HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 16
IVlUINI~II~/~LI I Y UP ANL;PI(,.)IdAL~I-
DE,. /tTMENT OF HEALTH AND HUMAN SER' ES
~'~ - Environmental Health Division "/
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
Address ¢ 0 SEPTIC ABSODPTION
'----., TANK FIELD WELL
~_~d '*'~ '"~*'¢'"J'l /2,.-, ~,,s,~,/~ -.'~,/F WELL
Phone(s)
Permit NO. IN°- °f Bed,~oms
LEGAL DESCRIPTION LOT LINE 3 5-
I Subdlv,slon
Lot//U/ Block _3 /i/,~;,'x~..,,.,o,:;z'~- FOUNDATION /Z2 /
Township, Range, Seclion \
7'-/.S-~v' d'~ 1Z.v' ~-~'¢ ,~ AS-BUILT DIAGRAM (Show Iocat,on Gl welt, septic system, property lines, loundabon
driveway, water bodies, etc.)
TAN S. r N
~ SEPTIC /.;'/'/- .~'~,.~ [] HOLDING
.....
Manulactu~er Capacl[y in gaffons
Material No. of Compadments
~TRENCH ~ BED ~ W. DRAIN ~ OTHER
FdJ added above original grade Gravel depth beneath p~pe
Total absor~on area
/~ 3 ~ S0 FTIoistanoe between hnes / ;1
WELLS -
~ PRIVATE ~ OTHER (Identifv)
C~asslflcmlon (A,B,C) Tola~ Depth FT Cased to
~ FT
REMARKS:
Scale: .~ ~, ENgINEEr'S SE~ ~
~ ~ ~ ~ Inspections Pedormed by:
Eagle River Engineering Services , '- ~" " '~" ::~ :~,
Date: Eagle River, AK 99577
I _ cedily Ihat this inspoction was pedormed according [0 all ~,,, ('~'.m ~'% C~:-o/¢~" ~'" ~ ~ .<~,-'""~?
Municipal and State Duidelines in effect on this date: / ~'~
Health Department Approval: /~ . . _ ~ Date: ~ ,
72 013 (3/85)
LDT ~
HDU2~
LDT t5
EASEMENT
EXISTING LEACH FIELD
NE~/ LEACH FIELD "~+-
CLEANDUT - ~
SCALEI 1' = 40'
WELL aND SEPTIC SITE PLaN
LEGAL~ LDT 16, BLDCK 3, NDRTH~/DD]]S
D~/NER~ MICHAEL & CARDLYN KNIGHT
CDNTRACTDR~ N/A
EAGLE RIVER ENGINEERING SERVICES
PD BX 773294
EAGLE RIVER, AK, 99577
694-5195
LEGAL:
A.
SPEOIFICATIONS FOR ON-SITE SEPTIO SYSTEM
NORTt~WOODS: LOT 16, 8LOCK 5
GENERAL
1. 'The well and septic plan are fcc a single family residence on].y.
2. The dr'awing and cc site plan shall bce a pact of this speeifioatior~.
3. All materials and workmanship shall meet ~:he Anchorage Depar'tmer~t of
Health and Stsate Department Of Envir"onmenta]. Conservation require~-
merits.
4. All soil tests are advisocy to the design and are
modified in the field by ~he engineer.
5. AIl excavations and depths ace advisory and ace
rnodified in the ¢ield by the contractor ~o meet Municipality of
Anchorage, Oepactmenb of Env~ronment;a.L Consecvat~on requirements.
6,, Z~ ~s the r'espons&b~&~y o¢ the owner ko obtain all necessary permits
or easements and to Locate any ad.~aoent mu~t;~-fami~y ~ells.
7. The excavation is ~o be exaot}y ~n the a~ea sho~n on the sibe plaR,
any deviatSon requires engineer approval.
8. Z~ is a~ways ~eoommended that a surveyor ~ooaEe
posit&on and ~he ~ooa&%on o¢ any easements.
DRAINFZELD
1.. The dcainfield is to follow the natural land contour to maintain
unif'ocm total depth of the trench bottom.
