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Home My WebLink AboutNORTH WOODS BLK 4 LT 23 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 IPRONE I~NEW MAILING ADDRESS ~8~ ~ u ~ooo~ Gox Cr EEGAL DESCRIPTION LOCATION ~ rr ~$' O~K NO. OF BEDROOMS PERMIT NO~ "~ DISTANCE TO: IWell ff/~ Abs°rpti°n areas'~ Dwelling Vl.t ~ 'anufacturer ~ e Material S,~ ~ N°' °f c°mpartmentsa Liq. capacitv in gallons inside length Width Liquid depth ~ ~ DISTANCE TO: Well ~1]~ Dwelling PERMIT ~O. O Z ( ~anufacturer/~/~/ Meteriel Liquid cepecitv in gellons Q Well ~ Foundation ~.~, , Nearest lot line ~ ~ PERMIT NO. ~ Nd. of lines a Length.ch 17~1 Total ,engt,~i~ Trench width Distance between ,ines~/~ ~ Top of tile to finish grade 3' ' .aterial beneath tile.______~0 inches Total effective a ea Q fO0 inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~]]~ Crib depth Total effective absorption area ~,/m ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ C3o~s Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building f~undetion Sewer Hne Septic tank Absorption area(s) OTHER PIPE MATERIALS I V "~ INSTALLER ~ ,~ REMARKS ' ' " : " ' ....... I /~-AMUNICIPALITY OF ANCHORAGE~ - Departmen'~ ~f Health and Environmenta'. !rotection . , 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit # ~ 0/~7 W~ AND/OR ON-SITE SEWER PERMIT Applicant: ~ Fl~ I ~ T ~Fo~ ~l~$~Mailing Address: Location: P'~ ~"S CF~ Legal Description: ~- ~ ~ Type of Soil AbSorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: ~ Phone Number: Seepage Bed: ~ Holding Tank: Soil Rating (sq. ft/br) The Required Size of the Soil Absorption System Is: DEPTH // LENGTH GRAVEL DEPTH / WIDTH 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 outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~;c¢-O 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. 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 returned 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, i 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 instaIl the system in accordance with codes. (3 I uKderstand that the on-site sewer system may require ~nlargement if the residence is remodeled to include more that 3 bedrooms. Signe~: ~%&'~/~'-~/F'JE~,~F~/,'"u/O Issued by: C~~ ?Z Date: / SWP/024 (1/81) LEGAL DESCR,PT~ON: Z- 'Z :3 /7 z/' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST -~O?~'*)~ '~"" DATE PERFORMED: [] 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 Robel't A. 1'40. WAS ~ROUND WATER ,,~/0 su ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ q/ ,'"~ (minutes/inch) PERFORMED BY: 72-008 (6/79) 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. # ~-~\ - 1. GENERAL INFORMATION Complete legal description Lot 23; Block 4..- Northwoods Location (site address or directions) Property owner Mailing address Lending agency Mailing address 22775 M~Manus Drive Chugiak, AK Lou W6ibl Day phone 688-2388 22775 McManus Drive Chuqiak, AK 99577 Day phone e Agent Target Realty Dick Brown Day phone 694-2388 Address 17034 N. Ea.qle River Loop Rd. Eaqle River~ AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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 t~nk Community on-site NOTE: XXX 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 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. Phone Name of Firm .S & $ ENGiN~.~-RiNG j--~ / Address 17034 Eagle River Loop R~a~r~o. 204 / Eagle River, Ala~,a,~ Engineer's signature , DHHS SIGNATURE ,~---,~, Approved for -,'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: /~z, '~_/~-~-~'~'~' ..... 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 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 MOAi¢21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ 7.---5 ~ ~ ~of--~ \,~arcel I.D. A. Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow ~ If A, B, or C, attach ADEC letter. ADEC water system number ~ '~o ~ I Date completed Driller Cased to Casing height Wires properly p~ PRO WELL .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~ ~ '~ Absorption field on lot ~ ~ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Da~ ; On adjacent lots ; On adjacent lots .g.p.m.~-TI Public sewer manhole/cleanout ~ ~t~'~~Petroleum ~'~-"~ Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts {~N) High water alarm (Y~I) Tank size ~ c~c~O r_~,~..~ compartments Foundation cleanout (~N) ~ ~// Depressio~ (Y~I~ Alarm tested (Y/N) Pumper ~.~Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation Well(s) on lot '7.~:~c, On adjacent lots To property line ~C> ~ Jd Absorption field Surtace water/drainage ~ I ~c, 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 Manufacturer Manhole/Access (WN) "Pump off" Level at ,Cycles tested Meets MOA electrical cedes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Length ~__~c~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~) Soil rating (GPD/FF) '7.-.t..~ '~'/~--- System type Width "%c:)'~ Gravel thickness ~' Total depth c~ ~, c> ~ Cleanout present(~N) ",/ Depression over field (Y/~ Results{;J~j~lail) ~-p,-~s for ~ After test L~ ~or.