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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 35  X ~.~' 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 PHONE J [~NEW LEGAL DESCRIPTION '~ ' LOCATION NO, OF BEDROOMS ] Absorption area Dwelling ~ DISTANCE TO: /~/ /~/ ~ Z Manufacturer Material No. of compartments ~ ~ Liq. capacity in gallons Inside length ~idth Liquid depth 1~ ~ ~F HOaE~OE: ~ M DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material LiquM capacity in gallons ~ DISTANCE TO: . ¢, Nearest lot ,in/~ PERMIT NO. Length of each line Total length of lines Trench width Distance between lines Top of tile to finish grade Material beneath tile Total effective absorption area Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ' ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS / iNSTALLER ' REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) . , ' :E:25 "'L~. FTFtEET., Rr. JL~HI.3Y:RCiE., ~./ 264-472E~ F'ERPI ~ T NFL ( t 3C:RT I E~N CF'E OF 'JO I L BE:SO[:F'T I 151~4 c, ,.- - ~:;:'IpII_.H NUHE:EF: OF E;ED¢:OOH5 = SOIL tE REOLIIR:ED %IZE OF THE 50II. flE:S0~rF'TION S'¢~:TEH 'E F'-I- Iff =: ~ L' E ['4 ':i-Y H =:: 7¢ ,3 ¢: FI '-.-' E: l__ THE LENGTrt C, IHEN%ION IS THE LENGTH (IN FEET;, OF THE T~:ENCH OR DRRIHFIEL[:,. 7HE [:,EF'I'tt OF R T~:ENCH 0~: F'IT IS THE [:,~,,'RNCE E;ETI,IEEH THE SUF:FRCE OF THE G~tOUHD FIND THE E'.OTTOH OF THE E>;CB',,.'F-ITIOH (IN FEET::,. THEF:E IS HO SET l,lIDl-t4 FOR T~:EHIZHES THE GRR',EL DEF'TH IS THE HINIHLIH DEPTH OF G¢:RVEL E:ETHEEN THE OLITFR[_L PIPE RI.ID TIiE EOTT3H OF THE EXCR',/RTION (IN FEET). .'~:t'IIT FIF'F'LIF_:FtNT HI:tS THE RESPONSIBILIT'¢ T() It.lF'Cll;:f'l THIS DEF'RF,:-FI'IEHT DI..I.riiING FHE ISTRLLRTIr3H INSF'EE:TIC~HS OF RN'¢ HELLS R£:,JRCEHT TO THIS P~,L-F'E~:T'¢ Fttl£:, THE .IHE=E~: OF RE::'ifDEHCES THRT THE MELL HILL SEF:VE. T !.11Zi ,--. ;:_-' ;:, I I'-1 :-Z; F' E ~3 T I C~ I'-1:5 l:: ~: l}( IR E IZ! LI I Fq: f£ iEKFILLING LqF RNY _,r_~lEfl I,JITHFIIIT F[HRL [NSPEE:TIIqN RND RF'F'~'FcVRL E"¢ THIS ~F'RPTHENT I,I~LL BE SLIE:..TECT TO PROSECUTION. ;HIFILIPI £:,ISTFtHE:E E:ETI4EEN R [,JELL RHD RN'T' ON-SITE ~ElllAGE DISPOSRL S'¢STEFd ;~0 FEET FOR F~ F'¢:IVRTE 14ELL. O~; ~SE~ TO 280 FEET F~:OH R FI..IE:LIC HELL DEPENDING :'OH THE TYPE OF F'LIBLIC I, IEI.L. ;NIHUI'I DISTRNCE FROFt R F'RIVRTE HELL T0 R PRI'v'RTE SEHE~: LINE IS 25 FEET ) R (OI'IHI_IHIT'¢ SEI.IE~: LIHE IS 7~ FEET. 71_t_ LCll~iS F~E:E E:EQI_ilR:ED FIND mUST E',E R%TI_IE:NED TO THE [:,EPRRTHEHT M~-rHZN 3'~, rile [,I~:I_L C:CIt'IF'L. ETIEIN. -HEP F/E~;~I.IIF:EHEHTS flIF4N' RFIF'LN'. :~;F'EC:IFICflTIOHS RN[:, C:ONSTt;:I.IICTION [:,IFtGRRr'Is FiRE CFtI[_RBLE TO IN:SURE F'ROF'E¢: INSTRI_LFi~IFff'L CEF:T IF'¢ ]-HF~T RI'I F,c~HII_IFt? l,llTt~ THE F:EQUIfiiEHENTS FOR OH-SITE SEI,IE~;'.5 RN[:, HELLS RS SET E','¢ TtiE l,lf.IH I C t F'RL I T'¢ OF FINE:HO~:RGE HILL IHSTRIZ.. THE SY$TEH IH RC:CO¢:DRNCE 14~TH THE CODES. UtIE',ERSI'RND THRT THE ON-SITE SEI,IER 5'T'STEPI P1R'¢ F;EQUI¢:E EHLRRGEHEHT IF THE ; G~4E-D: .................. ~ ...................................... F~F'F'L I CRt IT PERFORMED FOR: LEGAL DESC'RIPTION: ~.0'~ ~ SOILS LOG PERCOLATION TEST ' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? L O P E Gross Net ·Depth to Net Reading Date Time Time Wpter Drop "//ZS./~o 0 ~' '~" PERCOLATION RATE ~:~ (minutes/inch) TEST RUN BETWEEN ~" FT AND ('~'_ FT PERFORMED BY: ?2.oos ~7/?s) LEGAL DE,~'RIPTION: ~,0"~ 35 SOILS LOG PERCOLATION TEST 3 4 6 7 8 9 10 11 12 13 SLOPE SITE PLAN _i 14 15 16 17 18 19 2O COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'~- (minutes/inch) TEST RUN BETWEEN ~' , FT AND (.