Loading...
HomeMy WebLinkAboutBOREALIS #1 LT 19GRE'ER ANCHORAGE AREA MOl UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS /<;~' q~--f ~' ~"~)~' LEGAL DESCRIPTION ~q~)¢"'~ I I~ SEPTIC TANK: DISTANCE FROM WELL ]:~-O~ + INSIDE LENGTH MANUFACTURER INSIDE WIDTH NUMBER OF MATERIAL ~ ~'~ ( COMPARTMENTS LIQUID DEPTH LIQUID CAPACITYI~"'0 GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL TOTAL LENGTH FOUNDATION -- NEAREST LOT LINE ~ OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES ~ TRENCH WIDTH,~ IN. TOTAL EFFECTIVE ABSORPTION AREA '~"-<:~ ¢'"/ SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE ~OI/~.l LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE ABOVE TILE ~ .IN. WELL: CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION__ LOT LINE__, SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE , TANK , SYSTEM / -L 0 ' -/- , CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM Of SYSTEM INSTALLED BY: SEWER LINE DEPTH~ PIPE MATERIAL: LOT SLOPE: REMARKS: ~~ DATE ~./b/~)" APP ROV ED --- G.A.A.B. ,'r ANCHORA6E AREA BOr Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME F~& LOCAT,ON MAILING ADDRESS /::~¢X ~../~ ~e~ , LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL /00 ~ MANUFACTURER INSIDE LENGTH MATERIAL~-~ t qOff9 ) NUMBER OF COMPARTMENTS INSIDE WIDTH ~ LIQUID DEPTH '-" .LIQUID CAPACITY. /0~O .GALLONS· SEEPAGE PIt: NUMBER OF PITS / DIAMETER LINING MATERIAL /(~ CRIB SIZE: ! BUILDING FOUNDATION 50 OR WIDTH /~ LENGTH/'7 DEPTH /~/' DIAMETER~"q~ DEPTH ~'~ DISTANCE FROM: WELL NEAREST LOT LINE 30 / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~2'~:~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION CONSTRUCTION NEAREST NEA RES(~ LOT LINE , SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE , TANK , SYSTEM CESSPOOL APPROVED , OTHER SOURCES DISAPPROVED DISTANCES: REMARKS DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ-031 P, ou3¢. .:,1¢-I--¢:1 F- DATE APPROVED (.,/~/-~//-;)~h:; ~./.J- G.A.A.B. GrE/ --r Anchorage AREA BOI Ugh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. INSTALLATION OF: SEPTIC TANK SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED , SOIL TEST RESULTS DRAIN FIELD NOTE; THIS PERMIT IS NOT VALID WITHOUT SOIL TESI' COMPLETION DATE ANTICIPATED 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. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ., SEEPAGE PIT TO NEARESt LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD , DRAIN FIELD SEEPAGE AREA SIZE SEEPAGE PiT ALSO CONSIDER AREA WELLS. SEEPAGE PiT SEPTIC TANK, ., SEEPAGE PIT. , 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. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED ,DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ' ~ ~ DEPA~MENT 0~ H~LT~_&' ENVI ~ON~.~TALrpROTECTJON ....... ',... , ..... , ,- _ JAN 51g7 ~l~CtlO~: Complete ~11 p~rts-on p~ge 1, In~ompl~t~ r~qus~ will ~ot b~ pm~. Pleese ~1 ow ten HO) deys fo~ processing. ~AIEIN~DDRESS ' ' ~ ~- ' ' ~ ~ ~ ' · , ~~ ~ ~ PHONE, MAFLING ADDR~B . . * ' - ~ ~~ RE$1DEF · · -'~ IN E I One [] FOUr [] Othe~ ~ S GL FAMLY - ~ , - [] MULTIPLE FAMILY - [] Three ~ ~1~ ' ~ INDIVIDUAL* *ATTACH WELL LOG. Awetl log i~ ~eq~l~ed for aH well~ dri led ~ COMMUNITY , ~nce June 1975. For Wel~ drilled Pri0r'tothat date, give Well ~ ~ PUBEIC UTI LITY, ' ~ ~epth' (attach log if available.) ...., .... ' NDIV DUAL N SITE** If ndlv dual/on-rote, give installation date /~'~ ~ - if system isowr t~p (2) years old an adeqUacy testis required ~ PUBLIC UTILITY by this Depart~e~. -.OT~: THE iNSPECTION FEE MUsT A~coMP~NY EACH REQUEST BEFORE pRO~E~iNG cAN BE TIME DATE INSPECTOR DIRECTIONS: THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOI NTM ENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE INSPECTOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] TWO NUMBER OFBEDROOM$ [] THREE [] FIVE [] FOUR [] SIX 2.. WATER sUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] IN D IVi DUAL/ON -SITE [-'q PUBLIG UTILITY Connect-ion Verified []Septic Tank.or [] Holding Tank Size: ~/~)l~(~) If Tank is homemade .give dimensions: TYPE OF TANK "TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorl~tion Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER OTHER DATE INSTALLED INSTALLER ~ SOl LB RATING MANU FACTUR ER~t~ MATERIAL Septic/Holding Tank -IAbsorption Area ISewer Line INearest Lot Line 5. COMMENTS ~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 3/78) JACK BENNY'S AND ANCHORAGE CESSPOOL PUMPING Star Route A Box ].44 ANCHORAGE, ALASKA 99502 344-2632 or 349-1131 All claims and returned goods MUST be 10419 .