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Home My WebLink AboutTURNAGAIN BLK 2 LT 12 ~GREf"=~R~ ~ ANCHORAGE AREA BORmlGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME D/~U(1 DiCKlJ'~,OJkJ LOCAT,ON Celf:i:,,d SEPTIC TANK: DISTANCE FROM WELL J OO INSIDE LENGTH MAILING ADDRESS SP--'6, ~oX I ~)7'~_ PHONE ~ad ~h~Fk:Le~AL DESCRIPTION L, 1'2-j ISLK ,2,~-'['UR-~I~61A¢M NUMBER OF MANUFACTURER MATERIAL ~'T I~ ~ L_ COMPARTMENTS i- INSIDE WIDTH -- LIQUID DEPTH -- LIQUID CAPACITY I O0 0 GALLONS. SEEPAGE Pit: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION__ DIAMETER OR WIDTH Z.O, LENGTH I~," DEPTH 7 CRIB SIZE: DIAMETER DEPTH 7 / DISTANCE FROM: WELL ., NEAREST LOT LINE ~ z TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~l~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE -~) ~1L L~D CONSTRUCTION BUILDING j ~:::~ / NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED ~PPgo~P DEPTH I~O (Bpp~OXz~DiSTANCE FROM: NEAREST SEPTIC / SEEPAGE SEWER LINE NIONF-- TANK lOC) SYSTEM REMARKS DISTANCES: INSTALLED BY: iq OWF-~T ~old PIPE MATERIAL' &4 ~T I R_ot0 LOT SLOPE: REMARKS: 5eepggC Fir b~zck,Cillecl ~ui~-¼ c~uSh- Form NO. EQ-031 DIAGRAM OF SYSTEM cle*n ,~vi G,A,A.B.. 'I ~OuTH well O0 1 GREATER ANCHORAGE AREA BOROUGH ~=ERMIT NO. DEPAF~TMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT iNSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ,, DRAIN FIE{~D . FINANCED THROUGH TO BE INSTALLED BY , OTHER FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS; FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. / ., DRAIN FIELD WATER MAIN TO SEPTIC TANK , SEEPAGE P[T. J~ ALSO CONS[DER AREA WELLS. , SEEPAGE Pit AREA SIZE I~/ ~ /2~1 TYPE DIAGRAM OF SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND ]NTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT F]TTED WITH AIRT]GHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR [ CERTIFY THATI AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORD]NANCE NO. 28-68 AND THAT THE ABOVE DESCR]BED SYSTEM IS IN ACCORDANCE W[TH SAID CODE. APPLICANT'S SIGNATURE DEPAR1M. LiiF ~F EH~ IRON?~z:_.',L QtMLi[- 3500 TLIDOR R~AD ~NCHORAGE, ALASKA 99502 CASE Performed For ~o~ I'~scs~m~ Leaal Oescrintion: Lot ~ Block This Form Renorts Soils Log_~ Date Performed ~_ Subdivision T~-_NA~ Percolation Test Depth Feet Soil Characteristics 5 '6 7 8 9__ In s Ground Water Encountered? IF Yes, At what genth? I Reading Date Gross Time Net Time Denth Dron: i to ~20 Net Percolation Rate ~!i nuT:e Prnposed Inst~-~-~-~5-F,: Fecr,,!cle Dit~ n."ain Field Deoth of Inlet ~ Den~--~-~3'o~-~r~m r:F Pit -Test Performed 8v ~]~]~~ ..... Pat. a Cer,t~fieH 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~\~ - I ~ -'q(Z~ HAA# 1. GENERAL INFORMATION Complete legal description Lot 12; Block 2; Turnaqain Subdivision Location (site address or directions) 1200 East ll2th, Anchorage, Alaska Property owner Mailin~ address no~n~ Wi!ls Day phone q44-6165 1200 East ll2th, Anchorage, Alaska Lending agency Mailing address NBA Day phone ATTENTION: Emilee Cruz Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer Xx~ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025(Rev. 1/91) Front MOA#21 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. Name of Firm ;-;, & 5 ENGIN~RiNG Add ress 17034 Ea{~Ja River Loop Road No. 204 ~le RlVer~ Alaska 99577 Engineer's signature Phone Date DHH SIGNATURE //D~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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. 