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HomeMy WebLinkAboutWYNTER PARK #1 BLK 2 LT 29Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191096 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Name: MICHAEL BERGSTROM Address 20932 FROSTY DRIVE, CHUGIAK Phone Number of Bedrooms 3 LEGAL DESCRIPTION Subdivision Block Lot WYNTER PARK #1 2 29 Township Range Section Page of PID Number: 051-492-30 Multiple (SF and/or D) Project: ❑ New ® Upgrade SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer From Tank Field Tank Line Well 200'+ NA NA NA NA Surface water 100'+ NA NA NA Lot Line 5'+ NA NA NA N Foundation 10'+ NA NA NA Curtain Drain NA NA NA NA Remarks Existing septic tank decommissioned per UPC, new tank installed 5'+ from & connected to existingfield. ield. ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other Soil Rating otal depth from original grade GPD/SFI Ft. Depth to pipe invert from original grade JGravel depth beneath pipe Fill added above original grade JGravel length Ft. Ft. Gravel width Beds: Number of Lines Distance between lines Ft. Ft. Total absorption area Number of trenches Dist. between trenches Ft' -- -- Ft. TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCHORAGE TANK 1 1000 Gal. Material INumber of compartments STEEL 2 A LIFT STATION Manufacturer Capacity Gal. ump on level at IPump off level at IHigh water alarm at in. in. ump make and model JElectrical Inspections performed by in.l PIPE MATERIAL House to tank 3034 d Tank a nfie�o 3034 Installer NORTHERN EXCAVATION Drainfield CO/MT 3034 Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspection ection 1" 4/24/19 Znd 5/23/2019 Location and description 3rd 4th BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL e F \ Conditional Approval: Date -:4 *� MICHAEL N. ANDERSON: G� No. CE 9469 ,4. j 8/12/19 � s Approve L— Date ispecuon Keport_a--i-iz.aoc WYNTER PARK #1 BLOCK 2, LOT 29 PID* 051-492-30 A–C=13.8' B–C=29.7' A–D=17,9' B–D=34.4' PERMI OSP191096 165.00' _ x—x--x____-x_ e p 70 0 0 o) o _ (DO U) O GARAGE b p 0 N 24,p• GRAVEL DJW SHED o CONC RAMP 34, 0• 30.2• (11 r ® O � 00 b Z J CP _Z7 �mciLOT 29 �: EXISTING FIELDS ^� BILK 2 m A 34 p COCO Q B CO G COS O D � O DIV NEW 1000 -GAL O SEPTIC TANK SCALE: 1' = 30' SEPTIC SECTION 11 SCALE: NTS PREPARED FOR: SUPPORTQ SERVICES: MICHAEL & KATRINA BERGSTROM e ��� �F AL�� WYNTER PARK #1 BLOCK 2, LOT 29 F W, C. 5 � *� TH 20932 FROSTY DRIVE, CHUGI']AK,, AK 99567 . 4 9 — Michael N. Anderson, P.E. DATE: 8/12/2019 7� MICHAEL N. ANDERSON �L� No. CE 9469 4661 Natrona Ave. DRAWN: FWCS<" 8/12/19 G$ Anchorage, Alaska 99516 'a ��`' (907)727 8864/FAX: (907)345 1391 SCALE: �" = 30' �FESSIO0 ti �Ak, r MUNICIPALITY OF ANCHORAGE ri On -Site Water & Wastewater Rrogram P rj Boy 19 H M 4700 EIncre R -,w 19-134sa Pham.: mm 343-79D4 Fn(907) 34�J!9.y On -Site WaSte-WAter Difsposal Sy's-tern Permit Per nitNumber: 0,r`191IV06 Effealve, Ditq WorY, Type, S.nL)ticTar*,Upq-nde, Tax Clode Number: G5114q2�0000 Site Legal Address, VNINTER PAR,,( #1 8LK 2 LT 219 G; IHS Site MaifingAddrets: _-,10932FF"0STYDR, (hug;1qk. Owner: B ERG S—ROPi M I F>IAEL K. & Desigfi Englnoor: ANULR�;GN CONS71RUC:7014 & ENGINE-E-RENG This permits -For the construction of: 0 Dispcsat Fie,,d 0,1 SepttcTank. C1 Holding -ark EJ Privy All const-ructior shalt be in accordance. with-, 1, The a:tache ol appfoved design. Expfratiari Date - 411 612,0.,1 9 4A 512023 Lot Size in Sq F11- 24752 7Wpl Bedrooms: L 0 Ph � wak! Wel" 11 Wxer Stwage. 2. All requirermar, is specified in Anchorage NIuNdpal o0dP Charitar!j 15,551 arc 15.65 and the Sate of Ala5ka Wastewater DIsDosai. Regulations (18-P0,C72) and Drinking Water 1,04aguradons (18AI, Q) 3. TI Wa watnowster ca -de require-.-, inspecdonz dunng tme, installation. The c-ngineef sl­var L -IL, Developmert �er,tices DepaIment per .AMC 1.5.H. Provide rlotiflcaion by calling (907} 343-743L14 4, F,rora October 15 to ApriF 15, a sul?$Urfiace soil abso;'p.1don b -"stern under construction during freazzing kv�sther shall be either: a, Opened and Cr sec ori ,!,ie uavne day, or b. Covered, sealed, and heated !:c prevent froo-zing Reccrvbd BY' rS 1,;z,Pjky­1 _k Date: Date: MMHO PAU icy OF Community Development Department e Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-492-30 Property owner(s) MICHAEL & KATRINA BERGSTROM Day phone 2093 F 2 ROSTY DRIVE, CHUGIAK, AK 99567 Mailing address Site address 20932 FROSTY DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) WYNTER PARK #1 B2, L29 Legal description (Township, Range & Section) 752 Lot Size 24,Sq. Ft. Number of Bedrooms 907-222-7653 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) ❑ Single Family (SF) Absorption Field ❑ Initial (w/wo ADU) Septic Tank [ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: 9a5 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: �'1��J�� Receipt Number: Permit No. Waiver No. Permit App_9-1-12.