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HomeMy WebLinkAboutWYNTER PARK #1 BLK 3 LT 1Wynter Park Block 3 Lot 1 #051-492-48 0 Lo LL LL IL LL LL mN cocn =m n o M O ,��Pi" •� m T L m 3 c o �/. • ���j �� z El 0) a� F ID 'r % y a > NE° =NN_VLwL o Mn _ t O Z O �.•�I .. LIJ�Cz J ❑ L L > > ° a) w -0❑ -0 c M �j �. / C) .•��� Z = a' m J o m r_ m LU m Z m U 0 W C:) `f -IW �4• Ir p45� ° _� LL LL N p F- L is ° ~ C = '° p l`�•� V d Xm m E ° E] c > 0 0 00 W 1 p `o, z N -0 c�) W Na, E] r m ami E uj 2 CY) ti Z E Li W L O p o E m m m Z vi ❑ LU d J N % o LL LL 0 0 N m p _❑ N o � M rn o `-' � w 0 Z O Q Y .o N 2 J Qra . 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The attached approved design. 2. 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 (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. The field is to be located prior to construction in order to maintain the required tank to field separation. 2. The IR is to state which style Greer tank was installed. Re2gryed::By: J 4, /�lW G - Issued By: rL Date: Date: Date: 6 Z �Zc �3 MUNICIPALITY OF . ...................... ..... ... ......... .. Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-492-48 ANCHORAGE ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) JAMES K PARIETTI Day phone Mailinq address 21137 FROSTY DRIVE, CHUGIAK, AK 99567 Site address 21137 FROSTY DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) WYNTER PARK #1 BLOCK 3, LOT 1 Legal description (Township, Range & Section) Lot Size 20,366 Sq. Ft. Number of Bedrooms 3 Phone- 907-343-7904 Fax- 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (ED all that apply) Absorption Field F-1 Initial R Single Family (SF) nX (w/wo ADU) Septic Tank nX Upgrade nX Duplex ❑ (D) Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ure of property owner or authorized agent) Permit/Rush Fees: Date of Payment: (0 2-o Z Receipt Number: Permit No. 0 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewatefforrns\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! June 13, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: WYNTER PARK #1 BLOCK 3, LOT 1 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon Deep Burial HDPE tank per the attached design to serve the existing 3 -bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for current functionality and future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by public water and the water service line, any encroaching wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241139, Deb Wockenfuss, 06/25/24 FIRST WATER CONSULTING WYNTER PARK #1 BLOCK 3, LOT 1 DESIGN DETAILS: NO WELLS WITHIN 200' OF PROPOSED SEPTIC TANK. AREA SERVED BY PUBLIC WATER. MUST LOCATE WATER SERVICE LINE PRIOR TO CONST. WATER LINE WILL BE ON MOA INSPECTION REPORT. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241139, Deb Wockenfuss, 06/25/24 MUNICIPALITY OF ANCHORAGE �o DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 254-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME s PHONE KNEW - 'TEVE 6do — Zf93/ 0UPGRADE MAILING ADDRESS © Q a x n CA/06-8-7K 4 K, 99- -&7 LEGAL DESCRIPTION r_- Per. L J 4; LOCATION NO. OF BEDROOMS IZD S' `3 Well Absorption area Dwelling PERMIT NO. DISTANCE TO: comm IJ' /.5 W 1W a eQ Manufacturer Material No. of compartments u� 2E— _ ^r=L Z_ to Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 1000 0 Y DISTANCE TO: Well Dwelling PERMIT NO. t2Z 02 Q x I- Manufacturer Material Liquid capacity in gallons D Well Foundation Nearest lot line PERMIT NO. i wm DISTANCE TO: GOA4 1Wf.r 36r ;3 CJy f/�9N0 UiY7 [Zj�^ M u. z No. of lines 1_ength of each line Total length of lines Trench width Distance between lines / P ? —3 <3 // Z/ inches 'I P Top of tile to finish grade / Material beneath tile Total effective absorption area 0 (o inches Length Width Depth PERMIT NO. w D c -F- Type of crib Crib diameter Crib depth Total effective absorption area Lu W Well Building foundation _ Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER — PIPE MATERIALS G SOIL TEST RATING 5U U/l3p�wl — INSTALLER REMARKS ,oJ s P ( C7-r:7h /3Y 7-06 .5 MEeza I &Z 4 . aif U-1-1 ; — r .3 N v S' N PI PC4 c -a.