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Home My WebLink AboutSTOCKHAUSEN LT 50£1 ANCHORAGE AREA BOP IJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER/./ ///,;~ / (:/-f '/MATERIAL -,;¢~/,'/ COMPARTMENTS_ / · ___LIQUID CAPACITY /; ' 2o.c GALLONS. INSIDE WIDTH LIQUID DEPTH SEEPAGE Pit: NUMBER OF PITS / . DIAMETER OR WIDTH ,:,, LENGTH~ ~<2, DEPTH LINING MATERIAL/,-~-~, -/, CRIB SIZE: DIAMETER ~--,,-'::,"~ /¢ /~'/'-' ' - TOTAL EFFECTIVE . '.. , :' - '/' SQ. FT. BUILDING FOUNDATION ,7.> , NEAREST LOT LINE .:<d-' ABSORPTION AREA (WALL AREA)_ ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION -- iCESSPOOb - APPROVED CONSTRUCTION. NEAREST NEAREST LOT LINE SEWER LINE_ OTHER SOURCES DISAPPROVED REMARKS DEPTH_ DISTANCE FROM: SEEPAGE SEPTIC 7/].~ i TANK - . . SYSTEM DIAGRAM OF SYSTE~ GrE:aTe:r ANCHORAGE: ARE:A BorOugh DEPARTMENT OF ENVIRONMENTAL QUALITY 3350 "C" STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, TYPE TO NEAREST LOT LINE. DIAGRAM OF SYSTEM ~TIFY THAT [AM lAM[LIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGh ORDINANCE NO. 28-68 AND THAT THe ABOVE ~ '' ' APPLICANT'S; SIGNATURE OAAB HD I G~'E~TER ANCHORAGE AREA BOROUGH " HEALTH DEPARTMENT ' ~ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MAILING ADDRESS5? LEGAL DESCRIPTION ~'~' DISTANCE FROM WELL LIQUID CAPACITY MATERIAL NUMBER OF COMPARTMENTS GALLONS. INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH___ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE OUTSIDE DIAMETER OR WIDTH /~1~ , LENGTH / ~" , DEPTH DISTANCE FROM WELL //'~"~"' BUILDING FOUNDATION 1OTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /~L~- SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ....B6Hz~AT-Ti~TxJ~ NUMBER OF LINES t ~,*-'~" DISTANCE BETWEEN N ABSORPTION AREA , NEAREST LOT LINE TOTAL LENGTH · OF LINES = T~.,E~N.C~IJ WI[~H IN. TOTAL EFFECTIVE .SQ. FI. LENGTH OF EACH LINE __ ' DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILL IN. ABOVE TILE WELL: TYPE."~ "~ ~" ~ t/~/'~ DEPTH NEAREST LOT LINE , SEWER LINE DISTANCE FROM ~/ . WATER · BUILDING FOUNDATION SAMPLE. , NEAREST SEPTIC ~:~° SEEPAGE / ~..~ ! OTHER · SOURCES · TANK . SYSTEM CESSPOOL DISTANCES: DATE DIAGRAM OF SYSTEM 1 GAAB-HD-2 i ROUGH GREATE ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. -- RESIDENCE ADDRESS h?/, ?-~// ~/~,~ APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~ v~ ¢~¢ PERCOLATION TEST RESULTS MAILING ADDRESS-q?-; ?.,~?~,,?~/<e.x//~.~. PHONE NO. LOCATION OF INSTALLATI9~ ~, ~.~;/F~, ~, ,SEEPAGE PIT_ ~, DRAIN FIELD TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT OTHER //- ~-? THIS IS TO SERVE AS ,PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .. SEPTIC TANK SIZE. DISTANCES: Health Authority .TYPE SEEPAGE AREA DIAGRAM OF SYSTEM TYPE I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE /~.--/0'---~ ~ APPLICANTS SIGNATU n E~7 (/ ~rmed For ~escription: ~orm Re~orts ~eoth Feet Soil Characteristics Paul Wood~ Date PJrformed , 5-8-73 "' lot ~ glock Subdivision S¢oekhaus~n Soils Lop yes Percolation Test ~.' Overburden - Sandy Gravel -GW , (varies in depth thruout pit area) --' Silty Sandy Gravel GM-22~ __. bottom of Was Ground Water Encountered? NO ~?o~ IF Yes, At what Depth? Readinq. Date Grnss Time Net Time Depth to H20 i Net Droo I' ::i.;:Pe~colation Rate Uinute Proposed Installation: Seenaoe Pit Drain Field yes Depth To Bottom Of Pit Or Trench -9 lb. Deo~h of Inlet -4 ft. yes }::,i~MENTS. 180 sq~ ft. drainage area required per bedroom- based O~ ~,~, ~ Lab Manage Date: ~ ~ f3 · 3. 4. 5. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received AugUSt 20, 1973 Time of Inspection 3:30 p.m. Date of Inspection August 20, 1973,, REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WAI'ER FACILITIES FOR CMRO Aoproval Requested ~y: Paul Woodrum Address~ SR Box 1120 Chugiak AK 99567 Prooerty Owner: SC Legal Description: ..Lot 5~ Stockhausen SubdivisioD Location: Peter's Creek Type of Facility to be Inspected:_~Dup]ex Phone: Phonet Number of Bedrooms: Four,(4) Well Data: A. Type Drilled B. Depth 86' C. Construction Standard D. Bacterial Analysis 7. Sewage Disposal System~ Satisfactory A. Installed Oct 13~ 1969 __ 8. Installer Ed Tuck C. Septic Tank: 1. Size ]000 Gals 2. Manufacturer Wallace D. Seepage Pit: 1. Size ]8'X]8' 2. Material Log q. Disposal Field: Total Length of Lines Distances: A, 9Jel! Tot Septic Tank 60' . Nearest Lot Line Bo Foundation to Septic Tank ~7'__ , Absorption Area ]25' . Sewer Lines , Other Contamination "> Absorption Area 60' C, Absorotion Area to Nearest Lot Line Request fo~ Approval of Individual Sewer &.Water Faotlitius Page T~o 9. Comments: ~' Approval Valid for One Year From Date SiGned Greater Anchorage Area Borough, Department of Environmental Quality DIAGRA~ OF SYSTEE I certify that the information contained in this reguest for approval to be a true and accurate representation of the subiect sewer and w~ter facilities located at: Signed Date REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) a. Bacte~is_l b. Detergent Well data: a. Type Casing Size. Distance~ from well to c osest existing 1. Sewer line ,., 2. Septic tank 3. Seepafe Area 4. Cesspool~. - Property Line . Other sources of poss~le contamination, i.e., creeks, lakes, houses~ barn~ drainage ditch, etc. Sewa8~ disposal system. a. A eo ys em bo Septic tank capacity in gallons c. Name of septic tank manufactu, m~ 1. If "home made" show diagram on reverse side of this form. 1. Distance to properi~y. 3_ine to house fo~da~ion e. Percolati~ T~st ~results f. Percolation Test performed by , ,, · Use the reverse .side of this form to show diagram, Diagram should include .~he foilowlng info~mation: property lines;.welt location, house location, '~t~ptlc tank location, dlsposa~ area location, 10ca~ion of percolation test~ a~,.direction of ground slope, The ~orma%ion on this form is true and correct to the best of my knowledge. Signazure of Applicant Date Signed TO BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL ~--~e above described sanitary facilities are hereby approved, subje, c~ ,to the .......... ~owing conditions: Conditions: ./~~ The above described sanitary facilities are disapproved for the following reasons: Sign~k~/Joff,~ff"~f&~ ,3 '-',.' . Date :z," "~! .'.J" .~plyr. oval CPJ:cw is valid for one year following the date of approval. ADHW - LA~ - 2W BATE NAME CITY STATE OF ALASKA -"'~. D~"\RTMENT OF HEALTH AND WEI 'RE Lo~. No DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL:WATER ANALYSIS OFFICE I~ecords in this office indicate Ihis WATER SUPPLY fo be [] Saf~sfadory EJ Quesllonnble [] UnsoBsfactory Sanitary Sfalos. SAMPLE COLLECTED BY Analysis shows Ibis Wafer SAMPLE to be: Satisfactory E~ Questionable [] Unsdf;sfactory. TIME COLLECTED ~'~ : ~C s,:/ P~ DATE COLLECTED Sample Colle¢led From If an "Unsatisfactory" or "Queslionable" stalus is indlcoled above you snould tare immediate acflon as recommended below. 1. Notify consumers wmer is aolluled. Boll or chemically treat this waler as outllned in the enclosed leaflet "Drink It Pure." 2. Increase chlorinaBon suUi~ienlly 1o meet recommended residual stonc~ards. Determine source of contaminalion and take delian necessary 1o maintain a safe water supply al all times, 3. Check ~hlorJn611~n' and other mechanical, eauiament. Make cerlain it is 'unclloning p?o perly, Division of Public Health, sanitation of Bce for bulletins consuRalion and assistance, ;ANITARIAN'S REMARKS BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Date Received 0 N Lactose Broth 24 hours 48 hours REVERSE SIDE Brilliant Green 24 hours BEFORE 48 hou,~ EMB COLLECTING SAMPLE ta~,os, Bro*h. 2~ ~r, Coliform Density Received - - Lab. No AGAR / ,q3 2: -II .