HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 28 MUNICIPALITY OF ANCHORAGE
DE RTMENT OF HEALTH AND HUMAN SFR ,ES
Environmental Health Division
625 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
- '~ANKS
~'~ SEPTIC
[] HOLDING
TYPE OF SYSTEM
¢'rRENCH [} BED
OTHER
original glade ~iC) F'r ~ ,C:> FI
r'/"~, O FI
~'0 FT
'7.--, ~ FT
~J "~ 0 sgFt
WI-'LLS
PRIVATE ~ OTHER fldenlifv)
REMARKS:
DISTANCES
~ T[ SEPTIC ABSORPTION
FfJOM ."---C. TANK FIELD WELL
' WELL
LOT LINE
FOUNDATION ~::~
~NGINEERING
i SRB 196X ....... ~
....... cerldy t~,~J Ihls iflspe~.[.iofl was i)erlu~l~d acc~rdin[i Io all
Dlil]::'ARTMI!!]gT OF:' HEAI..'H'J AND ENVII:?OFIME:N"I'AL F:'ROTECT]:ON
[! l.':?. ', :i L. ,~Sl'l::!l!ii]!i21", AM[;IgORAGE, Al::: V9',~:i01
264,-'4'/;:~0
]:::'[!i]=~M I T
OA'TE ,~,dJI ]).
CC)FI'I'G.]T' F:'I-IONE:
99577
B I I ,,C M I SNI~i:I::/
I:::' 0 BOX '77()1!)72
EAGI...I.':': R I VEl:?, ('~1<
668"'4572,
I.[}] ,.~.IZI ....
I..OT I.,OCY-TI' I DN:
MAX I,DId]l II, ,,
L..[)'T': ,,=D I.. L, OI~I .... 1
15 N R Aixll3 Eiil :: 1W
DliZI::'TI'I "l"l] PIPE !:IO'ITOM (F'I'.) 4.0
[')RAVI~:I. DE[:~'III (I:::'T,,) 5,, ()
"I'O'f'AL DI!]::"[I'I (1::: I',, ) 9,, CI
ORAVEI WID'Ill (F:'I ,, ) 2., 5
Gl::d~Vl:i:l. I .li!i:NGTI-I (I:::T.) 7::!;,, 0
GI:~AVI~:I. VIII. JJMI!:: (CU,, YDS,, ) 37~ 2
'I'ANK S I Zlii: (G(]LS) 1,000,, 0 .1;.,1~.
SO I I- R(.'~]' :[ NG (S(:~ ,, I::'T ,, /BR ) 2.43
I c:l.:~r' L :i. } y I:.i-~at.:
{c~[";'J'l by the ML[,riic:Lpal:i,'Ly (::~t Anchc:.t'agc) (MOA) and '~11' ~ ~::' ~'~r. '~q~:. ('~ ~::) f Alaska.,
2. ]: wi ].1 :i, ns'La:L 1 'l:.he system in acc::umdai~c:~:.) with al :l, MOA c::ctde~ and ~'egu:l,a't. :i,~:]ns~
and in cc)topi:lance wi'Lb t. IHc~, cJ(:)~:[[~ll]
3. I wi:l,] adl~eH?? '!'.o ail H[I(:] and S'l'.at.o (::~1 t.]lasl.:a r'c.H::luil'em~'~n'l'.s t'c)r' t.h(:~ set. back
~i(~)~,.K.?l'~a~(,l(~ ~[~'[,(1)lll (]1'i t.h:i.s ol' atp/ acl,jac:(-~rrL cH' i]c2apb~z ].ot.,,
I uru:J(,:~r'stand '[hat, 'U]:i.s i)ePmi~' :i.~ va].:i.d icH' a maximum o[ 3 I:)edl'OOms ar'id
FU"~y C~ll].,'i:tl"l.]eHi]C)li[. I~JJ ].], P[:~qL.lil'e,) all
:(F' A I..IF:'T ST(VI'ION IS II".IE;'I'AI.,.L, ED 1:1',l AN AREA I][),~ERF:D BY M[)A BUILDIND CODES~
'I'H[Bq (1) AN EI.,.ECTRICAI., PERMI"I' AND .LI.I,:I I ,C, I .I. LIN I'flU~H' BE: OBTAINED~ (.~:.) AS'-~:'II':I TS
F' ,.. ,',,',' :', ,::,
QGRE
ANCHORAGE AREA BOF U H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
OISTANCE ~//-'~
FROM WELL "' -- MANUFACTURER MATERIAL COMPARTMENTS ~Z-
INSIDE[ LENGTH
.INSIDE WIDTH
LIQUID DEPTH
.LIQUID CAPACITY /0~'~ GALLONS.