�- APPROVED DATE LEGAL >0 72-013 (Rev. 3/78) I-- ti O O c � /W o LL V a_ Q O 2 V Z Q O1 J 0 � o V Z p M >� Uco �o/� 06 VJ L c � E O > v) (� 00 A LO N O N ti co ai D C O Q X W O O O I 00 t N Y / C) 0 U N ti LO rn J (Q '7 Y Y -j. LO m 0) � U Q � W U) I— O Z LLLL C C r o N Q � U O CU J (n U) W 2 Q I— H I 7 cY) 0 N O CL a� cu a) >+ cn cn c 0 aD x c O cu Q - N m C 0 _O N 3 ui O O (D A O A L O U) C 0 E O I m 0 a 0 H U) a CL U) 0 a Q. O 3 i, 'v in M v '= v, L =O a) C N 0) v ♦0 L O .0-j 0 L) d ,N cC 0 O CCL .N Q' conn > `, O o In a) 75C fn t Q > > Q v .O Q (n O N 0 0 ca z N Q O 3 0 E a cn . N > OL C w C. 0 'a c 0 M CL a O N Q O d C OL E x 0 m caa O 4- N+' Cl) 0 U) fn C y E'a Q >N 0 Q Q O O = 0 0 � a o cn > 4— O 0 Q. 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U)Z Cl) Y a w ww LLL a. a coM H W Wm U z Cn «, >+ a CL a a, a W m O H H U) Q Q > 0 n as > CV M L6 CD >cu > W m *.I 6G. a� O LL N K3 O CU LL U) 0 COSA Checklist.docx COSA Checklist Legal Description: WYNTER PARK #1 BLOCK 3 LOT 1 Parcel ID: 051-492-48 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER 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. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/13/1983 ALL standpipes present per record drawing Total measured depth from grade 5.3 ft (max) Measured depth to pipe invert from grade 4.8 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/7/24 Results Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 2 in Elapsed time <10 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 6” ED) Effective depth used 0 in ( Final Fluid Depth) Effective depth remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per visual observations, elevation measured shots of tank / field & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/5/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, 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 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 construction (workmanship & materials), the water usage of the family being served by the 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 or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/5/24 C 10 M r- P C) (/) M --A (1) M tO > M:;r C/) 0 0 Mm :r Z (n r Z C) --4 > 0 :* U) � —M I M --q Z 0 M w 2: 0;0 0 Z M U) m -s --i n IW- Ir elll 101 M :E;o 0 ;u M 0 rTj M OX () 0 M 0 0 ;Q M z M z 0 M cr. (D r) ---i �% . V(; o Vfj 3 0 MF CD (p 0) (D (D 0 C C) (D C CD 14 < 2. -Io M -n Cr 0 0 c-, > M o 1� a- to N) U) CD (D M --% 0 CL< Cr 7D (D y TIS! CD M 0 3 M (WX 0 D C/) NJ 3 0 •0 n 0 0 0 deck o 2 -ow--24 Co C Aw M 3 CU r% OD 1 2.71 23.3 Qo > 0 0 0 CD M C 00 00 00 LA 0 00 X 660 0 deck 7f < 3u y V) Cr 3 < rr XII' 0 > Gravel drive 3 (jM un 6,2— C --L 0 M :Z X M M way 31 > (D 1 3 1-4 0 X C: M 10' Utility Easement 1-4 o < 9-klp w o M 0 > 1) 0 ;o 0 0 CL 4) 0 f M w 0 L> C.11 CL z :C: o 1< o o' rn -n N00009'12"W 103-00 X 'u In 3 S foCo n C C 1 0 0 10 , — M .