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Home My WebLink AboutT15N R1W SEC 8 LT 40116/'J SFS g f',4UNIL-IIM~Ei.rY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H~:~ALTH & DE, tTMENT OF HEALTH AND HUMAN SER\ ,;~S ENVIRONMENTAL PROTeCtION Environmental Health Division 825 L otreet, Anchorage, Alaska 09502, Telephone 264-4720 ,.,U r ~ 4 ~' % ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Namo Address TANKS [J~'~EPTIC [] HOLDING Manulactufer Capacity in gallons Material No el Compaltments SEPTIC TANK WEI_L /mO/ LOT LINE .:t: ~/ FOUNDATION '~g ~ ABSORPTION FEI. D WELL , F~"~RENCH TYPIE= OF SYSTEM [] BED [~ W. DRAIN [] OTHER FI FT Total depth trom original grade /¢~ FT FT FT g Oislance between hnes s~ FT N'/,,~ F~ WELL8 ~/[i~ ~/~ ~RIVATE [] OTHER (Identify) REMARKS: ftlutiicipal and Health Department Approval: 72-013 (3/85) Scale: / Hmpections Performed by: cerlily thai this inspeclion was pedornled accordJnD I~1 all PEBFORMED FOR:_ LEGAL DESCRIPTION: 1 2 3~ 4- 5- 6- 7- 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICFS 825 "L" Street, AnchoragE;, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ~.~ ~ s L IF YES, AT WHAT O DEPTH? p E Depth to Waler Alter Me,~iloring? __ Dele: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE -- {minutes/incht PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FT AND __ FT COMMENTS '~'"~'-/L'[c~/'"~' '~'~- //~::~ ~~ ~ ~5'~/~~ PERFO~EDBY:--S"~ ~X --~~~ CERTIFY THAT THIS TEST WAS PERFORMED IN AGOO"DANOE WITHlam"[V~"~*~ELI~FEGT ON THIS DATE. ~ATE: _ /~' ~,/~ ~' 72-008 (Rev. 4/85) DA I]ii: , I.:l.Jl .1),, ('1 f ,...I. CAI l1 ~, ADI.)I d, ,, JEANET'f'E Jt]I-.tN,"-]~(]N / liilAGME RIVER!, AK 99577 6~74-;;!979 I..Ot' ,.. J. ZI .... MAX St,J B.(:) I V I S :1: O N ',' I',1 / A I. ,[)T: B L H 4, O SE:I.'::'I I I_')N: 8 'I]]WN~I'1:1: I':;': :1. 51',1 RANGE ~, :!. W 2,, 5A (S[~!,,I:::'I',, E)R Al]RES) BI.E)CK: I",1/('~ fAItl... MUST HAVE AT LIEAST 'TWO COMI::'ARTMEI'..ITS fl:)J'1:.h by t.I](~) Mur'~:iC:Ll::~aI:H'..y I::)f Anclicmagr~ (MOA) a~l(:/ '(.l'le Stati:.:, ot' 2,, I will ;i. nstal:l, the sy:~Ft:.(;.)fl', :i.~i ;::t(:::(:::(::)t*(::l~:~"~(::~.: ~,,~J.'~:.l'l [.'~]l Fl[IA (::t:;)~:l(:.)!~ arid .],,, I will ,'~l::ll'l(::~r'~:~ t.o ali. MOA arid SE. cd:.~ f:)t' Alaska pequir'ements ~(:)r' 'Lh(:~ ~i~..>'t'. back · q,, :[ undel's't'.arld t_ha'[. '[:.his I:.)(;;mmit :J.s va]id ('(:~, a ~fl¢Lt>[:i. lf~t.ufl (:)~' 4. J;:~c~dt"(::,(;~fft~E. IF A LIFf SI-A]':I:DN ]:,~ TIIILFI (:t) Ahl EMECTRI[ WI fL NO'I' ]..:IE AF"Pf~O'~, I!i:l~ IEC] I?): CAI_ WORK :1: I",I.~YI"AI..!..Iii:D I I~.1 AN AI:?IEA [;OVIZRED I:::'tEI::i:MI r' ~:.~I',,ID II',.h':~I::'I~i!;[iT'I:EIN MUST BE O'f:rI'~INEDI [CAI.. Il' ::lit! I::iI~iF;'EIRI'~ ¢~FID (3) 'IIIE Al t L t.(,AI,II; EER'S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TI=ST DATE PERFORMED: LEDA' DESCRiPTiON: t 2 3- 4 7~ 8- g~ ~0- 1 14- t~- 18- 20-, Township, Range, Section: SITE PLAN SLOPE ENCOUNTERED? PERCOLATION RATE __ (mmutes/~nch) PERC HOLE DIAMETER ~ERFO~ED .~: S & $ EN(~INEERINO ~~~F/' CE~T,r~ *HAT THiS T~ST WAS P~O.MEg .N ACOOHDANOEWTH~A~'~MUNICIPALGUIDELI~OTONTHISDATE. DATE: _~~ z~-0o~ {.