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HomeMy WebLinkAboutHERITAGE HILLS BLK 5 LT 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 TONY KNOWLES, GOVERNOR R I:°5 APR 2 4 199~ Municipality of Anchorage Dept. Health & Human Services April 17, 1996 Mr. Tobben Spurkland, P.E. · 203 West 15th., Avenue, Suite 203 Anchorage, Alaska 99501 Subject: Lot 2, Block 5 Heritage Hills Subdivision; Anchorage, Alaska AWPSO Project Number 9621-WW-233-090; Review Dear Mr. Spurldand: This letter is in response to your submittal received in this office on February 9, 1996 regarding the use ora Biocycle package treatment plant, installation of a new 1500 gallon two compartment septic tank, and the need for two separation distance waivers. I have reviewed the submitted information, information obtained from this and other agencies on the use of the Biocycle package treatment plant, information in this office's files on this facility, and pertinent design standards and regulations. Based on this review and investigation, I have the following comments. From the soils information found in ti-As office's files (collected in i986) and the written confirmation you provided (no soil logs were provided), the in place soils appear to be a tan colored silt, with a very slow percolation rate (55 to 60 minutes per inch) which lends strong support for the requested waivers. With the proposed use of the Biocycle package treatment plant, which has been shown to provide additional treatment to domestic wastewater, also lends strong support for the requested waivers. In fact, if the existing seepage pit can be used as you are proposing, the use of the Biocycle package treatment plant may extend its service life since the in place soils are fine grained. Although no design calculations were provided with the submittal, I have been able to confirm that the proposed 1500 gallon, two-compartment (the number of compartments is an assumption) is more than adequately sized. However, no design information or calculations were provided for the Biocycle package treatment plant. I believe that the proposed use of the Biocycle package treatment plant to serve a 5 bedroom facility has not been previously approved by either the Municipality of Mr. Tobben Spurkland, P.E. 2 Apfil17,1996 Anchorage or this Department. From my review of the information that has been provided to this office on the uses of the Bioeycle package treatment plant, the results of the testing program conducted on the Biocycle package treatment plant within the State of Alaska, and my conversations with representatives ofBiocycle Pty Limited (Wariewood Australia), the proposed use is feasible and the unit should be able to provide the level of treatment that has been documented over the last few years here in Ala.qka. WASTEWATER DISPOSAL The use of the 1500 gallon, two-compartment septic tank and a Biocycle package treatment plant is acceptable to this Department. Therefore, subject to the following requirements, the cons~ruction plans are approved for concerns of this Department, in accordance with 18 AAC 72, Wastewater Disposal Regulations: Installation of the 1500 gallon, two-compartment septic tank and the Biocycle package treatment plant will need to be monitored by a Professional Engineer (P.E.). CompIete as-built drawings (plan and profile view) of the septic tank, Biocycle package treatment plant, and seepage pit will need to be submitted to this office under the stamp ora P.E. The submitted as-built drawings will need to verify soils, groundwater and impermeable strata separation, and that the air system was properly installed to ensure warm air is forced into the system. Verification that the existing seepage pit can accept the necessary amount of treated wastewater will need to be submitted under the stamp of a P.E. A copy of the adequacy test results will need to be included with the verification. Design calculations, under the stamp of a P.E., will need to be submitted to this office verifying that the Biocycle package treatment plant can properly treat the amount of wastewater that will be generated ~om a five bedroo:n facility. 