HomeMy WebLinkAboutTIMBERLUX #1 BLK F LT 12l_oT
Department of Environmental (~uality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME //~,,~ ~//Z2 ,/"/g,/' ~_~ MAILING ADDRESS
' LEGAL DESCR,PT,ON
SEPTIC TANK:
DISTANCE ..~
FROM WELL/~./~.Z~Z2 MANUFACTURER
INSIDE LENGTH
MATERIAL
NUMBER OF /
COMPARTMENTS
INSIOE WIDTH
LIQUID DEPTH ~ LIQUID CAPACITY //~)'c~) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS /'. DIAMETER -~ ORWlDTH~7~ LENGTH''~/Z2, DEPTH ~/~/
LINING MATERIAL Z'g~.'.~/dJ~/~ lB SI : DIAMETER ~ DEPTH -~ DISTANCE FROM: WELL
BUILDING FOUNDATION/~./2,~£,~Z~ NEAREST LOT LINE ,~?/" TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~,].~'~ S(~, FT.
ADDITIONAL ABSORPTION ; -
WELL:
TYPE ~ CONSTRUCTION DEPTH
BUILDING ~ NEAREST SEPTIC
FOUNDATION --/ . LOT LINE~, SEWER LINE TANK
REMARKS
APPROVED
DISAPPROVED
DISTANCE FROM:
'~GE , SYSTEM.
DISTANCES:
DIAGRAM Of SYSTEM
INSTALLED BY:
PIPE MATERIAL:
REMARKS:
DATE
G,A,A.B.
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANC SKA 99503
TELEPH
GREA'?ER ANCHORAge AREA BOROUgh
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE Pit ~ ., D~AIN FIELD OTHER
SOiL TEST RESULTS /J'~'~ ~/ NOTE{ THl~ PERMIT I$ NOT VALID WITHOUT SOIL TE~T
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.
TVP ACE ^~EA siz~ ~ 7,.',~ Type
DIAGRAM Of SY~TE~
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ~
FOUNDATION TO SEEPAGE Pit . , DRAIN FIELD
SEPTIC TANK TO SEEPAGE Pit WALL /~'
SEEPAGE P DRAIN FIELD
TO NEAREST LO:T LINE.
WELL TO SEPTIC TANK / ~/ ~- O , SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATEr MAin TO SEPTIC TANk /~ r , SEEPAGE Pit /~
DRA]N FIELD
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 ~]lTH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
BOROUGH REGUL IONS REGARDING INSTALLATION.
GERT]FY 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 BAlD CODE,
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAl QUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Case #
Performed For
Legal Description: Lot
This Form Reports Soils
Soil
Depth
Feet
3--
4--
5--
7--
8--
9--
lO-
ll-
12...
14--
Was Ground
If Yes, At
Log. ~ Percolation Test
Test Must Be Logged To 4' Below Proposed Seepage S.ystem
~%/~LJ ~N/ Dated Perfqrmed
~ock F S~bdi,,isio.
Soil Characteristics
Water Encountered?
What Depth?
