HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 6 LT 8otc
ER ANCHORAGE AREA BOk,.UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska ggs03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SFPTIC TANK:
DISTANCE
FROM WELL
INSIDE L EN GT FJ~--'
MANUFACqURER ~-)~/'*,,~.-~1~ MATERIAL
INSIDE WIDTH___%~-__ _ LIQUID DEPTH
--.~ NUMBER OF
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTIh TOP OFTILE TO FINISFI GRADE /~
(/00 / FOUNDArlON L~" ~ TOTAL LENGTH > /
NEAREST LOT LINE OF LINES -~ (J/ __
/ D,STANCE TOT*.
DEPTH OF FILTER
MATERIAL BENEATH TILE 7~ IN. ABOVE TILE ~/ IN.
WELL: /~//_./,~.-y¢ i ,.¢¢,'
TYPE ....... /_~<~_~ CONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION __ LOT LINE SEWER LINE ~,¢/~)'/¢~,, TANI'~
C ESSPOO L __~_//~ O TNER SOURCES
AF'PROVED /'~'"/_ DISAPPROVED ...... REMARKS
SEEPAGE
SYSTEM
DISTANCES:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
Form EQ-032
DIAGRAM OF SYSTEM
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FIND /'lql!i: E',EFI'TEIH O1::: TI'lIE IC:'::E:I::I',,,'FIT :1: I::)t",l ':: ]: I",1 F'IEli:'I" >.
D 'artment of llcalth mtd EllvirOlll.(? I Protection
cfi,}. "~aI~'a~,:.%~.t'-mm~mi r:o~:~ v~ ~*c,~ p ~ ~ .'~ )
Anehovag'c, Alaska 99507
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GI~F. ATER ANCHORAGE AREA BORO'IGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl_ SYSTEM
'OCAT,ON / ze ((
SEPTIC TANK:
ADDRESs_MA'L'NG .PHONE
DISTANCE FROM WELL
LIQUID CAPACITY
_MATERIAL ~l¢ ¢~-~--~'~,- NUMBER OF
COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH.
LIQUID
_DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
F_ OUTSIDE DIAMETER OR WIDTH~ , lENGTH_ , DEPfH~
~~ DISTANCE FROM WELL ~ ¢ ., BUILDING FOUNDATION_
~¢~ ~ TO~AL EFFECTIVE ABSORPRON AREA (WALL AREA) ~ SQ. Ff.
TILE DRAIN FIELD:
DISTANCE FROM WELL ... ......... 7q=OUNDA~O~J_ , NEAI~EST LOT LINE: ~ ,~.~-,.---~'~,'"'~'"'OT~"~INES
NUMBER OF LI~J:S .......... ' DISTANCE BE EEN LINES ~.~ ................ ~'I~E
E.~ZN~: NCH WIDTH ___IN. TOTAL EFFECTIVE
ABSORPTION AREA ___SQ. Ff. ~CENGTH OF EACH LINE
DEPTH: TOP OF fILE fO FINISH GRADE
_DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE ~J'/"¢'t/~¢/ DEPTH (~ 7' DISTANCE FROM ~Z¢'~' WATER
___,BUILDING FOUNDATION.. SAMPLE ., NEAREST
NEAREST ;~ ~' SEPIIC j,~ SEEPAGE/,~/ ~ OTHER
LOT LINE "~) ~ ~ , SEWER LINE ,TANK_ , SYSTEM --~--/ , CESSPOOl SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE
GAAB-HD-2
GREATE. ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
AOROUGH
279-2511
Case N0.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMII'
NAME OF APPLICANT~/~/v~/~,/P
RESIDENCE ADDRESS_/7o2 ~'
LEGAL DESCRIPTION/-OT- ~ ~ g ~
APPLICATION TO INSTALL: SEPTIC TANK_ / ,SEEPAGE PIT /,DRAIN~'~FIELD
TO SERVE THE FOLLOWING FACIL. ITY ~ '~ ~ ~,
FINANCED THaOUGH_ ~W~
/P/gP~.~,/') MAILING ADDRESS ~o× ~'7 /I PHONEN .O~..~'~/~'/~,Dg.77
('~' M~/'% /~..,. LOCATION OF INSTALLATION__[~/dO ,~L (,,'~,
, OTHER
. T0 BE INSTAkkED BY. -}~ ~ ~,-' t,,' ~
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FIt. LED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS _ //~ ~, /("]a/-'~C~l .,PERMITTOINSTALLA ~zCu~c~-r.~_ A~,~/~-A4 _AS DESCRIBED BELOW. SIZE OF UNITTO BESERVED ~ ~ ~o0~
_, SEPTIC TANK SIZE ~O00 ~..TYPE ~oclc SEE~AGEAREA ] [ / TYPE
w DIAGRAM OF SYSTEM
DISTANCES: /"/,/
/~alth 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.
