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Home My WebLink AboutWYNTER PARK #1 BLK 1 LT 42 ~ ~'~ 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 NAME ~ PHONE LEGAL DESCRIPTION LOCATIQN NO, OF BEDROOMS ] Liq.capacit~in ~ ~¢O ¢ IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well ~ Dwelling PERMIT NO. i ~ DISTANCE TO: We'~o,~/ FounOa~g, Nearestlotli0e P'.~'~ i ~ No. of line~ ~ Length~of eac~ineo, Total length Ofllines~__ Trench wid~o~ inchesDistance between~li es ~ ~ Top of tile to finish grade ~f Material beneath tile ~~ 4~ ,n~hes Total effeotiue ab~tion aroa ~--~ ~ Type of crib Crib diameter ~rib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Ciass~ D~ ~ ~ ~Driller ~ ~ Distance to lot line PERMITNO, ~ ~ DISTANCE TO: Building foundation Sewer llne t Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING APPROVED ¢~ ~rA ~E~]al~al~ DATE LEGAL 72-013 (Rev. 3/78) DEPARTi¥1EN"I [:;iF HEALTH AND EJqVIRONMENTAL PRO"[ECT~ON 82'.5 I STREET~ AIILHOF~AGE. Al< 99501. 264-.4720 F'ERM I T NO~ -8.~ DATE ISSUED: 08/23185 AF'PI- _ [,AN I. ADDRESS: CONTACT PHONE :~ .~...~ E. NL~II~I_ERZNG TIM MAUS SRB 196-X EAGL_E RIVER, ql< 99577 694 -2979 LEGAL DESCRIP: SUBDIVISION: WYNTER PARK LOT: 42 SECTIGN: 10 TOWNSHIP: i5N RANGE: 1W LOT SIZE: 21679 (SQ. FT. GR AL]RES) MAX BEDIR'GOMS: 3 [LGCIq. 1 Listed below are the options avail, able to yOLt in designing ¥oup sep'~zc: system. Choose the optien that best fits youp site. DEPTH TG PIPE BOTTOM (FT.) 4.0 ~ 4.0 4.0 GRAVEL DEP-TH (F"T,) 4,, 0 ~ O, ,5 3.5 TOTAL DEPTH (FT.) 8.0 ~ 4.5 7.5 GRAVEL WIDTH (I::'T.) 2.5 ~'~ 22.0 5.0 GRAVEL. -ENGTH (FT. ~ 85.0 '~'~' ~ 44.0 75.0 GRAVEL VOLUME (CU.YI)S. I 35.5 35.9 54. 1 TANK SIZE (GALS) 1,000.0 ~'~ 1,000.0 ~-.~. ],000.0 ~-~' SOIL RATINS (SQ,F'T. /BR) 225 213 ;J25 GRAVEl- LENGTH > 7'5 F:"I-. REI:L!UIRES. _ MULTIPI_IF_ RUNS (F. IO]' EXCEEDING 75 C'T. LAC..h:: "') TANK MI_JST HAVE AT L..EA.~ r TWG C[]MF'ARTf'IENTS I ce~*ti£y that: [ am f'amiliar wi'Lh the pequzr, ement, s Fep on-site sewers and ~e].ls as se'c Forth by the dunicipa].ity of Anchor, age (MOA) and the State e£ Alaska, I will install the system in acccmdance wit. h all MOA codes and Pegulations. and in compliance with the design ct'itel'ia of this .3ermit. 3. I will adhere to a].] MOA and State of Alaska requirements fen the set back distances f'r'em any e;.,'isting well, wastewater disposal, system or' pub].ic sewer'age system on 'Lhis or any adjacent cm nea~-by lot.. 4, I understand that this permit zs valid £or a maxzmum of 3 bedr, c)oms and any enlargement will. require an additional perm:it. IF A LIPT .)FAr.[ON Is INSTAL. LED IN AN AREA [.,OVER~.D BY MOA BIJIL:DING CODES, THEN (1) AN LLECFF~IC~AI_ PERMIT AND IN,=F[zCTION MUST BE GBTAINED; (2) WILL NG"F BIS AF'PRGVED WITHGUT AN ELE[]TRICAL INSF:'ECTIGN REPORT; AND (.3) THE ELEECTRICAL~K MU~]"~E~)ONE BY A LICENSED. ELECTRICIAN. ~ /' AF'PI... t CANT.: ~~[1~1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORI~ LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20~ Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Depth to Waler Alter Monitoring? Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~--z~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND Lo FT COMMENTS ACCORDANCE WITH ALL ST/~,,A~IPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 IRev. 4185) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: QGRE?i R ANCHORAGE AREA BO ;t $H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LOCATION ~C'[C'~Z~ C~l,¢~.J( LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH INSIDE WIDTH ~'¢¢'~- . MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY / ~)1¢)0 GALLONS. SEEPAGE PIT: NUMBER OF PITS ~ LINING MATERIAL ~o~ BUILDING FOUNDATION__ ADDITIONAL ABSORPTION DIAMETER '~J2' OR WIDTH I~'. LENGTH J~"¢, DEPTH CRIB SIZE: DIAMETER ~; DEPTH ~1 DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE 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: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM "Dr fv ' DATE 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. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Lot 42, Block 1, Wynter Park S/D Complete legal .d..~scription Location (site address or directions) 21146 Lookout Circle Property owner Mailing address Lending agency Mailing address Agent Address Gary McAlpinq Day phone 688-4803 Day phone Day phone Unless otherwise requested, 'NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: HAA will be held for pickup. 3 XXX 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 Approva~ application shows that the on-site water supply and/or wastewater disposal system Js 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 flies 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 .- a~-,.,. ~-e4-. Phone_ ~' c/~_ ~ 7~ Address EagJe River, AJaBJca ¢'9577 Engineer's signature _ . . ;; Date -- (o ./,P. ~'~.~ 0 ¢ DHHS SIGNATURE / Approved for --. Disapproved. ?H~_.~ bedrooms. -- Conditional approval for __. bedrooms, with the following stipulations: Additional Comments 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. Emp oyees of DHHS do not conduct inspections or analyze data before a cert ficate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-~25 (Rev. 1/~1) Back MOA ~Y21 Municipality of Anchorage dUN 28 1 DEPARTMENT OF HEALTH & HUMAN SERVICES ~4UNICIPALITY OJ:A Environmental Services Division ENVIRONMF-NTALSERVI~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~-~'7-4~-) //~/--0~/<' /; /~/V'7"~/2- Parcel I.D.: A. WELL DATA Well type ~/~/~,,~/~/L/^///'-? If~B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed /f- ' T°tal depth __ /~,se~ Sanitary seal (Y/N~- Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level FROM WELL LOG Well production WATER SAMPLE RES~ Coliform / / Nitrate AT INSPECTION - g.p.m. D~le: B. SEPTIC/HOLDING TANK DATA Collected by: Other bacteria Date installed Foundation cleanoub~/N) Date of,Purfi~in~ ~/~'/~.,~g' C. ABSORPTION FIELD DATA Tank size / ~?~ ~' Number of Compartments ~--- Cleanouts~N) L~/~ Depression (Y~ /~/0 High water alarm (Y/N) A//.~ Pumper Daieinstalled ~/.~0 Soilrating (g.p.d./ft2o ~P--~ ~ Systemtype / / ( // / Length ~/~ ~ Width ~ '~ Gravel thickness below pipe ~ Total depth ,, , Effective absorption area ~O Monitoring Tube present~/N),~ Depression over field (Y~ Date ofadequacytest ~/~/~ Results~/Fai,) ~¢9 For Fluid depth in absorption field before test (in.); /~/~ Immediately after'gal, water added (in.): Fluid depth / ~/~ (ins) Minutes later: ~ ~ Absorption rate = ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ bedrooms / 72-026 (Rev. 3/96)* D. LIFT STATION Date installed .eX,/ //~ Manhole/Access (Y/N) High water alarm level at* Cycles tested ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ~ TO: Septic/holding tank on lot Absorption field on lot Public sewer main /'.//-"~ Sewer/septic service line Size in gallons "Pump on' lev~ ~ "Pump off" level at* ~tum On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,,~/aL Property line /~)/'7L Absorption field Water main/service line /0/'/. Surfacewater/drainage /~F-~~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water /~/-/- Curtain drain ,/v/¢/¢'~'- Building foundation /(~/¢L.