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Home My WebLink AboutNORTH WOODS BLK 3 LT 28 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW940198 PID Number: 051-731-54 Name: Wastewater System: [] New [~pgrade Don Marugg Address: ABSORPTION FIELD HC80, Box 7544, Chuqiak Ak 99567 No. of ~edrooms: Phone: 688--3424 [] Deep Trench ~ Shallow Trench []Bed []Mound []Other LEGAL D ESCR I PTI ON sci, Rating:0 · 45 GPD/Sq. Ft. Total Depth4 o 5fr°mr original grade: Lot: Block: Subdivision: Depth to pipe botlom from original grade: Gravel depth beneath pipe 28 3 Nor~:h Woods 2,5 ' Ft. 2, 0 ' Ft. Township: Range: Section: Fill added~bove original grade: Gravel length: Ft. '148 Ft. Number of lines: Distance between lines: WELL: [] New [] Upgrade Gravelwidth: 5 Ft. 2 "ells" 10, 10,F5 Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: community Ft. Ft. 1057 SQ. Ft D3034; lb" PVC Driller: Date Drilled: Static Water Level:installer: Date installed: Ft. Anderson Bros. 7-8-94 Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES [] Septic [] Holding I~S.T.E.P. To Septic Absorption Lifl Holding Public/PrivateManufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Ancb_, T ink 1250 Material: Number of Compartments: Well +200' +200 +200 .... fil-r:,~l Surface LIFT STATION Water +200 ' +200 +200 Lot Size in gallons: Manufacturer: Line 47.1 10.: 1250 Anch. Tank STEP High water alarm "Pump on" level at: "Pump off" level at: ~L 7-Ii at: Foundation 4~5" 6 . ~ 40 . C 41" Curtain Pump Make & Model Electrical Inspections performed by: Drain +50. 0 +50. 6 All Alaska Electric Remarks: BENCH MARK Location and Description: Small lmndit~ nn nnrfh~a~f side~ of dwellinq, elev. 100.0 I Assumed Elevation: Fi, E N G I[~.~F~'~,E A L Inspections performed by: Dates: 1st. 7-1-94 ~ ~ 2nd 7-2-94 / / //Final 7-8-94 Reviewed and approved h~/~ Date: 72-013 (Rev. 9/91) MOA 25 AS BUILT DETAILS REPLACEMENT WASTEWATER ABSORPTION SYSTEM LOT 28 BLOCK 3 NBRTHWBBDS SUBDIVISION SW 940198 P.I,D, 051-731-54 ;ULAT[DN OV£R 2R' DF TRENCH 2'~OL ID pVC A 46.8 B 60,3 C 75,8 D 29.4 / SUBDIVISION SERVED BY PUBLIC WATER EXISTING SEPTIC TANK PROPERLY ABANDONED EXISTING FIELD ABANDONED IN PLACE PREPARED FOR: DON MARUGGE HC80 BOX 7544 CHUGIAK, AK, 99567 688-3424 KND ENGINEERING 2S041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 DATE, 7-8-94 DRAWING SCALE, 1' = 50' 94-31-0505-AB WASTEWATER ABSORPTION SYSTEM LOT 28 ]}LOCK 3 NORTHWBO]]S SUBDIVISIBN SHALLBW TRENCH DETAIL VARIES -5' J 2" H]] INSUL. 0,5 ~ ~'~-----_ FILTER FABRIC 1,0 ~ '~'-1 1/4' PVC DIST LATERAL SEWE ROCK SW 940198 P,I.D, 051-731-54 HOLE SPACING: 1. 3/16" HOLES, 32" SPACING BN CENTER 2. HOLES PLACED UP, SPRAY COVERS BN EACH HOLE VARIES 2-5' (~TRENCH BOTTOM ALL THE SAME (~} BOTTOM OF TESTHOLE ALL DISTRIBUTION LATERALS i i/4" PVC TANK TO FIELD 2" PVC HOUSE TO TANK 4" SOLID PVC MONITOR TUBES D3034 PIPE PREPARED FOR: DON MARUGGE HC80 BOX 7544 CHUGIAK, AK, 99567 688-3424 KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 ATE: 7-8-94 DRAWING ~ NOT TI] SCALE t AS-BUILT ALL ALASKA £LEOTRIC ATTANTION Mr. CHUCK LANDERS JULY 12, 1994 BLS ON JULY 3. 1994 LIFT STATION FOR RESIDENT OF MR. DONALD MARUUG AT 22807 NORTHWOOD DR. CMUGIAK AK. 99567 WAS PgRFORMED BY ALL ALAMKA ~LECTRIC. ...... - c 229 Red Leaf .