~ ~ ~4-~oJ ~ Il yes, give date ~L Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~ On adjacent lots To building foundation ~ ~ ~ On adjacent lots '"~c~ ~ '~ Cutbank Surface water ~;~ \~.c~ Curtain drain ~ ~ ~ E. ENGINEER'S CERTIFICATION Property line To,existing or abandoned system on lot ~ / ~.~ Water main/service line Driveway, parking/vehicle storage area ~ ...... io~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeqCcm~h~e~? thisinspection. 17034 Ea ~r o ad NO. 2~ Engineers N~e HAP, Fee $ Waiver Fee $ Date of Payment /~ ~-~ ~ ~' ~/ '~ Date of Payment Receipt Number /,) ~ ~ ~'~ ~ ~ ~ Receipt Number 72-026 (3/93)' Back 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 GENERAL INFORMATION Complete legal description Lot 23; Block 4; North Woods Subdivision; Location (site address or directions) 22775 Mc Manus Driv~ Property owner Mailing address Show6n Day phone 19818 Fairmont Circle Eagl& River, Ak. 99577 Lending agency Mailing address. Day phone Agent I nu P. nmphoY£ AqqO,qIATFf) - 640 W~t 36~h Av~nu~ S~ Address An~hn~ag~ Al~ka/99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLYJ Individual well Community well XX Public water Day phone 563-3335 NOTE: 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 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/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 Address $ & ~ 17034 Eagle River Loop Road No. Phone E~gla River, Alaska 99577 Engineer's signature Date 6. DHHS SIGNATURE _/~ Approved for-~ Disapproved. Conditional approval for bedrooms. 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 engineeCs work. 72-025 (Rev. 1/91) Back MOA #21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.~'r' ~.-~ ~"~V--~ j~3C..~P¢ ~-J, ooo~; ~J~;~cel 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: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. ~-~:'~' ~' ; On adjacent lots '?.--~o ; On adjacent lots AT INSPECTION g'p'm'('~t ~. ~ O o Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~N) High water alarm (Y~)) Date of pumping Tank size \C:~::,r.~ ~,~1..~ Compartments Foundation cleanout~)'N) ,-~ '¢ Depression (Y,~ ~ Alarm tested (Y/N) "J-' '"'~t "L,'~ Pumper __..~'.,~- , ~.~d.~, ¢~ O SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ c, L ~' On adjacent lots To property line I~' ., Absorption field 7~2Surface water/drainage Foundation '7 I .Water main/service line ,:~. 'J~,~ ~ CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "PJ,IJ33ff'o/t'~vel at High water alarm level ~ed Meets MOA electrical codes (Y/N) ~ SEPARATION ~TATION TO: On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed L~ ~ ~,/--k' --~ ~ Length ~'~ I Width ~ Total absorption area ~ C>~ Depression over field (Y~) v~ Results ~:~ail) Peroxide treatment (past 12 months)(YN~ /~J~.~ Soil rating ~-L~' ~/~...- System type Gravel thickness Total depth Cleanouts present ~N) Date of adequacy test ~ ~ ~ for ~:~ ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~-c:~ ~ '~ On adjacent lots ~'~'//~ Property line To building foundation '~c~ t-~ To existing or abandoned system on lot On adjacent lots -Z~ ~ \ A~ .Cutbank '~"~/~-~ Water main/service line Surface water ""/~[~'C>" ~ Curtain drain ~l/~,- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect, Driveway, parking/vehicle storage area date of this inspection. Signature Engineer's Name Date $ & S ENGINEERING !7~34 Eagle River Loop Road No. l~qle Rlv~r, Alaska 99577 HAA Fee $ //7'~'''''''~ Date of ~syment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 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 February 19, 1992 FOR: S & S Engineering 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/of ~4 EB I 6 : 4 5 A'=J '=' 0 C I A T E D~ · ~ ' '\""' ~ ,~" '" '~,l'\ "X :'.~",: 'V, ~:~-/'u?~ , ' . ~ . ~. ... the existence of.any easements, covenants, d~vis~on lat. Under no circumstances shou d ,nv . NOTE ..tw .... ,~,' " ...... ~" -', ~ .............. ~V~¢ ~OWN O~T~ R~¢O~DED P~T, A~E NOT responsibilq~ for the action on~y ~;: ....... -- ].-' . ~--.~ , · ' ' L~EN_ D ." LOT ~'~ ~LOOK" ~' .'..~ ~' ~ ' -- .... ANCHORAGE RECORDIN~ DISTRICT [~ .u~ ~ ~ ,, ~' ' ....... ...... ~..u.,'~.,~' ~,.**~- . ' ' k-.-- .'--:----':; .......... APPLI¢' NT FILLS OUT UPPER HAI ONLY Property Owner ~/~/ ~..~-~'~ 7'- Phone Mailing Addre~ ~ 7~ ~ ~ Zip Code ~ 7 Buyer Address ~ Zip Code Phone Lending Institution Address / ~ / ,~ / .~ Zip Code ' Phone Realty Co. & A~nt Address~ Zip Code Legal Descript~n Street Locati~ Ty~ o~si~nce ~ngle Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ ~n~vidual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ommunity For wells drilled prior to that date. give well depth (attach log if available). ~ .~ublic Utility Se~er ~posal ~ndividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time ~ns/pe~tor ! Inspector Inspector Inspector Field Notes: (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received i ~ ~1~ ,~ Well to Tank Septic Tank Size 72-023 (3/82)