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 Fax 345 -1391 April 11, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Tank Permit Legal: WYNTER PARK #1 BLOCK 2, LOT 29 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by a class A water system and will not impact any of the neighboring properties due to the lot layout. Please contact me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191096, Rebecca Carroll, 04/16/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191096, Rebecca Carroll, 04/16/19 inspection Keport_a-i-­il.aoc Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131000 PID Number: 051-492-30 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: JOSEPH & SALLIE SCHULZ ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address PO BOX 1659, SEQUIM, WA 98382 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 3.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.91 Ft. Gravel depth beneath pipe 1.59 Ft. Subdivision Block Lot WYNTER PARK #1 2 29 Fill added above original grade 0.76'— 0.92 Ft. Gravel length 59 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 375 Ft2 1 Ft. Well 200'+ 200'+ 200'+ __ 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer EXISTING Capacity Gal. Surface Water 100'+ 100'+ 100'+ -- Material Number of compartments Lot Line 5'+ 10'+ 5'+ __ NA Foundation 5'+ 10'+ 5'+ __ LIFT STATION Manufacturer NA Capacity Gal. Curtain Drain na na na -- Remarks Field Insulated Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tank to D3034 drainfield Installer Northern Excavation Drainfield F810 CO/MT D3034 Inspector ArcTerra Consulting, Inc. BENCHMARK (Assumed elevation) 100 ft Inspection ase 9/6/13 9/6/13 Location and description 2nd 3`d 4`h Bottom of Siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 11 Conditional Approval: Date ,�Qo�F.0,444 itv+ - Kenner Ph. i; I,��' Approved � UP�� P c✓J OSC131ooZ Date /.o12-� /3 9CE/T�7lo •fit �`Awt �.S�Yie�`A `,� p inspection Keport_a-i-­il.aoc Municipality of Anchorage Page _ of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~Upgrade ~1~<- ~, ~~ Wastewater System: D New Address: ~ ~ ~.~ ~_ ABSORPTION FIELD Phone: INo ofB~ooms: ~ Deep Trench E] Shallow Trench ~Bed ~Mo.~d ~Other LEGAL DESCRIPTION ~ Soil Rating~/,~ GPD/Sq. Ft Tolal Depth from~original grade: Lot: '~* Block: ~ ~'"'~Subdivisi°n: ¢~__ .~ Depth~ Io pipe bottom~,rom original grade: Ft. Gravel depth b eneath~ pipe Ft. Township: /¢¢ IRango: / ¢ i.o,,o.: ,o Fill added above original grade: Gravel ,ong,>~ , WELL: D New ~ Upgrade Gravel widtl]: Number of lines: JDistancebetween~i~es: Classification (Private. A.B.C): Total Depth: Cased TO: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: ~ ~/ Yield: GPM J Pump Set at: F, J ca,ing Height Above Ground:F, TANK SEPARATION DISTANCES '~Septic ~ Holding ~ S.T.E.P. Ms~t lecturer: Capacity in gallons: To Septm Absorplion Lilt Holding Public/Private Material: Number of Co~rtments: Well ~¢ ~ ..... Surface w~t~ ~ ~oo~ -- -- -- LIFT STATION "Pump on" level al: I "Pump off;' level at: I Hioh water alarm at: I I Drain ..... Remarks: BENCH MARK Location and Description: Assumed Elevation: I ~o ~ Fh Inspections performed by: _ Dates: 1st/~/~/¢~ ¢, 2nd Department of Health and Human Services approval ~-~,. 72-013 IRev g/g1) MOA 25 Pmmit No, -~'~ ~ z~o~ Page 2--- of "~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ,/--~7' Z? ~'c/~ / /~,.)y~,,?-¢-/~. ,/~z~ PID No' i%-d- 16% C-Z. ~ ENGINEI~R'S SEAl. 72-013 A (Rev 9/91 ) MOA 25 Permit No. ~>V"/ ¢'~-'~//~,'~) Page -~ of ~'~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:/--¢,'r Z-~ /~u-~_. ~/ ///,.2~'~J',-¢__-¢6 ~;?