HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 4 LT 4
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 PHO~' ~EW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~. DISTANCE TO= ~~
~ Material. No. of compartments
~ ~ Liq. capacity in gallons Inside length Width Liquid depth
/¢¢ O IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ( Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
~ ~ ~ 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
O inches
PERMIT NO.
Length z Width ~ Depth
~ ~ T~ Cdb =;cm~er C;';b =cpth Total effective absorption are~.
' ~ ~ Building f°undati°n Nearest lot ~O'
~ DISTANCE TO: ~
¢~ ~~ ~ ~ ~ Dri,ler Distance to lot line PERMIT NO.
~ - ~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
PIPE MATERIALS
"
REMARKS ~ '
'/1
72-0131 /78)
rqUN I C I ~..L I TV OF ttNCH~RAC~E
DEPARTMENT I. WEALTH AND ENVIRONMENTAL :OTECTION
825 "k'" :,TREET, HNL. HOR~SE., AK. 99501
mg~ .SITF SEb~ER F'E~:NIT
PERMIT NO. ( 820771 )
APPLICANT KOEHLER CONST
LOCATION
LEGAL L4B4 NORTHWOOD- ~&
PO BOX l¢9 CHUGIRK -.~
TYPE OF SOIL MB_,ORFTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS = -~ _,OIL RATING (SQ FT/BR>=
688-2125 ~
LOT SIZE 999999 SQUARE FEET
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
['-,EPT| I: -'I LFI'-,lf.~TI I-- --q- "), m3Ri:::~'-.,,'FL [)EPTH: 2
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET).
THE TRF)~CI I W IDTI I IS 5. EIO0 FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
8ND THE BOTTOM OF THE EXCAVATION (IN FEET).
RELn~I_i I RE[:, SEPT I C: TnNK S I ZE-- I 000 GALLONS
PERMIT APPLICANT HH_, THE RESPONSIBILITY TO INFORM THIS DEF'ARTMENT DURING THE
INSTALLATION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TL~O (Z---~-~ .'-~ I ~-~SPFCT I O~S 8RF RFL~U I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEP~RTMENT WILL BE _~UBJEuT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
t00 FEET FOR R PRIVATE WELL OR 150 TO 280 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.
PFRP11 T F~P I RFS [-',ECFMBER ___l-:i.~ i_ 8---
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 THE CODES.
~: I UNDERSTAND THRT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
~V4. 0
Russell Oyster
694-2774
Performed for:
ENG.,~IEERING & DEVELO~ MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
SOIL LOG 688-2280
Name: /
Depth (feet)
0
1
2__
3__
Soil Characteristics
6__
7__
8__
9__
PLOT PLAN
15__
16__
Ground Water Encountered:
Proposed Installation:
Comments:
Performed by:
Yes /~
Seepage Pit
No If yes, what depth
Drain Field
PERC. TEST
~¢ OF
Date:
MUNICIPALITY OF ANCHORAGE
)EPARTMENT OF HEALTH &
:, Division of Env ronmenta Servi~
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
~ - APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address?,0r directions) 25154 No,'c~Ju~ood~ D/~<~u¢
Chugiak~ AK
Property owner Dcbi Rob.P. Zn Day phone
Mailing address 25154 Northwood6 Drive Chugiak, AK "99567
688-0412 {h)
Lending agency So~nd Mort,qa,q¢ Day. phone
, ..... ' ..... Attn: M~k . :' '.. :., .:,;'
Mailing address
272-9994
Agent ' · - Day~h~ne
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 2
m
TYPE OF WATER SUPPLY: .
Individual well
NOTE:
4. TYPE OFWASTEWATER DISPOSAL:
Community well XY, X
Public water
f mmunit well s stem, rovide written confirmation from State~.D, EC attest-
I CO y Y P .... ·
in to the legahty and status of system, '.
