Parcel ID: 015-231-77
Legal Description: BREITZMAN LT 1
Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 007201 ALATNA AVE
Owner Name: VICTOR MITTASCH Lot Size: 49500 SO. FT.
Owner Address: 7201 ALATNA STREET Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE. AK 99516 -
This permit is for the construction of.
❑� Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked 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.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By.
L
Date: / / C
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division,
On -Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ni5-ani-al
Property owner(s) VICTOR MITTASCH Day phone 250-8348
Mailing address 7201 ALATNA AVE ► ANCHORAGE. AK
Site address
Legal description (Sub'd, Block & Lot ) BREITZMAN LOT1
Legal description (Township, Section & Range)
Lot Size L43 . 5 CO Sq.FL
THIS APPLICATION IS FOR (Nall that apply):
Absorption Field
❑
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Zip Code 99516
Number of Bedrooms 5
THIS APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
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.
GARNESS ENGINEERING GROUP, Ltd.
Permit/Rush Fees: 4.1(, (7 . 0 0
Date of Payment: `3 7
Receipt Number. a.
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number.
MUNICIPALITY OF ANCHORAGE Page 9 of 1 .
Sonja Garness
From: Wockenfuss, Deborah M.[WockenfussDM@ci.anchorage.ak.usj
Sent: Monday, November 05, 2007 4:11 PM
To: Sonja Garness
Subject: Breitzman; L1.doc
Attachments: image002.png; oledata.mso
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site 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:
Legal description: Breitzman�L1
Permit C.O.S.A. Inspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
1.AMC 15.65.060.a.1.d requires a subsurface disposal field to be located not less than two times
the depth of gravel below the level of the horizontal perforated pipe or ten feet, whichever is
greater, from any existing or abandoned subsurface disposal field.
2.The proposed trench location is not parallel to the contours of the slope. Please change the
orientation or provide a cross-section of the trench that shows that the bottom will not encroach
on the required separation distances and the effective area stays within the tested stratum.
Name of reviewer: Deb
Date: 1115/07
1
i ( fin Jfi Fid ()/W L— -
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(fJ[, DH5Jf t11f�
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C-
11/5/2007
,G
11/5/2007
GARNESS ENGINEERING GROUP, Ltd.
- =-,r CONSULTANTS & GENERAL CONTRACTORS .- = _-
October 24, 2007
Municipality of Anchorage
Development Service Department
On -Site Water R Wastewater Program
4700 Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic Upgrade for Breitzman; Lot 1,
To whom it may concern:
The existing 5 bedroom house is served by a private well and septic system. The septic system is in a state
of failure and needs to be upgrade. We are proposing to install a 1500 gallon septic tank and a deep trench
type drainfield. Two test holes were excavated on the property. The drainfield will be designed around
the 30 foot radius of these test holes. Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the
drainfield is a 5-10 percent slope running approximately northwest to southeast.
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.
M.S.
NOTE.vAttached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (contact G.E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamesscnginecring.com
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AMUNDSEN. LOT 2
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SEPTIC SYSTEM
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it
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BREITZAM SUBDMSION,
rqEPTIC
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BREITZAM SUBDMSION.
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GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTOR�...... • • ...... • • .........
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PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••• • . • ....... .......•••
VICTOR MITTASCH 345-3669 1 OF 2 Q ' f A. G ness;
o .
LEGAL DESCRIPTION: DRAWN BY; %p- CE 3
BREITZMAN SUBDIVISION, LOT 1 0 re ''11•�� o Eo°o
TYPE OF WORK: DATE: �OQOOroOQQOoo�
PROPOSED SEPTIC SYSTEM UPGRADE DESIGN 10/23/2007
(Rev. OVd5)
NUMBER OF BEDROOMS:5
GALLONS PER DAY (GPD): 750
PERCOLATION RATE/S: 5/7.5/20 MIN./INCH
PROPOSED APPLICATION RATE: 0.6
MINIMUM DRAINFIELD SO.FT.: 1250
RAINFIELD DESIGN.
