HomeMy WebLinkAboutNORTH WOODS BLK 4 LT 24
~ MuniCipality of Anchorage Page I of
' 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: ~,,k.) ct~-o'5~ PID Number: o~ ~q ~ o ~
Name: ~o~T~O°O~ ~C- Wastewater System: ~ New ~ Upgrade
Phone: ~- ~O ~ No. of Bedrooms: ~ ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: O.~ GPD/Sq. Ft. Total Depth ~fr°m' original grade:
Lot: Block: Subdiv~ion: ~epth to pipe bottom from original grade: Gravel depth beneath pipe
Township: ~ Range: Section: ~ Fill added above original grade: Gravel length:
WELL:~xis~,~ D New D Upgrade Gravelwidth: ~ Number of lines:
Classification~o~(Private. A,B,C):~, Total Depth: Cased~ Total absorption ~ea: Pipe material:
Driller: ~ Static Water Level: Installer: Date installed:
Y~~. Sot at: Ft. I Casing Height Above Grou;;: TANK
SEPARATION DISTANCES ~se~tic ~ Ho~ding ~ S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufacturer: ~ Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~
~ Material: Number of Compa~ments:
su,,c. ~oo~ ~oo'+ ~ LIFT STATION
Water ~
Foundation ~' ~' ~ ~ ~ "Pump on" level at: I "Pump ~n water alarm at:
Cu~ain =~~lnspections pedormed by:
Drain ~ ~0~ ~C ~ ~
Remarks: ~S&~L ~o0 ~ I)~v/0~ BENCHMARK
Elevation:
ENGIN~EAL
Department of Heal h and Se ices approval · ¢,x .,.r?
72-013 (Rev. 9/91) MOA 25
Permit No. SW950399 Page 2 of 2
Municipality of Anchorage
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
LOT 24, BLOCK 4, NORTH WOODS S/D 05174107 ·
Legal Description: PID No ·
)T1 98 3'ST2 FINAL CB ~DE FINAL GRADE~
C03 &_~~
~ NEBr ---- INS[LATION~
TANK 90. ' 85 1
~/~-~ ~ 79.0' N0 WA~ER FOUND
21' 58'
"~;/ .... ~ I~c C04
''~(BE )WG~DE) X J II/~q, MT1 57'56' 74'72'
co~c°~ ~/ C05
~2 MI2 78' 95'
' C06 43' 85'
NFW 000 GAl ~
~ TAKI~ % ~T~. [ MT3 45' 87'
SEPTI ~ ~~o~~
~ ~ ~ ROBERT
72-013 A (Rev. 9/91) MOA 25
ANCHORAGE, ALASKA
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950399
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:NORTHWOODS INC
OWNER ADDRESS:709 WEST INTERNATIONAL AIRPORT RD.
ANCHORAGE, ALASKA 99518
DATE ISSUED:12/01/95
EXPIRATION DATE:12/01/96
PARCEL, ID:05174107
LEGAL DESCRIPTION:
NORTH WOODS BLK 4 LT 24
LOT SIZE: 20134 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL 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 NO[~IFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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: ~]~:5~'~
ISSUED BY:
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
November 9, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAO DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 24, Block 4, Northwoods S/D
Request you issue a permit to install a septic system to
serve the proposed three bedroom house on the referenced
property.
Two test holes were excavated and percolation tests
performed. The approximate location of the test holes are
located on the attached site plan.
At the time of excavation no water was encountered in the
test holes and after seven day ground water monitoring,
the monitoring tubes were found to be dry.
This property has enough area for a future.septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Ro ert C. Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
'" J
'i- = 40'
SITE PLAN
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5-
6-
7
8
(ENGINEER'S SEAL)
~~ ~ownship, Range, Section:
SLOPE SITE PLAN
I
,ak
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Deplh to Waler A~.~e[~
Monitoring? ~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN
"~'~ (minutes/inch) PERC HOLE DIAMETER
~-'~- FTAND ~'-~"~ FT
COMMENTS
5&3 .............
