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Home My WebLink AboutGRANITE VIEW BLK 11 LT 13 GAAB-HO- I GRF-,~kTER ANCHORAGE AREA BOROU~I~ HEALTH DEPARTMENT 327 EAG'LE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM '~' MAILING NAME ;/I e'"C CZ,, AODRESSiS -VZU 'k''O" . PHONE SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY .GALLONS. MATERIAL ~~I'4''cl'~e'/~-'' NUMBER OF [ COMPARTMENTS Q/J. ~i~ "~I rl"d'J'~ ~ ~,~ ~LIQUID ~NS~DE LENGTH ~NS~DE W~DTH. DEPTH_ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH / '~ J., LENGTH / 3 / , DEPTH ~" / LINING MATERIAL NEAREST LOT LINE DISTANCE FROM WELL i~) ~/' TOTAL EFFECTIVE ABSORPTION AREA {WALL AREA) BUILDING FOUNDATION· ~ ~/'i, SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA , FOUNdaTION .- .............. , NEAREST LOT LINE__ :~DJ:$:FA'I~'~E BETWEEN LINES_ TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ ~k/'~ DISTANCE FROM WATER WELL: TYPE '~""//',,* ~__ DEPTH ,BUILDING FOUNDATION ~'~ ~ ""'~ f · SAMPLE , NEAREST LOT LINE t';~ f NEAREST SEPTIC ! SEEPAGE //~ ~,~ ! OTHER , sEwER LINE= '~/' "7.~' '~' -~-" -- , TANK , SYSTEM , CESSPOOL , SOURCES DISTANCES: A ~ ~ 7.~'. DATE DIAGRAM OF SYSTEM ; ~;~'~''~ " ~/-;'~' ' : i ' ':. - :~ ' _ GREATER .,,NCHORA~GE"A~REA B ROUGH Case HEALTP~EFARTMENT 327 Eagle St. Anchorage,'Alaska 99501 279-2511~k ',~v SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ~'~/'d/~.'-~?/~L MAILING ADDRESS /-.~/~ NAME OF RESIDENCE ADDRESS APPLICATION TO INSTALL: SEPTIC TANK. L.~' TO SERVE THE FOLLOWING FACILITY %.~M(~LC'~' FINANCED THROUGH ~-- .50/~ ~1 ~t ~ /5~81444.- ~qog PHONE NO. , SEEPAGE PIT z.-~- , DRAIN FIELD , OTHER % TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS SEPTIC TANK SIZE I/~1~, ~-~Of~ tLI'~' ~ PERMITTO INSTALLA ~?'~/.O'~/~ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ /~)~ ~ ~ ~ L ~ TYPE ¢~8 E EPAG E AREA .TYPE DIA6RAM OF ~YSTEM DISTANCES: ~J¢_ Lc '7~ / -'~eaith Authority ~ ceztify tMt ! ~m familiar with the ~egukements of G~eate~ A~cho~age A~a Borough O~d~a~ce No. 28-68 and tMt above described system is in accordance with said code. /2 . / /.~ /~ DATE /~://~/~ ~ APPLICABTSSlBNATU.E ~:~- ~ ~'~:':' ?erfo~,med Fo~~ ~ Date Performed .Q.g; tot/ /,~ Th~s Form Reports a, oo~ls LoK ~ . 'lercola/:.on Test Depth Feet Soll Characte]-istics Location Sketch Was Ground Water Encounte~-ed'~ If Yes, At What DepTh Reading t ,a,e ~ G~o:s ~,ime ~ Net T.[me Depth To H20 Fmop~sed Seepage P~t~~~ _ .D~aln F~eld Depth Of Inle~ ' De ' " · ~ ..... COMH ........ · . ' 3~ .~tn ]o Bottom Of Test Performed By Data Cer:ifi~d By:~~_~ Net Drop MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date February 9, 1987 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13 Block 11 Gran~t~ V~_w Location (address or directions) . 9020 Granite Place (b) Applicant Name Vern Shelton Telephone: Home 344-0235 Applicant Address 9020 Granite Place, Anchorage, AK, (c) Business None Applicant is (check one): Lending'Institution []; Owner/builder}~; Btcyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address (f) Telephone Telephone M~iltheHAAtothefollowingaddress: Mr. Vern Shelton 9020 Granite Place Anchorage, AK 99516 TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Welt~]( Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental 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. 72-025 (11/84) Page 1 of 2 NOIJ. n¥o leAoJdd¥' leUO!l!puoo ~0 swJa/ leUO!l!puoo peAoJddes!Q --~/~ pe^oJddv ' -' Xq sguooJpaq /~,')2~/,,?