MMIMUM DEPTH:13 FEET
WIDTH:3 FEET
LENGTH:70 FEET
M.O.A. APPROVED SAND FILTER: N/A
EFFECTIVE:9 FEET
REDUCTION FACTOR: N/A
ACTUAL SO.FT.:1260
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
:ONTACT CEG. 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
BOOTLEGGED TRENCH TO BE
AND COMPLETELY ASAND
INSTALL DOUBLE
CLEANOUTS—
PROPOSED 1500
GALLON SEPTIC TM
NOTE: THE CONTRACTOR SHALL HAVE
THE EAST LOT LINE AND ALL WELL
RADII FLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO CONSTRUCTION.
\I a\
�\ ALTERNATE SffE�/// TH# !O;
GROPSED
RAINFIELD
BORING PIPE
I
I
AMUND:
LOT
EXISTING SEPTIC TANK TO I
BE PUMPED, CRUSHED, AND
COMPLETELY ABANDONED
I
EXISTING
I
5 BEDROOM 1�
HOUSE ..
F-1
GARNESS ENGINEERING GROUP, Ltd
. -••.• • CONSULTANTS 3 GENERAL CONTRACTORS --'---- '��
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PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
VICTOR MITTASCH 345-3669 2 OF 2
LEGAL DESCRIPTION: IDRAWN BY:
LOT 1
(TYPE OF WORK:
PROPOSED SEPTIC SYSTEM
K.D.M.
DESIGN 1 11/7/2007
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3701 L UM 101 • ASO L�LOG•
PERCOLATION TEST ' ,,,,, ,
LEGAL DESCRIPTION: BRIETZMAN LOT 1 a ' e E-795 ess °QO
PERFORMED FOR: VICTOR MITTASCH DATE: 10/18/2007
DEPTH
(feet) ORGANICS TEST HOLE 1 BORING HOLE TO 20 �00000����
a�3�
1 eay7
== SM—SILTY SOIL CLASSIFICATIONS
1 BREITZMAN
2 LOAM $UBDNISION,
GW cc== ORG
3 ,+ . GP ML
csEPnC
SM GM CL TH/x ��
4 SILTY GRAVEL GC OL
AND SAND °• °°• o SW MH
SP CH
5
SM � / : OH BORING
6 SC
7 DEPTH TO DATE
GROUNDWATER A
8 DRY 0/18/200
�0 2b
9scAtquSE
SM
10 LESS ROCK,
MORE SAND
NET DROP
11 DATE READING CLOCK NET TIME TIME WATER EL (MINUTES) READING
12
13
14
15
SM
16 MORE GRAVEL
MOIST 020'
17 NO BEDROCK
18
PERCOLATION RATE — (MIN./INCH) PERC. HOLE DIA. — (INCHES)
19
TEST RUN BETWEEN — FT. AND — FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ED YES F-1NO
B.O.H.
SOILS LOGGED BY: SUSAN PERCOLATION TEST PERFORMED BY: PNB
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: o
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DATE
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NET TIME
WATER LEVEL
9/12/2007
9/10/2007
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SOIL LOG
- PERCOLATION TEST
-
LEGAL
DESCRIPTION:
BRIETZMAN, LOT 1
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PERFORMED
FOR:
VICTOR MrTTASCH DATE: 9/4/2007
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DEPTH
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TEST HOLE#2'�0000��o
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SOIL CLASSIFICATIONS
BRE(RMAN
2
SUBDMSION,
GW c___ ORG
LOT 2
GP ML
1
GM CL
SM -SILTY FINE
GC OL
4
SAND WITH
LENSES OF GRAY
°° °°AREA
° o SW MH
S BEDROOM
SAND SOME
°•L•. ; SP CH
T:il
5
HOUSE
COBBLES
SM X i OH
SC
6
7
DEPTH TO DATE
GROUNDWATER
8
DRY 9/4/2007
EXISTING
9
0
SCALE:
10
o b
SW -GW, CLEAN
° ?d
GRAY SAND AND
TIME (MINUTES)
READING
(INCHES)
go
°O°°�ti.•'
GRAVEL
12
a°p
13
off'
14
B.O.H.