I~1~1~11~1~1~11~
PERFORMED BY: I_~A~A I~A~.I. River L~p Road No. ~ ~. )~ CERTIFY THAT THIS TEST WAS PERFORMED IN
E~e River, Alaska 99577 ~ _ ~ ~ ~q ~'
ACCORDANCE WITH AtE~TATE A~D MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DATE PERFORMEDt, q}~'~ ~.,,'%'.' ~'
,H~q ~ ¢o~Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
DEPTH? · ~< pO
E
Depth to Water After
Moniloring? [~\~5~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
(minutes/inch) PERC HOLE DIAMETER
FTAND--~'¢" FT
COMMENTS
$ & $ ENGINEERING ~
PERFORMED BY: ....... , ..... : ~ , .~j ~_ _~,[A~o ~3 C~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL~J~q'L~V~,I~P,A;~[.~DELINES IN EFFECT ON THIS DATE. DATE: - //'" /~ '"'?'~'~
72-008 (Rev. 4/85)
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE= Lot 24, Block 4, Northwoods S/D
November 9, 1995
OENEPJ%L:
1.
0
®
e
The scope of this project includes the installation of
a 1000 gallon septic tank and two five foot wide
drainfields to serve the proposed three bedroom
residence for the referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling. On all
leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation
growth over the mounded area.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
me
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
e
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
e
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP . SUITE 204 ' EAGLE RIVER, ALASKA 99577
Page Two
Lot 24, Block 4, Northwoods S/D
November 9, 1995
e
60
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DI~AINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
'2.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
e
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
De
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
Page Three
Lot 24, Block 4, Northwoods S/D
November 9, 1995
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
Se
e
e
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the ~200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 24, Block 4, Northwoods S/D
November 9, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
me
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
0
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
e
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and
S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/OWNER
/-~' 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
[] UPGRADE
MAILINGA~DRES~ (~ ~, ~ f
LEGAL DESCRIPTION
LOCATION~ - ~ NO. OF BEDROOMS
~ I ~~) ( ~e~ ~ Absorption area Dwelling PERMIT~
DISTANCE TO: /~ ,~ .
~N~ Manufactur¢~~OA Ma~__~ ~ No. ofcom~ments~
I Liq' ~gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
0 Z ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundatio~3 Nearest I line/ PERMIT
~ DISTANCE TO: ~ [ ~ ~ N~[ ¢~¢~
,o. of linest Length ~ ag, ~no Total [on~ivs Tren~i6 Distance between lines
_ ~/~ ~
to . Total eff~ti~¢absorptifn area
~ ~ Top of tile finish grade ~' Material beneath tile ~/ inches
~en~th Widthl De~th .
~ ~ 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 line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s}
~ DISTANCE TO:
OTHER
PIPE M~ERIALS
SOILTESTRA~6 'F
INSTAELER ~ ,
f ~ ~
APP~ ~ DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
RPPLICRNT
LOCRTION
LEGRL
DEPRR'TMENT ElF' HEF:L'"PI RN[:, Ei",m'IRONMENTFt! PI';'A"F'E'TtFi'.f '.~'~
'"L-" STREET.,
~K. PIGU=, CONSTRL!CTION F.) 6.,:':, D L'9.9567"
P!C'MRNUS DR I
L 26 B 4 NORTH WOODS S,."'D LOT SIZE 2¢888 StT. iURRE F'EET
TYPE OF SOIL. FIBS;ORPT!ON SYSTEM IS: TRENCH
MRXtMUM NUMBER OF BEDROOMS =' 3:
SOIL RR]'ING <SQ FT?BR)= 215
'THE REQUIRED SIZE OF' THE SOIL BB$ORPTION Sb'S'rEM IS:
£:" E"-.- F' T' ~4 ==: :.'L ;.:_::: L_ ETE ~"-.t G T' kt = ,:-1- ::L ~:,3 R R %." IrE tL IE:, E F' 'T ~--~ =: :.-~':
THE LENGTH DIMENE;ION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFtINFIELD.