72-025 (Rev* 1/91) Back MOA ¢Y21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-I- lb, ~-~; ~')L.D 'TU~-~vAc. d~ ~D Parcel · I.D, A. WELL DA~ Well type "CILID/~-~ E If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/~ ~-~(3 Date completed ~,.~ F-.. Driller Total depth /~ r~ Cased to t~0 ~'~- Casing height Sanitary seal (~N) Y~-~ Wires properly protected (~N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION g.p.m. ~-,2 O'4 : On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~5~ WATER SAMPLE RESULTS: Coliform (~ j ~'~ ~71~, ~,~ Nitrate Date of sample: Collected by: '~.~LDING TANK DATA~ ~L,~L-t (-- ~...................~g/,/"~f'L_ A~,,~ ¢'~ Tanksize ~,~'/~ Compartments _ ,,~ Cleanouts (Y/N)/~'~-~ ~Foundation cleanout (Y/N) /V~ Dep~) High water alarm (Y/~ ~ Alarm te~t~ Well(s) on lot ~ On adjacent lots Foundation ~ To property li~..~''''''''~''~ Absorption field Water main/service line Su rf~"~water/d rainage 72-026 (Rev. 7/91) Front CONTINUED ON:BACK PAGE / Size in gallons ~ _ Manhole/Access (Y/N) ~ Vent (Y/N)_ "Pump ~~ ~evel at_ High water alarm level /~__ Meets MOA electrical codes (Y/N)~.~~- ~ SEPARATION_.D48q-~C~M LIFT STATION TO: ~ On adjacent lots Surface water ABSORPTI{)N FIELD DATA ed Soil rating System type Length th Gravel thickness Total d Total absorption area Cleanouts present (Y/N) Depression over field (Y/N) Date of adequ Results (pass/fail) for bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM Well on lot To building foundation __ On adj Surface water Curt~ , ~cent lots '"-R~y line ~ To existing or abandoned system'~.... __Cutbank Water main/serviceline '"'-.. Driveway, parking/vehicle storage area ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA g, this inspection. 5 & S ENGINEERING 17034 Eagle River Loop Road NO, 204 Signature ~agle I~vor, Ala~a 99~77 Engineer's Name HAA Fee $ I"~ ,,"), Date of Payment ~-~, Receipt Number __ 72*026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALISI$ RgSULTS for INVOICE ! 52570 Chemlab Ref.t 92.1401 Sample t I l{atrlx: FAX: (907) 561-5301 WATER Client Sample ID PWSID Collected Received Preserved with L12 B2 OLD T~gNAGAIN S/D Client Name :$ & S ENGINEERING UA Client Acer :$NSENGP ~ his, BPOt : APR 7 92 @ 15:45 hzs. Reqt : AS REQUIRED Ordered By : POt :NONE RgCEIVED Analysis Completed : APR S 92 Send Reports to: Laboratory Supsr~isgr Released Ey : Parameter Raeults U~t~ ~ethod Allo~able Limits NITRATE-N ~CO.1O) ~/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY; J.~. NO TAG FOR TNIS SAMPLE. Re~arks; 1 Tests Performed See Special Instructions Above UA~Unavailable ND= None Detected ** See Sample Red, ks Above NA= Not Analyzed LT-Less Than, GT-Greater Than ~S~S Member of the SGS Group (Soch~t~ G~n~rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 S STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ¢olleoted ?~eee~¥e~ with Client Acct APR 6 ~2 ~ ZO;O0 hx~. ~eq! : APR 7 92 ! IS;4S ~. O~de[ed By Pasamete~ Re~ultg U~t! ................................................. 