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HomeMy WebLinkAboutKRAMP BLK 1 LT 9 G""ATER ANCHORAGE AREA BOROJ~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 N°. 685 INSPECTION REPORT ON-SITE SEWAGE DISPC)SAL SYSTEM SEPTIC TANK: ADDRESS LEGAL DESCRIPTION_./~ DISTANCE FROM WELL_~'~ / ./'~(,v~.. uaU~D CAPACITY /'~D__GAL'ONS. MATERIAL (~'?~¥ Ucv~¥-~--''~-' NUMBER OF / co~P~x~N~s INSIDE lENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: / .OUTSIDE DIAMETER / / OR W,DTH /,-~ ,LENGTH /~ . DEPt. DISTANCE FROM WELL ./7~("~ tOTAL EEFeCt~VE ABSORPTION AREA IWALL AREAl BUILDING FOUNDATION__ sa. FT. TILE DRAIN FIELD: DISTANCE FROM WELl __~ ~4:J~U.ND~N. , NEAREST LOT LINE NUMBER OF LINES DISIANCE BETWEEN LI TRENCH WIDTH ABSORPTIO~2,~A SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES I N, T.~O.~A'I~'EF F E C t I V E DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE____ )/~g?"t ' DISTANCE FROM --- WATER WELL: TYPE..__ /I¢) _, DEPTH "~ , BUILDING FOUNDATION.. SAMPLE , NEAREST '-- NEAREST . SEPTIC _ SEEPAGE OTHER LOT LINE ~, SEWER LINE ,TANK , SYSTEM . ~ , CESSPOOL --- , SOURCES DIAGRAM OF SYSTEM DISTANCES: I DATE APPROVED " HEALTH ~.l~,LI O R I T Y ! GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3S00 TUDOR ROAD POUCH 6-650 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGAL GESCR,PTION .r- INSTALLATION OF: SEPTIC TANK ~X~ · SEEPAGE PIT ~/" DRAIN FIELD OTHER NOTE: THIS PE_P.~..IT IS NOT VALID WITHOUT SOIL, COMPLETION DATE ANTICIPATED FINAL INSPECTION= 24 HOUR NOTI¢:E REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. ,I MINIMUM DISTANCES, REQUIREMENTS C FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE FIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANI'( , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD DIAGRAM OF SYSTEM , DRAIN FIELD ~}"~ / DRAIN FIELD SEEPAGE PIT ~)~ / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK . ,SEEPAGE PIT DRAIN FIELD SEPTIC TANK, ~[~"/ SEEPAGE Pit /~'~ ~ , , DRAIN FIELD CAST IRON I...~LT_~OUT Of SEPTIC TANK AND iNTO CRIB CROSSING GAP EXCAVATION S FEET INTO UNDISTURSED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE FITTED WITH AIRTIGHT ReMovABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING iNSTALLATION, I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS DA~ ~ ~~DESCR SYSTEM IS IN ACCORDANCE WITH SAID CODE. OF GREATER ANCHORAGE AREA ~OROUGH ORDINANCE ~O. 28-68 AND THAT THE ABOVE :RLA1ER ANCIIORAGE AP, EA BOI{OUGH Ill;AL'fl{ DEPAI':THENT 327 J]AGLE STREET ANCHORAGE, ALASKA 9§501 CA~£ g Lea, al Dc$cpip~ Lot ~ Block ~ Subdzvxa~.on K y,o,.,w,r~ Depth I'ee~ Soil Chapaczeriszics if Yes, At What Depth___ _ Locatio? Sk'et ch Reading Froposed Instal-i-~Tion: Seepage Pit Drain Field Depth Of inlet Depth To Bottom O-f~P-it Or Trench Daze Ceptified By: Wm. 1v. AtBvood · ' 197i Date. Jg~ne 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 0/'/ '~-,/~"t~2 GENERAL INFORMATION Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Pe ~-ir' ,.~¢ht~.~o..~ Telephone: Home .'~ ~/5'"- 70 ~ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agenl Address Telephone (f) Mail the HAA to the following address: 'TYPE OF RESIDENCE Single-Family~ Multi-Family[] Number of Bedrooms ~' Other 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 DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verily that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater 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 Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ~ Name of Firm ('~lrx(--/cat,~ 'T~r~'¢c~( ..~/~¢~/ Telephone Address 1~/'5'-3(2 _~c/~a Z~', ,, ,,~c/~o¢'~r~¢ ,/~-(4 · Engineer's Seal DHEP APPROVAL ~ Approved ~ Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in 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 [ending iastitutions in order to satisfy certain federal and state requirements. 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. Page 2 of 2 72-025 (1 ~/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF,ENVIRONMENTAL HEALTH .~ · CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPR~)VAL OF ON-SITE SEWER AND WATER FACILITY ' "264-4720~' , '. · ~ ,~ Application Date 3 / 2-.4¢ /~' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ' (b) Applicant Name />¢_.~Lcf- .~'¢h/~ro/~ Telephone: Home ~ ¥~5'° ?°~~ Business Applicant Address ~ ¥O(::2 C/~;/~ ~/~' '~. t'.' ,. (c) Applicant is (check one): Lending InstitutiOn []; Owner/builder []; Buyer []; Other [-] (explain)', (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAAto the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Other Number of Bedrooms ~ WATER SUPPLY ' ' ;':~ . ,,; ]':;i.:... ,. :...