HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 2 LT 9Northwoods
Block 2
Lot 9
#051-821-09
r
'°""t; MUNICIPALITY OF ANCHORAGE „�.��r
On-Site Water & Wastewater Program _ 5.^�„r`� PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 --
-7http:!lwww.muni.orglonsite '
CNONP l301(
On-Site Wastewater Disposal System Permit Ion07
I0/111if7 70 P it am,
Permit Number: OSP171288 Effective Date: 10/11/2017
Work Type: Septic Upgrade Expiration Date: 10/11/2018
Tax Code Number: 05182109000
Site Legal Address: NORTH WOODS PHASE 2 BLK 2 LT 9 G:1560
Site Mailing Address: 22348 SHADOWY SPRUCE DR, Chugiak
Owner: PRICE JESSEE LEE & Lot Size in Sq Ft: 26914
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
2 Disposal Field El Septic Tank ❑ Holding Tank 0 Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: F. -7:-
��l Date: �4/(2// 7
Issued By: irt&C(.4( ll �% Date: 10/00, 7
MUN CO P AIJ T Y OF ANCHORAGE
Community Development Department \, • r// Phone: 907-343-7904
Development Services Division �. ,
Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICAT NSEP 26 201/
Parcel I.D. Q " 82 ( - Dy
Property owner(s) 1 [CF Day phone 2 30-052 7
Mailing address 22 3`i Sh`/d j/ S vCT per'
Site address RR
Legal description (Sub'd.. Block & Lot) A/r• {�r�c - -J t,4 z U a L 7
Legal description (Township, Range & Section)
Lot Size ZC, *y Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
El all that apply)
Absorption Field Initial Single Family (SF)
(w/wo ADU)
Septic Tank Upgrade
Holding Tank CIRenewal Duplex (D) ❑
❑ Multiple Dwellings ❑
Privy n (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner o authorized agent)
Permit/Rush Fees: 5-61 Waiver Fees:
Date of Payment: Vo //7- Date of Payment:
Receipt Number: Q731/QReceipt Number:
Permit No. OLAP/ay, Waiver No.
Permit App_9-1-12.doc
1\10-IF-RI M
ENGINEERING SteveEng.com
Steve Eng,PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 9/25/17 Number of Pages: 5-
To:
To: MOA On-Site Services
Subject: North Woods Phase 2 Block 2 Lot 9
Septic System Upgrade
An existing trench is failing on the subject lot. A number of soil tests in the area reveal silty sandy
gravel soil and no groundwater. The design calls for a new deep trench and a new septic tank. The
old trench will be connected via diverter valve. The entire subdivision is on public water and septic
systems. The terrain slopes north slightly at the trench site. The system size is a single family at 3
bedrooms. A previous soil test is being used for design.
Please review the wastewater system design for the existing 3 bedroom home. I have included
design plans& specs, design guidelines, & soil tests. If there is need for additional information or
clarification please give me a call.
Thanks-St
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ENGINEERING SteveEng.comNorth Woods Phase 2 Block 2 Lot 9 ,+
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•
SPECIFICATIONS & DESIGN GUIDELINES 4'4 �f` /a/.
7 +,
Wastewater System Sizing: This is an existing 3-bedroom, single family home. This is a
developed subdivision. These lots are large and are served by public water. No adverse
impacts are expected from trench/tank upgrade. No conflicts to the other lots will take
place by this septic system construction. The easements are located on the drawing and are
not encroached upon. A new soil test reveals silty sandy w/gravel. An application rate of
0.8 GPD/FT2. Trench Length = 564 FT2/5.5'x 2 = 52' trench, 5.5' effective. A new 1000
gallon septic tank will be installed; Decommission old tank per UPC. New Diverter Valve
to be installed. 2" insulation over trench with 2' cover.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment,New 1000 gallon septic tank. Install Double Cleanouts.
• Install Diverter Valve, Connect to both trenches; "ON" to new trench.
• Decommission old tank per UPC.
• 5' minimum between the tank and trenches. 10' to property lines, 14' between trenches.
• 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation
can substitute for l' cover.
