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Home My WebLink AboutT12N R3W SEC 33 LT 249 MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99503 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I We~ ~ I Absorptio area Dwelling PERMIT NO. DISTANCE TO: ~Z Manufacturer~ L~ /./~~~ Material No. of compartments ¢ Liq. capacity in gallons IF HOME'~DE: Inside leith Width Liquid depth , ~ Well Dwelring PERMIT NO. Trench width ~, No. of ,,ned/o ~ Length of eac~__ Total length of.~t~ ~,inches Dislan~en lines ~.~ ~ Top, of tile tO finJ,h~rae~ Materia, beneath tile ~ ,-~S~r Total effective absor~n/T--~oarea Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ ( ~ ~ Depth DdUer Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIALS OTHER 1 APPROVED ~ ~ , DATE LEGAL 72-013 (Rev~/3/78) ...TR. EE T., b,~'*.ll--__.--. ~ TE FERHIT N0. ,' 8±Eli:El4 ) L. HRUL, uHRRLE ..... ~ET RPF'LICFINT .... ' .... ' '-- *FI '" I OCRTION PTRF.:MIGRN TERF,'H_.E LEQRL LOT ,~ $_ _,Eu 2:2: MRNuNE=,TER SUB TYPE QF =,uIL HE,_,URFTIuN .~Y_,TEM I--,: TREN_-H MR,',IH_M NUMBER OF E:EDROOMS = ~ _,R.R BU,.:, 4~i~ZI~Z~ .... / 4..4-. ,- 7 '- SC~LIFIKE FEET ' LOT --,I~E , p ,:: ,_-]Q ....... SOIL RRT I N.~ FT, THE REQUIRED =,I~E OF 'THE _-,OIL RBSORF'TION =,¥_,TEH I_. [:.EF"TH== :liE~ L Ei'-;JG TH= ?~] ~]i F-.' Fq "-.-' E L [:. E;2 F" TH=: 'THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE 'EXCRk,'RTION (IN FEET),. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMLIM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE FIND THE BOTTOM OF THE E',ffCA'v'RTION (IN. FEET). F'ERMIT MFPLI_.MN'f HR-, THE F.E:FON--,IE, ILIT, TF~ INFGRM TFtlL--; DEPRRTMENT DI_IRIN.~ THE IN:,THLLtlrIuN INSF'ECTIQNS OF ANY WELLS ADJFICEWT TO THIS PROPE:RTY ANC, THE NUMBER OF RE_,IDENuE_, THAT THE WELL WILL SERVE. '- ..... I -' -', ,c ' ' ' 'rl~,' ~ BY ': E, ME.k. FIL_INb OF RNY =,~_,TEM WITHOI_IT FINRL INSPECTION RND RFFR-,HL THI_, DEPRRTMENT WILL E,E =,UE, JECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN A WELL RND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS · l_~._.-~E~ FEET FOR A PRIYATE WELL OR ~-SEl TO 2EIL'-I FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL, MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS .';'5 FEET RND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY APPLY. SPECIFICRTIONS RND CONSTRUCTION DIAGRRMS RRE FI',,,'RILABLE TO INSURE PROPER INSTFILLATION. I CERTIFY THAT i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SE"F FORTH BY THE MUNICIPRLITY OF RNCHORAGE. 2: I WILL INSTRLL THE SYSTEM IN ACCORDRNCE WITH THE CODES. Z.':: I UNDERSTAND THAT 'FHE ON-SITE SEWER SYSTEM MRY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~: BEDROOMS. [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTN]ENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2B4o4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST 2 3 4 5 6 7 8 9 DATE PERFORMED: SLOPE SITE PLAN i 10- 11 13- 14~ 15- 16- 17- 18- 19- 20- COMMENTS ENCOUNTERED? ~ E IF YES, AT WHAT ~ DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) -- FT GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C~' Street, Anchorage, Alaska 99503 274-4561 Date Received .~/~/D-'-//~~5 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 5. Type of facility to be"?~spected ~]~'' ~. 6. Well Data: A. Type~ · B. Depth t 7. Sewage Disposal System: ~ C, Septic Tank:· 1. Size ~.~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: " ~ , Sewer Lines/~~ A. Well to: Septic tank ~ , Absorption area /~ ~ Nearest lot line~-~ ~ , Other contamination /~/~/~ .~<~,~/ . B. Foundation to septic tank ~ , Absorption area ~)/~ C. Absorption area to nearest lot line <~ ~' EQ-034 (1/74) Page 1 of two pages .i, ?age',2 of ~two p~ges - Re!q.-~t for Approval of Individual b..,er & Water Facilities ~Legal Description ~ z:~ ~/~ ~/ ~zm. ~ ~ ~ ~/~ Approved Disapproved ./F:, .