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Home My WebLink AboutDRAKE BLK 3 LT 6 GREA,, R ANCHORAGE AREA BORc.GH Department of Environmental Quality 3330 ¢ Street Anchorage, Alaska gg503 INSPECTION REPORT NAME ~---- --MAILING ADDRESS LOCATION ~ ~¢~LEGAL DESCR, SEPTIC TANK: FROM WELL MANUFACTURER MATERIAL INSIDE LENGTH /~"2 INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS / LIQUID CAPACITY //2"6~GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /'~ NUMBER OF LINES / / FOUNDATION NEAREST LOT LINE ~:~ DISTANCE BETWEEN LINES TRENCH WIDTH~/ SQ. FT. LENGTH OF EACH LINE ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH / OF LINES c~''(-') IN. TOTAL EFFECTIVE DEPTH OF FILTER ~.//]~~J~,j MATERIAL BENEATH TILE'7"~. TILE IN. CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST FOUNDATION__, LOT LINE__ NEAREST SEPTIC ! SEEPAGE SEWER LINE , TANK /'~:2~ , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISTANCES: DISAPPROVED REMARKS RAM OF SYSTEM INSTALLED BY: ~ /~-~ .~ SEWER LINE DEPTH: LOT sLOPE: REMARKS: G.A.A.B. Form LQ-032 · ~_~ GREA r ANChOragE ArEa B or ~GH - / " 3330 "C" STREET ANCHORAGE, ALASKA 99503 ~ TELEPHONE 274-456 ! SEWAGE DISPOSAL SYSTEM I APPLICATION'AN. D PERMIT FINANCED THROUGH ~f NOTE, THIS PERMIT IS NOT VALID WITHO~/JT SOIL TESt' COMPLETION DATE ANTICIPATED C~ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS /~ DIAGRAM OF SYSTEM ! FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ?AIN FIELD ~PTIC TANK TO SEEPAGE PIT WALL ,EPTIC TANK , SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE. SEEFAGE PIT . ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, , SEEPAGE PIT , DRAIN FIELD TO RIVER. LAKE, STREAM. EXCAVAT ON 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G .A .A .B. OR LICENSED DESIGNER WELL TO SEPTIC TANK : /'/ ~SEPTIC // TANK DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIREDSYSTEM IS IN ACCORDANCE WITH SAIDCODE, ~ ~/D 7~"""'~' I) ~~~ DATE FORM NO. EQ-016 ~ GREATER ANCtlORIkGE AkLA UOROUu Department of Environmerl~a] Quality 3330 "C" Street Anchorage, A1 aska 99b03 SOI1,S' 1,0(; - I)EROI,ATION TEST Legal Description:_'So~i s. ~:~.w- , This form reports: log ' ion test Depth I i -. 8~ lO¸- ll- 12- 13- ground water encountered? Depth to Water Net Drop mi nute. Seepage Pi t braiff'Field to bottom of Depth of Inlet De~tl't ~ pi~r~,rench ~ co..~,~: ._/5~.._-~:~=~_.~ .Am~.~...~~~~~ ~¢~ .... ~_,.~__r..~_~ Reading Date Pe rcol a ti on -r-j~-e ........ -Proposed installa~'T~-n~ -- Gross Time Net Time If yes, at wi)at depth? MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ~'~_c3t '~'L ~coA,.¢ ~v~. Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone 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 State ADEC attest- ing 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. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application 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 regUlations in effect on the date of this inspection. Name of Firm Address Engineer's si g n atu re --~-~~ ~ Phone Date ~'/---~:~,/~'~ DHHS ~SlGNATURE '...~ Approved for Disapproved. bedrooms. Conditional approval for Note: The well for this bedrooms, with the following stipulations: property meets existing State and Munic±pal Codes, There are nitrates present. It is suggested that periodic testing be performed to insure the we±is continued suitabiiiny. Currenn nitrate .......... ~-- i~ ~ ~ /~ p~A ~,,~ concentration ~= 10 n Additio~B~~stion on nitrates is available from the On-site Services Pro~ram, S, 343-4744. 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~ZI Municipality of Anchorage ' R ECE IV E D DEPARTMENT oF HEALTH & HUMAN SERVICI~,~ c:~ Environmental Services Division JUL -1 997 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Muhicipality of Anch~orage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: Z~. ~, ~'~.~'~"~ tZR K~=. S/'~) Parcel I;D.: . (~ (~' -- ~'/'~Z - C) ~ A. WELL DATA Well type ~'~ ~A--/-~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~ O Date completed L~/d~'~Uc~v ,.x Total depth ~ h~ Ic~J~' Cased to ~/C~ '{' Casing height (above ground) / '7. v · ¥' Wires properly protected (Y/N) Sanitary seal (Y/N) . Date of test FROM WELL LOG Static water level Well production g.p.m. .. .