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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 3 LT 1Lcwf6 k.'>ravokr 3 X050 281 OI GP,nATER ANCHORAGE AREA EIOROL_lf�H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM �yy MAILING NAME f SSU �!i�TF 1-7 cam ;C'S ADDRESS!���X//, E. .�'. PHONE-� LOCATION rC ift/l. QTS- _ LEGAL DESCRIPTIOt SEPTIC TANK: ,�� MATERIAL S NUMBER OF �� DISTANCE FROM WELC�m�:�� a. - COMPARTMENTS sr�c.Ksrxiy�� v�-,s��s9..as;I�uID� LIQUID CAPACITY -,Z -42,0 -,4z ----GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH — SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITSOUTSIDE DIAMETER OR WIDTH. LENGTH, DEPTH .. �+. 2 LINING MATERIAL L �� � r .DISTANCE FROM Wf�L(/i! /' �.� �e. BUILDING FOUNDATION NEAREST LOT LINE �� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ��' 7` SO. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OEAfNES DISTANCE BETWEEN -MES TRENCH AREA SO. FT. LENGTH OF EACH LIN TOTAL LENGTH OF LINES DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: � DISTANCE FROM WATER TYPEc-n2,Z ,�Tl' `' DEPTH ,BUILDING FOUNDATION. SAMPLE. NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINE , SEWER LINE-. TANK , SYSTEM , CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM DISTANCES: DATE `5 APPROVE MELLIX AUIrtOPtlY tID-2 GREATEI,^ANCHORAGE AREA ROUGH IIEALTII DEPARTNIENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. // f9, j 1, 10""� T uI NAME OF APPLICANT s� o.r7. '� MAILING ADDRESS o // PHONE NOA4 Zy- a' RESIDENCE ADDRESS S ss- LOCATION OF INSTALLATION e le LEGAL DESCRIPTIO APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS Z CA' SEEPAGE PITy , DRAIN FIELD , OTHER TO BE INSTALLED BY_���i �•+��- ANTICIPATED DATE OF COMPLETION BELOW TO Bt FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS e ^ i(' u •7 "'Ll , PERMIT TO INSTALL A _'y /' � S AS DESCRIBED BELOW. SIZE OF UNTO F SERVED 3 b of ion ., ra. •{.. , c .SEPTIC TANK SIZE 1000 %41TYPE A Z'7� SEEPAGE AREA 13,Y13Y7 TYPE o DISTANCES: jN Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. JJ DATE 0- '20 APPLICANTS SIGNATURE 6tg.1.1 "c -!q MSINICIPALITY OF ANCHORAGE r ` DIVISION OF WmOM ENTAL HEALTH ~ APPLICRATIOPROTECTION N FOR HEALTH ADTHORITY APPROVALCE TIFICATE 1. General Information Application Date 31 1 �J (a) Legal Description (b) (include lot ,inion, section, township, range) Applicants Address -TTr✓ 'v• (c) Applicant is (check one) Lending Institution Owner/builder Buyer [= ; Other [= (explain); (d) Lending Institution /(oto :J /G Telephone Address (e) Real Estate Co. 6 Agent Xr X-7 AJ Address Telephone (f) the UAA to the following address: /A_) 8 a £ E.`:0'1NHcn:tM Cnn +r .� ^tC L`IVFR At.ASRy a.�7 2. Type of Residence Single -Family Multi -Family Number of Bedrooms Other (describe) - 3. Water Supply Individual Well Community Public Note: If community well system, must have written confir.:ation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite = Public q Community Holding Tank Q Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 -+t V 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date show below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein.. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the'on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tioin effect on the date of this inspection. Name of Firm S P.: E`IO1hE�P. P.3 6fl� �38d' TUYER. AIASK� S.AT Date Cr (ENGINEER SEAL) 6. DHEP Approval Approved for 1f1.