~ Water main/service line /O /~- Driveway, parking/vehicle storage area /.~'/'v',¢.¢~'/~ Wells on adjacent lots 2Z,¢'..~¢ /?L F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records tha~c~Lems are ,, conformance with MOA HAA gu,defines ,n effect on th,s date. Signature Engineer's Name , - HAA Fee $ -'~ ~ ~'~ Waiver Fee $ Date of Payment ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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. # 051-491-11 HAA# k'~-~q.~f'b.L~k~ ~ GENERAL INFORMATION Complete legal description Wvnter Park #1, Lot 42, Block 1 T15N R1W Section 10 4~ Location (site address or directions) 21146 Lookout Circle, Chuqiak Property owner Charles & Teresa Se~er Mailing address P.Oo Box 670297, Chugiak; AK Lending agency N/A 99567 Day phone Day phone 552-5407 Mailing address Agent Address Betty Fields/Ptarmigan Realty Day phone 694-2321' 12801 Old ~]~nn Hwy. ~9. Eagle River. AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: individual well Community well Public water x 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 X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 s~uewwoo leUO!~!pP¥ :suo!~elnd!js I~U!MOIIOJ eqJ q~.!M 'swooJpeq JOt le^oJdde leUOg!puoo 'pe^oJddes!Q 'SLUOOJp@q JoJ peAoJddv ~ ~lt:lnl~'NelS SHHO "~ ~ eJn~euB!s s,JeeuiGu=l ' · uo!;oedsu! sjq1 jo e~ep eql uo ~,oejje u! suo!lelneeJ pue 'seoueulpJo 'sepoo e~e~9 pub led!o!unR lib q~,!M eOUB!IdLUoO U! S! LUelS/,S IBsOds!p Je~BMe~,SBM Jo/puB Xlddns Je~BM el!s-uo eq~ 'uolloedsu! pub UO!IBeI~SeAU! XLU LUOJJ pUB Sal!J eeBJoqou¥ jo ,q!lBdio!unlAl ~uoJj peu!B),qo uo!leuJJoju! eq; uo peseq ~,Bql Xjpe^ Jeq~Jnj I 'u!eJeq pe~Bo!pu! e~n~on~s jo edXi pub SLUOOJpeq JO ~eqLunu eql JoJ elBnbepB pub iBuop, ounj 'ejBs s! buels/,s IBsods!p ~e;eMelSBM Jo/puB Xlddns JeleM e1!s-uo eqj leq~ SMOqS uo!leo!ldd~ IBAoJdd¥ X~poq~nv q~,leeH s!q~ jo uo!leep, seAu! XLU ~,eql XJpeA I 'MOleq UMOqS e~Bp UO!IBp!IBA eql Jo sB pub o~eJeq pexgJB lees Xtu Xq pe!J!peo sV tJ~I:aNI!DN~] AG NOIIO~idSNI 40 "9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~'yt~l~ ~i)l~{V~, ~fi,. ~4)f'zf2? J~/.t', I Parcel I.D. ~).,~.-I-~q i '~ II A. WELL DATA Well type If A, B, or C, attach AltEC letter. ADEC water system number '~resent (Y/N) Date completed Driller Total d~ Cased to Casing height_ Sanitary seal'~ Wires properly protected (Y/N) __ ~ FROM WELL LOG AT INSPECTION Date of te;t "~ ' Static water level g.p.m. Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ' ~'' ;~O-- ~' Tank size - Cleano~ts(Y/N) ~/~$ Foundation cleanout (Y/N) High Water: alarm (y/N).: .' ~,~ Alarm tested (Y/N) Oate0'fpumping ~//~'/~ ,.~/)-~ ~g~,~l/'/~/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: . ~.. Well(s) on lot ,~,'~f~/,'= /'r/~ ~ On adjacent lots To property line "f/O/ Absorption field g.p.m. ent lots __ __; On adja'b~ots _~ Public sewer manhole/cl~q,out Petroleum tank ~ Other Collected by: Surface water/drainage Compartments ~- Depression (Y/N) /~ Foundation ~ Water main/service line 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Vent (Y/N) ~Size in gallons ~"'~--~1 at High water alarm level ~. ~1/ ENVIRONMENTAL SERVICES DIVISION Meets MOA electrical codes (Y/N) __ ~ J::L 17 1992 SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots ~Surface ~: J V E D D. ABSORPTION FIELD DATA~ ~..~ Date installed ~ ._ ~ .L Length ~ ' Width .