• Tank& solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required l' to 4' from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10' from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from
drain-rock.
• Drain rock to be `/2 inch to 2 '/2 inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier(filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• The finish grade must be mounded to promote drainage away from trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
DESIGN NOTES:
1 . Total Depth of Trench is 7.5.
2. Sewer Service Line minimum 2% slope.
3. Public Water System.
4. Decommission Old Tank Per UPC.
5. Connect Old Trench Via Diverter Valve.
Septic V
I
New Trench
In Slope
Electric Easement
127. Slope T181
T —
c'�e V / 4% Slope
/ 47. Slope `IiMT
I47 lo• ewValve Diverter
o
c Old Trench Old
H Septic Tank
11 2% Slope PER UPC &
Replace w/ 1000 Gallon
Septic Tank
3 Bdrm w/ Double Cleanouts
3
rD
3
Lim
9
IT' Utility Easement Kewbox
Shadowy Spruce Drive
NORTH WOODS PHASE 2 = 40'1
NOR THRIMP
ENGINEERING * 4m . . BLOCK 2 LOT 9 PLAN
Po Box 770724Sim Erg LAYOUT
Eagle River, Alaska 99577 '1, WASTEWATER DESIGN Date:
907. 694. 7028 ���� ����ff k UPGRADE SEPTIC 10/10/17 rETOf 3
Foundation Cleanout
7 Tank Cleanouts
Fin ^amide Opposing Cleanouts Between Septic Tank & Trenches
.4.„7/,F
4 Foot Cover
or Equal Diverter Valve
r-- _ Lam..`.
1000 Gallon Steel Mounded Cover To Match Terrain
'Anchorage Tank'
Or Equal /
Monitor Tube
Solid Pipe leanout
I
DESIGN NOTES:
1
1, Depth of New Trenche is 7.5',
2. Septic Tank & Solid Pipe to be Placed on Compacted,
Stable Soil, Free from Boulders, Filter Fabric ��
3. Sewer Service Line is Minimum 2% 3'Slope & Cover. + 2' Insulation
p -!:-/-_'�-."`�
4, Water-Tight Couplings.
5, See Specification Sheet. Pz 11:111:11,;711,01,;:e:
-0=0=1=•'
6. All Work To Conform to Municipality of Anchorage (AMC) 1x" " " "
Requirements & Specifications.
7. Maintain 2' Cover Over Trench + Insulate, 11:111:11M:111:111„;Drain Rock ! '='=1='='=1=
8. Public Water System. Il= .:.:•:•:•:•:
9. Install Diverter Valve To Old & New Trench. ' '=0='=! =O=!=
P. 11:11:110:•:•:�:
1 r: •Hitt e 1
2.5'
=�P,�� of , TRENCH END VIEW NORTH WOODS PHASE 2
NOR THRIM *:.� �� .
ENGINEERING
'� , SEPTIC TANK PROFILE BLOCK 2 LOT 9
17237 Bear Pow Circle st . e
Eagle River, Alaska 99577 ; •., %ief. SEPTIC SYSTEM
907.694.7028 *4 UPGRADE Dote:10/10/17 (Drown EipSE ISCale 1• = 5 ' rEET:3
of 3
SE
S❑ILS LOG - PERC❑LATI❑N TEST
NICR1-1--R I M Date Performed: 10/3/17
ENGINEERING
Performed For: Krystal
Legal Description: North Woods Phase 2 Block 2 Lot 9
DEPTH
(FEET)
T.H. Location: See Attached Test
Organic
1 - Boring Location Map
2 - p 0 SM Silty Sand
3 -
4 - °.
5 - .
