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Home My WebLink AboutT15N R1W SEC 30 LT 47 GRE ' _R ANCHORAGE AREA BOr' $H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL i O~ t .MANUFACTURER ~--(~-{SI,~' ,~-~c~('~MATERIAL[~~ ~<~'[,z_/~,~ COMPARTMENTS /' INSIDE LENGTH ~ INSIDE WIDTH -- ,LIQUID DEPTH -- LIQUID CAPACITY]~F~LGALLONS. SEEPAGE PIT: NUMBER OF PITS I . DIAMETER -- OR WIDTH~=-~{ ], LENGTH ICSi,/ DEPTH LINING MATERIAL /~o(]r~ CRIB SIZE: DIAMETER~//~)EPTH /O/ DISTANCE FROM: TOTAL EFFECTIVE BUILDING FOUNDATION /h/C~) /.. NEAREST LOT LINE~::'2--~ [· ABSORPTION AREA (WALL AREA) WELL ~1 (') /' ~(dmd~) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCT ON BUILDING ~, , NEAREST~ __/ NEAREST FOUNDATION '~S~" LOT LINE ~"~--~ SEWER LINE -- CESSPOOL '- OTHER SOURCES APPROVED / DISAPPROVED REMARKS DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE SYSTEM { / (~3 / INSTALLED BY: PiPE MATERIAl · LOT SLOPE: REMARKS: Form NO, EQ-031 DIAGRAM OF SYSTEM G.A.A.B. GREATER ANCHORAGE AREa BOROUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO.. NAME OF INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED · ~/ ~ COMPLETION DATE ANTICIPATED OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST 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, MINIMU~I DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK WELL TO SEPTIC TANK DRAIN FIELD DRAIN FIELD /<~ SEPT]C TANK, /~/ SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. , SEEPAGE PIt /~// 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 W[TH AIRTIGHT REMOVABLE CAPS. TYPE I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH O INANCE NO. 26-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DEPARTMENT OK £NVIRONMC~TAL OUAL!TY- -.. 3500 TUDOR ROAD rHORAGE, ^LASKA 99502 PerfoYmed For Evelyn Huntinton Legal Description: Lot 47 Block This Form Reports Soils Log xx Date Performed May 29,1973' Subdivision Sec30, T15N, RIW Percolation Test Depth .Feet Soil Characteristics Fi11 gravels GW Organics and silt PT-ML Gravel with sand pockets and lenses GW - SW W~s Ground Water Encountered?. Ho If Yes, At What Depth? I ) ' i DePth"to H20 :Net Drop Reading . Date Gross Time j Net'.TimeI ) nute _ Proposed Installation: Seepa§e Pit xx Drain Field Depth Of Inlet Depth TO Bottom Of Pit Or Trench COMMENTS: The soilcharacteristics requirelO6sq, ft. per bedroom. eT~-t Performed By w. F_ Atwood ALASKA MINERAL & MATERIALS LAB, INC ~ Data Certified By: Da te :__M3_x 29, 19~ N DL-Fo WATER WELL DRILLERS LOG 8/66 Drilling Co. ,t~['~/ Location (address of: DO NOT FILL IN Well No. Permit No. Certificate No. Area Use of well Township, Range, & Section, if known; or distance main Size of casing (/~' Depth of Hole_~z__feet Static water level~'~ ft. (above) (q~l~:~) land surface. Open end ( ~ ); Screen ( ); Perforated ( ). Describe screen or perfo~ati0ns Well pumping test at ~-~- gallons per (h~) (minute) for of drawdown from static level. Was casing ~ollar seated with cemen.~ grout Cased to__<5-_O feet Finish of well (check one) hours with ft. WELL LOG Depth in feet from Give details of formations penetrated, size of material, color, Eround surface and hardness. __TO. TO TO 44 TO ~' TO TO 'TO TO TO TO MuNICIpALWY OF ANCHORAOJ~ DEPT. OF HEA~3N & ENVIRONMENTAL PROTECTIOJ'~ TO TO TO TO MUNICIPAMTY 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. # (~\ .1. _. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING T15N; RIW; See. 30 Lot 47 L.ocation.(,site address or directions) ~ ' / Pr6~)erty owner t'~ Ev¢£un Huntinqton Mailing'-addr~'~ *':P.O. Box 670377 '~. % Mailing address~ ¢orn¢~ of Mooseb~r~ Bend and S. Birehwood Loop Rd Day phone 696-2843 ' AK 995'~7 Day phone Day phone 694-4200 Address .... 16~00 Ce~.~i~d D~ve Ea,~le RZv~_~, AK :.;99577 .~_:.._.. ...... ~ nd~wdua we XXZ .:~_~-: Communi~ well '' ""'?'. ~" :?:~ Public water NOTE:. If communi~ well s~tom, provide wri~en confirmation from -.~ . .. , .~ ~ng to the legali~ and status of system. 4.' TYPE OF WASTEWATER DISPOSAL: ~?" ',: -~.~-~?~.