HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 7Wynter Park
Lot 7
Block 1
#051-491-46
Department3330°f EnvironmentaIc Street Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~///~ ~/~/~- MAILING ADDRESS/-~/~/~/,~ ~:~, ~¢~;-~,( ~L, PHONE
LOCATION /~2~ /~-'~'//-~ LEGAL DESCRIPTION ~¢r>~,~ /~-'._//~/ /~/~/~c_/-'&~
SEPTIC TANK:
DISTANCE ..£//~Z_/~'~~' ./~--/:..~-~; ~ NUMBER OF
FROM WEL ,L~/~/~' MANUFACTURER' /~/P-/&~g:~- MATERIAL ,~//~2/ COMPARTMENTS -/~<~/M~
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH____LIQUID CAPACITY ///2 ./)~ GALLONS.
SEEPAGE Pit:
NUMBER OF PItS ~4/'g;~ DIAMETER OR WIDTH -~, LENGTH/f~. DEPTH /'/
LINING MATERIAL ~.~'/~JJ CRIB SIZE: DIAMETER~ DEPTH ~ /DISTANCE FROM: WELL
,?'~z~,'''~'-/~'~'~'~ '/¢¢~"'"~¢'?/¢' . TOTAL EFFECTIVE
BUILDING FOUNDATION ,:*'J'~: NEAREST LOT LINE -~,'~ ABSORPTION AREA (WALL AREA)
~- ~ ~ SQ. FT.
ADDITIONAL ABSORPTION
TYPE /~/~¢~/~/¢% CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION_ LOT LINE SEWER LINE TANK __ SYSTEM
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED
PIPE MATERIAL:
LOT SLOPe:
/
DIAGRAM OF SYSTEM
:R ANCHORAGE AREA BOI
DEPARTMENT OF ENVIRONMENTAL QUALITY
JGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
NAME Of APPLICANT /// ' ~/~ MAILfNG ADDRESS PHONE
INSTALLATION LOCATION
V ~- ~, DRAIN PIELD . , OTHER
INSTALLATION OF: SEPTIC TANK SEEPAGE P~T
SOIL TEST RESULTS /~ / '~' /--'Z/~q ~ / ~ ~U~/NOTE,WFIIS ~MiT IS NOT VALID .WITHOUT
COMPLETION DATE ANTICIPATED
SOIL TEST
SEPTIC TANK SIZE ff~ TYPE ~-~fll,¢~'~' SEEPAGE AREA SIZE
MINIMUM DISTANC:E$, RI"QUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE pit r~)
f
SEPTIC TANK TO SEEPAGE Pit WALL // ~
SEPTIC TANK .SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC tANK
D~AIN FIELD
WATE~ MAIN TO SEPTIC TANK
SEPtiC TANk, /~t---- ., SEEPAGE PIt
· DRAIN FIELD
'~-'~'~/~ ., DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
/~ ., DRAIN FIELD
~XCAVATION 5 FEET INTO UNDJSTUSBED SOIL
4 INCH DIAMETER CAST ~RON SIPHON PIPES ON SE=TIC TANK. AND SEEPAGE PIT
TO ~OROUG EGULA'rlONS REGARDING INSTALLATION.
OR
I CERTIFY THAT I AM FAMILIAR WITH THe ReQuIREMENTS OF G.E ER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT The ABOVE
DESCRIBED SYSTEM )S mn ACCORDANCE WITH ~AID CODE.
O8' EGEOTECHNICAL Er DEVELOPMENT CO.
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 688-2280
Soils F:I- Foundations Land Development
AOIL LOG
Performed for: Name: ~'~/~/~/~ ~'~:~/~ ~-~/l/.~__.Tel, No,._~m__
Legal Description: L~'7~ ~1~ I; W~t~ ~/2.1~
Sotl Ch~ct~ertst~_~t
1
3
7
8
Ground Water Encountered:
Proposed Installation:
Con~ents '.