2. The bottom of Che drainfield shall be level, plus or' minus
5. The total depth of' the dcainfield excavation is not to exceed
any point.
4. The sewer line is ~o replace the existing sewer line ~ha[; leads ~o the
existing leach ~renoh.
5. The drainfield gravel is Eo be covered wi~h bypar or fabric material.
6. Soil cc combination of soil and exbcuded board insula~ion to a depth
of 4~ or equivalen~ is to be placed owar ~he drainfield,
7. The area owsc the drainfieZd is ~o be finish graded ~o prevent ponding
of sur'faoe wa~er runoff.
8. The septic ~ank and leaohfie].d mus~ no~ be closer ~han 100' ~o any
exisbing private well, 150~ bo any Class "C" well, or 200 feet to any
communiby well.
REOOMMENDED LEAOHFIELD DIMENSIONS
TOTAL DEPTH = 1.5~
DRAINFIELD LENGTH :: 155'total
GRAVEL DEPTH =
DRAINFiELD WIDTH
Soil Rating = 225
Bedroom Capacity × 3
Septic Tank Size = lO00 EXISTING PLUS LIFT STATION
LIFT STATION TO BE ANOHORAGE TANK 500 GALLON APPROVED LIFT STATION, WIRED BY A
LICENSED ELECTRICIAN.
SITE TOPOGRAPHY AND SOIL
LIFT STATION DELIVERY TO
45' LONG.
CONDITIONS WARRANT A STEPPED DRAINFIELD DESIGN WITH
DRAINFIELD AT HIGHER ELEVATION. EAOH DRAINFIELD IS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street~ Anchorage, Alaska 99501 264,4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION: WO V' ~'~t z~ O ~-~' /f// (:~'f /~'
SLOPE
SITE PLAN
3
4
5-
6-
7
8
9-
10
GROUND WATER
11 'ERED?
12
;, AT WHAT
13
~'~
/
PERC(
Gross Net Depth to Net
Reading Date Time Time Water Drop
14
15
16
17
18
19
20
ATION RATE 7 (~inutes/inch)
TEST RUN BETWEEN )/~ FT AND '~ '~'~ FT
PERFORMED BY:
72-008 {6/79)
Eagle River Enlineering Servlcea
Eagle I~ive~, AK 9~577
694-5195
CERTIFIED BY:~J~
) ',...~. 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/ID4~$~[I_ INSPECTION REPORT
NAME PH O~-~' ,--~J EW
MAILING ADDRESS
PO ox' 21.1o
DESCRIPTION
DISTANCE TO: IWeH Absorp~2F Dw. Ui~a (/¢~.2j PERMIT NO.
~<~Z Manufacturer ~0¢ ~¢ Ma~rJa~ ND. of compartments ~
~ ~ / ~¢O ~ i~ .UlVl~lW~M:: Inside length Width Liquid depth
Liq. capacity in ¢lJpns
~ ~ DISTANCE Well Dwel~
PERMIT NO.
O~ Manuf~ / I M~/]
~ -- H Li~citv in gallons
] Well FoundaQon Nearest lot line PERMIT NO,
DISTANCE TO: ~,~,:~, /~ ~ ~ ~,~ ~
~i ~ ND. of lines Length ofe~h lin~' ' Totallengt~fl~nes Trench width ¢ ' Distance between lines
~ ~/¢ ~ Total effective aCsorption area
~ Top o' tile to ,,n,sh grade Materia] bene.¥tile . inches
Length Wi Depth .~ :~E~MIT N
~< ~ Type of crib / ~ diameter / ~rib depth T~e/absorption area
~ DIS~TO: Well / Building foundation ¢/ Nearest lot line
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: BuHdin~ foundation Sewer Hne Septic tank Absorption area{s}
OTHERI,
PIPE MATERIALS / ~¢( ~ ,¢-~
SOIL TEST RATING' / ~/~ ~'
REMARKS
APPROVED , I ~ ~ O ~/ ' DATE LEGAL
72-013 (Rev. 3/78)
DEF'RRTMENT 'OF' HERLTH RNE:, Er.