W/
0
Gravel
6 - Groundwater? Seep-Bottom
7 - Depth --
8 - JQI Water Depth
9 - A
After Monitoring. 12' Date: 10/10/17
10 - # Date Gross Time Net Time Depth Net Drop
11 - O 1 10/3 0 -- 6' --
12 - 2 10/3 10 10 min. 5' 1'
13 - 3 10/3 20 -- 6' --
14 - 4 10/3 30 10 min, 5' 1"
15 - 5 10/3 30 -- 6' --
16 - 6 10/3 40 10 min. 5' 1'
17 - 7 10/3 40 -- 6' --
18 - 8 10/3 50 10 min. 5' 1'
19 - 9 10/3 50 -- 6' --
20 - 10 10/3 60 10 min. 5' 1'
21 - Percolation Rate 10 rein/in Perc Hole Diameter 6'
Test Run Between 3' & 4'
Comments:
Performed By NorthRim Fng, I CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: ///r-r7
00067,4444,44
P,.. North Woods Phase 2 TH2
NOR THRllvl 0;.
ENGINEERING * 4sm BLOCK 2 LETS 9
PO Box 770724 „ .
Eagle River, Alaska 99577 • ix . . T E S T H❑L E LOG
907.694.7028 r6• OT.
GE❑TECHNICAL Date:
10/10/17 I1
~'~' MUNICIPALITY OF ANCHORAGE
/~ ', DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONiVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE [~I~EW
MAILING ADDRESS
LEGAL DESCRIPTION
DISTANCE TO: ~:~ ,,. , ....~ ~ Absorption area Dwelling , PERMIT NO.
~E~ Manufacturer ~k--~"~"--'-- ' ~e~ Material~.. L__ No. of com~tments
Liq. capacity in gallons Inside length Width Liquid depth
~OZ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~O Z ~ Manufacturer Material Liquid capacity in gallons
ad.= DISTANCE TO: ~~.~ Foundation,~ Nearest lot+line/0 / PERMIT NO.
~ ~ ~ Length of each line V Total length of Ii.es Trench width Distance betwee~ lines
--N~Z Top of tile to finish grade% .~ ( Materiai beneath tile'~__ / '~,c,,~ Total effectiv~on area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
!?~ Driller Distance to lot line PERMIT NO.
~ : Building foundation Sewer line Septic tank Absorption area(s)
OTHER ~C ~b
PIPE MATERIALS
SOIL TEST RATING
INSTAELER~~ } (~
REMARKS ~ /
APPROVED DATE LEGAL
72-013 (Rev, 3/78)
........... 'Z'~' , ~'~"."-L.~ ' ...... ."~"~-~":
: .-~ ,
F:!F'F'I...ICF!Iq'I" F'FIT I.,!]:L.I'"IOTH ::;r4:.a Bo;,.,; ~:.:.;u :.:.:~95er;? ~)~"~....-"'
LOI,]:FIT l O!'.,!
LE:GFlL L.~[::2 fqOE4:THI,4OOD.S PHFISE I:[ ,¢-,?~,,.¢.., L. OT S";IZE :99'9'9'9'9 SL:.iUF:IRE FEE"~'
THE ':'tqF' F- ', ......... ~' ,- . .
LE_' =T. l E: Il'tEl ~:,.[Lt ,, I.:, THE LEt'-~G"FH ,:' ]:N FEET> OF 'TNE 'T'~;;:EI",ICN OF.: E:,~:FIINFIELD.~ I/
THE E:,EF'TH OF Fl TF.:ENCN OR [:'Il" I:E; THE [:,I:STFINCE EE'TI.4EEN THE '.E~ ~'FFlr:E OF THEE
GFi!OUI'.,!E:~ FqNE:, THEE E;OT'I'OI"I OF' THE ET,.'.,;CFIVFI'f'ION ,'.;IN FEET>.
'TNEF.:E I:B iqO :E;ET P.IIDTH F'Or4: TF.:ENCFIE::5.
THE GF.:FIVEL [>EF.'TH Z:5 "FI-IEE f"I. iN:[MLti',t DEF'TH OF' GF.:FI',,,'EL BE'Tb. IEEEN "I,'HE OL.tTFFIL. L PIPE
RNE:, THE BOTTOP~ OF:' THE EXCFIVFITION ,:::iN FEE'T::,.