- ~ ~:J~_Z~ Date Approval Valid for one year from date signed Greater Anchorage Ar6a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. Date SIGNED EQ-034 (1/74) DATE STATE OF ALASKA ,-~ DEP/['-'~ENT- OF HEALT~ AND SOCIAL SI ~'ICES DIVISION OF PI]BLIC HEALTH BACTERIOLOGICAL -WATER ANALYSIS PUBMC E~ SEMbPUBLIC E-~ INDIVIDUAL E~"-' OTH ER ' REPORT RESULTS TO NAME ._. ~ATE COLLECTED ~;'/'~ '__ TIME COLLECTED Wel [] Dug i'- Driven rTM Drilred SOURCE: D Spring ~1 Cistern [] Other Dug Weft or Cistern Construction; Walls - [] Wooc [] Concrete [] Metal Brick or [] Tile r'l Concrete [] Open Top [] Under House Septic Feet. Tank Feet. Feet. Pdw · F~t Diameter of Well Depth Feet Well Casing Material Diameter Deotn Length of Water Deoth Orop Pipe From Bottom Feet Offset In In Utility PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room [] On Tou [] Other Of Well PURPOSE OF EXAMINATION: Illness Suspected7 [] Yes [] No New Source of Supply? [] Yes [] NO Repairs to System? [] Yes [] No 06-1220 (b) Lab. NO. ' ~" OFFICE Records in this office indicate this WATER SUPPLY to be of: [] Satisfactory [] Questionable [] Unsatisfactory Sanitary Sfatus. Analysis showf this Water SAMPLE to be: F~-Sa~tisfactory [] Questionable [] Unsatisfactory. If an "Unsatisfactorv' or "Questionable" status is indicated above you should take immediate action as recommended below. 1. Notify consumerswater is polluted. Boil or chemically treat this water as outlined in the enclosBd leaflel 2. Increase chlorination sufficiently to meet recommenoea residual standards. Determine source of contamination and take action necessary to maintain a safe water supply a: all times. 3. Check chlorination and other mechanical eauiDmenL Make certain tt is functioning properly. 4. f after checking equtpment a disinfecting residual is noi. obtained, p]ease wire this office for emergency assistance or advisory services. 5. This is a surface water source and subject to poBution by man and animals. An approved water sUpply source should be deve[oped, 6. Improve¥our I~spring []dugwell []driven well [] ~rilled well []cistern 7. Relocateyourwell to a safe location in relationship to yoursewage disposal system, [] see enclosure 8. SamPle [oo long in transit; sample should not be over 48 hours old al examination to indicate reliable results, please send new sample. ~] Bottle Broken in transit, please send new sample. 9. Contact your nearest [] Local Health Department or [] Alaska Division of Public Health, sanitation office for bulletins, consultation and assistance. . SANITARIAN'S REMARKS BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Date Received ¢ - ~/~ ' ~ Time Received /0 Pr"'Lab. No, Lactose Broth .,~-: - ..- 10cc 10cc 10cc 10cc 10cc 1,0cc 0.1cc 24 hours Brilliant Green 24 hours - 48 hours EMB AGAR --Lactose Broth, 24 hrs. 48 hrs._ Gram's stain -Coliform Density. {Most probable No, oar 100cc.) --Mr results am pm April 24, 1974 Betty Conley P, O. 8ox 4~2076 Anchorage~ Alaska SUBJECT: On--site sower and water system - SE 1/3 of Lot 249, Section 33, T12N, tt3B - 2-bedroem single fmm~ly dwelling Boar Hrs. Conley: The above sewer and wa'~er facilities were inspected by tbls [~epartment on April 18~ 1974. Tho se~.]er syst¢a is approved and located an adequate dis- tance from the well, A water sample was obtained from the well and the bacteriological water analysis sa%isfactory. As per our conversation on 4/23~ 1974~ the only discrepamcy noted was the t~ell pit. For this Department's approval, the fei]owing ~,ill ~eed to be compl 'led wi th: 1) Exte,ld well casiilg a rntrdmun* of 12'~ above ground level. 2) Ins~all pitless ada~)ter. 2) Fill pit i~ with ,~r slot*i[g a~ay at groued level frem tho ~.mtl casing. ~hen the well corrections have been completed, please contact me for a retnspectton of the well. C. S. McKechnte, R.S., Envtro};~mntal Control Officer CSM/ko , I Form Approved - ' HEALTH AUTH'ORITY APPROVAL * ', , 'INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTG:GEE s E RI A L ~ ~i ~.O{j~6Q~F.