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Home My WebLink AboutLAZY ACRES LT 6 GR~ ,R ANCHORAGE AREA BOROU DEI'ARTMENT OF ENVIRONN1ENTAL QUALn ~. 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCAT SEPTIC TANK: MAILING -- ,~. -- ADDRESS_.:~--~.~'''~'-<?-'" ~'~'~,/4/,,z-:'(,'~,0¢'~' ~'~..~¢'~-~-~'-?" PHONE LEGAL DESCRIPTION~_~ ~;~ ~~ DISTANCE FROM WELL LIQUID CAPACITY ./~_)~2~Y .... GALLONS. NUMBER OE MATERIAL ¢."~ ,ZA'...'t ~ .d~'~z~'rT''~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER LINING MATERIAL ~ ~-'¢ ~,"""'~-~ ~. NEAREST LOT LINE · DISTANCE FROM WELL ¢'2"/~',,.,¢'47.,..~, /J~_z~ ..¢)__ BUILDING FOUNDATION¢'-'?zp ~, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)_ -'-¢? c--~:'¢~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELt FOUNDATION DISTANCE BEIWEE [l~S SQ. FI. LENGTH OF EAC~N E , NEAREST LOT LINE___ TRENCH WIDTH TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE___ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: TYPE ~'~z:~,,~:"~:~/-"'.,;~ , DEPTH NEAREST SEPTIC LOT LINE ~ , SEWER LINE ~ ,TANK DISTANCE FROM , BUILDING FOUNDATION.__/C:&~_~_ SEEPAGE ~-/ , SYSTEM WATER _SAMPLE ~ NEAREST OTHER , CESSPOOL ~ , SOURCES~ DIAGRAM 01: SYSTEM DISTANCES: DATE GREATEI NCHORAGE AREA .r- ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. ,,~ NAME OF APPLICANT . RESIDENCE ADDRESS LEGAL DESCRIPTION. APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH (-~(:~ ~( / PERCOLATION TEST RESULTS LOCATION OF INSTALLATION , DRAIN FIELD __,OTHER. TO BE INSTALLED BY_ - ~ / ?'~: /f'"~ ANTICIPATED DATE OF COMPLETION. ':-?C/,'J'~ /' BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBE[] BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE ((.~(.)() TYPE (' (::I¥](:'U"/-SEEPAGE AREA .TYPE DIAGRAM OF SYSTEM LICENSED DESIGNER I ce:rtify 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. '/ APPLICANTS SIGNATURE //?' ; . DATE i ( .:, . ..... : ~ ..... ,' , .-.~ : --_ ,,.. GENERAL INFORIViATION (a) (b) (c) MUNICIPALITY OF ANCHORAGE I::)EPARTMENT 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 ____'~--~./~L/~ 0r'''l Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) g',z -o ";'Po y Applicant Name ~'~_~_ ~t~F~'~:~./'~¢~/ Telephone: Home ,-~*/'/~, ,5/,~.~ __ Business Applicant Address ~ ¢'?..~ O ,~r~¢ ~_~ Applicant is (check one): Lending Institution []; Owner/bu~JerJ~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Companyand Agent _ Ef;~./~ 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. 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 I of 2 72-025 01/84) ENGINEERING FIRIVI PROVIDING 11'~.SPECTIONS, TESTS, FILE SEARCH, DATA ~ND INFORMATION "" As certified by my seal affixed hereto and as of the validation date shown 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 and type of structure indicated herein. I further verify tbat 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 o, this ,nspecti~ ~ 7~_ ~ ~ ~ / ~. Address ~ ~ Engineer's Seal DHEP APPROVAL ? ,..../ Approved for ~2'~-~g bedrooms b~") ~4~L..-~L~ ~/-~-/~Date Approved ~~__ Disapprove~ Conditiona.~ 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 Jn 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 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 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 WELL DATA Well Classification -/~/34/C ~"~7~'/~ .MUNICIPALII'Y OF ANCHORAG2 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ":1986 LegalDescriptionI ~/'~' /----.~,¢v' 1,7 q . EIVED Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground 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 IJne Cleanout/Manhole Water Sample Collected by Water Sample Test Results Commenls If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Deptll of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ?/7/ Standpipes (Y/N) y / Depression over Tank (Y/N) ,,,~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) //FA . Separation Distances from Septic/Holding Tank: To Water-Supply Well P~./¢~'~' To Property Line ' 3// ' To Water Main/Service Line Course Comments Size /_f"7'~_ NO. of Compartments ~ Air-tight Caps (Y/N) __y Foundation Clean.out(Y/N) Date Last Pumped_ "~/-~//~ ,/~ , ; for , ,~/X, Temporary Holding Tank Permit (Y/N) To Building Foundation _ ~'""~d/ To Disposal Field __~?~ ! To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9/7/ Width of Field / /~.,~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Ab_sorption Field: To Water-Supply Well /'~///~/ /r:....~¢/'/~'~2¢~ .... To Building Foundation ,ot / To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Length of Field /~, ' K Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Y - Date of Last Adequacy Test Type of System Design Comments To Property Line 2J~'~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed ,~_~.~F 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, verifieC,~or conformed to ail,MOA and HAA guidelines in effect on Signed '~-~-'. ~ Date '7'/.2'""//~~ the date of this inspection,. MOA No. Company ? Receipt No, Date of Payment Amount: $ Page 2 of 2 72-026 (11184) Engineer's Seal 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-391 ~, SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: SEPTIC SYSTEM: LOT 6, LACY ACRES 8280 POKEY DENNIS GWALTNEY SINGLE FAMILY, THREE BEDROOMS DATE OF PUMPING: FROM MUNICIPAL RECORDS: TANK: ESPINOTA CONCRETE, 1000 GAL, 2 COMP. ABSORPTION SYSTEM: LOG CRIB ABSORPTION AREA: 288 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: SEPTEMBER 1971 JULY 21, 1986 DATE OF TEST: JULY 14, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FIVE FEET OF COVER. LIQUID DEPTH WAS 37 INCHES. HEAVY CONCENTRATION OF SLUDGE. CRIB WAS NINE FEET DEEP AND DRY. 410 GALLONS OF WATER WAS ADDED TO THE CRIB. NO WATER WAS OBSERVED TO BE RETAINED. 300 GALLONS WAS THEN ADDED TO TANK. THIS CAUSED THE LIQUID LEVEL IN THE TANK TO RISE 8 INCHES. WITHIN 15 MINUTES THE LEVEL DROPPED 5 INCHES NO WATER SHOWED UP IN THE CRIB. ' TEST RESULT: THIS SYSTEM MEETS THE OPERATIONAL REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State.