~ Anchorage ,,~/ Aiaska ~ ,99504 ,,'~ 337-5104 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUqw_A~ SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 0N-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940198 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:MARUGG DONALD R & JILL M OWNER ADDRESS:22807 NORTHWOODS DR CHUGIAK, ALASKA 99567 DATE ISSUED: 6/24/94 EXPIRATION DATE: 6/24/95 PARCEL ID:05173154 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 28 LOT SIZE: 20046 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MIINICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~~"~-~"~ ~'~. · ISSUED BY: ~~ DATE: ~/~ ~//~/' KMD 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)694-2359/FAX (907)696-8111 On-Site Services DHHS 825 L Street Anchorage, AK 99501 June 4,1994 Dear Sirs: REF: Lot 28, Blk 3, Northwoods Subdivision Attached is our permit request for an on-site replacement wastewater sewer system for the above lot. The existing system failed to pass an adequacy test. This has been a common occurrence for the area which has relatively tight soils. We are therefore proposing to construct a pressurized field system to provide a more uniform distribution of the effluent. This subdivision is serviced by a public water system; the service line enters from Northwoods Drive. As shown on the site plan, there are no conflicts with existing on-site sewer systems or with potential reserve areas. This lot is generally flat but slopes towards Northwoods Drive from 2-5%. The rear of the lot has a 6' to 8' drop off running northwest to southeast with a 1:1 slope which is identified on the soils log. With the proposed pressurized system, there is adequate area on the northwest (rear of lot) portion of the lot to install both an original and a replacement system. The natural slope will provide positive drainage away from the proposed installation site. There is no surface water within 100 feet of any portion of the proposed installation. We performed a soils test on this property. It appears that the soil gets progressively better towards the south and is indicative of the surrounding tight soils (40 min./inch) with water observed (approximate 11'). Area lots show water from 3-8'. The design we are submitting provides for the best overall solution in light of the soils and water conditions observed. Monitoring will be continued for fluctuations in water table until construction of the facility. If it is determined that the water level increases we will contact DHHS and discuss the results as well as any recommended solutions prior to construction of the facility. Thank you for your consideration of this request. If there are any questions, please call me at 696-6111 or leave a message at 694-2359. Sincerely, KND Engineering Attachments: On-Site Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test SITE PLAN REPLACEMENT WASTEWATER ABSORPTION SYSTEM LOT 28 ]}LOCK 3 NBRTHWBBDS SU]}DIVISIBN /? 26 ED 1250 GAL S,T,E.P, x 70'L SHALLDW 27 TEST HDLE TB SE EXISTING IN PLACE SEPTIC --NCH (TDTAL 3O SUBDIVISIBN SERVED BY PUBLIC WATER LOT SIZE~ LESS: PERIMETER HOUSE FOOTPRINT TOTAL AREA AVAILABLE FOR ABSORPTION SYSTEM 20,046 SF 14,796 SF 5,250 SF PREPARED FOR: DON MARUGGE HC80 BOX 7544 CHUGIAK, AK, 99567 688-3424 KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 DATE~ 5-20-94 DRAWING ~ SCALE~ 1' = 100' 94-S1-0505 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM LOT 28 ]}LOCK 3 NORTHWOODS SUBDIVISION PROPERTY LINE 250 GAL S,T,E,P, CO EXISTING HOUSE W Z >- O~ W O_ O~ Q_ ALL DISTRIBUTION LATERALS TO BE 1 1/4" PVC TANK TO FIELD TO SE 2" PVC HOUSE TO TANK TO BE 4" SOLID PVC MONITOR TU]}ES TO SE D3034 PIPE SHALLOW TRENCH DETAIL 2' HD INSUL, FILTER FABRIC I 114' PVC DIST LATERAL SEWEl ROCK~ HOLE SPACING CALCULATIONS: 1. 