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HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 37 Municipality of Anchorage DEPARTMENT OF HEAL'TH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL ADDRESS /~'~ ~ '~, ~ /~ ¢~ ?~-O ~ PERMIT NUMBER LEGAL DESCRIPTI()N ~0FBEDR00MS SEPTIC TANK MANUFACTURER MATERIAl. / o-~''¢ CAPAC TY N GALS. #OF COMPARTMENTS INSIDE DIMENSIONl LENGTH mWIDTH DEPTH SE' E PAGE SYSTEM [] TILE DRAINI:IELD NUMBER OF LINES LENGTH EACH TOTAl. LENGTH DISTANCE BETWEEN LINES TRENCH WIDTH DEPTHS: TILE TO GRADE FILL BELOW 'FILE FILL ABOVE TILE ¥SEEPAGE TRENCH OR [] PIT W,BT. _~¢ LENGT. .~-/ OEPT. ~? [/"'.~ ,4 £ [] LOG CRIB [ I'LL' T R '!DEP . [] R,NDS- ITOTAL EFFECTIVE,~BSORPTION AREA; ,. . . SQ, FT. WELL CLASSIFICATION DEPTH PiPE MATERIAL ,I,NSTALLER REMARKS 72-012 (9/77) DISTANCES SEPTIC SEEPAGE! SEWER TANK SYSTEM LINE CESSPOOL WELL '- SYSTEM DIAGRAM I::IF:'F'[. ~[ CF:IN'I- LCIC:i:::IT]: ON L,.E(:~FII .... J'"ll::iX]:i'~LJl'"i i",II. 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L,.l[ii:l.I..% Fl:i!!: Russell Oyster 694-2774 Soils Et Foundations GEO, ,:CFINICAL 8 DEVELOPMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG CO. Earl Ellis 688-22.80 Lend Development Performed for: Legal Description:, Depth, {feet_). 1 ~haracteris~tic_~9_ 3 4 6 11 12 Ground Water Encountered: Yes, , __No ~// If yes, what depth Proposed Installation: Seepage Pit v/ Drain Field Cements: ~,-~' _~'~, ~t,~ __~~~,, ~_ ~> ~,, ~ ~ ~. Date: 08-E CO. Russe# Oyster 694-2774 Soils E~ Foundations GEOTECHNICAL Er DEVELOPMENT Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 Earl Ellis 688-2280 Land Development .SOIL LO._.._._J~, Perfo~ed for: Legal Description: D_e t~ fe_L~ 0 1 3 5 7 8 12 G?ound Water Encountered: Yes~ Proposed Installation: Seepage Pit v/ Drain Field If yes, what depth~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWEF{ AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I. D, # _ E~,~~/- /?/¢//-/~ NAA # ~,1 ~<,~- ~ L~.~d~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~¢'~, ~'tr, ~' ' ~' Mailing Address_ ~-~-0 ~, (c) Lending Institution Telephone: (home) / Telephone Business Mailing Address (d) Rea[ Estate Company and Agent ~'-'~--- ¢/Jct,1~. ~- ~ Address I0~?.~' '~;Z~L.,.~. '~qV~'----------------~'l~--~:::~, ~ Telephone ~ ¢ ~O (e) Mail the HAA to the following address: (or check here~ if hold for pick up,) List contact person and day phone number below: 17034 Eagle Ri~er Leop Roa~ No~, 2~ 2. TYPE OF RESIDENCE Single-Famil¢~.,. _ Number of bedrooms 3. WATER SUPPLY IndividualWell© Communityr~-- PublicE] "~,.~:"".~}r'-~ t~ Ilj~."~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status, 4, SEWAGE DISPOSAL On-site¢ Public [] Community [] Holding Tank [] Nete; If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 72-025 (Rev. 7/88) Page 1 of 2 5. 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 th is 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 Telephone S & S ENGINEE.