PERMIT NO. '( 8ZE4;07 ::, ~~
RPF'LICR?T ,MRRCELL ,R. MFIRTZN * PO BOX 2Z:t8 [,.IRSILLFI
LOCRTIO,'4 FETERS CREEK
LEGR~ LZ6 E:Z~ NORTHI.,.IOODS LOT SI~E 2E:egE~ $QI~IRE/~-FE~T'-
._., ..._,_,,..__ ...,..._ .... . . .
TTF_ _F =J_IL HE,=,..RFI!UN =,N':,FEM I:,. TEENL. H
hlR~.::TMIIM NIIMBER F~F BEDROOMS = 3: SOIL RRTING
THE REQUIRED SI~:E OF THE SOIL RBDORPTION SYSTEM
C, EF':" T F~ == Ea L. E ~-~ O-F H ==. ,~I. ~l ,~ F: t-~"-.-" E L [:,EP1-H= 5
THE LENGTH DIMENSION tS THE LENGTH (IN FEE'T"~ OF THE 'FRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DIS'I'R[.TCE BETWEEN THE SURFFICE OF THE
GROIJND RND THE BOTTOM OF' THE EXCB',,,'RTION (IN FEET.'.',.
THERE IS; NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFFtLL PIPE
RND THE BOTTOM OF 'THE E:=:CR',,,'R]'ION (IN FEET).
PERMIT RPF'LICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTFtLLRTION INSPECTIONS OF FINS' WELLS FI[.',JRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES TNRT THE WELL WILL SERVE.
BRCKFILLING OF RNN' SYSTEM WITHOUT FINRL INE;PECTION RND RPPROVRL B"r' THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R NELL RND RNY ON-SITE SEWRGE DISPOSRL S'¢GTEM IS
&El8 FEET FOR R PRIVRTE WELL OR J. 58 TO 288 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TN'PE OF PUBLIC WELL.
b!INIMI_IM [:,ISTRNCE FROM R F'RIVRTE WELL TO R PRI',,,'RTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MR'¢ RPPL'T'. SPECIFICRTIONS RND CONSTRUCTION DiRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F'EF.:fi I T E:=-,:F' Z F4:ES [:,EE:Ef"IE:E f-i: ~:±..
I CERTIFY THRT
'1: IRM FRMILIRR WITH THE RE;;!U!REMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE.
2: I WILL INSTRL. L THE S'¢STEM IN RCCORDFINCE WITH THE CODES.
]:: I UNDERSTFIND THFIT THE ON-SiTE SEWER S'¢STEM MR'¢ REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED 7'0 INCLUDE MORE THRN ]: BEDROOMS.
_,I ~NE[ .
RPPL!CFINT MRRCEL. L R. MRRTtN
ISSUED BY- ................ DRTE ........ ¥4. E~
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL pROTECTION []
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
'~'-~'~'"""9 -
10-
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE SITE PLAN
L
ENCOUNTERED? ' ~ O
P
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
PERFORMED BY: ~,/r~_~
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
L./')~'7- ?SJL/?¢'/ HAA # ~ ~c~ _
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Northwoods #1 Lot 16 Block 3
(b)
(c)
Location (address or directions)
SR3 7986 McManus Drive Chugiak. Ag: 99567
Property ownerM~;bael and Ca~ollfn F.~ight . Telephone: (home) 688-3892
Mailing Address ~R3 7986 McManus Drive
Lending Institution N/A
Mailing Address
Chugiak. AK 99567
Telephone
Business2_76-5121
(d) Real Estate Company and Agent ~,ay] e Nickoli/ColaNcell Banker
Address 4105 Tu~n~ c~n~ Driv~ An~hor~ge~ A]~.~ka 99508
Telephone %A1 -PARR
(e) Mail the HAA to the following address: (or check here I-1, if hold for pick up.)
List contact person and day phone number below:
Pick-up by Engineer
TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms 3
WATER SUPPLY
Individual Well []
Community [% Public []
Note: If community w~ll system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site [] Public F-I 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.