5 PSI RESIDUAL HEAD 2, 3/16' HOLES, ,63 GAL/HOLE 3, 130 LF DISTRIBUTION LATERALS 4. 130LF + <30 + ,63) = 32' SPACING 5, HOLES PLACED UP, SPRAY COVERS ON EACH HOLE 1250 GAL S.T,E,P. SEWER ROCK =o cO LENGTH VARIES---SEE ABOVE FOR DETAILS 1 1/4" PVC DISTRIBUTION LATERALS DESIGN CRITERIA: 3 BEDROOMS x 150 GAL/DAY/]}EDROOM = 450 GPO SOILS RATING: 40 MIN/INCH = O,45GPD/SF (TRENCH) 450 GPO + 0,45 GPD/SF = 1000 SF ABSORPTION AREA USING SHALLOW 'WIDE TRENCH DESIGN, 1000 SF MINIMUM AREP 1000 SF ~ 5' W x CORR FACTOR (2'D=,70) = 140' TRENCH DESIGN MINIMUM SIZE 2 EA 2']) x 5'W x 70'L TRENCH 2" HI] INSULATION REQUIRED OVER FIELD IF < 4'COVER INSTALL 1250 GAL S,T,E,P, TANK TANK REQUIRES 2~ HD INSULATION IF <4~ COVER PREPARED FDR~ DON MARUGGE HC80 BOX 7544 CHUGIAK, AK, 99567 688-3424 KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 DATE: 6-8-94 ]DRA¥/ING ~ ~T ~ SCALEJ 94-S2-0S05 PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST Don Marugge L28, B1 k3, Northwoods Sub Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O __ t20 Silty Loam Sandy Loam Sand Perc Hole Elev Sandy Silt 5/24/94 Sandy Silt, Dense COMMENTS Hole presoaked prior SLOPE ew 1 WAS GROUND WATER ENCOUNTERED? Yes S L IF YES, AT WHAT .5 ~ DEPTH? 11 pO, Depth to Water AfterE Monitoring? 1 I. 0 ~Dale: SITE PLAN Northwoods BR. _ev ;1 Reading Date Gross Net Depth to Net Time Time Water Drop 0 5/]'4/94 1:30 pm 4" _ 1 1:50 20 miin 4 9/16" 9/16" 2 2:10 20 min 5 1/16" 1/2" 3 2:30 20 rain 5 9/16" 1/2" 4 2:50 20 min 6 1/16" 1/2" 5 3:10 20 min 6 5/8" 9/16" PERCOLATION RATE TEST RUN BETWEEN . to testing ~..0 (minutes/inch) PERC HOLE DIAMETER 4 FT AND ~ ET PERFORMED BY: KHD ~ Kenneth r~l)~-~lm~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 5/12/94 72-008 (Rev. 4/85) t%) '~. 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/OR WELL INSPECTION REPORT DESCRIPTION W~ / Absorption ~a) Dwelling _ / PERMIT NO. ~ ~ DISTANCE TO: ~&/l~7 .5 ~/0~ ~ ~<~ZN Manufacturer~ -~-- Materialp~, No. of compartments ~ Liq. capacity in ~ons~ Inside length Width Liquid depth /O~ O IF HOMEMADE: ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~z ~ Manufacturer Materia] Liquid capacity in gallons O Well Foundation / Nearest lot line / PERMIT NO.~/ ~ ~ DISTANCE TO: /) ~ io /¢ ~~ Z No, of lines / Length of ¢~zeach line Total length ¢~°f lines Trench widthj~ inches Distance between lines ~/~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~~ inches 7~g$ Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class~ / Depth Driller Distance to lot lifie PERMIT NO, Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS ~ ~ ~' APPROVED ~ DATE LEGAL (Rev. 3/78) PERMIT NO. DEPRRTMENT O,?HERLTH RN[:, EN',,,'iRONMENTRL i---,-<L IECTION L ~ 825 '"L"' STREET..;;~E4.-472E~~NCHORAGE" AK. 99501 / :~0 ~/~i~'~~ "8t0092 ) APPLICANT LOC:RTION LEGAL STEVEN L. SKAGGS PETERS CREEK L28 B~ NORTHWOODS PO BOX D CHUGiAK LOT SIZE 688-28~i 23000 SQt. IRRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH btAXIMUM NUMBER OF BE[:,F.'