~ l,% - FT 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. # 05173147 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 35, Block 3, North Woods S/D 22621 Northwoods Drive Location (site address or directions) Property owner Mailing address Lending agency Mailing address Richard & Helen T. Suddon Day phone 2P6~1Northwoods Dr., Chug~ak, AK 99567 Day phone 688-2823 Jack White/Lynn Swanson Agent Addres~1823 Old Glenn Hwy., Eagle River, AK 99577 Day phone 694-5500 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: If community well system, provide written confirmation from State ADEC attest- ' lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank ~'~ ':' Community on-site Public sewer If community wastewater system; provide written confirmatior~ from State ADEC attesting to the legality and Status'of ~J~stem. NOTE: 72q)25 (Rev. 1/91) Front MOAII21 STATEMENT OF INSPECTION BY ENGINEER As certified by my se.al 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 an~l/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 & S ENGINEERING Name of Firm 17034 Eagle River Loop Road NO. 204 Address v;~,qle P, ive r,~sE¢~7 Engineers signature · ,'~'. Phone DHHS SIGNATURE ,}{ Approved for 4 Disapproved. Conditional approval for bedrooms. ~ ¢ ~ RO.ERT C COWAN ~ ~¢ 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. 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. 72~25(Rev. 1/91) Bsck MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES FEB 2_ 2 ~9(:J~ Environmental Services Division ~N 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~ t I~vIcE$ DIVISION Health Authority Approval Checklist LegalDescription: LOT- 33'- ~oo~ ) /vc.4./'H ~ ~ ,'~ J Parcel I.D.: ©~'/ A. WELL DATA Welltype C~r',¢ ~ /fl Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to C~ (above ground) ,W~res properly protected (Y/N) FROM WELL LOG ~ AT INSPECTION Sanitary seal (Y/N) Date of test Static water level ,/' Well production _~ WATER SAMPLE RES~~.' Coliform ~ Nitrate Date of sample: g.p.m. Collected by: Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed ii//~ / ~r O Tank size I~- $-~ Number of Compartments ~ Cleanouts CN)___ Foundation cleanout ~/N) "/,~ $ Depression (Y/~ W ~) High water alarm ~N) '"/'¢-¢ Date of Pumping 9-/~'//¢4~) Pumper ~TFO-~ ?,.'p4a,~C C. ABSORPTION FIELD DATA Date installed '1~/~0/¢O Length t~o' 'T¢'r/~ Width 7.. Effective absorption area ~/o~'- ~; Date of adequacy test '~ ) I -/ ) ~'i ~) Soil rating (g.p.d./fF or fF/bdrm) i ¢/'0 System type Gravel thickness below pipe ,~ Total depth Monitoring Tube present (~/N) ¥¢/' Depression over field Results ~ail) /~ ~ :; ~ For Fluid depth in absorption field before test (in.); ~P-'f Immediately after~ gal. water added (in.): Fluid depth 3/~" (ins) Minutes later: ) ~ Absorption rate = ~ ~) ¢' 1- .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~>'/z_ f4,~,,,.~ If yes, give date ~ bedrooms 72-026 (Rev. 3/96)* LIFT STATION · Date installed Manhole/Access ~N) High water alarm level at* Size in gallons "Pump on" level at* ~ / 3 Cycles tested *Datum SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* -7 Septic/holding tank on lot Absorption field on lot Public sewer main / Sewer/septic servigeJine Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation i s'- Property line ~:~ o V- Absorption field Water main/service line ) 0 ~ Surface wateddrainage /°° ~- Wells on adjacent lots On adj ac e n._~.._..,.----'~/ ~/~..QJ:~ffj~ t lots Public sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation z~ 0 Water main/service line o -~- Driveway, parking/vehicle storage area Property line Surface water Curtain drain '30 -~- Wells on adjacent lots ENGINEER'S CERTIFICATION I cedim that I have determined thru field inspections and review of Municeal reca~[{h~t,th~'~b~ms are in conformance ~ith MOA ~A guidefines in effect on this date. Signature ' ~ ..... " ' / Date '~ / ~ ~ / ~ ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 1. GENERAL INFORMATION Complete legal description Lot 35; Block 3; North Woods Subdivision; Location (site address or directions) 22621 Nortkcooods D~u~v6 Property owner Mailing address Lending agency Mailing address Richard sutton HC 80 'Box 7592 Chu.gx'ak: Day phone A~. 