~. ~s) I~OLE RIVER, AK 99577 Reading Da/te (~ r °sS/--': Net Depth to Net Time Time Water Drop ANCHORAGE AREA BOR""GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'~.¢~/ J~.Y~/.~'.J'~¢)/~/ . MAILING ADDRESS ~ ~.~;"~ ~.~ ~. ,~, ~, ~ ..~ .. LOCATION~/~/~-~/2~ /--~ ~4 LEGAL DESCRIPTION SEPTIC TANK: DISTANCE . / FROM WELL .//~/'~) MANUFACTURER INSIDE LENGTH_~. INSIDE WIDTH NUMBER OF COMPARTMENTb ~ '- MATERIAL. ~:E;-L-- - L~/¢~2 ' SEEPAGE PIT: NUMBER OF PITS /' DIAMETER ~-' OR WIDTH /'-5:-~ / ,"/,,~') / ¢ __. . LENGTN , DEPTH ~"~¢/ LINING MATERIAL/--/~2¢~£__ CRIB SIZE: DIAMETER ~-/~'DEPTH. Z~ /'DISTANCE FROM: WELL~/''~?'' / BUILDING FOUNDATION ~'--~_, NEAREST LOT LINI--~:~2 ~-' TOTAL EFFECTIVE · ABSORPTION AREA (WALL AREA)'/~/(~/~ SQ. FT. ADDITIONAL· ABSORPTION /~'~-~ WELL: TYPE ~.-//¢/~';¢./~//-~'./~'¢~z¢~CONSTRUCTION 4:~'//~2¢"~J-/.-z~.~-:~/.~¢/~''- DEPTH ~/-_/'~¢2 ~<:~- DISTANCE FROM: BUILDING ~ / NEAREST NEAREST SEPTIC . . / SEEPAGE FOUNDATION ~ LOT LINE -/~:? /~ SEWER LINE TANK_'/~"2/~', SYSTEM. ./'-=~./: / CESSPOOL~--(~/~c' , OTHER SOURCES APPROVED___. DISAPPROVED DISTANCES: INSTALLED 13Y: PIPE MATERIAL: LOT SLOPE: DIAGRAM OF SYSTEM ~., ' ,0 7~) "O~e ~as~ is ~orth a 6~ousa~d Lethal ~escription: Lot., Block Subdivision~~~ This ~orm Re~orts Soils Log .... ~ _ Perco~-ation Tes~_~ Oeoth , Feet Soil Characteristics ,.. $: Wa'$. ~round Water Encountered?./q/t~ If Yes, At what Depth? ......... Reading I Date Grass Time Net Time Depth to H20 Net Drop Percolation Rate Hinute Proposed Insta-~lation: Seeoaee Pit ~,~-~ Drain Field Death of Inlet ' ,Denth ~ Bottom~f,Pit Or Trench Date: GREATER ANCHORAGF AREA BOROUGH LEGA'-.DESOR,,~T,ON ~0~ qo PERMIT NO, SI:'WAGE DISPOSAL SYS'rEM -- APPLICATION AN~D.PERMIT SEEPAGE PiT- -. DRAIN FIELD ~, OTHER To BE ,.STAL,.ED .¥ NOTI""~ THIS PERMIT 18 NOT VALID WlTROI.IT 8GIL TrEST F'INAL, INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLINL~ OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT . SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK TO NEAREST LOT L,.E. DRAIN FIELD SEEPAGE P,T _ / 6T~/ ALSO CONSIDER AREA WELLS. DIAGRAM OF SYSTEM CAST~ IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP ~ EXCAVATION ~ FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE Pit F~ITTED_WITh AIRTIGHT REMOVABLE CARS~ GRAVEL BACKFILL CONFORm TO E~OROU GULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 2B-68 AND THAT THE ABOVE S;/? M'I/ 6r~re/ ,5';/? ;:/,'?: ccr~re/ [- rea' Johnson Loot, load ¥ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMF. NTAL HEALTH DEPAK~4ENT OF ttEALTH AND ENVIKONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE (a) Legal Description (include lot, ~lock, suhdivision, section, to~mship, ra~e) Location (address or dlrect;io~) , ' ~ N Applicants Name ~ Tele hone Home Business Applicants ~dres~~~~ ~ ~~ ~d?~/ (d) Lending Institution ~~ ~ ~ ~ Telephone Ad d r e s s (e) Real Estate Co~ & Agent ~ /~j~ Address (f) Telepho ne Mai]. the HAA to the following address.' T_j~.