HomeMy WebLinkAboutNORTH WOODS BLK 1 LT 6
NAME
MUNICIPALITY OF ANCHORAGE '.~..
DEPARTMENT OF HEAl~TH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl_ INSPECTION REPORT
-rdPHONE
LEGAL DESCRIPTION
LOCATION
~ I- L,q.:~a~.~y~_~' ' ' gallons IF HOMEMADE: Inside length ~ '~~'~Width
.~Z¢& ~ DISTANCE TO~ell ~ Dwelling ..,
u~ ;';', ~ No. of lipes Leng~f~ of eac .line.---
-~:~w ,/ ' ~
Top of tile to finish grade~ ~,
Length Width
~ ~ I Type of crib / ~rib diameter
~ C as~ Depth
Material beneath tile
Depth
NO. OF BEDROOMS
PERM TNO. ~
No. or. compartments
Liqu id~_~de, pth
PERMIT NO.
-ETquid
PERMIT NO.
Crib depth ~._~te! tffecti.v~ absorption area
Driller ] Distance to lot line PERMIT NO.
Sewer line [ Septic tank Absorption area s
OTHER
PiPE MATERIALS
SOl L TEST RATING
INSTAILILER
RE~ARKS
DATE LEGAL
PERMIT f.40~ ( 810536 )
FIPPLICFINT GREINER CONST
LOCFIT I ON NORTI'i14OODS DR.
LEGFIL L.~ Bi NORTHHOODS SUE:
[:,EF'I::IF.:TMENT r tNF'FiLTH FINE:, ENVI'F'-NHENTF1L ,. .]TEE:TION
'82' 5 '" L '" "--- T R E E T. FI N c:!..I 0 R FI G E., A K. 995 ~:J:l.
264-4720
LIT SIZE
.T.q, --. ~=
,_- 4~. 4,:
2'1.00E~ S Y..!L FIRE FEET
~F'E OF SOIl... FIE:SORF'TI]I'.I S'-/STEM I'D: TRENCH
i'IFI;:-:]Ii'qUi"I I'.,ILIHE:EF.: OF BEE:,F:OL-$1S =
SOIL RRTING ,:;SC! FT,.."BR)= 250
.:,i~_E OF SOIL FI.E:SOF.:PTION ::,?=,TEM IS
]"HE REC&.I ! RE[:, '-' "- TFIE '-' "- :
T!4E LENGTH [.',IMEh,ISIEIN IS 'Tt4E LENGTH <IN FEET) OF THE TRENCN OR DRR!NFiEL. D.
]'HE DEPTH OF FI TRENCH 0¢.! PI:" iS TNE DtSTRI'.,ICE BETI4EEN THE SURFFICE OF THE
GROUND RN[:, THE BOT"FOH OF' THE EXCFIVRTION (IN FEET::,.
THERE IS NO SET .WIDTH FOR TRENCHES.
THE GRFI',,,'EL [:,EPTH IS TNE hIINIMUH [:,EPTN OF GRFI',,,'EL BET.WEEN THE OU'I"FRLL PIPE
RND THE E','E~TTOM [:IF' THE Ei:.::C:RVRTION (IN FEET::,.
-, ,"', '~ ...... F.:ESF'E$1StBILIT'.¢ TO INFOF:M '~"T"'
F'ERMIT hFFLI_.H ,IF HFIS THE m...:, E:,EF'FIRTMENT E:,UF.:T. NG THE
F'~'-F'F~'T'¢ RN[:, THE
ih~STFILLFITION INSF'ECTIONS 0~ FIN'T' HE[.LS RE:,..TRCENT~TO THIS r ...........
.... =,ER, E. .
NilMEE'R OF REEI[:,E'NE:E'5 t"HRT THE HELL HILL ''~ "'
MINIMUH [:,ISTF!NCE BETI.,.IEEN FI HELL RI",ID RN"? Oh,I-SITE SEWFIGE DISPOSRL S'T'STEH iS
f. 00 FEET FOR R PRI',/FITE 1.4ELL. OR' 150 TO 200 FEET FROM R PUBLIC t4ELL DEPENDING
LIPON THE T"r'F'E OF' PUBLIC NELL
hlINI!"lUi"l DISTFINCE FROM R PRI',,,'FITE'.WELL TO Ft PRI',,,'FITE SEWER LINE IS 25 FEET FIND
'FO R COHI"IUNIT"/ SEI.4ER t_INE IS 75 FEET.
