HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 14
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
PHONE ~] NEW
WeN Absorption area:
DISTANCE TO: ~-
Manufacturer
I_iq.Manu[acturerDiSTANcEcapacity in TO:gall°ns lwoiiF H OMEMA D E~_)/~ DwellinglnSlde length
DISTANCE TO:
No. of lines
Top of tile to finish grade
Le ng t h~¢~, Width ~.~,
Width
tMaterial
Nearest lot lille
~d~
Material beneath tile
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Total effective absorption area
PER IT NO.
Type.o.~f crib ~ Crib diameter
DISTANCE TO: )i.~
Class
DISTANCE TO: Building foundation
Crib depth
Buildingf unda[io
Driller
Sewer line
OTHER
PIPE MATERIALS
INSTALLER
REMARKS
Total effective a~a.~
LEGAL
72-013 (Re,;. 3/78)
'IZI?M I'] N[]:
~A'I'Ei: "c'c,' ::: · ,,
.I, ..,.diE3) ,,
D,5OGS"]. ENiu .I. I'.11 ,I .I~E D DE,:~ ]. (:~h.I
LI. 0 / 0 4 / i3 ',5
:OIxF f'(-'~[71" F:'HI]Ni~: ~
c: c0 r' 't, :i, f' 5' 't. h a t ~,
~'or'th by 'Lh(e MLu~:ic::i.l~alitY o{ ~l"~d-lorag~ (H(](,~) a~ld the S't.a'l'.,~? o{' ~:l,a~sl.::a.
2. :1: t,~:i,],],:Ll~a;'Lcxl:l, 't:,lle) Dye~i't:.(~lll :i.r~ i.ac:ic::ol'dalH:::~ wi'Lb a:L:l. I~1(:1~ c::oc:l~?:~a and
a~l-~ct Jr~ c:ompl ianc:~,~ ~i'Lh the d~s:i, gr'~ ~:r' i'Le~r':i.a of t.l'l:k~; p~,r,m:i.t.
:::~;~ I wil~ ac:lher,~:e 'Lo all M[JA ar.:J S'La'Le of' (~la~sl.::a ]'~:~qLk:i.r'~.::.n~;:~rlL~ {or' LI'..~ sc~t. bad::
I::; A LIF'T S'I'AT'I(]N :1:~ INS'I'J~I,..I,];~D IN (:~lxl (.~RI~:F~ COVE:RIZD BY Mi]P~ BLJ:I:LDIIxIG
HEN ( :t. ) (.'~N I~):I_I~:CTI::~:I:I::P~L.. I:::'ERM Z T ~.¥xlD I IxlSI::'E:CT 1 [)N MI,I~FI' ]::~E OB'T'~ I NED ~i C~'.) ~3' ']31J I LTS
~ L.,L. NOT BE (:IF'I::'FH::)VE]:) N ~ THOUT ¢~1~1 EL, ECTI~ I C~I.. I NSI::'I~CT' I ON RI~]::'[)RT ~ (~NX:) (:5) FHE
I.,IZCTI:?IC~I,.. NORI':: ML.I~T BE DONE BY A I,,.ICIZNSE:D IZLE:CTF~ICIAN,,
Municipality el Anchorage
DEPARTMENT OF HI:ALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: AI,,~,',~_~I ~3~t,,.~_'~ '~,)~'(.~"~'-'-'-'-'-'-'-~ ~:~.'~ DATE PERFORMED:
LEGAL DESCRIPTION: e.~-~f' IL}f. ~'~g~l/.., I
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
Township, Range, Section;
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PEAN (
IF YES, AT WHAT
Deplh to Water Alter
monitoring? "~
Reading Date Gross Net Depth to Net
Time Time Water Drop
t ~t-'5~-¢~ ~/,, ~.~A -~- · ~, -5 ~/.~.'
PERCOLATION RATE ~'~ ~' {minutes/inch} PERC HOLE DIAMETER _~,4~ [[ _
TEST RUN BETWEEN ~ FT AND __
PERFORMED BY: ~ & ~ I;'!,,~OINI[I~RI~,[~
· .8RB leeX ~/ -
ACCORDANCE W'~ k~"~~?*IDELI~FFECT ON 'HIS DA~E.
72-008 (Rev. 4/85) ...... ,**.~4:-., ....
CERTIFY THAT THI~,TEST,/WAS PERFORMED IN
GRE,-,,ER ANCHORAGE AREA BOk, JGH
Department of Environmental QuaJity
3330 g Street
Anchorage, Alaska ggs03
INSPECIION~EPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER DP
COMPARTMENTS
LIQUID CAPACITY__ GALLONS.