~. o__f Residence Number of Bedrooms %ndivid=l Well ~[ Co=nunity Note: If community well system, must have %~itten cogitation from the State Department of Enviro~ental Conse~ation attesting to the legality a~ status. M~wag~~ Onsite ~ Public Note: If community ~11 sy~:em, must have ~ltten confirmation from ghe Stat~ Department of Enviro~ental Conse~ation attesting to the l~gality and s~a~us. [Page 1 of 2] 5. ~:n~ineeriug~ Firm providin$ Ins e~ion~3_~u~est__~sz~_~ile___2~ea_~rch_~z Data and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investiga~ion of this Heall:h Authority Approval sho~,~ that the water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and ~'ype of structure indicated herein.- I further verify ~hat, based on the information ohtained from the ~,nicipality of Anchorage files and from my' investigation and inspectien, the on-site wa~er supply and/or wastewater disposal system is in compliance with all M~nicipal and State codes, ordinances, and regula.- tione in effect on the date of this inspection. Name of Firm Address Date Telephone Approved for~ <~J bedrooms By Approved _~V~i_" Disapproved Terms of Conditional Approval Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEt'AR~/~ENT OF ~J'2ALT~I AND ENVIRONMENT~%L PROTECTION (DHEP) ISSUES HEALTH AUTHORITY AI~PROVAL GERTIFICATE$ BASED SOLELY UPON THE REPRESENT~ ATIONS GIVEN IN PARAGFu~?H 5 ABOVE BY AN INDEPENDENT PROFESS-~iOb~ ENGINEER REGISTERJ~D IN THE Sq~kTE OF ALASKA° T~IE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LE}[DING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND Sq~TE REQUIRE- M3ZNTS. ~LMPLOYEES OF DHEP DO NOT CO}~UCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITg OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROI.~ESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/e~/D18 [~'age 2 of 2] MUNICIPALITY OF ANCHORAGq'] DIVISION OF ENVIRON/4ENJfAL Ifl~iALTI{ DEPARTMENT OF HEALTH A/~D ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o Genera__l Information Application Date (a) Legal Description (include lot, block, suhdivislon, section~ ~ownship, range) Location ~addre~s or direc~io~ ~ ..~ ) Buyer ~ ~ Other [~I (~plain); Address (e) Real Estate Co, & Agent Address Telephone /./-,o 0 .......... (f) '-M~fifl the HAA to the following address: Z. _o __Resi!e o e Number of Bedrooms ~. )__ - Note: If community well sys~e~ must have v~i~ten confirmation from the State Department of Enviro~ental Co~me~ation attesting to th~ legality and status. Note: If community well system~ must have ~zritten con£irmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] File oearc~h~Data and Info~latiou ~m~g~fie~ by my seal. affixed hereto and as of :he validation date sho~ below, I verify tha~ ~ imves~igation of this He~th Authority Approval sho~ that the on-si~e ~;ater supply and/or ~stewater disposal system is safe~ f~ction~l and adequate for gh~ number ef bedrooms and type of structure indicat(~ herein.