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Home My WebLink AboutNORTH WOODS PHASE 2 BLK 3 LT 3 '~"~ 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 PHON~ ~NEW MAI LING ADDRESS '~// LEGAL DESCRIPTION / · LOCATION NO, OF BEDROOMS ~- 2~ Manufacturer Material No. of compartmonts u~ I- Liq, capacitv in gallons Inside length Width Liquid depth 6 v DISTANCE TO: Well Dwelling PERMIT NO, O Z ~ Manufacturer Material Liquid capacitv in gallons 13 Well Foundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: ~ ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines -- inches ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ inches UJ Length ~.~ Width 3~"' Depth ~(~f PERMITNO.~ ~H'~ T.¥~"_ cf c~!b O~l~di~;~;er ~_ CrLb dcF~th Total effective absorption area (~uJ DISTANCE TO: I~~.~ Building...//"/'!f°undati°n Nearest lot line //~ t _~ Class~ ~'~ ~.~Depth Driller Distance to lot line PERMIT NO, LU Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~ ~t~ SOIL TEST RATING INSTALLER REMARKS / / APPROVED DATE LEGAL 72-013 (Rev. 3~78) ..~, DEFARTMENT ( XHEALTH AND ENVIRONMENTAL . 9TECTION ~/~.~, ~" 825 ~L' STREET, ANCHORAGE, AK. 99501 ~.O~I--5ITF SE~FR PERMIT~.~ PERMIT NO. ( 820~0 > LOCATIoNAPPLICANT STEVEN SKAGGS PO BOX D CHUGIAK, AK 995~? LEGAL L~ B~ NORTHWOODS S/D PHASE. II LOT SIZE 999999 SQUARE FEE~ TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ~ SOIL RATING (SQ FT/BR)= 290 THE REQLIRED SIZE OF THE SOIL ABSORPTION SYSTEM [:,EF'TH= 8 LENGTH= 131 GRAVEL DEPTH= 4 THE LENGTH DIMENSION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R 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 OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. REL~LII~)ED SEPT ICz TRr4kJ S IZF ....... ~ 000 GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTV AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TLdO ~. 2 :) I r'ISPECT IONS ARE REnU I RED 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 i00 FEET FOR R PRIVATE WELL OR i50 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PER~'I I T E.'~P I RES DECEP1BER 31.- I CERTIFY THAT l: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. . · I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~' I UNDERSTAND THAT THE ON-SITE SEWER _z_,TEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE~MORE THAN ~ BEDROOMS. SIANED: ..... ~.~r~k ~ ,/'_ O & E ENG.,qEERING & DEVELO~ MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: .~'~'~1,/' -~--/~j' /--. ~/~;J~ ~ -~ ~'~'J,' T-/p-. Tel. Mailing Address: ~.- ~, ~X D / ~P~/~/~., ~/~. Legal Description: ~O~ ~ ~,~/~ ~ ~O~/V~ ~. /~/~ Depth (feet) Soil Characteristics 0 9__ 10__ 11__ 12 ' 13__ 14__ 15__ 16__ Ground Water Encountered: Yes /'~ No If yes, what depth jZ Proposed Installation: See. page Pit Drain Field i~omments: ~/~'~fi~/~//~ P(. PLOT PLAN PERC. TEST Performed by: O & E ENG:~., EERING & DEVELO;:-?dENT CO. Box 90, Davia St., Eagle River, Alaska 99577 694-2774 or 688-2280 Ru~,~ell Oyster 694-2774 Performed for: Legal Description: Earl Ellis SOIL LOG 688-2280 Name:. -'~7'~'''7//~:~:: iv/ Z ...... ,~/:)6-~ _~ (fJ~:~A,,',~7-. Tel, No ~f~-. 2ff3/ Depth (feet) /2';/'7' //? / $o1! Char,cterlatics 3 --- 12__ 13__ 14__ 15__ 16__ Ground Water Encountered: Yes_ /"':~ No_._.___ If yes, what depth Proposed Installation: Seepage Pit Drain Field. , Comments:_/( ).5' ,..~,,,~ .~ ~, ~- "-.:~' ~ ~) /~f /'~-4..~. Performed by: PLOT PLAN PERC. TEST Date: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) (b) Property owner A.H.?.C. Telephone: (home) Business Mailing Address #41598 (c) Lending Institution Mailing Address Telephone (d) RealEstate Company and Agent Lee Walker- Re/Max of Eagle River Address 16600 Centerfield Dr. #201, Eagle River, Alaska 99577 Telephone 694-4200, (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle RWer Loop Road No. 204 Eagle River, Alaska ~577' 2. TYPE OF RESIDENCE Single-Family r~ Number of bedrooms 3 3. WATER SUPPLY Individual Well [] Community~ Public[] P.W.S. ID.