TILE DRAIN FIELD: ~,j~_ (~,O 1' TOTAL LENGTI~O/ /
DISTANCE FROM WELL _FOUNDATION ____NEAREST LOT LINE . OF LINES
NUMBER OF LINES ] ___ DISTANCE BETWEEN LINES M/~- TRENCH Wi~TH.7~iN. TOTAL EFFECTIVE
DEPTH: TOPOFTiLE TO FiNiSH GRADE ~ / DEPTH OF FILTER ~ ¢/
MATERIAL BENEATH TILE ~ IN. ABOVE TILE~'~ IN,
WELL:
TYPE
BUILDING
FOUNDATION
VNEAREST NEAREST
LOT LINE-- , SEWER LINE
SEPTIC SEEPAGE
__, TANK ____, SYSTEM
DISTANCE FROM:
CESSPOOL _._
OTHER SOURCES
APPROVED__
DISAPPROVED
REMARKS
DISTANCES: //
INSTALLED BY:
PIPE MATERIAL'
LOT SLOPE:
DR. FWt'
Form EQ-032
DIAGRAM OF SYSTEM
G.A,A.B.
/o- / .q 7
I::II::'F'I. :!; CI:::II",IT
I.CIC:FFI' :[ CIN
LIEI::!iF:iI.
'Il'liE I...EI",IGTH E:, ]: HE:Nt:i!; ]; CU",I
'T'FIE: DE:I:::"I'H OF:' t:::1 TI:'?.E:NC:H Eff;~: I:::':!:"1' :I::E; THlii: t:::, ]: ::ii;I'I:::INE:E: [i!',l!i:l'l.'.lli:!%N THE: '_:i;L.II:;;:F::I;:l(3[ii: O1:::' I'l'llii:
(:!iI:;?.OUNI:;:' FIF,II:::, THE; BOITCfl'"I CIF:' TI'lIE I~:F0:?F:I',/FI'I':[ON '::]:1",! I:::'lEt!i:'l::'.
~llt[i[ 'I"I:;?.Iii;F,ICFI I.,.1:1:1:::,'11"t FOB: I:)l:~:Fl:[l",ll:::':[lii:l...13,::ii;
'l'ldlE (::i1::i:1:::1~,,,%[.. E:'t~:I:::'lll :[:E; 't'HIE I"l:[i".l:l:l"ll._ll"l D[i:l::'l'l'l OF E:il;;?.I::IVtEL E',Iii:TI,I[ii:t!i:N '['t'IE: OLII-F:'I:::II.I. i:::' :[ I:::'E:
I::lhlD THE: E~Crf'I'CIH (:il::: THE: IEF,',C:FIMF:[T ~: I:)1",1 ,:: ): I",1 I:::IEI:71' ::'.
I'1 :[ N :[ I"1U1"1 E:' ;1: Ei;"l I:::II",tCI!i: E!UETNE:E:N I::1 I.'.IELI. F:INI?' FIIq"r' Ol",l'"':i!i; :1: TIE :!i;[ii:l.,.ll::l[::ilii: [) :1: E';[::'O:i~;f:l[. :E;"r'?i:;TIEH :i: %
::lJii!~O I:::'IEIi:T [::'l.::ll;ir FI I:::'l:;i:]:',,,ff::l'l'E: I.'IE:I.!.. O1:;?. 21?.nZI F'E:Ei:"I' ]:::Ed;~r F:I I:::'IIIE',I.:[C
'.Ei;I::'E;C ]: I:::' ]: I:::I:::IT ]: I::)N:ili; I::llqD I:::CII'.,I'.ili;'I-I:;?.LIC:T:[I::;IN [) :[ F:ll::!ilE'.l::lf'l::i-; FII:;~:E: Fi¥1:::IZI.FIEilI..Ei: TO I:N'SI. JI:;~:IE
]; F,f:E; T 1:::1 L. L I:::1T :[
:!: E:Ei:I:;i:T ]; F"¢ Tl.ll::rl'
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I:::'OI;i:TII I-ii?.r~ 'l'Hlii: I"IIJI'.,I];(:::];PI:::tl,.]: I~./
2: :[ I,.I]:!.1 :l:l'.,IfF;'rF:ll..I THE E:;"r".iFl'[i:H :1:1'-,I
:-!:: ]: I...II'.,IDEI:;~?.!;'T'I::II'.,II:) TIII:::I'T 'TI'lEi: ON'-'.iE;];TE:
I:E'.l?.i!;]:13,11i;l',l(:::lE ]::!!!; I:,UEI'IEE)IEI.E;I:;:, I'O
:E; :1: (!iNEi:E:,: ...........................................................................................................
FIF:'F'I .. ]h;;:FIN T HI:..IIE'.V ]: I'.,I
:[ E; '.E;I..I E:: [)Effl"
:!:NE';I:::'E:C'I~:[CIN 14 ]: '.iii;'r'cIF;:]"r' ..... '.E;IEb. Iri;I;[: d. 12!!~ :51E:I,.IIEI:;i: 2
I,IIEI...I.. ]:N:E;F' E=i I.,.lii!:l.L I.I[3G [)fYi'E: IZI
GREATER ANCHORAGE AREA BOROUGH
"EPA"TME"T OF EN",RONME,,,'AL QUAL,TY
3330 "C"STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4§61
SI:WAGE DISPOSAL SYS'rI~M -- APPLICATION AND PERMIT
HAME OF ^PPL,O*NT,
'MSTALLAT'ON LO OAT,ON /~/'V~-
'EGALDESO.,PT,ON_ /9-
INSTALLATION OF= SEPTIC TANK
SEEPAGE PiT DRAIN FIELD ~, OTHER,
TYPE AND SIZE Of FACILITY TO BE SERVED __
FINANCED 'rHROUGM _ -- TO BE INSTALLED BY
TEST RES.LT
SOIL
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOU'T FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL i3E SUBJEET TO PROSECUTION.
