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HomeMy WebLinkAboutBIRCHWOOD ACRES LT 4 Municipality of Anchorage r EPAR'~;'/IENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AN, D/OR WELL Z~ o~'/'~ PERMIT NUMBER ADDRESS ~'~ ~o~ ~'~ ;~ LEGALBESCRIPTION ~/'¢~7~ y · r ~ #OF BEDROOMS SEPTIC TANK /~-~c MATERIAL #OF COMPARTMENTS INSIDE DIMENSIONS LENGTH WIDTH DEPTH SEEPAGE SYSTEM"i [] TILE DRAINFIELD NUMBER OF LINES LENGTH .EACH TOTAL LENGTH DISTANCE BETWEEN LINES TRENCH WIDTH DEPTHS: TILE T.O~ADE FILL BELOW TILE FILL ABOVE TILE I[~'~EPAGE TRENCH OR [] PIT / [] LoG CR,B [] RINGS- DIA. FILL MATERIAL DEPTH TOTAL EFFI~cTIVE[ AiBSOflPTION AREA: ,~,. ~-'~7, SO~ FT. C LASS I Fl CATI 0 N WELL DEPTH PIPE MATERIAL INSTALLER REMARKS DATE//* /[~ 79 72.012 {9/77); DISTANCES FROM~~ SEPTIC SEEPAGE SEWER TANK SYSTEM LINE CESSPOOL WELL WELL LINE SYSTEM DIAGRAM LOT:, Y BLOCK: NAME OF APPLICANT GREATEr ANCHORaGe AREa BOROUGH ~-~ 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHO.E SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION LEGAL DESCRIPTION C d '~'~' INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED ,~ DRAIN FIELD b~l~J OTHER TO BE INSTALLED BY ~'~l-~C~ ~ //~ NOTe, THiS 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 SIZE I~ ~ ~ TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PiT WALL . DRA~N FIELD /d r SEPTIC TANK ,SEEPAGE PIT . DRAIN FIELD TO NEAREST LOT LINE. WELLTO SEPT,C TANK SEEPAGE P,T DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, / ~ SEEPAGE PIT / O~-~/ ~ 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 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS~RDING INSTALLATION. / / G.A .A .B, OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA/~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~ ~ k /_ ~ FORM NO. EQ-016 ~ ~ ~ -- - ~ M-W DRILLING, INC. Well Owner Location DRILLING LOG Use of Well (address of: Township, Range, Section, if known; or distance main road .Depth of Hole .Lt;) feet Cased to :]0.4 feet ' ft. ~.O!b~o.Y~3 (below) land surface, Finish of well (check one) Size of casing. Static water level Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at -~ gallons per (kou~) of drawdown from static level. Date of completion r~' ; ' ~ ;'~ i ~;~ ~ (minute) for ? hours with open end ( ); ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness .TO · '~ .TO ::~ ~ .TO ~ - .TO r ' ' ~ .TO .TO .TO .TO .TO --.TO .TO .TO ,Orgasmic :~ NW'WA C('"Uf;cd Con~etor (,'erfif':c. tc No's. 814 & 973 2--STATE MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ /-Jr' '"u'~(JIPALiTy OF A" _. DEPT. OF J~NVIRONMENTALC/~HT£~T/O RECEIVED A. WELL DATA Well Classification Well Log Presenti~)N) '~, ~'. If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ - ~" '7 7 Yield Casedto z'~,~'*,~'~ Depth of Grouting '"-'"' Pu m p Set At t./, Total Depth · Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~/N) Separation Distances from Well: To Septic/,Hofl3Tl~ Tank on Lot Sanitary Seal on Casing~N) Depression Around Wellhead (Y/{~ · On Adjoining Lots To Nearest Edge of Absorption Field on~ot t~~4''' ~-; On Adjoining Lots _t~-~,~.~4 To Nearest Public Sewer Line ~3/'/5' To Nearest Public Sewer Cleanout/Manhole f..3/~ To Nearest Sewer Service Line on Lot Water Sample Collected by '~-'.~4 ~ "~l/~"-~g'~.~-.~ ; Date ]~-' ] Water Sample Test Results '~,-~-I~ l~'-~r~-~'~"~ Comments A ~,,/f~t...~ yl~,~/~ '-r~.,.¢' ,$'/,~1~.,/~-,"~ '7"[~'~ ~/~[,,4- ~ ~'~.