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Home My WebLink AboutSIEFKER #3 LT 7A GRE' iR ANCHORAGE AREA BOr' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 'GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /¢'', LOCATION SEPTIC TANK: DISTANCE [?/'--" / FROM WELL INSIDE LENGTH_ MANUFACTURER INSIDE WIDTH /\ NUMBEROF MATERIAL /~'"~'~ ')1(') ~; ('~ COMPARTMENTS .LIQUID DEPTH __.LIQUID CAPACITY / ~*~ ~'''*) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH / LINING MATERIAL ~'[i./~/"r~/ CRIB SIZE: DIAMETER__ BUILDING FOUNDATION ~-:' ;/,' NEAREST LOT LINE -7,?':-)4. ADDITIONAL ABSORPTION LENGTH t '"~, DEPTH / .DEPTH ///) z DISTANCE FROM: WELL ,// TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) > ~/~"~) SQ. FT. WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE , OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH ,P' DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: INSTALLED BY: /:') ~'U; )"~ fr:;' y" PIPE MATERIAL: (".':4 ~-/ )["/;)j LOT SLOPE: REMARKS: Form No. EQ-O31 DIAGRAM OF SYSTEM~ R ANCHORAGE AREA BDt DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! GH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. PHONE , OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL 1'EST FINAL INSPECTION' 24 HOUR NOT CE REQU RED BACKF LLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE MINIMUM DISTANCES, REOUlREMENT5 DIAGRAM O~ ~ ' FOUNDATION TO SEEPAGE PIT '~ ( , DRAIN FIELD SEPTIC TANK TO SEEPAGE PITWALL ~'~ / SEEPAGE PIT Z~ ¢ TO NEAREST LOT LINE.~'/~/¢'~¢~ ~ WATER MAIN TO SEPTIC TANK DRAIN FIELD ' SEPTIC TANK, , SEEPAGE PIT 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. CONFORM TO EIOROUGH .R~EGU~I~TIONS REGARDING INSTALLAT[ON. OR LIbENSED DESIGNER J CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER//~NCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ,/ DESCRIB D SYSTEM IS IN ACCORDANCE WITH SAID CODE. P~RO, ~''0'' -- / /¢Z*APPLICANTIS SI~NATUR~ . GREATER ANCHORAGE AREA DOROUO~ epartlnent of Environmental Qu 3330 "C" Street Anchorage, Alaska 99503 SOII.,S I.,OG - PEROI,ATION TEST PerformoO for Legal Descrip~c-'Joh:_ li;~-_~'_~_/_~[~' -- This form reports: Soils log~_ Depth Feet Was ground water encountered? /Percolation res t If yes, at what depth? ................... Reading Date Gross l'ime Net Time _!)~e~[)t~h__t_~ W,a~t_e__r_ Net Drop · Proposed ins~allat-~o~-:-'--S~q]'~ge Pit Drain Field ............. DeptH-G' i;b~'t~l~3~=)~i t or [renc h :X~pth of Inlet ..... · .......................... E~.-040 (~/74) WA~t~R · L DRI~LERS L~G DO N~T FILL l~N Locablon (add~ess off: Township~ ~ange//& sect~on~ if knoE; or dls~ce , , ,. ~ ~ ./ .-. Static ~ater level ,~&~ fet (above)(below) land surface. Finish of we:. Describe screen or perforations per'~h~ur~in~) for ~. hours with Well pumping test at~>~._gallons ............. _--- ~_~.~__ ..... feeT, of da~wdo~.m from static level Remarks Well Lo~a_.~- ~ Give de'~~ii--ls of for~m~tions penetrated~ size of material~ to to to 'to 'to to to to to to 0 r) REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in T i Ilame of person requesting approval 2.- uaTne of property !owner4 C- 3. !-,aleal. descriptio 4. Number oj)edrooms in house 5. Water, Analysis: a. Bactc--rial, b. Detergent 6. Well data: a. Type b. Depth C. Casing Size— —60 d. Distance from well to closest existing or proposed: 1. Sevier line 2. Septic tank 3. Seepage Area —LI —0, — 4. Cesspool, 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system, a. Age of system b. Septic tank capacity in gallons c. Name of septic taTik manufacturer 1. If "home made" show diagram on reverse side of this form. d., Disposal field or seepage pit size and type_ 1, Distance to property line to house foundation e, Percolation, Test results f. Percolation Test performed by Use ti,e reverse ,side of this form to show diaE7ram, Di.a.gram should include the foll.oaing, information: property lines;•well location, house location, ->'jiic tank, location, disposal area location, "location of percolation test, ai.d direction of j=round slope. 9. The S.r,t,rnat;on on this form is is true and correct to the best of my kno ledge. Signature Applicant �_ Aate Si- ed 70 BE FILLED OUT BY HEALTH DEPARVIENT PERSONNEL above described sanitary facilities are hereby approved, subject to the _=bllowing condi:t#ons: Conditions: The above described sanitary facilities are disapproved for the following reasons: Signature of 5ffiela'J Date Approval is valid for one year following the date of approval, CPJ:cw MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION , DIVISION OF ENVIRONMENTAL HEALTH ~-~,~_/~. f~3 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~// GENERAL INFORIVIATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~ ~ Telephone: Home - "7 Business Applicant Address I Z~¢~--[ ~f~cZ~t,~ ~'~' . ~,,,)~lZ4,ec&'ts'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 (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,J~¢ ~4ulti-Family Number of Bedrooms Other WATER SUPPLY Individual Well [~;]0 Community [] Public [] 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/~2 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 ~1~,~- ~4~ Telephone Address i ~ (~ ~?