< -4, r ---1 0 0 > Cc r— a; P > 0 CU 3-0 ID jC) a �D ft, - CL 33 =r w -7U > Z CA X 0 , -0 M E CL > > M >0 -- i --j 0 Z CL . > 0 0 (D CL o o0 :7 PAJ �w -�o(M = '31 Hca W zr M Cr M cc 0 CL Owl C/) U) UI) ,2 C) C') \ Municipality of Anchorage .a Development Services Department ea e.. Building Safety Division Onsite Water and Wastewater Program e e a a a 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # D DD 15 Expiration Date: % — Z 1. GENERAL INFORMATION Complete legal description In Location (site address) 2//3 7 !=RO sTy , PEi d 12EE/t Current Property owners) c NrF to.J Day phone 35/ - a Ll?,P Mailing address Lending agency Mailing address Real Estate Agent Mailing Address //3?,sgorr f &E7-E2J' are Day phone . i I Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ,--I_ Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. Name of Address Firm AL^ al', 9--v Phone 6'`/L%%O Zcp j6b 8sK 77 a Z2V - 0 7zc/ Engineer's Printed Name _%^-,ir, Date stcwn W. Ln; C%. Z; 5. DSD SIGNATURE V�Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Dater % (Rw 11M) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: &.�4w/TEd2 ?elgk '6"/ BA3 _k 3 La f / Parcel ID: A. WELL DATA P(J 61_ fc Ujo,47re -- 6,4VJ/'/ W/4 'L C 7; . ptu'ah Well type If A. B, or C provide D # _ Well Log (Y/N) Date c rn I Sanitary seal ( ) _ Wires properly protected /N) Total dep ft. Cased to ft. Casing height (above ound) In. FROM WELL L AT INSPECTION Date of test Static water level Well production WATER SAMPLE 171 Coliform colonies/100 mL Nitrate mg/L Arsenic: _ mg/I B. SEPTIC/HOLDING TANK DATA ft. Other bacteria colonies/100 mL Date of sample: _ Collected by. Tank Type/Material rPJF4�5oe Z S i !zL Date Installed 3 Tank size /AXQ gal. Number of Compartments z Cleanouts (Y/N) Foundation cleanout(Y/N) Depression over tank (Y/N) _A�_ High water alarm (Y/N) Al Date of pumpi%?/Pumper 5L!%&f2n Qy e'54Jsr t/Ei2 C. ABSORPTION FIELD DATA Date installed _ Soil rating -(c17Sl? or ft2/bdrm) ZJVQ System type &A"A Length _ ft. Width .400 -ft. Gravel below pipe a: S ft. Total depth &Z ft. Eff. absorption area7Xf12 MonitorizF1__ tube Depression Depression over field Al Date of adequacy test L �/ 7�6 % Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test Q In. Water added[(0V gal. New depth -1— in. Elapsed Time: 10 min. Final fluid depth Q in. Absorption rale >= aSOt'Fr�� Any rejuvenation treatment (past 12 mo.) (YM & type) U&Y4 If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access IN) "Pump on' level at in. "Pump off" eve _ in. High water rm level at in. Datum Cycles tes d Meets arm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: PV 4900 t.••1#4 rcv-3- Septic tankAift station on Absorption field on I _ Public sewer m n Sewer /se c service line Anim ontainment areas On adjacent lots On adjacent Public sewO manhole/cleanout excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /Q /f Property line /0/1" Absorption field /-,5, r Water main to 41 Wells on adjacent lots 2 GO Ir Water service line /(3 "r Surface water /rl) O 'r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D If Building foundation /s r Water main /6 Water Service line /61 ,t Surface water. /0 Q f Driveway, parking vehde storage O �r r� Curtain drain � tom_ Wells on adjacent lots 2� F. COMMENTS G. ENGINEER'S CERTIFICATION �; �; ••''. ....... I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in i... • 0, conformance with MOA COSA guidelines in effect on this date. Fr [ •� t: Sturen YI.E. 9 Engineer's Printed Name �� f ;• pE 6156 Date COSA Fee $ �� Waiver Fee $ Date of Payment Dale of Payment Receipt Number (/��� Receipt Number (Rev. 11105) 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. # 0 r t - y q 2 HAA It / ( / 1. GENERAL INFORMATION�� Complete legal description