/'z~g. PID No.: :-I SEAL 72-013 A (Rev 9/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920408 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:UNDERWOOD CHARLES E & OWNER ADDRESS:20932 FROSTY DR CHUGIAK, ALASKA 9956'7 PARCEL ID:05149230 DATE ISSUED:12/09/92 EXPIRATION DATE:12/09/93 LEGAL DESCRIPTION: WYNTER PARK #1 BLK 2 LT 29 LOT SIZE: 24750 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2o ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: / David R. D~yto, P.E. 20210 Donalar St. Chugialc, Alaska 99567 David R. Dayton P.E. 20210 Donalar St. Chuglak~ Alaska 99567 D. Fi. DAYTON, P.E., R.L.S. ~x~J-~ Chugiak, Alaska 99567 20210 Donalar St. (907) ~!7~ ~ 696-2417 October 23, 1992 Lot 29, Block 2, Wynter Park Subdivision Septic System Upgrade In 1990 a permit (SW 900170) was issued to Alaska Housing Finance Corporation to upgrade the septic system on this lot. For some reason the work was never done. The original test hole monitor tube is still in place and a second test hole has been dug and a percolation test performed. The lot slopes from East to West at approximately 10% and is nearly flat from North to South. The subdivision is on a Public Water System. The new system will not affect wells, other waste systems, reserve space or drainage on this or neighboring lots. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL OESCR,PT,ON: /~r Z~/ /~' ¢-' ~/~,"~Tow.ship, RaDOe, S.otion: ~,_ /~ T/~-'--', ~/~J 1 2 3 4 5 6 7 8 9 10 11 13- 15- 16- 17- 18- 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Moniloring? /Fo ~'~- OaLe:z Gross Net Depth to Net Reading Date Time Time Water Drop '//,~h~ ~':'¢~ ~" ~ PERCOLATION RATE //' ~'~ Immutes/mch) PERC ROLE DIAMETER __ TEST RUN~3ETWEEN '~ _ FTAND ~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED IN Tom Fink, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 10, 1991 Alaska Housing Finance Corporation 520 East 34th Avenue Anchorage, Alaska 99503 Subject: Lot 29 Block 2 Wynter Park Subdivision #1 Permit #900170, PID #051-492-30 The subject permit, issued by this Dffice for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation snd to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 a combined on-site wastewater and well permit. for ISi you have any questions, P r/~g r am Manager Od-site Services please call this office at 343-4744. JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" (./(:1 i?.~'J i?l_~ i:!iI lc! :i !ll:,.!l~ !~l!'.i; :I. [ !qF []i'fl"l L), ! I. 11 ~= ii ,, I:::'t::,'..[C)t:R I'[I :t: I~llil::'li:EFl' 1: [.iN.c:; !,ly I!!:lxl13 ]t: NI,i:I:EI:R !, :t: ~::' ill:l','i Phil,fi'l! I ILXF:':IIRti:!:i :t;~:'/::i!;:t/~l::l ~!~hlD V~l,:l:i) I:'[)R ~ i!l:i:lxtlil.hL I:: ~M Z[ I,. Y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3- 4 5 6- 7 8 9- 10- 11 12 13 14- 15- 16- 17 18 19- 20- DATE PERFORME ~ '~-- ~ ~0..-3-ownship, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water A?.A,~..~. , Monitoring? ' J,,."'l~ Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ ~--~ AND / COMMENTS ~;~,.~.q. ~ ~.NGINEEEINGEagle Ri~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~ E~CT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE Development Services Department s Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I. D. 051-492-30 Certificate of On -Site Systems Approval Expiration Date: 9 '1 q-2020 1. GENERAL INFORMATION Complete legal description WYNTER PARK #1 BLOCK 2, LOT 29 Location (site address) 20932 FROSTY DRIVE, CHUGIAK, AK 99567 Current property owner(s) MICHAEL & KATRINA BERGSTROM Mailing address Real estate agent 20932 FROSTY DRIVE. CHUGIAK. AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well ❑ Holding Tank ❑ Water Storage ❑ Community ❑ Community Well A ® Public Sewer ❑ Public Water System ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 2j gl q Receipt Number COSA # ©��d Waiver Fee $ Date of Payment Receipt Number Waiver # STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AI< 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 08/07/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, ®'%OkN and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change AW �9F CT,4 due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of (workmanship & materials), the water the family being by the c�� s' �Cl ( �;' construction usage of served system and maintenance. The operational life of all well and septic systems are subject to * these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory :•49TH e �7' for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given byi and Anderson Construction & Engineering. F (� �'f MICHAEL N. ANDERSON: No. CE 9469 / �T�' AO 8/7/19 �� 6. DSD SIGNATURE ' •........•'/ �nsstal,;� ,w System #1 Approved for bedrooms ®\a.� System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulatio``s`ll�ll(((((((((��� � L QAiF*n 1A o `D fNgr� =- p EwAT m.1 `$1 %!))fli1t111 l By: 1�.