5. The property owners will need to agree in writing to the following: AlIowthe State of Alaska, Department of Environmental Conservation the perpetual right of entry to the property during normal working hours,' to allow for effluent sam~ting or evaluating the general state of repair or function of the system. Submit to the Anchorage/Western Public Service Office of the Department of Environmental Conservation, on a semi-annual basis, an inspection and operation statement from a P.E., registered in the State of Alaska. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. Mr. Tobben Spurkland, P.E. 4 April 17, 1996 Thank you for your cooperation and coordination with this Deparmaent. If you have any questions, please do not hesitate to contact me. Keven K Kleweno, P.E. Environmental Engineer KKK/cf Enclosure: As Stated ce: Jim Cross, P:E., MOA/DHitS, w/o Enc;" Mr. Tobben Spurkland, P.E. 3 April 17, 1996 Verification that there is four feet of cover over the seepage pit will need to be submitted. If there is not four foot of cover, the as-builts will need to verify that needed cover was placed over the seepage pit. Notify the Anchorage/Western Public Service Office at least 48 hours prior to installation of the new septic system so staff, depending on availability, can inspect the installation. This approval does not imply the granting of additional authorizations, nor obligate any state, federal, or local ,,~gul,~o,y o~d~. ~o grant required authorizations. WAIVERS Turning to the waiver requests, as noted above, the in-place soils and the use of the Biocycle package treatment plant did assist in determining that the requests were reasonable. Including the recent water test results, it does appear that the Class C Public Water System Source Well could be sufficiently protected from contamination from the onsite wastewater treatment and disposal system. Therefore, in accordance with the provisions of 18 AAC 80.030 and 18 AAC 72.015, the following waivers are being granted: The separation distance from the existing Class C Public Water System Source Well to 1500 gallon Septic Tank, from 150 feet to 100 feet. The separation dist~ance from the existing Class C Public Water System Source Well to the Biocycle package treatment plant, from 150 feet to 100 feet. The separation distance from the existing Class C Public Water System Source Well to the seepage pit had been waived from 150 feet to 120 feet in August of 1986 by th~ D,~par~mer,~. These waivers will be valid as long as the semi-annual inspection reports are properly submitted to the Anchorage Western Public Service Office, no additional bedrooms or connections of other structures to the existing Class C Public Water System are made, and the existing seepage pit can be used. Any future expansion of the subject facility or failure to comply with the requirements of the waivers will require additional approval from this office. PUBLIC WATER The Class C Public Water System was approved for operation on July 28, 1986 by this Department. This approval is still valid. I have enclosed a copy of the Construction and Operation Certificate for Public Water Systems that was issued for the public water system serving the facility located on the referenced lot. "' '" sTATE OF ALASKA .-.._.:.: .i~' DEPARTMENT OF ENVIRONMENTAL CONSERVATI°N ' ' CONSTRUCTION AND oPERATIoN cERTIFICATE - for PUBLIC' WATER SYSTEMS · A; ' APPROVAL TO CONSTRUCT Plans for the co.ruction or modification of La f Z l. ~/'.I~ ~ ~d.,'~q~ / ~ p~b~ water system located in .