15
16
17
18
PERCOLATION RATE 5 (MIN./INCH) PERC. HOLE DIA.
6 (INCHES)
19
TEST RUN BETWEEN 6 FT. AND 6.5
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO
SOILS
LOGGED
BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY:
PIERCE BLEWETT
COMMENTS:
GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERF RMED IN ACCORDANCE
PERFORMED
BY
WITH ALL
STATE
AND MUNICIPAL
GUIDELINES IN EFFECT ON THIS DATE: S
U
DATE
READING
CLOCK
NET TIME
WATER LEVEL
9/12/2007
9/10/2007
1
4:58
-
DATE
READING
CLOCK
NET TIME
WATER LEVEL
NET DROP
9/10/2007
1
4:58
-
6"
-
2
5:28
30
0
6"
3
5:29
-
6"
-
4
5:59
30
.25"
5.75 '
5
6:00
-
6"
-
6
6:30
30
0
6"
i
x
/
1
S BEDROOM
*•�,
HOUSE
�____
� !�`\�
DATE
READING
CLOCK
NET TIME
WATER LEVEL
NET DROP
9/10/2007
1
4:58
-
6"
-
2
5:28
30
0
6"
3
5:29
-
6"
-
4
5:59
30
.25"
5.75 '
5
6:00
-
6"
-
6
6:30
30
0
6"
GARNLSS
o ENGINEERSULTANTS& GENERALING GROUP, Ltd.
32" • •EBSC ,un.�wgrwln9.•a"
101 • AWJ40& GL A 69507 • ha„L 90 7-6179 • 7AL 907 11
�0�0000�
,• ...............
1)01 L 1 90W. aurz
0009
9/12/2007
9/10/2007
SOIL LOG - PERCOLATION TEST
....
'•.
....0
TH/2
0
r A. Garss.-
LEGAL
DESCRIPTION:
BRIETZMAN LOT 1
s
C�IE{
PERFORMED FOR:
VICTOR MITASCH DATE: 9 4 2007
v e'
1 �Aovp
44� q.
DEPTH
(feet)
_=y�
(yp Aonoo
l
�OD0000��
5:55
30
TEST HOLE 1 BENCH 1
1.5'
1
y=z
ORGANICS
6"
0
/
6:26
30
x I
1.5"
SM -SILTY SOIL CLASSIFICATIONS
2
LOAMGW
1
.. X`
ORG
S BEDROOM
SG,aeusE
` ,+'+t GP ML
3
SM -SILTY GM CL
4
VERY FINE GC OL
SAND °. 00 o SW MH
5
'• �•• SP CH
SM iii OH
6
SC
�•:•• •
7
•.:.•
,.�•�,•
DEPTH TO DATE
•...•
GROUNDWATER
8
• •'•'
SP -MED DRY
•: ••••
COARSE
9
••:•;••
•• • ••
SAND AND
SMALL
•• • ••
.•.•.,•
COBBLES BUT
10
•' ••••
FAIRLY WELL
••'•"••
BONDED
.. �.� .•
•'•••
11
...•.••
..;•� 6•
•...•
12
,•�•�,.
•...•
13
•'•••
.. ••
14—=
B.O.11.
15
16
17
18
PERCOLATION RATE 20 (MIN./INCH) PERC.
HOLE DIA.