'NOTE:
Holding tank
Public sewer
'~ :),.~"~ ~ i~ ~,~,i ? ;' ~;~.~'~,' ~ ~ ' '~ [ ~,;:~ :', ~,~:'~,~,~' ':~V~.~;.?~.~:
If community wastewal
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 I ~lldation date shown below, I verify that my
investigation of this Health AuthoritY"'~AP~i;°ValapPlic~ti°n shows that the on-site water supply
and/or wastewater disposal system is safe,~fu~tional and adequate for the nu tuber of bedrooms
and type of Structure indicated hereini/f~:~tii~'~rify that based on the information obtained from
the Municipality of Anchorage files~d' frb~my/nvestigati°n and inspection, the on-site water
supply and/or wastewater,disposal system isin compliance with all Municipal and State codes,
in effeCt On the date of this inspection.· ..~:. ~... ,.- ~ .~.~.~
;-. ordinances,.anc
Phone
Name of Fi
AddreSs' ~' "" :~' ~''~ ~17034 Eagle
Engineer's signature
bedrooms.
· ~ DHHS SIGNATURE
3proved
Disapproved.
Conditional approval for
bedrooms, with t'h'e following stipulations:
Additional Comments
"i~allty of Anchorage DePartmeii'C~)fHealth and Human Services (DHHS) issues Health Authority
ertificateS; ba~donlY';upon the?~i~6~b*r~'tatl0ns given;"ln' paragraph 5 above bY an independent
professio~Clna engineer registered in the State of Alaska. The DHHS does this as a courtesy to pumhasers of homes
· ' ' s n order to satisty certain federal and state requirements. ,Employees of DHHS do not
andtheirlendingln,st!t~t~o~ ....... ~,,.~.~ ..... ~. ........ "."'.-, *(;",,. .... ,, " .... Iai ',of Anchorage is not
"'~^..' ~ ' ' .... ~" "~'"tial ;e:~data 'beforea'certlf cate is, ~ssued, The Mum.c,, p ty
,,; ~. ,.,..duct, mspecflons.,or,,a YZ ' ,.,; ~, ,, .,.~,~,?, '-, ~:-,~-,'~o ,,,nrE -~.,i~,~ ~,:; '.'.:~ ~,;~;'~3'..? :'- '
~i!' responsible for errors o~;'omlssions In me pro~ess~ona~ e.cJ'--u=h. ..... ,'~? .... "' ' '
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~/~ ~::~/-'~ ~,~o~ ~ ~ Pamel 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
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N~J
g.p.m, g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ ~ ~
; On adjacent lots
Absorption field on lot "~F~ c> ; On adjacent lots
Public sewer main Public sewer manhole/~
Sewer service line Petroleu.~~
WATER SAMPLE ~
Coliform Nitrate Other bacteria
~ Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed c~ ~ ~ ~ ~
Cleanouts ~1) ~
High water alarm ('t~ ~
Date of pumping
Tank size ~ ~ c>q:;> Compartments
Foundation cleanout ~ ~ Depression (Y~
Alarm tested (Y/N)
/- ?~ Pumper .~-~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
/
Well(s) on lot ~ '~ ~ ~ On adjacent lots "J ~
To property line J ~ / ~ Absorption field /~ /
Surface water/drainage
Foundation
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer.
MOA electrical codes (Y/N)
Meets ~
SEPARATION DISTA
Welfon ~t~ On adjacent lots
Manhole/Access (Y/N)
"Pump off" Level at
Surface water
D. ABSORPTION FIELD DATA
Date installed c~ ~. i~ -~5 ~
Length ~ I Width
Total absorption area ]/~% ~
Date of adequacy test ~'- .? ? ~ ?.7
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/.~
Soil rating (GPD/Ft2)
~ ~ Gravel thickness
Cleanout present
ResultsJ~i~fail)
7_.~\ ~'- ~'/~--- System type
~, ~- ' Total depth
/ Depression over field (Y/~i~
for ~
After test ~
,j'~,l~ tz-,Jo~./~J If yes, give date
""fflO DISTA CE FROM ABSORPTIO~PIEL~IU: ._ ~ I" ~P
~ ~O~ ~ '~v'~~'~'~ " ~// Prope~line
Well on lot ~ ~ ~ ~ On adjace~ lots '~
To bui~ing foundation ~ ~ ~ To existing or abandon~ system on lot
On adjace~ lots ~ ~ ~ ~ Cutbank ~/~ Water mai~sewice line
Sufla~ water I bo ~ ~ Driveway, pa~in~vehicle storage area
Cu~ain drain ~ j~
Bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
Engineer's Name
a,e /
this inspection.
