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HomeMy WebLinkAboutPATNODE BLK 1 LT 7 QGRE/ ~.R ANCHORAGE AREA BOI~' JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: D,ST^NCE //~' FROM WELL INSIDE LENGTH MANUFACTURER ~%'~:'/~7~ / MATERIAL INSIDE WIDTH LIQUID DEPTH l]L//-s- o. COMPARTMENTS LIQUID CAPACITY 4 '~C'~:L"?' GALLONS. SEEPAGE Pit: / LINING MATERIAL SIZE: DIAMETER__ BUILDING FOUNDATION .~ '/ , NEAREST LOT LINE__'~2' ~' ADDITIONAL ABSORPTION LENGTHS(';? DEPTH DEPT,__ D,STANCE FROM: WELL 14~ ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE ,/~ ~"2/>/;~ ~) CONSTRUCTION BUILDING '"'~.,_ ,,~ ~' NEAREST FOUNDATION ,' ~f--'~ LOT LINE ~.s~.oo. ~/~ .OTH.. ~o..~.~ APPROVED DISAPPROVED SEWER LINE DEPTH __~,~ ~ DISTANCE FROM: SEPTIC ~' , ;"'" "" SEEPAGE /~ ,m ,TANK ///~'2~ , SYSTEM REMARKS DISTANCES: INSTALLED BY: LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM ~1 . ~ G.A.A.B. Grea 'r ANCHOrage Area Bol~ DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ! Jgh PERMIT O. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT NAME OF APPLICANT ~-/~/~// ~,.~/~./~1.? ,NSTALLAT,ON LOCAT,ON INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT ~ DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL 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. TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ / FOUNDATION TO SEEPAGE Pit ~ , DRAIN FIELD SEPTIC Tank TO SEEPAGE Pit WALL SEPTIC Tank ~'J SEEPAGE PIt ~-~ ~) / , DRain field TO neAREST LOT Line. WELL tO SEPtiC tank Drain FIELD ., SEEPAGE PIt //~"')'~) / ALSO CONSIDER AREA WELLS. SEEPAGE PIT ,/ ~) DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD (~/ ~' SEPTIC TANK, ? ~.J~ SEEPAGE PIT TO RIVER, LAKe, STREAM. CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. DIAGRAM OF SYSTEM 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT GRAVEL laACKi~iLI~ /CZ CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G .A .A .B. OR ENS D DESI R ~'/ I CERTIFY THAT I AM FAM L Q AND LICANT'S SIGNATURE , DAT - FORM NO. E~-01 6 GREATER ANCtlOId\(iL AREA BOROUh.. Department of EnvironmenLal Quality 3330 "C" Street Anchorage, Alaska 99503 S()II~S I,()(; I~I~ROI,ATION TEST P rmed forII?~,~ ;)ate PerfonH,,d Legal Desc ri pt ion: .-.~-Or-.*--- -e~.~ :?-~~~--,--.~:-a lhis form reports: Sol~s log_ ~~_ verco~a:~on s, Dep th Feet 1 -_ 2- 3- 4- 5- 6- 7- 8- 9- 10~ ll - 12.-- 13- 14- Was round water encountered? ~ If yes, at wilat depth? Percolation rate minute. ,Proposed installation: oeepage Pit Drain Field Depth of Inlet DeptT~'-b6'E't~-m'-6:C'pit or trench EQ-040 (6/74) I. -i DRILLING :COM GALS. PER HR'. 3 ©0 g~~ .................................... KIND .OF CASING ....... ~.:...~'. ............ DRILLER'S NAME ...L~./...~.~.'.L.~.[~.-~.....~.f..~..~.~..~.. .................... MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIROf~NTAL HEALTH DEPA~THENT OF. HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, rar~e) Location (address or directions) (b) Applicants Name ~,-~,'11,~ ~L~m~,', Telephone - Home Applicants Address ~o~949 (C) Applican~ is (check~) Lendin~ ~us~i~u~ion ~; ~er/b~lder ~; Buyer ~ ; OCherI I(~plain); (d) Lendin~ Ins=itu=ion Te,~ephone A~ss Business (e) Real Estate Co. & Agent Address (f) Telephone , Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms Multi-Family Other (describe) 3. Water Supply Individual Well~, ,, Community~-~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Dispos,al . Onsite ~ Public ~--~ Community ~--~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation a~testing to the legality and status. [Page 1 of 2] E.n~ineerin~ Firm Providing Inspecttons~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation dace shown below, I verify that my investigation of' this Health Authority Approval shows Chat the on-site water supply and/or wssCewater 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 AnchoraEe files and from my investigation and inspection, the on-site water supply and/or wastewaCer disposal system is in compliance with all Municipal and State codes, ordinances, and re§ula- tions in effect on the date of this inspection. Name of Firm Address Date (ENGINEER SEAL) DHEP Approval Approved for ~t/Za%/%z) bedrooms APproved~ ~/~/~,~ ,, ,.,' Disapproved Terms of Conditional Approval Conditional CA~TION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONHENTAL PROTECTION (DHEP) ISSUES m~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN I/~ PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) KK4/eJ/D 18 [Pa§e 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) A~UN~C~P^U~ O~R~UMORiTY APPROVAL (HAA) D~PT. OF ENVIRONMENTAL PR~i~-~ - FEBRUARY 1984 S~P P, 4 ~ Legal Description If A, B, c~ C, D.E.C. Approved(Y/N) Yield Depth of G~outing Well