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HomeMy WebLinkAboutRAVEN WOODS BLK 1 LT 1 GRI:< ER ANCHORAGE AREA DOFf_.,I H Department of Environmental OuBlity 3330 C Street Anchorege, Alaska gg503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL '--- MANUEACTURER INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY J2-~TM GALLONS. I.~ZZ Z,R.-77 =;--L-'~: DISTANCE FROM WELL "'""' FOUNDATION NUMBER OF LINES ~ DISTANCE BETWEEN LINES ~ TRENCH WIDTH?/~'~ IN. ABSORPTION AREA ] (0)~ ~. SQ. FT. LENGTH OF EACH LINE ~ DEPTH OF FILTER . DEPTH: TOP OF TILE TO FINISH GRADE _'~-~1/'~' MATERIAL BENEATH TILE TOTAL LENGTH t NEAREST LOT LINE /(~ ~'1~ OF LINES (,.¢~ TOTAL EFFECTIVE ABOVE TILE ~/t IN. WELL: TYPE ~l/*8'?f~ _~e J CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE_ CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED DEPTH NEAREST SEPTIC SEEPAGE SEWER LINE__, TANK , SYSTEM DISTANCE FROM: REMARKS DISTANCES: INSTALLED BY: --~k~. SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: XMARKS: \.032 DIAGRAM OF SYSTEM 10o¥~,.,~,,,','":1 ....,''": ~[ ioI , GREATER ANCHORAGe AReA Borough PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCAT[O~ ~IZ . ~ . -- ~ , TO BE INS ALLED B~ SOil TEST .:RESULTS ~ NOTE~ THI~ PERMIT iS NOT VALID WITHOUT ~OIL COMPLET'~N DATE ANTICIPATED 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. CAST IRON INTO AND OUT OF SEPTIC TaNK AND INTO CRIB crosSING GAP OF FOUNDATION TO SEEPAGE PIT ~ . DRAIN SEPTIC TAN K tO ~"E'I~FG%'~rl T-~/f~V'~ 'ALL --~ ~ SEPTIC TANK ~ .,SEEPAGE Pit .,DRAIN TO NEAREST LOT L~NE. DRAIN FIELD ~ ALSO CON~IDER AREA WELLS. WATER MAiN TO SEPTIC TANK ~ SEEPAGE Pit DRAIN FIELD TO R~VER, LAKE. STREAM. EXCAVATtON 5 FEET iNTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT GRAVEL BACKFILL ' ~( ~ CONFORM TO ~OROUGH ~EGU~IONS REGARDING INSTALLATION. i CERTIFY THAT i AM FAMiliar WITH THE REQUIREMENTS OF GREATER A/~AG~A BOROUGH ORDINaNCe NO. 28-68 AND THAT THE ABOVE DESCRIB SYSTEM IS IN ACCORDANCE WITH SAID CODe..~ ~ ~ DA - APPLICANT'S SigNATURE · GREATER ANCHORAGE AREA BOROt]~,~ ' Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS I,OG ~ PEROI,ATION TEST This form reports: Soils log .,/' Percolation test Depth Feet 13- 14- Was ground water encountered? If yes, at what depth? Reading Date Gross Time Percolation ~-a-~-e-- .......... ~n-i-nute. Net Time Depth to Water Net Drop ,Proposed installation: Seepage Pit Drain Field Depth of Inlet '. Depth to bottom o'F pit or ~renc.h ..................... _~CL ..................... t-- -;- -~'~ ~- -~ Perfa~-=By :~~c :~ ~7,~ZL._ 5err' f' ed By: EQ 040 (6/74) v GReatER ANCHORAGE ArEA BOROUGh 3330 "C" STREET ANCHORAGE~ ALASKA 99503 ~//~::// TELEPHONE 274-456 ! SYSTEM -- APPLICATION AND PERMIT MAilING aDDRESS .~'~'~,~.' /'~0'~ ~/~ PHONE INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE Of FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETIO. DATE ANTIC,PATED /~ SEEPAGE PIT . DRAIN FIELD TO SE ,NSTALLED S', ., 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. SEPTIC TANK Size ~- TYPE SEEPAGE AREA SiZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK .. SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD / WATER ~AIN TO SEPTIC TANK .~DRAIN FIELD . ~ / ALSO CONSIDER AREA WELLS. / ~ SEEPAGE PIT j~ ., 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. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. TYPE DIAGRAM OF SYSTEM 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. '' ; ....... 