6 (INCHES)
19
TEST RUN BETWEEN 3.5 FT. AND 4
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: N
YES ❑ NO
SOILS
LOGGED
BY: SUSAN PERCOLATION TEST PERFORMED BY:
PNB
COMMENTS:
GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERF RMED IN ACCORDANCE
PERFORMED BY
WITH ALL STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 16
0
DATE
READING
9/4/2007
DRY
9/12/2007
9/10/2007
1
Lor 2
—
DATE
READING
BRERZMAN
NET TIME
(MINUTES)
WATER LEVEL
READING
SUBDMSION,
9/10/2007
1
Lor 2
—
TH/2
0
•
ARS
N
4.25"
1.75'
3
5:25
-
1 T:�1
0
4
5:55
30
1 /
1.5'
5
5:56
-
6"
0
/
6:26
30
x I
1.5"
I �
1
.. X`
EXISTING
S BEDROOM
SG,aeusE
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
9/10/2007
1
4:54
—
6"
0
2
5:24
30
4.25"
1.75'
3
5:25
-
6"
0
4
5:55
30
4.5"
1.5'
5
5:56
-
6"
0
6
6:26
30
4.5"
1.5"
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: BRIETZMAN LOT i
PERFORMED FOR: VICTOR MITTASCH DATE:_2
DEPTm;;;;;;
(feeTEST HOLE 1 BENCH 21 ORGANICS
F5
81-10-0-0
-• •-•-
.••0.�
DRY
9/4/2007
DRY
SP -MED COARSE
9
��Ill�lliCLASSIFICATIONS
SAND AND SMALL
0
'•
COBBLES BUT
30
••L•'••
FAIRLY WELL
10
��
• -
6'
0
4
5:57
30
2-
4'
5
5:58
-
IIII1111GW
0
6
6:28
30
2'
4'
IG111!11ML
I GM
1 I
SM -SILTY VERY GC 0�� H,NN�CIL
•MH
I
EXISTING
FINE SAND SWIIIIIIIII
5 BEDROOM
SchwSE
L----- t--- \ ' -
77 ++SPCH
•
Sc
F5
81-10-0-0
-• •-•-
.••0.�
DRY
9/4/2007
DRY
SP -MED COARSE
9
.� • • •
SAND AND SMALL
0
'•
COBBLES BUT
30
••L•'••
FAIRLY WELL
10
,
BONDED
13-
14—=
3 14=
15-
16-
17-
18—
DEPTH
5161718
DEPTH TO
GROUNDWATER
DATE
DRY
9/4/2007
DRY
9/12/2007
4:56
i{
LOT 2
2
0
DATE READING
}
BREITZMAN
WATER LEVEL
READING
NET DROP
(INCHES)
N,
SUBLOT
4:56
i{
LOT 2
2
0
\\ TH/Z
AR
30
2-
LAD
N
I �
-
6'
0
4
5:57
30
2-
4'
5
5:58
-
6'
0
6
6:28
30
2'
4'
1 I
1 1 ,
I
EXISTING
�A
rT \
5 BEDROOM
SchwSE
L----- t--- \ ' -
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
9/10/2007 1
4:56
-
6'
0
2
5:26
30
2-
4-
3
5:27
-
6'
0
4
5:57
30
2-
4'
5
5:58
-
6'
0
6
6:28
30
2'
4'
19 I I PERCOLATION RATE 7.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
- �I�_JII TEST RUN BETWEEN 6 FT. AND 6.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: SUSAN PERCOLATION TEST PERFORMED BY: PNB
COMMENTS:
PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THISWAS ERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: B o
i
Gon �u'�s
(Ray. O1N5)
P Lam.,
1
\
/
/
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I I
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i
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APTI
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— — — — — — ——
_ _ __
BREITZAM SUBDM N,
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I_
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LOT 2
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Si1ER�EAC
BRERZAM SUBDIVISION,
I LOT 3
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/
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11
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- -- - - - - - - r \A
AVE
II /
T12 . R3 , C 3, \ II
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HAWKINSON,
LOT Al
LOT 1
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1' 100' II ARS
I I
0..
GARNL'SS LNGINEERING GROUP, Ltd.
. 0.
• � - ••-- CONSULTANTS 3 GENERAL CONTRACTORS ..+,...�.�.�,,...,«.......,....
n1 [ TIoOM Ig10, 1U1[ 101 NC11pMWl. Mt NW7 n .�..w71 In • ra J " • e[B ..w.