PERM I'T' FIF:'F:'L t C:FINT HFlS; THE RESPONS i B I L. I'T'¥ TO I NF'ORM TH i.'5 .C"EPf~RTt"!ENT Dt..JR i N(3 'THE
IN:F.';TF!LL.R]"ION tN'E,F'ECTION"2; OF' FIN"¢ I.,.IELLS; FIE:'...~RCENT 'TO THIS PROPEf~T'¢ FIND '['HE
lqUi','tBEE: OF F4'.ESiIE:,ENCE~:'.- 'T'HR"F THE b. IELL I.,!.T. LI... S;ERVE.
............... 'T lt...,~ C.'.~ .:.' ;:;;:-:: .'::,, Z t'-,,ii S; F" IFil: C:: 'T ::ECi t'-,I '.'~S; IF--:tl F,:',:: E~ f,;.::.' E ~]..:.~ LII ::E: i:;: E: [:, .............
BRC:!<FILi._:I,NG OF' ANY S'¢:STEP! HI'T'HOUT FINAl... iN:'.SPECTION AND ,'aPF'RO',,,'FIL BY 'THIF~;
DEPFII-~:TP'!ENt" I,.iIL. L E;E :5UB..)'ECT 'TO PI:;;:OSECLITt]II'4.
P!iN].'MI..i!','! DISTRNCE BETI.,.tEEN Fl t.4ELL. RND RNY OI'.,I-$ITE 2~;EF.!FIGE r;,I..S';PO'=-;F:IL SYS'I"EN
::LOO FEET F'OIR Fl PR'I'¢RTE t.4EL. L OR ±50 TO 200 FEET FROP1 Fl PUBLIC 1.4ELL.
LIPON TFtE T"r'F'E OF PUBI._IC tqEL. L_
PI!N.T. P1UM [':'IL=;TFINCE F"'ROI"! R PRZVR'TE 14ELL 'T'O Fl P.[~:I'¢FI'!"E :E;EI.,.!.ER LINE I:'~ 2:5 FEET FIND
TO Fl C:Ot'qI"IUNITY SEI4EF.': LINE: IS ';:'5 FEET,
OTHER RE(..iUIREP'IENTS MFlY RPPL"/. SPECIF'IC:RTIO!",I% F:!t'.,ID CONS'T'RUC:TION DIRGRRf"l% FIRE
R"..,'FtIL. PaBLE TO INE;URE PF~:OF:'ER INSTRLLFITiON.
I CERTIFY 't"HFIT
±: ! FlH F:'F4t"!ILIF!R .klI'TH, THE RE(;!UtREP1ENT:~; FOR ON'"-."::iITE :SE!.qERS AND !-4ELL. S R:E; 2';ET
FOR'TH .E,"¢ THE I"IUNICIPRL. ITY OF FiNCHORRGE.
2: .T. kilL[.. IN~;TRLL. TNE :.~;YSTEFI I!",l F:ICCOR.D, FiNCE t.'.IITH THE CODE'-.:';.
3:: I UNDERS'T'R.~-,![:, 'T'HRT THE ON-SITE SEI.4ER SYF.';TEM PIi:~Y REg!UIRE ENLF¢:eGEPIENT IF:' THE
FIF'F'L. I CFlNT F'F~;Z [4 Z LP1OTH , ,~
~,;A ask:a 9957~
Russell Oyster Ear~ Ellis
694-2774 ~IL ,EO~(~~ 688-2280
Performed for: N ,a~, ~e~,, ',:, / ': :", ..... ' " '::'" '( "' ~/' '" "~;,( ( ;, ' ~, ,' j~ 7'; . '" Tel'.
Depths(feet).
7
8
Si)il :'CharacteriStios~-
11
15
16 "
PEOT PLAN}
PERC. TEST
GroundWater Encountered: ¥~a~- NO t/ If yes~ what'depth
Proposed. Installation: Seepa'ge~Pit:': Drain Field_.,'
Comments: '
Performed by: . - , - Date:
~ L
APPLI¢ HT FILS OUT UPPER HALf'ONLY
Property Owner ~J~ ~1~ t ~A ~ ~L'T/~ Phone
Mailing Address ~ ~)~ ~'~ 7~
Address ~1 J!¢4~! Zip Code
Lending Institution ~/~ .~ ~/~j~ Phooe
Address ]~ ~i .~ ~m ~
Address ~"'/;, ~/(, ~,! ~ ~,~ Zip Code
Legal Description J LO+ ~ y ~ ~ ~ ~f~O~ "~,]',
Type of Residence
,~ Single Family
[] Multiple Family No. of Bedrooms
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
,~_ Community For we}tls drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal ?
