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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 24 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 MAILING ADDRESS LEGAL DESCRIPTION 24 LOCATION Manufacturer Liq. DISTANCE TO: IF HOMEMADE: Well Inside length Dwelling Well DISTANCE TO: N/~ Length of each line No. of lines ~ IA' Top of tile to finish grade .~ i Width of crib Crib diameter Well DISTANCE TO: Class Depth DISTANCE TO: Building foundation PHONE ] [~NEW ~t~B --35157 [] UPGRADE Dwelling Material Foundation/ Nearest lot line Trench width -'.~3 ~ 34' inches Material beneath tile , inches l Depth Sewerline NO. OF BEDROOMS PERMIT NO. _iquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance~tween lines Total effective absorp~ion area I,I 7~_ Ft~ PERMIT NO, Crib depth I Total effective absorption area Building foundation I Nearest lot line Driller Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS &PPROVED DATE 72-013 (Rev. 3/78) 264-4720 * * * HANDWRITTEN PERMIT * * * W,~E~_~.ml ~ AND/OR ON-SITE SEWER PERMIT Applicant: ~h ~q I g T ~FO$ ~nSCMailing Address: Location: P~S CC~ Legal Description: t~ d B Ty~e of Soi~ ~'sorption System ~s: Trench: Drainfie~a: Maximum N~ber of Bedrooms: ~ Departmen< ?f Health and Environmentai~_ )rotection 825-~=L Street, Anchorage, AK. ~'~501 Phone Number: ~-~87 Lot si e: 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 re'~u~ned 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 ~ 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. Applicant ~/~ / Date: / p~___ The Required Size of the Soil Absorption System Is: DEPTH /'~ LENGTH GRAVEL DEPTH /' WIDTH ~a ~C~ ¢ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of 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 outfatl pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~)-'(~0 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. SWP/024 (1/81) Seepage Bed: ~ Holding Tank: Soil Rating(sq.ft/br) ~ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST COMMENTS SLOPE [] SOILS LOG PERCOLATION TEST DATE PEREORMED: / SITE PLAN WASGROUNDWATER ENCOUNTERED? O P ~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ?- (minutes/inch) TEST RUN BETWEEN ~-- FT AND--~ FT 8 & 8 ENGINEERING PERFORMED By: ~RB !96× EA(~LE RIVER, ALASKA PH, 694-2979 72-008 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 05~- '-'~ '~ \ - E-~-~ HAA# GENERAL INFORMATION Complete legal description Lot 24; Block 3; Northwoods Subdivision Location (site address or directions) 22875 Northwoods Drive Property owner Gary Rigdon Day phone 562-2132 wk Mailing address P.O. Box 873234, Wasilla, Alaska 99687 Lending agency Mailing address CIT~Z MORTGAGE Day phone Eagle River, Alaska Agent Lynda Banner - RE/MAX OF EAGLE RIVER 16600 Centerfield Drive, Suite 201, Address Unless otherwise requested, HAA will be held for pickup. / NUMBER OF BEDROOMS: 32 ¢/ Day phone 694-4200 Eaqte River, Alaska 99577 TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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 NOTE: 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) Front 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. Ifurtherverifythat 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 S & S ENGINEEEING Ad dress 17034 Eaclle River' Loop Ee~ ~_~. _~.~ ~,~. ~.,z..te River, Alaska 99577 Engineer's signature Phone Date - DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 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. 72-025 (Rev. 1/91) 8ack MOA  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-o'F ~-~ ~-~.-V-~'z~ h-(~o~'~ ~/~,oo~arcel I.D. A. WELL DATA Well type ,~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed. Cased to ADEC water system number Driller~ Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: g.p.m. Septic/holding tank on lot Absorption field on lot AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed \ Cleanouts (~)'N) High water alarm (Y~ Date of pumping Tank size \~OO (~'t.- Compartments Foundation cleanout ~ ,~ V Depression (Y~[~ ~ Alarm tested (Y/N) ~/~. ~2 ~ ~ ~ --°~'/.-- Pumper ::~[~(Z~_ (_~-E_S% f ~)o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ o ~ l~ On adjacent lots To propertY line lO ~ t~ Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front ~~Foundation ~ ~ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DIS~&N~FT STATION TO: W o.~¢¢~~t On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump-6f-f;' level at ~ f--O~y~les tested Surface water D. ABSORPTION FIELD DATA Date installed Length '~'~ \ Width Total absorption area Depression over field (Y~) R es u Its6(_pa__s.~ail) Peroxide treatment (past 12 months) Soil rating '~.~b~ ~/~z.~ Gravel thickness \'% Cleanouts present (~'/N) Date of adequacy test for ~ ~ If yes, give date __ System type Total depth ~ .