~ / ( ,' , ,
;.: /// i/, - /' ., , -
DATE ~, :.,,/~ ·'/ APPLICANTSSIGNATURE ,,/' ';, / / ' ~ ~.(/ p,/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OI-' HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WA'FER FACILITY
264-4744
Application Date ~'~,;t'.,'~ ~ /¢ ~:~u'~
GENERAL INFORMATION (MUST BI-- COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner ¢~-~ ( ~P~ ~' [''
Mailing Address (' 70 cE)
(c) Lending Institution ~¢~L~'xcZr~ ~*¢~(~ ~/ Telephone
MailingAddress [ ~0 ~ ~ ~ t.gk ~,~, ~ (~
(d) Real Estate Company and Agent
Address ~;20 ( "C" ~f:
Telephone __ ~'~"
(e)
Telephone: Home
Mail the HAA to the followina address: or; Check here [~, if hold for pick Lip.
List contact person and day phone number below.
TYPE OF RESIDENCF.
Single-Family []
Number of Bedrooms
WATER SUPPLY
Individual Well [] Community J"] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
//
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite J~J Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department ol Environmental Conservation
attesting to the legality and status.
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-§
WELL DATA
, O~IU~I~I~ ~AEI~V OF ANCHORAGE (MOA)
C~B~.\~,'~ ~EAI'~I'H AUTHORITY APPROVAL (HAA)
~,:~;~,~s ~ECKLIST - FEBRUARY 1984
_., ~) . ~o('~ 264-4744
Well Classification ~r't ~'~',~/'-e If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) _~- Date Completed
Total Depth .(~'7' ,~'~;~'~¢ Cased to --~.~-'¢- d'?' _ Depth of Groating
Static Water Level ~ ~ *
Casing Height Above Ground __
Electrical Wiring in Conduit (Y/N)
i(jI~
N
Pump Set At _~'/!'
Sanitary Seal on Casing (Y/N) ~'
Depression Around Wellhead (Y/N) ~
Separation Distances from Well:
~,~
TO Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot I
To Nearest Public Sewer Line /~,/~'' To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Comments .~' /'-¢~.r_~y
s-c.'
to/¢
Date Installed 0'-/~(
Standpipes (Y/N)
Depression over Tank (Y/N)
SEPTIC/HOLDING TANK DATA
Size ~'~'~"~'! __ No. of Compartments I ¢~c ~
Air-tight Caps (Y/N) ~" Foundation Cleanout (Y/N) N
I"~t Date Last Pumped ~'/11/~7
Pumping/Maintenance Contract on File (Y/N) (V,/~. ;for
Holding Tank High-Water Alarm (Y/N) N,,~. Temporary Holding Tank Permit (Y/N) (~'
Separa ion Distances from Septic/Holding Tank:
To Water-Supply Well ~.~,~ ~ ~m Ir.~o~! ~.. o,
r ¢
To Property Line __ '~ ~
To Water Main/Service Line ~ fO:Os
Course '~ (¢~ ~
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026 fRev 8/861 Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~,
Width of Field
Type of System Design
Depth of Field Id'
Gravel Bed Thickness ~I-c¢,~/~ -~"
Standpipes Present (Y/N)
Date of Last Adequacy Test ¢"-/,¢/~ 7
To Property Line ',~ ~'0 '
To Existing or Abandoned System on
; On Adjoining Lots '~ ~ /
To Cutbank (if present) ~N ,,~.
I~, f ~b'~'
Square Feet of Absorption Area
Depression over Field (Y/N) N
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~O'
To Building Foundation
To Water Main/Service Line ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION Jklr/)-,
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed .:..,~¢,.~z_ ~' "~2q~ Date
Company i¢'(¢e/L',/~ '~'~c/~ ~c,~ MOA No.
