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Home My WebLink AboutTHOMAS W SPERSTAD #1 BLK 1 LT 19 OAAB FID- I GR~O, TER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION SEPTIC 'rANK: DISTANCE- FROM WELl LIQUID CAPACITY GALLONS. MATERIAL (';~_~',.' ~ / ,~: COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH C.: :~/~'A/£: ~' .'j 'DEPTH__ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE SEEPAGE PIT: // OtJTSIDE DIAMETER. "~ __OR WIDTH__ ///~ ,~-~') ~'' TOTAL EEFECTIVE ABSORPTION AREA (WALL AREA) / / , LENGTH__ /4./ , DEPTH & __, , BUILDING FOUNDATION ~-'~ /, / :; [ g// SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION ~.~'~'~,, NEAREST LOT LINE LENGTH GE EACH HNE TOTAL LENGTH · OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE .~)/.('~/L.~ ~:/'.~ DEPTH ///~ /~ DISTANCE FROM ' ":~ ,BUILDING FOUNDATION. 1~ "~/~ / SEPTIC /~/ SEEPAGE ~7 NEAREST ':~ ~' '/' TANK 622 , CESSPOOL LOT LINE ., SEWER LINE , , SYSTEM__ r/''~6' /"7 DIAGRAM OF SYSTEM WATER SAMPLE /k/(' , NEAREST OTHER , SOURCES DISTANCES: // / /x?~ ::; i,~ ' DATE APPROVED GREATER NCHORAGE AREA IL ROUGH C.seN0 HEALTIt DEPARTMENT ~0 327Eagle St. Anchorage, alaska 995~1 Alt ~ 279-2oll SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMI? NAME OF APPLICANT~ ]~, )~) ~ ~,~=~ MAILING ADDRESS PHONE NO RESIDENCE ADDRESS LOCATION Gl: INSTALLATION APPLICATION TO INSTALL: SEPTIC TANK_ ~, SEEPAGE PIT. L'~/~ ,[)RAIN FIELD ,OTHER. TO SERVE THE FOLLOWING FACILITY. ~ FINANCED THROUGH___ TO BE INSTALLED BY_ PERCOLATION TEST RESULT8 ANTICIPATED DATE 0F COMPLETION. BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS , PERMIT TO iNSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED_ · SEPTIC TANK SIZE .TYPE SEEPAGE AREA DISTANCES: Health Authority TYPE ___~ DIAGRAM OF SYSTEM I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordhmnce No. 28-68 and that the above described system is ill accordance with said code. _ ~ .7 BATE ~ APPLIOANT8 81BBAT~ RE ,~ATER ANCHORAGE AREA BOROUGH~ HEALTH DEPAkTMENT 3.~27 r. AGLE STRE~ ANCHORAGE, ALASKA 99501 CASE # Performed For._.~/~/l~_/~ll?e~ tPx~x,~Z~o _ . ..Date Legal Description: Lo5z. Block ~ubd~ This Form Reports a: S~I, og_ . ............ _ D~pth Feet Soil Characteris%ics Location Sketch Was Ground Water Encountered?_~¢.=._~;~._~ ~f Yes, At What Depth.~.___~_:.:~i Gross Time Net Time Depth To H20 Net Drop Prop>sed Instai~'~o~.' Seepage Pit / Drain l:'ield Depth Of Test Perfommed MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division ol 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 HAA # _ t-(/I 1. GENERAL INFORMATION Complete legal description £o 7 IcJ I'~Lo t.,( I '1 lto/.~ti ) ~v' s,'~ ~,'~,~o .v / Location (site address or directions) ~ ~ ~'£'S- 0~/2 tl,vc~lc,t',l ~,~. ~ Property owner Mailing address Lending agency Day phone :-~ 't -¥- - '/('' (; / //),,,c//o'.e4oz'_ /t¢~ Cie) ~-o ') Day phone Mailing address Agent Address Day phone. Unless otherwise requested, HAA will be held lor pickup. 2, NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well 2( Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWAI'ER DISPOSAL: Individual on-site 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. 