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
•• ••••••••••• ....0
If A. ess:
VICTOR MITTASCH 345-3669i OF 1
Y
Q
'
LEGAL DESCRIPTION: DRAWN BY:
BRIE AN SUBDIVISION, LOT 1 K.D.M.
C -7953 • `Fo0
OD v
DRK: DATE: 400�p/o/esfl0��p
�40000��
SWrpbW D 10/4/2007
(Ray. O1N5)
P Lam.,
Municipality of Anchorage
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: GEG
Legal description: Breltzman. L1
®Permit []C.O.SJL []inspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
1. AMC 15.65.060.a.1.d requires a subsurface disposal field to be located not less than two times
the depth of gravel below the level of the horizontal perforated pipe or ten feet, whichever is
greater, from any existing or abandoned subsurface disposal field.
2. The proposed trench location is not parallel to the contours of the slope. Please change the
orientation or provide a cross-section of the trench that shows that the bottom Will not encroach
on the required separation distances and the effective area stays within the tested stratum.
Name of reviewer: Deb
Date: 1115107
II/ S/O7
SII TOr M�dl
xx/e. &f
Cj/ /stem Acle,Acle,fV bC. �W/CG -the @VTCG77�Vt
111 frD,,
o,6.j'4cd
1ct4
fico.
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
NUMBER OF SEDROOMS:u
GALLONS PER DAY (GPD)): 750
PERCOLATION RATE/S:5/7.5/20 MIN./INCH
PROPOSED APPLICATION RATE 25 0.6
0
MINIMUM DRAINFIELD SO.FT.:1
MAXIMU�( �H:
WIDTH: 70 FEET
LENGTH: N/A
M.O.A. APP$O� SAND FILTER:
EFFECTIVE: N/A
REDUCDON FAC�4�
ACTUAL SO. FT.:
TO OBTAIN A COPY OF THE LETTER
CONTACT CEG. BY PROCEEDING FORWARE
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
BOOTLEGGED TRENCH TO BE PUMPED
AND COMPLETELY ABANDONED
AMUND!
LOT
GALLON SEPTIC TANK
/I
NOTE: THE CONTRACTOR SHALL HAVE
THE EAST LOT LINE AND ALL WELL
RADII FLAGGED BY A REGISTERED LAND
1 SURVEYOR PRIOR TO CONSTRUCTION.
570 UPoe E: its E®E
\ S7
O,t
�y O;
ALTERNATE SITE//� TH/71'
/ 4
°� ED
DRNNFIELD
f/ / //
/ /
PE
-EXISTING SEPTIC TANK TO
BE PUMPED. CRUSHED, AND
COMPLETELY ABANDONED
EXISTING 11
S BEDROOM
HOUSE
-
ARNESS ENGINEERING GROUP, Ltd.per'?• 9
-_... .,....,,..,- -„ CONSULTANTS S GENERAL CONTRACTORS ••���+•-•--Y—^� �""' "' "" """" """"
7101 L TAM 00N. MC 101 • MLIGMM Mf 0 7 . F11.'1[ (007)=7 IA • fMl (007)07 ". 0VL2 w�.,mwgOwM1gM.n a
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: '. ,. ff A. GDT.I SS.•
VICTOR MITTASCH 345-3669 2 OF 2 Q s
�l
LEGAL DESCRIPTION: DRAWN BY: Qa o E- 53 ,• `F�
BREITZMAN. LOT 1 K.D.M. ��e�s'1'►�7.j.o'��Qo
TYPE OF WORK: DATE: 4�QdPfofesslo oo�
PROPOSED SEPTIC SYSTEM UPGRADE DESIGN 11/7/2007 DODo��o
IR". MAIM
/ I
I
______-___-4-_____J
- - - - - - - - - -
t
\ I
AMUNDSEN. LOT 2
---J 1
SEPTIC
'D I
I
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PROPOSED
cs-EPTIC
SEPTIC SYSTEM
f
I
ARS 1 WCL RAOIUS I
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AMUNDSEN. LOT T I
I
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1
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LOT 2
ARa
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CPT
ARS
I
BREITZAM SUBDN,SIO
LOT 3
I
I
1
I
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II
W I I BREITZAM SUBI
1 i LOT 4
- EXISTING I
S BEDROOM
HOUSE/
�A -FNA AVE
I
IX ISE1
I
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TIM R3W. SEC 23,
E2. NW4, SE4, SE4 \ I I , TENGBERG• HAWKINSON,
/ LOT Al LOT 1
IIS---�
II CSEPTIC
II ARS
GARNGSS LNGINLLRING GROUP, Ltd
- CONSULTANTS d GENERAL CONTRACTORS . .
