HomeMy WebLinkAboutWYNTER PARK #1 BLK 2 LT 10LoT'
NAME
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
PHONE [~]NEW
,,I~IDGRADE
LEGAL DESCRIPTION
,-
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well I Absorption area
F / 5'7- ~Al 4
IF HOMEMADE:
DISTANCE TO' Well
I Manufacturer /~
Top of tile tO ~ish Cade '
Length Width
Type of crib Crib diameter
DiSTANCE TO: WoH
Class Depth
Inside length
Dwelling
Material
Width
Foundatio~ ~,~ /~
Total 19~gt g~gf i[ines
aterial~'~e~ath file
No, of compartments
Liquid depth
Dwelling PERMIT NO,
Material Liquid capacitv in gallons
Nearest lot
Trench wi~
lepth
Total effective~,~a~.~rption area
PERM T NO,
//
inches
~b depth Total effective absorption area
Building foundation Nearest lot line
Driller
.-.,/ ~
S~w/line
Distance to lot line
Septic tank
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERI LS
SOIL TEST RATING
REMARKS
72-013 (Rev, 3~78)
GRE' R ANCHORAGE AREA BOI'"'GH
Department of Environmental (~uality
3330 C Street
Anchorage, Alaska 99503
INSPE'CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME '~)1~l~1 ~0(~(-¢ MAILING ADDRESS PHONE
SEPTIC TANK:
DISTANCE
FROM WELL --
INSIDE LENGTH
NUMBER OF
MATERIAL "2 f¢'£ ~ COMPARTMENTS
INSIDE WIDTH
LIQUID DEPTH
.LIQUID CAPACITY /~O/~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
DIAMETER ~.1 OR WIDTH /¢ LENGTH /7, DEPTH
CRIB SIZE: DIAMETER ~ DEPTH DISTANCE FROM: WELL
NEAREST LOT LINE ~C~I TOTAL EFFECTIVE q~,~,
, ABSORPTION AREA (WALL AREA)
SQ. FT.
WELL:
TYPE ~ l~ ~AA
BUILDING
FOUNDATION
CONSTRUCTION DEPTH DISTANCE FROM:
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE TANK __ SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
P,~.E M~ER,~t.: ~ ~,
LOT SLOPE:
REMARKS:
~6~
Form No. EQ~031
]DIA~RAI'OF SYSTEM
APPROVE/~I /¢C¢ ~
// G.A.A,B,
C) r-,I--'_5 ;[ TE '--.-~EI-,IEi~: F"EF41','! X T
PERMIT NR
[:,RTE ISSLIEB:
'-'-,' ~1
,. 4~ 4 _ ~. UPGRRBE
C~r'i9,/84
HFFLI_.~N1:
C:ONTRC:T FHJNE:
NOODY ROGERS
X S&S ENGINEERING
ERGLE,RIVER., RK 99577
694-29?9
LEGRL [:'ESCRIP:
LOT ~I~E:
SUBDIVISION: WYNTER FHRK.
_E_.TI -N. st¢..4 TCIHNSHIP:
2.'480~ ~SL.-.. FT. OF.: RE:RES)
LOT: stE'l E, LL*L.}.,. 2
St5N RRNGE:
I CERTIFY THRT:
st. I RM FRMILIRR HITH THE REQUIREMENTS FOR ON-SITE SEI4ERS RNB HELLS RS SET
FORTH B',r' THE i'IUNICtPRLITY OF RNCHORRGE (HOFI) RND THE STRTE OF RLRSKR.
2. I HILL INSTRLL THE SYSTEH IN RCCOR.[:,RNCE HITH RLL MOR COBES RNB REGULRTION2%
RNB IN COi'tPLIRNCE HITH .THE BESIGN CRITERIR OF THIS PERMIT.
I HILL, RBNERE TO RLL MOB RN[:, STRTE OF RLRSI-i:R REQUIREi',~ENT'-'; FOR THE ~ET BRCK
BISTF;NCES FROM RNY EXISTING HELL, HRSTEHRTER [:,ISF'OSRL SYSTEi','I O;q: PUBLIC
SEWERRGE SYS]'EI',I ON THIS OR FINY RBJRCENT OF,' NERRBY LOT.
IF R
"FNEN
HILL
ELECTRIC:FIL HCFK BE [:,ONE E:Y R LIL..ENz. EB ELEL. T~I_.IFIN
LIFT STRTION IS INSTRLI_EB IN RN RRER CCIVERED BY MCIR BUILDING
(st) RN ELE_.TRIt..RL 'PERNIT RNB IN_FEL. TION MUST BE OBTRINEE:u ,,~.., RS-BUILTS
NOT BE RPPRO'v'EB HITHOUT RN EL. EC:TRICRL IN_PEL. fION'R -" ' REPuRT,' - ' RNr) ,:'-~)' THE
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82B g Street, Anchorage, Alaska 99S01 264-4720
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
SLOPE
WAS GROUND WATER N../~ I~
ENCOUNTERED? O
P
/ E
IF YES, AT WHAT
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE //V'//~ (minutes/inch)
TEST RUN BETWEEN F..~A/N~D FT
MUNICIPALITY OF ANCHORAGE
' DIVISION OF ENVIRONMENTAL HEAL~7{
DEPARTMENT OF HF~LTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEAL~{AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date (~: d
(a) Leg.al Desc~i_ption (include .lot, block,, ~subdivision, sectiont tcwn~hipl~ range)
notation (add.ess or directions)
(b)
Applicants Address
(c) Applicant is (check one) Lending Institution [~_~.; O~ner/buildbr ~;
Buyer~___~ ; Othe~(explain);
(d) fending Institution Telephone
Address
(e) ~al Estate Co. & Agent
Address
Telephone
2. Type. of Nesidenoe
Numbe~ of Bedrooms
Multi-Family~-~ Other (describe)
3. Water Supply
Note: If ~.~nity ~11 system, must ha~ w~it~n ~nfi~mtion f~c~ ~e State
~pal~nt of ~vil'on~ental Con~rvation attesti~lg to t~ legality ~d
Is ~e ~11 adequate fo~ the n~r of ~ s~cified in this H~
4.