ROBERT C, cOWAN
CE - 8801
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93}* Back
Waiver ;Fee $
Date of Payment
Receipt Number
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
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 10t, block, subdivision, section, township, range)
Location (address or directions)
23134 Northwoods Drive
(b) Property oWner Jery and Roxey Estes
Mailing Address ~ ¢. /~¢-¢¢ /¢'¢¢
Telephone: (home)
Business
(C) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER -
Address 16600 Centerfield Drive, St~it~_ 201, Eagle
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/694-2979
99577
1703~ Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
TYPE OF RESIDENCE
S r~g e-Fam ly ~ Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community:t~ Public []
Note; If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality' ar~8 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
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A. WELL DATA
Well Classification
Well Log Present (Y/N)
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 Sample Collected by
Water Sample Test Results
Comments
MUNICIPALITY OF ANCHORAGE (MOA) ~
(~'~.~J~UNtC pALIHe~llfl~'~i:~y Approval (NAA)
~,~IP, O NM~,Ni~ I~I~¢IIG..~I ~I'1~ I~B R U A R Y 1984
343-4744
APR 6 1990
_ Legal D. escription:
RECEIVED
Date Completed
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (WN)
If A, B, C, D.E.C. Approved (Y/N)
Yield
"Z-'~'~'~ J~- ; On Adjoining Lots
"~-~c~'~ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed '~/['~/~Z-~ Size
Standpipes ~Z~'N) ~ Air-tight Caps<(~/N)
Depresslor over Tank ~
Pumping/Maintenance Contact on File (Y/N~/~
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~ ~ ~ To Building Foundation
To Property Line \°t ~ To Disposal Field
To .,Water Main/Service Line \ ~ Jr"'
To Stream, Pond, Lake or Major Drainage Course
Comments '~'?'~ ~-~-~'~:~:)~.-- "~,~-'-~'~..
No. of Corn partments "-2_
Foundation Cleanout t'~
Dante Last Pu m ped z3c -- ~'
r.A/~..._ ; for -- '
Temporary Holding Tank Permit (Y/N)
72-026 IRev. 7/86, Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/.~ /.
Type of System Design
Length of Field ~'~D'~'
Depth of Field C~t
Gravel Bed Thickness ~ ~
Statndpipes PresentdCC,/N)
Date of Last Adequacy Test
Results of Last Adequacy Test ~,/~'7'"1E~ ~-~
/
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots "'~'~c~
To Cutback (if present) /"~/~
--
D. LIFT STATION
Date In"~
,S, ize in Gallons-"~
Pump On" Level
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ _~....~mping Cycles during Adequacy Test.
Company 170~4 Eagle River Loop Road No.
**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 this
inspection.
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
Eagle River, Alask,a g,~577
Date
MOA No. (~-~_~-'
Receipt No,
Date of Payment /-"/~' ~ ~ ~'~(-~
Amount: $ /
72-026 (Rev. 7/88) Back
April 25, 1990
ROBERT SHAFER, P.E.
ROGER SHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
Ms. Susan Oswalt
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 4; Block 4; North Woods Subdivision #2
Dear Susan,
Reference our telephone conversation of this date concerning the
referenced property.
A deck has been constructed on the back of the house which makes it
impractical to install a cleanout within 4 fe~t of the foundation. The
total distance between the foundation wall and the entrance to the tank
is approximately 10 feet. A cleanout located within the crawl space
provides a reasonable access for routing the discharge line between the
house and septic tank. Therefore, it is our opinion that in this
particular case, to r~move the deck to install a cleanout is not
warranted.