~/~o~ ~ ' · - ',' Alaska, submitted in accordance with 18 ~C 80.100 conditionally approved (see attached conditions). BY . TITLE DATE If construction h~s not started .:..~r.'. two-years of the approval date, this certificate is void and new plans and specifications must be submitteo iu~ re**b*,w and approval before construction. B. APPROVED CI-IANGE ORDERS Change (contract ~ no. ~r,~,*~'riptive reference) t... //. Approved by Date The "APPROVAL-lO OPERATE" section must be completed and signed by the Department before any water is made availabl~ to the public. water system wa~ completed on ~'/,' //-'f"/~ ~ ~,,,/t (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As-built plans saL~a~itted during the interim approval ,period, or an inspection by the Department, has confirmed the system was c~anstructed according to the approved plans. The system is hereby granted final approval to operate.. BY / TITLE DATE 18-o407(Rev. 11183) DISTRIBUTION.- 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI.BOROUGH (Complete Section C) 4. GOLDENROD ~ MUNI*BOROUGH (Co~ i~lel~Sectlon A) .... " 'N°. 546 r '"" ~'~ / HEALTH DEPARTMENT ",~ / 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279~2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION "7~"~]'' C ;;/ SEPTIC TANK: A D D RESS/,,J6"~''~, PHONE___ DISTANCE PROM WELL GALLONS. MATERIAL ~/~-~L~ / NUMBER OF . COMPARTMENTS INSIDE LENGTH ~'~/~' ~(/J '~'~( >/~'/~/ LIQUID INSIDE WIDTH DEPTH ~ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH .,LENGTH , DEPTH /' (~-~) ·DISTANCE ~.,.,?: EROM WELL I z ~ BU,LD,NO FOUNDAT,ON TOTAL EFFECTIVE ABSORPTION AREA (WALL ARE~)( / ~ SQ. FT. TILE~DRAIN FIELD: DISTANCE FROM WELL .... ~.L NUMBER OF LINES. , FOUNDATION , NEAREST LOT LINE DISTANCE BET~/-~E~L~'-~ ................. .T~RENCH WIDTH ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE. IN. ABOVE TILE ' ~' ~ ',/ DEPTH , BUILDING FOUNDATION ~ SAMPLE WELL: TYPE ;' ~' UC"(/ d~/'Yl~'/'Vz/~/~J"~' -~2~/,f DISTANCE FROM / WATER NEAREST ,, .~, ~,,z SEPTIC --~ ~ SEEPAGE // ,_~() LOT LINE SEWER LINEcp!>~t'//;~ , TANK ,~ ~ , SYSTEM , CESSPOOl , NEAREST OTHER · SOURCES DISTANCES: DIAGRAM OF SYSTEM . :4.: ~ : ,: :' GreATER ANChORagE AREa BO~o~Ugh DEPARTMENT O F ENVIRON MENTAL QUALITY PERMIT NO, ./.~ ~%~ 3500 TUDOR ROaD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 27g-8686 /~/ SEWAGE,DISPOSAL.SYSTEM -- APPLICATION AND PERMIT FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTICTA.KS': E I '--00 TYPE SeEPaGEAREAS,ZEJ/XSIXI 'C'6 ,p?;¢ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ~ ., SEEPAGE Pit , DRAIN FIELD TO NEAREST LOT LINE. · WELLTO SEPTIC TaNK DRAIN FIELD ~""~ ~ /~ WATER MAIN TO SePTiC TANK //~ , SEEPage PIT DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAKE STREAM. SeePage PIt. / ~7~ ALSO CONSIDER AREA WELLS. ., 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. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER 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 DESCRIBE SYSTEM ISIN ACCORDANCE WITH SAID CODE. Da /., ,,. ~_ . ANC}iORA~J~, ALa.;.,A ..... 1 This Form Repo.'ts a~ So~.,~ L,.g.~ Depth ,Soil un~: Was G~ound Water Encountez'ed?~~ , - .-~, Sketch Reading Date Gr os ~:; T i me Depth To H20 Net Drop Test: performed MON CIPAUTY OF ANC,ORAGE 'UN C PAU ^N .ORAOE ENVIRONMENTAL ENGINEERING D V S ON FiOV ~ t978 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow mn H0) davs for processing, I PROPERTY OWNER ~ , PHON ~. MAILINQ ADD~ESS ~ 4, R~LTOR/AGENT PHONE 5. LE,~L DESCRIPTION 6. TYPE OF RESIDENCE ~ One ~ Four ~ SINGLE FAMILY ~ Two ~ Five [] Other 7. WATER SUPPLY [~ INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE~* [] PUBLIC UTILITY **if individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. C __I~H~_-~ & eEOLOGIC, AL LABORATORIF.