Receipt No. ~ ' ~ 0/~' ~ O~/
Date of Payment ./- ~ ~ ;'/E
Page 2 of 2
72-026 fRev 8/861 8ack
· INSPECTION APPOINTMENTS
TIME TIME TIME
0'
~ATE [:)ATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAOE
f~c,~.tA- ~ t~ - ~.~_~.~ J~)~'rJ~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
(~L~L~ f~J2~. DEPARTMI]NT OF HEALTH & ENVIRONMENTAL PROTECT~IRONMENTAL PROTEC[ION
ENVIRONMENTAL SANITATION DIVISION NOV 2 9 1979
Telephone 264.4720
DIRECTIONS: Complete all parts o~l page 1. Incomplete requests will not be processed, Please allow ten (10) days [or processing.
1, PROPERTY OWNER PHONE
William Payto~ 344-847~ (h)
MAILING ADDRESS
Woo Boulevard ~±ly Payton 272-5491(w)
PROPERTY RESIDENT {If different from above) PHONE
2. BUYER PRONE
Paul Dietz
MAILING ADDRESS
3741 Parsons
~--. LENDING INSTITUTION PRONE --
National BAnk of Alaska 265-2883 (Rut
MAILING ADDRESS
Pouch 7-025 99510
4. REALTOR/AGENT t PRONE
Patricia Mc Manamin % Marston Real EstateJ 2'76-2804
MAILING ADDRESS
h)
5. LEGAl. DESCRIPTION
Lot 8 Block 6 Skyway Park Estates Subdivision
STREET LOCATION
Woo Boulevard
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four ~ Other
[~ SINGLE FAMILY
~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
~ INDIVIDUAL* 'ATTACHWELLL.OG Awel Io§ is required for ~ weHsdrilled
[] COMMUNITY since JUne 1975. Eot wells drilled orior to that date, give well
[] PUBLIC UTI LITY aemh (attach log if availaMe.}
8. SEWAGE DISPOSAL SYSTEM
X[~ INDIVIDUAL~ON.SITE-~ . tc'~.'~,~ Y["AR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO --~ FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
-~] INDIVIDUAL DEPTH OF WELL
[]COMMUNITY DATE DRILLED \ , /
[] PUBLIC UTILITY\1~
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~INGIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
'E~]Septic ~'ank or [],Hplding Tank (~¢zj.~.~.~, , ~¢~,.¢ ~
S.,ze:~-~'~_~_~made SOILS SATING
g~ve a~menslons: \~'~),
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL {letter must accompany certificate)
[] DISAPPROVED ,~j
DATE BY
72 010 (Rev, 6/79)
NORTHERN TESTING LAS0 : / ¥0RIES, INC,,
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479.3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378
Flattop Technical
14530 Echo Street
Anchorage, Alaska
Attn: Ted Moore
Services Date Arrived: 6/09/87
Time Arrived: 1630
99516 Date Sampled: 6/09/87
Time Sampled: 1150-1300
Date Completed'. 6/09/87
Source: Lot 2 flamann S/D, L 8 B 6 Skyway P1 Lst.
Sample ID#: A060987-4,5
Lot 2 }Iamann L8 B6 Skyway
Parameter Unit A060987---4 A060987-5 ADEC MCC$
Nitrate-N mg/L 0.t2 <0.10 10
Carol J. Garrison, Vice-President
* MCC = Maximum Contaminant Concentration
MUNICIPALITY OF ANCHORAr
DeparEment o~ Ilealth and EnvJronmenLc1 Protection
825 L Shreeh, Anchorage, Alaska 99501
264-4720
~ ~luest for Approval of Individual Sewer and Water Fa, c~llties ~.. ~._~ ~
Property Owner: -~-~. P .~~-
Mailing Address:
Phone:
Mailing Address:
Legal Description:
Street Location:
Lending InstitutJ on:
Mailing Address: ~_~
Phone:
Single 1.'amily Residence: (X Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well (~ Public/Community System ( )
If Individual Well, well depth
If Con~unity System, name of system
8. Sewage Disposal System: *'COn-site System (/ Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77