�,( J % Original Certificate Date:��(,q The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: WYNTER PARK #1 132 L29 Parcel ID: 051-492-30 If more than 1 septic system on lot: COSA Checklist # of _ Structure served by this system _ A. WELL DATA — CLASS A ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA —412412019 1000 -Gal Age of tanks) NEW years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping NA — NEW TANK Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _ mg/L E]Nitrate less than MRL (ND) Arsenic _ ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION - NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA — 59'L x 5'W x 1.59'ED — @ 1.2 sf/br = 1770SF Which system tested (date installed) 9/6/2013 ® ALL standpipes present per record drawing Total measured depth from grade 4_3 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Com ments/Deficiencies COSA Checklist.docx Adequacy test date 6/7/2019 Results 2 Pass For 3 bedrooms Fluid depth prior to test 5_5 in Water added 450 gal New depth 11 in Elapsed time 90 min Final fluid depth 6_5 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date N '--_ .11 E. SEPARATION DISTANCES Fram.Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift StaVo-n on Lot > 100' ® Yes if No Community Sewer Manhoe/-creanout > 100' _I� Yes if No ftp -� ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes Neighboring Tank > 100' ® Yes If Nco-- _ ft Pkat "9ewer/Septic Line > 25' ® Yes if No ® Yes if No ft Community Wells > 200' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No _-ft --Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100'-1_ Animal Containment > 50' ® Yes if No Yes if No ft __ Manure/Animal Excreta Storage X100' Community ewer Main > 75' ® Yes if No ft ® Yeses-if_No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Absorption Field > 5' ® Yes if No ft Water Main > 10' ® Yes if No ft Water Service Line >®Yes ' if No ft 10Community Wells > 200' ® Yes if No - _ Surface Water > 100' If septic tank is under driveway comment below _ ®Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) ft ft ft ft ft ft ft Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist.docx OF .�� :49TH MICHAEL N. ANDERSON: No. CE 9469 w : Alf �FESSIO��`y LOT 28 N 85-59'07" E Y\ X— X __.-- X --- X -- X ---- 1 CR x \ x i x� � 1 1 6)- ` t L x t ` 1 G z�x T 1i AS-BUfLT OF: 11 LOT 29 BLOCK 30' 165.00' X--X— a 8�• i �� O � to 0 GARAGE b o c N 2c.0, GRAVEL D/W SHED z., • j CONC R^1MA 34 0, Ln 0 SEPTIC Q VENT00 (t}P) q I� 'l 4' tin LOT 29 BLK 2 133.78' S80°40'24:'\n SURVEY CERTIF ICATB: I, John L. Schuller, Have conducted a physical survey of this property as shown on this draAing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. lJnder no circumstance should any information on this drawing be used for construction offences. structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to detennine the existence of any easements, covenants, or restrictions which. do not appear on the recorded subdivision plat. WORK ORDER NUMBER: RATE SCAtE: E-MA3L• MAY 21, 2019 1"=30' 19-019 DRAM BY; CHECKED SYJ wo twM$uL $DDK( AGE JLS N W1381 190119 LOT 14 R. 49TH . J.... ................. J07 L. SCHULLER o LS -10408 . i fessionQt �' 30' `a Q m 51 i LAND tea• °� �C 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 65-'/ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~/~ :~o NAA# ~¢~\ ¢~-,,o\(¢.. 1, GENERAL INFORMATION Complete legal description Lot 29~ Blo¢~ 2; Wynter Parr SubdivisionS\ Location (site address or directions) 20932 Frosty Drive, Chualar, AK Property owner Mailing address Steve & Liz 0 Conne~Z Day phone 272-8462 P.O. Box 672286 Chugiak, AK 99567 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system, TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER 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 application 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 Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eaqle River, Alaska 99577 Phone ~c~_ ~.q.7~/. Date 5'- /, ,/~2 (, DNHS SIGNATURE Approved for Disapproved. ,¢ bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date By: __ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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 1/91) Back MOA ~21 i~uNICIpAt,IIY OF ANCHORA(~E ~j~VIRObIN~-NTAL $1~VICLS DIVISION Municipality of Anchorage J~y 0 1 1~6 ~ DEPARTMENT OF HEALTH & HUMAN SERVICES EnvJronmentm 8e~ices Division ~.~,~E IV eD 825"L" Street, Room 502 e Anchorage, Alaska 99501e (g07) 3 Legal Description: A. WELL DATA Well type /44 Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Health Authority Approval Checklist If A, B. or C, attach ADEC letter. ADEC water system lmmber ~-'J / ~/..~ / Date completed ~' Cased tot Casit~e groand) ~ ~-~'cs'"'P~m P e r IY P r °t ecl_ed (Y/N) FROM WE~,,,~ AT INSPECTION g.p.m, g.p.m. WATER SAM~SIJLTS: ~lte ol' sample: Nitrate Other bacteria Collected by: ' B. SEPTIC/HOLDING TANK DATA Date ~sta ed _2~Z.