THE DEPTH OF R TRENCH OR PIT IS ']'HE DI~;'TRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF' THE E?:,'CF4VBTION (IN FEET).
THERE IS NO '..gET' WIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN ']'HE OUTFFILL PIPE
FIND THE BOTTOM OF THE EXCFCv'RTION (IN FEET).
PERMIT RPPLICRNT HFIS THE RESPONSIBILtT'¢ TO INF'ORM ]"HIS DEPFtRTMENT DURING 'THE
INS]"RLLRTION INSPECTIONS OF 8N"r' WELLS RD..IRCEN. T TO ]"HIS F:'ROPERT"¢ RND ]"HE
NUMBER OF: RESIDENCE'.=.; THRT THE WELL WILL SERVE.
............ "TI...IC~ ,:: 2:: :) I I%~':_-':,PEC:T ]: CtP-.t:~::, R F..'F.: F,:: [£~]'::.~ td :]:
B8CKF'!LLING OF RN¥ SYSTEM WITHOUT F'tN~L INSPECTION BND F~PF'F::OVRL B'¢ THIS
DEPRRTMENT t4IL. L BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R NELL RND PI. NY ON-SITE SEWP]GE DISPOSFtL S'¢STEM IS
:.t.r.;!~C~ FEET FOR ~ PRI'¢RTE WELL OR ±5C~ 'TO 2E~O FEET FROM.R PUBLIC WELL DEPENDING
UPON THE T"r'PE OF' PUBLIC WELL
MINIMUM DISTFfNC:E FROM R PRIVF4TE WELL TO ~ PRIVRTE SEWER LINE IS ;..7:5 FEET RND
TO R COMMtJNITY SEWER LINE IS 75 FEET.
OTHER REE.!LIIREMENTS MR"¢ RF'PL"rL SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
FI',/RIL. RBLE TO INSURE; PROPER IN"STBLLRTION.
I CERTIF'¢ THRT
±: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RN[:, WELLS RS SE']"
FORTH 8~r' THE MUNiC:IP8LIT¥ OF RNC:HORF!GE.
':2.: I WILL INSTRLL THE SYSTEM IN F4C'CORDFtNCE WITH THE CODES.
3:: I LIN[:'ERSTRND THF!T THE ON-SITE SEWER SYSTEM MR"r' REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 2; BEDROOMS.
S I GNED: ................................................................................
RPPL I CFIN'T SKRGGS CONS;TRUC:T I ON
............................................................. [ RTE ................... } .............. V4. 0
~MUNICIPALITY OF ANCHORAGE?~
Department~, f Health and Environmenta_ ~rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
.~/OR ON-SITE SEWER PERMIT
Applicant: .~ kava 5 Cn~c~ Mailin~ Address: ~.0. ~0f
d~
Location: ~a~a~ ~-~P Phone Number: A~' 2~,~
Legal Description: ~ ~ ~L~ ~f)r~6m~ ~/~ LOt Size:
Type of Soil Absorption System Is:
Trench: ~/. Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) 2~ ~F/~
0
The Required Size of the Soil Absorption System Is:
DEPTH: ~2~ LENGTH~ ~_~ ~(~%. GRAVEL DEPTH' ~L. .
T~e length dimension is the length(in feet) of the trench or d~ainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom o~ the excavation(in feet). There is no set width ~or trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(~) TANK SIZE = /~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 1 9 8 1 * * *
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 install the system in accordance with codes.
(3) I understand thDt the on-site sewer system may require enlargement if
Signe~: t~~re ene's remodeled to include Issued more by: ~~~"~'that- 3 bedrooms.
Applicant
Date: 2~ ~._~ /~/
SWP/024(1/81)
!
Russell Oyster
694-2774
0 & E EN(~.m, qEERING & DEVELO~ENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Earl Ellis
688-2280
Performed for: Name: ,- d-
Mailing Address:
Depth (feet)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Soil Characteristics
PLOT PLAN
PERC. TEST
Ground Water Encountered: Yes No
Proposed Installation: Seepage Pit
Comments:
t .... If yes, what depth
Drain Field '
Performed by: '- Date:
PERM
DEPRRTMENT (. !HEFIL. TH F4ND ENVIRONMENTFtt. .... OTECTION
825 "L" STREET., RNCNORRGE., RK. 9950:l.
