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HomeMy WebLinkAboutLot 06 ,C~-~ATER ANCHORAGE AREA BORO~Im~" HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N°. 635 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: MAILINGADDRESS p HO N E,~2~-q~ LEGAL DESCRIPTION DISTANCE FROM WELL LIQUID CAPACITY. ~ GALLONS NUMBER OF /' MATERIAl ~-~'~--~---~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH DEPTH__ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS ~ .OUTSIDE DIAMETER / .OR WIDTH ~ENGTH. ~., DEPTH LINING MATERIAL --/~-~'~--r~' DISTANCE FROM WELI~~'~/~' ~ /~./?~ . BUILDING FOUNDATION NEAREST LOT LINE ~ z~._ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: F~ O~ TOTAL LENGTH DISTANCE F ., NEAREST LOT LINE. OF LINES NUMBER/OF LINES DISTANCE BETWEEN TRENCH WIDTH IN. TOTAL EFFECTIVE / SQ. FT EACI~L~N E DEPTH: TOP OF TILE TO FINISH GRADE .DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: NEAREST LOT LINE /~2 x~z-.* SEWER LINE /~ ~'' SEPTIC , , TANK ~/__~_('/,4/~ ~-~,,~.~'~;~ ~z~/~'~'~,~'~-'~-~,-~/ DISTANCE FROM TYPE ~//~-~' , DEPTH ~/i~' ~ . BUILDING FOUNDATION. DISTANCES: SEEPAGE--~ / CESSPOOL SYSTEM /~'~ '~/-~/~, DIAGRAM OF SYSTEM WATER .~ __~ SAMPLE .~'~:~--~ NEAREST ~.....~, OTHER SOURCES GREATER ANCHORAGE AREA BOROOGH DEPARTMENT OF ENVIRONMENTAL OUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION PERMIT NO. / ~--~*'-" ~~mONE INSTALLATION OF: SEPTIC TANK ~ SEE AGE PIT ., DRAIN FIELD , OTHER FINANCED THROUGH .~/h~f~ TO Be INSTALLED bY :: FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPT,C TANK S,ZE 7 5-O T PE SEEPAGE AREA S'ZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ SEPTIC TANK TO SEEPAGE PIT WALL / SEPTIC TANK ~ , SEEPAGE PIt . TO NEAREST LOT LINE, WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK ~ · DRAIN FIELD , DRAIN FIELD SEEPAGE PIT . ALSO CONSIDER ArEA WELLS. , SEEPAGE PIT DRAIN FIELD SEPTIC TANK, , SEEPAGE Pit TO RIVER, LAKE, STREAM. , DRAIN FIELD CAST 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 SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM CONFORM TO E~OROUGH REGULATIONS REGARDING INSTALLATION. t~/ ~/ HEALTH AUTHORITY or LICENSED DESIGNER I CERTIFY THAT IAM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DAT APPLICANT'S SIGNATURE ~_- . ~ Approval Requested By GREATER BNOiO~.GE AREA BOROUGL ['~AL~I DEPARtmeNT 327 EAGLE STP~ET ~NCHORAGE, ALASKA 99S01 279-2Sll DATE PECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE /D~D WATER FACILITIES FOR 2, Property Owner ~o/:/~? /c/f//:: S. Legal Description ~': ~ ~D5'/.5': ?p ~/ ~, Type Of Facility to b~ Inspected ~&~/~{'¢~ET: /5%)~ / Number of Bedrooms ~ S. Well Data: A. Type B. Depth ~>~ / c. Size ~// ~)~_r D. Construction_ E. Bacterial Analysis Sewage Disposal System: A. Septic Tank (If homemade, show diagram on back) 2. Age.,. 5. Nanufacturer ~f~ 4. Installer ~/f~f~fz:7~'~~'/~~/~ Approval Request for S? ~e ~ Water Facilities Paie Two Seepage Pit 2. Lining ..... ~W~o~ C. ~Disposal Field 1. Number o£ Lines 2. Total Length Required Measurements A. Well to Septic Tank B. Well to Seepage Pit?, C. Well to Sewer Line //~? D. Well ~o Property Line //~ E. Well to Other Possible Contamination .... Foundation to Septic Tank /f / / G. Foundation to Seepage Pit H. Seepage Pit to Property Line~2f/f'~ 8. COP~IENTS: DISAPPROVED: DATE: APPROVAL VALID FOR ONE YEAR FROtl DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70 Approval Requested By Address 5-- ~ 3 Phone GREATER ,~NC!.iORAGE .AP4JA BOROUGL !-~BL?H DEP~R~,'~NT 327 EAGLE STP~ET ~NCHORAGE, ALASKA 99501 279-2511 DATE PECEIVED .... ~////~Z/7/ TINE: REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE P2ID WATER FACILITIES FOR 3. Legal Description ~ ~ 4. Type of Facility to be Inspected Number of Bedrooms ~) ;Veil Data: ~ ~ A. Type . _ .' ." B. Depth .. C. Size ~ ---"/ Ao D, Construction _ E. Bacterial Analysis Sewage Disposal System: Septic Tank (If homemade, show diagram on back)? 1. Size ,.--' 2. 