OTHER REQUIF. tEMENTS i"lR'¢ FiPPLY. SPECIFIE:RTIONS FIND CONSTRUCTION [:'IFIGRRMS FiRE
FIYRIL.RBLE TO INSURE PROPER INSTRLLFIT!Oh,I.
! CERTIF"r' THFIT
i: ! RM FRMILIRR I.,tITH THE REQUIREMENTS FOR ON-SITE SEHERS RN[:' 1.4EEL. LS RS SET
FORTH. E:'¢ THEE MUNICIPRLIT'-? OF FINCHORRGE.
2: I HILL INSTRLL THE S'¢STEM IN FICCOR[:,RNCE 1.4ITH THE CODES.
]:: I LIh,I[:,ERSTFIND 'TI-IRT 'THE ON-SITE SEHER S'¢STEH I"IFI'-/ REQUIRE Ei'.,!LRRGEMENT
RESIDENCE IS REMODELED TO !NCLU[:'E i"IORE THFI.N ]: BEE:,ROOHS.
RF'PL I E:FINT ~iF..'E Z NEF: CONST
I E '.E;UE[:, B"r' _ ..... [:'RTE ......
IF THE
O & E ENG~-NEERING & DEVELO'~-~VlEN~ CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-~774 SOIL LOG
Earl Ellis
688-2280
Performed for: Name: : "q?;:: ' :" "' ?'
Mailing Address: ,? ' '" '/' ~;:~ ;": .'- "/
Legal Description: "" "~/- ~? -'
Tel. No ~' '~ ·
Depth (feet)
Soil Characteristics
8__
9
10__
11--
12__
13__
14__
15__
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
No
If yes, what depth
Drain Field__
Comments:
'PLOT PLAN
PERC. TEST
Performed by: " rr r ~ ' :' Date:
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ~..~1--'~- ~;:~ NAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
7607 Nort~oo~ D~v6
(b) Property owner
Mailing Address
and Mrs. Larson
Telephone: (home)
688-4473 Business
(c) Lending Institution
Mailing Address
Northland Mortgage
Telephone
(d) RealEstate Company and Agent JACK WHITE COMPANY/Ly~da Banner
Address 10928 Eagle RiVer Road, Eagle River, Alaska 99577
Telephone
694-5500
(e) Mail the HAA to the following address: (or check hereY~,, if hold for' pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
10734 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family);~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well [] Community rN Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site~ Public [] Community [] Holding Tank []
Note: Jf community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' '
As certified by my seal affixed hereto and as of the validation date shown below, I ver[fy that my investigation of th is
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,
Name of Firm Telephone
S & S ENGINEERING
Address 17034 Eagle River Loop Road No. 204
Date
6. DHHS APPROVAL
Approved for ~ bedrooms
Approved Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 inordertosatisfycertain federal and state requirements. Employees of DHHSdonotconduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
,! U L 1 ? D89
^. WELLDg[CEIVED
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring ih Conduit (Y/N)
' ~ ' MUNICIPALITY OF ANCHORAGE (MOA) ~
MtINICIPALITY OF (~'~E Health Authority Approval (HAA)
'"-" E TALSER~I$1ON CHECKLIST - FEBRUARY 1984
ENVIRONM N ',~15 343-4744
Legal Description: ~ g~ ~g~z-.
Date Completed
Depth of Grouting
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments '~..3~ ~,~
If A, B, C, D.E.C. Approved ¢~JZN)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
¢7_..,¢~'t'J~'" ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
No. of Compartments "2_ ~
Foundation Cleanout (..~i~)
~:)ate Last Pumped ~ -- ~'Zt'
I~/~· ; for
Temporary Holding Tank Permit (Y/N)
B. SEPTIC/HOLDING TANK DATA
Date Installed Lc-t~¢~, Size \~
Standpipes(-~P/N) '-( Air-tight Caps ¢~/N)
Depression over Tank (YZ4~
Pumping/Maintenance Contact on File (Y/N)
rm yN
Holding Tank High-Water Ala ( / )
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Building Foundation
To D~posal Field
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments '~"-~?
72-026 (Rev. 7/88} Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata '~-'~ o4¢~ Type of System Design
Date Installed (¢= ~ ~, ~.o ~ ~.~ ] Length of Field
Width of Field ~ ~ ~ Depth of Field \~:::?
Gravel Bed Thickness "~ ~
Square Feet of Absortion Area ~ I ED ~ Statndpipes Present ¢~'N) 7
Depression over Field (Y~ r-~ Date of Last Adequacy Test
Results of Last Adequacy Test ~~¢~~ -- ~ ~.
