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Home My WebLink AboutWAGERS LT 24B GAAB:HD. I GR"~.TER ANCHORAGE AREA BOROP"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELl ~'~ / LIQUID CAPAC]1Y__.//-~';) ~'~ GALLONS. _ A D D R E S S ~.~ .2~:~1//~,~,,::::~..~, ~ ~'~. .PHONE/.~.~ ~ MATERIAL ~//~< COMPARTMENTS ~ /~ /J ~ ~ LIQUID INSIDE LENGTH_ INSIDE WIDTH DEPTH~ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS_ /' OUTSIDE DIAMETER_ LINING MATERIAl NEAREST LOT LINE -- OR WIDTH /~";' / . DISTANCE FROM WELL_ /' ~ ~ ''~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH ~,-'~_ , DEPTH BUILDING FOUNDATION TILE DRAIN FIELD: 1'~-,-~¢c?~ TOTAL LENGTH DISTANCE FROM WELL_ / OUNDATION , NEAREST LOT LINE , OF LINES // CE~T N~/~~T~ DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEAIH TILE_ .IN. ABOVE TILE WELL: LOT LINE TYI)EJ~..~'~./:~,..,'~'-~'~'~,'~ DEPTH~;~'~ ¢ ~ 7 DISTANCE FROM ~ / WATER . ~,BULDING FOUNDATION, SAMPLE_ ~ NEAREST NEAREST SEPTIC ~ .~ SEEPAGE /~,~ ~ OTHER SEWER LINE '~ ,lANK , SYSTEM , CESSPOOL ~' , SOURCES DIAGRAM OF SYSTEM DISTANCES: DATE GAAB-HD-2 GREATEI 327 Eagle St. ANCHORAGE AREA' HEALTH DEPARTMENT Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAl. SYSTEM -, APPLICATION & PERMIT NAME OF APPLICANT ~/4.,z-l/.,t. , REB,DENCE^DDRESS I.EGAL DESCRIPTION APPLICA'rlONTO INSTALL: SEPTIC TANK_ TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS MAILING ADDRESS ~]/J'~'2"/7 '2 LOCATION OF INSTALLATION. V , SEEPAGE PiT /z~ __, DRAIN FIELD TO BE ~NSTALLED BY. ANTICIPATED DATE OF CB'MPLETION PHONE NO, ,OTHER. BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS'~']/~ SEPTIC TANK SIZE DISTANCES: , PERMIT TO INSTALL A '~ AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED - '~¢/~¢-e-~.~ ~ TYPE /__~)-~,,~4~L~. SEEPAGE AREA TYPE_ DIAGRAM OF SYSTEM I certify that I am familiar with the requfl'ements of Greater Anchorage Area Borough, Ordfl~ance No. 28-68 anti that the above described system is in accordance with said code. ..~ ~? ~~ ~ ~_ DATE '~'~_g~ /~ APPLICANTSSIGNATURE ~~'~/~,~ SREATER ANCHORAGE.AREA BOROUGH HEALTH DEPARTMENT 927 EAGLE STREET ANCHORAGE, ALASKA'99501 CASE Performed ror_~~~._c/~.~.~.~_.Date Perf°rmed-j~.~ Legal Description: Lot Block Subdivision This Form R po ts Depth Feet Soil Characteristics Lon ~ e. {. Was Ground Water Encountered?_~Ck~ If: Yes, At What Depth ........ Reading Date Net Time Location Sketch Net Drop Depth To Proposed Installat~on:~'--~''----~Seepage Pit~ ~ Dpain Field Depth Of Inlet. Test Performed B~, Date: GP, EATER ANCtlORAGE AREA BOROb Department of Environmental Qu, 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROI,ATION TEST ty Performed for__[~£ s Legal De s c ri p t i on :__/o2L_-~J/- This form reports: Soils log_/._ Percolation test Depth F'eet 10 - r_.~. r.D o_ d'?ox)o 1'1 - Was ground water encountered? _ )~__C). ........ If yes, at wl~at depth? Reading * Date Gross l'ime ~Net Time--epth [o Water Net Drop f~'F~.61 at]-o~ ................. ra~e in-i nu te. Proposed insLalla~T6h-:'-~-t~)a--ue Pit Drain Field :Jepth of [nleL Dept~l--¢o"~ii~:~'~)i t or Lrench COHHEIITS: 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. GENERAL INFORMATION Complete legal description Location (site address or directions) /I ~--~ ¢o¢z ~-~ Property owner Mailing address Day phone Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: --~ TYPE OF WATER SUPPLY: Individual well K 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, 1191) Fronl MOA #21 STATEMEN'f' 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 ~=~--r-~ue..,~ p--.~,~,,~,,~c~,~_r ___ Phone '~;74,-q'zq~ Address ~'.o. Poo'w /~z¢~- ~,~, o~., ~-/~ Engineers signature~'~ -- Date ,w--~ ,~--~, -~ 6. DHHS SIGNATURE ~ .~,, ,~,- ?'_ '.-_,: .... ~'X',.