SEEPAGE Pit:
-- __.
LINING MATERIAL__ __ CRIB SIZE: DIAMETER_~ /DEPTH (¢ _ DISTANCE FROM: WELL
· TOTAL EFFECTIVE
BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
_SQ. FT.
ADDITIONAL ABSORPTION
WELL: ~/~'~¢(g~/(/.~
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVE[:)
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
LOT SLOPE:
RFMARKS:
Form No. EQ-031
GREATER ANCHORAGF AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO,
INSTALLATION Of: SEPTIC TANK ~ ' I SEEPAGE PIT ~ i DRAIN FIELD
SOIL TEST RESULTS
PHONE
OTHER
COMPLETION DATE ANTICIPATED .......
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PRO.~ECUTION.
CAST IRON INTO AND OUT OF SEPTIC 'rANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL,
4 I~NC_~.~J~R~L~=GAS. T Ir.~2ON SIJHO~.~N PIPES ON SEPT[C: 'rANK
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING iNSTALLATION,
I CERTIFY THAT I AM FAMILIAR WITH THE REQBIREM~NTS OF GREATER ANCHORAGE AREA BOROUGt4 ORDINANCE NO. 28-68 AND TNAT THE ABOVE
Municipality si Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORA ~
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
Township, Range, Section:
13.
14-
15-
16-
17-
18-
19-
20-
SLOPE
SITE 'PLAN
WAS GROUND WATER ~ ~
ENCOUNTERED? r~ c,
s
IF YES, AT WHAT (~
DEPTH? p
E
geplh Io Water After
Monitoring? ~c,
Gross Net Depth to Net
Reading Date Time Time Water Drop
~',~y ~o" ~ ~1~' '
PERCOLATION RATE ~"~ (m,nutes/inch) PERC HOLE DIAMETER __~__
TEST RUN BETWEEN _ '7 -FTAND ~ .FT
L
COMMENTS
ER ORMED : CERT, THATT.,STES. WAS ERPORMED ,N
ACCORDANCE WlT~:d,~A~A~IF_V~(~'~IDELIN[~N'~'FFECT ON THIS DATE, DATE:
72-008 (Rev. 4/§5)
264 4 ] ! i
5026 H(ax't:h;;tono Lxt:Jvc:
ChugJak, hl~asha 99567
Sub}eot: '1~o[: 2~ 8i.o.-:k ~L Wynt(~r Par]{ Subdivision
Approval :6o~ he ired{vi, dual sewe}: and wale)- fac] ].it les
(13a~1!1o% b~! g~'an{od unLJ] bhe fo]lovshlg Jhell/S [lave bec}l!
complkeL ed:
(1) A ckc~nout hOOds t:o be inst. a]_].ed [:o bI~e sephlc ban];.
h~ diopartmen~ ·
~'s}sll i].J need {o be reJnspec ed by ' '~'
hhis oil:Joe.
