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Home My WebLink AboutLot 07, 08 GREA? R ANCHORAGE AREA BOR, GH, Department of Environmental ~uality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'"'.~d/;/,4).S' ,4'~'~,]',,//,-~'~ MAILING ADDRESS ~/~ ~ ~ r'~ PHONE SEPTIC TANK: DISTANCE ,~,Op,~'y ~'~ ,4/ /'~'~/P2 ~/ NUMBER OF FROM WELL '~,~/ MANUFACTURERJ~/'/~,C~ ,3'~(~Z-/2'' MATERIAL J/~"~/~' COMPARTMENTS_ ~ INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID DEPTH --LIQUID CAPACITY /'~,~,.~d~ GALLONS. SEEPAGE PIT: NUMBER OF PITS ./ DIAMETER LINING MATERIAL /b,::? 5'~/z~ CRIB SIZE: BUILOING FOUNDATION /z/(, NEAREST LOT LINE '~/. OR WIDTH -- , LENGTH ..~ , DEPTH DIAMETER ~ DEPTH ~/ DISTANCE FROM: WELL /'(~),-~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~/,~/~ ~7~ CONSTRUCTION BUILDING / NEAREST // NEAREST FOUNDATION ~A',~' LOT LINE /~ SEWER LINE CESSPOOL ~ OTHER SOURCES APPROVED -- DISAPPROVED DEPTH //~ / DISTANCE FROM: SEPTIC SEEPAGE SYSTEM DISTANCES: INSTALLED BY: /~/////(/g~C/~/~', ~D PIPE MATERIAC: ~/~~Z"~'~'///~ LOT SLOPE: // Form No. EQ-O31 DIAGRAM OF SYSTEM DATE APPROVED /~'~'~C-c~ /~//.-S_~./'A~-2 G.A.A.B. GREATEr ANOH~A~~~OUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SiZE FINANCED THROUGH SOil TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY DRAIN FIELD , OTHER . NOTE= THIS PERMIT I$ NOT VALID WITHO T 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. ! MINIMUIV~ DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPtiC TANK TO SEEPAGE PIT WALL SEPT]C TANK ~/~ / .* SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE. / WELL TO SEPTIC TANK //~J ~ ! , SEEPAGE PIT. DRAIN FJELD . ALSO CONSIDER AREA WELLS. DRAIN FIELD ~ T/A · SEEPAGE PIT SEPTIC TANK, ~'('*~ / , SEEPAGE PIT DRAIN FIELD I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE Performe~ Legal Description; This Form Reports Soil Test Must Depth Feet Soil 1 i-- B~own silty organics 2 3 6 '8 -- 9 -- '10 i ItECEIyE~RE~, R ANCHORAG£ AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY OCT 9 1973 PM 3330 "c" Street ANCHORAGE, ALASKA 99503 For Thomas, Ros~ing Dated Performed oct. 3, 1973 Lot 8 B.1 ock I Subdivision Turnagain Soils Log xx Percolatior Test Be Logged To 4' Below Proposed Seepage System - Characteristics Gray sand (GP) vfith well graded sand seams below 5' with sandy silt seam 10,5' to 11' Case Was Ground Water Encountered? No ..... · If Yes, At What Depth? Reading Date ' Gross Time Net time Depth to H20 Net Drop Percolation Rate Minute '?'. Proposed' Installation;. See p a g e Pit ×x ..Drain'. Field Depth of Inlet .... Depth to Bottom of P~t o~ Trench 'COMMENTS: 155 square feet of dra'inage area is required per bedroom.'' ' Test Performed BY R,E. Carlisle ALASKA MINERAL & MATERIALS LAB Date Certified BY: Da i;e: STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation data 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 cod, es, ordinances, and regu!atio s in elf. act on the, date of,this in~spection. NameofFirm F: ¢-~/-/~,,¢ '7'-e'c.,fl?,t~( .E'~ ( ,~ Phon Address .~ ¥S30 ~c.4o .¢';/"~ ,,~r~¢bo,'-~'~./ Engin~er'ssignature ¢J~~ ~.-/'~¢¢¢,~-~L Date ~-/.,.T//G/ DHHS SIGNATURE Approved for .,, // t~edrooms. Disapproved. ,:~ ~ _Jco%~ ,'~4- Conditional approval for ~ bedrooms, with the following stipulations: ~r ' - i ,;,' ~ ' - Date_ ~4--~/ The Municipality of Anchorage Depar[ment of Health and Human Services (DHHS) issues Health Authority Approval Cer[ificates 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 anatyze 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 Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ' HAA # - Location (site address or directions) I_g'oo Property owner /"-0~ ~ ,..7'¢~,y goW/,',~ Day phone Mailingaddress ~.0. ~o~ I~I~E ~ ~or~/ ~k Lending agency 5~¢~1~ ~r~ Day phone Mailing address ~¢0 ¢ ~ ~¢~. Agent N~el Thomc¢,¢, ~-or:l~ ?