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Home My WebLink AboutLAZY ACRES LT 7 GR" ~R ANCHORAGE AREA BOROU'- DErARTMENT OF ENVIRONMENTAL QUALI', , 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING > --x ;- ADDRESS ,J--~'~'"'~ &/~2~/--~¢'"'--/,~''~''2'¢/~''= PHONE LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL_ ~'~'~?~¢__/'/¢'/' LIQUID CAPACITY _/.~_~.2~_ .... GALLONS. NUMBER OF MATERIAL /~'~ t~,/--~'~"~'"~,'T~''~- COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID ~.._._ DEPTH __ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS.__ _// OUTSIDE DIAMETER LINING MATERIAL NEAREST LOT LINE , LENGTH /~ , DEPTH_ OR WIDTH__ DISTANCE FROM WELL ~/Z./?///',/-/-'C/&~/'~'-~~/:' __, BUILDING FOUNDATION'~?(? TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ, FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUMBER OF LINES~ ABSORPTIf~ARkA DEPTH: TOP OF TILE TO FINISH GRADE DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE , NEA~E~LINE_ TRENCH TOTAL LENGTH OF LINES IN, TOTAL EFFECTIVE IN. ABOVE TILE WELL: TYPE ~<'/¢:?./~.2/27~/,.//.,..,~. DEPTH ~'~ NEAREST c~'- SEPTIC LOT LINE c~ , SEWER LINE . TANK~ DISTANCE FROM ¢...~-- WATER , BUILDING FOUNDATION ....... SAMPLE SEEPAGE ~.~ ~-,-~' , SYSTEM ..... CESSPOOL NEAREST OTHER SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE ~ ' G.A.A.B. GAAB-I'I I~.2 GREATEF 327 Eagle St. .,,NCHORAGE AREA ltEALTH DEPAILTMENT Anchorage, Alaska 99501 ROUGH 279-2511 Case No. ¥> /'~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL. DESCR PT ON LOCATION OF INSTALLATION ?~z)'))x ~:,/{' //.~, APPLICATION TO INSTALL: SEPTIC TANK t- , SEEPAGE PIT. ~' ,DRAIN FIELD ____,OTHER TO SERVF THE FOLLOWING FACILITY_ "~ 't!'~ t)i? FINANCED THROUGH _~ L ~ . TO REINSTALLED BY_ PERCOLATION TEST RESULTS /~J ~ ~ANTIClPATED DATEOF COMPLETION. BELOW TO BE FILLED OUT BY HEALTH DE~ART~E~T AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED : ~ · SEPTIC TANK SIZE /(')( !(,) TYPE ~:/"~/l')(::'//J"'il SEEPAGE AREA DIAGRAM OF SYSTEM TYPE I ce['tJ£¥ that ! am £amJ]iar with the reguJrements o: Gre~ter Anchorage Area ~orou~h Ordinance No. 28-68 and that the above described system is in accordance with said code. ~~:~:,/ DATE (_ ~ APPLICANTS SIGNATURE 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~ ~'¢-.~<,."( ~(::~"/~ _ Telephone: Home ~ ~Business Applicant Address ~ o I ~, ~O~ ~ ~LVD . (c) Applicant is (check one): Lending Institution ~ Owner/builder~ Buyer ~; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (l) Mail the HAA to tire lollowing address: TYPE OF RESIDENCE Single-Family.~ Multi-Family [] Number of Bedrooms ~-- Other WATER SUPPLY Individual Well [] Community [] Public,l~' 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 [] Floiding Tank [] Note: If community well system, must have written confirmation from the State Department 0[ 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 inlormation obtained from tim Municipality of A~chorage files and from my investigation a~d i~specdon, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, a~d regulations i~ effect o~ the date of this inspection. NameofFirm ~~ ~ ~N~ Telephone ~ ~ Address ~_k~O ~ ~ ~ /,_~O~ / ~L ~ ~/~ ~.;'.t~.~.~,/~ ~ V~¢Engineer's Seal ~a ~"., THOM A. FISCHER ~'~ , CE-6793 ,' Approved 2'"~" Disapproved Conditional Terms of Conditional Approval 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 fo 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 ENVIRONMI~NTAL RECEIVED 264-4720 WELL DATA Well Classification . ~ ~L.~6. Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments Bm SEPTIC/HOLDING TANK DATA Date Installed ,.