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Home My WebLink AboutRAYMOND TEDROW LOOP RD ADDN LT E1 GRr"TER ANCFIORAGE AREA BOROU'"=H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LIQUID CAPACIIY /'~ <~ LO _GALLONS. INSIDE LENGTH '~' / NUMBER OF COMPARTMENTS / INSIDE WIDTH LIQUID /~'~ j~.) '~' DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBEROF PItS / OUTSIDEDtAMETER LINING MATERIAL____~~i''~''~-~'/ .-~ NEAREST LOT LINE OR WIDTH DISTANCE FROM WELL /~'~7 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH '~'~ / , DEPTH . BUILDING FOUNDATION ,. ~-'~ SO. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA FOUNDATION. DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EAC, H LINE DEPTH: TOP OF TILE TO FINISH GRADE , NEAREST LOT LINE TOTAL LENGTH , OF LINES. TRENCH WIDTH IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: LOT LINE ~.~ .,.,~ Y'/ NEAREST ~'~' ~, /' SEPTIC ., SEWER LINE__~/~ . TANK DISTANCE FROM ~f~ ,~7 '" SEEPAGE , SYSTEM WATER SAMPLE~ , CESSPOOL , NEAREST OTHER .~ , SOURCES_. DISTANCES: / DIAGRAM OF SYSTEM DATE HEALTH AUTHORITY GREATER ANCHORAGE AREA LOROUGH HEALTH DEPARTMENT 327 Eagle St Anchorage, Alaska 995012 SEWAGE DISPOSAL SYSTEM- APPLICA?I~ NAME OF APPL~ 'Bite S~O'~ MAILING ADDRESS.. RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY_ FINANCED THROUGH PERCOLATION TEST RESULTS ATL~: LOCATION OF INSTALLATION '-~ , SEEPAGE PIT ~ ,DRAIN FIELD. ANTICIPATED DATE OF COMPLETION ¢.~-,~ *L~BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT __, OTHER /~/Ix, x' g THIS IS TO SERVE AS DISTANCES: ,s~/,,- /,, ,-'/< AS DESCRIBEO BELOW. SIZE OF UNIT TO BE SERVED. ~ _, SEPTIC TANK SIZE ~)~ TYPE ~~ SEEPAGE AREA. ~'~ TYPE DIAGRAM OF SYSTEM '0~ Health Authority I certify that I am familiar with the requfl'ements of Greater Anchorage Area Borough Ordfi~ance No. 28-68 and that the above described system is in accordance with said code. DATE ~ ~q APPLIgANTS SI6NATURE ~Z~. ~ 503 E. 6th AVE. ANCHORAGE, ALASKA 99501 April 24, 1969 PHONE 272.3428 Mr. Bill Scott Eagle River Alaska 99577 PROJECT: Percolation Test - Lot E Tedrow Subdivision Dear Mr. Scott: A percolation test was performed on the subject lot on 23 April 1969. Data are shown on the attached sheet. The percolation rate was determined to be 1" per ten minutes. Very truly yours, ALASKA TESTLAB Ste~n~n Sklute, Staff Engineer Enclosure SS:Id LAS KA TE STLAB ---- 1940 Post Road Anchorage, Alaska Cnent ~/:. /~,W ~// FHA No. I~cation, Lot ~ ,Block -- ,Subdivision Sheet / of / we No ~z~ ?, PERCOLATION TEST DATA Depth Soil Class Feet Visual - Unified \/ Location Sketch Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Pate i'W / ~ ,.,nnut._ . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343~4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (- ::¢' - '.L':"- i' i 1. GENERAL INFORMATION Complete legal description Location (site address or directions) /~2~, (:~- /~/, Prope~y owner '~E~:E~. Lc ¢ ~'~ ~- / ~" Day phone Mailing address ¢'0,' 6ox ?~7 8c~ ,, , Lending agency Day phone Mailin_g address Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/01) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER 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 application 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 s & $ ENGINEERING 17034 Eagle River Loop Road No, 204 Address Engineer's signature Phone Date ~'/"'~ G "/¢'//~i DHHS SIGNATURE l/"' Approved for -TH J~ ~' ~' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date 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, 72-025(P~v. 1/91) Back MOAI¢21 ECEIV -U Municipality of Anchorage MAY DFPARTMENT OF HEALTH & HUMAN SERVICE,~uN~Cm^u~-¥ oF ^NC~ Environmental Services Division ENVIRONMENTAL SERVICES, 825 L o otreet, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: ~_(_.2 2-- c/2-/ Health Authority Approval Checklist A. WELL DATA Well type ~/"~./,~/~J'~- 'If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanita.ry seal (Y/N) Date of test Static water level Well produmierr''''',~'''' .......---" Date completed ~ ..... Cased to .~Oasffig height (above ground) ~ Wires properlY protected (Y/N) g,p,m. AT INSPECTION g.p,m, WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~'/,~ ~ _ Tank size [ 27~ Foundation cleanout (Y/~.). N o ~ Depression (Y/[~I Date of Pum.p)ng. ~- Pumper C. ABSORPTION FIELD DATA Number of Compartments / Cleanouts (Y/N) )~/6 High water alarm (Y/N) /',4//~ Date installed ff /¢ q Soil rating (g.p.d./fForft~/bdrm) u/K Systemtype ~121 Length 2 [ / Width ~ f 6 / Gravel thickness below pipe . Total depth / Effective absorption area ~4~ ¢ Monitoring Tube present ~N) ~:5 Depression over field (Y~ Date of adequaoy test ¢1¢'Z-/¢~ Results~Fai,)"~.~ For -~ bedrooms I -- Fluid depth in absorption field before test (in.); ~/Z- Immediately afferl ¢¢~gal. water added (in.): Fluid depth ~ ~1 ~/~" (ins) Minutes later: 3 0 Absorption rate = ~5'-~ '~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~E~(- ~¢~ If yes, give date -- 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pu~~*. High water alarm level at* ~ *Datum Cycles teste,~d ~ E. SEPARATIONI~ISTANCES /,~-'L_L. O*-,/ L_~T' SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gat!_ons "Pump off" level at* Septic/holding tank on lot z~' 0 / "'f- On ~~'~'---/(~O / "/"' Absorption field on lot / (~7~ / ?,-- ~""O~n adjacent lots // Public sewer main Public sewer manhole/cleanout ,/V/,'~r Sewer/septic s~j3zic~ ne~ (~/'¢- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation '~-/~ Property line ~" ~+ '; - Absorption field Water main/service line /e J ~L ' / Surface water/drainage. /E?O 'C--Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ ~ / '~ /' Building foundation ~-- Water main/service line Surface water /.i/~0-: ~'-~ .... ~-"~,~_ Driveway, parking/vehicle storage area Cudain drain ~ ~/¢~ ~ ~ Wells on adjacent lots /¢~ / ENGINEER'S CERTIFICATION ~%S OF I cedify that l have determined thru field inspections and review of Municipal r~hat the~. in conformance with MOA NAA guidelines in effect on this date. Engineers Name . 'T , O~ ~, ~., CE~8801 Date of Payment Receipt Number 72-026 (Rev. 3~96)* Waiver Fee $ Date of Payment Receipt Number