The URL can be used to link to this page

Home My WebLink AboutBROWNS RESUB LT 37(PLAT P-498) LT 1 T13N R3W SEC 22 GRE :ER ANCHORAGE AREA BO' UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS 17 ~-' ~ ~/~7~ LEGAL DESCRIPTION . PHONEZ- 7 ~ -- Z<::2 ~ SEPTIC TANK: DISTANCE C.[f7 FROM WELL- INSIDE LENGTH MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE WIDTH . LIQUID DEPTH_ LIQUID CAPACITY/~) O ~) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER LINING MATERIAL~ CRIB SIZE: OR W,DTH/' , DIAMETER BUILDING FOUNDATION J ~-, NEAREST LOT LINE ADDITIONAL ABSORPTION LENGTH ~~, DEPTH //--~ DEPTH ~-~ ~ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)~¢/~f.c~r SQ. FT. WELL: TYPEC/-~7 ~)(~/~ CONSTRUCTION BUILDING NEAREST FOUNDATION __ , LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE , TANK , SYSTEM REMARKS DISTANCES: PIPE MATERIAL: (~ // C~ez/-i~O)~ LOT SLOPE: REMARKS: Form No. EQ~031 DIAGRAM OF SYSTEM DATE .// ' / - ?~ APPROV ED('~(~A.B. - . GReaTEr ANChOraGe ArEa BONOUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, INSTALLATION LOCATION ~"--~_ , E GAL D E SC R, PT,ON INSTALLATION OF: SEPTIC TANK : , ~GE PIT ~ FIELD FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS OTHER - NOTE; THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION 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. . ~ TYPE' MINIMUM ~DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ? ( ; DRAIN FIELD / SEPTIC TANK TO SEEPAGE PIT WALL / ~ SEPTIC TANK ,. SEEPAGE PiT ,'~X~ ~V,6q t~F LD WELL TO SEPTIC TANK ~ , SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK / ~',' ~' SEEPAGE PIT f~ ~'' , DRAIN FIELD //~' TO RIVER, LAKE, STREAM, C~ST 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. OR I~ICENSED DESIGNER DIAGRAM OF SYSTEM L I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE . FORM NO. E~-O~ 6 GRE,.,ER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case NOV AB Performed For J & J Excavating Dated Per~A~O~D~%~om%0~u1973 Legal Oescript.ion. Lot 1 B,lock 37 'Subdivision rc n S t~esuDa:LV:LS:LOn · , B~; ~ ~mON~ ~U~TT ~ This Form Reports Soils Log xx Percolation Test - Soil Test Mus~ Be Logged To 4' Below Proposed Seepage System - Depth Soil CharacteristilCs. Gray Sandy Gravel (GW) Was Ground Water F~ncountered? If Yes, At What Depth? Feet 6~ 81--- 18~ Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute '?' Proposed Installation: Seepage Pit xx Drain' Field , Depth of Inlet. . Depth' 'to Bottom""Of Pit .or Trench' '"' " COMMENTS: 85 sq'. ft. of drainage area is required per bedroom,' The excavated .~.materia~ .can be used for backfill. Test Performed BY ..... g; ~'~-Carlisle............... i .... Date Certified BY: ~LASKA MINERAL & MATERIALS LAB Date: ' ' ' ' I~A'iE R/E'CEIVED ' - INSPECTI?N APPOINTMENTS '" TIM'E ' ' ' i TIME //' ] ' TIME DATE ' DATE .~ (/ . DATE [ i iNSPECTOR INSPECTOR S CTOR MUNICIPALITY OF ANCHORAGE ........ LIW OF AUCHORAGE 82B L Street - Ancherage, Alaska 99501 ~" ~EN~AL pRO~E~ION ENVIRON ENVIRONMENTAL SANITATION DIVISION NO~ 2 ~ 1981 Telephone 264~720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ~105~ E D DIRECTIONS: Complete all parts on page 1, Incomplete requ~ will not be proc~d. Please allow ten (10) days for processing. . 1.' PROPERTY OWNER ' · ' I PHONE ' I MAILING ADDRESS - ' .... PROPERTY RESIDENT (If different ~rom abo~e) ..... PHONE Z aUYER '- ~ ' PhON~ ' '.' MAILING ADDRESS F.C, , ,, , . 3. LEN~B~G INSTITUTION- ' I PHONE MAI LING ADDRESS , _ 4, REALTOR/AG MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF'RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY ,,~ PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER 'OF~BEDROOMS [] One [] Four [] Other ~ Two [] Five Three [] Six * ATTACH WELL LOG, A well log is required for all wells drilled since June 1975, For wells drilled prior {o that date, give well depth (attach log if available.). , YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1. TYPE OF RESIDENCE 7-1. SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SI.TE i--I PUBLIC UTILITY t~ Connection Verified ~ []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AR EA 4. DISTANCES WELL TO: Absorption Area to near'est Lot Line THISSIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS , [] THREE [] FIVE [] OTHER [] FOUR [] SIX [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 'PERMIT NUMBER ' ' INSTALLER SOl LS RATING MANUFACTURER MATERIAL 'Sel~tic/Holding Tank IAbsorption Area ISewer Line INearest Lot Line 5. COMMENTS [] APPROVED FOR , BEDROOMS [] cONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED_ BY 72-010 (Rev. 6/79) December lO, 1981 Gayle Libbey P.O. Box 1058 Anchorage, AK Subject: Lot t, Browns Resub of I~t 37 5040 E. 24th Dear Ms. Libbey: Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The septic tank pumped with a receipt submitted to this department. The total number of gallons pumped needs to be on the receipt and verified by a registered engineer as to the actual number of gallons pumped. This is to verify the size of the septic tank. Locate and expose the standpipe to the seepage pit for our inspection. This is to insure the minimum distance requirements are met between the well and sewer system. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Plemse notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist Enclosure ALASKA eFIUIROFImeFITAL COFITROL SeRUICe$, IFIC. I~n§ineerin§ ~, I~nuironmental Studies 12/11/81 GAILE LIBBEY 420 B FISH,RES STREET ANCHORAGE AK 99502 SRLT.RR - JIM ~ROWN BUYER-GAILE LIBBEY SUBDIVISION-BROWNS RESUB BLOCK-LOT 1 LOT-OF 37 ADEQUACY TEST FOR S~_A SYSTEM THE TYPE OF ABSORPTION SYSTSM IS A PIT WITH AN UNKNOWN AREA. THE SYST~ IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYST~4 IS 735 GALLONS. BAS~I) UPON THE TEST DATA THE SYST~4 IS ACCEPTABLE FOR A 3 BEDROC~ HOME. THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1000 1220 JJUest 25th Auenue · Anchora§e, Alaska 99503 · {907) 276-1361 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions)., Property owner ~--~/,le ~ ,,~,~_~3Y~L~¢ Day phone Mailing address II ol ~fb~ A~~e; A~ ~o~ Lending agency Se~/~ ~r~ Day phone Mailing address ~ ~ ~ Y ~~ hnc~r~/ ~ ~0~ Agent N. A. ( R~ ~i~o~c~) Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ",4 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. I,,"" % TYPE OF WASTEWATER DISPOSAL: "Individual on-sitb ' Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER 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 application 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 ~' f~z (--fo/, "F~,c4~,¢cd' -~¢r'c,'~c,~' Phone ~ ~'..5-- I 3' ¢.5- Address I Y 5' 3 ~ ~c[,,o ~'¢'7 A ,~¢ /,,,~,"¢,.~.¢,, AK ? :~.¢¢ ¢' Engineer's signature ,¢r~-/.,~ ~. ~,~,,/_~_~_ Date 'A./t¢ / ? 2_. 6. DHHS SIGNATURE Approved for '~'4¢4~- ~'.3_) Disapproved. Conditional approval fOr bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-.o~'.~; Br~'£ Parcel I.D. 00~ -- ~9~ ~Z--o ~ A. WELL DATA Well type Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: g.p.m. g.p.m. 1.1-! Septic/holding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank m WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed II / [ ! 7.3 Cleanouts (Y/N) ~' High water alarm (Y/N) Nitrate Collected by: Other bacteria Tank size (ooo ~,~( Compartments Foundation cleanout (Y/N) t~ Depression (Y/N) N./~-, Alarm tested .(Y/N) ~. A, Date of pumping ~/' (5" ! ? ( Pumper ~-~c~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N, A. TO property line (O ~ Surface water/drainage On adjacent lots Absorption field Foundation ~o, Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA II / ~ ! 7.7 Date installed ii { Length .1 ~ Width t Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) No,~_ Soil rating ~' Gravel thickness Cleanouts present (Y/N) Date of adequacy test for ~--'~ ~,,.~,~ o/ If yes, give date System type 5'~, Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /N, ~. To building foundation On adjacent lots '~ .? c, Surface water ~ too Curtain drain None On adjacent lots ~> ~oc~ ' Property line i 8 ~ To existing or abandoned system on lot tV. ,4. Cutbank /',(, A. Water main/service line Driveway, parking/vehicle storage area 5' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect gn the date of this inspection. Engineer's Name '7"/4~-o ~ ~ /'-~o~,,'~ Date ~-./~l I~) ~- HAA Fee $ / 7/~) ~"-' Date of Payment ~ '"~'/"-' ~--- Receipt Number ,,~,~ ~'._/~ Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21