HomeMy WebLinkAboutGLEN EAGLE BLK 3 LT 7 QGRE! 'R ANCHORAGE AREA BOP Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 ¸'GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM - MAILING ADDRESS ' ~ PHONE NAME ~. ' L LOCATION , · : LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL-' / MANUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL' ~ -'. NUMBER OF COMPARTMENTS LIQUID DEPTH__ LIQUID CAPACITY . GALLONS, SEEPAGE PIT: / NUMBER OF PITS . . DIAMETER__ LINING MATERIAL / -, CRIB SIZE: BUILDING FOUNDATION-~ OR WIDTH ~ -; LENGTH DEPTH ' DIAMETER%DEPTH . DISTANCE FROM: WELL f . -¢ . TOTAL EFFECTIVE NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) - SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION __ LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH NEAREST SEPTIC SEWER LINE TANK REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIA LOT SLOPE: REMARKS: Form No, EQ-031 DATE- APPROVED G.A.A.B. e SEWAGE Greater ANChOrage AREA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK J- SEEPAGE PIT ~' DRAIN FIELD TYPE AND ~IZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLE Y / COMPLETION DATE ANTICIPATED PERMIT NO PHONE ., OTHEB NOTE= THIS PERMIT IS NOT VALID WITHOUT 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. SEEPAGE AREA SiZE TYPE 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 DRAIN FIELD DRAIN FIELD · DRAIN FIELD BEEPAGE P,T ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, , SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE. STREAM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 .I~NCH D_J_AMETER CAST IRON SlPHOi~ PIPES ON SEPTIC TANK AND SEEPAGE Pit GRAVEL BACKFILL DIAGRAM OF SYSTEM CONFORM TO B OROU. I:~REG~/____LATION~ ~A~iNG I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA ~O UGH ~DINANCE NO 28-6~ AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE With SAID CODE. ,- .. / / '- GRLAlER ANCIIORAGL AREA BOROU Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 SOIhS I,OG - PEROI,ATION 'FI';ST Perforn~d Legal Description:~-T-_____i~r~--~ ~ This form reports: Soils log v~ Percolation test Depth Feet 2- 3- 4- 5- 6- 7- 8- 10 -- 2?n~ay' 12- 13- Date Pe rfo nned~'-- 14 - Was §round water encountered? z~//~_ . If yes, at wi)at depth? Readi n§ Date Gross Time Net Time Depth to Water Net Drop f~-~ o'l 'a-tq-o-~ ' F-3~-e ............ ~--nq n--~ -t-e-. - .... Drain Field Proposed insLalla~-~n-:-'--~'ei!i~ue Pit ___ __x~q-~. ...... . . m Ucpth of Inlet . _.~De_ptt~ ~i, bottom of ~]t~or,crencn 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 Parcel I.D. # 050-601-26-000 HAA # ~76)~- ~-~ GENERAL INFORMATION Complete legal description Lot 7, Block 3 Glen Eagle Location (site address or directions) The Clearing Drive Property owner Mailing address Larry S. Garland, Jr. Day phone P.O. Box 876246, Wasilla, Ak 99687-6246 Lending agency City Mortgage __ Day phone 263 -0700 121 W. Fireweed , Anchorage , Ak 99503 Mailing address Rolfe Milton 694-5500 Agent Day phone 11823 old Glenn Highway, Wuite 117, Eagle River, Ak 99577 Address Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer 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 It21 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 A/'/0612~o~J -~-,JO//J~.~24,J~ Phone Address ~:~(~ ~Ox Z~'77 '~ ~o~ ~ ~ Engineer's signature ~ ~ ~ ' Date DHHS SIGNATURE ?~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: , ~. Date 'fi lllifll The Munici~ality'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 DH HS 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 enginee¢s work. 72~}25 (Rev. 1/91) Back MOA i¢21 mwR~JNMENTAL SERVICEs DIVISION Municipality of Anchorage FEE{ ~' ,. , DEPARTMENT OF HEALTH & HUMAN Sfi~¥1CI=S~ ~_ ~ ~ I U Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Lot 7, Health Authority Approval Checklist Block 3 Glen Eagle Parcel I.D.: 050-601-26-000 A. WELL DATA Well type private N Log present (Y/N) GT 55' Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed L) GT 40 ' Cased to Casing height (above ground) Sanitary seal (Y/N) yes 24" Wires properly protected (Y/N) ye s Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O