- 9 L- Tank size Fotmdation cleanoot (~t4) Date of Pumping ~/WT--'~ 6, \ oc:~C) Number of Compartments 2.- Cleanouts ~qq) ,-~ Depression (Y~)~ r) High water alarm (Y/N) }'~ IA Pumper C. ABSORPTION FIELD DATA Date installed /_2-:.~ g- Soil rating (g.p,d,/ft2 or ft2/bdrm) /,Z.. System type Gravel thickness below pipe Monitoring Tube present~]~q) ~ Result~ail) /'a,4¢ 53 Length q/¢ * Width Effective absorption area ¢t9~¢ Date of adequacy test t./'...! Fhfid depth in absorption field before test (in.); /t~ hnmediately after7 gal. water added (ill.): Fhfid depth .~5'~" (ins.) Minutes later: ;2.,,~ Absotptioo rate = lC, y7 4- g,p.d. Peroxide treatment (past 12 months)(Y~]) /,.)d /O, /.q/.)o,,O,a,}lf yes. give date /'fi/A' ff / Total depth / c~ t ~ Oepressioo over field (Y,~ ~ For ~ bedrooms D. LIFT STATION Date installed Size iu gallons Manhole/Access (Y/N) "Pump on" level at* .~p off' level at* High water alarm level at* ~/*Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots Public sewer nmnbole/clcanout Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Building foundation 5'~ /'~ Property line /9 ' -b . Absorption field lo t -k Water mailffservice line [ o t .,c Surface water/drainage /~ o t 4- Wells on adjacent lots Z.oo t 4-' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Bnilding foondation Surface ;vater Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line h9 Driveway, parking/vebicle storage area Wells on adjacent lots 2.~.~ o t~- Property line in conJbrmaace with 4'[0.4 IL,IA guidedines in effect oa this date. Date J/ I ~ ~ ~~ ................ s,~%,~.~.~?~.,~ ........ HAA Fee * ~)~" Date of Payment Receipt Number Rev. 8/95 eSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number SENT §Y:ADEC ANOHORAOE ; 5-2~-~8 ; 14;30 ;ANSHORA(]E/WESTEI~N D0~ 90"/3434'/IJ~;# 2 DE~. OF ENVIRONMENTAL cONSERVATION ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE 866 CORDOVA STREET ANCHORAG.E, ALASKA 99601 (gO7) 26g-7605 'RECEIVED MAY 28 1996 Municipality ot Anchorage Certified Mall RequestedDept, Health & -I~man Services Return Receipt ' May24, lgg6 Mr, David McCaba Dawn Water Company 716 L Street, Suite #8 Anchorage, Alaska 99601 SubjeCt: Dawn Water Company, Class A Public Water System, PWSID # 211431 ADEC Project Number 952'1-DW-086-099 Dear Mr. McCabe: Over the last three weeks I have again re~ived repo~ that not all subdivisions within the Dawn Water Company service area are receiving water, Based on the Information provided by the staff cf the Alaska Public Utilities Commission, there may be conditions such as Iow water pressure or no water, which ~ould result in back siphoning, This risk to the public health and the aquifer is not acceptable, I have reviewed all the information that you have provided and all information that I c~uld find in the files in this office relating to subdivisions being served by Dawn Water Company. It Is very clear that lack of water and poor water quality within your service area have been a.prcb!em since the mid-19708. Although you have submitted Information to this office, very little of it can be used to address the ~ncerns noted in my March 29, May 1, and ~eptember '12, ~l~g6 letters, After consulting with the Department's Drinking Water Program St~ff, It became vePj clear that all monitoring samples were being taken at the well houses. Based on the submitted monitoring data, It Is evident that the total coliform bacteria cotJnt~ are fine at the well head, but it is unknowrt what levels can be found in the distribution system. This is In violation of the State's Total Coliform Rule (18 AAC 8g.6as). The well head testing for nitrates (as nitrogen) shows an increase (above 6,0 rng/I), which has resulted In the requirement for quarterly sampling for nitrates. SBNT BY;ADEO ANGHORAOB i 5-~8-~§ ; 14;80 ;ANOHORA6E/WEBTERN DO* 00~4~4~0§;#, 2 Mr, David McCaba 2 May 24, 1996 My review of all the Information in the Department files Indicates that you are operating components of the Dawn Water Company and providing water to the publio In violet!on cf several provisions of the State DHnking Water Regulations (18 AAC 80), as folldws', 18AAC 80.200 Routine Sampling and Analysis - For the well located on Lot 22, Wynter Park Subdivision, the Department has not mcaiveq the results for Lead and Copper, Nitrate (as nitrogen), and Nitrite, For the two wells located on Lot 112, Dawn Subdivision, the Department has not received the resutts for Old Regulated. Inorganic, a, Nit~ate, Nitrite, Gross'Alpha Radiations, Vo{atJle O~snlce, and Lead and Copper, I IlaVe enclosed a monitoring summery for your use. 18 AAC 80,300 Plan ApProval - Vem Haik Subdivision has not received final operation approval, which is required prior to serving water to the publlo, Connecting wells located on Lot 112 Dawn Subd[vlslon to the distribution system ls not authorized by this Department. Being aertlflcatad by the Alaska Public Utilities Commission is not a substitute for an approved plan. Information In thls offica'.'