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HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 45 GRE - 'R ANCHORAGE AREA BOr [3epartment of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM PHONE __ MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL __ INSIDE LENGTH M AN U FACT U R E R,~'~//-/(~/~' __INSIDE WIDTH ~-~'~P f-~ MATERIAL _LIQUID DEPTH NUMBER OF COMPARTMENTS __LI(~UID CAPACITY /(-'~'~) GALLONS. SEEPAGE PIT: NUMBER OF PITS ~ LINING MATERIAL J~/~ BUILDING FOUNDATION__ ADDITIONAL ABSORPTION DIAMETER_/2,t~, OR WIDTH /~/I, LENGTH ~:, DEPTH y' CRIB SIZE: DIAMETER __DEPTH ~-'[ DISTANCE FROM: WELL TOTAL. EFFECTIVE NEAREST LOT LINE ~OI ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE BUILDING FOUNDATION _CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE LOT LINE ., SEWER LINE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTAl_LED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ~O31 DIAGP, AM OF SYSTEM GREATER ANCHORAGE AREA E~OROUGh PERMIT NO, SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT INSTALLAT[ON LOCATION INSTA[~LATI(}N Op': SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED NOTE= TI'IlS P~'RMIT IS NOT VALID WITHOUT 8OIL TEST ALSO CONSIDER AREA WELLS. SEEPAge PIt GRAVEL BACKFILL TO BOROUGH R LATIONS REGARDINg INSTALLATION, I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE DESCRIBE SYSTEM IS IN ACCORDANCE WITH SAID CODE. ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE ~ ALASKA 99503 563~-6775 DATE: August 25, 1989 PWSID: 211431 Requested By: S&S Engineering According to the records on file in this office, th~ Dawn Water Co./ Meadow R~dge/Wynter Park Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Cindy Thomas Environmental Engineer MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL. INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) NHN Hearthston6 Street (b) Property owner AJ-~9~'A Mailing Address P.0.Box 196615 (c) Lending Institution Telephone: (home) A~¢ho~a,qe, A~aska 99517-6613 Telephone Bu.sine. ss 786-2800 Mailing Address (d) Real Estate Company and Agent Address USA F6deral Credit Union ATT~: Ron MeAlpin Telephone (e) Mail the HAA to the following address: (or check here,~,~ if hold for pick up.) List contact person and day phone number below: -- $ & S ENGINEERING 17034 15~lte River Loep Ea~le River, Alaska ~9577 2. TYPE OF RESIDENCE Sin,qle-FamilyY~ Number of bedrooms ,~ 3. WATER SUPPLY Individual Well [] Community [~X Public [] 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 [] Note: 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 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 Telephone ~"~?~7~"-,~~ ~'~:~.~ ~ & ~ FNGINEERING 17034 Eagle River Loop Road No, 204 Address ~[ngle Rivet', Alaska 99577 Approved for --¢ _bedrooms by . Date ~_ / Approved ~.~'~ Disapproved Conditional Terms of Conditional Approval 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)88ck Page 2 of 2 ~ MU ,N, ICIPALI'FY OF ANCHORAGE (MOA) /~,e~'"~t'[',' ~ ^f-~Hl~i/l~,ulhority Approval (HAA) ~H~"~-ii,~. sE~vlcORIE/(~).~ST - FEBRUARY 1984 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth: Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holdieg Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~-'~¢~ ~1~C'~C~ ~ 1%9 Date Completed 343-4744 Lega, Descr,pt on'. Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed/~///[~/~-~ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line /O00 Air-tight Caps (Y/N)_ / No. of Compartments ,~ Foundation Cleanout (Y/N) /~ Date Last Pumped & / /~d~, ~ ~' ; for /~/¢f Temporary Holding Tank Permit (Y/N) g/,/~ To Building Foundation To Disposal Field _ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Fronl Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ,/O/f~ Width of Field Type of System Design / Length of Field / ~ Depth of Field ( 0 Gravel Bed Thickness /O ' Square Feet of Absortion Area ~z_/ ~ ¢ Statndpipes Present (Y/N) Depression over Field (Y/N) ~k) . . Date of Last Adequacy Test Results of Last Adequacy Test .~¢.'J~{~¢~c¢Od~q :;~b ~J V' ocbcv~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ O0 ' '~ To Building Foundation ~ © 7L Lot /~/~ To Water Main/Service Line //O ' ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line r~ O To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) D. LIFT STATION Date Installed % Size in Gallons "Pump On" Level at 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) Pumping Cycles 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 thls~2':,; inspection. Receipt No, "~'~..v,, ,~' Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ $ & S ENGINEERING 17_n3a Eagle River Loop Road No. 204 Eagle RNer~ Alaska 99577 Waiver Fee: $ Date of Payment 72 026 (Rev 7/88)Back Page 2 of 2