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Home My WebLink AboutNORTH WOODS BLK 3 LT 12Name MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address Phone(s)~._~ ( ~ [ ~'J ~) 0 J~e~oJ~) '1 ~ ~>Permit No. JNo. o~edrooms LEGAL DESCRIPTION Lot J Block Subdivision Township, Range, Section TANKS SEPTIC [] HOLDING No. of Compa~_.ments' TYPE OF SYSTEM Material [] TRENCH J~ BED Depth to pipe bottom from original grade [] W. DRAIN [] OTHER I depth from ori FT depth beneath FT Gravel width Fill added above original grade Gravel length Total absorption area DISTANCES ~ TANK WELL I ~,'",-~'~' ~ SEPTIC ABSORPTION FIELD LOT LINE FOUNDATION ~ ~ *t-- AS-BUiLT DIAGRAM (Show location driveway, water bodies, etc.) WELL I, S( lines, foundation, FT Number of lines ~oil rating installer CCC, [] PRIVATE Classincation ~,B,C) Distance between lines so Pipe material WELLS installer OTHER {Identify) Total Depth J Cased to I FT Date Installed: REMARKS: Inspections Performed by: ~" ~," ~ .,.~,~'~'~'~cm~l~,.. cerlily Ihat this insoection was pedormed according to all Municipal aniJ~t~*~J~i~l'l~rn~i"~_ No. 204 Eagle River, AJaska.,99577~/ ~ / Health Department Appro - ~ Date 72-013 A. Sharer' Ho. 1457-E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW90 Date Issued: ~- ~ Design Engineer: Owner Name: ~.~ ~ Owner Address: ~zo Permit Type: ~a~3~ Expiration Date: /~//~?/~ Day Phone: Parcel ID: ~ ~/- 7D /~ ~ f Lot Legal: Subdivision: ~/~/L~z PJ~ Lot: Section: ,% Township: /~ Range: Lot Size: ~o~& (sq.ft. or acres) Max Bedrooms: This Permit: ~3 Total Capacity: SEPTIC TANK: Minimum septic tank capacity: /~-~-~ gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot . 3. I understand that this permit is v~t~l for a single family dwelling with a maximum of ~,~edrooms. I also understand that any enlargement will-- require an additional permit. ~. I understand this permit is issued for the calendar year and expires on December 31 of the year issued. 5. I will notify DHHS prior to all inspections by the engineer or well driller. ( 0w~e~/~ s/g ne e ) -- ~ ~// db/ll5 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: J,*'" 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15 16 17 18 19 20 DATE ~7~Township, Range, Section:'~'~i~p , '~.1.~.0 ~.~'~ SLOPE - SITE PLAN I WAS GROUND WATER ENCO.NTE.ED? ! Depth to Water A~edAc'' Monitoring? ~ "I'. Date:~ Reading Date Gross Net Depth to Net Time Time Water Drop -~ ~-~ ~ ~. ~-'-U~~ ~-/~, PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~:~ c[ TEST RUN BETWEEN /~?FT AND "~-' FT 5~Z ' ' ~/ , THAT~THIS TEST WAS PERFORMED IN ACCORDAN~E~TH ALL STATE AND MUNIC~PAL GUIDEL ON TH~S DATE. DATE: ~ / 72-008 (Rev. 4/85) ' i~.~ / 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 IPHO-N E r MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDROOMS 'Well ~/a Absor:: ~rea Dwelling PERMIT NO. ~ ~,'~ DISTANCE TO: ~ ~ Manu[acturer Material ~o. o[~ partments ~ ~ Liq. capacity in gallons ~ - Inside length Width Liquid depth I /~00 IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ Manufacturer ~ //~ Material ~ -- ~ Liquid capacity in gallons ~ Well Foundation ~ Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: No, of lines Length of each line Total length of lines Trench width Distance between Hnes ~ ., /~ inches Top of tile to finish grade / v/~ Material beneath tile Total effective absorption area ~ inches Length /~ Width ~/ Depth /_ ~ PERMIT NO. ~ ~ (U Type of crib ..... Crib diameter Crib depth Total effective absorption area ~ / ~ DISTANCE TO: Well ~/~ Building fouD~ation Nearest lot line ~ Classy,__ 'O~ffi~qt r~ Depth Driller Distance to lot line I PERMIT NO. I ~ DISTANCE TO: Building foundation Sewer line Septic tank ~ Absorption area(s) OTHER SOIL TEST RATING INSTALLER REMARKS , APP ~~~~ - VE ~,, ~ ~Z~ DATE/ LEGAL ~?~ 1,: ~-I ~;;~:¢,~.t ..... E3, ~:)~': ~:~ F~, ':'g~ ¢oU~.~)~: ~ P~rmit ~ Applicant: ~C_~ ~ I ~ 1 Location: ¢~FB Legal Description: ~-/ ~)~ Type of Soil ~sorption System Is: Trench: Drainfield: Maximum N~ber of Bedrooms: MUNICIPALITY OF ANCHORAGE Departmen. Df Health and Environmenta~ )rotection 825~/L Street, Anchorage, AK. ~=~9501 264-4720 ~ /~ * * * HANDWRITTEN PERMIT * * * ~ W~LL AND/OR ON-SITE SEWER PERMIT Phone Nunfoer: Lot Size: Seepage Bed: ~ Holding Tank: Soil Rating(sq.ft/br) DEPTH The Required Size of the Soil Absorption System Is: /7/ LENGTH . GRAVEL DEPTH ' / WIDTH The length d~imension is the length(in feet) of the trench or drainfield. The depth of a tz-ench or pit is the distance between the surface ell the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~9-C~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signe~: ,f~f/~Zv~//u~/~-/C//~/~Applicant Date:ISsued by:~ ~/~~~//~ ~ _~~/~. SWP/024 (1/81) PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16- 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) Robert A. No, [] SOILS LOG PERCOLATION TEST SLOPE SITE PLAN WAS GROUND WATER /z-[~, ~) SL ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ,~ '//, t ~ I'f PERCOLATION RATE -~"d~'~ (minutes/inch) TEST RUN BETWEEN , ~ FT AND ~' FT CERTIFIED l',Ia?