Lot 1; Block 3; Wynter Park Subdivision Location (site address or directions) 21137 Frosty Drive Chugiak, AK Property owner Al Mongeau Day phone 208-772-3523 Mailing address 6512. Rude Street Coeur d' Alene, Idaho 83814 ...Lending agency Ci.ty Mortgage/ Kelli Hutchison Day phone 263-0700 Mailing address_;' Agent Day phone Address Unless otherwise requested, NAA will be held for pickup. RECEIVED C C C 2. NUMBER OF BEDROOMS: 3 IC E C E I V E D 3. TYPE OF WATER SUPPLY: MAY 0 2 1997 Individual wellMunicipality of Anchorage Dept. Health & Human Services 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. a_ TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site xxx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of systema 72-025(Rev.1191) FroM MOA#21 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 ^ndtynen <tre• r !rid icatodhnrein.Ifurth^r verifyth:atbv!cvlontheinform,,,,tionobtained frorn he Munici ;alif. nchorane 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. S & S ENGINEERING Name of Firm 77034 Eagle River Loon Road N8,204 Phone 6 9 H — a- q -79 Eagle River, Alaska 99577 Address Engineer's signature Approved for T/Ui� (3)bedrooms. Disapproved. Date// /4 Y' s ; KV,bCKf L. wv 41t �l,,.O4 Conditional approval for ��� bedrpgr�s, with the following stipulations: -� W/r%f-rte Syf7YM b ' Note: The RaL-_W, for t is property meets existing State and Municipal Codes. There are nitrates present. It is suggested that a periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 5.28 mg/1. EPA - vi m,m nnnron trof•i nn is In n mpa� Mere information On n1tY2_tEG i� available from the On -Site Services Section at DHHS, 343-4744. Additional Comments p 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 DHHS does this as a courtesyto 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 engineers work. 72.W-S(Rev.1/91) Back MOAtl! MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION *0Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVATED 2 1997 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 *ff-Q4PVj1D Health Authority Approval Checklist Legal Description: 4o7-19wck3 %)VNrek PART S/O Parcell.D.: 06/ `<4a-43 A. WELL DATA Well type (26% A If A, B, or C, attach ADEC letter. ADEC water system number c2) I q31 Log present(Y/N) Total depth Sanitary seal(Y/N) Date of test Static water level Well production WATER SAMPLE Col Date completed Cased to FROM WELL LOG Casing height (above ground) Wires properly AT IDIBPECTION Nitrate 5 , d e) Other bacteria D of sample: �% % Collected by: S �..5 ��C>2 B. SEPTIC/HOLDING TANK DATA g.p.m. Date installed 3 4 Tank size 1000g Number of Compartments cL Cleanou Foundation cleanout&N) N) Ve� Depression (XNPy _ High water alarm (YQ On * G.gPS , s/„ Date of Pumping -1' --Pumper =SP . Cow v) t � t � C. ABSORPTION FIELD DATA >e FkoH DW40S F'ser5 Date installed 1 Soil rating (g.p.d./ft2 ort2/bdrm 15U)�goeM System type GD Length a 9K Width Gravel thickness below pipe 0,'S' $ Total depth 'S R cc Effective absorption area -75( Monitoring Tube presen�N)4— Depression over field (X Date of adequacy test "9-27 Result�<F!ass/ ail) Pass For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after/mngal. water added (in.): �- Fluid depth �� (ins) Minutes later: Absorption rate = SVS D g.p.d. Peroxide treatment (past 12 months) give date _ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main service line Size in gallons at* On adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation J, Property line 10 '4- Absorption field 5 Water main/service line o t,- Surface water/drainage 020011- Wells on adjacent lots o�00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 30 Building foundation 35 Water main/service line lu Surface water���� 6200 +- Driveway, parking/vehicle storage area 2O Curtain drain /i/oAP k4/,9WAI Wells on adjacent lots X00 ,I- F. ENGINEER'S CERTIFICATION.