.OOMS = SOiL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFItNFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SLIRFRCE OF' THE GROUND AND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF' GRAVEL BETWEEN THE OUTFRLL PiPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DLIRING THE INSTRLL. ATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NIJMBER OF RESIDENCES THAT THE WELL WILL SER',,,'E. BRCKFILLING OF .RNY S"r'STEM WITHOLIT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMEN'F HILL BE SUBJECT TO PROSECUTION. MINIMUM D!STRNCE BETWEEN R WELL AND ANY ON-SITE SEWAGE [.',ISPOSRL SYSTEM IS t£~0 FEET FOR FI PRI'./RTE WELL OR -150 TO 200 FEET FROM R PUBLIC WELL [:,EPEN[:,ING UPON THE TYF'E OF PUBLIC HELL MINIMUM DISTANCE FROM R PRI',/RTE WELL TO R PRI'¢RTE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEI4ER LINE IS 75 FEET. OTHER REQUIREMENTS MAY RPPL'¢. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE A',,,'RILA. BLE TO !NSLIRE PROPER INS'I"RLLATION. I CERTIFY THFIT ±: I AM FFIMILIRR HITH ]"HE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 8Y THE MUNICIPALITY OF ANCHORAGE. 2: I WILL IN.~RLL TFIE SYSTEM IN ACCOR.[:,ANCE WITH THE CO[:,ES. I UN[.ER_,T~¢~[. THAT T~ C~-~,ITE _,EWER =,,:.TEr~ r~ RE~!UIEE ENL~RuEMEN] IF THE RPF'LICRN] STEVEN L./ ~KRUGS .................................. V4. e O & E ENG~qEERING & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Performed for: Name: -~".~//~ '-~'/~/~'~ ~ --~ Tel. No, Earl Ellis 688-2280 Mailing Address: Legal Description: Z'~::)7" '~'/ Depth (feet) 0 Soil Characteristics 6-~-' 8 ~ 9 - 10' 11__ 12 ' 13__ 14__ 15__ Ground Water Encountered; Yes.__ Proposed Installation: Seepage Pit Comments: No ~ If yes, what depth Drain Field Performed by: PLOT PLAN PERC. TEST 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 051-731-54 HAA# 1. GENERAL INFORMATION Complete legal description Lot 28, Block 3, North Woods Location (site address or directions) 22807 North %¢oods Drive Chugiak, Alaska Property owner ::!.,Mailing aSdress L~hding agency Mailing address . Agent Address Don Maruqq Day phone. 688-3424 A1 a.~a 99567 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XX 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 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 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. NameofFirm ~:,~n p,~gin~c,r~ng: T4¢~ m]f¢~m: P-~.- Phone 694-2359 Address 22401 Ptarmigan Drive, Eagle,River, Alaska 99577 Engineer's signature ~ ' DHHS SIGNATURE __~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date~~/ 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 prolosslona engineer registered In tile State of Alaska. Tile 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/gl) 8~ck MOAii21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lt. 28, Blk. 3, North WoddsParcelI.D. 051-731-54 A. Well Data COMML~q ITY WelFt~l~e. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N~')~ Date completed Driller Total depth ~ Cased to Casingh~ht~ Sanitary seal (Y/N) Date of test Static water level Well flow ~ FROM WELL~CTION .