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HomeMy WebLinkAboutVUE TOR LT 8  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEAI,.TH & ENVIRONMENTAL PROTECTION ENVIRONIVlENTAL ENGINEERING DIVISION 825 [, Street- AItchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT AD RESS DESCRIPTION LOCATI N ; ~;:¢:C :~:'"~ ] Absorption a,e~ Dwelling PERMIT NO. Manufacturer Material No, of compartments ~. capacity in 9allons IF FIOMEMADE: Inside length Width Liquid depth Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons We) - ¢ Foundation / Nearest lot line ~ / IPERMITNO. No. of lines~ ~ / Total length Trench widt~ Distance between lines~, OTHER ~ , 72-013 (Rev. 3/78) F:tF'F'I_. ill C:FIN'i" L .OCFIT ill ON 't"H[~ Fi:EI~!U ]: ?,Ei:D ~i~; ]: ~!:1!!~ I])F::' 'Fl'lEi: SO :1: L. 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UAL~ 3§00 TUDOR ROAD ANCHORAGE, ALASKA gg§07 27g-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM NAME~,~ ADDRESS __PHONE S'bZ. SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY_ ____MATERIAL COMPARTMENTS GALLONS. INSIDE LENGTH LIQUID __INSIDE WlDT/fl. _DEPTH__ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF P,TS~/___. OUTSIDE DIAMETER NEAREST LOT LINE. c~~ / ~ /~ ~OTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ OR WIDTH ~'~' , LENGTH ~r~ , DEPTH DISTANCE FROM WELL ~, '~L~' Z~/" BUILDING FOUNDATION TILE DRAIN FIELD: DISTANCE FROM WeLL ~O~.~N. NUMBER OF LINES / ____DISTANCE BETWEEN LINE"S~. DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH , NEAREST LOT LIN[! , GE LINES TRENCH WIDTH _7~r~. TOTAL EFFECTIVE _DEPTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE__ WELL: TYPE~(~, ~J /,/., , DEPTH -~ NEAREST ~- SEPTIC LOT LINE , SEWER UNE . TANK DISTANCE FROM WATER · BUILDING FOUNDATION. SAMPLE _, NEAREST .__ SEEPAGE .~ OTHER , SYSTEM -i CESSPOOL , SOURCES.__ DIAGRAM OF SYSTEM DISTANCES: '~-~ t- L'~'~'~ vq~(: DATE ;'× t"~? GRE/-,:'ER ANCHORAGE AREA FRON,..)UGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ,N,TALL^T,ON LOCAT'ON INSTALLATION OF: SEPTIC TANK ,SEEPAGE PIT , DR N FIELD FINANCED THROUGH ~~J3 TO BI INSTALLED BY TEST RESULTS COMPLETION DATE ANTICIPATED 737'-~-o/7 PHONE 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 HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK £ FOUNDATION TO SEEPAGE PIT ~/ , DRAIN FIELD SEPTIC TANK tO SEEPAGE Pit WALL /~'-- SEPTIC TANK ~ F SEEPAGE PIT ~ ~ ~ , , DRAIN FIELD WATER SEPTIC TANK / SEEPAGE SEPTIC TANKi 2--~--. SEEPAGE PIT ./O~, DRAIN F:ELD 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 WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER DIAGRAM OF SYSTEM ALASKA 8DUIRODmeDTAL CODTROL SeRUIC S, IFIC. ~qin~rin§ ~- ~nuironm~nl~l $1u~i~s MUNICIPALITY OF ANCHORAGE DFPT ©c laE'I.T'4 ~- J U L 2 0 t982 RECEIVED JULY 9 1982 SUE DELANY 2033 OTTOR STREET ~CHORAGE AK 99501 SELLER - SUE DELANY BUYER- SUBDIVISION-VUETOR BLOCK-1 LOT-8 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 954 SQFT. THE SYSTEM IS CA~ABLE OF ACCEPTING 100 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 150 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 4 BEDROOMS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TARqK VOLUME OF THIS 4 BEDROOM HOUSE, 1500 IS ADEQUATE FOR 1220 LUcsl 251h Auenu¢ · Ancl~oro§¢, Alaska 99503 · (907) 276-1361 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF I-'NVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL :k~ ~'~- ~)-~-- OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date J~="~'~ ~2~ I~'~ 7 GENERAL INFORMATION (e) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 'go33__ _oFt-er (b) Applicant Name ,~'~.'~n4 D~ te4'e/y__ Telephone: Home _ ~o,,t ~. (c) Business ApplicantAddress -- ~O~_?~ ~¢.~¢. $1~. ~ ~/tc~tor,~¢V ~l~ Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution ~o~,',~-"gl4n~:~- /"-~or"~ Telephone Address ~00 ~. ~/0~ ~ ~or~ ~1~ (e) Real Estate Company and Agent Address ~~ D~ ~ ~' Telephone - ~ ~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms -- ~ Other WATER SUPPLY individual Well [] Community [] Public ~' Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater ¢isposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I ".' ' further.verily that based on the reformation obtained from the Municipality of Anchorage files and from my invc~'~?,on and 'inspeSfiop; the on-site water supply and/or wastewater disposal system is in compliance with all Municipa~,c¢~,,State codesl ordinances, and regulations in effect on the date of this inspection. Address_ Approved for ,~/.4,¢~ bedrooms by Date Approved y~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a cer[Jficate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/841 WELL DATA Well Classification MUNI~C~,A~TY OF ANCHORAGE (MOA) ~ .,~"~'~THORITY APPROVAL ("AA) ,~ I~,~,5~'%'~ .,~ 264'4720 ~:;~;~ _ ,,~ Legal Descript,om ~ ~'~ ~ ~ t~c /~ z~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N). Date Completed Yield Total Depth _ _ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot -- To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ Cleenout/Manhole Water Sample ColLected by Water Sample Test Results Comments Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DA'rA Date Installed ~/I,~/ -//_Size-- (5'f;'~'~y~! No. of Compartments / Standpipes (Y/N). ~ ._ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) _ Depression over Tank (Y/N) -- Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/FIolding Tank: To Water-Supply Well _ To Property Line _ Il~ To Water Main/Service Line _~ 1[(2 i _ Course ~ ~ Date Last Pumped 7{ 1¢ (,¢¢ ; for _ /~, A. Temporary Holding Tank Permit (Y/N) . _ To Building Foundation '8. 3 ' ~ ~. ~', To Disposal Field _~ t¢ r To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed $'eap~/~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ,/4d e¢.c~¢ Separation Distance from Absorption Field: To Water-Supply Well N,/~. To Building Foundation EO < Lot 0o ~ .~l-e~ c¢,,~/~,¢. /..~ To Water Main/Service Line ~ (~ ' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Fl[ ~' Depth of Field Gravel Bed Thickness %r¢~¢ ~¢'¢ '¢Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line 1 ~ To Existing or Abandoned System on ; On Adjoining Lots '~;' ~' To Cutbank (if present) D. LIFT STATION Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection, Signed ~¢'~"~ ~,.~,~, Date Company ~ (~ ~,/'~'.~ re¢t~,~! "~'~VIOA NO, ReceiptNo. //OO /' O 0~".~ __ Date of Payment '"~//'~,~/~.~ Page 2 of 2 72-026 (11/84)