~ Individua~ Year Individual Installed:
[] Public Dtility When Gonnectod to Public Utility:
[] Holding
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
~UNICIPALITY OF ANCHORAGE
DFPT C'c HE'q.T'-i
S E P ~ ? 1§82
D "'" I~ I \/i: B
(.~) ,., m-
APPROVED
BEDROOMS
*CONDITIONS
OF
APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ~- ~ (3~- y
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
"~.~' ~ ~ ~ ~- ~<~"~,~ Well to Tank Septic Tank Size
72-023 (3182)
...... Building S~,t'ely Division '
On-Site Water and Wastewalet Program .,
' . ......'470b SdbJh J3r~gaw SL..-. ..
P.O. Box lg66~0 Anchorage, Ak ggstg-6$50
' WwW.~::i.anchorage.ak. Us
· (907) 34;J-7904
CERTIFICATE OF HEALTH AUTHORiTY'ApPRoVAL
'Parce o5 -8 -o9 HAA
GENERAL INFORMATION ':
Comple. lelegaldescrJptic~n hot 9i Block '2..'Nor~:h'~-o~d.~ ~/r).lJ-12 " ....
Location (.site, ad.cl~e, ss 0Fd!re.clio.ns) 223/,8 .,Shadowy. Sr, ruce,. Chi~'i. ak.:...AK . ..,,
Mailing address
Lending agency
Mailing address
Real Estat.e ~gent
Maili.ng Address· ,,
PO Box 100651, Anchorage, AK 99510-0651'
Day phone
Unless o~herwise requested, HA/[ will 'b~ ~I~1 by D~b fo~.pic'kup. . ~ ~
NUMBER OF BEDROOMS: 3 .... '
TYPE C~F ~ATEi~ s~PPLy:
Individual Well
Individual Waler Storage
Community Class.
Public Wa!er System
Well
TYPE OF WASTEWATER DISPO§AL: '
[] -Individual Holding tank []
[] Commu, niJy On-site []
[] Public Sewer []
The Municipality of Anchorage Development ~;eA, Ice~ DepartmeM (DSD) Issues Certificates or' Health Authority
Approval (HAA) based only upon Ihe representations given In paragraph 5 by an Independent proresslona c v
engineer registered In the State of Alaska. Certit'ica~es of Health Authority Approval are required for the |ransfer
title (except between spouses) for propedies s~rved by a single family on-site wastewaler disposal ahdlor water
supply system. DSD also issues HAAs IJpon request Io I'lomeowners. Certi~ca[es of Health AUthority Approval are
valid for 90 days from the date of Issue for properties seA, ed by a private or Class C well and may be reissued with
new wa[er sample results less than 30 days old. (Certificates may be reissued for a period of up lo one year with
valid water samples.) Certific~ll~s ar~ Valid roi' one year for propedies served by Class A or B wells or a ptJblic
water system. The Municipality o1' Anchorage Is not responsible for errors er omissions In the proressional
engineer's work.
S.TATEMENT OF INSPECTION BY ENGINEER
As certified by ~ny seal affixed hereto and as o~' th; valirJation date shown below, I verify Ihat my inves[igalion,
based on procedures outlined In lhe I-leal~] Aulhori~y Approval Guidelines for Ihis application, shows Ihat file
on-site water supply and/or wastowater disposal ~y§terfi Is(are) safe, functional end adequale for tho number of
bedrooms and lype of struck, e Indicated here~n. I fudher verify that based cn tho Information obtained fi'om Ihe
Municipality of Anchorage files and from my Investigation and lnspecllon, tho on-site water supply and/or
wastewater disposal system is(are) in compliance With all applicable Municipal and Stale codes, ordinances,
and regulations In effect at the t!me of Installa!ion.