101 • MIbOIVL[. Mt w501 • wuK 007"Vl lA • IM (007) b 2" • RBSIIC: w.. a
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q. { ey OFNe55.•
VICTOR MITTASCH 345-3669 1 OF 2
LEGAL DESCRIPTION: DRAWN BY: wop. CE -7953 FG
BREITZMAN SUBDIVISION, LOT 1 K.D.M.
TYPE OF WORK: DATE: �OQO4Op�OOoa�
PROPOSED SEPTIC SYSTEM UPGRADE DESIGN 10/23/2007
(Rw. OIN5)
NUMBER OF BEDROOMS:5
GALLONS PER DAY (CPO): 750
PERCOLATION RATE/S: 5/7.5/20 MIN./INCH
PROPOSED APPLICATION RATE: 0.5
MINIMUM DRAINFIELD SO.FT.: 1250
WIDTH:3 FEET
LENGTH:70 FEET
M.O.A. APPROVED SAND FILTER: N/A
EFFECTIVE:9 FEET
REDUCTION FACTOR: N/A
ACTUAL SO.FT.:1260
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT CEC. 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
BOOTLEGGED TRENCH TO
AND COMPLETELY AS
INSTALL
PROPOSED 1500
GALLON SEPTIC TAI
r— — — — — — —-
NOTE: THE CONTRACTOR SHALL HAVE
THE EAST LOT LINE AND ALL WELL
RADII FLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO CONSTRUCTION.
PI.�� k , y
IE
�\ ALTERNATE SffE \
;p ROPSED
DRAINFIELD
TH 1 / / 1 i
BORING PIPE�cb
s $ /
1
AMLOT I , I
LOT �(II+
N I
/ EXISTING SEPTIC TANK TO I
BE PUMPED. CRUSHED. AND
COMPLETELY ABANDONED
I
EXISTING
5 BEDROOM
HOUSE
GARNESS ENGINEERING
GROUP, Ltd.
;?
yam`
"•"••
--- -•--�•--.-••-^- CONSULTANTS 6 GENERAL CONTRACTORS
...
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DDt L TAW OMD. IAM 101 . AWMR4L 10 ftW 9 ($01)111-91" • N% (901)1)! -RN - 1,®9R: �. M.w+
PREPARED FOR: PHONE NUMBER:
VICTOR MITTASCH 345-3669
PACE NUMBER:
2 OF 2QO
•• ;
•• •••• ....."'
of r y A. Ga esS:
LEGAL DESCRIPTION:
DRAWN BY:
a
�p
OQ
CE -79 3 ei
••. SFO
V°
BREITZMAN, LOT 1
K.D.M.
s (lAo
DATE.
40rofe3�0000sjoTl
TYPE OF WORK:
PROPOSED SEPTIC SYSTEM UPGRADE DESIGN
10/26/2007
(w olms)
MUNICIPALITY OF ANCHORAGE
0 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
NAME
PHONE
y❑ UPGRADE
MAILING ADDntl e
n ,
LEGAL DESCRIPTION
LOCAT O
NO. OF BEDROOM
UY
DISTANCE TO:
el�� l
- qII
AbsorPtio r
Dwelling fJ
PERMIT NO. G� �J / S%
a ZQ
w E.