~:~ To Water-Supply Well To Property Line To Water Main/Service Line Course Date Installed /j--J(o' ?? Standpipesd~)'N) Depression Over Tank (Y/{~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic~lel~'n~ Tank: Size / 4;;~21~ No. of Compartments Air-tight Oaps~)'N) Foundation Cleanout (Y/J~ _vDate Last Pumped / for "~"'J'/~ Temporary Holding Tank Permit (Y/N) ~.3/,~ To Building Foundation ~ ~ To Disposal Field ~ t To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ - ~. ~o - Width of"Field " '~ ~ Square Feet of Absorption Area Depression over Field (Y/,~j;' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well [. ~ t j,~ ~ To Building Foundation ~ ~ Lot I~ ]~ To Water Main/Service Line ~ c=, ¢ ,.~ To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area ~ ~.~ Type of System Design Length of Field Depth of Field ~;~ Gravel Bed Thickness ,~ 1 '~::;¢~P'~'~'-' Standpipes Present~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ;On Adjoining Lots ~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Ma?hole/Access (Y/N) fPump Off" Level at /A Vent (Y/N) 'Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA g,u~.~jnes in effect on the date of this inspection. Signed ~ ~ ~.~ .E.~qG_"..~:~_E.~ Date /O - ~ ~ ~ Comoa~,G~ ~V'~ A~ '~5~ MOA No. ~~ ~ Receipt No. ~'~'~ Date of Payment I0 ' ~' ~ Amount: $ ~~ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE .... '= ....... ~equest for Approval of Individual oewer and Prot. ectibn 99501 Water Facilities Mail.lng Address: Phone I,ending Institu'tion: ~ Mailing Address: Phone 4 6 Single Family Residence: Phone: Multipl. e Family Residence: ( ) Number of Bedrooms: 7 Water Supply: * Individual Well (~Public/Community System If Individual Well, well depth /_~ . ( ) If' Connnunity System, name of system 8. Sewage Disposal System: *'©n-site System ~~P/blic System ( ) If On-site System, date of installation: __,~././~"7 *NOTE: A well log is required on ALL wells drilled since 6/75. ** Iff on-s.ii:e sewer system is over two(2) years old, an adequacy test is required by this department. A fee ef $25.00 must accompany each request before precessing can 3/77 MUNICIPALITY OF ANCHORAG,_ DEPARTME~. OF HEALTH AND ENVIRONMENT. PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: ~oMe~b_-e.r 16_~. ,,1~3_.! .... #1: Time __1~.1:.00 a.m,_ #2: Date 11-17-77__ T__bursday Insp .Pratt Time Date Time Date Insp Insp REQUEST FOR APPROVAL OF ' ~ INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: State of Alaska, Veteran's Administration · Mailing Address: Phone: 688-2468 2, Property Owner: Michael Quarne Phone: Mailing Address: S~a_r Rout_ ~ ~ox.,642 99.567 3. Legal Description: Lot 4 Birchwood Acres Subdivision , Three 4: Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) 'Number of Bedrooms: well System: Individual Welt (x) Community/Public System ( Permit 9 Depth of Well 180' Well Log on File Construction Bacteria]. Analysis 6. Sewage Disposal System: On-site System (x) Permit # Installed ...'1977 Installer ..... Manufacturer Septic Tank Size Absorption Area _ Soils Rate Well to Septic Tank Public Utility ( ) 7, Distances: Material to Absorption Area to Sewer Line to Nearest Lot Line Nearest Lot line Absorption Area Legal Pa~e -Two Department of Request for Approval Description: Lot 4 Birchwood Acr_es Subdi__vision Comments: Health and Environmental Protection of Individual Sewer and Water Facilities Affadavit Attached: (/S-~ Letter Attached ~sa~nrover~: Date: Department Worksheet: