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HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 3 LT 15 GP'~ ~TER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLI:] ST. ANCHORAGE, ALA.~KA 99501 279-2511 N°. INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME c:~ c~.'~'~-~ ,~ ADDRESS~/,~ O ~ /~ ~'ff PHONE SEPTIC TANK: DISTANCE FROM WELL__ LIQUID CAPACITY NUMBER OF MATERIAL_ ..~ Y '~-/~'L .COMPARTMENTS ~ ,~( ~9 d.-,~ .~'7%~-~.. / ~ 7(-/? LIQUID GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS__ / OUTSIDE DIAMETER ~2 ' OR WIDTH /~ , LENGTH /~'~ DEPTH (~ LINING MATERIAL /~ /L ,'& f[~ DISTANCE FROM WELL /O~ '' BUILDING FOUNDATION ?,~' ' NEAREST LOT LINE_ /~'- ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~ ~?(~ SQ. FT. TILE DRAIN FIELD: IOTAL LENGTH DISTANCE FROM~ WELL ,FOUNDATION~ ,NEAREST LOT LINE ,OF LINES NUMBER OF I.I''/'~ES /:~r~ ~ DEPTH: TOP OF TILE TO FINISH GRADE .DEPTH OF FILTER MATERIAL BENEATH TILE .IN. ABOVE TILE WELL: TYPE c DEPTH (:) ~') ,BUILDING FOUNDATION. SAMPLE NEAREST NEAREST SEPTIC C~[~ SEEPAGE , OTHER LOT LINE ., SEWER LINF , TANK , SYSTEM /~)~-) _, CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVE _~~// HEALTH AUJHORIIY G A A B -H D .2 GREATEI 327 Eagle St. ANCHORAGE AREA 11EALTIt DEpARTMENT Anchorage, Alaaka 99501 9ROUGH 279.25 SEWAGE DISPOSAL SYSTEM - APPLICAI'ION & PERMIT NAME OF APPLICANT ('."~ RESIDENCE ADDRESS LEGAL DESCRIPTION. APPLICATION TO INSTALL: SEPTIC TANK. TO SERVE THE FOLLOWING FACILITY F,NANCED T,ROU . :/:///4 PERCOLATION TEST RESULTS LOCATION OF INSTALLATION_ o OC~t.~ ~/'"., SEEPAGE PIT &'*' , DRAIN FIELD , OTHER.. TO BE INSI'ALLED BY~-~L~*~` ~' ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT __AS DESCRIBED BELOW. SIZE OF UNIT TO ~ESERVED -~ SEPTIC TANK SIZE _ .//5'~2(::~TYPI SEEPAGE AREA ,-rYPE , M OF SYSTEM I certif ' mt [ alii fa mhar with the requu'e nents of Greater Anchorage, e/Area Borough~Ord.inanc:e hip. 28-6~and thatIhg/ above described system 1S i~l accordance wztb said code. <::,i , ,,'" )-:?,, DATE (}/ ~>':"0 //~ APPLICANTS SIGNATURE--s] ',EATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE~ ALASKA 99501 CASE Performed )or _ 9~O~j.J~l~__~x~..~-.-J)ate Perf°rmed-~°~gr'/~7-~;L ........ ~ Legal Pescrip~: Lot 15Block~ Suoc~v~szon Zodiak Manor This Form Repo~ts a: Sokls Lor~ xx Depth Feet 4~ 6~ ~0~ 12 --~.~ Soil ChaP,:cterJs:ics brown sand & silt (ML) gray sand (SP) gray fine to coarse sand ~ (sw) bet 2 line Location Sketch Depth To H20 Net gr, op [ .~ ..... ill..tal2 , ,: f',(;r~i~,'U~e !'i~_ Or'aln Field CO~i~,l);s'r5: ~guare feet draina~ area is needed per bedroom Test Perfopmed By: R. E. Carlisle These reCOtTanendarions are computed from ................................... visual observaC&on and based on fJed classificatJon system. Data Cortified By :~[~j!~J;,~%~j~R.~%i,~_~.~ Inc. Dare: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AN[) WATER FACILITY FOF1 SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location '.<" (b) Propqrty owner (c) Lend ng Iustl~ut~en · Mailing Telephone: (home) .~ z/'~,. ;!, 70(, Business- Telephone (d) Real Estate Company and Agent Address Telephone ;~'-4, ,,{ - ~'/?¢ (e) Mail the HAA to the following address: (or check here'¢~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE .! Single-Family~ Number of bedrooms -- 3, WATER SUPPLY Individual Well~, Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Enwronmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 72-0251Rev. 7/8B) 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 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 Jn compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /¢¢'~--~$ Telephone ~"??- 5~5~<"-~ Address /9'~7-~ /,*J -~-~'"-? ./~// ~ ¢¢'5~] Date Approve~ for ¢//_._bedrooms by Approved /X'~, '_ Disapproved Conditional Date Terms of Conditiorml Approval Note: The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 5.4 mg/1. EPA maximum concentration 10.0 mg/1. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) 8ack Page 2 of 2 A. WELL DATA ~ MUNICIPALITY OF ANCHORAGE (MOA) ~A'~,I'fY OP A~GAuthority Approval (HAA) ~N~,fAi. 5ERViC.