2-~.....?.,..~.. ........................... at rate gallons per ~our; - - ' certifieate to yoUr deed;: ' Parcel I.D. # · : ' . ' 1. GENERAL INFORMATION (Must be completed prior to submittal):~_'-' ~ (a) Legal Description (include 10t, block, subdivision, section, township, range) Mu'NIcIPALITY OF ANCHORAGE;" ',hz~ ?!':;;:,.t .:',~ - Department of Health & Human Services .~'~"--? . .. -,~ 343-4744 -; ~"- ',~ ~' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL-OE. ?.'~ .,:r,'..,'",- O N--SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING?' :.',- ' ~--~--~ '' ' HAA~ '~~~" ........ Lot I~ Block Ii Raven Woods Subdivision; Location(addressordirections) 12001 Gillette Road (b) Property owner Ronald A.& Lenora P.Wood Mailing Address 1821 (c) Lending Institution Mailing Address Telephone:(home) 271-6588 Parkside D~ve, Anchorage, Alaska 99501 Telephone Business 243-1902 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here~E~, if hold for pick up.) List contact person and day phone number below: I7034 Eagle Ri~er Loop Road No~ 2. TYPE OF RESIDENCE Single-Family El( Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public [] must have wr tten con[ rmat oo frqm tie State:Depactment ~f E~wronmental' Note: community,,~we system 4. N~t~lf commuhit~:~ell s~iem, mus~ fi~:~"Writt~'c0n~irmati0h~;'?)~ (he s~ate Depa~e~t'df Environmental;~ - Conse~ation attesting to the legality and statue. -.,',--..,,~; L?-'~..., ~,~.' - 72-025 (Rev, 7/88) Page I of 2 leUOpjpuoo p@AoJddes!a I~^oJdd¥ leUO!l!~uoo to scu~o£ .~7- JOj poAoJddV.. lVAOlddd¥ SHHO '9 e3eC] iPO~'oN peo~ doo'l ,~e,H~l ell~e3 · wJ~:.4 jo OWEN' r - . 'uo.~oedeu! s!qt jo atop eq] uo ~oe~a q! suo!~e nOeJ pue 'seoueulP~O 'sepoo ale,S ' : · .:pue led!o!unR I1~ q~ eoue~ e~oo u s ~ete~s lesOds p ~e~e~etse~ ~o/pue ~ ddns~a]e~ eHezuo eq~'uo ~oedsu ' · ';?pud UO.le611SOAUl. X~'~Ji'pue Sellj. ~6eJoqou~' jo XllledlmUn~. . . oql"woJl'peulelqo UO ~BWJOiUI eql UO peseq '='. : '. ~8q~ ~IJGA Jeq~n~ I 'ule~¢q peleo!pu! eJnlon~s ~o edX1 pue s~ooJpeq jo Jeq~nu eq~ 4o~ e~enbapu pug' euo lounj '. '-:' .:' ' -' 'e~es ~ melSXS esods!P.'JeleMOlSeM Jo/pu~fAddne JOleM el!s-uo eql'~eH~ SMOHS~IeAoJddv X~!Joqlnv qlleeH_' --.:?~ ,NOIZ~..O,NI aN~ ~z~a 'HOa~aS a~la 'szsaz 'SNOIZOadSNI eNlalAOad ..la 9NlaaaNIeNa 'g WELL DATA Well Classification ¢.~,~/~. /.-~m, Well Log Present (y/N) ~_ Date Completed Total Depth / ~' ~ ICased'to z-'¢'O/-r Depth of Grouting Stat!.c Water Level ! ~,_ ~7 / Casing Height Above Ground / 2. ' ' '~- Electrical.Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line &-)/~ To Nearest Sewer Service Line on Lot MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) IfA, B, C, D.E.C. Approved (Y/N))0/.¢i Yield 7_,~ ~ p.~A.~ Pump Set At C) ~ Sanitary Seal on Casing (Y/N) ~1 Depression Around Wellhead (Y/N) /k) Water Sample Collected by Water Sample Test Results -/- ; On Adjoining Lots / I CO 'J' ; On Adjoining Lots [ CO To Nearest Public Sewer Cieanout/Manhole ~/~ Comments SEPTIC/HOLDING/TAt~K DATA Date Installed 7/.2~//~-'Size ,/-.~--5"'"~)?~ ) NO. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) t,d Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) k)/zA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: 1 Foundation Cleanout (Y/N) Date LaSt Pumped ,~- ~ il- ~ I /,,.) / ~ ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~ ~p '¢-'f 'C- iD© ¢A.¢ e d To Building Foundation ( ~' To Disposal Field ! (oo -f 12-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION F~ECb DATA Soils Rating id Absorption Strata ~__ ~) ~ i"~ Type of System Design D.ate,:l~¢s'(alled .