-- Address 17034 Eagle Riw , ,-~, ~oad No. 204 Eagle River, AIa,~--;~577 Date 6. DHHS APPROVAL Approved for ~' bedrooms by Approved /~'~-~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 (Rev. 7/88) 8ack Page 2 of 2 Well Classification ~ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA), CHI-'CKLIST - FEBRUARY 1984 343-4744 Legal De~scription: L..¢.~- ~-~- '7 "~L~-¢- Date Completed Depth of Grouting Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot '~_.--~;'o To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line If A, B, C, P.I--.C. Approvedc~N) y Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots "~.-,L'~> ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ¢-(¢'~, ~- ; Date B. SI"PTIC/HOLDING TANK DATA Date Installed l-c,/"~"~ Size ( ~ No. of Compartments Standpipesf.(?..)N) ~/~ Air-tight CapsON) _ ~-/ Foundation Cleanout Depression over Tank (y/~V~ t~ / Date Last Pumped ~ Pumping/Maintenance Contact on File (Y/N) ~./-r'¢~ ;for Holdir)g Tank High-Water Alarm (Y/N) ! /¢'~ Temporary Holding Tank Permit SEPARATION DISTANCES FROM SEPTIC~G TANK: To Water-Supply Well "'2~'~ Lf To Building Foundation _~_ 14" TO Disposal Field To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments-"~ t-~'O '~21 t ..,(.. ~-~fT~-) i'~t'~. 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Date Installed Id-~" { ~ '- ~"/ Length of Field Width of Field '"~2 Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPT ON FIELD: To Water-Supply Well '~f~'~O (-~ To Property Line Depth of Field "7 I Gravel Bed Thickness Statndpipes Presen~N) Date of Last Adequacy Test TOLotBUilding Fou nd~, To Water Main/Service Line ~.~I;~ ~4- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing ; On Adjoining Lots %~:) £~ To Cutback (if present) or Abandoned System on Comments D. LIFT STATION Date Installed "Pump On" Level High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at % _~Vent (Y/N) ~P-Gmpkqg~y~.cles during Adequacy Test. **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 S & S ENGINEERING Company .............. MOA No. ¢.~-~-- ~ '~ Receipt No. Date of Payment Amount: $ / Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 72-026 (Rev ?/88) Back S?'EVE COWPER, GOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, AI~AS IfA 99503 563-6775 DATE: 0ct. 6~. ]958 _. PWSID: 2] 143:[ To Whom It May Concern: According to the records on file in this office, the DAWN/WYNTH~: PARK Water System is in compliance with the State of Alaska Drinking Water Regulations. MPL:pkk Sincerely, Michael P. Lewis, PE Environmental Engineer MUNICIPALITY O~ ANCHORAGE DE~T, OF HEAL~4 /IRON~t~NTAL PRQTECrlON MUNICIPALITY OF ANCHO~E D~ISION OF ~RONME~ ~ ~R ] (~ DF~ME~ OF ~7~ ~D ~IR~MENT~ ~EC~ION ED 1. ~neral Infc~tion ~plic~tion Date ~ Legal Desc£iption (include lot', block, s~bdivision, (a) ___~J~.~../...5~/ -~/-~/~'~*-/'7~-J~'/~ section, t~ship, range) (c) Applicant i~ (chedi one) ~nding Institu~on, (d) ~nding Institution ~(~ ~/7~ Telephone Address (e) l%~al Estate Co. & Agent Address Te le phone 2. _~1~ of Fesidence Single-Family Number of Be. drocms 3..Wa te? Individual Multi-Family Community Other (describe) Note: If cca~unity ~ell system, must have written confirr~tion fr~n the State Depart~snt of Environr~ntal Conservation attesting to th.