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. S & S ENGINEERING Name of Firm _ 17634_Eagle_River_L_~ol~Road_No~.204' Address Eagle River, Alaska 99577 Engineer's signature ~//_cL~/~/~' ~ Phone Date 4 DHHS SIGNATURE Approved for ~/ 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. 72~25 (Rev. I/9t) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street Room 502 · Anchorage Alaska 99501o (907) 343-4744 Health Authority Approval Ch e, cklist Legal Description: LO 'C A. WELL DATA Iq (~t-,< I Tt/omnJ W-~'?Geszf/~arcelI.D.: Welltype I>,~¥¢/rE ffA, B, orC. artachADECletter. ADEC water system number Log present (Yt~ N o Date completed ~ I ~ g ~ To~fl depth __ I J ~.~_L ~?'.~ Cased to _ ~ O ~ Casing height (above ground) S~ se~ ~ ~ ~ Wires properly protected ~) ~OM ~[[ LOG AT INSPEC~ON Dateoftest U [ ~ q/,O /~ C Static water level ~ ] g ~ G Well production g.p.m WATER SAMPLE RESULTS: 3 y~ $ g.p.m. Coliform O Date ofsample: q/g /0 ~ B. SEPTIC/ItOLDING- TANK DATA Nitrate O, / Other bacteria O Collected by: S & S ENGINEERING 11U34 ~agle River Loop Read No, 2~ ' Eagle River, Alaska 99577 Date installed Tank size Fotmdation cleanou! (Y/N) Depression (VA, l) __ Date of Pumping Pumper C, ABSORPTION FIELD DATA Date installed Length Width _ _ Effective absorption area Date of adequacy test P M~oJlitO~ng Tube present(Y/N) //" Results (Pass/Fail) __ Fluid depth in absorpd, ga' m~lM before test (in.); __ Fluid depths// [ins.) Minutes later: Ped'm~e treatment (past 12 months) (Yh'q) Number of Compamnents _ Cleanouts [Y[N) High water alarm . System type Total depth Depression over field (WN) _ For bedroolns hmnediately after, gal. water added (in.): Absorption rate = /;.p.d. If yes, give date D. LIFr STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* Size in gallons E. SEPARATION DISTANCES "Pump ._~'-~*Daturn "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot /v /,a, ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field /'~ Water main/service line Surface water/drainage . We~~ S::iA~rR~r gTo~nl;a~i~:ANCE FROM ABSO~O.' Water nlain/service line Surface water ~ Driveway, parklng/valficle storage area Wells on adjacent lots F, ENGINEER'S CERTIFICATION 1 certify that I have determined thrufield inspections and review of Municipal record.~.~.l.~.,,~,,~.a IR ~lns are m conformance wtth MO~A ~mdehna~' m e~ect on this date. Engineer s Name ~05~ CP C. Cown~ ,~,~.~n~ ~ ~ Date ~/~-~ /0 C _ _ ~.~ ~ Fee $ v 0 O 0, W~ver Fee $ Date of Payment ~ / # / q ~ Date of Pa~xent Receipt Number ] ~ ~ ~ ( 7 0 3 ~ ) Receipt Number Rev. 8/95 OSS: haa.wk.doc 04/10×96 14:50 CT&E ESI ANCHORAGE ~ 90?6941211 NO. 949 Q06 CT&E Environmental Services Inc, Laboratory Division mrar-~r~r~l~l~ ~.a~J~~l~,;i~a~. Laboratory Analysis Report CT&E Ref.# ¢,lient Sample ID Matrix PW$1D 0 Sample Remarks: 9612,31,972.1 LIS T,W. $PERSTA1) S/DJ 1231-01 Dri~lkiug Water Collected Date 04~08~96 Technical Director Released Bye'" quaL Meehod Alioaabt~ Prep An~iysls [nit Limits 0~te Date ~PA ]53,~ e4/09/96 04/09/96 BNU 200 W Potter Drive, Anchorage, Al( 99518.1605 ,-- Tel: (907) 562-2343 Fax: (907) 501-5301 3180 Pager Road, Fairbanks, AK 99'?09-547t -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, ONIO, WEST VIRGINIA