Is the wastewateu dis~sal system adequate f~' the r~m~ of ~drc~u~ )
[Page 1 cf 2]
2-15-84
5. E__nginee~ing F.irm P_~ovid____!~_n~ctions, Tests, D~ta and Infornmtion
I oe~tify that I/h~'g~ checked, verified, or conformed to all MOA HAA Guidelines in
effect on the~/~te~/~//fnsp~ction. ,
N~o of ~ Toio~
Address
(ENGINEER SEAL)
6. DHEP A_p_proval
Approved for ~
f3~l~ert A, Sh~r
Conditional ~_.~
Tezws of Conditional Approval
The Municipality of Anchorage Department of Health and Envirorm~ntal P£otection does
not guarantee the continued satisfactory perfomnanc~ of the water supply and/or the
wastewater disposal system. ~his approval indicates that~ as of the validation date
shcwn above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedroc~ns and type of structtme indicated°
( ~dEP SFAL)
7. 52~il the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPA, I. Ii¥ OF ANCHORAo~
I)EPT, OF IlEAl. T/{ &
I~NV/P,O '41~'iENTAL P,qOTI~CTION
Well Classification
Well LogP~esent (Y/N)
Total Depth
Static Water Level
Cased to
If A, B, or C, D.E.C. Appro ).
Date Completed ~Yleld
Depth of Grouting.
Pump Set At
Above Grcund Sanitary Seal Casing (~/N)
Casing Heigh~ . / ~ on _ _
Electrical Wiring in Conduit (Y/N) / / / Depression Around Wellhead (Y/N)
Separation Dlstanaes f~om Well.'_.
To Septic/Holding Ta~k o~ Lot ~ /. / ~; C~ Adjoining Lots__
To Nearest Edge of Absorption Field on ~-~3 7t- ; On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected By
Water Sample Test R~sults
To Nearest Public Sewer
To Nearest Sewer ServiceLine on Lot
; Date
Core,Tents
SEPTIC/HOLDING TANK DATA
Date Instal~9,d /~)/~/7~ Size /~O No. of C~%~a~tm~ts
Standpipes/Y~) ~_Air-tight Caps~.~/N) Fou~da,ticn Cleanout (Y~
Depression ok~o~ Tank (Y~ Date Las~.P~m)ped ~z~, ~//_~ //~ ~
Pump!ng/Mainte?an~ Contr'aet on File, (,Y/N)~//~--; for ~--
~eOlpd~i~kDi~gah~-~te~(~Alact.(iyc~Ta~:mpora~y Holding Tank Permit (Y/N)
To Water-Supply Well
To P~operty Line
To Water ~aln/Servl.c~
Co~ts
To Building Foundation /~9 7/-
To Disposal Field /~- /
To Stream, Pond, Lake, c~ Major D~ainage
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption St~,ata /~~ Type of System Desig~~
Date Installed /D/2~/~3 Length of Field I7!
Width of Field/'9/ Depth of Field ~ /
Gravel Bed Thickness 6 !
Square Feet of Absorption A~ea ~ ~-- Standpipes P~esent~Y~)
Depression ove~ Field (~0 Date of Last Adequacy Test--~/--~
~ Results of Last Adequacy Test ~/~ /m~)!~ /
Separation Distance f~om Absorption Field:
To ~ate~-Supply Well ~ '~- TO P~operty Line ~ (
TO Building Foundation ~-~ ~ To Existing or Abandoned System on
Lot )6 //'$- ; On Adjoining Lots ~ /~
To Water Main/Service Line /~J/~r/~x3C/~To Cutbank(if present)
To Stream/Pond/La.ke/c~ Major D~ainage CoJ~se ~/~
To D~iveway, Packing A~ea, c~ Vehicle Sto~age A~ea /J
D. 'LIFT STATION
Date Installed
Size in Gallons
"Pump On" ~evel at
High Water Alarm ~vel at
Tested for
Electrical Codes(Y/N)
Dimg~sions
Manhole/Access (Y/N)
/'~m~/~/f" Level at
Pumping Cycl~s du~ing Adequacy Test.
Meets MOA
Counts
** Cheek Permitted Bed~ocm Ratin,g Against HAA Request **
I oe~tify that I/~a~ checR~d, verified, or confo~r~d to all
on the date~/~~~/~- ~- MOA HAA Guidelines_ "'¥%'~'~%~.in effect
KB1/dS/s
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2-15-84