/ JO~ pe^oJddv ~~/~Y "IYA Ol::ld d~ d':lHa A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification Well Log Present (Y/N) Total Depth Apx Static Water Le~,el 56' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Yes Separation Distances from Well: To Septic/Holding Tank on Lot 75+ ' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole H/J[ Water Sample Collected by Water Sample Test Results Comments Legal Description: Lot 13 Blk 11 Granite View Subdivision PriYate IfA, B, C, D.E.C. Approved (Y/N) No Date Completed Unkn~°~n Yield Cased to $0+' Depth of Grouting H/J[ Pump Set At Approx ?0' 2/+" Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) No GP~i ~ ; On Adjoining Lots 100+' 100+' ; On Adjoining Lots 97* To Nearest Public Sewer To Nearest Sewer Service Line on Lot H/J[ Roy Inman ; Date 02/4/87 ~ Satisfactory B. SEPTIC/HOLDING TANK DATA Date Installed 10/28/69 Size 1000 Gal No. of Compartments Standpipes (Y/N) yes Air-tightCaps (Y/N) yes Foundation Cleanout (Y/N) yes Depression over Tank (Y/N) HO Date Last Pumped Pumping/Maintenance Contract on File (Y/N) H/J[ ; for Holding Tank High-Water Alarm (Y/N) ~/j[ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ? 5 ' To Property Line 55' To Water Main/Service Line 25+' Course 10 O+ ' To Building Foundation 10 ' To Disposal Field 10 ' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 10/1 LF/69 Width of Field 1 ~' ~ 100' Square Feet of Absorption Area Depression over Field (Y/N) ~O Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Su pply Well 10 O+ ' 20' Type of System Design Length of Field 1 ..3 ' .' Depth of Field 9' Gravel Bed Thickness 6' "' ~12'~ - Standpipes Present(Y/N) Date of Last Adequacy Test Satisfactory ~ · To Building Foundation Lot N/A To Water Main/Service Line .50+' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Seepage Yes 02/6/87,, To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~0+' To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical C..~/N) Dimensions M a n~7'~cess (Y/N) "F~p 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 h~tye checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed"'""~% _.K~-~_ _ ~-;~. Date February 9, 198? Company ~hhiCewater En$inee~b~g4o. ReceiptNo. / D~ / ~ O/~ .~_UF ~ Date of Payment W/5/~ ~'~"'"-- .' .~A '?'~..~ % '; ~ Engineer's Seal Amount: $ /00~ P.r~Z* ' ......--;~ ..... ~{~",, Cfi-6793., ~% ~ Page 2 of 2 ~?~ -... ...... ...., ¢~* r- I:JML INC. ' '?liZ7 OLD SEWARD HIGHWAY .ANCHORAGE, ALASKA 99518 (907) 344-$551 LABb..,~TORY I.D. I.D, ~0. (PUBLIC'SYSTEMS) NAME OF SYSTEM I%4~Cll~RIOLOGICAL WATER ANALYSIS TO BE COMPLETED BY WATER SUPPLIER DATE COLLECTED TINE COLLECTED TYPE OF S. YSTEM ~ONTH DAY l-) PUBLIC. INDIVIDUAL CTRCLE CLASS A B C Residential SYSTEH ADDRESS CITY STATL LOCATION WHERE SAMPLE WAS COLLECTED COLLECTED BY:(SIGNATURE)~ ., COL .N) [] DRINKING WATER ~CHECK TREATMENT ri RAW SOURCE WATER [] NEW CONSTRUCTION OR REPAIRS [] OTHER(Specify). NUMBER ZIP CODE [-)CHLORINATED F')FILTERED ~UNTREATED OR OTHER IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? [~ YES I1NO PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE 7/,,' AO.RESS CITY FOR LAB USE ONLY r) RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE [] Sample too long in transit. Sample should not be over 30 hours. F') Sample received too late in week []Not in proper container [])Leaked out F') Insufficient information provided. Please read instructions on form. I']Other (Specify) RECEIVEO FROM RECEXVED ~ . DATE ~-~.-~q TIME ~MBRANE FILTER ~ FERMENTATION TUBE Date & Time Started Date & Time Completed~ LABORATORY RESULTS [] Other Bacteria ~ Test unsuitable because: ~ Confluent Growth ~. TNTC ~TISFACTORY ~TXSFACTORY BACllERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY ~TOTAL COLIFOP, JqS FECAL COLIFORMS OTHER Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By IIEMD ~qlIPLE COLLECTION iNSTRUCTIONS BACK OF 1~ Col iform/lOOml BGB Date Time Col i form/lOOml P,:H.