:%n ade(lftJa(:!r' f:e~.l needs Lo bo pGL-~o~'iI/ed o!l t he exJ
leaching are}. This hesL will dehermine i f' /..bc syst::eiu
is adi:y_~t].lthe ,7tOCO]'d~ll(~ Iio Nat::i. ona] Standa}:(h~. A ]
report new,ds ho bt: submihked ko hhis of~fJ.(;e flor
l.there are an': [urtthe~ qdo:l;t:Jons, please ca].l Lh:i.s
264 -,4720,
(2)
/(3)
S inc;eceilS,,
AssocJ. a!:e Sp(tc[al i
RCP/] j w
Pouch 7' 087 ci95] 0
~vere1:.P Cai k ins
-' (}l?ea[.].{tF!d i~oa'! i ',
Pos[; O]:[:ice Box 2i9
9 9 5 6 7
(¢8 Lal a.] d
Ga].lex'}/ of Homes
West .udo,. !,',oadl
99503
ALASKA er'IUIROI'Ime TAL cor'ITROL SeRUICe$, Inc.
~nclinee~'incj [, ~nuiPonmenlal Studies
MAY ].4 1981
P~OPLES BANI{ & TRUST/MYSNER
POUCH 7007
ANCHORAGE AK 99510
SET,LER - WALTER WILSON
SUBDIVISION-WYNTER PARK BLOC.K-1 LOT-28
~E ~PE 0]~' ABSORPTION SYST~ IS A PIT WITH AN AREA OF 324 SQFT.
~E SYST~I~ IS CAPABLE OF ACCEPTING 340 GAIJ~ONS OF WATER PER DAY.
BASED UPON THE TF~T DATA T~E SYST~4 IS ACCEPTABLE [~)R A
2 BEDROQ~ HOME.
THE SF~PTIC TANK WAS PUMP];~D ON 5-14-81 .
CLEAN OUT PIPE HAS BEEN INSTALLED FOR SEPTIC TANK
1220 ~Uest 251~ ~uenue · ~nchoroq¢, ~1o$~c~ 99503 e, (907) 276-1361
.' ' -- DA~'E RECEIVED
INSPFCTION APPOINTMENTS
'~ME TIME TIME
DATE
INSPECTOR INSPECTO INSPECT~ ~
MUNICIPALITY OF ANCHORAGE D~PT. OF HFALTtl
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVJRONMFNTAL P;.O'FFCTION
825 L Street - Anchorage, Alaska 99501
( ~ ENVIRONMENTAL SANITATION DIVISION
2
8
Telephone 264-4720 R ~ C [ J V
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIg~S: Complete ~11 parts ou page 1, Incomplete requests will not b~ processed. Pleese ellow ten (10) d~ys for processing.
~AI LIN~ ADD,E88 '
~OPER'FY RESIDENt (If dff'f~rent fr~m above') .... PHONE
~ BUYER PHONE
~AI klN¢~ A~ DR ES~ '
~ L~NDING INSTITUTION PHONE
MAI kl NG
~AILINGADDRES8 ' // ' ~ ....
~',' LEGAL DESCRIPTION
STREET LOCATION
6, TYPE OF RESIDENCE NUMBEF{ OF~BEDROOMS
~ One ~_ Four
'~ SINGLE FAMILY .~ Two ~__ Five
[] MULTIPLE FAMILY ~_ Three ~__ Six
[] Other
7, WATER SUPPLY
[] NDIVI DDAL* - ATTACH WELL LOG. A well log is required for all wells drilled
~;] COMMUNITY since June 1975. For wells drilled prior to that date, give wel
[] PUBLIC UTILITY depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
41 ~ ~ YEAR ON-SITE SYSTEM WAS INSTALLED.
NDIVIDUAL feN-SITE**
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNtTY
DATE DRILLED
[] PUBLIC UTi LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~- ~ ~-~ '_~
Connection Verified INSTALLER
[~]Septi~ Tank or [] Holding Tank
Size: /OOO If Tank is homemade SOILS RATING
give dimensions:
TYPEOFTANK MANUFACTURER ~,~..~_U~
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR ~-- BEDROOMS
[~'~ONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE WY ~
72-010 (Rev, 6/79)