?2-025 (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 verify 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 ail Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of FirmEagle River Engineering Servs. Telephone 694-5195
Address P.O.B. 773294 Eagle River, Alaska 99577
Date ///z/CF
6. DHHS APPROVAL
Approved for -,~ bedrooms by
Approved ~.'~._ Disapproved
Terms of Conditional Approval
Conditional
Date
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 in ordei' to satisfy certain federal and state requirements. Employees of DHHS do not condu'ct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisn°t responsible for errors or omissions
in the professional engineer's work.
72+025 (Rev. 7/88) Back
Page 2 of 2
Well Classification
Well Log Present (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (HAA),
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~-~/- /~/ /~//¢'/~
T/4-~J /C /~ .re ~ ~¢
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Y
Total Depth Cased to
Depth of Grouting
Static Water Level
Pump Set At
Casing Height Above Ground
Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
; On Adjoining Lots
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 Sample Collected by
Water Sample Test Results
Comments ~/z~)/~ ;~'
Date
B. SEPTIC/HOLDING TANK DATA
Date Installed /2~f Size
Standpipes (Y/N) ,Y Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ¢"~¢¢ /
To Property Line ,*/o /
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments '"
No. of Compartments ~.
Y' Foundation Cleanout (Y/N) /v
Date Last Pumped ~/~'
; for
Temporary Holding Tank Permit (Y/N).
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~Z' ? ,,~.~/,4,~'/-'
Width of Field ,~-¥ / ¢'
Square Feet of Absortion Area /¢ ~0%._ .~'
Depression over Field (Y/N) ,,t/
Results of Last Adequacy Test
Type of System Design
Length of Field /-'/¢~-'¢~-
Depth of Field //~-
Gravel Bed Thickness ~//
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~2,¢¢ /
To Building Foundation 5-.¢
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line +/o
To Existing or Abandoned System on
; On Adjoining Lots "~'~ /
To Cutback (if present)
D. LIFT STATION
Date Installed /Y,¢7
Size in Gallons
"Pump On" Level at -/- l&//
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments ,¢e,.¢ .r,y~-~.
Dimensions /~r¢
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certifythatlhavechecked,~~ -~-~--~verified' or conformed toall MOAand HAAguidelines:?~ffec, on the,~;te of this
inspection. ,:5':~: ;: 'i: ~''';:~ i:.i'I' i)~,~,
~0!6 R:vcr En[finoering Services
Company ;. o. 9ox 773294
"-,-re !'Ih,er, AK 99577
Date _)///,/~ 00.¢ 5~95
MOA No. %7--_:~d':
Date of Payment /~- //c;~ ._¢L~/ Waiver Fee: $
Amount: $ /,,,~¢ ~ Date of Payment
Receipt No.
72-026 (Rev. 7/88) Back
Page 2 of 2
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 1334
ANCHORAGE, ALASKA 99503
563-6775
Pws D: 3
To Whom It May Concern:
According to the records on file in this office, the C~O C//~/~
(,,T~L~T,~L/A/ofTJ~j~oDjWater System is in compliance with the
State of/Alaska Drinking Water Regulations.
MPL:pkk
Sincerely,
//// Lewis, PE
Michaei~.