¢com~.n,.d ~.,.,a ~,,,. SERIES JM'L I I II . I I II I John M. Lambe, P.E. 4303 North Star Street I I Anchorage, Alaska, 99503 907-279-8056 ~,/ PHONE NUMBER 276-4113 S,O,,,I,,,L, ABSORPTI,ON ,SY,ST~,~,, TEST PERFORMED ~OR: TELEPHONE: DATE OF TESTS: /~/~ /-/7~79' /- z~', - 7 9" LEGAL DESCRIPTION: /o 7- /.<~ /~¢~?~/4 z zJ' .J~Z,;~3,o ~, / ......... NO. OF BEDROOMS: RECORDS ON FILE: CRIB DRAINFIELD OTHER ~ TEST PERFORMED IN ACCORDANCE WITH ~L STANDARD PROC~DUR.~ ' ~ ACCEPTED BY MUNICIPALITY OF ANCHORAGE, DEPT. 0F ENVIROnmENTAL QUALITY WITH THE FOLLOWING MODIFICATIONS: ~URGE CAPACITY:' ' / / / / STEADY STATE ..i o~ / SEPTIC TA~VK PLUS SAS ABSORPTION RATE ~.~,~.,~ ~.<~ ~ AVERAGE 24 hrs ~,~ ~;m~,~ OBSERVATIONS: JML SHEET :/ OF I II I I John M. L~b~, P.E. 4303 North Star Strut Anchorage, Aimka, 99503 907-279-8056 DATE /-//-?~... PERFORMED BY: Z~,~ /~,w,,~C LEGAL DESCRIPTION: /_or /~/ /R¢-,,,r,~/,2 -~,~,~R 3/ Department of Environmental Quality Water and Sewer Questionnaire Subdivision Lot ~__~___ Owner's Name: Mailing Address: Date 0"//3, Time ~.'/~ , Block , Questions: 1. How many bedrooms are now in your housc~? /c~ ~o 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom walls "roughed in" at the time of purchase? ~//~,~ 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? ?~ ~ Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom? /~/~) 6. If on a public water supply, do you always have an adequate supply of water? ~.~ 7. Is the pressure always adequate? OTHER COMMENTS: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR hEALth AUTHORITY APPROVAL PI~/- L-~'.--J~-~. OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Oc.~' ~1, j~ ~ 7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Prope~y Owner ~~ ~, Telephone: Home Mailing Address Business (c) (d) (e) Lending Institution ~,e..~.J ~ Telephone Mailing Address ! O [ Real Estate Company and Agent Address Telephone ~'l(e "' j ~'~ '~ Mail the HAA to the followina address: or: Check here J]jj[, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms 3. WATER SUPPLY Individual Well [] Communit~X Public [] Note: If community well system, must have written confi~ma~tion from the State Department of Environmental Conservation attesting to the legality and status. ",~' ' SEWAGE DISPOSAL Onsite/~ Public [] Cor~munity [] Holding Tank [] ' - Note: it 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 IRev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seat 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 ~ Address ~.0 '~ I~ ./~-I~ Date ,~)~ ~_c:~, Telephone Seal DHHS APPROVAL Approved for ~'~') Approved ~ Disapproved Terms of Conditional Approval bedrooms by '~~ '''~' ~ ~ Date II/~--/,~-~ Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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 IRev 8/861 Back WELL DATA MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) E_MUNICIPALiTy OF~. HEALTH AUTHORITY APPROVAL (HAA) 0(.~ ~' ~ 0 ]987 NVIRONIvfE,, .... '~r~c/'/©R,~HECKLIST - FEBRUARY 1984 ' " ~ "% SERVICEs DIV I~-IbN 264-4744 OCT .~0 ]987 Legat.,~L~. C._,~ ,¢-_Descripti°n: "~ I ~, I"~J_ ~ 'r ~.l d~_ t~,~.~l~l~,~L..~,.