/-¢?~rCq~z Dayphone. Address ::TOO o Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 72-025 (Rev. 1/91) Front MOA #21 NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ~ -Fo be co~c/~( ~ co'~¢z;t''°'~ of fi/IA TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site PuNic sewer If community well system, provide written confit;mation from State ADEC attest- ing to the legality 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 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 regulatioQs in effect on the date of this inspection.. Engineer's signature ~~ ¢ ~ ' Date 5--/_7 / 19/ By: DHHS SIGNATURE __ Approved for bedrooms. Disapproved. Oond t,ona, approva, for bedrooms, w,th the fo,owing st pu,ations: 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 th is 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. 724)25 (Rev, 1/91) Back MOA #21 Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. Legal Description: LOT 8 N A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date O~test: Static waier level Well flow Pump level FROM WELL LOG Date completed Casedto ~ IIZ Casing height Wires properly protected (Y/N) AT INSPECTION 5/2 t SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ )O ' Absorption field on lot ~ ~O~'~ Public sewer main ~ _-~ ¢oo~ Public sewer Service line ~2 ADEC water system number Jo/73 oR S£FO~S Driller (JNK. ENVIRGNMENTAL SERVICES DIVIStON MAY [ 1991 g.p.m. ?'f' g.p.r ECEIVED ;On adjacent lots ~ 4oo ' ; On adjacent lots Publio sewer manhole/cleanout ~ t~o ' Petroleum tank' NONE WATER sAMpLE F~ESULTS: Coliform d' Nitrate z.. c~. / Other bacteria 0 Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) N High water alarm(Y/N) Date of pumping Collected by: Tank size l ~ ~'~! Foundation cleanout (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~2~ On adjacent lots ..~ ~c,~,' To propertyline ~, ¢o' ~ Surface water/drainage Compartments '~ Depression (Y/N). /V Foundation Water main/service line Absorption field toot 72-076 (Rev. 3/91) Front MOA2! CONTINUED ON BACK PAGE C. LIFT STATION I~, ~. Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at 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 Date installed la /~7/72 Soil rating I ~ System type ~ .~-~ ~'~' Length I ~ Width I ?.. Gravel thickness ~ Total depth I~-. Total absorption area ~(2 Cleanouts present (Y/N) /V Depression over field (Y/N) I'¢ Date of adequacy test /~, Results (pass/fa) I~J, ~. for ,. ~ bedrooms Peroxide treatment (past 12 months) (Y/N) , I~(, ~., If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~o..~ On adjacent lots To building foundation '~. On adjacent lots ';~ Surface water Curtain drain Property line To existing or abandoned system on Cutbank ;:> ,5'¢' ' Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines inspection. Engineer's Name Date ~"{ ~/ 14AA Fee $ ~.~0 Date of Payment '~' ''~ ~ R e cei pt N u m be r ¢~'"""~ ~'~ 5 ( ~ /~ 72-026 (Rev, 3/91) 8~ck MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEiVIICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska §9518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~t~P~f 7"ec,4 5%-¢ '3 q¢'- Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [~ Untreated Water SAMPLE NO. LOCATION - Time Collected Collected By TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: i$ shows this Water SAMPLE to be: sfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Membrane Filter * No. of colonies/lO0 mi, Lab Ref. No. Result* 91.2152" FT-S l-lq Analyst READ INSTRUCTIONS BACTERIOLOGICAL WA~TER ANAJ. Y,,~I.S RECORD / - A.D.E.~ .