Environmental Engineer
k~/ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
~ /
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
LOT 16, BLOCK 3, NORTHWOODS~ T15N, R1W~ Section
4
Location (address or directions)
7986 MCMANUS DBIVE, CHUGIAK, AK 99567
(b) Applicant Name ]VTTP,,FIARf, I~TNTP, Hq? Telephone: Home 68~-_~892 Business 56~-6887
Applicant Address SR 3, 7986 MC'MANUS DRXVE, CHUGLAK, AK 99567
(c) Applicant is (check one): Lending Institution []; Owner/builder [~ Buyer []; Other [] (explain);
(d) Lending Institution HO[~E SAVINGS & LO~ Telephone
Address 1001 E. BENSON: ANCHORAGE; AK 99510
(e) Real Estate Company an.d Agent N~
Address NA
Telephone NA
(f) Mail the HAA to the following address:
M~T.D ~R PT~RTTP RY RACJ,R RT~/R,R RNC, TNRRRTNG SRRVTCES
276-1451
TYPE OF RESIDENCE
Single-Family'S(- Multi-Family []
Number of Bedrooms .~
Other
WATER SUPPLY
Individual Well [] Community][][ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite][X 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 (11z84)
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 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 ade'quate
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 ~.AC, f,R RTVRR ~qC~TN~.~.RTHC, SF~RVTC, F;,R Telephone 69L~-5195
Address P.O. BOX 775294, EAGLE RIVER, AK 99577
Date
DHEP APPROVAL
Approved for ~'~.~'(,~) bedrooms by
Approved ./~ Disapproved
Terms of Conditional Approval
Conditional
Date
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
MUNICIPALITY OF ANCHORAGE
.?. DIVISION
£NV, IRoNMENTAL SERVICES
1987
RECEIVED
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: }_OT I/P,
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
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Depth of Grouting
Pump Set At
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
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed '/'~
Standpipes (Y/N) .?/
Depression over Tank (Y/N)
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
Size ///~¢0 ,_~/, No. of Compartments
Air-tight Caps (Y/N) _/L/ Foundation Cleanout (Y/N)
Date 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(11/841
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~../,~ 7
Width of Field ~ ~'" ~- -
Square Feet of Absorption Area .//~
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well '~ ~''-' /
To Building Foundation ,I¢'-,,¢-
Lot ~"~ /
To Water Main/Service Line ¢'//~ /
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ~'//
Standpipes Present (Y/N)
Date of Last Adequacy Test
'Fo Property Line
To Existing or Abandoned System on
; On Adjoining Lots d- 3',~ /
To Cutbank (if present)
/
Comments
LIFT STATION ~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** 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 ~"'-~ ;..~-.~.'~-~..,-'~ -- Date
Company ~//~'"'./~,/~, -¢ - MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Seal
,STEVE ~OWPER, GOV~'RNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA ~9501
274-2533
DATE: %?"-/~---~"'~--
To Whom it May Concern:
According to records on file in this office the
Water Regulations
Water System is in compliance with the State Drinking
Sincerely,
~x. ~, D~-~_ ( RECEIVED
INSPECTION APPOINTMENTS
DATE DATE (~/0'/ / ~ DATE
I N~PECTO~ I N~PECTO~ I N~PECTO~
MUNICIPALI~ OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~ONMENTAL Pg:OTEC~ION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION JUL ~ ~ ,981
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~E~ ~ILYT~E~
DIRECTIONS: Complete all parts on page 1. Incomplete requests wilt not be processed. Please allow ten (10) ~ays for processing.
1. PROPERTY OWNER PHONE
PROPERTY RE~[DENT (If different from above) PHONE
MA~UNO AD~S
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
X [] One [] Four
SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~. Three [] Six
[] Other
7. WATER SUPPLY
[] INDIVIDUAL*
COMMUNITY
PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 7975, For wells drilled prior to that date, give well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
~. INDIVIDUAL/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 O~NLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
31 SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified ~NSTALLER
[]Septic Tank or []HoldingTank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DiSTANCESwELL TO: Sept[c/Holding Tank Absorption Area Sewer Line Nearest. Lot Line
Absorption Area to n0arest Lot Line
5. CO~IMENTS
[~A~PROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
July 23, 1981
Clifford I. Martin
Post office Box 2110
Wasilla, Alaska 99687
Subject: Lot 16 Block 3 North Woods Subdivision
The~.sewer system on the subject property was installed
by an unapproved excavator.
In order for this department to approve the construction
and send the approval to the lending agency, the excavator
will need to fill out an application so he may be included
on the list of approved excavators. The excavator permit
fee is $10.00.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
cc: Home Federal Savings and Loan
535 D Street 99501
Bob Simmons
% Century 21 - Metropolitan
~ost office Box 677 99577