Manufacturer
Materi
No. of compartments
N
Liq. ca acity in gallon s
IF HOMEMADE:
Inside length
Width
Liquid depth
O� Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
w=
DISTANCE TO:
Well
Foundatio t
8
Nearest lot line
*-� Q
PERMIT NO. --7
'7 03
W!2 LL v
H Z w
No. of lines
��
Length of each n
g�
Total length lire
gJ O�
Trench th
inches
Distance be wee lips i
GK.J
G
Top of i e to finish grade- .
�-(,�
Material beneath tile
Z'
Total effective bssorptin area
G�
W
t7
Length
Width
Depth
PERMIT NO.
Q H
as
W
Type of
ib diameter
C '
Total effective absor '
W
DISTANCE TO:
Well
Building fou dation
crest lot line
Depth
Driller
Distance to lot line
PERMIT NO. /-/ %039
W
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
D 3o3(1
SOIL TEST RATING
C
IN LE�i
1
REMARKS
77
I Io
00, Tic,
APPROVED
DATE LEGAL
Y
71W,
q
72-013 (Ipv. 3/78) / / Q
rlNJ r4 IK__ I
DEPARTMENT OF
825 'L'
WE=_&_K_
PERMIT NO ( 790374 >
APPLICANT YIC MITTHCASH
LOCATION HILLS%0E/HLANTR
LEGAL LOT I BRITZMAN SUB
� '10«��
CiF=" "r-40-"t-����
HEHLTH AND ENVIRONMENTAL PhuTECTION
STREET, ANCHORAGE.- AK. 99501
264-4720
� I -r I -F *F. FEE L4 E: F-* �E=- FR. Irl 11 -T
~1q
'(
���~
8818 ABBOTT LP RD. �}44-I�3�~/ //or=+
LOT SIZE 56000 SQUARE FEET
TYPE OF SOIL HBS8RBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ, FT./BR)= 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
����" - !90 L_ E: " 13 _r "= 0_5 �L ��" V I=- I ���-r "= 15
THE LENGTH DIMENSION IS THE LENGfH (IN BET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (%N FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
�a Q U I F;.:'.'a E --v F=* -r I iZ-. -F F=l " K <-:::; I =- E == A- :2 15�� ���������*�F-
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.
_FW0 <;2 > I N!F. F" EE 17D -r 10 r-J!S f=l F;.-'- E=- FR. F= G-_! tJ 1 FF C.-
BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H 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.
�r=- F;:?- M I -F �X F=* I F -l' E::F. E-08 I=- 0. r=- 1* -1 E3 FE F;?- =s::lL.- 1L�71'!E4
I CERTIFY THAT
1: % RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCH8RAGE,
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
~ �l
SIGNED:_��lJ�'-���Jl_�z���_�/�__________________
APPLICANT YIC MITTHCASH
ISSUED BY' -J, ------ X-4 ______DHTE_ -�� ___ Y3. 2
nY*cxocAse
\
—�u`r `� �� �� oo/Lo Los \ ~ 'nom
MUNICIPALITY OFANCHORAGE
DEP4RTWENT0FHEALTHANDENV\RU0K8ENT�LPRVTECT/o�PA1[� '.��Nc»��nom
TEST
Pouch 6-G50, Anchorage, Alaska 99502 776-2221
\�SCIL3LOG—PERC]LAT|[NTE3T DL.[LD
PERFORMED
FOR:_
Gross
Time.-
Net
Time
Depth to
Water
Net
Drop
LEGAL
DESCRIPTION:
/ `
DEPTH
SLOPE
SITE PLAN
2
3
'
4
o
-
| ! !
J��'���
lU
`
11
WAS GROUND WATER
'���r~
s i
L
smooumrsneor ----------
o
P
12
|pvs�^TWHAT ------
ei
' !
uspTnr
13
14
15
16
17
18
19
2O-
commLmTs
Reading
Date
Gross
Time.-
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
reyrRUN BETWEEN
PERFORMED BY: 11 CERTIFIED BY._
rn::///7*`
(minutes/inch)
FT AND -__-__'pr
0
1x XPLORATION SUPPLY AND EQUIPMENT, INC.