~ Approved for bedrooms. Disap~;Oved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,,c~- - ,- . -.-¢ ~ ,~ 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. ?2~25(Rev. 1/91) 8ack MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal D es c ri pt i o n ~-'-F"I '2 ~'-~ A. WELL DATA Well type ~-~ ¢-~o,~ L Log present (Y/N) Total depth .p~ (~ ,-t- ~ Sanitary seal (Y/N) to&'& Date of test Static water level Well flow Pump level If A, B. or C, attach ADEC letter. Date completed Cased to ADEC water system number FROM WELL LOG Driller S'o~" ~--c Casing height orA- ~" Wires properly protected (Y/N) AT INSPECTION g.p,m, ~ 1' G:~P~-,~, SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ,~ lA ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform O//¢0 ~ ~ .~ Date of sample: ~ B. SEPTIC/HOLDING TANK DATA Nitrate _ ,~ a/~,, Other bacteria 'N.D~ -~ Collected by: h.~0ra"c~,~-a4k.t --¢c-z.~s-c-¢..'~-. CA '~ Date installed '--~v'¢¢ d ¢10)9o Tank size ,' c,¢~ Cleanouts (Y/N) '¢~-s Foundation cleanout (Y/N) High water alarm (Y/N) ,,~¢D Alarm tested (Y/N) Date of pumping /-1-11~9"~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ¢~,~ 1- ~0m On adjacent lots To property line Absorption field Surface water/drainage Compartments Depression (Y/N) Foundation % Water main/service line 72-026 (Rev. 7/9~) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed /¢///% Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed q-v,,~ Length ~2_.' Width Total absorption area -~ Depression over field (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water System type Total depth Results (pass/tail) ~:~¢~ s s Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test If yes, give date SEPARATION DISTANCE FROM ABSORP'I-ION FIELD TO: / ~o'e -¢-r On adjacent lots t c,o ~-P-r Propertyline ~ O~ J~m To existing or abandoned system on lot Cutbank '~'[ ¢' Water main/service line Driveway, parking/vehicle storage area Well on lot To building foundation On adjacent lots Surface water Curtain drain bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature~ Engineer's Name Date ~ -- HAA Fee $ Date of Payment 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Steve Pannone 2515 A Street Anchorage AK 99503 NORTHERN TESTING ILABORATORIES 3330 INDUSTRIAl. AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Report Date: 05/08/92 Attn: Date Arrived: 05/07/92 Date Sampled: 05/07/92 Time Sampled: lllO Collected By: WEB Our Lab #: Al17192 Location/Project: - Your Sample ID: 11050 Our Road Sample Matrix: Water Comments: Method Parameter MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = ~bove Regulatory Max. E = Below Detection Limit Estimated Value Units Date Result Flag MDL Analyzed EPA 353.3 Nitrate-N mg/1 0.5 0.1 05/07/92 ~ ur ic paii~' ot Anchorage Dept. l-lealth & I~urnan Serwces Reported By: Susan C. ~'ifental Mic~:obiology Supervisor NORTHER 'T STIHG LAgO RATORIE$ 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Clara Anderson 11050 Our Anchorage AK 99516 Attn: - Our Lab #: Al16994 Location/Project: Your Sample ID: Home sample Matrix: Water Con~ents: Report Date: 04/24/92 Date Arrived: 04/21/92 Date Sampled: 04/21/92 ~m. e~S-am p-l-e d~..~q,.... MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag MDL Analyzed EPA 353.3 Nitrate-N mg/1 0.5 0.1 04/23/92 Reported By: Susan c. ~fental Microbiology Supervisor~ HOME SERVICES, INC INVOICE # 6257 15900 Francesca Drive Anchorage, Alaska 99516 345-1890 or 345-2444 CUSTOMER Block ~t DATE DESCRIPTION AMOUNT TOTAL REMARKS ~ Gallons ¢ Septic Leach Area __ Holding Tank ~..Standpipes ~',?.P~ 'Ti~e B PROBLEM AREA--CALL FOR MORE INFORMATION ~ NEEDS TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape ~ Sludge buildup on bottom ~ Floater on top ~ Jim cap missing or ~ Cut standpipe to 1' above ground ~ Needs Septictrine needs replacing CUSTOMER COPY -- KEEP FOR YOUR RECORDS --PLEASE PAY FROM THIS iNVOICE-- Municipality of Anchorage Page __ of_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposa~ System and/or Well Inspection Report Permit Number: PID Number: ~l.