~ files dating back to March and Apdl, 1978 confirms this determination. t8 AAC 80.608 Routine Monlteri.g - It appears that the majority, if net all, of the total coliform bacteria samples colleoted have been colleoted at the well houses, not at sites that are representative of water oondition$ throughout the distribution system in aocordanoe with a wdtten sample siting plan, t8 AAC 80.9t0 Public Notice Requirements -As the owner of the existing Class A Public Water System, you failed to notify persons served by this public water system that you failed to perform rncnitodng required by the Alaska Ddnking Water Regulations, To address the above noted Violations of State Drinking Water Regulations and the concerns noted in my March 29, May 1, and September 12, 1995 letters, the following Issues will need to be addressed within 313 days of receipt of this letter. If the requested information is not submitted, I have no other choice but to go forward with enfor~ernent s~ons, In addition, I may inform the Alaska P[Jblic Utilities Commission you am no longer able to provide safe and adequate water to the publi,~, 1. A copy of the site sampling plan will need to bs submitted to this office for review and approval. The site sampling plan will need to Include the oomplete service area with the exception of Meadow Ridge Estates. This was first requested on March 29, and May 2, lgg~i. 2. My review reveals that the APUC has issued the nece~sry certificates under their authority, However, this certification does not mean that any type of operation or plan al3proval was issued by this office. This Is obvious from the BENT BY:ADEC ANOHORABE ; 5-28-S6 ; 14:81 ;ANOHORA~E/WEBTERN DO* SO?8484?~B;# 4 Mr. David MoCabe 3 May 24, 1996 1976 Information. One Item that I have been abJe to clear up Is that the connection between the Wynter Park and Eklunta distribution systems at the · Intersection of Monron and Homestead was approved by the Department. However, I am unable to find any design calculations that show that the connect would not affect the efficiency of the booster pump for Meadow Ridge Estates. Using the Ilffle information I have been abJe to obtain, it appears that when the demand of the system is greater than that which san 'be met by the source well on Lot 22, and when the source welJs on Lot 112 are not available to meet the demand, the amount of water f~owlng towards !he booster pump Is substantially decreased, It appears that the decrease m water flow to the booster pump may l~e causing the Iow water pressure to the no water conditions and then failure of the pump that the Meadow Ridge Estates Homeowners Association maintains. I'n discussions with APUC staff regarding the amount of water that is available for Wynter Park and Meadow Ridge homeowners, we completed ' a ~edes of calculations te determine the peak demand for the complete water system and the equalizing water storage volume needed to meet the peak demand using just the Lot 22 source well. We were able to determine that the Lot 22 source well would be unable to meet peak demand, Based upon the above, data showing that the ~pablllty ef the existing public water system with the three source wells can meet minimum water c, cnsumption needs, criteria for water demand calculations, and production capability of the water plant will need to be submitted to this office under the stamp of a Professional Engineer (P,E.). The requested capability assessment of the existing public water system will need to include all servlc~ connections, the total number of people being served at each service connect (this is needed to determine the final monitoring requirements), and the total number of bedrooms per service connects (this is to assist the Department Jn determining nitrate loading problems in the area). This information was requested in my March 29, and May 2, 1995 letters. I have yet to receive the information that I have asked for concerning the two source wells on Lot 112 Dawn Subdivision. As a result, I am beginning an Investigation to determine if the two source wells are (3rel~ndwate~' Undsl' the Direct Influence