~ 213001 Note: If community well system, must have~written confirmation.from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site I'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 '~JOM s,Jeeu!Bue leuo!ssatoJd eql u! SUOlSSlLUO JO ~JOJJe JOJ elq!SuodsaJ 1OU S! aBeJoqouv Jo ~i!led!o!un~ aqi 'penss! s! eleoy!iJeo e eJojeq elep ez~leue Jo sUOilO~dsu! jonpuoo leu op SHHa jo sea,old,U3 'SlUeU~aJ!nbeJ elels pue leJepej u!elJeo ~Js!les ol Jap Jo u! suo!lnl!lSu! Bu!puel J!eql pue se~uoq jo sJeseqoJnd Ol ~salJnoo e se s!ql seep SHHO eq.L 'e)ISel¥ jo elels eql u! peJe~s!BaJ ~eamBue leUO!SSajo~d luapuedepu! ue ~q eAoqe ~ qde~Se~ed u! ua^!B suo!leluese~de~ eql uodn XlUO peseq peleo!jpeo le^oJddv ~lpoqln¥ q~leeH senss! (SHHQ) sao!^Jes ue~unH pue qlleeH jo luauul~edecI eBe~oqou¥ jo ~l!led!o!u nlAI eqJ. auoqdele£ b0?. -oN paoli doo'l .ze. Ilt ell~e~! ~:0z t ONIti:I:aNIONn S '~ S ssaJpp¥ W,,I?.I JO eWeN MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) o* '~?~¢HE,G.,,K~LIST - FEBRUARY 1984 A. WELL DATA nJ ~ *% :~ 4 Well Classification A Well Log Present (Y/N) Date Completed Total Depth Cased to __ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot. To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sam pie Collected Water Sam pie Test Results Comments ~3 ~'~_ ~ ~. Legal Description: ~ "~ '~;:)L.~d-, ~'~ Depth of Grouting IfA. B, C, D.E.C. Approved ~'N)~ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ l-,L' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manho|e ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~'~-i~l.- Size Standpipes ~:~7~ N ) ~' Depression over Tank (Y/~ Air-tight Capsd~N) Pumping/Maintenance Contact on File (y/N~..3/~ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-SuPply Well ,.?~ I Jr- To Property Line T° Water Main/Service Line No. of Corn partments "7' ~__.,~F_oun. dation Cleanout (Y~]i) __~ I~ate Last ~u~-mp--~d ~-----'~- '7...7.~ lA/~:'' ' ; for ' Temporary Holding Tank Permit (Y/N) To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation \ ~ To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 Square Feet of Absortion Area Depression over Field (Y~J~ Results of Last Adequacy Test C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '~-~'~,c~'c~4t~fl.~ Type of System Design Date Installed ~ \ - ~'Z-.--- Length of Field ~ Width of Field ~ ~' I Depth of Field ~/ Gravel Bed Thickness (.~,U / '~"~ ~' ~ Statndpipes Present ~TN) r-5 Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation LOt I'~ /~ To Water Main/Service Line \ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION Date Installed Pump On" High Water Alarm Level--at Tested for Meets MOA Electrical Codes (Y/N) Comments ~Pumping Cycles during Adequacy Test. Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of.tills inspection. ~- ............ .,.,: Signed Company 17034 Eagle Ri~ L~ Road No. 2~ ~ ~ ~ ..~ -~ Date MOA No. Receipt NO.05 '-~'~0(~ Date of Payment Amount: $ 72-026 (Rev, 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: January 26, 1989 PWSID: 213001 To Whom It May Concern: According to the records on file in this office, the CHUGIAK UTILITIES/NORTHWOODS Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental Field Officer Drinking Water Program ~"h~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (inctude lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~2,..-.~':. "~-,,~'~ Telephone: Home 8P¢'~'~¢l?ur~ Business Applicant Address '¢-~fL"3 [;~c¢. ~c~_ ~¢r,e,,C;~'~J ~ .~-~i~, ~(.~Ir~'Od~;.,~.'¢~, ,~-,l~.- Applicant is (check one): Lending Institution []; Owner/bu+tder,~; Buyer []; Other [] (explain); (d) Lending Institution ,/~J~ ~-~ Telephone Address ~.¢~,. ~ ~ ¢¢¢'Z~- (e) Real Estate Company and Agent ¢'J¢,~¢% (f) Address Telephone the HAA to the following address: 8 & ~ E~'IGINEEP~iN¢~ .8H15 TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms '~ Other 3. WATER SUPPLY Individual Well D Community [] Public attesting to the legality and status. 