264-4720
( 8t:1.81]: )
RPPI._ I CF-INT
LOCRT I ON
LEGRL
PFIT NILMOTH
LOT 26 BL.K 4
308 G ST
NOR"rHNOODS S?D
LOT SIZE
20888 SQURRE FEET
'T'~.'PE OF SOIL RBSORF'TtON S"¢STEM IS: TRENC:H
MF:!XIMUM NUMBER OF BEDROOMS
SOl[.. RFITING (SQ FT/BR)= 2!5
THE REQUIRED SIZE OF' THE SOIL. RBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
THE DEPTH OF' R TRENCH OR PIT IS THE DISTF~NCE BETWEEN THE SURFRCE OF' 'THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
'THERE IS NO SET FI!C,"FPI FOR TRENCHES.
TNE GRRVEL DEPTH IS 'THE MINIMUM DEPTH OF GRRVEL. BETNEEN THE OUTFRL. L PIPE
RND THE BOTTOM OF THE EXCRVRTZON (Zf.,I FEE:T).
PERMIT RPPL. ICRNT HRS THE RESPONSIBILIT"r' 'TO INFORM THIS DEPRRTMENT DURING THE
INSTRL. LBTION INSF'ECTIONS OF RN'-r' NELLS RDJRE:ENT TO THIS PROPERTY RND THE
NUMBER OF' RESIDENCES THRT TNE NELL NILL SERVE.
BRCKFILLiNG OF RNV S'¢STEM HITHOUT FINRL INSPECTION RN[:, RPPROVRL B'¢ THIS
DEPRRTMENT l,.!IfJ_ BE SUBJECT TO F'ROSEE:UTION.
MINIMUM DIS'TRNCE BE'FHEEN R NELL F~ND RN"r' ON-SITE SENRGE DISPOSRL. ':];"¢STEIi IS
10E~ FEET FOR R PRIVRTE NELL. OR 158 TO 208 FEET FROM R PUBLIC HELL [:,EPENDING
UPON THE T'¢PE OF PUBLIC HELL.
MINIMUM DISTRNC;E F'R. OM R PRIVFFTE P. tELL TO R PRZVRTE SENER L.~NE ~S 25 FEET RND
TO R C:OMMUNITV SENER LINE IS 'F5 FEET.
OTHER REQUIREMENTS MR"¢ F:IPPL'¢. SPECIFICRTIONS 8ND C()NS"rRUCTtON DIRGRRMS RRE
RVRILFtBLE TO INSURE PROPER INSTRLL..RTION.
I CERTIF"r' TFIRT
1: I RM FRMILIRR HtTH THE REQLIIREMENTS FOR ON-SITE SEWERS RND NEL..LS RS SE]'
FORTH. B'?' THE MUNICIPALITY OF' RNCHORRGE.
2: I NILL INSTRLL. THE S"r'STEbl IN RCCORDRNCE 14ITH THE CODES.
3: I UN[:'ERST~',I[:' TNFrr THE ()N-SITE SEI.,.!ER S'-rS-,TEM MFI.r REL...n. UIF. E ENLARGEb1ENT IF' ]".PIE
REF;I[:,ENC:E ISI REMODELEE:,iTO INCLU[:,E MORE THRN ]: E:EDR. OOMS. ·
........ .... .......
Russell Oyster
694-2774
Performed for:
Legal Description:
Depth (feet)
0__
7__
~8 __
10__
O & E ENG, NEERING & DEVELOvMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
SOIL LOG 688-2280
Name: .~-/&.Z:f ~.4;b ~ ~~-p~WT'~ J? ' Tel. N0. ~-~/
Soil Characteristics
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
PERC. TEST
No /'"""~' If yes, what depth.