of Surface Water (GWUDISW). To assist my investigation, the following information will need to be submitted to this office: well logs, drill logs or geophysical logs, geological reports, elevation data for the static water levels In the wells and the nearby wetlands, and well yield teats. If the two source wails on Lot 112 are GWLIDISW, the water from the two SOL,me wells may require treatment before entering the distribution 8~NT DY:AD~ ANGHORAQE ; 5-28-96 ~ 14:32 iANCHORAQE/NESTERN Mr. David McCabe 4 May 24, system, This Information was request~ tn my Mar~ 2e, ~nd May 2, lettem, 4. , I have su~ctent info.etlon to dete~ine th~ ~e ~o sour~ wells on L~ 112, D~wn Subdivision am withdmwlng wamr from a different aqu{fer than · e source well on Lot 22. Apparently, ~e water from the ~o different aquifers la mixed in ff~e di~bution system, which r~ults in a~me homes ~e Dawn and Veto Haik Subdivisions m~ivlng wamr from both squirm. ' Therefore, both source must be monitor, I have a~ched ~e r~uimd monitoring schedule for you~ review and uae. P[ease ensure ~at the site sampling plan ~vem ~e issue of two d~mnt source aquifers. 8. N~ifi~on of ail pomona sewed by this public water system of the Milum to monitor In aeco~an~ w~h 18 ~C 80.910 ia required. A r~py of the will need to be subm~ed to ~ls offi~ no later ~an seven days publi~on, A ~por{wl I also n~ to ~ submiff~ to ~is (~ a~fing what measures have been, am being token, or am pmpe~ to be ~ken to and contmt the ~nditions outlined in the published 6. As-bulE drawings for the en~re publi~ water system owned and opm~t~ by D~wn Developrnent will need to be submlffed to this office under the stump ~a P.E. Penalties for violation of the above ~n be quite severe. In a civil a~lon, a pemon who violates or ~uses pe~its to be v eated, a prowmon of this regulation, is liable to ~e State for a sum to be assessed by the cou~ of not less than $500, nor mom than $100,000 for ~he Inffial violation, nor more than $5,000 for each day tl~ereaffer, on whie~ the violation In a ~mlnal violation, a pemon found guil~ of a Class A r~isdemea~or may be sentenced to pay a fine of up to $5,0~0 and/or se~e a senten~ of up to one year In Jail for each violation. A defendant that is an organization, when found guil~, may be flnaa up to $20~,000 or an amount which Is ~e times ~e pe~nia~ gain realized by ~e defendant aa a result of the offen~e. Each day e~vlolation · ~nstdered a s~a~e violation. laws allow the State to pumue b~th a~lons co~l~ffently. Noffilng in this Notl~ shall be construed as a waiver ef the State's authod~ or as an ag~ment on ~e pa~ of ~e S~te to forego judicial or administers enforcement of abov~esafibed violation er to seek recaveW of damages, ~sa and penalties as pms~fibed by law, In addition, neffiing herein shall be cone~ed a~ a waiver of en~rcement for past, present, or ~tum violations. BENT DY:ADEO ANGHORAQE ; 5-~1~-8D ; 14:28 ;AN(~HORA~E/Wl;BTERN OO-~ If Y°u h~ve any que~Non~' Please ~o not h~ ~ ~n~ me. ~, umw. ~_ .. Env~ leweno -~" ~' W/Eno, ..' BENT BY:ADEC ANCHOEA~E ; 5-28-9§ ; 1&:34 ;AN6HO~A6~/WBBTBRN DO~ Monitoring Sum_ma~ for mu~ May 20, 199~ OM 2aNalated InorNanlc~ ~,,~, ~ Pll~e ¥ l. organlea ~,t~vm~ 1 sample par period Annually ~, in,~ Qp~rly 1 sample in first peri{gl Not added so not requ~d Bwry quarter Quarterly for 1 ye~' gw~ 6 ?~.eQu~fly s~g in 1995 ~,~u., 1 sample ~D~¢ 95. Noue N~ test cn record No :est ou re, etd No lest on record No Tustin~ on re~ord. No mating on re, ord. No I~stln8 on ~ord. San'~la D~ Now Sample Due Now qua~eHy samplm duo now Qu~a.~riy ~ampi~m d,~ T~tln{{ ia ov,e~lue Waivsr should applied for, Waiver should applied ~or,, , ~ ~ ~d Cepp~ m~ ~ul~ i~nQfl~on ~ wa~t ~ a~plo sims ~d ~ ~ ~or ~n~ il a ~u~eut for tho w~ supplier ~ flH ou~ die f~s SENT §Y;ADEO ANCHORAGE ; §-20-~8 ; 14:32 ;ANOHORA~E/NBBTBRN Monitoring Summax3r for DAlv'g WA~ CO (2:1.:I.431.) Lot 2:2, Wynter Park Subd (source 001) May 20, 1996 Torsi Coliform B~t¢ri~ /s~tcso, oo$ Old R~sular~d Inorgantes I.,,,~ ~ ~eu~, t~t~ 18AAC80.201(c) ~itrato .... Is~csa~Olea Nitrite OrossAlphaRadlation~ ]RAACP, O,2OOTabt~B Lead and Copped I~.~c~o.s$O Pestlcldag & Other Orsanics , I,SAACSO.,D~, A~be~to$ l~80.~Ol(b~ I sample In ~at period _N~t addad sonot requi£ad Every 4 Yeara Annual for 3 ~ve~ 6 Montha ,,,~.~Qum~rl~?t~ng n 1995 sample by Dec 95. Last sample 10-01.94 No Te~tlng on No testing on record, NO tasting on r~aord, Due Now Sin~s aampl~ will b~ re~lutt~d before 10-31.97 Before 1~31/9fi T~ling tS overdue appl[~ for w~ver, applied for w~wr, Tho p~clod~ m thr~ yo~s in len~h ~nd stoJ't in 1P93. TM~ l~tod~ ~ 1/1,~ tu l~t~ 1/~5. 