NameofFl~mS &'S',gngineering' :
Address 17034 ~. Eagle River Loop
Engineer's Printed Name Robert C. Co.an
DSD SIGNATURE
~ Al~proved for ~ bedrooms.
Disappro~/ed.
Conditional approval for
EaRle
Phone 694-2979
R:iver, Ak 99577
Date 2/11/03
~'.-~... ,~. ,., ..' l..,.~. .,.~
...,7.. ¢...,' . ...'-,,.~:,:,~
· '." EUGINEERS; ~..~, J~
..: .-. ... ,..-..
,... .... . . ..... .: ....... .,.
.~,~, · ...... :..... ~
[~'~ I "~-,-.~., ".
'~2'"' ~-" 2~~'
bedrooms, with the following stipulalions:
Additional Comments
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
,/
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ -,..~...~"- 0 ~
· Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sita Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~F'q~' ~C)¢-~ Z] ,~7'~FU~Z~S ~/9 Parcel ID: ~5[ -~/-~
WELL DATA & ~ I ' ': :*" *'
Well type
Date compiled '
Total deP7
Date of :est
Static ater level
Well eduction
WATi: SAMPLE RESULTS:
Coliforr colonies/lO0 mi.
Amemc: mgJI.
If A, B, or C provide PW/~ID #.. ' Well L°g (Y~
Sanitary seal (Y/~ Wires propedy p~lbcted (Y/N)
ft. Cased to ._.~.ft. Casing height~.ove ground) in.
FROM WELL LOG / ATINsP~N ft
/ g.p.m.
g.p.m.
Nitr[te ~ mg./l.
Dat !of sample:
Other bacteria
colonies/100 mi.
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ~
Tank size J ID~30 gal. Number of Compadments
Foundation cleanout (Y/N) "// Depression over tank (Y/N)
Date of pumping ~-"t~¢~, Pumper.. ,-~ ~ '$
f !
C. ABSORPTION FIELD OATA
D.ate installed ~'Z,-Soi, rating (g.p.d./ft: °~) .~"~
Length ~ ft. Width "~ ff.
Total depth ~ ff. Eft. absorption araa~j~l ft~ Monitoring tube
Il
Date of adequacy test ~"1~[0'~ Results(Pass/Fail)
Fluid depth in absorption field- 'before test 4~ in. Water added,/O~a,.
Elapsed Time: I I ~"min. Final fluid depth ~,'~ in.
Any rejuvenation treatment (past 12 mo,) (YIN & type)
Date installed
Cleanouts (Y/N) ~7~
High water alarm (Y/N) /'J
Gravel below pipe ~ ft.
Depression over field.
For ~ bedrooms
Newdept
Absorption rate >= ~ g.p.d.
If yes. give date
D. LIFT STATION
Date installed ~in./~-
"Pump on" level at~__
/
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at~ in.
Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot //'
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /? f Property line ~'
Water main lC) ~,{--
Water service line
Wells on adjacent lots /J/,~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line { O t
4- Building foundation
Water Service line ~ O 14- Surface water ~
Curtain drain ~J~- J~',,,~O v,J ~Vells on adjacent lots __
On adjacent lots /
On adjacent lots //
Absorption field ~- If_
Surface water ./0
Water main
Driveway, parking/vehicle storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I ced/fy that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name~'~4);,~
Date
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
(12,' fl,h II;I 12:4~
I hereby certify that a eUrvey o{ th~ followln~ deqlcrlbed pro~erly
,"liMn the property Ilnoe and do'not overlap or encroach on 1%o property adjacent
' "harolo~lhal ~a.lmprovemenJs on property lying adjacent thereto encroach onlha
· ~rom~os In qua~llon'and that Jhire are no roadways~lren~mleelon Ilne~ or ether
,,hlblo oa~omonla on said properly ~xcep{ ai indicated h6reOn,
.;;,atari et Anchorage,Alaska, this ~.-~'
· '..ON'IflACTII'IG ENGINEEI~S /~ ASSOC.
;!1~. E. International Airport ,Road .
Anchoro~tn, Ala',kn 9950Z
I
I
:
SEAL