Yes_ No.__~._~, If yes, what depth~
Seepage Pit~..~__Dratn Fie~cl_~.~
Perfomed _=_~ ..... ~,
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 DWELLIblG
.arcell.D.# ,--/~-'/-~9/-- ./~'~'"~ . . HAA#.~~)
1. GENERAL INFORMATION . . . :,,;...:
Complete'legaldescdption hot 7, Block 1, Wynter Park
Location (site address or directions) 24129 Park:Dr±ye, Chu§±ak, AK 99567
Property owner Gerald
Mailing address
Lending agency
Maiiin. g address
Soleng Dayphone 333-3964
Chu~iak, AK 99567
Day phone
24111 Park Dr.,
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Agent'Remax E.R./Debbie Lewis
Address ig630 Centerf~eld Dr.~Suite 201, EaRle Ri~er~
Unlessotherwiserequested, HAA willbeheld ~rpickup.
3
NOTE:
Community well
Public water
XXX'
payphone 694-4200
AK qq577
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system. ~
4. TYPE OF wASTEWATER DISPOSAL:
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 system.
NOTE:
72-025 (Rev. 1]~1) Front MOA
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
l~'U;~4 Eagle River Loop Eoad No. 204
Eagle River, Alaska 99577
Phone
Date
DHHS SIGNATURE
~ A?proved for ~
Disapproved.
Conditional approval for
Additiona4 comments
bedrooms.
bedrooms, with the following stipulations:
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 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.
DEPARTMENT OF HEALTH & HUMAN SERVI~,~
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)
Health Authority Approval Checklist
Legal Description: ~-~ ~ / ¢~/JI'~_.¢..'~p~..S/D ParcelI.D.:
A. WELL DATA
Weft type A
Log present (Y/N)
Total depth
Sanitary seal (Y/N).
Date of test
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to _ __ Casing~e¢~ ground)
__ __ ~perty protected (Y/N)
FROM WELL LOG,~~ AT INSPECTION _
Static water level
Well production
WATE.
Coliform ..... Nitrate
~d~te of sample:
g.p.m, g.p.m.
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed I~"- Tanksize Irp£A::~ Number of Compartments L Cleanoutsd~/N).~
4~'~oundation~ '-~ Depression(Y~ High water alarm (Y/N) "31~ ] .
Date of Pumping t ~ t ~ - ~' ~ Pumper ~.¢~,. ~dw,,f ~.~1
C. ABSORPTION FIELD DATA
Date installed ~J¢
Length I ~ Width
Effective absorption area ~¢C
Date of adequacy test
Gravel thickness below pipe
Monitoring Tube presetS) ~
Result~ail) ¢::>,~S
Soil rating (g.p.d./fF or fF/bdrm) ~ O'~)~, System type
~¢' Total depth
_ Depression over field
For ~ bedrooms
Fluid depth in absorption field before test (in.); ~:~ '~ Immediately afterz/'~'~ gal. water added (in.):
Fluid depth ~ ~ (ins) Minutes later: ~) Absorption rate
= g.p.d.
Peroxide treatment (past 12 months) (Y/.~ ;"/~ N'~.-. 12_¢J~ ~'d~lf yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N) "Pump on" level at*
High water alarm level at* _ .,~atum
"Pure " * /
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: ~o,~,-,,~ ~' 7 I~, 7 ~ ~
Septic/holding tank on lot
Absorption field on lot
Public sewer main.
8e~er¢~ line
On adjacent lots
On adjacent lots
__-.--------~Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~D I.t- ;~,~1¢,1),-'¢z¢~ Property line I L~ IF- Absorption field ~' ~'
Water main/service line \o~¥ Surface water/drainage {'oc~[4- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line I-,:~ I &-
Surface water ~ ¢~-~
Curtain drain ~"~ 1 ~,
F. ENGINEER'S CERTIFICATION
Building foundation ~l~- ,,-/¢~b¢¢r_~' ~/ater main/service line /o ¢''/'
Driveway, parking/vehicle storage area
Wells on adjacent lots
in conformance with MOA HAA guidelines in effect on this date.
~ ~ ~ '~
Engineer's Name
"AA Fee $ /~D
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*