SEPARATION DISTANCE FROM ABSORPTION FIELD:
.?.~.¢:~,=~1 ~p_ ~ T/o Property Line ). ~-
To Existing or Abandoned System on
To Water-Supply Well
To Building Foundat)on
Lot ¢ //~'
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments :~.~k~,,j ~ I
; On Adjoining Lots ~ ¢¢ To Cutback (if present)
D. LIFT STATION r~//,~
Date Installed
Size ~
"Pump On" LevePal~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~---~ ------_ Pumping Cycles during Adequacy Test.
~-...._
**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"bi'!his
inspection.
Signed
Company
~, gNGINEERING
:,', Eagle River Loop Road No. 204
' ~ River, Alaska 99577
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. O~ ENViRONMeNtaL ~ONS~//~TlfON/
/
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: July 14, 1989
PWSID: 213001
To Whom It May Concern:
According to the records on file in this office, the Chugiak
Utilities/Northwoods Water System is in corapliance with the State
of Alaska Drinking Water Regulations.
Thank You,
Cindy Thomas,
Environmental Engineer
CT: gd
'.~_ .~, D~.~6 RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTOR
/vlUl'~Ul?ALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IROi"IMENTAL PROTECTION
825 L Street Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 ~ECEiL~~
~EOUEST FO~ APPROVAL OF I~DIVlDUAL ~ATE~ A~D SEWE~ FACl
DIreCTIOnS: Complete all parts on page 1. Incomplete requests will not be pro~essea. Please allow ten (10} days for processing.
1. PROPERTYOWNER ] PHONE
MAI LING ADDRESS'
PROPERTY RESIDENT(Ifdifferehtfrom'above) ~ PHONE
2, BUYER
MAILING ADDRESS
LENDING INSTITUTION ] PHONE
MAILING ~DDR ES
4. REALTOR/AGENT_ ~ ~ ' ''' J PHONE
MAI LING AD6~SS
5..~GAL DESCRIPTION
07- !
STREET LOCATIO
~ One ~ Four
~INGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~hree ~ Six
[] Other
7, WATER SUPPLY
[] INDIVIDUAL*
~ COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
I~'~N DIVI DUAL/ON-SITE**
[] PUBLIC UTILITY
.~/~/~,'/YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[~'~SI N G LE FAMILY [] ONE J~;~"~ TH R E E [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SlX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
~'COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
(Z~NDIVIDUAL/ON -SITE DATE INSTALLED
L~]PUBLIC UTILITY
Connection Verified
INSTALLER
E~Septic Tank or []HoldingTank
Size: If Tank is homemade '=8OILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCE8 ' ' Septic/Holding Tank Absorption Area [Sewer Line Nearest Lot Line
/
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~,PP ROV E O FOR '~7 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
l.. ~' APPLIC ~IT FILLS OUT UPPER HAL...ONLY
· "u.:~.± ,? g ,, ]~ CO Phone
688-3766
Mailing Address Zip Code
Address 53]- D 8th ~, ]-Pa6, Riohardson~ Ak ZipCode 995n5,
(Vicki Case) 562=2!81
Address o~..m.e 107~ 701
~,, . Ancho-esr,'~.ATf ZipCode qqqOq
RealtyOo.&A~nt ~[};~/~[J~.~ of eagle river, Inc. (Audrey i..~asolg Phone
Address PO Box 848~ Eagle River~ AK 99577 ZipCode 694-Z~200
s~.et Lo~a~i~ ~orth~.mods Drive
Type of Resi~nce
~ single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
%l~ommunity · For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Indiv~ual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACOOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: ~ F~i~,,~(M .V~,k.k~ '
~ ) .~.owo ~D~OO~S 'co~g~,O~ O~*~.OW~
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Well Log Received ~/~'
Soils Rating Date~wer~ {~lnstslled' (:~ ( WelIWell TOte Tank~S°rpti°~m~ ~L J~ Septic T~k Size / ~ ~ O '
72-023 (3182)
, Jr., and aary J. Rice
~a~ject: Lot 6, Block 1, Northwood Subdivision ~1
.royal ~or ti~e in.~ividuat sewer and water facilities cannot
;jranted until the following items have been complehed:
£he septic tank' pumped with a receipt submitteo to this
department.
~-lease notify this Department for a reinspection when the
noted discrepa[]cies have " =
oe~_.n corrected. If there are any
further questions, please call this office at 264-472[;.
Sincerely,
CWllO/ej/Ei