~-* bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~- Propertyline \o t-F To existing or abandoned system on lot ~ ~ Cutbank ~IA-- Water main/service line \o \A- 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~ep.~thed, e~,e of this inspection $ & S ~NGINEERING 17034 Eagle River Loop Roa~ Signature ::~ ;k,~ ....... , ~¢577 Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91~ Back MOA Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349-7755 FOR: S & S Engineering February 19, 1992 PWSID # 213001 My review of the records on file in this office reveals that the Northwood Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf MUNICIPALITY OF ANCHORAGE , DEPARTM~'F4~ OF HEALTH AND ENVIRONMENTAL PI~'O~TECTION DIVISION OF ENVIRONMENTAL HEALTH OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Legal Description (in, clude lot, block, subdivision, section, township, range) or-l-k co s 'P/au I/ ,, Local;ion (address or directions) Applicant Name b* ~ Telephone:Home Applicant Address Applicant is (check one): Lending Institution []; Owner/builder ;[~Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to.bhe following address: \ Lo'-'1 \ Single-Family ~ Multi-Family [] Other Number of Bedrooms '~ WATER SUPPLY Individual Welt [] Community [] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ' ,.- . . 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) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCN, DATA AND 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 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 th s ir),,spection. ~ Name of Firm ~O~-~ li~ ~ A.~.4~Ccf'd~, ~/"/Q~. Telephone Date ~ Apc;I 1ff '7 ........ ~x,~ :/~.t~._ ~.>:~:'~ Engineer's Seal DHEP APPROVAL Approved for ~4~?.-z'4 (~.,~ bedrooms by Approved ,~/~. Disapproved Terms of Conditional Approval Conditional 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. ['age 2 of 2 ~" MUNICIPALITY OF ANCHORAGE (MO~A~/ HEALTH AUTHORITY APPROVAL (HAA) MUNICIPAUTY OF '~~T- FEBRUARY 1984 DEPT. OF HEAL-F'J~-,~'''' ENVIRONMENTAL P~T~ON 264-4720 ~" ~ 'l ~87 Legal Description: REC.EiVED Well Log Present (Y/N) Date Completed Yield Total Depth ~ Cased to ~ ~ Depth of Grouting Static Water Le~ .... Pump Set At Electrical Wiring ~ ~nd~t ~__ ~ Depr~round Wellhead (Y/N~ Separation DJsta~s ~ Well: To Septic/Holding Tank on Lot ~,~joi~g bots .....' To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole /~ To Nearest Sewer Service Line on Lot Water Samp~t~ ; Date Water Sa~ Test Results B. SEPTIC/HOLDING TANK DATA Date Installed ~f'~! {q~Size No. of Compartments Standpipes (Y/N) ~1 ~ ~ Air-tight Caps (Y/N) ~/ .E,-~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) /~Jt~ Date Last Pumped ji~/. J~f ;for ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) //~. ~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Ii' To Stream, Pond, Lake, or Major Drainage Comments _ Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Width of Field .~'Z~ ~' .-~ ,--' Depth of Fiel~d Gravel Bed Thickness /(~ Square FeetofAbsorptionArea ~1~,~ ~.~" ~'~-' Standpipes Present(Y/N) ~ ~'~% Depression over Field (Y/N) ~0 Date of Last Adequacy Test Results of Last Adequacy Test ~.~ ~0¢ ~ ~(~'*"- Separation Distance from ~b~r~tion Field: To Water-Supply Well · To Prope~y Line To Building Foundation ~/ ~ To Existing or Abandoned System on Lot ~. ; On Adjoining Lots To Water Main/Se~ice Line ~O/ To Cutbank (if present) ~,.~, To Stream/Pond/Lake/or Major Drainage Course ~'A, To Driveway, Parking Area, or Vehicle Storage Area , ~O ' Comments ~ ~O~ ~5 /)~ ~0~. ~0 ~~¢ D. LIFT STATION Dimensions Man hol~A~--'(Y/N) ............. /...-'~"Pu m p Off" Level at ~'~ Vent (Y/N) Date Installed( Size in Gallon~x "Pump On" Lev~l,~t High Water Alarm ~'~.vt~l at Tested for "'"'"'"'--- / Electrical Codes (Y/N) -"~" -- Comments / Pumping Cycles during A~eqa~cy Test, Meets MOA ~'** C-h~c~'~P~}/r~tted Be~.~m Rating Against HAA Request ** I certify th~ F~,~/eh~,a~,~,e~, verified, or conformed to ~11 M~A and HAA guidelines in effect on the date of this inspection. Amount:Date of Payment, ~// ¢~¢¢¢ ' ;:..:' ' )Eng near s Seal' Page 2 of 2 72-026 (11/84) Time ~ / Time Date Date Date Inspector Inspector Inspector Comments Conditional Approval (9~)- Approwd 12ed~-ooms Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILL~ OUT LOWER HALF ONLY . Property Owner ~ff Phone MailingBuyer Address ~~ff~--' ~ 7Y ¢¢ ~ Address Lending Institution ~ Phone Address Type ~sidence ~ Single Family ~ Multiple Family No. of Bedrooms Q Other Water Sup~ ~vidual A~AOH WELL LOG. A well log is required for all wells dritl~d since June ~Community 1975. For wells drilled prior to that date, give well depth (attach log if / ~ Publ~tilit~ available.) Sewag~posal ~lndividual Year Individual Installed: G Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCE~IN~ CAN BE INITIATED.