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Home My WebLink AboutDALE BRIGGS BLK 2 LT 4[)ale Briggs Block 2 Lot 4 #050-182-04 GRE'"O"ANCHORAGE AREA BV1-1 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_1i14VE U11NvtU- MAILING ADDRESSL4 Z4 NckSnr F -cd C PHONE n LOCATION CNiC l'�CAi, LEGAL DESCRIPTION L � .4 ,n r iI(`i,� Z ll, t - r�;n ( l SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER�uti't�'{ aq�rtS MATERIAL I rP' 1, COMPARTMENTS 1 INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH. I (QUID CAPACITY /(120 GALLONS. SEEPAGE PIT: �' ' NUMBER OF PITS DIAMETER OR WIDTH LENGTH, DEPTH F LINING MATERIAL "�'� K CRIB SIZE: DIAMETER DEPTH('r DISTANCE FROM: WELL IGS TOTAL EFFECTIVE BUILDING FOUNDATION IL , NEAREST LOT LINE � + ABSORPTION AREA (WALL AREA) ZQ� 5Q, FT, ADDITIONAL ABSORPTION WELL: TYPE ! 11ILJLtr CONSTRUCTION ST -Al �t �p DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST LOT LINE SEWER — SEPTICi SEEPAGE /Vs �(1�) LINE TANK SYSTEM , CESSPOOL CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMAR DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ -071 DIAGRAM OF SYSTEM mow.. •'' GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 •'C•• STREET ANCHORAGE. ALASKA 99503 TELEPHONE 274.4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT L�%Vc- M INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FA FINANCED THROUGH SOIL TEST RESULTS MAILING ADDRESS PERMIT NO. PHONE COMPLETION DATE ANTICIPATED 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. SEPTIC TANK 512E -' " I TYPE 11 al MINIMUM DISTANCES. REQUIREMENTS FOUNDATION 70 SEPTIC TANK f-/ SEEPAGE AREA SIZE/?)(/-)- TYPE FOUNDATION TO SEEPAGE PIT z ( DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /✓ / SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. /^� WELL TO SEPTIC TANK - /"O SEEPAGE PIT -- /•'� DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK. leo SEEPAGE PIT /e`,/ DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON eJPES.LtLiiPiNHANKd1NPiiiPAGb_PIT FITTED WITH AIRTIGHT REMOVABLE CAPS, GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED YSTEM IS IN ACCORDANCE WITH SAID CODE. DATE O APPLICANT'S SIGNATURE / • � r FOpM O.EO-OIf 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, Location (address or directions) %__ %-. " Application Date ion section, township, range) BT. (b) Applicant Name �"'� "i ��*d Telephone: Home Business 9S�-S3o0 Appucant Huuress ;01" J --- -- - I I,per (c) Applicant is (check one): Lending Institution 13; Owner/builder ❑ ; Buyer ❑ ; Other (explain); A,&64� (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Q nett - - - i e - (1)_ tJ Rh`e HAA to the following address: D O 1�7 _. G9s�-9��G 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other b to d ms _3 Num er o e roo 3. WATER SUPPLY Individual WO 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 Onsito', 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. r2-025111,84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION r' 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S t g fin Telephone Address Sf:C 1962 Erls: °.Ivsr. Elaska 99S" \Z--Z,4—es' Date 1 ti I DHEP APPROVAL (3) Approved for bedroom! Approved Disapproved Terms of Conditional Approval OF At t»A A. Shafer No. 1437.E C ��?ROFESSIgh1 Conditional 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 certificate 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 (11/84) r ' MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANOiCk"KLIST- FEBRUARY 1984 DEPT. CF HEALTH 8 264-4720 ENVIRONMENTAL P90T1 P 1^K1 Legal Description: I-_C�rT' R" t3L-Y, - _L_ DEC 2 6'1985 Va.% 6, GS s A. WELL DATA RECEIVED Well Classification .5 • C• If A, B. C, D.E.C. Approved (Y/N) a /A Well Log Present (YAQ Date Completed EVA o4, ta-7 5 Yield SLA F24 -V Total Depth 0•IL. Cased to 4.014" Depth of Grouting Static Water Level q I L Z - Pump Set At U • tC. Casing Height Above Ground .2, Sanitary Seal on Casing ON) Electrical Wiring in Conduit47N) Separation Distances from Well Depression Around Wellhead (Y(tW To Septic/Hotdmg Tank on Lot I C=D ; On Adjoining Lots toot+ To Nearest Edge of Absorption Field on Lot t o<' ; On Adjoining Lots 1 on tt To Nearest Public Sewer Line '%�'), _ To Nearest Public Sewer / Cleanout/Manhole • A To Nearest Sewer Service Line on Lot Z5 } Water Sample Collected by !t4 5- E 4-11.