= legality and status. Is the 9~11' adequate ~or the nombe;~- of ~ s~cified in this ~ (Y/N) 4. ~Disp~a~ Onsi ~ ~blic [~] ~,munity :~ Holding Tank Is ~e wastewater dis~sal system adequate for the nu~mr of ~droc [Page 1 of 2] 2-15-84 5. _t~l~erin_~Firm Provi~d~n~_I_n_s_Dections !_~%!?s~ Dar]a_ ,~ad Inf__ormation I certify th~'].~ave c.h~.cked, verified, or conformed to all MOA HAA C~idmlines in Nam 'of Firm !3 g_ ~'~ ~ff;llN~ _ %L~lej~hone Sigmd by Date ( E~GINEER 6. DHEP Ap.p.r.o_v__al~ Approved for__ Approved [~[ Disapproved Conditional Terms of Conditional Approval 'Fne Municipality of Anchorage I~partm~nt (~f Health and EnvirorJnsntal Protecticn does not guarantee the continued satisfactory rx~rfermanc~ of the water supply and/or the wastewate~ dist~Dsal system. %~lis approval indicates thaL, as cf t~e validaticr, date shc~in above, based on the data and information furnished by an engim=er registered in the State of Alaska, the water supply and wastewater disposal system is safe and func~ tional for the number of beclrooms and typ~ of structure indicated. ( E~EP S~%L) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANC}K)RAGE (MOA) HEALTH ~]/HORITY APPROVAL (HAlt) CHECKLIST - FEBRUARY 1984 / WELL DATA ~ Well Classification_/__~_ If A, B, c~ C, D.E.C. App~ov~d(__~Y/~l~- Well LoG Present (Y/N) Date Completed __ Yield Total Depth Cased to Depth of G~outing_ Static Water Level Pump Set At Casing Height Above Ground / ) Sanit. a~y Seal on Casing (_Y/N) Electrical W~ing in Conduit (Y~) / / Dep~esslol~ Around Wellhead (Y_t~N). Cleanout/Manhole ?o Nearest Sewe~ Service Line on Lot Water Sample Collected By __ ; Date Wate~ Sample Test ~sults SEPTIC/~6~f~-~TANK DATA Date Install,9~ /~/: ~/~ Size /~47~ NO. of C~a~tm~nts Standpi~s~ ~Ai~-ti~ht Cap~ Fou~datlo~ Clea~out (~ Sep~ation Distan~s ~ ~p~ic~olding Tank: TO Wate=-Supply *11 ::> To ~,ilding F~,ndation To ~o~rty Li~ _ ~O ~ To Disposal Field .~'~ / [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ./ET /'7 ~ ' Length of Field ~J~- / Width of Field 36 /~ D~pth of Field · S~e ~et of ~sorption~ea ~ '~- Stand,ms ~esent~) ~p~ession ove~ Field (~ ~te of ~st A~a~ Test Results of ~st Ade~a~ ~st ~ ~/~d-~3/g~ Separation Distan~ f~ ~s~ption Field: To ~te~-Supply ~11 /~ ~$~ To ~o~ty Li~ To Buildi~ ~un~tion /~ / To Existing or ~ndo~d System Lot / ~ ~'/~ ; ~ Admoinin~ ~ts ~//~' To Wate~ Main/~vi~ ni~ /~ ~ To ~t~(if pre~nt) . To St~e~ond~ke/~ Majo~ ~aina~ C~ ~ .//~ To ~iveway, Pa~ki~ ~ea, ~ Vehicle Stora~ ~ea ~ C~nts .~ /~ ~-~ /~ ~ -~ ~//~'~ ~c~ LI~ S~TI~ Date Installed / Dimensions Size in Gallons //~ / /~ A Manhole/Access (Y/N) "Pump On" Level at ~/ " /~. "Pump Off" Level at High Water Alarm Level at/~ Vent (Y/N) Tested fox Pumping Cycles du~ing Adequacy Test. Electrical Codes(Y/N) Meets MOA Comments ** Check Pe~ Bedroom Rating ~A~.ainst HAA Request ** I certify t/~t I ~.a~we.. checke~, verified, ox eonfo~n~d to all MOA HAA Guidelines in effect [Page 2 of 2] 2-15-84