~'_J~ ~,/ P RE,CHi VED Well Classification ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (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 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 Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~'/~'/'~g' Size /~'~ No. of Compartments (~ Standpipes (Y/N) O i~"' Air-tight Caps (Y/N) Y'" Foundation Cleanout (Y/N) Depression over Tank (Y/N) J~ Date Last Pumped 7/~'0 / Pumping/Maintenance Contract on File (Y/N) ~,ey ;for Holding Tank High-Water Alarm (Y/N) ' r/'~r Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~-o ~ To Property Line To Water Main/Service Line Course Comments '~ Temporary Holding Tank Permit (Y/N) To Building Foundation -~ To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 (Rev 8/86~ Fron! C. ABSORPTION FIELD DATA Soils Rating in Abso. rption Strata Date Installed ~/~'~/'~ ~' P~ 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 I"~0 ~ To Water Main/Service Line ~ ! O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 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 ,~--0 ~ TO Cutbank (if present) ~,~0 ~ N o D. LIFT STATION ['~ C) iN ~, 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 O~ ~-~, ! ~ ~7 Company MOA No. Receipt No. o4D_ O O /' -~OC-~ .~ Date of Payment //O ~ .~'(-.) ¢ 00'7 Amount: $ ,//~--~' ~ ~ Page 2 of 2 72-026 fRev 8/86~ Back Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION DISTRICT OFFICE / ANCHORAGE/WEStERN 3601 "C" STREET. SUITE 1334 ANCHORAGE, ALASRA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: __lgz2~z~Z ........ PWSIO #: __210Z~6 .......... To Whom It May Concern: According to the records on ?ile in this o??ice, the OUE~8__SWBQ!Wi~!O~_ Water System is in compliance with the State o~ Alaska Drinking Water Regulations. MPL:pkk Sincerely. Michael P. Lewis Environmental Engineer ALASKA C.,UIROF1Frli FITAL CONTROL IFIC. MARSTON REAL ESTATE 2804 W. NORTHERN LIGHTS ANCHORAGE ALASKA 99517 SELLER-JEAN HOHNSTEIN JULY 31 1986 MARSTON REAL ESTATE 2804 W. NORTHERN LIGHTS ANCHORAGE ALASKA 99517 60418 LEGAL:BOREALIS #1 LOT 19 BLOCK 0 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-,IULY 29 1986 THE TYPE OF ABSORPTION SYSTEM IS A CRIB-TRENCH WITH AN AREA OF 1080 SQFT. TIlE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1265 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME, SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JULY 30 1986 THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. 1200 U, Jesl 33rd Aucnu¢, Suil¢ [~ · Anchoroqe, Alosko 99503 ,(907) 561-50~40 To Whom it may concern: RE: 4919 Omega Circle Anchorage, Alaska 10/28/87 Per phone conversation with the owner of this property, Equitable Relocation Company on 10/28/87, this property was vacated on 7/30/86. Listing agent 3. 4. 6. Anchorage, A~aska Date Received Time of Inspection Date of Inspection Approval requested by: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & ,~co ~ArT~TTT~q FOR Property Owner: _ ~]~z-~/~ Phone: .~ ~-d- =F ~ ~_/_ ~ C. Construction ~~ ' ! ! 7. Sewage Disposal System: .:. .~_.~_.~._~ i. :' . C. Septic Tank: O. Seepage Pit: E. Disposal' Field: !. Size /moo 2. Manufacturer 1. Absorption Area ~5-~$ 2. Material ___~ Total length of iines Distances: / A. Wel'i to: Septic tank ~o ~ , Nearest lot line ~'/~D [~ Other conta'.':-,!r~ati,'~n ~ B' Foundation to seotic tank ~-- / , Absorption area C. Absorption area. to nearest lot line ~/ Sewer Lines Absorption area EQ-034 (!t74) Page 1 of two pages GREAT~ ," L,~ ANCItORAGE AI~,[.], BOROUUtt Department of Environh]cntal Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: 2. Property Owner: CMRO Fred Smith VA ' FHA CONV xxxxx Mailin9 Address: Name of Buyer: ~o.~e~t a~d A~na Haa~e llailing Address: ...... Da~ Phone D~y Phone 277-6686 Name of Lending Institution: First National Bank of Anchorage 279-4481 Ext. 231 Nailing Address: F.o. B~x 720 Phone Name of Realtor or Agent: Mailing Address: Phone Legal Description: Lot 19, Borealis .Subdivision Addition #1 Location: NHN Omega Road 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility SFR No. Bdrms. 2 '~ Individual If Individual, number of dwellings presently served If Individual, depth of w~ll Sewage Disposal' System Type of S~stem: Public Utility if Individual, date of installation Individual (on-site) XX