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Home My WebLink AboutFIRE LAKE BLK 3 LT 3A GRF ' ' ANCHORAGE AREA B0' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS I~0~ W-17Z$ LEGAL DESCRIPTION LOi' SEPTIC TANK: tjilts' I(tF¢71 '~')~ ~-~--~L~'~'~,I~LR~'3~'% ~;l_b DISTANCE ~ FROM WELL MANUFACTURER f~£f~ <-~ MATERIAL fif~-F~ NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY /~'~ GALLONS. SEEPAGE PIT: LINING MATERIAL L~1 CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: BUILDING FOUNDATION ff~.l NEAREST LOT LINEt7~ TOTAL EFFECTIVE , ABSORPTION AREA (WALL AREA) WELL ~(~ .SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE"-~ ~ ~. ~. i.~ ~ BUILDING FOUNDATION CESSPOOL APPROVED NEAREST LOT LINE OTHER SOURCES DISAPPROVED_ CONSTRUCTION (~ Cf ~ I~,A I'~ I~ DEPTH NEAREST SEPTIC SEWER LINE TANK DISTANCE FROM: SEEPAGE ~' SYSTEM REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL' LOT SLOPE: REMARKS: Form No, EQ-031 J G.A.A.B. GAAB HD I GRr.~TER ANCHORAGE AREA BOR01' ",H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MAILING , _ ADDRESS 7 ~"/''~/'(' ~T,~/C/~(~'~g :':'~'~,;'~/ PHONE LEGAL DESCRIPTION~' ;~~;.~. '~ ~:-~-~J~;. _ DISTANCE FROM WELL ~',..~' LIQUID CAPACITY GALLONS. NUMBER OF ~ MATERIAL ,.,~'~-,~--'~"~/--- - COMPARTMENTS C'''~''''7'-''~-~L'~ '"'C ~7 -"'~--'~-"~'~ '~'/"~ ~'~"'~'2 > LiqUID INSIDE LENGTH /,,-~' INSIDE WIDTH ~ DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE OUTSIDE DIAMETER o ~' .OR WIDTH. DISTANCE EROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH /"~ / , DEPTH ~ / , BUILDING FOUNDATION '~"""'~,~ / ET. TILE DRAIN FIELD: ~'"\ , FOUNDATION. , TOTAL L EU-GfH' DISTANCE~ .~, F R O .M/W'E~[ ,~' '"" N~[~E / TRENCH WIJT NUM~e~ ~.'~- LINES DISTA BETWEEN LINES ~H// IN. TOTAL EFFECTIVE ,~RPTION AREA SO.NE ~DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE ,,~/'"../z::/_~--~'~ , DEPTH ~." NEAREST / SEPTIC LOT LINE /'~'h /'2z''- , SEWER LINE . TANK DISTANCE FROM _ /-- WAIER , BUILDING FOUNDATION.~SAMPLE ../Y~" , NEAREST ~,,,~ / SEEPAGE., .,--2 / OTHER , SYSTEM /"/~2,,~/ , CESSPOOL J'~"'~", SOURCES DIAGRAM OF SYSTEM DISTANCES: ,,~:.~ d =/~ ' NAME OF APPLICANT GREATER ANCHORAge AREA BOROUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF; SEPTIC TANK TYPE AND SIZE OF FACILITY TO SE SERVED FINANCED THROUGH SOIL TEST RESULTS ~/~ ' COMPLETION DATE ANTICIPATED ~ SEEPAGE PIT ~,/"' DRAIN PiE/~.. FI~t~i4~ I , ., OTHER , , TO BE INSTALLED BY NOTE= THIS PERMIT IS NOT VALID WITHOUT BOIL TEST 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 DISTANC:E$, REQUIR£MENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT . SEPTIC TANK TO SEEPAGE PIT WALl SEPTIC TANK TO NEAREST LOT LINE. , SEEPAGE PIT WELL TO SEPTIC TANK DRAIN FIELD · DRAIN FIELD DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. . SEEPAGE PIT WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT . TO RIVER, LAKe. STREAM. , DRAIN FIELD DIAGRAM OF SYB, TEM C~ST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND ~FFPAgE PIT Fitted WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION· I CERTIF~HAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE G A A B -H D-2 GREATEF 327 Eagle St. .NCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 ~ROUGH 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION MAILING ADDRESS PHONE NO. LOCATION OF INSTALLATION APPLICATION TO INSTALL: SEPTIC TANK C--''/ ,SEEPAGE PIT z...-~' , DRAIN FIELD TO SERVE THE FOLLOWING FACILITY 2 d ~/~,,----r, ,-,.~, 4.. · ~J FINANCED THROUGH TO BE INSTALLED BY '~'~-~- 4' PERCOLATION TEST RESULTS ?x-~ bO' .~-/'~,o,~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , OTHER THIS IS TO SERVE AS C¢" -'/' < "/'~ r~' , PERMIT TO INSTALL A ~'~'"/= 7z', ~ ~-'~., '/' -- ; AS DESCRIBED BELOW. SIZE OF UNITTO BE~E~V~O ~ ~, ',' - ,~''~--- . SEPTIC TANK SIZE/~ o ~ ~ TYPE ~'-/ SEEPAGE AREA~ ~ ~ ~ TYPE/¢~ ~ ~-, / /., , ~ / . . ~ ~ OF DISTANCES: ,, "C 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. DATE / 'REATER ANCHORAGE AREA BOROUGH ?,' HEALTH DEPARTMENT 92? EAGLE STREET ANCHORAGE, ALASKA 99501 pel~formed For f' ~'p~ [1 ~ .... /Tq~,"~. ~b[~) Date Performed Legal Descz'ipt~on: Lot Block Sub~ivision This Form Repor%s a: So~ls Log ~ . CASE # Percolatzon rest Depth .... Char,.~,_t e7 ~stzcs ~ eel. Soll .... '" ' Was Gmound Water Encountered? _ ////~.~ , ~. 'fl Yes, At What Depth ..... Location Sketch Reading Date Gross Time Net Time Depth To H2( e~'~Ola~ibn (ate' ],,/ ~'~';;~'~ Net Drop Proposed Install'~i~n: Seepage Pit ~epth Of Inlet D: ~ , ' ])e'~ To' B'o~':~- Drain Field Date,?_' DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE June 28, 1974. WILLIAMA. EGAN, GOVERNOR 338 DENAL I STREET MACKAYBUILOING ROOM850 A NCRORA GE 99501 Mr. John Lee Dept. of Environmental Quality Greater Anchorage Area Borough Eagle River, Alaska 99577 SUBJECT: Lot 3A, BIk 3 ~ ' ':? Alaska~Subdivision (Robert T. Gall) Dear Mr. Lee: From talking with Mr. Gall, apparently he has been planning this addition before the advent of the Alaska Department of Environmental Conservation Wastewater Regulations, which were promulgated on July I0, 1973. Therefore we have no objection to his meeting the standards which were in existence prior to that time for the addition which will make his building a two-plex. If you should have any questions please do not hesitate to contact me. Yours truly, Kyie J. Regional Environmental Engineer' MUNICIPALITY OF ANCHORAGE MEMORANDUM DATE: TO: FROM: SUBJECT: July 28, 1993 Accounting & Budget, DHHS On-site Services, ESD, DHHS Request for Refund - Account #2570 - 9426 The application for health authority approval by this office is being returned to the engineer. The review process and approval will be processed by the ADEC since they have considered it a mul.tiple dwelling. Thank you. David R. Dayton 20210 Donalar Chugiak, Alaska 99567 Receipt~24934 Account 9 2570 - 9426 Amount: $170.00 Health Authority Approval Request Lot 3A Block 3 Fire Lake~ Laura J. Montgomery On-site Services cc: File 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -?- TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev. 1/gl) Front MOA#21 Legal Description: A. Well Data Well type ~--~A-~,~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level1 g.p.m. .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: ; On adjacent lots ; On adjacent lots ! ~o/- Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Oleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~o~t~ Compartments Foundation cleanout (Y/N) /t/ Depression (Y/N) AJ/,~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot r~' ~f' To property line ~" Surface water/drainage 72-026 (3/93)* Front On adjacent lots Absorption field I C)~-/- Foundation I '2._. I Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/~//? ~ Length / ~ Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) ~?'~' 5~/~/~ System type ,~' Gravel thickness ~ Total depth /// Cleanout present (Y/N) ~// Depression over field (Y/N) Results (pass/fail) ~,~'~' for ~2, 4~ ~ After test ~ '¢' /tO/ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~:~ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /g;~::~ -~- Property line ~ Z. To existing or abandoned system on lot Cutbank x.,x'///~z- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION e ~ that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~.4~'~l~3te of this inspection. I c rt'fy Signature Engineer's Name . . HAAFee$ /'~O Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Legal Descript on: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ..Parcel I.D, A. Well Data Well type C~--~--_~_ _ ~- If A, B, or C, attach ADEC letter. ADEC water system number~L/~ - -- Driller Date completed Log present (Y/N) Total depth Cased to Casing height Wires properly protected (Y/N)_ sanitary seal (Y/N) FROM WELL LOG g.p.m. AT INSPECTION _; On adjacent lots Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot __ .~Z~' -'~ ! Absorption field on lot ____------~/;~--~-~" ; On adjacent lots /~:~:~/'' Public sewer main ~ .-~~//~ __ .Public sewer manhole/cleanout-- Sewer service line ~ Petroleum tank /"///~- WATER SAMPLE RESULTS: ~ ,,~.~ ~.,/,~-/,,"~"'F.J' Other bacteria Nitrate Coliform Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ..~/~/~' /~?-~ _Tank size _ Cleanouts (Y/N) __ ~ ..Foundation cleanout (Y/N) High water alarm (Y/N) ~ /~/'~' Date of pumping __ ~/Z ~//.~- 2'_-.- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~ ~ ._On adjacent lots _ _~ C~. _Absorption field_ To property line ~ Surface water/drainage ~ ~ ~ ~c~.. .Compartments _ /t/' Depression (Y/N) Alarm tested (Y/N) Pumper - '~''''~-~ ~- Foundation ~ Water main/service line CONTINUED ON BACK PAGE 72.026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lets Surface water D. ABSORPTION FIELD DATA Date installed ~../.~//./~' Length /~,',',',',',',',','~- Width Total absorption area Date of adequacy test .~'/z'/',',~//~'~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft / ~ Gravel thickness Cleanout present (Y/N) Results (pass/fail) ~/~/¢-- System type ~-~'~4~ '~' ' Total depth Depression over field (Y/N) for ~ Bedrooms After test ,E.,~ .if yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /'~ To building foundation On adjacent lots Surface water ,/~:~:)/- Curtain drain On adjacent lots /O~ /'- Property line To existing or abandoned system on lot Cutbank ,"~/,'~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~Z~,_o4~d~ate of this inspection. Signature ~-,-¥-'~ ~, ,/'~.~-f/..~z~,~/ ~'~::~""~' ?.%~" Dav,d ,. Dayton Engineer's Name ~ ~ ~-' ~ ~- - ~ ~'.. ~. 220~-E ~ Oa , - q H~ Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number 72-026 (3/93)* Back