Due to the topography in this area (sloping sidehill) it is reasonable
to assume a high ground water would not be present to affect the
absorption bed. If the absorption bed was to become over saturated
surfacing of the effluent on the lower sidehill wou~d be evident. This
is not the case. It may be that the construction of the Eklutna water
line along the adjacent property to the east may have provided a
conduit that drains goundwat~r from alongside the buried water line.
In any event there is insufficient evidence of a high groundwater in
this particular area to warrant the cost of installing a monitoring
tube specifically for groundwater monitoring.
Request you issue the attached Health Authority Approval (HAA) as
originally requested.
If you require additional information please contact me.
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR 2 6 1990
RECEIVED
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHOr%GE, ALASKA 99503
April 4, 1990
STEVE COWPER, GOVERNOR
563-6775
FOR: S & S ENGINEERING
Attn: Roger
PWSID: 9213001
According to the records on file in this office, the Chuqiak
Utility Northwoods Deer Horn Subdivision Water System is in
compliance with the State of Alaska Drinking Water Regulations.
Sincerely,
Richard Sundet
Environmental Field Officer
RS:bas
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE ~
Department of Health & Human Services ;
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY AP~PROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 4; Block 4; Northwoods Subdivision #2
Location (address or directions)
(b) Property owner AHF¢ #42785
Mailing Address
Telephone: (home)
Business
(c)
Lending Institution
Mailing Address
Telephone
(d)
(e)
Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Eva Lokcn
Address 16600 Ccnterfield Drive. Suite 201. Eagle Riv~r~ Alaska ~99577
Telephone 694-4200 ' '
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 ENC, INEERINC,/~94-2979
17034 Eag.~a R.iv~n Lnop RcJad:
Eag£a R.iuan: A£a~,~a 99577
2. TYPE OF RESIDENCE
Single-Family)i~ Number of bedrooms
3. WATER SUPPLY
Individual Well []
Community [] Public []
Note: If community well system, must have written confirmation from the State Depaff~ment of Environmental
'conservation attesting to th legality and status.
4. sEWAGE DISPOSAL
On-site,[[ 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 (Rev. 7/88) 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,
functiona 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 __ Telephone '~"~Y'"~
Address 17034 Eagle RI.vet Loop Road No_,
Eegle River, AlasKa
Date
6. DHHS APPROVAL
Approved for ,.~ bedrooms by
Approved ~,/~ Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back Page 2 of 2
' MUNICIP,~LII"¢,. OF ANCHOi~AGE/,~-~,~
R EC E D
A. WELL DATA
Well Ol~ifio~io~
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) __
Total Depth Cased to
Sta~[ic 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 Sample Collected by
Water Sample Test Results
Comments
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
' ; On Adjoining Lots
; On Adjoining Lots
T° Nearest Public Sewer Cleanout/Manhole
; Date
Date Installed ~//2/~ ~- Size /,/~(..,3 No. of Compartments
Standpipe (~N) Air-tight CaPs~N) Foundation Cleanout (/~
Depression over Tank (Y(~ Date Last Pumped /~--~
Pumping/Maintenance Contact on File (Y/N) , ,/'-').///") ,'for
Holding Tank High-Water Alarm (Y/N) /~'J//~ Temporary Holding Tank Permit
SEPARATION DISTANCES FROM SEPTIC/~ TANK:
To. Water-Supply Well ;~. ¢_~20 ~'./L.
To Property Line jC~ ~.7~,
To Water Main/Service Line ~ .~ /-¢'
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation ' /O
To Disposal Field ./' ¢ /
Comments
72-026 (Rev. 7/88} Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field/ --
Square Feet of Absortion Area
Depression over Field (Y(N~
Results (~f Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Presen (~N)
Date of Last Adequacy Test
¢
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~ ~ (
To Building Foundation ~-~_ ~
Lot /AP L~ ~/~' ; On Adjoining Lots
To Water Main/Service Line -~ ~- ~' To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /'-P ~'~ r/'-r
To Driveway, Parking Area, or Vehicle Storage Area ~,~--O (-/-
To Property Line /~ t~
To Existing or Abandoned System on
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
/' /~Vlanhole/Access (Y/N)
/ ?A~Bump Off" Level at.