~--'~F' ~ 1~'7/Size J CCc) No. of Compartments Standpipes (Y/N) ~r"~'~ Air-tight Caps (Y/N) Depression over Tank (Y/N) __~q;:~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) f,4/v~ Separation Distances from Septic/Holding Tank: To Water-Supply Well '~¢c.'~ ~.-4¢¢Te_.*¢-. To Property Line '~7 '" To Water Main/Service Line ¢~(~.r..f.~ Course ~'"~/¢'~ Foundation Cleanout (Y/N) ~'~. ¢¢ Date Last Pumped ~/'~,/1~G, ;for N/C, Temporary Holding Tank Permit (Y/N) ~/¢~ / To Building Foundation ~'~ To Disposal Field ! ~ e To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~-~2'1- ~ 0 Width of Field /'~--/ 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 1',4 / ¢~ To Water Main/Service Line I To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 1',4 '/V'~ To Driveway, Parking Area, or Vehicle Storage Area Type of System Design "~"~-- Length of Field /?-- Depth of Field ~" Gravel Bed Thickness Standpipes Present (Y/N) ~:~ Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots Comments D, LIFT STATION Date Installed Dimensions Size in Gallons ~ess (Y/N) "Pump On" Level at ~ "Pump ?ff" Level at High Water Alarm Level at ~z~ Font(Y/N). Tested for / '~equacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I Jqave chec.l~-:~tcqerified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ~ ~ ~, ~.k~ ' Date Company ~~Nq~ ~¢MOA No. Receipt No. ~ ~ ~ ~"'~'""~'"" .,,'~'-,..~:, ~"~ Date of Payment /.". ~%~ ~ ~ '%' *' Engineer's Seal Amount: $ :....% :: ..... ~ ~ % THOM A. FISCHER Page 2 of 2 ?,¢,~ 0~.% ~b-6793 .' ~O~ ' DaLe Rece.tved: June 23, 1977 ~~//EQU~' ~%~' 'EQUESI' b'OR APPROVAL O~ INDIVIDUAL SEWER ....... AND WATER PA(RILITIEg 1~ ~/ % Carol Owens -~__ , LertdJ.ng Inshituhion Request: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 275-3580 2. Prop(;rhy Owner: Wesley J. Willard Phone: ~ai]_ing Address: 8260 Pokey Circle 99507 '3. LegaA Descript:ion: 4: Sing].e Fam:i. ly Residence: ( Multiple Family Residence: Lot 7 Lazy Acres Subdivision Number of Bedroo~: ~WO Number of Bedrooms: 5. WetJ Sys'hem: IndJ.vidual Well ( ) Co~mumit:y/Public System (z) Permit # ................... Depth of '~ ' ;,7e].]. Well Lo~ on File ( ) ConshrucLion ~ BacLer'ial Analysis ~ Sewage Disposal Sysbem: On~'sic(.~ System (:~ Pub]_:ic Utility ( ) Septic Tank ~'" , ~_ /,, Distances: Well t.o Septic Tank tO ~" ~ ~r .,O~ AiDe oew¢._ ]',Jne Nearest 1' - to Nearest Lot Line to Absorption Area ................ Absorption Area · Page.' ~o Department of Health and Enwtronmental Protection Request for Approval of Individual Sewer and Water Faci].ities Legal Description: Lot '7 Lazy Acres Subdivision Affadavi't Attached: ( ) Letter Attached: ( ) Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO. VA_ FHA CONV 2. Property Owner: Wesley J. Willard Mailing Address: 8260 Pokey Circle, Anch. Ak. 07 Day Phone:__276-5727 3. Name of Buyer: Charles B. Cox Mailing Address: 7331 East 21st.¢ Apt. A Day Phone:__277-1561 Ext 236 4. Name of Lending Institution: First National Bank of AnchoraRe Mailing Address:_ ?,0, Box 720~ Anch. Ak. 99510phone: 265-3580 5. Name of Realtor or Agent: None Mailing Address: Phone:_, 6. Legal Description: Lot 7, Lazy Acres Subdivision Location: 8260 Pokey Circle, Anch. Ak. 99507 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Modular Home Public Utility. No, Bdrms, 2 Individual Community If Individual, number of dwellings presently served If Individual, depth of well, Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site) x Carol Owens Mortgage Loan Processor 72-003(3/76)