0.0i6 ~/1 ABT# D2972-?8B*HYD ~$ENIC COLLECTED BY; J.W, performed · ~ee Spe:~el Imt~uct~or~ Above UA-Unavailable Member of Ihe SGS Group (Societal adn{,raie de Surveillance) ~,~1 II I~/ Department of Environmental Quality ~ ~/ 3330 "C" Street, Anchorage, Alaska 99503 274-4561 0 , ~Ol( , ,½~ Date Received il-I~)-F~ ~P~ .~ '~ ~_ ( ~- "//~ ~D~WDUAL SEWE~ a ~¢ATER FACiLiTiES 1. Approval requested by: Mailing Address: L~)~ 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: ~Pn~ ~Y~ ~~ 4~L~ , ~o~, ~ ~Lo~ 5. Type of facility to be inspected_ 6. Well Data: A. Type I ~m~ ~b~ ~) C. Construction Sewage Disposal System: A. Installed ~F~/?3 B. C. Septic Tank: 1. Size Phone: ~rl~l-~6~ J Phone. ~-qEI-Lol~ i B. Depth D. Bacterial Analysis Installer /~b('~')' 2. Manufacturer 2. Material D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: , Absorption area , Other contamination , Absorption area Septic tank Nearest lot line B. Foundation to septic tank , Sewer Lines , C. Absorption area to nearest lot line __ EQ-034 (1/74) Page I of two pages Page 2 of two pages - Re~ 'st for Approval of Individual !~-'Xer & Water Facilities L~gal Description F~'f¥~ Approval Valid for one year from date signed Greater Anchorage Area 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) REQUEST FOR APPROVAL OF INDIVIDUAL ,SEWER & WATER,-ACIL., ': ~--tILSF' '1. Type of Inspection: 2. Property Owner: Mailing Address: C iRO VAX FHA CONV 3. Name of Buyer: R. W. Borcherevink SRA Box 1361 Thomas F. Wills Da.y Ph°ne ~C~Oq?m i' Mailing Address: 1410 W. 45th _ BCe- Phone 272-0898 Name of Lending Institution: Alaska Mutual Mailing Address: 601 W Fifth Ave. Phone 274-3561 5. Name of Realtor or Agent: Robert T. Ohrt Mailing Address 401E 36th Ave. Phone 279-0491 Legal Description Lot 12 Block 2 Turnagain Sub. Location: Across from Baseball diamond, Behind Oriental Gardens 7. !-yDe of Facility to be inspected: Wate~ Supply Type of Supply: Public Utility If Individual~ number of dwellings ln~l,,,idual depth of well Sewage Disposal System Type .of System: Public Utility If individual, date of i.nstallation Residential No, Bdrms. 3 Individual X presently served 1 Individual (on-site} X Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~//7, ~ ~ ,a~~~ Time of Inspection .~0:~o p~in~. ..F~'~]~ REQUEST FOR APPROVgL' OF I~IVIDUAL SE~ER & WA~R FACILITIES FOR 1. Approval Re~es[ed By: .,,, Address~ 2. Prooertv Owner: 3, Legel Description: ..... Phone 4. Location: 5. Type of Facility to be Inspected:~ Number of Bedrooms: Sewage Disposal System.'~ A. Installed S'3- ~ C. Septic Tank: 1. Sfze/O00 2. D. Seepage Pit: 1. Stze~O~7~ 2. Manufacturer _~ Material ~ · E. Disposal Field: Total Length of Lines ------' 8. Distances: A. Well To: ~ ~, Nearest Lot Line~_~_~____, Other Contamination Tank ~' '!~ Absorption Area B. Foundetfon to Septic ~ . ~'~O'~- C. Ahaorption ATea to Nearest Lot Line_~_~~ Septic TsnkJ~_O ., Absorption Ares /190 , Sewer Lines ...Request for Approval of/--hdividual Sawer & Water "~CPage Two 9. Comments: Approva~Valfd for One Year From Date Signed Greater Anchorage Area Borough, Department of Envirgnmental Quality D~AGRA~ OF SYSTEM I ~ertif,,~ that the information contained in this request for approval to be a true and accurate representation of bhe subject sewer and water facilities located at: Signed Date