~lnd;v~dual on-s te · ~olding ~.:~.~ ._: .... .:;-:~ :>-~ tank · ........-"-'~ '~- ;"- -'m~u~'~uo mm~ ..... :.- :...~ Public sewer NOTE: '~,/,~-~l_~x?~-,). 4~1 ~%. ~ ,..- If communi~ Was~owa~or s~tem, provide wriffen confirmation fro~ Sta~o ADEC aResting to the legali~ and status of system. 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 ~nd'cated herein. I further Verify that based on the information obtained from the Municipality of Anchorage files and from my invest_i_gation 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. s & s ENGINEERING Phone Name of Firm 17o3,% t=agie i~iver L~p ~.,~-'" ,';", Address Eagle River, Alaska 99511 ~ Engineer's signature ,.'~.~Z. ~ Date 1! /?F/ ~" 6. DHHS SIGNATURE /~/. Approved for Disapproved. - .... Conditional approval for bedrooms. ~-Fbedrooms, with the~following Stipulations: Additional Comments .i '~' ' / , ,' '. ~ ':',:',.the I~.dni~,pality of'~c~lorage Department of Health and Human 8e~ices (DHHS)i~ues Health.Auth~ri~ ~',, :~APprova ~e~if~c~[~b~sed only Upon the representations given in paragraph 5 above by an in~epen~em. ' '~r~fessional edg~e~'r ~egistered in the State of Alaska. The DHHS does this ~s a cou~esy to purchasem of homes ~' ~ at~s ce~am f~eraland state requirements Employes of DHHS do not and thei~'t~nding institutions in order to s ' ~ ' . conduct inspections or analyze data before a ce~ificate is issued. The Municipali~ of Anchorage is not responsible for errata or omissions in the profe~ional engin~fs work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~-~ c~I \ <~ .~_.. $~ ;~fft~-~ ,,(L-ix~[ Parcel I.D.: A. WELL DATA Well Lype ~¢4xl Log present ~,1) Total depth If A, B, or C, attach ADEC letter· ADEC water system number Date completed ~ cl ~ q Cased to ~'~1~ ' Casing height (above ground) Sanitary seal (~q) ~/ FROM WELL LOG Wires properly protected {~2N) AT INSPECTION Date Static water level Well production WATER SAMPLE RESULTS: Bo Coliform ~ Date of sample: /O" $ t~- 9 5~ SEPTIC/HOLDING TANK DATA Nitrate O, .Z t Other bacteria 0 Collected by: $ & S ENGINEERING 17~34 2~e R;,ur Lvap Road bio. 204 Eagle River, Alaska 99577 Co Date installed \q~/~5 Tank size Foundation clCanout~/N) q Depression (Y~ ~ DateofPfl~nping [o'-~>-a'-~:i~s Pumper '~-~..~-. ~>O/,4{~t~q ABSORPTION FIELD DATA Date installed Number of Compartments I Cleanouts High water alarm (Y~). , ; 2 / o~'/¢,t.~ System type [ ~.~ 9> ,. Soil rating (g.p.d./ft~ or fi A~drm) Length ~ '~ ' Width 'Z. I ~ Gravel thickness below pipe k~ * Total depth Effective absorption area' "z)l~o ~ ~-- Monitoring Tube present(~N) y Date of adequacy test ~ o -'~ ~ ~ ~7- ResuLts ~ail) ~¢t:'~s For '~ bedrooms Fluid depth m absorption field before test (in.); ~ q" Immediately after glo gal. water added (in.): Fluid depth .3o ,t (ins.) Minutes later: ./5'- ¢4{~/~ Absorptiou rate = ~d'~ ~ _gp.d. Peroxide treatment (past 12 months) (Y(~ ~[e ~J~ t~,,-(ulJ, Myes, give date · Depression over field D. LIlT STATION Date iostallcd Manhole/Access (Y/N) High xvatcr alarm level at* Size in gallons "Pnmp o11" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT 'FO: Septic/holding tank on lot I ~¢> ~ : On adjacent lots Abso~tion field oo lot k ~ ~ : On adjacent lots Pablic sewer lllaill ~ ' ~ ~ Public sewer manhole/cleanout Sewer/septic sen,ice line ¢ ~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~._ t 4- Property line /o t g' Absorption field /O t ~ Water main/service line lC, I 4- Surfaco wateffdrainage /o0 I./ Wells on adjacent lots /Oo t 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Bnilding foundation / 6 ! ~ Surface ~vater /oo Curtain drain .~t//~ Water mailffservice line /o Driveway, parking/vehicle storage area Wells on adjaceut lots [ o O Property line /~ /4- F. ENGINEER'S CERTIFICATION I certi~.P that I have determined thrufield inspections and review of Municipal records in coq/brmance with MOA IIA~ ~uidelines in qf~ct on this date. Eagineer's Nanle ~0~/~ >-- C. G~A~ HAAFee $ ~O~ t ~ WaiverFee* Date of Payment //~ 7 ~ Date of Payment Rev. 8/95 OSS: haa.wk.doc