- I further verify that~ based on the info~ation obtainc~ from the Y~nicipaligy of Anchorage files and from my lnve:stigation m~d inspection, the on-site water supply and/or wastewager disposal ~ystem is in compliance ~t:h ~[1 Municipal and S~ate codes, ordinances~ and regis t:ions in effect on the date of ~his Name of Firm Address Date (ENGINEER Approved for /% ~ bedrooms Approved \~" Disapproved Te~ns of Conditional Approval Telephone. Cond~ Dar ,' , CAUTION TIIE I~JNICIPALITY OF ANCHORAGE UEPAR~]~ENT OF Hq~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES I~ALTE AUTHORITY APPROVAL CERTIFICATES BASED SOI~I,Y UPON lite ]LEPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER ]AEGISTEtLED IN Tt[E STATE OF ALAEKA. ~HE DHEP DOES THIS AS A COURTESY TO PU]ICHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEIIAL AND SqLATE REQUIRE- MENTS. I'~4PLOYEES OF DHEP DO NOT CONDUC~.~' INSPLCTIONS' ~ OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSI~D. %]{E MUNICIPALITY OF A~NCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGI~']ER'S WORK. (DHEP S F~aJ~ ) RR4/ej/D18 [Page 2 of 2] 7-19-"84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHEC2(LLS~f - FEBRUARY 1984 Well Classificatio/~ ~/~/~ ~ Total Depth ~'~' ~'~'7 / Cased to Static Water Leal _ ,~ / Casing ~ight ~ G=~nd ~ '~ Elec~ical Wiring in ~nduit~(~) ~p~ation Distan~s ~On ~1~ TO ~ptic~ Ta~ ~ ~t ~ ~ To ~a~st ~ge of ~)s~ption Field on ~ If A, B, cyr C, D.E.C. Approved(_Y/N). _~i__;(.C~_~// Date Completed /,~ ~d~ Y~eld ~ ~,~ ~pth of G~outing. Seta Sani~ ~al on Casin~) ._ ~esslon ~ound ~l~lead (~-~ _ ; On Adjoining Lots To Nesu~est Public! Sewer Line /J ,//~ To Nearest Public Se~r Cleancut/Manhole /~r//Q To '.Nearest Sewer Service Lioe on ]Lot Water Sar~.~le Test, Results __<S~'.~ ~/J'~9¢'F'~/C---f , SEPTIC/HOLDING TANK DATA Date Instal~d Size No. of Ccmpa~tm~nts / Standpipes (~/N~--/ , Air-ti~h't Caps .~,~/99) Foundation Cleanout __~-'~_~ Dapression 'over Tank (~f~ _ Date Last P,u~.~ed ~ ~/~;~- . Pumping/Maintenanc~ Contract on File ~/1 ; for .~-- Holding Tank Hlgh-Wate= Alarm (Y/Ng'/ ,~ Temporary Holding Tank Permit Separation Distano~s frou Septic/H~giung-,Tank: ~ To Building Foundation ~c~-~ / To Water-Supply Well To P~operty Line /O 7 To ~ter Main/Service Line Course Counts TO Disposal Field /0 ~ TO Str~eam, Pond, L~ke, ¢~ ~jor ~aina~ [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ~':/7,-.~ Width of Field /~- Length of Field Depth of Field Gravel Bed .Thickness Standpipes Present/(~/N~ . Square Feet of Absorption A~ea ~%"~:~ ' -%/' _/_/~ -- Depression over Field (;fA Date of Last Adequacy Test Results of Lest Adequacy Test~ ,~-{,.jo,~ ;~¢. Separation Distance from Absorption Field: To Water-Supply Well //.~.O w To P~ope~ty Line ~ g~ To Building Foundation ~2 ¢ To Existing or' Abandoned System on Lot ~O ~uf~ ; O~ Adjoining Lots .~ To Water Main/Service Line /~ ~/ To Cutback(if present) ~c~p To Stream/Pond/Lake/o= Major D~ainage Course .<~m ~-~/~ To Driveway, Parking Area, o~ Vehicle Storage Area ~'--6] ~ Cu~ments W~ ~ /~ ~ De LIFT STATION Date Installed Size in Gallons "P~f~ O~" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Cc~m~nts Dimensions /. / /'Pump Off" Level at. /z%/ / l~' Vent (Y/N) Pumpi>g Cycles duaring Adequacy Test. M~ets MOA ** ** Check l:ermitted Bedrocm Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA }{AA Gui~Des in effect on tP~ date of this inspection. Signed ! . S~ 1~;~ Dat KB1/d5/s [Page 2 of 2] :~-- 2-15-84