~CST - FEBRUARY 1984 MAY 2 6 1988 RECI-:IV£D 343-4744 Legal Description: /~/~' 2~/~ Well Classification Well Log Present (Y~-- Date Completed Total Depth ~/ Cased to </~/C--Depth of Grouting -- ~J/ Static Water Level 7~' / Pump Set At If A, B, C, D.E.C. Approved (Y/N) 4//~ Yield ~" / Casing Height Above Ground Electrical Wiring in Conduit ON) -- SEPARATION DISTANCES FROM WELL.: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /'¢~ ¢- Sanitary Seal on Casing CN) Depression Around Wellhead (Y~ _ __; On Adjo n ng Lots. ; On Adjoining Lots "~'///~ ,, To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot _ Water Sample Collected by _ t Water Sample Test Results ~A¢ 1'- '~ Comments .A/~FZ,Z- ,~'/-~ J B. SEPTIC/HOLDING 'rANK DATA -- ,~z~/¢ D'"'~a Ll~lled Size __ No. of Compartments Standpipe~ ("~N~- __ Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Ta~/~~~ Date Last Pumped Pumping/Maintenance Contact ~N) .... ; for Holding Tagk, High-,~ater Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N) SEPAR~' 8~'~D~S~,~ES FROM SEPTIC/HOL[~ANK: To wat~rLsaP~¢~,l. [,~ ':': To 8~t~_ Foundation TO Propel,t.y. bine ~- ..... ~ To D sposa ~ To Water ~,MAi~YSe~lo.e~Ein e To Stream, Po~d, L'ake,6r Maior Drainage Course Comments 72 028 IRev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA - ~.~oils Rating in Absorption Strata Type of System Design [3~lnstalled ~_ Length of Field ___ Widt~d ____ Depth of Field __ _ _ ~. Gravel Bed Thickness ____ Square Feet of Abs~'o~.? Area _ Statndpipes Present (Y/N) Depression over Field (Y~.)..~ __ Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM AB~S RP~TION FIELD: To Water-Supply Well ~'""'-~- To Property Line __ To Building Foundation '"'~'"~. To Existing or Abandoned System on Lot ; On Adjo~ To Water Main/Service Line To Cutbac~k~present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ~teJ~d Size in Gallons~'~'"~-~. "Pump On" Level at - ~'~-. High Water Alarm Level at ~"'~ Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) '~-- -_. Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company ~ ~?'~ ~ Engf~6s Sea~ Date MOA No. Date of Payment 72 026 (Rev. 7/88) 8ack Receipt No, __ Waiver Fee: $ Date of Payment __ Page 2 of 2 CHEMICAL & GEoLoGIcAL'LABORAtORIES OF ALASKA, INC. 5633 B STREFT ANCH~)RAGE, ALASKA 99518 TELEPHONE (907) 562-2343 k FEDERAL TAX ID # 92-0040440 Date I~oport Printed: },lAY 2'i g9 ~ 07:16 Collected gAY 17 89 0 i3:35 hrs. ~.sco:~ved ~ 11 89 q 14:00 Mls!ysis Completed :gM ]9 89 Send Report~ to: La,;o~atoz? oUDery1/?z, .S??,PH~,J C. gDE / Special kmmrks: SM4PL~] COLLF, CTED ~,Y A. WIF, IL [ Tosts p~iormed ' See Special Instructions lbove U~,.UnaYailab]e 1. Approval requested by: Mailing Address: 2. Property Owner: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received -9--r Time of Inspection [)ate of Inspection REQUEST FOR APPROVAl. OF INDIVIDUAL SEWER & WATER PACILITIES FOR ,'~..~.,r ~ ~-~.~,'7~: Phone: o 4. 5. 6. Mailing Address: Type of facility to be inspected Well Data: A. Type ,c~,~'"~,---~.--~.--~-'- C. Construction ~,~.~ Sewage Disposal System: A. Installed __/~70 C. Septic Tank: 1. D. Seepage Pit: 1. No. of bedrooms B. Depth ~ ~F / D. Bacterial Analysis ~.., B. Installer Size 2. Manufacturer Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines ___, Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1174) Page 1 of two pages Page 2 of two pages - Re( st for Approval of Individual Legal Description , ,,/~7' er & Water Facilities Comments Approved ~/~'~~A Disapproved roval Valid for one year from date s~gned Greater Anchorage AFea BorolJgh, DepaFtment of Environmental DIAGRAM OF SYSTEM Date Quality 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. EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St,, Anchorage, Alaska 99503 - 274-4561 REQUEST EOR APPROVAL OF INDIVIDUAL SEWER & WATER EACI[.ITIES o Type of Inspection: Property Owner: Mailing Address: Name of Buyer: _~_~ Mailing Address: Name of Lending Institution: Mailing Address: Name of Realtor or Agent: Mailing Address CMRO VA FFIA ........... Da~v_ Phone __ D~ay_ Phone Phone CONV o Legal Description: Location: o Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual If Individual, date of installation J~7C~ (on-site) EQ-037 (~/74) f :5. GREATER ANCHORAGE AREA BOROUGE HEALTH DEPARTB~ENT 327 EAGLE STREET ANCIiORAGE, ALASKA 99501 279-2Sll INSPECT: TIME: REQUEST FOIl APPROVAL OF INDIVIDUAL SELVAGE AND [~ATER FACILITIES FOR Phone .... ~ 7,7 -~f''p Property Owner. .