1/I/~6 to t~.~ 1DS, 1111~9 to 1~3 I~001, eta, initial ~.unli of t~s¢lng, a ~ln~o ~m~l~ b ~luh'ed o v~y f~ur ~r$, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address ~,, ~,/¢,~¢~/,o¢~ Day phone Day phone Agent ~7'~-~'*-~ ~;:~rv'- "~¢.-r'ry '~-,.~¢s ,,J--r' Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless ofherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water ~ If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site )4, Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91) FrOnl MOA #21 '~JOM s,Jaeu!Sue leUO!SSajoJd eq~ u! suoissiuJo Jo sJoJJe ~oj elq!suodsa~ ~ou s! eBeJoqouv JO Xl!led!o!un[q eqJ_ 'panss! s! mea!jiHao e eJojeq m, ep ez/,leUe JO suo!~oadsu! lonpuoo iou op 9HHC] jo saaXoldLu3 's3UeLUeJ!nba~ a~e~s pus leJapaj u!e]JaO/,Js!3es oh Jap~o u! suo!im!lsu! 6u!puel J!eq~ pus seUUOLI JO sjeseqoJnd oi AselJno3 e se s!qi seop SHHC] eq.L 'mlSel¥ jo e3elS sql u! peJeis!Se] Je@u!!Eu@ leUO!SSejoJd ~uepuadepu! ue Aq eAoqe g qdeJSeJed u! ua^!8 suo!~eiuase~de] eq~ uodn XlUO peseq se3eo[j!]JeC) le^o]ddv X~poqin¥ qileeH sanss! (SHHC]) seo!AJ@S usLunH pub LI31e@H JO ~ueLuHedeQ eSe]oLloU¥ jo X3!led!g!un~ eli/ S~UeLULUOO leUO!l!pPV suo!l~lndqs BU!MOllOJ emi ql!M 'SLUOOJpeq JoJ leAoJdde leUO]].!puoo 'peAoJddgs!a 'stuooJp@q ~ JOt peAoJdd¥ ~ BI~nlYN~I~ SHHa "9 Municipality of Anchorage Department of Health & Human Services HEAl. TH AUTHORITY APPROVAL CHECKLIST Legal Description: ~1' ~ /'~cl,'~ ~ A. WELL DATA Well type p~.FS,-4 ¢-.- If A, B, or C, attach ADEC letter. Parcel I.D, ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FFIOM WELL LOG Al' INSPEC'rlON Date of test Static water level Well flow g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/heldif',g tank on lot Absorption field on lot .?_~,~ cc, .~- Public sewer main A.Jo ~,,j Sewer service line '7.--,--~-~ -4- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/~ING TANK DATA Date installed (.{ ~ z:,0,s~J/J Cleanouts (Y/N) f'~ High water alarm (Y/N) Date of pumping Tank size ~ o~ Compartments Foundation cleanout (Y/N) ~, Depression (Y/N) /-J//A- Alarm tested (Y/N) .~ bcf..O ~5 f"~f¢/ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot A//¢ ',0¢- To propertyline .~ Surface water/drainage On adjacent lots /k,/o ,u ¢ Absorption field '-~ ~. Foundation Water main/service line , , 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length 4'~2'~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating t, 'L ~/J/$tz Gravel thickness Cleanouts present (Y/N) Date of adequacy test for __ Peroxide treatment (past 12 months) (Y/N) System type Total depth bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /t/¢,v ¢ Property line To existing or abandoned system on lot Cutbank },,~ o,,J ~ Water main/service line Driveway, parking/vehicle storage area ~-~ ' '~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~::.:wld R. Dayton P.E. ' ~':,V~lO Dona]at' St. ,;.;~.;31 a k, Alaska Signature (/(~/¢¢"~'~)~,,~f-~/- Engineer's Name Date ~ ,, /-- HAA Fee $ / "7~) ~' ~ Date of Payment Receipt Number 72-026 (Rev. 3/91) 8ack MOA Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3~470 ANCHORAGE, ALASKA 99515 Mr. David Dayton December 30, 1992 (907) 349-7755 SUBJECT: Wynter Park Subdivision Class "A" Public Water System, PWSID 211431 Dear Mr. Dayton: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on December 15, 1992. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on October 8, 1990. This does meet the provisions of 18 AAC 80.200(a). The last Radioactive Contaminants Sample results were submitted to the Department on October 30, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on October 31, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "_A./.~" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, M c~h~el Lu Environmental Eng. Asst. II APPLIC NT FILLS OUT UPPER HAL ONLY Buyer ~(2 Address Zip Code Really Co. & A~nt /~/6 /~C~ Phone Address Zip Code 'Type of Resi~nce ~ Single Family ~ Other Water Supply , A~AC~ WELL LOG. A ~1 log Is re'qulred for all Wells drilled since June 1975. Individual "" For w¢~Js drillBd prior t~ that date, give well depth (attach log if available). ~ Community ~ ,' .. Sewer Disposal -- ~ Individual Year Indiv~ual installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time , , Da~e Date Date Date it, Inspector Inspeclor Inspector Inspector Field Notes: APR 0 6/983 ( ~'/"'~PROVED BEDROOMS ~ *CONDITIONS OF APPROVAh~t. fflf~b~ll~t~ ( ) CONDITIONAL APPROVAL* Soils Rating Date Sewer Installed Well To Absorption Area Weg Log Received Well to Tank Septic Tank Size