~ OF ALASKAt INC. P.O. BOX4-1276 ANCHORAGE, ALASKA 99509 4849BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Cdllform Bacteria TELEPHONE (gO7) 279-4014 TO BE COMPLETED BY WATER SUPPLIER Public Water Sy,stem Nacre Marling Address~ ._ City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE NO. 1 2 3 '5 LOCATION [] Treated Water [] Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME ' ADDRESS CITY Date Received Time Received Analytical Method: [] Fermentation Tube /~Membrane Filter Lab Ref. No. Result* Analyst * No. of colonlel 1100 mi; or No. of Polltlve portlo~.. READ INSTRUCTIONS' BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-i220(b) . . ! :BACTERIOLOGICALWATERANALYSIS RECORD Rev. 19~8 ~ '., Date Collected Conflr rnatory 24 Hours Multlpte Tube Report: Membrane Filter: Direct count Verification: LTD Final M em b r a n; F-I~/er (~!Ol~t s/. ~/) Reported By ~~'i~~ lOml Tubes Positive/Total lOml Portions January 2, 1979 R&~I No. 851599 Totem Realty, Inc. 724 E. 15th Avenue Anchorage, Alaska Attention: James Trombley Re: Adequacy Test on Existing Sanitary Sewer System; Lot 2, Block 5~ Heritage Hills Subdivision, Anchorage, Alaska Dear Mr. Trombley: Per your request of November 10, 1978, we conducted a test of the sanitary sewer system on the above described property. The septic tank was pumped prior to the performance of the test on the seepage pit. During the test the liquid level in the seepage pit was measured before and after the addition of 1000 gallons of water. The total depth of the seepage pit was 16 feet. All liquid levels were measured below the top of the standpipe and are shown in the following table: Initial Water Second 24 hour Total Reading Added Reading Reading Drop (gallons) 10' 1000 5.25' 8.9' 3.65' The water level rose 57 inches with the addition of 1000 gallons of water, indicating a capacity of 17.5 gallons per inch. Twenty-four hours later the liquid level was again measured and found to be 8.9 feet. It had dropped 3.65 feet or 43.8 inches. This indicates an average effluent acceptance rate of 768 gallons per day for the surrounding soils. If the 6 bedroom residence on the property is to house 12 people, the average load on the system can be expected to be 720 gallons per day. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 6 bedroom duplex. We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours, R&MCONSULTANTS, INC. Ernest R. Rahaim Staff Geologist Smith Project Manager ANCHORAGE fAIRBANKS JUNEAU VALDEZ WASILLA November 15, 1978 Audrey l~ason % 93otem Realty 7~4 ~amt i5th Avenue ~chorage, Alaska 99501 Subject: t.~t 2 Block 5 ~eritage ~[ills Subdivision Jm~es Trombley Property Approval for your individual sewer and water facilities wi!l not be granted ~nttl the following items have been completed~ (~ The septic tank is ~i}ed with a receipt s~m!tted to this (~ A percolation test be perfo)~med on m ' Stana~ds. A list of private firms who perfo~ th~ test ~ avail- able at this office. (~ The water analysis r~rt delivered to this office from Chem ~b. R64-4720. Sinuerely~ Robert C. Pratt, R.S. Associate Specialist ~ortgag~ Loan Department Post Office Box 4-2090 99509 December 19, 1978 R&M No. 851599 Totem Realty, Inc. 724 E. 15th Ave. Anchorage, Alaska Attention: James Trombley Re: Adequacy Test on Existing Sanitary Sewer System; Lot 2, Block 5, Heritage Hills Subdivision, Anchorage, Alaska. For Professional Services Rendered . Dear Mr. Trombley: The following is our invoice for professional services rendered on the above- referenced project. InVoice No. 851599-1 Professional Services Fixed Fee $155.00 Total Invoice No. 851599-1 $155.00 Please note our invoice number on your remittance. Should you have any questions concerning this invoice, please contact me or the Project Manager, Mr. Gary Smith. Thank you, R&MCONSULTANTS, INC. C. J.