Classification Well Log P=esent (Y/N) ~ ~/ Date C~leted Static Water Level Pump Set At Casing Height Above Ground Elect=ical Wiring in Conduit (Y/N) Sepa=ation Distances f=cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Se~r Line N sanitary Seal on Casing (Y/N)~ Depression A~ound Wellhead (y/N)~ ; On Adjoining Lots }(i~/+ ; On Adjoining Lots To Nearest Public Se~r Cleanout/Manhole /~ To Nearest se~r Service Line on Lot Wate= Sample Collected By Qn~&~- ~ ~ ; Date Ware= Sample Test Results Cc~snts B~. SEPTIC/HOLDING TANK ~ATA Date Installed 5~.4 %~79 Size I~00 No. of Ccmpa=tments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N.) N Date Last Pumped ~ Pumping/Maintenance Contnsact on File (Y/N) N~,; for Holding Tank High-Water Alarm (Y/N)~ Temporaz-~ Holding Tank Permit (Y/N)~ Separation Distances f=cm Septic/Holding Tank: To Wate=-Supply Well . II $'~ To Building Foundation 4i~ To Property Line ~+ To Disposal Field ~' ~'~ To Water Main/Se=vice Line ~4~ To Stream, Pond, Lake, or Major D~ainage Com~lents .m~, Receipt # Date Paid: Amount: ~ [~Page 1 of 2] 2-15-84 5 5 O0 NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A 6957 OLD SEWARD HIGHWAY, SUITE 101 FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99502 907-479-3115 909-349-8623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. # ~ PRIVATE WATER SYSTEM Mailing Addrea~ ~ f~,. City State SAMPLE DATE: ~ ~ Z~ Phone Mo. Day Year Purchase Order No. SAMPLE TYPE: ~'/Routine [] Special Purpose [] Check Sample (for original contaminated Zip Code sample with lab reference no.. Sample Time No. Location Collected 2 3 4 5 6 7 8 9 10 [] Treated Water [] Untreated Water  by Laboratory Ref. No. Signature of Representative CASH CHARGE PREPAID TRANSMITTAL SPECIAL INSTRUCTIONS MAIL HOLD FOR PICKUP Received at~, Anch. [] Fbks. Date Received ?~ k.~~ S~'~ Time Received / '~7 ~'~ (~ Next Sample Due COMMENTS: SATISFACTORY (~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final Count LSB BGB Result* Comments *No.(~'l~p~ (~orm Colonies per 100 mis. Reportei~:)y ~ Date Time GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received March 23, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Alaska Mutual Savings Ban Post Office Box 1120 PhOne: 274-3561 William D. Hansen Phone: 694-9493 Box 949, Eagle River, 99577 3. Legal Description: Lot 7 Block 1 Patnode Subdivision 4. Location: See attached map 5. Type of facility to be inspected 6. Well Data: Individual A. Type Single Family B. Depth No. of bedrooms 4 ,_~:" ~ / ' ,' .-' -(., 301' C. Construction D. Bacterial Analysis Sewage Disposal System: On-site system. .. A. Installed 9-30-?5 B. Installer C. Septic Tank: D. Seepage Pit: E. Disposal Field: l. Size ,'"~ '~;~ l. Absorption Area 2. Manpfacturer 2. Material Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines 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 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRQ VA FHA 1. Type of Inspection: 2. Property Owner: ~-~)/z'/ //2 ''(/I Mailing Address: BO)4 3. Name of Buyer: .~,f..21Z/~,,'Z4,~. /...~. Mailing Address: 4. Name of Lending.Institution: Mailing Address: ,4 5. Name of Realtor or Agent: CONV. ~ Day Phone: Phone: ~?~' S~-~/ Mailing Address: Legal Description: ~.,o T Location: ~-"~ ~ Phone: Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: No. Bdrms. '~ Individual Public Utility If Individual, date of installation . Individual (on-site) 72-003(3/76) Page 2 of two pages - Re st for Approval of Individual er & Water Facilities Legal Description Lot 7 Block 1 Patnode Subdivision Comments Approved ;~~~~~ Di s~ved v/ Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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. SIGNED Date EQ-034 (1/74) C. ABSORPTION FIELD E~TA Soils Rating in Absorption St=ara Date .Installed Width of Field Square Feet of .Absorption A=ea Depression ove~ Field (Y/N) ~3 Date of Last Adequacy Test ~c~ Separation Distance f~cm A~sorption Field: To Wate~-SupDly Well ~D~ ~ To P=operty Line Z5f~ To Building Foundation 90! To Existing or Abandoned System cn Lot A3~ ; On Adjoining Lots I00'+ To Ware= Main/Se=vice Line /OOr4: To Cutbank(if ~esent) ~ To St=earn/Pond/Lake/or Major Drainage Course ~4 ~ To Driveway, Parking Area, or Vehicle Storage A=ea ~f I5o~£/Iw~.,,a:~4~ Type of System Design Length of Field ~o~ Depth of Field ~' ~ ,, Gravel Bed Thickness _ 'Tfo .~ ~ Standpipes P=esent (Y/N) De LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo= Electrical Codes(Y/N) . Ccn~ents Dimensions Manhole/Access ,,~.~ o~f"~.,~vel at Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or eonfc~med to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date cc~ar~y ~o~ ~ ' ~..~..~.~. m/dS/~ %: ~-:""%%:g~-, i.~, [Page 2 of 2] 2-15-84