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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 CPa~ 2 of 2] 2-15-84