~ Membrane Filter; Direct Count (~ Coliformtl00 mi BEFORE COLLECTING SANIPLE Verilication: LTB BGB Final Membrane Filter Results ColiformtlOo mi Reported By ,~ --~--~k~'~ ~-,. i _ Date ._~--_¢~c:~ / TNTC -- Too Numerous To Count OB = Other Bacteria PART ONE OF T~O REiIAINDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 AMALYSI$ REPORT BY SAMPLE for WORRozde~ 3440E Date Report P~inted: II{AY 22 91 ~ 19:09 FAX:(907) 561-5301 Client Sa.,pl~ ID:LB El TURNAGAIR FRONT SPIGOT Client Name :FLATTOP TECHNICAL SRV FWSiD :DA Client Acct :FLATTO? Collected }MY 21 91 ~ 14:30 hrs. BPO i PO ~ N0~E RECEIVED Received MAY 21 91 ~ 15;45 hrs. Req $ Preserved uith :AS REQUIRED Ordered By :UA 3end Reports to: Completed :I,~Y 22 91 Laboratory Suoervicor :STEPHEIi U. EDE 1)~LATTOP TECHNICAL SRV / ShemIab Ref ~: 912152 Lab S]~pl ID: 1 ~at~ix: WATER Allowable Parameter Tested Re,nit Units Method nil~ts MITRATE-N IID(D.iO) ~g/l EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: T.F. MOORE. T~sts Pezfor~d ' See Special !nst~uctions Above UAgUnavailable None Detected *~ See Sample Remarks Abowe t]ot Analyzed LTiLess Than, GT=Ozeater Than o 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: Mailing Address: Property Owner: Mailing Address: ~f~- ~ Legal Description: Location: Type of facility to be inspected ~?J-~7 P ho ne: Phone: / No. of bedrooms Well Data: A. Type ~~. -- C. Construction Sewage Disposal System: A. Installed /~"]-~ C, Septic Tank: D, Seepage Pit: E. Disposal Field: B. Depth D. Bacterial Analysis B. Installer 1. Size 1~-~ 2. Manufacturer 1. Absorption Area ~ .~ ~2. Material Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line __ , Absorption area Other contamination , Absorption area Sewer Lines , EQ-034 (1/74) Page I of two pages Page ~ of two pages - R ~.. st for Approval Legal Description of Individual .~er & Water Facilities Comments Approved ~-~ ~._ ~/~ Disapproved Date ~__~C~ Approval Valid for one year from date signed Greater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 333O 'GREATER ANCHORAGE AREI~ BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. TYpe of Inspection: CMRO VA FNA CONV ×xxx 2. Property Owner: Thomas R. Rosling " '<'~ 99507 '" Mailing Address: S1L~, Box 1368, Anchorage D~_)t Phone 344-3901 .,.. 3. Name of Buyer: Thomas R. Rosling :. (Business) Mailing Address: SAME 0a_y Phone 344-6013 4. ~ame of Lending Institution: The First National Bank of Anchorage, South Center Branch Mailing Address: Box 4-2090, Anchorage, 99509Phone 274-1521 Name of Realtor or Agent: None Mailing Address: Phone 6. Legal Description: Lot 8, Block 1, Tnrnagain S/D Location: NHN Oren St. Anchorage, Alaska 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public If Individual, number of Single Family NO. Bdrms, ~ 4 Utility Individual xxxx dwellings presently served One If Individual, depth o'f well Unknown Sewage Disposal' System Type ,of S>stem: Public Utility If Individual, date o'f installation Individual on-site) xxx Unknown 06-1220[a) ~ev. 1973 DATE ~ '~ .h~LA~''''''' DEPARTMENT OF HEALTH AND SOCIAL Sr'-'"CES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC B ,A.~C ?.,E R ~LO G lC A L ~: WATER ANALYSIS INDIVIDUAL [] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ADDRESS OF SOURCE ZIP ICODE - COMPLETE THIS SECTION ONLY IF WA.I'ER I~ AN~]ICDIVIDUAL SUPPLY [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lab No. OFFICE -~.naJysls shows Ibis Water SAMPLE to be: [] SaUsfactory [] Unsatlsfaclory Et Quesllonable [] Samp]e too tong in transB'; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample· [] BotUe broken i~ transit, please send new sample· SANITARIAN'S REMARKS o6-122o ~bl / BA~TE~IOI~oGICAL WATER ANALYSIS R~CORD Rev. 1973 ~'~ t j ~> / ~,~ ]/ C ~} arn "~; · Date Received ~/ ~'-~ , ~ Time Received ~ ' ~ ~ob. No. Lactose Broth T0cc 10cc 10cc 10cc 10cc t.0cc 1.0cc 24 Hours 24 Hours --48 Hours EMB __ AGAR Lactose Broth, 24 hrs. 48 hrs. Gram's stczln Coliform Densib (Mosl probable No. per 100cc} MF ResuBs be: t.~ Absen~t) Reported by This analysis indicates Col~form;Organlsm~to