�ru��t .OF-cE OF AiM� I certify that I have determined thru field inspections and review of in conformance -w�ittehOMO A gy+ elines in effect on this date. Signature &Il -r / — Engineer's Name C Date S- // / °l i HAA Fee $ , t, D, (R) Date of Payment S 1� Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH ' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY 264.4720 Application Date ) / °F- ' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) '�L.). 114 11 h100 . Location (address or (b) Applicant Name A Telephone: Home ici' Business Applicant Address AL (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 4g ;—/u�r ❑ ; Other ❑ (explain); — (d) Lending Institution Telephone Address _ (e) Real Estate Company and Agent Tnln nhn no (f) Mail the HAA to the following address: �. rI . '157v (0'1U& -V) SSz� 2. TYPE OF RESIDEyEE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 — 3. WATER SUPPLY � Individual Well 11 Community 2 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DjSPOSAL Onsite 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. Page 1 of 2 72-025 (11,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION Li 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. r Name of Firm L01 tUU\1.J )C'1C�VeS Telephone Address �l7 9� 73us-encs s lc r Q/� Tj/c/7�_�/ Date �CfiJ 2 l z�(p Ar 0 " . -�. 4, V iP •.� 0. CE -'i269 . r DHEPAPPROVAL Approved for bedrooms,L� ( Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION Engineer's Seal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11184) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Desc iption: 7 � SLc�Ci,t'UySLo�w) �,z��IOC j A. WELL DATA Well Classification �.i) Q,�5 Yt If A, B, C, D.E.C. Approved (Y/N) L Well Log Present (Y/N) Date Completed — Yield Total Depth — Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Depth of Grouting — Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed 6.14,QM Size 006 0- • No. of Compartments 4 Standpipes (Y/N) �z Air -tight Caps (Y/N) C1 V6 Foundation Cleanout (Y/N) Depression over Tank (Y/N) NO Date Last Pumped Pumping/Maintenance Contract on File (Y/N) NI N - ; for Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N)� Separation Distances from Septic/Holding Tank: To Water -Supply Well Soo 4- To Building Foundation To Property Line 3b To Disposal Field S To Water Main/Service Line D To Stream, Pond, Lake, or Major Drainage Course N /11 Comments * 17r`urM D-11- P LS Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA y Soils Rating in Absorption Strata �JrO Type of System Design 6` Date Installed �A 1983 Length of Field 4 I - Width of Field 81 Depth of Field .6 - (JJ Gc Gravel Bed Thickness 0•S lol Square Feet of Absorption Area '7S1c, Standpipes Present (Y/N) �-!� Depression over Field (Y/N) /Jo Date of Last Adequacy Test d a .v a%cp�n Results of Last Adequacy Test( �tCLT4a'f- 4r.2f Ldm om h01v.5R . Je J 'aD Separation Distance from Absorption Field: To Water -Supply Well Soo i 4- To Property Line G r 7 To Building Foundation To Existing or Abandoned System on Lot N.17i On Adjoining Lots to 7 To Water Main/Service Line To Cutbank (if present) I11IN To Stream/Pond/Lake/or Major Drainage Course IN To Driveway, Parking Area, or Vehicle Storage Area 36r Comments * Fcom 7 d1 f 6 I�S D. LIFT STATION /A Date Installed Dimensions Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Manhole/Access (Y/N) — "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments Check6PmittedLed,verified, g Against HAA RequestI certify t or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed DateCompanMOA No. Receipt No. (\T' 2 � %� Date of Payment — l l U�.i ie9 /� :9 ��, �J Amount: $ (9� • F e ��?.