>r c; bedrooms By Approved '/ Disapproved L Terms of Conditional Approval CAUTION Telephone t.ar ti ' N�, It57•E : �: THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVI10', 1ENTAI. PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF =12S AN THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. E2PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS- OF, ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEERS WORK- (DHEP SEAL) RR4/ej/D18 7-19-84 (Page 2 of 21 MJNIaPA M OF ANC HORAC9O .. DEPT. OF HEALTH & /-1 ;WIRONMENTAL PROTECTION A. WELL DATA .1111 M1'• . 'M .•'h .' CHECKLIST - FEBmiARY 1984 MAR 2 0 1985 RECEIVED Legal Description: L/ 03 1 'OW'T Well Classification /l/.? / e If A, B, cc C, D.E.C. Approved(Y/N) Well Log Present Date Coupleted Lt K/00/9l0 Yie1dE Total Depth Cased to `fy Depth of Clouting„ Static Water Level % Pump Set At 9�7 Casing Height Above GroundAs Sanitary Seal on Casing i 3 Electrical Wiring in ConduiDepression Around Wellhead (Y Separation Distances from W To Septic/Holding Tank on Lot AILA ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot T On Adjoining Lots To Nearest Public Sewer Line lf To Nearest Public Sewer riear%nit/Maekfole ZOO To Nearest Sewer Service Line on Lot 2S' q4- Water Sample Collected By Water Sanple Test Results Date .S /7—YJ- B. SEPPIC/HDWING TANK DATA Date Installed Size No. of Ccnpartments _ Standpipes (Y/N) Air -tight Caps ) Foundation Cleanout (Y/N) Depression over Tank (YIN) Date Las d pumping/Maintenance Contract c File Holding Tank High -Wager Alarm Y ng Tank Permit (Y/N) Separation Distances from septic/Holding s To Water -Supply We Ll Building Foundation To Property jure To Disposal Field To Water Main/Servioe Line To Stream, Pond, rake, ar Major Drainage Course Ccaments Receipt # 9 3 Date Paid: Amount: )v [page 1 of 21 2-15-94 C. ABSORPTICN FIELD RATA Soils Rating in Absorption Strata Type of System Design Date I tailed Length of Field Width Field Depth of Field Gravel Bed Thickness Square Meet Absorption Area Standpipes Present ( ) Depssion ield (Y/N) Date of Last Adequacy 18 rest Results of Last ev Test Separation Distance as AtisCrpti F To water -Supply. Wall /d Property Line To Building Foundation atim on� To Water Main/Servics Line _ To Stream/P =/Lake% Major To Driveway, Parking Area, cr D. LIFT STATICN Date Installed Sias in Gallons 'Rapp On' Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) kc` Storage (Y/N) y, at System cn Test. Meets MDP, 'i Check Permit d Bedrom Rating Against HAA Request *' I certify the ` have checked, verified, on ccnf==d to all MDA HAA on the date of this inspection. Signed a s P EAGINEERW3 Date CaepanY CLt PH. 84,178 MDA No. KBl/d5/s (Page 2 of 21 effect 2-15-84 =� CHEMICAL & Co'�'9LOGICAL LABORATORIL OF ALASKA, INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: (') See h on back Analysis shows this Water SAMPLE to be: _ I•D• O'e # Satisfactory ❑ Unsatisfactory Water¢ Na ^ OF Phone No. � / .//tel �' ❑Sample too long in transit; sample should LX not be over 30 hours old at examination to Mailina!,0dr �7 Indicate reliable results. Please send new + sample via special delivery mall. Circ Suu Zip Cods M © r• ;.�--t Date Received SAMPLE DATE: I J Mo. My Year Time Received d`a SAMPLE TYPE: Analytical Method: � p utlne L-0 ❑Fermentation Tube Check Sample (tor routine sample with lab rot.nO Treated Water Q Membrane Filter O Special Purpose -Untreated Water SAMPLE Time Collected Lab Ref, No. Result' Analyst NO. LOCATION Collected /0 1 I Z -1,6S �t�tC• t' (/� I lYZ 2 3 I I I m 4 I m •w M vao 1/100 M a Nn W vovl w porpon, W220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD 11ay. 1993 READ INSTRUCTIONS Membrane Filter. Direct Count Collforml100ml Verification: LTB BGS Final Membrane Filte exults 12 Collfonnl100ml BEFORE Reported By L Date Z ''7) Time: � " a.m. P.M. COLLECTING SAMPLE TNTC= Too Numerous To Count —61 (ewl) t IRI : )NII, mu". 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