FROM WELL LOG Nitrate g.p.m. AT INSPECTION 2 -18 -97 25.9' 4GPM Other bacteria C'0 g.p.m. Date of sample: 2-19-97 B. SEPTIC/HOLDING TANK DATA Collected by: st,,~rt cilbez~ Date installed 6/16/75 Foundation cleanout (Y/N) Date of Pumping 2/15/97 Tank size 1, ooo Number of Compartments ; Cleanouts (Y/N) . .. Y Depression (Y/N) h' High water alarm (Y/N) N Pumper JR Septic PL~p~rs Y (1) C. ABSORPTION FIELD DATA Date installed 6/16/75 Soil rating (g.p.d./fF or fF/bdrm) 15o System type Seepa~ Pit (coazrete) Length 28' Width 15' Gravel thickness below pipe 6' Total depth 126" Effective absorption area 516 Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 2/19/97 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test (in.); 3.5" Immediately after1,130gal, water added (in.): 25" Fluid depth 17" (ins) Minutes later: 24hrs. Absorption rate = 57o g.p.d. mo evidence Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed None Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot GT 100' On adjacent lots GT 100' Absorption field on lot GT 100 ' On adjacent lots GT 100 ' N/A Public sewer main Public sewer manhole/cleanout Sewer/septic service line GT 1 0 0 ' Lift station None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation GT N/A Water main/_se[vi__ce I_in~e GT 1 0 'Surface water/drainageri°ne ob $ ~Ce~o~ adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: GT 10' Property line GT 10 ' Building foundation GT 10 ' Water main/service line SudacewaternOne obsrved ~,,,,/,,,L,..,/~9(:D 50' Driveway, parking/vehicle storage area Wells on adjacent lots GT 100 ' no evidence Curtain drain ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco~~,;{~bove sy$~s are in conformance with MOA HAA guidelines in effect on this date. ~'~.~.'~ '* ~, ·, ~..~. Engineer's Name ~1~ ~ ~5o~ ~1~. t ~ HAAFee $. -~ Date of Payment Receipt 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 9707S7001 S© Technical Lot 7 Block 3 Glen EaTIc outside ~huc~t Drinking W:ner Client PO# Printed Date/Time 02/24/97 14:50 Collected Date/Time 02/19/97 13:00 Received Date/Time 02/19/97 13:45 ' Technical Director: Stephen C. Ede Released By ~,,',../~" ~ Sample Rcmark.~: Total Coliform Results 0.623 0 PQL Units Method At[ouab[e Prep Analysis Limits Date Date Init O.lO0 mg/L SM18 4500-NOSF 10 max co[/lOOmL SMI8 9222B 02/20/97 EMB 02/19/97 RAM GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received % - ~-~ - ~'~ ~ ~ ~,~ INDIVIDUAL SEWER & WATER FACILITIES T~~/ Approval requested by: ~~_ ~_.~ ~t T 2. Property Owner: Mailing Address: 3. Legal Description: ~ -~ 4. Location: ~x,~t-~k~x) 5. Type of facility to be inspected 6. Well Data: ~L~ Phone: No. of bedrooms o A. Type C. Construction Sewage Disposal System: A. Installed B. Depth D. Bacterial Analysis ~-\"~--~ ~ B. Installer C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: 1. Size \ (~C~ ~ 1. Absorption Area Total length of lines 2. Manufacturer 2. Material A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages August 21, 1975 GREATER .ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: Mailing Address: CMRO VA FHA Brad W. Dickey and Paula S. D%ckey SRA Box 194. Ea~le River. Ag Day Phone Samuel J. Roser and Jo Elle~ 30-310 H Cherry Drive, Day Phone Elmendorf AFB, Alaska -9506 4. Name of Lending Institution: Mailing Address: Pouch 7-010~ Anchorag% ~ Phone 5. Name of Realtor or Agent: None Mailing Address: Phone Alaska National Bank CONV x_ 694-9239~___ 752-2280 277-5511 o Legal Description: Location: l~t 7, B!eck 3: Glmn Em~lm SLlbdivi~imn NHN The Clearing. Eagle R~ver~ Alaska 7. Type of Facility to be inspected: House 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation The Borough has already approved the septic system. of the water only. Thank you. No. Bdrms. 3 Individual (on-site) x We now need approval EQ-037 (1/74) Page 2 of two pages - Re~ st for Approval of Individual .~ _~r & Water Facilities Lega~n ~ -~ ~~'~,(~'~~ t I ~ Comments Approved ~,~4~x~~.-. Disapproved Date ~/'?~. Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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)