-" *~,,~' O~ ~,'~ ' '. ~-"¢'F8 t h of EibC.d' Square 'Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test '~ ~ Length of Field Depth of Field Gravel Bed Thickness ~ ¢ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation [ O Lot To Water Main/Service Line [ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line / To Existing or Abandoned System on ; On Adjoining Lots ~::><~) To Cutback (if present) Comments D. LIFT STATION Date Installed ~ Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at ~J %'%.~ Tested for Meets MOA Electrical Codes (Y/N) Comments '~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 inspection. Company Eagle R[vc~', At~s~;u '295Y? Date ~ ( ~ ¢ ¢ Receipt NO. Date of Payment Amount: $ 72-028 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 31712 Date Report Fzinted: FEB 4 91 @ 12:24 Client Sample ID:L1 E1 RAVEN WOOD PWSID :UA Collected EEB 1 91 ~ 12:00 hrs. Received FEB 1 91 @ 14:30 h~s. Preserved with :AS REQUIRED Analysis Completed :FEB I 91 Laboratory Supe~P.HBN C. EDE Client Name Client A¢ct BPO # Req { Ordered By ENGINEERING SNSENGP R. SHAFER Send Repozts to~ 1)$ ~ S ENGINEERING 2) PO # NONE RECEIVED Chemlab Ref ~: 910357 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.67 mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BT: R.D.J. Remarks: 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA~ Not Analyzed LT~Less Than, GT~Greater Than GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 INDIVIDUAL SEWER & WATER FACILITIES FOR Date Received May 7, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF Cony. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: First National Bank of Anchorage % Dixie Post Office Box 720, 99510 Ronald A Wood Star Route A Box 1620-B, 99507 Phone: 279-4481 x 231 Phone: 344-2518 (Mrs.) 3. Legal Description': 4. Location: Lot 1 Blo6k 1 Ravenwood Subdivision NHN Gillette~ off of Birch Road 5. Type of facility to'be'inspected :Single Family 6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank No. of bedrooms 3 1. Absorption Area Total length of lines B. Depth ,.-. D. Bacterial Analysis On-site system B. Installer 2. Manufacturer 2. Material , Absorption area /~/ , Other contamination , Sewer Lines , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages 1. Type of Inspection: 2. Property Owner: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALI'I¥ OF ANCHORAGE DEPT. OF t'tEALTH & ENVIRONMENTAL PROTEC?ION UAY ? RECEI.V ED CMRO VA FHA Ronald A. Wood and wife, Lenore P. Wood CONV xx Mailing Address: 3. Name of Buyer: SRA Box 1620 B, Anchorage, Ak 99507Day Phone no ne 344=2518 (Mrs.) Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: Day Phone The First National Bank of Anchorage p. O. Box 720, Anchorage none Phone 279-4481 x 231 (Dixie) Phone 6. Legal Description: Lot 1, Block 1, Ravenwood Location: Off Birch Road - NHN Gillette 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Single Family Residence No. Bdrms. 3 Public Utility Individual Private Well If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (1/74) Mailed 5/4/76 (dO) Page' 2 Of'two pages - Reel .~st for Approval of Individual -~ .~r & water Vacl)ltles regal Description Lot 1 Block 1 Ravenwood Comments Approval:Valid for one year from date signed Greater Anchorage Aria 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. Date SIGNED EQ-034 (1/74)