~03 MORTGAGOR OR SPONSOR SUBDIVISION NAME ' · Z 2 Z J~,,Yes [] No PROPERTY ADDRESS ] New installation WATER SUPPLY BY: [] Public system [] Community system SEWAGE DISPOSAL BY: [] Public system [] Community system BLOCK NO. LOT NO. ~C) additional bedrooms? (If Yes, how many~) SYSTEM DESIGNED FOR ~ Individual .o. oF BDRM$. GARBAaE DISPOSAL PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH jjlllllJJI'~'~ I1[11 II """'"1 '"""1 II1,,, IIIIIIII IIIIIII i"rllllii' Irlllll lllllllJ IIIII Ililllll IIIIIIII lllll ""JJ[lllllll ii Jllll III j~llllJ~lll ill IIIIIIII IIIlllll IIIllllJlillJlltl, lllll '1 "'"111 IIIIII IIII "" JJiJ,,,I ,,, 'Jill:' JJJJl,,,~,~,,,ll,,,~,,, I ""1IIIIl'''''''llj II Ill'"'" IJJ,,,,, ,,,,, II,,,,,,,, ii,,,,,,,Ij,,,,,,,,lJ''''~'' ""JJJJ,,, ,,,,, '"'lll'"'~l,,,,,,~J,,,,, jJJJ" III IIIlllll IIIII 'JllJJ"'""'"l'"' ' I '"'l'"'" IIIIJJll IJllllll IIIIIIIIIJJllllJlllllllllll Illlllll I Jill Illll II III I II II It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County tern with proper maintenance: J-~'l Can be expected to function satisfactorily, and is not likely to create an/insanitary condition DATE I SIGNATqRE / ~, / , ,' [~] Local Department of Health that this individual sewage-disposal sys- --J Cannot be expected to function satisfactorily TITLE NOTE: The health authorlt~ should complete the appropriate opinion statement above and affix date, signature and title in the spaces provided. clrid for Health Department Inspector*s sketch as well as use of the back of this form is at ~he option of the Use of the above health PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed:: the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER sUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 25/~ Rev. July 1958 INFORMATION - The estimates of fl~e insurance, taxes, maintenance/repairs, heat/u~Uztles and cloaln~ c(~sts eta furnished for mortgagee% sad mortgagor's informatlom They may be used to prepare FHA Fo~m 2900, Appltce~{o~ f6r ~adit Approval; when a firm commitment is de~ifed. GENERAL COMM TMENT[ COHO TIONS (a) OCCUPANT MORTGAGORS: The mortgage amount,end term Co) NONOCCUPAHT MORTGAGORS: If the mortgagoz ' r~i~ts'ha~ed on total acquisition cost o[ the Real Property. 3." cOMMITMENT TERM: This commitment shall expire SIX. MOHTRS from ,thee issue.date in the case of an EXISTING HOUSE or ONE YEA~ ~rbm its date in the case of PROPOSED CONSTRUCTION (F~A..elassifies all cases as either "EXISTING" or "PR P~$~? for th~g.purpoze vf determining when a commitment eJc- pirgj~. Accordingly, a house, even though still under construe tierS,, rna~ b&' classi[icd as an ~xisting house ii it was'not ap . ;ptav~d ~by' FHA or VA prior to thc beginning of'¢onstntction. 4.'-'CA~LLATION:--Thin commitment may be cancelled after d~ys'from th~ date of issuance if construction has not 'ti~inss:'~fie ~ortgagee has disbdrsed loan p~bceeds. STANDARDS:--AII construction, repairs, or alte~a- i~sued upon receipt of 'an Application for Credit Approval, FHA ?:~i6ns P~o ,pO~ed in the application or on the drawings and specifi- Form 2900, executed by an approved mortgagee and ii borrower'~ ."' ~at[~ns>imtiirned her~with~ shall equal or exdeed the FHA Mini- satisfactory to the Commissioner. If any are i~cluded in the~s~le; I(~ ~u~::t~operty Standards SPECIFIC coMMITME"I~' CO~I ti'XjON~"[.4~plfca~[e wh'en ehec/~ed) H~AI~TH AUTHORITY APPROVAL:--Execution of ~0~L~: the Health .Authotfty indicating approval oJ the water supply ~Id// ~r Sewage disposal installation is requl~'d. (Appro~vl~I~ lg~teg~,, ~EPa~rrs co~n~or: ~a) EXm~a~a ~busE~ -~'~as~ ~t~tg ~.rec, reputable termite conirol operator that the~ho~me' and in his: opinion islftael~fl termites. (b) PROPOSED CONSTRUCTION: Furnish briginal and two cop~es of Termite SEll Treatment Guarantee FHA Form ~052.