4:! sEWAGE DISPOSAL Note: If community well system, must have written confirmation from the State Department of Env ronmenta Conservation Onsite,~ Public [] Community [] Holding Tank [] - Note: If community well system, must have written confirmation from the State Department of Environmental Conservation' attesting to the legality and status, 72-025 [11/84) Page 1 of 2 - 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ';' 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 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 ¢~ ~ Telephone Approved f~ b;;Srooms by ~ Approved /~ Disapproved Conditional T~rms of Conditional,'A'~proval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or om~ssions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL {HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ - -: ~: ' -'- '-' ] Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If A, B, C. D.E.C. Approved~:)'N) Date Completed Yield Depth of Grouting }k..~ J Pump Set At /¢~nitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot '~=~::>~ 4- '/'" : On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~ 4- ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sam pie Collected by ; Date Water Sample Test Results Comments ~'.~--rt-~,,5~mc:~!~ '~, N,~J ,~. [~* '~ '~-t~ ~. /' B. SEPTIC/.L=IOL-EICNG' TANK DATA Date Installed ~'"~ Standpipesd~2'N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~-~ Separation Distances from Septic/N~ Tank: Size ~.~ ~ No. of Compartments Air-tight Caps~P/N) Foundation Cleanout (Y,~)~ Date Last Pumped ; for Temporary Holding Tank Permit (y/N) To Water-SUpply Well To Property Line To Water Main/Service Line Course To Building Foundation [ cJ¢ ! To Disposal Field I,~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA ~ ~.)/,.~ Soils Rating in Absorption Strata '2-'~'~' ~ I i2¢,¢I-~ Type of System Design Date Installed ~ ~ f~/"~ ' Length of Field Width of Field .'~%"' Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ['Z.~¢ ~¢¢¢' ...... Standpipes Present ~:YN) Depression over Field (Y/i~ Cate of Last Adequacy Test Results of Last Adequacy Test ,~-.;.~r~ ~,~.~r~,,~ ~.~ ' Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ ~- To Water Main/Service Line ~.,=,. t' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ~ '~' To. Cutbank (if present) .,~1/,,~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checl~ed, verified, or conformed to all MOA ~nd H/~A guidelines in effect on the date of this inspection. Signed ~"~ L~ I~GIEiF..~I~iI~ Date '~// Com~'~ ~IVE~ A~8~ ~9~ MOA No. OJ Receipt No. ' '_~*'~7¢5 Date of Payment Amount: $ 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL .~4EFFIELD, GOVERNOR Telephone: [~07) Address: 274-2533 DATE: PWS I.D.# TO Whom it May Concern: A~cording to records on file in this office the ~~ ~_~ '~ Water System is in compliance with the Sta~e Drinking Wager Regulations Sincerely, APPLIC-3~NT FILLS OUT UPPER HA'~'-~ 0NLy Phone Property~ Owner Address Buyer Zip Code Address Zip Code Lending Institution Address Realty Co. & Agent Address Legal Description Zip Code Zip Code Phone Street Location Family [] Multiple Family No. of Bedrooms ~ -- [] Other Water Supply [~ I_ndiv~..ij~at ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. (;;;[,.,~'~mmunity For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer D?D.~,oeal ~ L~--flTdividual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank 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: MUNICIPALITY OF ANCHORAGE ENVI~ .,;g'.'.!I.A. r :O E' :'i: ,,1 S E P 1 5 1082 RECEIVED ( '~_,.)~PPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APP-ROVAL* DATE I~ "c:~/~"- j~ 'i~.-~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received 4:~-- (~::' ( Well to Tank Septic Tank Size / (~0 f,5 72.023 (31P,2)