~-47 [~ g.p.m. WATER SAMPLE RESULTS: Coliform '--- ~:~ --' Dateofsample: ~///3//?-~/' :F,/t/ ~ ~F- Nitrate B. SEPTIC/HOLDING TANK DATA Date installed -/¢~/$1/~~'~ Tank size ~., o*:~ Other bacteria ~ c.~ j Collected by: ~ 72-F' l"Z $0 Number of Compartments ! Cleanouts (Y/N) Foundation cleanout (Y/N) ~ Depression (Y/N) }',4 High water alarm (Y/N) Date o~f ~P[!3' g ' :_~'~ ;~R[ Pumper ~ ~ ~ C. ABSORPTION'RELD D= [hst~lled .... /~/,~,~ Soil r=ino (O.p.ddff= or ff=/bdrm) / ~ Systemtype Length~ ~O ~Wi~th ~? ~ Gravel thickness below pipe ~ / Total depth :. ,/. : ,~,'. - , Effective abaorptionarea -~ ~ ~ Monitoring Tube present ~/N) ~ Depression over field (WN) Date of adequacy {~t'. ~/~t ~ Results (Pass/Fail) ~ ~A~ For ~ . bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after ~gal. water added (in.): Fluid depth '~l~'t" (ins) Minutes later: '~.._.eroxlde treatment (past 12 months) (Y/N) ~ - Absorption rate = ~-,~'r' ~,oo g.p.d. · ~ (:~ if yes, give date ~ 72-026 (Rev. 3/96)* LIFT STATION Date installed n" level at* Manhole/Access (Y/N) High wa~ atum ~.v. oles~'~sted "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / C~ ,~". Absorption field on lot / ~ ] Public sewer main / c~o '-'c//,j A (' Sewer/septic service.line :~'0 ~ On adjacent lots / C:)C) ''~ On adjacent lots ! C)C) ''~ Public sewer manhole/cleanout ,,~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation [-~-( Property line / ¢) -~ Absorption field / Water main/service line ~0 { Surface water/drainage /~o'* Wells on,adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface ~Nater Curtain drain /0''+ Building foundation ~,.~ ( Water main/service line / C~O'4' Dr veway,.parking/vehicle storage area Z ~ ~ells~on adjacerit lots .... /oO '/'' ! 00'{' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and revieWof Municipal in conformance with MOA HAA guidelines in effect on this date. Signature_~3~-'~ Engineer's Name HAA Fee $ ~t~'~ Date of Payment "~ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* .YUL-O~-1997 18~11 CT&H H~I ~NC~OR~H 9875615301 P.Ol/Oi - Laboratory Division s,'.,~,..,~.'.,a,..,~,,'..~,".,~",,~:. CT&E Environmental. S Drinking Water Analysts [cport f'oF Tc .......... Anchorage, AK RE. dE [A~TRUCT/O:¥S ON REVERE SIDE BEFORE COLLECTING SAMPLE Ta~: (907) 5~2-2343 Fax: (907) 561-5301 MUST Bt COMPLETED BY WATE~ 5UPPL[E~ ~O BE COMPLETED BY LABO~ATOEY ' ' --- An~l)'s[~ shows chis Water SAMPLE to ~ PU~LICWATERSYSTE~II.D., J ~J [ I t ~ $ati,t~cto~ ~ PRIVATE WATER SYSTEbl , _ O Unsatisfacto~ be unreliable 3 Sample too ~on~ tn ;ransk; sample should r,u.~ ~.=~ F~ ~.~..~ ' not b¢ ov~r 48 hours old at e~aminadon m indicate reliable results, Ptcas~ send Sr~[i., ~au,~, new sample via special delive~ mail. c,. ~,.t, t,~-Coa~ Date R~c~ived Time Received [ Analytical Method: M~mSmne Fil[~r ~O:] T?, Result" Analys~ SAMPLE ~PE: g Routine ~ Treated WaJer S~n~ to A,0,g.C. Anch gbk~ Jun ~ R~peat Sample (far routine sample ~ Untreated Wa~er with lab ref. no. } Dat~: . Time: ~ Special Puepose Time Collected Client notified or unsads~acto~' results: SAMPLE LOCATION Collected By BACTERIOLOGICAL WATER ANALYSIS RECORD F~;d [] 3,1MO-,MIJG Result: Total Coliform ?.lembrnne Filter': Did'ecl CounC~) Verliqenllen: LTB RGB Fecal Coliform Confirmation Final ,~~_.~ ~ .... R~port~d B yl~,~'~J~~ ~' D'-,cc~~"/Time E. Cuti Colonies/100 mi COLIItlRDI CollformllO0 mi fit! - ¢ )l/lc1' TOTAL P.O1 ,ZUN-&?-~997 27=06 CT&E ES~ RNCHORRGE 9_~?.;b2¢302~ c ' P,02/'04 ztr~,,, CT&;; Environmentat,,~=. Services~lnc. ..... ~-~_-.., .~;~._-_~.~ CT&E Ref.# 973070001 Client Name Pannone ~Bag Sty. Project Name/// Front Hose Client Sample ILD Front Hose Matrix Drinking Water Ordered By PWSID g~nple R~mark.~: Client PO// Printed Date/Time 06117/97 13:50 Collected Date/Time 06/13197 07:.30 Received Date/Time 06/13/97 11:35 Technical Director: Stephen C. Ede Released By~ ,~/~ W{t~ate-N 7.07 0.100 mg/L WO COL] COL/lOO ~L. A[touab[e Prep Anatys~s Method Limits Date Date Init EPA 300.0 10 max 06/13/97 SPM $M18 ¢222B 06/13/97 RAM