/ ].0, 1982 Mr. Ken Best SRA 78-B Anchora(~e, AK 99507 Subject: Lot 12 Block 3 Northwood~ub~[lllslon ° '~' ~' Approval for the individual sewer and water facilities cannot be granted until the following items have been corapleted: o The depression over the sewer syste~] will need to be ~..llle~ so that surface water drains away from the sewer system. Please notify this De,~)artment for a reinspection when the noted discrepancies have been corrected.. If ~here are any further questions, please call this office at 264-4720. S_i__n~cere ~, Robert C. Pratt Associate Environmental. Specialist 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 ~)~\- '~.~ \--~-~ HAA# 1. GENERAL INFORMATION Complete legal description Lot 12; Block 3~ North Woods Subdivision: Location (site address or directions) 22662 Mc Manus Drive Property owner A.H.F.C. #38264 Mailing address Day phone Lending agency Mailing address Day phone Agent Sharon Minsch Re/Max of Eagle River Day phone 6~'~-4200 : Address 16600 Centerfi~Id Drive Suite #201, Eagle River, Ak. '99577 Unless otherwise requested, HAA will be held for pickup. .,, NUMBER OF BEDROOMS: TYPE OFWATERSUPPLY: Individual well Community well Public water XX NOTE: If community well system, provide written confirmation from State ADEC attest- lng 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. 72-025 (Rev. 1/91) Front MOA #21 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 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 E~I~';~''~ER[NG 7034 Eagle River Loop Road Name of Firm Address Engineer's signature DHHS SIGNATURE /'//k_ Approved for ~ ~' Disa'pproved. Conditional approval for bedrooms. 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. Em ployees 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. 72~325 (Rev. 1/91) Back MOA ~Y21 Legal Description: Munlolpahty of Anchorage E~R~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~D~-~,~,,,~.~oo~ ~oParcel I.D. m-~ ,- -.- ,-- - A. WELL DATA ~'~ Well type /~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller To~h Cased to Casing height~ Sanitary s'~.~ ~ Wires properly protecte~,bl~ ~ Date of test ~ '/~ Static water level ~ ~ m Wellflow ~ g'P~~ ~g'P' ' Pump level ~~~ SEPARATION DISTANCES FROM WELL T% Septic/holding tank on lot '2'"c:~~: ; On adj'~ots Absorption field on lot /,~'¢"~ ; On adjacent Iots'"-,~ Coliform ?' Nitrate Other bacteria Date of sa~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ Cleanouts ¢¢/NI High water alarm (Y{~ Date of pumping Tank size ~ oO~:~ Compartments '~ Foundation cleanout~/N) \1 Depression (Y~D Alarm tested (Y/N) Well(s) on lot To property Ii ne Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots Absorption field ~ Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (Rev, 3/91) Front MOA 21 C. LIFT STATION Date installed Size in gallons Vent .~N) "Pump on" level at High water alarm level "~L~'" Meets MOA electrical codes~/N) %/ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ¢.c~::~ *-- On adjacent lots Manufacturer Ma n h ole/Access~_'~, N) ¢.//2"~" "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Soil rating Gravel thickness Length '~-f'~ ' Width Total absorption area _ Depression over field (Y/~ Results (pass/fail) Peroxide treatment (past 12 months) System type ~ Total depth Cleanouts present ~Z~'N) Date of adequacy test o r ~ h..~¢__~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: bedrooms Wellon lot To building foundation On adjacent lots Surface water Curtain drain ~"~/,'~ On adjacent lots ~ I~ Property line ~ ~'~- To existing or abandoned system on lot Cutbank ~ 1¢,. Water main/service line Driveway, parking/vehicle storage area Eo ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines Signature Engineer's NamF~agle 14. iver, A aska 99577 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR 583-6775 April 15, 1991 FOR: Ray S & S Engineering PWSID #213001 Northwoods--Deerhorn Park S/D--ER/Chug My review of the records on file in this office reveals-that the Northwoods--Deerhorn Park S/D Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, T~arnowski Environmental Engineer