>�_+ --34 ; Date —[:Z-- B S Water Sample Test Results S]A r . Comments %-J6"4_ I Ea.O 77>` Ewa- tzz ra. v.Ttx_ . a 2aCG_.e�5 o f B. SEPTIC/HeTVMG TANK DATA Date Installed LO -4-15 Size I o0o No. of Compartments 1 Standpipes 4PN) Air -tight Caps (AN) Foundation Cleanout (YA _ Depression over Tank (Ya Date Last Pumped 12 - 7-1 - B Pumping/Maintenance Contract on File (Y/N) I'PJ s ; for a A N A Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Ho+ding Tank: To Water -Supply Well I oo r To Building Foundation 17 1 To Property Line tc, L'+ To Disposal Field 25 1 To Water Main/Service Line , k o A- To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-02601,84) &7) A. I C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type Type of System Design P� f Date Installed to - `(' q!5 Length of Field tZ Width of Field 1 �-� Depth of Field Gravel Bed Thickness lD r Square Feet of Absorption Area Z p f3 , Standpipes Present MN) Depression over Field (Y/6P Date of Last Adequacy Test Results of Last Adequacy Test sknSr;�n. Separation Distance from Absorption Field: To Water -Supply Well t oS To Property Line lt5 tt To Building Foundation 3 tom To Existing or Abandoned System on Lot (13 P ; On Adjoining Lots 301't" To Water Main/Service Line t a �'f to Cutbank (if present) tJ A To Stream/Pond/Lake/or Major Drainage Course a A To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at 'Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• 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 S ! S Engineering Date 6�x Company -alesIm "M_ MOA No. Af-! 52P_2 Receipt No. 3 1.0 U 1 11 Date of Payment 1 a -,Au- 917 Amount: $ to .O b Page 2 of 2 72-016411,841 K)� 3�'�v oTAP�D�2 774 -}Otis G/7 /79 MUNICIPAUiY C. P,NCFIOP.AG@ MUNICIPALITY OF ANCHORAGE DEPT. 0. : 'IT" & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION,; -' ;;,•-I�T:i! i : J::.CTION •// 925 L Street • Anchorage, Alaska 99501 I/\ JUIN ENVIRONMENTAL ENGINEERING DIVISION Telephone 2644720 RECFIM REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEFCFACILt71ES' DIRECTIONS: Complete all parts on page 1. Incomplete requests will not lye processed. Please allow ten (10) days for processing. 1—P PERTYOWNER 6. TYPE OF RESIDENCE //PHONE [Sr FAMILY ❑ One ❑ Four ❑ Other b) - MAI ING ADDRESS ❑ MULTIPLE FAMILY PR P RTY RESI DEN If different from 19)ovel P ONE I . L f' �4 6 94-Ck 2.,PUYER \ PHONE MAILINGODES f F> 3. LENDING INS UTION1�'r PHONE n c P Pt 2` INDIVIDUAL/ON-SITE" MAILING ADDRESS 4. REALTOR/AGENT PHONE uJ YI NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDRESS i 5. LEGAL DESCRIPTION k CO IG! oC REE T LOCATION O 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [Sr FAMILY ❑ One ❑ Four ❑ Other SINGLE ❑ Two ❑ Five ❑ MULTIPLE FAMILY C5�, Three ❑ Six 7. WATER SUPPLY g INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 106 - B. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE" "If individual/on-site, give installation date. If system is over two (2) years old an adequacy tee is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72,01013179) y�� wo. ^ THIS SIDE FOR OFFICIAL USE ONLY ' INSPECTION APPOINTMENTS I' DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTORINSPECTOR INSPECTOR DIRECTIONS:. - - 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER of BEDROOMS I I ❑ ONE ❑ THREE ! ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX I' I 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY _. Connection Verified ` PERMIT NUMBER I DEPTH OF WELL DATE DRILLED LOG RECEIVED .. 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER I DATEINSTALLED INSTALLER. ❑Sep icJbtr ❑Holding Tank Size: l(jj If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA - MATERIAL _ i 4. DISTANCES ' ' WELLTO: Septic/Holding Tank Absorption Are I QS— l Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS i I 0"APPROVED FOR S BEDROOMS - ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED seal I DATE } BY Till 1 .. LEGALD SCRIPTION 72-010 (Rev. 3/78)