~ SUBDIVISION / REQUIREMENTS:--Comply with Requiremalit s :PROP~ERTY INSPECTIONS:--A notice of construction status shall 'be ~g~..v?I/'by Form 2289X,. letter or telephone at ~e ~e ~fficated :(~:' ~ ~ROP~ ~NSTRUCTION CAS~: At ieaat ~o ' ' ' ~ ~ay~fO~ ~i~g of constmc~on' and (aX1) or ~ . '~?.(~X2)'~h~ check~ (~) ~CER~CATE OF ~LE~ON: A 8~iflcate'~at- required repairs and that they have been satisfactorily completed will be accepted. 7. ~ VA IN~PECTIONS:--Flirntsh a copy of a' clear VA.final report. 1. Complete conversion of garage. 2. Complete door to bathroom from bedroom. NO' 2800'5 Rev' 5/'67 SENO TO MORTGAGEE AFTER AUTHORIZSD AGENT SIGNS REQUEST FOR APPROVAL OF INDIVIDgAL SEWAG~ AND WATER FACILITIES ~ (Fill out in Triplicate) ~,~*'j ~ ~f::/~ Name of property owner Legal .description ,, ~>~ {-, > 47~'~ . ~ /'>' z% Number'of bedrooms in house ,~ Water Analysis: a. Bacterial b. Detergent Well data: a. Type b -,lI j b, Depth_ I 0 r~ c. Casing Size &fl d, Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank ~Z~~ . 3. Seepage Area /~ Cesspool' 5. Property Line 7,, Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. Sewage disposal system. a. Age of system b. Septic tank capacity in gallons,, c. Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of: this form. Disposal field or seepage pit size and type ~-~g; ~;~./~ 1. Distance to property llne to house foundation Percolation Test f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagram should include ~he foilowing information: ~operty lines~.well location, house location, ~ptlc tank location, disposal area location, location of percolation test, an~ direction of ground slope. The information on this form is true and correct to the best of my knowledge. Signature of Applicant .... ~e Signed TO BE FILLED OUT BY HEALTH DEPART~4ENT PERSONNEL [----]~he[ above described sanitary facilities are hereby approved, subject to the ........... ~llowing con~iions: Conditions: The above described sanitary facilities are disapproved for the following reasons; ''Signature of ~f~i'¢i~&~a ~"'"' ~--: .... . .. , .... 'D~te '~' i~, :'~.~}. Approval is valid for one year following the date of approval. CPJ:cw ADHW L&8 - 2W NAME STATE 'OF ALASKA D~ \RTMENT OF HEALTH AND WEL ~,E DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Records in Ibis oBice indicate this WATER SUPPLY lo be of: [] Sat;sfaclory [] Questionable [] Unsatisfactory Sanitary Stalus Analysis shows this Woler SAMPLE to be: [] Satisfactory [] Questionable [] Unsalislaclory. · · , If an "Unsafistactory" or "Questionable" stalus is indicaled above CITY "' ' · you should lake immediale action as recommended below, ADDRESS j I. Nolif¥ consumers water is polluled. Boil or chemicahy Well- [] Dug [] Driven ~] Drilled SOURCE: [] Spring [~ Cislerr J~ Other Dug Well ar Cistern Construction: [] Yes 0 No 5. This is a surface waler source ana ~ubject 1o pollution by man and animals An approved waler supply source should be developed. 6. Imorove your [] spring [] dug weU [] driven well [] drilled well [] cislern 7. Relocate your well Ia a sate ~ocolion ;n relationship to your sewage disposal syslem. J~ see enclosure B. Sample Ioo long in transil; sample should not be over 48 hours old al examinalion to indlcate reliable resuBs oJease send new sample. [] Bol~le Broken in Iransit, please send new sample. 9. Conrad your nearest [] Local Health Depar~mem or [] A~aska Division of Public Health son'laBan office for bulletins consultation and assistance. SANITARIAN'S REMARKS [] OI Well [] Olher PURPOSE OF EXAMINATION: Illness Susoected? 0 Yes [] No Signalure READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD 0GT 16 1968 48 hours Brilliant Green 24 hours 48 hours EMB AGAR ,, Lactose Broth, 24 hrs. 48 hrs.- -Gram's slain ' __ Coliform Density {Mosl probable No. per IOOcc.) Star Route A. Bok ]44 ANOHORAGE, Al ASKA 99502 Phone 34~-25;~2 or 3~-Z453