5. Manufacturer 4. Installer ? Appro~v~l Requ~ ~t for ~ ge ~ Water Facilities Pa~ge Two *- ° B. Seepage Pit 1. Size 2. Lining C. _Disposal Field 1. Number of Lines 2. Total Length Required Measurements Well to Septic Tank C. Well to Sewer Line D. Well to Property Line E. ~Vell to Other Possible Cont~nation Fo~dation to Septic T~k G. ~oundation ~ Seepage Pit COb~,~NTS: APPROVED: APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70 ADHW - LAB - 2w DATE STATE OF ALASKA D~;z~6. RTMENT OF HEALTH AND WELFA.R,E DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Lab. No. OFFICE REPORT RESULTS TO NAME ADDRESS CITY ADDRESS OF SOURCE SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED SampJe Collecled From [~ Kilchen Tap [] Bathroom Tap [] Other (Listl Well- [] Dug [] Driven ~) Drilled [] Bored SOURCE: [] Spring [] Cistern [] Olher Dug Well or Cistern Construction: Brick or Walls - [] Wood [] Concrele [] Metal [] Tile [] Concrete Tap - [] Wood [] Concrete [] Metal [] Open Top LOCATION: [] In Basement [] Basement Offset [] Under House [] In Yard [] Other Building Sewer Septic DISTANCE TO: or Other Drainage Pipe Feet. Tank Feel. Ti~e Seepage Cess- Field Feet. Pit Feet. Pool Foet. PHvy Feet Olher Posslble Sources at Conlominatlon Asbeslos MATERIAL: Building Sewer - [] Cast [] Wood [] Time [] Fibre [~ Cement -- [.] Plastic Joint Material -- Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameler of Well. Well Casing Material Lenglh o! Drop Pipe PUMP LOCATION: [] In Well On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source o( Supply? [] Yes [] No Repairs to System? Depth Eeet. Diameter Depth Waler Depth From Bottom Feel. [] Ofltet In [] In Basement [] Roam [] No [] Yes [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE ~ Records in this office indlcale this WATER SUPPLY to be of: [] Satisfactory [] Questionable [] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: [] Satisfactory [] Questionable [] Unsatisfactory. Il an "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. __1. Notify consumers water is polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." 2. Increase chlorination sufficiently to meet recommended residual standards. Determine source of contamination and take action necessary to maintain o sale water supply at all times. --.3. Check chlorlr~atinn and other mechanical equipment. Make certain Jt is functioning properly. 4; If afier checking equipment a disinfecting residual is not obtained, please wire IhJs office for emergency assistance or advisory serv}ces. 5. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cistern. 7. Relocale your well to a safe location in relationship lo your sewage disposaJsystem. [] see enclosure 8. Sample too long in fransitl sample should not be over 48 hours old al examination to indicate reliable results, please send new sample. [-7 Bottle Broken in translt, ptease send new sample. 9. Conlactyour nearest [] Local Health Department or [] Alaska Division of Public Health, sanitation office for bulletins, consultation and SANITARIAN'S REMARKS Signature BACTERIOLOGICAL WATER ANALYSIS RECORD om Date Received ~ Time Received pm Lab. No Lactose Broth : 10cc 10cc 10cc 10cc I 10cc 1.0cc 0.1cc I 24 hours 48 hours Brilliant Green 24 hours 48 hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs:~ Greta's slain Coliform Density {Most probable NO. per i00c¢.I MF results pm Date Reported by Absent This analysis indicates Colilorm Organisms to be: ?!ay 2.7, 1071 °~ b<' · 'i t6iller, C~vner SUBJECT: LoC 6, Wilsm) .~u uivis on; Daily K. b~ar Sirs: Upon ins)Jectio~ of the ,'.~ ~,;]e~,~ "nl~ prop,~rt,y, "~)re~,, (3) cesspool~ were discovered to be servit)t~ as the sm,~er systeif~, The one (1) cesspool r~ceives waste from the kttch~)? s't~)k and tile ulasniJ~g machi)te, This cesspool is 42' fr~m) the well, There ah~ tu~.~ (2) mor~ cess?ools connected i:] a series receivi~,'~ i:i~o vlaste from the batnro(~.~), These t~o (2) cc'ssi*ools are 127~ fro(~ the well, ~vas~c, frg;.J ti~e kitchen a)~.d lau~Jdry~, needs to b~ ltl)ed im ~nd a 7!;0 gallon sFJptic ta)lk~ a mini)~um of 50' fro~;) th~ ~el1, needs to be installed on the lin~ that !To~s to the other twe (2) cess~)ool$. The lin~ frorl tile kitchen and lau))dry ~u,)uld -~lso have to ru~) i))to the septic tank. ta,< w(_qt prow ~atisfactory. A wat~:r sa ~ple ~aP, en from '~ '~ Si ncerely, John R. Lee, ~.S. Sanitarian rn PS: Spokane ~,~ortgage Co. Daily K. P, lller Tu~pomary approval can be give)~ by this Depart~m~)t subject to the esc~(~w of fuF~ds to upgrade the Subject system.