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Home My WebLink AboutDELUCIA LT 42o? '{% MUNICIPALITY OF ANCHORAGE. ,, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ IPHONE [ [] NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS J we. I Absorption area Dwelling / PERMIT NO. ~ ~ DISTANCE TO: j~'~] ~ ' ~ ~ ~ ~ ~ Z Manufacturer Material No. of compartments ~Liq. capacity in gallons Inside length width ~iquid depth /~ ~O IF HOME,DE: ~ ~ DISTANCE TO: well Dwelling PERMIT NO. Manufaoturer Material Liquid capacity in gallons ~ DISTANCE TO:, Well j~ o ' , F°undati°n 'O~' Nearestl°tline'o ~ PERMITNO' ~O~*~ No. of lines j Length of each line Total length of lines Trench width / Distance between lines ~ ~ Top of tile to finish grade Material beneath tile / Total effective ~bsorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective abs~ption area ~ Well Building foundation Nearest lot line z ~ DISTANCE TO: /lO b S e ~ O ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~p SOl L~-TEST R~TING /~* , ~ ~E~A~KS ~'~RO~E~~ ~%., CE-~35 ......... ." .'~%~Z~ DATE LEGAL~ ~,~ ~.~' 72-0 GRE. 'R ANCHORAGE AREA BOF ~GH {~ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ,,~ . .~ ;,_ '~,/ ~.~ ~. /-',.~.,. ~ SEPTIC TANK: DISTANCE ~ FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL , COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY ~u,w~.- GALLONS. SEEPAGE PIT: NUMBER OF PITS -- DIAMETER __ LINING MATERIAL/~i(r /~)/~")~' CRIB SIZE: DIAMETER__ BUILDING FOUNDATION ~-4' , NEAREST LOT LINE OR W,DTH/2,' LENGTH/Z: DEPTH DEPTH DISTANCE FROM: WELL TOT AL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT. WELL: BUILDING ~' FOUNDATION '"'~ ('"' NEAREST ~.~. __, LOT LINE CESSPOOL /'/4 , OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE DEPTH ~-- DISTANCE FROM: SEPTIC ~,.,~'... ~ SEEPAGE TANK ~' '~ , SYSTEM REMARKS DISTANCES: INSTALLED BY: Li'~'~'/~' d/~ LOT SLOPE: ~'% k ~z-' Form No. EQ-031 OF SYSTEM "t>;; --[ ':" J,' DATE/'~'//L/7 ~ APPROVED pC' G.A.A.B. Gre~ R ANCHOrAGe Area Bof ~gh DEPARTMENT Of ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION MA,LING ADD.ESS LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT TYPE AND S,ZE OF FAC,L'TY TO BE SE"VED 'Z-/'~/?'<O' FINANCED THROUGH COMPLETION DATE ANTICIPATED DRAIN FIELD OTHER TO BE INSTALLED BY 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 SIZE TYPE s.m, ' j/z' SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENI~S - ..,--' FOUNDATION TO SePTiC Tank FOUNDATION TO seePage PIT SEPTIC TANK J .,SEEPAGE PIT TO NEAREST LOT LINE. Drain field /~}C WATER MAIN TO SEPTIC TANK DRAIN FIELD / ~t' SEPTIC Tank, /~--~}~ , DRAIN FIELD , SEEPAGE PIT ALSO CONSIDER AREA WELLS. , SEEPAGE PIT SEEPAGE P,T TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. DIAGRAM OF SYSTEM 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILiar WITH THE REQUIREMENTS OF GREATER ANCHORAGe AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ... //'~ 1 APPLICANT'S SIGNATURE DATE ~OR~ ~O. ~-~ 08'E GEO', _CHNI CAL El' DEVEL,. .'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 R~j.~sel! .Oyster' .-, ~7~ 694-2774 or 688-2280 69~ 2774 ~"~ ~'- SOIL LOG %o~ls ~ Foundations Perfomed for: Name: ~ ~~O~ ~-~~ Tel. Hatllng Address: '~ ?1~ ~~x~ ,~epth (feet) So1~ ~har~cterlstlcf No. Earl Ellis 688-2280 Land Development c q 4-7 ~ater Encountered: Yes No .._ If yes, what depth Installation: Seepage Pit V%Drain Fie~d 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 42 Delucia Subdivision Location (address or directions) Needles Drive (b) Applicant Name George Creasey .... Telephone: Home Business Applicant Address PO Box 670715, Chugiak, Alaska 99567 (c) Applicant is (check one): Lending Institution [] · Owner/builder I~(; Buyer [] · Other [] (explain); ___ (d) Lending Institution Alaska Mutual Bank Address % Cindy Gorman (e) Real Estate Company and Agent Address Telephone 694-9571 Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family:[~x Multi-Family [] Number of Bedrooms three (3) Other WATER SUPPLY Individual We~l{~[ Community [] Public El 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. Page 1 of 2 72-025 (11~84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 Telephone Address Date Engineer's Seal This office has recieved written confirmation from the engineer(Eagle River Engineering Services) and the conditional of May 24, 1985 has been corrected. This property now meets with MOA codes and requirements and is approved. DHEP APPROVAL Approved for l:hree(3) bedrooms byC'(~ L_! '"~c~_,," M _ Approved ~ Disapproved /Conditional Terms of Conditional ApProval Date July 11~ 1985 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 (1 t/84) 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 264-472O Application Date GENERAL'INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name~O (~¢~ C£eCt&e~4 Telephone: Home (~ ~-.~,_%O~ I~usiness Applicant Address /~.O, ~_c~.,,c ~,,0.,~ '~/~'"' ~_.,~CiSi~/¢ _/~. (c) Applicant is (check one): Lending Institution [] ' Owner/builder,,l~; Buyer [] ' Other [] (explain); (d) Lendinglnstitution~/~.~/'/~'- /~/¢~LrJ~// /~,~J~ Telephone Address' ~2¢2 ¢/ /P- ,/~_ 4/' ~' Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~' Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well I~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION "~%_ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of t,his, ~ Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional a..nd ad, e~.u~ for the number of bedrooms and type of structure indicated herein. I further verify that based on the information,ob_tai~n,e~. from the Municipality of Anchorage files and from my investigation and inspection, the on-site water, supply..an?/or '~ wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulaf~ons 'm effect on ~%% the date of this inspection. Name of Firm EN~LE RIVER ENGINEERING SERVICES Telephone EAGLE RIVER, AK 99577 Address P. 0. ~nv ...... Date ,..~ ~.~ ,f'"'- $g4-519§ Seal Approved for ~' bedrooms Approved Disapproved Conditional Terms of Conditional Approval /--'''~'L~ Z4'~// ~ _J'~,,~C 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) WELL DATA Well Classification ,~--t ~ ~, ~ Well Log Present (Y/N) / Total Depth ,,2.~ ~" Cased to MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 NIUNICIPALrrv 264-4720 Legal Description: ~ ~ ~ Ri C IVFD If A, B, C, D.E.C. Approved (Y/N) Date Completed /~: 7 ~ o%L.Z ~ / Depth of Grouting Yield Static Water Level /~4- & z Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Pump Set At ~ ~ Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) ~ To Nearest Edge of Absorption Field on Lot · On Adjoining Lots · On Adjoining Lots To Nearest Public Sewer Line "'~ To Nearest Public Sewer Cleanout/Manhole ,,'M¢-,-,,~ To Nearest Sewer Service Line on Lot Water Sample Collected by ,~-,~_~i *, ~-~t-- ; Date ~',"~,/~'~'- Water Sample Test Results Comments ~:~ B. SEPTIC/HOLDING TANK DATA Date Installed /~/~ :~ Standpipes (Y/N) ,Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well .~0" To Property Line '/~ c- To Water Main/Service Line /'Z~ Course Size /~ ~ ~ No. of Compartments / ,,,f"'" Foundation Cleanout (Y/N) /L,/ Date Last Pumped 'for. Temporary Holding Tank Permit (Y/N} To Building Foundation '~ "' To Disposal Field ,~-- 3' ' 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 /'~' ? Width of ~ Type of System Design Length of ~ ,7 c:~ '" Depth of Field /o Gravel Bed Thickness 't"~'~ '~ Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'/*/¢ To Building Foundation ~ ~'" Lot To Water Main/Service Line /0 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~-~ ~ ~,¢'/'..¢ To Property Line /~:;~ To Existing or Abandoned System on · On Adjoining Lots --~ To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump 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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'""~,,~!~¢~-'-~ Date Company ~'",~, ~-,~'~"'~*-/~ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/841 Engineer's Seal