~a'risena Anchorage Office Manager CJP/djb/20C-A L ,'JEPARTNEDFF Of ~'~VIROJ,~IEI~D'/~I_ ~UAI..ITY 3500 TUDOR ROAD J~CHORAGE, J]LLASKA ggE07 22g-8ES5 I~SPECT', TIRE: RECUEST FOR APPROVAL OF INDIVIDUAL SB,!ER AND ~,IATER FACILITIES FOR C, SIZE. SEPTIC T~'~ (IF I-DF~,VEDE, SH~'I DIAGR/~I ON BACK) I[.~STA~ ~ FR APPROVAL r,~--r~H?.O-,- FOR P-?.:R ~" ~' ,..~-u,._o, S "' ° /AT~:R FACILITIES PAGE 'P. ~0 ,)E!:PAGL: PIT 1, sIZ,'_'~ ~/'.k o-~' ' C, 2IS~SAL F~E~ / 1, ~UI~u~, OF LI~:~ 2, TOT~ 7, [~E~UIR~ :'~EASUR~ENTS ~, ~'~ELL TO SEPTIC TA~ ::'~ /~ ' B,' ~ELL TO SEEPAGE PIT C, ~?ELL TO ~ D, ~'~ELL TO PROPER~ LI;]E E, '?ELL TO OTflER ~go.~,~ ~- , .,,...~ ~,~.: COUrT. II; JATIOP.~ F, F~['DATIOD~ TO SE~IC FOUNDATION TO SEEPAGE PI~__ SEEPAGE PIT TO PRO~ LINE 8, ,~I~I~'I'BI~ A~PJ:IOP, A(E ,AREA BOROUGH DEPARTNEI'ff OF E~,~IRO~1Et, II'AL eUALITY m;7! ,~^TER gNOiOPd. GE 3REg BOROUGH 327 E^GLE STREET ~NCHORAGE, ALASKA 99501 279-2511 DATE RECEIVED INSPECT: TL'*E. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR 1. Approval Requested Address .~O /~ ¢ 2. Property Owner 3. Legal Description Number of Bedrooms Well Data: C. Size ~ /1 D. Construction E. Bacterial Analysis 6. Sewage Disposal System: Phone A. Septic Tank (If homemade, show diagram on back) 2. 3. 4. ' ~prbva~l Request for Sew~,? ~ Water Facilities Pkge Two Seepage Pit 2. Lining , - Disposal Field 1. Number of Lines 2. Total Length Required Measurements A. Well to Septic Tank , ,~ B. lqell to Seepage Pit ...... C. Well to Sewer Line D. Well to Property Line E. t~ell to Other Possible Contamination F. Foundation to Septic Tank G. Foundation to Seepage Pit H. Seepage Pit to Property Line APPROVAL VALID FOR ONE YEAR FRO~ DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPPaRT~ENT EDll70 ~o- /INDIVIDUAL SEWAGE AND WATER FACILITIES / (Fill out in Tz*iplicate) ,~g' ..... _ /~ama .of person request~g approval , ~// ...... 5. Natelx~ysis. "' ~ c. Casing Size d. Distance f~om well to closest existing o~ proposed: 2 Sep,ic tank ~ . 3 Seepage Area · , ..... . Cesspool~ '- -- · Property Line ~O~. Other sources of possible contamination, i.e., creeks, lakes, houses~ barn~ drainage ditch, etc. ,. .. Sewage disposal system. a. Age of system, ,,IV/~r.~~ . b. Septic tank capacity in gallons do' /1'~,. , :: ~ : , ' , ..... - _. 1. If "home made" show diaFi~am on reverse side of this form. Disposal field or seepaf, e pit size and type, ,-.;~/j,. ~¢., . _ : _ - .......... "J" _, :% / / / / ~ to house fo~dation~ ¢ X~ 1. Distance p~ope~y &ine ,, .... ~ '% e. PercoXatio~ Te~t ~re.su~ts . f. Percolation Test performed by , Use the revemse.side of this form to s~ow diagram. Diagram should include ~he following information: ~moperty llnes~.we!l location, house location, ~m~ptzc tank location, dzsposal area location, location of percolation test~ an~ direction of ground slope. 9. The [~ommation on this form is true and correct to the best of my knowledge. Signature of Applicant Date Sig'n~d T,O, BE,,?I,L,,LE, D OUT BY HE,ALTH, D, EPARTUENT PERSONNEL ~e above described uanitary facilities are hereby approved, subject .t.o. ,t. he ~$'~,t~owin~ cond~'ions: Conditions: The above described sanitary facilities are disepproved for the following reasons: .Approval is valid for one year following the date of approval. CPJ:cw FHA Forms 2573 ~/ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT~',~..,/'~ FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Form Approved Budget Bureau Na. 63-R296.$ PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE MORTGAGOR OR SPONSOR I/. ,..'il TOTAL NI~IMBER: LIVING UNITS BEDROOMS SAmS [] BASEMENT Yes [--] No PROPERTY ADDRESS New installation WATER SUPPLY BY: [] Public system 1--] Community system SEWAGB DISPOSAL BYt [] Public system [~ Community system SERIAL NO. J BLOCK NO. J LOT NO. Can attic or other area be made into additional bedrooms? (If Yes, how many~) · NO. OF SYSTEM DESIGNED FOR ] Individual SDRMS. O~OE DISPOSAL PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the ~ State [-'] County [--] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestid water supply for the subject property. It is the opinion of the [~ State ~1 County tern with proper maintenance: [--] Can be expected to function satisfactorily, and is not likely to create an insanitary condition [] Local Department of Health that this individual sewage-disposal sys- [~ Cannot be expected to function satisfactorily DATE JSIGNATURE JTITLE ~ I NOTE: The health authority rhould, complete the appropriate opinion statement above and affix date, signature and title in the spaces provided. Use of the above grid 'for Health Department Inspector's sketch as well as use of the back of this form is at the option of the health.authority. PART III.mFOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [-'] Acceptable ~] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT r --1 DEPUTYFOR CHIEF ARCHITECT FHA Form 2S73 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. Distance from well,__.feet. Material, Total liquid capacity, gallons. Capacity inlet comparm=ent, Inside length, feet. Inside width, feet. Liquid depth, Cesspool: Number of compartments feet. __ gallons. Distance from: Well, feet; fi)undation, fret; nearest lot line at [] front, [] side, [] rear, Inside diameter, feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from: Well, Total length of tile lines, Trench width Length of each line feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Number of lines,__ Distance between lines, inches. Total effective absorption area in bottom of trenches feet. Depth, top of tile to finish grade, Type of filter material: [] Gravel. [] Broken stone. Other__ Depth of filter material beneath tile,~ inches. Depth of filter material over tile, S~p~ge Pits: Number of pits .... Outside diameter, feet. Depth, Distance from: Well, feet; building foundation, Iflsp~ctlon mode by: [] State. feet. feet. square feet. inches. Date of inspection. inches. feet. feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by- 19_ (TITLE) REPORT OF INSPECTION~INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main feet. Size of main, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide, __feet deep. Dwelling set back from front property line,, feet. Individual water supply t¥om: [] Drilled well. [] l)riven well. [] Dug well. [] Bored well. Distance of well from: Building foundation, cast iron sewer,, feet; tile sewer, seepage pit,_ .feet; cesspool, Well construction: Diameter, inches. Total depth, feet. Type of casing, Approximate depth to pumping level of water in well, feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe, __ feet. Pump capacity, la)cared in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity,. gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Local Health Authority. Inspected by Date of inspection 19__ feet; nearest lot line at [] front, [] side, [] rear,. fbet; septic tank,. -feet; disposal field, feet; other sources of possible pollution, .}-eet. Depth of casing, .gallons per minute. __gallons per minute. (TITLE) feet; .feet. GPO 878 471 06-1220(a) R?v. 1973 DATE ALA~ DEPARTMENT OF HEALTH AND SOCIAL SF CES r ~' DIVISION OF PUBLIC HEALTH ~-~' Lob No. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS oF.cE INDIVIDUAL [] SEMI-PUBLIC [] CHLORINE RESIDUAL RPM REPORT RESULTS TO ' NAME ADDRESS CITY ' ADDRESS OF SOURCE ZIP CODE : : Analysis shows this Water SAMPLE to be: E] Satisfactory [] Unsatisfactory [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED Sample Collected From [] Other (List) Well- [] Dug [] Driven [] Drilled SOURCE: [] Spring [] Cistern [] Olher. Dug Well or Cistern Conslructlon: Walls--[] Wood [] Concrete [] Metal Top -- [] Wood [] Concrete [] Metal LOCATION: [] In Basement [] Basement Offset []ln Yard [] Other Building Sewer DISTANCE TO: or Olher Dra[nage Pipe Feet. Tile Seepage Field- Feet. Pit--- Other Possible Sources of Contamination -- TIME COLLECTED [] Kitchen Tap ~athroQm Tap Feet. Pool MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] PlasHc Joint Malerlal - Type GENERAL: Does Water Become Muddy or Discolored? When? Diameter of Well Depth []Basement Tgp READ INSTRUCTIONS [] Fibre [] Asbestos [] Yes [] No Feet. Well Casing Material Diameler Depth . Length of Water Deplh From Bottom Feet. Drop Pipe Offset in In Ulilily PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of Supply? [] Yes [] No Repairs to System? ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] No · : [] Yes [] No Signature _-- 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Lactose Broth ' ;i: 10cc 1acc 10cc 10cc 10cc 1.0cc T.0cc 24 Hours 48 Hours ..... - Brilliant Green 24 Hours 48 Hours EMB AGAR Laclose Broth, 24 hrs, 48 hrs._ Gram's stain Coliform Density _ (Most probable No. per 100cc) MF Results Reported by : '! This analysts indicates Coliform Organisms fo be: Date :' p~m. : Absent [] Bored [] Tile Brick or [] Open Top [] Concrete [] Under Ho'use DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION Read Carefully ~nd Follow Instrections Exactly Bear in mind that water analysis deals with materials present itl very rninute quantities. The least care- lessness in collecting and handling may give rise to results which are misleading. Samples are accepted at the regional laboratories in tile early part of the week (Monday-Wednesday) unless there is em ernergency or prior arrangements have been made. Arrangements should be made to have the water samples reach the laboratory as quickly as possible and within 48 ho~rs after collection. After 48 hours, the significance of the bacteriological analysis is impaired. In collecting samples from TAPS or PIJMPS proceed as follows: (a) Thoroughly flush tap or pump by allowing water to run freely for five minutes. (b) Shut off water and flame the outlet with torch or burning paper. The flame should not be merely passed over the outiet but should be applied untii fixture shows h~dlcat[on of being hot. Flame should be directed against inside edge. (c) ()pen fixture so that a small stream flows. (d) Remove bottle from mailing tube. Hold b.'~ttle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving foil protecting cover in place. Fill the bottle to the shoulder. Replace cap with fei[ cover, screwing firmly into place but do not apply pres- st~re which will spill cap. (e) Pack bottle carefully in mailing tube enclosing this completed information sheet. DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD HYDRANTS, DRINKING FOUNTAINS OR SIMILAR OUTLETS WHICH ARE DIFFICULT TO DISINFECT PROPERLY. STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM: Dept. o~ ttectlth & Social Services Southeastern Regional Sanitarian Poud~ J Juneau, Alaska 99801 Dept. of Health & Serial Services Soufhcentra[ Reglonal Sanitarian 338 Denall Street, MacKay Bldg. Anchorage, Alaska 9~501 Dept. of Health &Sodal Services Northern Regbnal SanifarZa~ ~04 Barnette Slreet Fairbanks, Alaska 99701 Or D~shkt Offices in Fairbanks, Juneau, Ketchikan~ Kodiak, Nome, Palm~r, Soklotna and Valdez. Consult Iaea[ telephone directory for ~anltatbn offices located ~n these communities. Anchorc~ge area~contact Greater Anchorage Are~ Borough Department of ~nvJron- mental Quality.