Drain Field
Parcel I.D. #
1.
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
Lot 24;
GENERAL INFORMATION
Complete legal description
Location (site address or directions
Thomas Co.
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
'8510 Solar Drive
Block 4; North Woods Subdivision
NHN McManu~ D~'u~
Chugiak, AK
Anchorage~
Day phone
AK 99507
346-4025
Day phone , ,
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
MuNiCiPALil¥ OF ANCN~J~'~c
E~/tRONMEN'fAL S~B, VICES DIVISION
!" ',~ '15' 'JqgG
ECEIVF D
NOTE:
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community well system, provide written confirmation from State ADEC attest-
AAA
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 if21
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 ali Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
$ & $ ENGINEERING
Name of Firm 17034 Eagle River Loop ~oaci No. ~ ~
Phone
Eagle River, Alaska 99577
Address
Engineer's signature
!.
bedrooms.
DHHS SIGNATURE
~ Approved for
,Oq '-/-~-q 7~f
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
' ",', /1111
By: ~ L~. ~ Date /
..,
! !
.4,,lil:,ji
The Municipali~ of Anchorage Department of Health and Human Services (DHH$) 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 ) ~ack MOA ~21
825"12' Street
-t5 12:26 RCVD
ES' ~-
(907) 343'~4744 ~
H ealt~ AUthority Approval 'Checklist -
LegalDescriPtion: ~.~-- '2L~, l'~t-~ '~*/"~ Jcv~6[9 ParcelI.D2 05"1~/4107~. ', i
A. WELL DATA
Well type /~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A,- B, or;c, attach ADEC le[ter. ADE~'water system number
i' Date completed~: ' '
~:~ :Led to -'.. casing/~ . -
Date of test
Static water level ~~_
Well production
: . g,p.m, g.p.m.
WATER SAMPLE ~
Coliform
DaPple:
B.~OLDING TANK DATA
Nitrate Other bacteria
Collected by:
Date installed \7.~1~.-q5" Tank size loc>C> Number of Compartments
Foundation~leafioht.~/N): ,f ~ : Depression (Ytl~ rJ High water alarm (Y~
· 'Date installed 17..-t ¢~-q:g'
'Length i~ L-' ' W!gth
Effective absorption area [,e?'"/~ : Monit6ring TUbe Present~) ~ Depression Over field'(Y/~ ~
Date of adequacy test Results (Pass 1) '---"--- · For ~'~ bedrooms
Fluid depth in absorption field before test (in.); .~mmediately after --'g-ill, water added (in.): ~
Soft raung (g.p.d./ft or ff godrm) O,~,~ System type ~,-aul
Gravel thickness below pipe "5, 5' Total depth .~,,
Peroxide treatment (past 12 months)(~/N) ' ~ ' If yes give date --
Fluid depth ~ [ins.) Minutes lhter: "--'-- : Absorption rate =
D. LIFT STATION
Eo
Date installed
Manhole/Access (Y/N)
High water alarm level at*
SEPARATION DISTANCES
Size in gallons
"Pump ou' level at* "Pum '~-l~~~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer mare
S~ line
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO:
Building foundation el ' Property line ~ o' & Absorption field
Water main/service line ~ot¥ Surface water/drainage Io~~4' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 'Z.~ I
Water main/service line
Surface water
Curtain drain
Driveway, parking/vehicle storage area
Wells on adjacent lots ~..-o.~ ~'' Property line
F. ENGINEER'S CERTIFICATION
! certify% that I have determined thru field inspections and review of Municipal records ~'~~~. are
in conJormance w~th M. OA HzIA gui~lines in effect on this date. ~~'~.~~~
Engineer'sName *O~Ar C. G~ gg ~~~~~ e .... ~
........................................................................................................... .[~,; ~:~z~:~i4.~;2~:}~ .....
HAA Fee $ ~ ~ ~ Waiver Fee $
Date of Payment .~~/~ Date of Payment
Receipt Number ~Y~* ~ ~ Receipt Number
Rev. 8/95 OSS: haa.wk.doc