l. I
I I I i
~ L
L_I. i _1 __LJ I__J
Reading
Date
Gross Time i Net Time Depth to H20 Net Dre
· ~'- ........ J Z
Percolation Rate Min,'ce
Proposed Ins~all'~: SeeDag~ Pit Drain
Depth of Inlet ....................... Depth
COM~ENTS:
Field
to Bottom of Pit Or Trench'
Test Performed BY
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVIRONMENTAL HEALTH
DEPARTME~T OF HEAL%H AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HF.~Lq~H AUTHORITY APPROVAL CERTIFICA~'E
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivisic~-, section, township, range)
Location (add~ess
(c) Applicant is (check one) Lending Institution
Bu_yer ~ ; Other ~ (explain);
?~..~... l .-~ .., .. ~ r, -~ ~-~, ~ ,- . "
tO ~' (e) ~ai Estate ~. a Agent . ~u~ ~: F~%~ ~,-.~? ~)<.~ ~o~,.~ ~_
Address
TelephoP~ '.9 'v xt ..... ~/
2. T~%pe of ~sidence
Single-Family ~
Number of Bedro~rs
3. Wate~ Supply
Individual Well
Othe~ (describe)
Ccmmunity ~. Public ~
Note: If cx~nnunity well system, must ~ave written confirnvntion from the State
Department of Environm-=ntai Conservation attesting to the legality arid status°
Is the well adequate fo~ the number of tedrcx~s specified in this HAA (Y/N)
Se w-a~e D_i~os a 1
Onsite C~ Public F---~_[ Corammity F-~ Holding TacJ< ~
Is the wastewater disposal system adequate for the num~e~ cf bedroom.~ (Y/N)
[Page 1 of 2]
a-_b-84
5. Enpineering Firm Pro~spections, Tests, Data and Information
I certify that I have oX~cked, verified, or conformed to all MOA ,~blA Guideiirms in,
the dat~7of Uqis inspection. ( c,-_~.%f/ ~kc~'~- .r~,~ ,~,~.~-~.~,~
Te lepho~ 3~-~ ~"7 ~' ~
(ENGINEER SEAL)
Name of Firm
Address
Signed by
Date
3 be. drccms
Disapproved
6. DHEP Approval
Approved for
Approved ~
Terms of Conditional Approval
Tne Municipality of Anchorage Depa~tn~nt of Health and Environmental P~-otection does
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system° This approval indicates that, as of the validation date
shcIwn above, based on the data and information furnished by an engineer registered in
the State of Alaska, the wate~ supply and wastewater disposal system is safe and func-
tional for the numbe~ of bedrooms and type of structure indicated.
(D~EP SEAL)
7. Mai]. the HAA to the follc~;ing address;
KB2/dS/s
[Page 2 of 2]
2-15-84
ae
Well Classification
Well Log P~esent (Y/N)
Total Depth
MUNICIPALITY OF ANCHORAGE (MOA)
~EALTH AUTHORITY APPROVAL (~AA)
CHECKLIST - FEBRUARY 1984
Legal Description: /~J~ ~2 _
If A, B, ~ c, D.~..C. A~proved(Y/N)
Date C~t~leted ~/~-~/~/3A) Yield
Cased to /~/~6/ox/ Depth of G~outing.
Static Wate~ Level /~//~/d/zgA/
Casing Height Above Grcund ~Q,~>'
Electrical Wi~ing in Conduit (Y/N)
Separation DistanCes f~cm Well:
To Septic/Holding Tank on Lot
Pump Set At L{M'K4/DII3/¢
Sanitary Seal on Casing (Y/N)~
Depression Around Wellhead (Y/N)~O
~'~/~l~'- ; On A~joining Lots }O0' +
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sew~s Line ~/~/~
Cleanout a ole
Water Sample Collected BI; /////~/~
Water Sample Test Results
C~t~,ents
; On Adjoining Lots /~'
To Nearest Public Sewe~
To Nearest Sewe~ se~Vic~ Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~%~'-~ Size /g2~f~.~g/~ No. of Compartments /
Standpipes (Y/N) %/~ Ai~-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) /Dc'3
Depression Over Tank (Y/N) ~)~ Date Last Pumped ~'~-~-~
Pump~ng/Maintenano~ Contract on File (Y/N)~//~ ; fo~ ~/~
Holding Tank High-Wate~ Alarm (Y/N)~//~ Tempo~a~y Holding Tank Permit (Y/N) ~1/~
Separation D~stances f~om Septic/Holding Tank:
To Water-Supply Well
To P~ope~ty Line ~ ~ '
To Wate~ Main/Service Line
course //
TO Building Foundation / ~ '
To Disposal Field ~'
To Stream, Pond, Lake, o~ Major D~ainage
CoUnts
MUNICIPALII¥ OF ANCHOP, A(DI:
ENVIRONMENTAL PROTECTION
[Page 1 of 2]
MAY 1 '1 1984
RECEIVED
2-15-84
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