99567 Day phone 688-2823 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 4 Individual well Community well 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 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 ofstructure 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 Address Engineer's signature £ & S ~NGINEERING ~,70~4 ~-"3~.' o~.,,. Loop Eagle RiYeh Alaska 99577 Phone DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHFIS) 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) Back MOA Municipality of Anchorage . , Department of Health & Human Services HEALTH AUTHORITY APPROVAL OHEOKMST 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 FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line_ ADEC water system number '~,\'~ ~:)O\ Driller Casing height Wires properly protected (Y/N) AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAl- SERVICES DIVISION g.p.m. ~:~.~.~p.~.'J RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/clean, out Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts {~/N) High water alarm (Y~ Date of pumping Tank size \'/...~'O ~ Compartments ~ Foundation cleanout (~'N) '~ Depression (Y/~ /~ Alarm tested (Y/N) ~"~/A' 3,~ Pumper '~-~'- (_~.~¢'~(.~ L.- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field \ oOL'~ Foundation \ '~'~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent ~N) High water alarm level \/ "Pump on" level at Manufacturer '~¢4' ~-/~,//'~-T~c~'"'z.~ Manhole/Access ~N) \ ~e ~/~ v- "Pump off" level at Cycles tested Meets MOA electrical codesr.~TN) '~/'~'¢~' ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot '7..-~c~ ~ ~¢- On adjacent lots ~lpo¢ Surface water ~ \~' D. ABSORPTION FIELD DATA Date installed \~,¢ \O Length \\ L~' "~'ol~idth Total absorption area __ Depression over field (Yff__~ R esu Its <U_~a,ss~fa il) Peroxide treatment (past 12 months) (Y~ Soil rating \ ~ ~ ~/¢~¢~ System type. ~:)¢-P.~ Gravel thickness Total depth _ ~O~ CJeanouts present ~N) Date of adequacy test for_ ~o0 ~ ~ bedrooms ~b~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '7~-.~ o To building foundation On adjacent lots On adjacent lots. ~"~/~ Property line To existing or abandoned system on lot Cutban k ~ Water main/service line_ Surface water Driveway, parking/vehicle storage area Curtain drain. E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. (.,,.~ll~ River, Alaska 99577 HAA Fee $ / ~¢ W alver bee: Date of Payment ' .¢~'-//- ~ ~') 8 ~'-' ~ ~ Date of Payment Receipt Number ,~ .... ~// ~ /'~¢ Receipt Number '.i~...~ . ,.' .~ i 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 · '~ DAVE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H2ALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~qVIRONMENTAL PJ~OTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. P~ease allow ten (10) days for processing. MAILING ADDRESS ; PROPERTY RESIDENT (If different from above) PHONE BAILI~6 3. LENDING INSTITUTION ~ ' . A ~ . / / PHONE ;TR EET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS ~" [] 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 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM E~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE E~ 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 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING live dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line WELL TO: I I Absorption Area to nearest Lot Line 5, COMMENTS [~ APPROVED FOR b/~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ 72-010 (Rev. 6/79)