~-I~¢1~ EE'~f Name: Wastewater System: D New ~ Upgrade Address: ABSORPTION FIELD (/~ ~ ~ No. of B~rooms: Phone: ~ ~_ ~ ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION ~o ~s~. ~b Lob Block: Subdivision: Deplh to pipe bogota from odginal grade: Grave] depth beneath pipe Township: Range~~ I Section: Fill added above original grade: Gravel length: Gravel depth: Number of lines: Distance between lines: WELL: D New ~ Upgrade ~ ~t. Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: ~ ~ ~t. Ft. ~ W~O se. Ft. Driller: Date Drilled: Static Water Leveb installer: Date installed: Y~eld:~ '~ gPMIJ Pump Se~ ~t: Ft.IJ C~sing mHeight- ~'A~ave ~round:Ft. TANK SEPARATION DISTANCES ~ Septic ~ Holding ~f~o~ ...... LIFT STATION WsJer Lot Size in g~Jlons: M~nuf~cJurer: Line .... ~ "Pump on" level at: J "Pump off;' level at: ~igh water alarm at: Foundation I Curtain .-- ~ _~ ~ Pump Make & Mod~Electrical Inspections performed by: Drain / Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: Dates: 1st. /;'~ '/ ' .... : '" ~' :;''' Department of Health and Human Services approval '~',~"',:,: -.. e-z~¢" ' · Reviewed and approved by: Date: 72-013 (1/91) MOA 25 Permit No. Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspectio,~ Report 72 013 A (2/91} MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~.. LEGAL DESCRIPTION: 1 2 3 4- 5- 6~ 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- DATE PERFORMED: Township, Range, Section: -F'I~/,~.~ ~_~ ~./ ~ ~./ L~'¢' ~Z~//.~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth Io Waler Alter Mogiloring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~/~ ' :/L Immures/inch) PERC HOLE DIAMETER TES~ RUN BETWEEN FT AND FT PERFO~MEDBY: '~'~'~~ I ~g~ ~~ GE~TIFY THAT THIS TEST WAS PERFORMED IN AGGORDANGE WITH ALL STATE AND MUNIOIPAL GUIDELINES IN EFFEOT ON THIS DATE. DATE: ~ ~' 72-008 {Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAl.. DESCRIPTION:_~I ~r~.~l~ ~)L)(~ ~--'~), Township, Range, Section: 1 2 3- 4 5 6 7 8 9 10 11 13- 14- 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH7 Oeplh to Waler Afler Monitoriflg? Reading Cate Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST BUN BETWEEN __ - (m~nutes/inch) PERC HOLE DIAMETER FT AND . FT PERFORMED By: ~),~P.,~t'~Je~JOp,)~:... ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~l"--( t2 ,,~ ~ ~__ Sprit System Adecuacy Test For Mr. Mike Anderson 11050 Our Rd Anchorage Alaska 99516 READING 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 DATE 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 4-10-92 GROSS TIME NET TIME OH 00M OH 05M OH 1 OM OH 15M OH 20M OH 27M OH 30M OH 40M OH 50M 1H 00M 1H 10M 1 H 20M 1H 30M 1H 40M 1 H 50M 2H 00M DEPTH TO WATER 12" 11" 10.25" 9.5" 12.5" 12.75" 12,75" 12.75" 12.75" 12.75" 12.75" 12.75" 12.75" 12,75" NET DROP 0 +1" + 1.75" +2.5" +4" 0 -0,5" -0.75 -0,75 ~0.75 -0.75 -0.75 -0,75 -0.75 -0.75 -0.75 FLOW TEST 6 GPM 6 GPM 6 GPM 6 GPM 6 GPM Remarks: Added water to the septic tank at 6 gpm for two (2) hours. There was a noticable rise in the septic tank in the first thirty minutes. It looked like a restiction in the tank broke loose during the test. After the restiction released there was no noticable rise of the water level in the septic tank. The water flowed from the well at a steady six (6) gallons per minute for two (2) hours. There was about 720 gallons added to the septic system. The septic tank was pumped on 4-11-92. F