~ I.ndividual Well [] Community [] Public [] '." .... ;"' Note: If community well system, must have written'co r~firmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL i . Onsite [] Public [] Community [] Holding Tank [] '" ' Note: if'community ~vell system, must l~ave written confirmatic r~ from the State Department of Environmental Conservation attesting to the legality and status. ,.. · ~ Page 1 of 2 72-025 (1~/84) §. ~ ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION '~ As certified by my seal affixed hereto and as of the validation date Sllown below, I verify that my investigation of this Health ~ Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms end type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. '~' Name of Firm. J~'/<,~/"'~/* ',)-e_c/l~l'~ cc~/ ~'¢Cv;C~" Telephone . Address I ~,.~'.~ .J~¢~O ~ ~ ~o~o~¢ ~ ~ ': ~-(~ Date ~ Z~ IP~ ~ .,-. . ; ,'t, ¢_.". ........ .: _× ¥-.. ,: . ~'¢~,j'~,." .... ~ ,,~9~ : Engineer's Seal ~ ~ ~THEODORE F. MOORE 2 Approved for F"~::)L~.,~ ~ bedrooms by L.J Approved Disapproved Conditional Terms of Conditional Approval '~")~ '~ .... ' ' cAUTION ...:; . ,. 'The MuncJpality of Anchorage Department of Health and Envronmenta Protect on (DI-EP) issues Heath Authority t': i!..ili.i i~,Approval certificates based solely upon the representer ons g yen n paragraph 5 above by an ndependent profess cna · ': :::5' engineer registered in the State of Alaska The DHEP does h s'as a courtesy to purchasers of homes and their lending . ~ ,:i.!. ,' nst tut 0n~ n order to satisfy c{,rta n federa and state reqL rements Emp oyees of DHEP do not conduct nspect ons or ~. ,. ',' :.: ',.analyze data before a cert f cate s ssued. The Munic pa ty of Anchorage s not respons b e for errors o'r om ss ons n the Page 2 of 2 MUNICIPALI'rY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2, 8 WELL DATA Well Classification ____ Well Log Present (Y/N) /~ Date Completed 1~ 71 Yield Total Depth _;~' 1 ~" __ Cased to ~ I ZK' Depth of Grouting Static Water Level ~"¥° Pump Set At Sanitary Seal on Casing (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot I~,~, To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line. Cleanout/Man hole Water Sample Collected by _ Sample Test Results $~ ~r.r~c/o~-.y Water Comments~ m~ t l ¢,¢~r'~..~ ~o,~ _; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DA'TA Date Installed Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding 'rank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, er Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA H, ~. Soils Rating in Absorption Strata [)ate Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Fouedation ' Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course 1-o Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION 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 oRhis inspection. Signed ~4'/~ ~' ¢¢t0'~' Date 3/~'/~6'''' Company Y'{~/¢~/ ~'~ ~r~n~4/ MOA No. ~,~-0,.¢8 Receipt No, __ *'~-h_ '~ "7 c)9 ¢t~ Date of Payment '~'~-'~ ~(,~ Amount: $ (.¢~,"-c,~.J~, Engineer's Seal Page 2 of 2 72-026 (11/84) .... ~A ~ E RECEIVED INSPECTION APPOINTMENTS . TIME TIME D,~T~- DATE DATE .~,~ INSPECTOR~ INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 9~501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER . PHONE MAILING ADDRESS PROPERTY RESIDENT (tf different from above) '/ PHONE ' BUYER '- PHONE MAILING ADDRESS ~ 3, LENDING INSTITUTION / PHONE MA LNG ADDRESS ~( ¢¢~ 5. LEGAL DESCRIP'rlON STREET LOCATION / 1 ~. ~.~ o~ .~s,~.~ / ~ o~,~ooMs ~ SINGLE FAMILY O '~u' /¢ ;¢ ~ © One ~ Four ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six Other WATER SUPPLV INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to/,,.that date, give wel/,I depth (attach Icg if available.) // /¢F~ YEAR ON-SITE SYSTFM WAS ,NSTALLED. NOTE: THE INSPECTION FEE MUST A~CCOMIZANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. / -d~--~'-~ F~~-~~. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE E~] OTHER [] MULTIP/.E FAMILY [] TWO [] FOUR [] SIX ---- PERMIT NUMBER "-- 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NOMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSQRPTION AREA MATERIAl. ~-- Absorption Area Sewer 4. DISTANCES Septic/Holding Tank Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line '~, COMMENTS [] APPROVED FOB ~¢' BEDROOMS I~--'~ONDITIONAL APPROVAL (letter must accompany certificate) [~] DISAPPROVED DATE BY 72-010 (Rev. 6/79) GREATER ANCHOF~\GE AREA BOROUGH Departraent of Environraental Quality 3500 Tudor Road, Anchorage~ Alaska 99507 279,~8686 Date Received Time of ~nspection ~,' Date of Inspectio~~_Z~ REQUEST FOR APPROVAl. OF INDIVIDUAL SE~ER & I;.~A'rER FACILITIES FOR A. Ty~e_ , C. Construction Sewage Disposal System: A. Insta 11 ed__~.;~ Bo Installer g. Seepage Pit: 1. Size/~'/~'~'}t~2.'''Mater.iaI E. Disposal Field: To~.a] Length of l,ines Distances: A. !^.~e] 1 To: Septic , Nearest I,ot lane , Other Contamination Foundation to Septic Tank L~ ';, AbSorption Area C -.~ Abserption Area to Nearest Lot Line , Absorption Area~_, Sewer Lines RequesT. for Approval of ' ividual Sawer 6, Water Facfliti{ Page Two 9, Comments Disapproved Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, De. Fartment of F. nvironmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water faci!it~es located at: Signed Date