SEPTIC TANK SIZE J~'~'~ IE~7~TYPE
DRAIN FIELD
CAST IRON INTO ANB OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEe'r INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVE. BACKP'I L.
CONFORM TO BOROUGH REGULATIONS REGARDIN~G ]NS~'ALLAT~ON.
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE MO. 2S.08 AND THAT TNE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE - APPLICANT'S SIGNATURE
O 8- E GEO'
.CHNICAL Et DEVEL
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
~MENT CO.
Russell Oyster Earl Ellis
694-2774 S_~0IL LOG 688-2260
Soils ~ Foundations Land Development
2
Ground Water Fncountered: Yes__...,.,=_~/' No.~,.
Proposed Installation: Seepage Pit Drain
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1, GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name"~:~ ~'c:~,~:,/"~,~__ Telephone: Home ~:~- '~'~ ~G. Business
Applicant Address ",~.~,, ~ Z-~'~c[~ /'~..5¢_~-L, ) /~/-~.,
(C) Applicant is (check one): Lending Institution []; Owner/builder[~-; Buyer [-i; Other [-I (explain);
(d) Lending Institution b,-.~_~,~ __ Telephone
Address ./~('N2~
(e) Real Estate Company and Agent
Address
Telephone
(f)
-Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family [] Other
Number of Bedrooms _~" _ __
WATFR SUPPLY
[adividual Well r'] Community [] PubliciSt-
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite,,~ Public [] Community r'] 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, FILl-' 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:.~r~(~-3~Rl[~l~.~ Telephone
~R~ ~9~ ,
Address ,:, ,~~~
Date ~H. 6g~979
DHEP APPROVAL
Approved ' /':'J'--- '_ Disap~ved ~' Con/d~nal.
Terms of Conditional A. pproval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. ']'he DHEP does this as a courtesy to purchasers of homes and their lending
institetions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct iaspections 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 ANCHORAQt]
DEPT. OF HEALTH &
ENVIRONMENTAL PRO'rEcTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FFBRUARY 1984
264-4720
Legal Descrieuon: L~:~'T-
0 ? 1985
RECEIVE[)
WELL DATA
A
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holdi'r~ Tank on Lot
To Nearest Edge of Absorption Field on LO1
TO Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A. B, C, D.E.C, Approved~TN)
Date Comeleted
Cased to ~,~ fi~Depth of Grouting
Pume Set At
Yield
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
~"' -"/-'"~z-.~ 'Jr On Adjoining Lots
~J~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
B, .SEPTIC. PcI~L-DfN~ TANK DATA
Date Installed -~~" Size
Standpipes ~N) Air-t ght Caps~N)
Depression over Tank (Y,~
Pumping/Maintenance Contract on File (Y/~¢) [
Holding Tank High-Water Alarm (Y/N) A
Separation Distances from Septic/Ne-iding Tank:
To Water-Supply Well "~-~-~,~:~ ~ ~
To Property Line ~,c~ ~4-
To Water Main/Service Line ~, b ' 4-
Course ~ / ~
No. of Comoartments
Foundation Cleanout
Date Last Pumpea
__: for
Temporary Holding Tank Permil (Y/N)
'Fo Building Foundatior
To Disposal Field
1'o Stream. Pond, Lake, or Ma, or Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ! ~ --~ ~
Width of Field ,.~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area '~.~.~z_~ c~ Standpipes Presentd~J)
Depression over Field (Y~/'~¢' , Date of Last Adequacy Test
Results of Last Adequacy Test \~4~-'~==~,. f'~L--'~--~-~-¢--~ "~/~'1 ~--'--~,/ ~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot .~'~r~ '"~'-
TO Water Main/Service Line
~ ~ '"~ TO Property Line [ C::::, ] ~'-'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots ~ ~"~- '~--
~ Cutbank (if.present)44/~.
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
"Pum P Ovf~'n~;~lN~t
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
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 ~J~,~B~_'~ Date
Company~l ~ ~IV~. A~SKA '9~57~' MOA No,
Receipt No. '" S%~'t;61 I-
DateoJ Payment ~-g
Amount: $
Page 2 of 2
72-026 {11/84)
t
/
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL ,~IEFFIE~.D~ GOVERNOR
274-2533
I~UNICIPALITy OF ANCHORAGF.
DEP1. OF HEALTH &
ENVIRONMENTAL PROTECTION
R£CEIVED
To Whom it May Concern:
According to records on file in this office the w4 _?
/~//~LcA /~/~ .Water System is in compliance with the St~e. Drinking
Water Regulations
Sincerely,
.?
SUBJECT:
QOMPUf^i'ION SHEET
DAT~:
,SHEET OF
BY_