~..z.~-c~_.g ~ ~, Number of Bedrooms C, Size D. Construction E. Bacterial Analysis 6. Sewage Disposal System: Septic Tank (If homemade, show diagram on back) l. Size ,. Age Manufacturer 4. Installer HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--tO BE COMPLETED BY FHA INSURING OFEICE Anchorage ~ J~aska MORTGAGEE l?irst National Bank of Anchorage SERIAL NO. 59010 000 1 MORTGAGOR OR SPONSOR George Collins PROPERTY ADDRESS 8810 Solar Drives ~achorage, ~laska SUBDIVISION NAMI~ Zocl~,:%:: Me. or BLOCK,~ NO. LOTl~NO. TOTAL NUMBER~ -[ LIVING UNITS BEDflOOM$ 1 BASEMENT [] ','es [~] New installation 3 WATER SUPPLY BY: [] Public system [~ Community system SEWAGE DIIPOSAL [] Public system ['-3 Community system additional bedrooml? (ff Yes, hm'; rnan¥~} Individual ~i5,]KIndividual [~ Yes [] No PART Il.---TO BE COMPLETED BY HEALTH DEPARTMENT 4EALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County [] Local Department of Health that this individnal water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. of the [] Stare [] County J~ Local Department of Heahh that this individual It is the opinion sewage-disposal tern with proper mainteDance: [] Can be expected to function satisfactorily, and ~-] Cannot be expected to function satisfactorily is not likely to create an i.ns~anitary condition DATE -- -- SIGIqA 0RE~----- T TLE NOTE: PART III.~FOR USE OF FHA OFFICE YO THE CHIEF UNDERWRITERJ I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable C'] Not Acceptable Sewage disposal be considered [--] Acceptable [] Not Acceptable. HEALTH AUTHORITY APPROVAL 161DIVIDUAL WATEIIt SUPPLY AND SEWAGE DISPOSe'- SYSTEM ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITFCT FHA Form 2573 Rev July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists uf [] Septic tank. [] Cesspool. Septic Tank: Distance from well.__feet. Material Total liquid capacity, Inside length, fret. Inside width,. Distance from: Well feet: tilundationl Inside diameter1 feet. Depth, gallons. Capacity inlet compartment teet Liquid dept fi, Number of compartments gallons. feet. feet. feet; nearest lot line at [] front. [] side, [] rear, feet. Liquid capacity, gallons, kining material [] Seepage pits. Dther Depth of filter material over tile,. feet. feet. ____inches. Total length of tile lines, Trench width, Length of each line. Type of filter material: [] Gravel. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Number of lines, Distance between lines, inches. Total effective absorption area in bottom of trenches, feet. Depth. top of tile to finish grade. inches. inches. Date of inspection Depth, feet. Lining material feet; nearest lot hne at [] front, [] side, [] rear,. [] Local Health Authority. Inspected by- REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of lailure of wells in immediale wcinity to furnish adequate supply of water__ Properties in neighborh~×~d [] are [] are not being developed with both individual water.supply and sewage-disposal systems. Lot size: feet wide. feet deep. Dwelling sel back from front property line,, feet. Individual water supply trom: [] Drilled well. [] Driven well. [] Dug well [] Bored well. Diet.nee of well from: Building foundation, seepage pit~ feet; nearest h)t line at [] front, [] side, [] rear, teet; tile sewer ......... feet; septic tank1_ feet; disposal field~ feet; cesspool, feet; other sources of possible pollution, i%et. Diameter, inches. Total depth, fret. Type of casing, Approxi~nate depth to pumping level of water in well, feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe,, feet. Pump capacity. Located in: [] Basement. [] Pumproom off basement. [] Pumpbouse above ground. [] Pxlmp pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Y~'s. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date. Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] l.ocal Health Authority. Inspected by Date of inspection 19 Depth of casing. _gallons per minute. _gallons per minute. .,19 feet, feet; feet.