~ ~ / ~-~-4~/ ~'~ ~/(~, Approved ~/ Disapproved ~/ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage D,epa, rtment of Health and Environmental Protection (DHEP) issues Health Authority Approva cerbflcates based so e y upon the representat ons given in paragraph 5 above by an independent professional engineer registered in the State oflAlaska, 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) -~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) -~'J~ ,C.,.,j _~, CHECKLIST- FEBRUARY 1984 ~,~' ~ ,,~.~'~- ,,~ 264-4720 WELL DATA -'~'¢ Well Classification ~ If A, B, C, D.E.C. Approved (Y/N) ~'~ Well Log Present (Y/N) .~-~' Date Completed /~"/i C> /J~ -~f~ Yield . · Total Depth ,~t Cased to '"~:~" (~Z~Depth of Grouting Static Water Level 4"<~ ''~' ~, ~1 Pump Set At ~"~ ", Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ ?On Adjoining Lots 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 ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~.~(~) 1,.~-- ~'-~ ; Date ~ / ~/~' f~ Comments SEPTIC/HOLDING TANK DATA Date Installed ~fl65'~ 'Size I~-'~O No, of Compartments ~ I Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N), ~' Depression over Tank (Y/N) ~O Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~ /~ ;for Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding ~ank: / To Water-Supply Well ~ ~ ~ (~ ~ To Building Foundation To Property Line ~O/~ To Disposal Field ~'~ To Water Mai n~~ ~/¢ To Stream, Pond, Lake, or Major Drainage Course I00 t ~ Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~ Ig~f-..f,4~,',..~ ~,.~ Type of System Design ~. ~ '7~" Length of Field \ c:j ! Depth of Field Gravel Bed Thickness ~ (~) / ~::~"(;~ Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / \~-~;~ / To Building Foundation Lot To Water Mai~; Line~ To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area To Property Line ; On Adjoining Lots To Existing or Abandoned System on To Cutbank (if present) Comments LIFT STATION ~'-~ (-,Tv~-L=~,,.~ o V~"Y._ ~r ~'~'~- ~i;fee i Inn ~ ~llll~ s /,//~imensions "Pump On" Level at ~ Chela/Access (Y/N) / "Pump Off" Level at High Water Alarm Leve/~ ~ Vent(Y/N) Tested f0rcomElectrical Co~(Y/N)// &~u~ring Adequacy 'lest. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t h.~_ e checke~, verified, or~onformed to all MOA/and HAA guidelines in effect on the date of this inspection. Signed r I~''''~'-'- ~~,'~ Date Company L~ V-,~ f4~.~v'm_,~L- Receipt No. ~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal INVOICE N P.O. BOX 112688 PHONE 345-25'13 ANCHORAGE, ALASKA 99511-2688 Job Address [ " b~~C' "' ' ROTOR ROOTER SERVICE CALL HRS STEAM THAWING HRS TRIP CHARGE HRS OVER-rIME CHARGE HRS ~ + ADDITIONAt. LABOR CHARGE HRS HYDRO-JET SERVICE HRS TOTA FOOTAGE CLEANED OR THAWED ........ BLADES USED LINE CLEANED ~~ 'T' (%'2~=~/~ JOB NOT GUA~ANTE~I~ FOH FOLLOWING REASON ___ BI~TERIOLOGICAL II~TER NIAL~SIS H DAY AR I.D. NO. (PUBLIC 'SYSTEHS) ,~ t a t o I I NAME OF SYSTEM SYSTEM ADD.SS CITY STATE CTRCLE CLASS ~de ,B C ntta~ TELEPHONE NUMBER ZIP CODE L~OCAT']ON WHERE SAMPLE WAS COLLECTED TYPE OF" SAMPLE ,, r ,'(CHECK ONLY ONE THIS COLUMN> DRI,KI,G .ATE. OC,LORI TEO ~/CHECK TREATI~NT ~-IFILTERED .~, ,~U,_NTREATED OR OTHER l"1 RAW SOURCE WATER r'l NEW CONSTRUCTION OR REPAIRS : I"1 OTHER(Specify) IS THIS SAMPLE A CHECK SAMPLE TO A PREVIO? NOt(-CONFORMIN~.SAMPLE? r'l YES ~l~)40 PREVIOUS~OLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORH) SEND REPORT TO:(PRINT FU~L NAME,ADDRESS AND ZIP CODE NAME ~ ~,'1~~ '~fx.'F.q--]Z_ ~.Jc~t,,F~ ADDRESS ~ ~0~ C_1~ ~ ~ CITY ~~ STATE ~ ZI~ CHECK ONE OR MORE CZ) Smmple too long in transit. Smmple should not be over 30 hours. [-1 Sample Peceived too lmte in week I"lNot in proper container [:3Leaked out ~-1 Insufficient information provided. Please read instructions on form. 1-10ther (Specify) RECEIVED RY DATE ~/,~;'-~/-~TIME ANALYTICAL ~THOD: ~NE FILTER ~ ~NTATION TUBE Date & Time Started ~'/~-~ Date & Time Completed ~/~ ~h~:~/<x-~] LABORATORY RESULTS I") Other Bacteria D Test unsuitable because: [] Confluent Growth [] TNTC SATISFACTORY SATISFACTORY BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS FECAL COLIFORMS OTHER Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM BGB Date Time Coliform/lOOml Coliform/lOOml