/ /~ Vent(Y/N)
Pumping Cycles during Adequacy Test.
**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
inspection.
Signed
$ & S ENGINEERING
Company ~ =-~'- ~,; .... ~ ,,-,- "---' -. --- ·
Eagle River, Alaska 99577
Date /
MOA No.C '
Receipt NO. O ~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
)f this
/-¢c// Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. OF ENVIRON MENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE /
3601 C STREET, SUITE 316
/
ANCHORAGE, ALASKA 99503 '~
563,6'
DATE:
January 26, 1989
PWSID: 21300].
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 OffJrcer · .:
Drinking Water Progr~m.i~ii~'
APPLIC ' /T FILLS OUT UPPER HAI. ONLY
Prope~y Owner '~'t~(J~'~i~ % ~ ~o(~.~'~ Phone
Realty Co. & A~nt t~.~/~~ Phone
Address Zip Code
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~ ~.
~ Other
Water Supply
~ Individual . A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975,
'~ Community For wells drilled prior to that date, give well depth (attach Icg if available),
~ Public Utility
Sewer Disposal
.~ Individual Year Individual Installed:
~ Public ~ility 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
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
~UNICIPALITY OF ANCHO~,AG[~
ENViROt,IM,_-t,; A ..... O,ZCTION
~. ~PPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Boils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~ ~ Well to Tank Septic T~k Size
72,023
Anchor e
(907) 264-41iI
lON~ I(NOWLi,%
MA
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO FECTIC)N
August 15, 1983
Wadeen Schrader
3315 Fairbanks Street
Anchorage, Alaska 99503
Subject: Lot 4 Block 4 North Woods Subdivision 92
At the time your sewer system was installed a cleanout to the
seepage bed was not required. Since that time, we have required
a cleant to seepage beds.
Even though it is required noW, this department will not require
you to install a cleanout to your seepage bed because it was
installed prior to the most recent requirement.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
3315 Fairbanks Sfreef
Anchorage, Ak. 99503
Augusf 12, 1983
Hr. Roberf C. Praff, R.S., Associafe Specialisf
Deparfmenf of Healfh & Enviromenfal Profecfion
~unicipalify of Anchorage
Pouch 6-650
Anchorage, Ak. 99502-0650
RE: Leffer of July 7, 1983 - Lof 4, 3lock 4 Norfh Woods Subdivision ¢2
Dear Hr. Praff:
Wifh reference fo fhe above subjecf maffer, I am enclosing a copy of fhe
above menfioned leffer. To dale I have nor received a reply from you.
Please send your reply in fhe stamped-self addressed envelope I have
enclosed for your convenience. I would like fo get fhis cleared up before
fhe snow flies,
Thank you,
Wadeen Schrader
WSdim
Enc.
3315 Fairbanks Street
Anchorage,. Ak. 99503
July 7,_ 1983
Mr. Robert C. Pratt, R.S.,..Associate Specialist
Department of Healt~ & Enviromental Protection
Municipality of Anchorage
Pouch 6-650
Anchorage,. Ak. 99502-0650
Dear Mr. Pratt: RE: Lot 4 Block 4 North Woods Subdivision #2
With reference to our recent telephone conversatJ, en regarding
stand pipes on the subject property.
Originally when I talked with you,. I explained there were three
stand pipes on the property -'two.for the septic system and
one on the leaching field. Before the final inspection the
excavator accidently knocked over the pipe to the leaching
field and buried it.
On June 23rd, you told me in our telephone conversation that
the stand pi~e on the leaching field was not needed, even
though three pipes were originally installed,_ there ~nly need
be two. I asked you to confirm this in a letter because if
the house is sold it is best to have documentation from your
office that the system is in order with only the two pipes.
Upon receipt of your letter of June 30,i 1983 you say "At the
time of installation a cleanout was not required for the bed
portion of the system" This statement leads one to believe it
may be required now. If this is the case we want to correct
the problem. Will you please clarify this for me.
Thank you for your assistance with this situation.
Sincerely,_
Wadeen Schrader
WS/dim