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot + 2 0 0 + Absorption field on lot + 2 0 0 ' Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA 7-8-94 Tank size 1250 STEP Foundation cleanout (Y/N) Y Date installed Cleanout~"(Y/N) Y High water alarm (y/N)i,i~ y' Date of pumping~ · .... NA. ~,.. New,,. system SEPARATI:0~ DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot: ~ NA On adjacent lots + 2 0 0 ' Compartments 2 Depression (Y/N) Alarm tested (Y/N) Pumper N To property line 4 7.1 Sudace water/drainage Absorption field 25 ' +%00' Foundation 6 ' Water main/service line +50 ' 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 7 - 8- 94 Size in gallons -I ? r~n STEP Vent (Y/N)_ y "Pump on" level at High water alarm level 4- -~" Meets MOA electrical codes (Y/N) ¥ 45" Manufacturer Anchorage Tank Manhole/Access (Y/N) y "Pump off" Level at 41" Cycles tested Z_ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed 7- 8- 9 4 2 "~" total ' Width 5 Length Total absorption area 10 5 7 Date o! adequacy test New Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Cleanout present (Y/N) Results (pass/fail) Soil rating (GPD/Ft2) .4.5 Gravel thickness 2.0 ' System type Total depth 4, ,5 ' Depression over field (Y/N) for After test If yes, give date *Pressurized system Bedrooms Well on lot_ NA On adjacent lots + 20 Q ' Property line _ 1 Q To building foundation closest, edge 29.4' To existing or abandoned system on iot +50' On adjacent lots + 50 ' Cutbank + 50 ' Water main/service line + 5 Surface water + 100 ' Driveway, parking/vehicle storage area _ 5 ]. ' Curtain drain +100 ' E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect.o.?~t, be,,~, I!~ of this inspection. Engineer s Name -- ' ' HAA Fee $ ~/")~) ~/.:/~-3 Waiver Fee $ Date of Payment .?~ -- ~,gz[ Date of Payment Receipt Number ~ (,~-r"//-~.~ OC)~' Receipt Number 72-026 (3/93)' Back ? MUNICIPALITY OF ANCHORAGE '%~ DIVISION OF ENVIROklREN'~IKL HEALTH DEPARTMENT OF HEALTH AND ~NVIRONMENT~%L PROTEC£ION APPLICATION FOR ~A_LTH AUTHORITY A~°PROVAL CERTIFICATE 1. General Information Application Date (a) Legal Des~iption (include lot, block, subdivision, section, t~,~nship, range) (b) Applicants Nan~_~/~ ~ ~/~f'~Z. Applicants Address ~/~ ~ /~ ~_.~ (c) Applicant is (check one) Lending Institution Buyer~--~; Other ~--~ (explain); (d) Lending Institution (e) Telephone Te te p hone Address Te le phone _T]L!~._- of Pesidence Single-Family Number of Bedrcoms Multi-Family Other (describe) Wate~ Supply_ Individual Well ~_~ Pgblic~ Note: If conmunity ~11 system, must have wr_itten confirmation fr~n the State Department of Enviror~rental Conservation attesting to the, legality and status. Is t. he well adequate for the number of bedrc~r~ specified in this HAA (Y/N) Sewage Disposal Onsite ~ Public ~ Community ~ Holding Taxx ~ ' Is the wastewate~ disposal system adequate f~r the ~mmbe~ of b~drecms (Y/N) [Page 1 of 2] 2-15-84 Jngineering Filnn provid_~ Ins~ections~ Tests, Data and i'nformatlon I certify that~ ~-~.~ check~ verified, or conformmd to all MOA HAA Guidelines in S ig ~ ..... Name 6~f .Firm Telephone & ~/~/>-'Z ~ 7 ~ Sigmd Date ( ENGINEER SEAL) 6. DHEP Approval Approve d for ~ Approved ~ Te~ms of Conditional Approval ~_ /~~t~x~(~" ~ne Municipality of Anchorage Department of ~alth and Environmental Protection does not Guarantee the continued satisfactory ~erfo~mance of ~%e water supply and/or ~h_ wastewate~ disposal system. This approval indicates that, as of the v~iidation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional fo~ the numbe~ of kedroc~s and type of structure indicated° 2-15-84 MUNICIPALIT'I OF ANCI"IORAGt~ ' DEPT. OF HEALTH & 'ENVIRONMENTAL PROTECI'IOhI Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground / MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (BAA) CHECKLIST - FEBRUARY 1984 Cased to .If A~ B, or C, D.E.C. Approv~)/N)J Date Comt31e ted Yield Depth of Grouting. Pump Set At Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) / : Depression A~ound Wellhead (Y/N) Separation Distances fram Well: ~'~/. . . TO Septic/Holding Tap~k on Lot ~On'Adjoining Lots To Nearest Edge. of Absorption Field on Lot t On Adjoining Lots To Nearest Public Sewe~ Line To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ; gate Wate~ Sample Test Results Cc~arents SEPTIC/5IS~Bt4~G TANK DATA gate IDstalled 3/~J~ ~/ Size /~3"'~ b/No. of Cc~,~artm~nts standpi~s/~) ~. ~ Ai~-tight Caps ~ Foundation Clean~'~ ~~' Holding Ta~ High--Wate, ~a~ (Y~:/2g' Te~ra~ Holdi~ Tank ~p~ation Distances ~ ~ptic~olding Ta~: . /CD ~ To S~e~ Pond, ~e, ~ Majo~ ~aina~ Counts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ /~ f. ~ / Width of Field ~ ~ ¢ /3'~ Type of System Design'~~/~// Length of Field ..~ / - L/~ / Depth of Field /'7~ ( Gravel Bed Thickness Square Feet of Absorptlon.~ea ' ~ ,~ ~ ~'~ Standpipes ~ese~ ~p~ession over Field (Y~? ~te..of ~st A~a~ Test ~-//'~ ~' ~' ' Results of ~st Adequa~ ~st ~//'~L ~/~ ' / Separation Distan~ fr~sorption Field: To ~te~-Supply ~11 ~ ~ ~/~.~// To ~o~rty Line /~ To Building Foundation /~ z / To Existing or ~ndo~d System Lot /~ ~'~ ; ~ ~joining ~ts ~D .~ To Water ~/~vi~ Line /O ~.. To ~t~(if pre~nt) To St~e~ond~ke/~ ~jo~ ~aina~ C~se ~ /~<~ To ~iveway, Parki~ ~ea, ~ Vehicle Stora~ ~ea ~' '~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes(Y/N) Di~e ns ions Manhole/Access (,Y/N) "~ .Pu~. Off" Level at ~[~ Vent(Y/N) l~3~ping Cycles du~ing Adequacy Test. Meets MOA Co~nts ** Check Permitted Bedrcom Rating Against HAA Request I oertify that~I~ve ch~cked, verified, o~ confor~ed to all on the date ~ thi/s ~Ds~e~t~ion. Signed /:~'//~/~~L ~' pate //~ / ~7~'d/ K~I/d5/s [Page 2 of 2] 2-15-84 · r~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME INSPECTOR INSPECTOR % ~" INSPECTOR DEPT, OF HEALTH DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECTION E - 825 L Street - Anchorage, Alaska 99501 NV ~(Dr,iM~NT,AL P~C'~'£CTION ENYmONMENTALSAN~TAT~ON DW~S~ON MAY ~ 8 Telephone 254.4?20 DIRECTIONS: Complete all parts on pa§e 1. IncompIota raquosts will not ba proa~$$ad. Please allow ten I10) days for processing. MAILING ADDRESS PROPERTY RESIDENT {If different from above} PHONE 2. BUYER PHONE MAILING ADDRESS - I PHONE tEND,NG,NST,TUT,ON I MAILING ADDRESS 4, REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION 6. TYPE OF RESIDENCE [~1NG LE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four E~"~"Two [] Five [] Three [] Six Other 7. WATER SUPPLY MMUNITY [] 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.) SEWAGE O,SPOSA, SYSTEM [~'~1~ I V I 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) 1. TYPE OF RESIDEN( [] SINGLE FAMI [] MULTIPLE THIS SIDE FOR OFFICIAL USE ONLY [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILI Connection Ver .' - 3, SEWAGE DISPOSAL~-~~~~;:~:'~?.~ ~' ~ ::.~ ~ ' ~INDIVIDUAL/ON -S · - - ' . - :.'..,~-..~.~ ~ ..... :v-'j '~. ~: Connect on Vet f e{ - ' ./" - ~ ~Septic Tank or ~Hc-- : ' '/ ~',~ - ~ .,;~ Size: If Tar~? .... -' ..... - ~ ~ '~ ~ give dimensions: I TYPE OF TANK TOTAL ABSORPTION ARE 4. DISTANCES WELL T( Absorption Area to nearest L §. COMMENTS Nearest Lot Line [~"~PP ROV ED FOR ~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~] DISAPPROVED DATE BY /~'~1~ 72-010 (Rev. 6/79)