� .0 I.3 Engineer's Seal (JJ Gc � 7 G'ba `OCOCeO nw••s �'J Page 2 of 2 ccs u•e J. Convi J °eb Ce..5283 ` . Je J 'aD n-ozs (1vea) APPLK Ni FILLS OUT UPPER HX ONLY Property Owner l! i/ I� EPhono':ZipCode' 1"ime Date Malting Address Date Buyer �Yf{tl�f11/���I-I(y��//', J Inspector Inspector Address Zip Code , Phone Inspector Field Nates: Lending Instltution I/ , Address Zip Code -- Phone Realty Co. & Agent RECEIVED _ ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Zip Code —_. Address - _— < Legal,D ascription ..:_)� \ (�lJ((r)'I(I( I k" j— Street Street Locationl�fy— Type of Residence BY: — D Single Family ❑ Multiple Family No. of Bedrooms— Soils Rating El Other -- Well Log Received Water Supply WELL LOG. A well log is required for all wells drilled since June 1975. ❑ 1g71IviUual TATTACH wells drilled prior to that date, give wall depth (attach log if available). LI�Communityor ❑ Public Utility -- -- —_-- Sewer Disposal / - ,t Year Individual Installed: --- C3' individual ❑ Public Utility —I—� When Connected to Public Utility: Ll Holding Tank — NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time 1"ime Date Date Date Date Inspector Inspector Inspector Inspector Field Nates: MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & NNVIRONMENTAL PROTECTION SAF' 14 19 RECEIVED _ ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITI NA < l7PROVAL' BY: — Soils Rating Date Sewer Installed To Absorption Area Well Log Received Well ell to Tank Septic Tank Size 72-02313'821 lei '�N w A A EXCAVATION WORK August 30, 1983 Scott Peppers Dear Scott, Reference: Lot 1; Block 3; Wynter Park Subdivision ROBERT A. SHAFER CIVIL ENGINEER 6942979 A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank had been pumped by you previously and had been verified ied to have a capacity of 1000 gallons. The seepage p it was by filling the crib with approximately 1700 galonsf w atercolated After a period of 24 hours approximately 182 gallons out of the crib. I regret to inform you that as a resultOf this est thedroome seepage pit appears to only be adequate for approximately It is my understanding that in the past: this system was upgraded with the addition of a trench. If the trench can be located and a monitoring tube installed in the end of the trench, further testing of this system may prove it to be adequate. However, at this point in time, I can only justify its adequacy for one bedroom. If we may be of further service, please do not hesitate to contact us. cc: Municipality of Ancnerage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA ALASKA eI ififfleffik COOK SCRUIUS, IN. Engineerinq 6 l3nuironmental Studies �h C/F✓yCnA(/Ty �F .c qNC August 12, 1983 VTqz RoiF Municipality of Anchorage�To��F Department of Health & Environmental Protection 825 L. Street 114cel Anchorage, Ak. 99501 Re: Health Authority On August 12, 1982 our company inspected the sewer system on Wynter Park Subdivision, Block 3, Lot 1. All the standpipes are capped. The well is a community well and did not require our inspection per Mike Mathews, Alaska Department of Environmental Conservation. I..I...,..,.:.,a .V oy C. Raid, .Ir. No. 2251E 47pyOFESSIOC:P 1200 Wes] 33rd Auenue, Suite B 9 Anchorage, Alaska 99503 9 907) 276-1361