S
C
0 Drill Shift Report
CONTRACTOR 7 DATE , : -76 - .%k ir9
EQUIPMENT TYPE rv� r -� �" ��' f r PARTY
UNIT NO.
f7 a / c. 1 4;" rt
DEPARTED CAMP
TRAVEL TIME
ARRIVED FIELD
BREAKDOWN TIME
DEPARTED FIELD
MOVE TIME
ARRIVED CAMP_
CHARGEABLE TIME
LOCATION
FORMATION
FOOTAGE
.J
c)
4 i}
za
1
r
�
CJs -, �' U �•.,
.p . ! Y � —r. .1 C� �,a: }
DRILLER
TIME
•i �
HELPER.-�`��
P sf
,/tri
TIME
ROCK BITS"
INSERT BITS -�
MUD USED -"
APPROVED BY
5. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR INSPECTOR INSPECTOR
DEPT. OF I I-EALTH &
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL PF,'OTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
n 1979
825 L Street - Anchorage, Alaska 99501 DEC
n 1 G l�
1 7 7
0*
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
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. PROPERTYQWNER
PHONE
MAILING ADDRESS SW
6 '455
PROPERTY RESIDENT (If different from above) 61
PHONE
✓ t f% 15
2. BUYER
PHONE
5 ___C1_
MAILING ADDRESS
3. LENDING INSTITUTION � S �
/��_` �4 gO�Jr' ��7�
ONE
�
7 O �
/
MAILING ADDRESS
4. REALTOR/A ENT
PHONE
MAILINGADDRESSK
5. LEGAL DESCRIPTION
l A�
STREET LOCATION
0
6. TYPE OF R1ES1D CE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
SINGLE FAMILY
❑ 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
INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. sns)
w9l C_suu.W)
J-°
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ 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
INSTALLER
(cam
❑Septic Tank or ❑ Holding Tank
Size: 12-$-0 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding TanT
bsorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
`-
`
❑ APPROVED FOR BEDROOMS
L�1- CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
B-QcY
72-010 (Rev. 6/79)
3
CHDOCAL III GEOLOGICAL LMKMTORIE8 OF ALAS
INCO TELEPHONE
(907) 279.4014
P.O. BOX 4-1276 ANCHORAGE, ALASKA 99M 4649 BUSj,NESS PARK BLVD.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER T013E COMPLETED BY LABORATORY
a
PUBLIC WATER SYSTEM: LABORATORY:
11 . w 'in n I.D. NO. (4/�60to h A d
Name
Ls,'-) DL -)
mamnp areas
City State Zip Code
SAMPLE DATE: I t 121 CO
Mo. Day Year
SAMPLE TYPE:
❑ Routine
❑ Check Sample (for routine sampla�.
with lab ref. no. ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
2
3
4
5 I .:
Oe -1220 (b)
Rev. 1978
Date Collected
READ INSTRUCTIONS
Date Received
Presumptive
24 Hours
BEFORE '<'- 48 Hours
Confirmatory
x,24 Hours
48 Hours
COLLECTING SAMPLE
Form No. 18.310 (3.78)
e NAME
ADD
XE
�C
-� CITY
Date Received
Time Received
Analytical Method:
❑ Fermentation Tube
-xMembrane Filter
Lab Ref. No. Result* An st
I�o_IEM
i EE
I �
m
* No. of colonies /700 ml. or No. of Positive portions.
BACTERIOLOGICAL WATER ANALYSIS RECORD
Multiple Tube Report:
Membrane Filter: Direct Count
Verlficatlon: LTB
Final Membraneer�)k ROMIts
Reported By
—Time Received
10ml 1 10.1
Source
a.m.
p.m. Lab. No. —
1 ml I loml I loml
1.0ml 0.1ml
Broth 48 hours.
_10ml Tubes Positive/Total 10ml Portions
Col lform/100ml
Date • 0Time:
Iform/100ml
a.m.
p.m.