~d) Total absorption area ~"~ ~ ~'-~ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested MUNICIPALITY OF ANCHORAGE bedrooms Soil rating Z 2-5- z~ System type '7-,~/~'.,y Gravel thickness ~tY ~ ~ Total depth Cleanouts present (Y/N) Date of adequacy test for ~' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation On adjacent lots Surface water ,/~/~'~' On adjacent lots~/~¢/"/, /'-~242 Property fine To existing or abandoned system on lot ~ Cutbank a/:¢ /~//~A' Water main/service line_ Driveway, parking/vehicle storage area ,~F' Curtain drain E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, orconformed to all MOA and HAA guidelines in effec[,,'_a~e~.~his inspaction. . SignatureEngineer,s_ Name/ ~' ...../~ ~' ~' . ~" ""'"'"'~'"~'""'" ' ~ ~ Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) BaCk MOA 2f Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD:, SUITE 3-470 ANCHORAGE, AK 99503 WALTER J. HICKEL, GOVERNOR FOR: Eagle River Engineering May 18, 1992 PWSID Cf 211431 My review of the records on file in this office reveals that the Dawn Water Company Class "A" Public Water System is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200 only. At this time, they are not in compliance with either the volatile organic chemical sampling or the radiological sampling listed in Table B of 18 AAC 80.200. Sincerely, Rachel Clark College Intern -~.,/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON~/tENTAL PROV~'ECTION DIVISION OF ENVIRONIVtENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264°4720 Application Date __!1 ~ ~~!r' '~::~ GENERAL INFORIV1ATION (b) Legal DescriptionL.~=, d'- z0c'z~(include Iot,,~L~..bl°ck' subdivision,/~ction,i k,. L~ N.)"ll~::fz~township' range)~,,,~,~ Location (address or directions) Applicant Name ,"~¢-.¢. ~/~ Applicant Address ~" O~ Telephone: Home ~/~ ' .Z.J~'¢¢ I Business (c) Applicant is (check one): Lending Institution []; Owner/builder J~-; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (ei Real Estate Company and Agent Address Telephone (f) rv~h[he HAA to the following address: TYPE OF RESIDENCE Single-Family ~¢' Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well [] Community• Public ~¢2 Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~L Public [] Community [] Holding Tank [] Note: If comm unity 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 (tlz84) ENGINEERING FIRM PROVIDIN%..~JSPECTIONS, TESTS, FILE SEARCH, DA*k~ND INFORMATION ~ 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 Apchorage tiles 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 , : .~ .,,~: Telephone Address '" ~ ~ ~r':~ ~:~'~ ' ~ Date :' '=:: '!' ''!~ ;' :~'~ ~:~ ::v,': /../- J, ~- --~'.'~ Approved ~ DisapproveC~/~/ /-- Conditional Terms of Conditional Approval CAUTION 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 (t1/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Desc[iption: ~ ENVIRONMENTAL PROTECTION r 0v 1 5 lg85 RECEIVED WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level 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 ~.~. S~ k~',' "~ I(A, B, C, D.E.C. Approved"~N) Date Completed Yield Depth/of Grouting ~/1 Pump Set At : v/'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 SEPTIC/.H~ TANK DATA Date Installed ~'~'~:)- ~" Size ~ No. of Compartments '~- Standpipes ~/N) Air-tight Caps ~N) Foundation Cleanout4C~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Hokfi~g Tank: To Watbr-Supply Well To Property Line To Water Main/Service Line Course D~te Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA S~ils Rating in Absorption Strata "'-Z-"2~,~---~ /¢~¢~"- Type of System Design Date Installed ~ ~'~-~ ~ '~='~' Length of Field Width of Field Square Feet of Absorption Area t.c.'