(Most probable No. per IOOcc.] pr-esOt ADHW- LAB 2W DATE STATE OF ALASKA ~ r~ARTMENT OF HEALTH AND WE, \RE DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Lab. No. OFFICE NAME ADDRESS CITY SAMPLE COLLECTED BY DATE COLLECTED Saml~le Collected From Kitchen Tap am D[ameler of Well. Oeplh Well Casing Malerlal D~ometer Depth Length al Woler Deplh Drop Pipe From Bottom Records in Ih[s office indicate this WATER SUPPLY to be of: Analysis shows this Water SAMPLE to be: Satisfactory ~ Questionable ~] Unsatisfactory. SANITARIAN'S REMARKS In Utility [] READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received ' ' :Time Received ~ pn~: Lab. Lactose Broth 1Otc IOcc 1Otc 1Oct I 10¢c 1.0cc 0.1cc I 24 hours EM8 AGAR L.ctose Broth, 24 hrs. 48 hrs. .Groin's slain Coliform Density {Mod probable No. per IOOcc.) a. Bac%e~is ], b. Detergent_ "' W~] 1 data: a. 'i'ype~ b. Deptb~ k5 / '. c. Casing Size~ fLz Distance from ~e].l to ,,closest existing or prop~.S~e~ 3. Seepage Area 4. Cesspooll_ .~ ,5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes houses, barn, drainage ditch, etc. ~-- Sewage disposal system. b. c0 Septic tank capacity in gallons Name of septic tank manufactu~e~ 1. If "home made" show diagram on reverse ~ide of this form. d.' Disposal field or seepage pit size and t~e - 1, Distance to p~per~y- ~ne to house fotmdation -e, PercoLatlo~ Test b~eauftts .>~ f. Percolation Test performed by .. "~. Use the reverse .side of this form to show diagram. Diagram should include · ~ ~-%he fo~lowlng~ ' ~nformation: p?operty lines~.well location, house location, ~i, tic tank location, disposal area location~ location of percolation test~ a~. direction of ground slope. 9. The i,~o-~.~on .on this form is true and correct to the best of my knowledge. Signature 'of Applicant Date Signed T_O~BE_~FILLED OUT BY HEALTH DEPAET~.~ENT PERSOHNEL Tho~ above descrmbed' sanitary facilities are hereby approved, subject to the r. ol3~ow~ng con~iions.' · ' Conditions: The above described sanitary facilities are disspproved for the following /~ignature· ~--Date ,~r~.,. Approval is valid for one year following the date of approval. CPJ:cw I~HA Form 2S73 -," HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM, PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE Spokanr, I{o~tgage Oomp~n7 MORTGAGOR OR SPONSOR pROPERTY ADDRESS SUBDIVISION NAME BLOCK NO. LOT NO. TOTAL NUMBER~ 2 4 ~ WATER SUPPLY DY~ F-] Public system BASEMENT J--J Yes [] No [~ Community system '-]New installation 5 Can attic or other area be mede Into additional bedrooms? ~lf Yes, how monyt) 'SYSTEM DESIGNED FOR [] Individual ~ Yes o SEWAGE DISPOSAL BYt [~] Public system --]Community system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT · IEALTH DEPA'RTMENT 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 domestic water supply for the subject property. It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition NOTE: The health authority shei'qd, complete the a~zproprlate'epinlon statement ~b0ve and -,f~X date, signature end title in the Use of the obove grid 'for Health Department Inspector's sketch as well os use of the back of this form is at the option of the PART III.~FOR 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 [] N~cceptable Sewage disposal be considered [] Acceptable [] Not Acceptable/.. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT ]DEPUTY FOR CHIEF ARCHITECT FHA Form 257,~ Rev. July 1958