~-t::, Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ ~ ''~ To Building Foundation ¢~'~'~ Lot ~ c~ ' To Water Main/Service Line ~. ,~ I .~- Depth of Field Gravel Bed Thickness Standpipes Present ~"/N) Date of Last ¢,dequacy Test To Property Line _ To Existing or Abandoned System on ; On Adjoining Lots ...~,~:::~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutba, nk (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed -~; .~; ~'~ ¥~!,](~i'~.¢.'.'.,!f,!¢;¢ Date //- / ~'-~" '~ ..... ~'" ,..-.~. MOA No. Receipt NO. ~ ~D~ Date of Payment L~- [~-%~ Amount: $. ~o~ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CON§ERVATION ANCHORAGE/WESTERN DISTRICT OFFICE ~37 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL ~HEFFIELD, GOVERNOR Telephone: ~ddres$: 274-2533 Pws llX/51 MUNICIPALITY OF ANCHORAGE D~PT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED ~,~To Whom it May~Concern: - ,,/~./~/.~ ~/ Acgocding to recocds on file in this office .the /~lj~J~, 7//~Z~)Water System is in comp, lance with the State Drinking tearer Regul atlons Sincerely, MUNICIPALITY OF ANCHORAGE DIVISION OF EN~-IRONMENTAL HEAL1/H DEPARTMEN~i' OF HEALTH AND ~NVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date-:~ legal Description ( include lot ~ block, subdivision, .-s~ctior~, township, range ) o~t$on (~ess/o~ directions),_ Applicants Address (c) Applicant is (check cneJ Lending In~titu*ion- ~ Buyer ~-1; Othe ,- ' · ~ ~" :' ~; (d) lending Institution Address (e) Real Estate Co. Address 2. Type of Residence Nun~ber of Bedrooms Owner/builder ~ ; Telephone Other (describe) 3. Wate____~ Supply_ Note: If ccamunity %ell system, must ha,~ ,,~itten confirmation from the State Department of EnviroD~rental Conservation attesting to the legality and status. Is tl~e well adequate fo~ the number of be, drcoms specified in this ~AA ,(.Y/N) 4. Sewage Disp_o~_a__l ?ns~d ~blic ~-~ Co~nunity ~ Holding TaDJ< ~--~ Is the wastewater disposal system adequate far the rmmber of t~drooms (Y/N) [Page 1 of 2] 2-15-84 5. 6dgln-~erlng Firm Provi tions, Tests, :'~ta and ±'~%fcrmatlon I certify/~ ~that/~' h~cked, verified, o~ ~f~d to all ~A [{~A C~i~iines in effect on ~ d~~~ction. (ENGINEER SEAL) 6 .p_HE__P...~.~orcva 1 Apprcved for __~ kedr ooms Approvad ~ Disapproved. T~r~s of Condition. al App~..oval (1) Trailer must be moved so that the' tank in±et is no closer than 5--feet to trailer. ~'27 ~s~ I~on 'o~' ~S~-~ ~3034 ~iping installed connectinq tank to trailer a[~l_t~i~K_3lCkJexmCh~ng area___ _(3) Septic tank to--be thawed and pumped with ~ receipt sub~littaa this office. Verify that tank is properly insula~_~/~_d~hlzjae~_g3zD3/n~i.' cove~. The Municipality of Anchorage De. partme~nt of Bealth and EnvironmentalProtection d¢~s not guarantee t~ continued satisfactory perfomnance of the water supply and/or ~e wastewater dispcsal system. Tais approval indicates that, as of the validation (hte sh~,m abo~, based on the data ap~ inf~Tmation furnished ~- an engir~er~egistered in the State of Alaska, t~e water supply m-;d v~s~%~t~r dispcsal x=,stem is sa:~ and func~ ticnal for the ri~mber of bedrooms and type of structure indicated. (D EP 7. Mail the H~% to~ fox, lowing addressp - KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHOZAGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROT£C'i'IO~ HEALTH AU'i~ORITY APPROVAL (HAA) Well Classification Well Lcg P~esent (Y/N) Date Completed Yield Total D~p~ Cased to Depth of G~outlnq Static Water Le~-,~ Pump Set At Casing Height .Above. Grou~n~ '~ Sani~t~a~y~ o~on Casing (Y/N) Electrical Wiring in Conduit (~~g3~pr~s~ion Around Wellhead (Y/N) Separation Distanaes f~om Weil: To Septic/Holding Tank on Lot ~/'~/~ ~-On' Adjoining Lots To Nearest Edge of Absorpti~o,g~F~e/ld on Lot ~'oining Lots To Nearest Public Se~?.3~Llne __ To Nea~est~c Sewer Cleancut/M~%~.''j TO Neare. stn~w~r Service Line~b~ _ Water. Sable~ Collected By- , Date W~t~/ample Test Results . SEPTIC/HOLDING TANK [I~TA Stan~i~s~- ' ~Air-tight Caps P~ing~intenan~ ~n~ac~ ~ File ~) Holding Ta~k High-Wate~ ~a~ (Y~) ~~a~ Holdi~ Tank ~t (Y~ ~p~ation Distance ~ ~p~ic~ Ta~: ' [Page 1 of 2] 2~15-84 Ce ABSORPTION FIELD DATA Soils ~ating in Absorption ~t~ata Date Installed /~),//~,//?--~ Width of Field /~-~ / Type of System Design )~//?~/~.._/~ Length of Field Depth of Field ~qu~ Fee~ O~ ~s0r~lon~ea ~5 ~' Standpipe ~.~ ~p~sssion ove~ Field ~>~ Dete Separation Distan~ f,~ ~s~tion Field~. To Building Foun~tion ~ f ~%~ o Existing or ~ndo~d System To Wate~ Main/~vi~ ~i~~ ~ To ~,t~(if p~e~nt) To St~e~ond~ke/~ Majo~ ~aina~ C~se To ~iveway, Pa~ki~ ~ea, ~ Vehicle Sto~a~ ~ea / D. LIFT STATION Date Installed Dimensions Size in Gallons / / Manhole/Access (Y/N) vel s cy Electrical Codes(Y/N) Test. M~ets MOA Cc~aents ** Check Permitted Bed~oc~a Rating _A~,ainst HAA P~quest I certify th~ve~heck~d, verified, or conformed to all MOA HAA.~,C~.i..d~lines in eff. ect on the d~tg/gf t~{~~, · ""';' signed ' . . '. [Pa~ 2 of 2] 2-15-84 ~-, 274-2533 -:: . . . _ 437 E. Street -- Suite 200 Anchorase, AK 99501 "' PWS I.D. #211431 To Whom I[ ~y Concern: ' ' . ~o~d~n to records on. file az ~his office Da~ k'ater System, ~ynter Park Subdivision is in compliance with the State Drinking Water Regulation. Sineerely~ - [.like ~iathews ' ' Environmental Field Officer ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOILTEST ON SITE WAST E WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK ROBERTA. SHAFER March 21, 1984 CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 42; Block 1; Wynter Park Subdivision Request a Health Authority Approval Certificate be provided for the residence located on the referenced property. Provided for your information are the following documents: A. Application for Health Authority Approval Certificate B. Health Authority Approval Checklist dated February 1984 C. A copy of a letter from DEC stating that the existing community water system is in good standing. When the adequacy test was perfumed on this system it was determined that the seepage p{t is currently functioning adequately to serve a three bedroom residence; however~ the septic tank is currently located underneat~ the existing trailer and is frozen and could not be pumped. It is reco~e~dedthafv~the.Health AUtho~i~yf~App~val incfu~e~the following conditions: 1. The trailer house must be moved so that it does not set closer than five feet from the nearest edge of~the septic tank. me A new line will need to be installed between the outlet under the trailer and the inlet to the existing septic tank. This line should be, buried aiimidimum of three feet. Be The septic tank needs to be tha~ed.~,.~As soon as it is thawed a copy of the pumping receipt needs to be provided both to this office and to the Municipality of Anchorage files. SRB 196X EAGLE RIVER, ALASKA 99577 page two Lot 42,; Block 1; Wynter Park Subdivision If we ma~ be of further service~ please do not he§irate to contact us.