HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 2
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241116
Work Type: SepticTank Upgrade
Tax Code Number: 05173211000
Site Legal Address: NORTH WOODS UNIT 3 BLK 12 LT 2 G:1459
Site Mailing Address: 22849 GREEN GARDEN DR, Chugiak
Owner: HARTER LINDA JOYCE REVOCABLE
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
t>k�lmrtmeitt
6/6/2024
6/6/2025
48099
❑ 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
4
Received By:r r j¢ I 'n Date:
Issued By: Date: i
MUNICIPALITY OF ANCHORAGE
W I
Development Services Department -343-7904
Phone:907
On -Site Water & Wastewater Section Fax: 907-343-7997
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 05173211000
Property owner(s) HARTER LINDA
Mailing address 22849 GREEN GARDEN DR
Site address same
Day phone 688-4128
Legal description (Sub's., Block & Lot) NORTH WOODS UNIT 3 BLK 12 LT 2
Legal description (Township, Range & Section)
Lot Size 48,099 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
F-1
Initial ❑
Single Family (SF) El
(w/wo, AD U)
Septic Tank
El
Upgrade
Duplex (D)
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
El
Water Storage
FJ
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable MunicgW-QDdes.
(Signature of property owner or 5-0agent)
Permit/Rush Fees: Z Z_ 5;- Waiver Fees:
Date of Payment: 5 Z�/ ZDI, X
Receipt Number:
Permit No. ("') -S (0 __ y // / 0
Date of Payment:
Receipt Number:
Waiver No.
GAIDevelopment Services\Building Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc
SteveEng.com North Woods #3 B12 L2
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current septic tank has failed- the fields still function.
Replace septic tank w/ new diverter valve. This lot is over an acre and on public water .
No adverse impacts are expected from tank replacement. Easements are depicted on the
lot. The slope is negligible in the area of the septic system. No conflicts to neighbor
properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.
5 minimum between the tank and trench. 5 to property lines & 10 to house.
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2 nd 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. Manhole Riser required in 1 st tank compartment.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
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)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241116, Curtis Townsend, 06/06/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241116, Curtis Townsend, 06/06/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241116, Curtis Townsend, 06/06/24
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#Ij°��Uf•••••t4P�� It is the responsibility of the owner, to determine '
ssloNr+ the existence of any easements, covenants, or rie-!
EASEMh V CORD, OTT R THAN stricti'ons' whYch do not appear on'' th.e'recoi ded,sub_� ,
THOSE SHOWN ON THE RECORD division plat. Under no circumstances should any`
PLAT, ARE NOT SHOWN HEREON. data hereon be used for construction'or for 'estab-'
lishing boundary or fence lines.,
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LEQEN;D-' '
0-1 SVRMEY CE;RTI.0 C/�.TIQ -- do7 i oN PIPAL'p M014VMEN1"
1' STEI!L PIN
LOT 2 BLOCK 0 SURVEY MUS a TACK
Nc►F-x*,Vjo0eJsSlthdivisic►n !'ni- -_ •
ANCHORAGE RECORDING DISTRICT REVISIONS DATE BY
.�
PREPARED ey: DOWLING -& •.A'$SOCIATES' ' i; ,Raside"
nee
' 04 EA9,r '1l5th Ave Sidle i'2
ANCHORAGE, ALASK*A 0 '9950'11
RIND' .
aaT ,irJ r,,7 ' �Y. �cn „� 4 , W. '- C o1Z� @. ' i NI1 � 5�
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name ~ DISTANCES
×~dre,, TANK FIELD WELL
Phone(s) Permit NOT of Bedrooms WELL f'.,~.~,~ ~
J J Subdivision
Lot ~ Bloc~ ~ ~o ~ ~4~ oo~ ~ ~ FOUNDATION ~ /
AS-BUIlT DIAGRAM (Bhow location of well, sepbc system, propeNy lin~s, loundation,
TANKS
~ SEPTIC~,~ ~ HOLDING/__15
Manufacturer Capacity in gallons
Material No. of Compadments
Depth to pipe bottom from Total depth from original grade / /'
Fill .dded above original gr.de GCave, de.th beneath pi.e / / ~' /Z/
Tot., .bsorption .rea Di.,.nce be,ween lines / ~ ~ ,.~
Pipe material ~ ~
Number of lines ~ Soil rating
~ PRIVATE ~ ~ OTHER Ildentifv)
/
classification (A,B,C)' f Total DepLh MUI ~lCffALIT ( OF AN, :HO ~A~.
J Cased to
REMARKS:
Date: Eagle River, AK 9957'
I ~ ceflily that this inspe~iofl was pedormed according lo all
Municipal a,d Stale ,,i,,lines in elfecl on IMs dale: ~/~
Health DepaAmenl Approwl' Date;
72-013 (3/85)
F:'e? P tn ~ 't. I\tc.tml::~ 6? r' '~ 880 :t 8C)
Up g p ad e
E.r'~g i ne.'.er' Des :}. ctr"Jec.~
Owner ,,.h~.~m=:,, DAV:[D KEL..I...Y
EA=4..E. RIVIER~ AK
99577
D ~'~ V F'h 01] E' Il
6~::IEF'" 4...:, 7 ....
F:'arcel Id: 051-73',?,-11
Lot L. egal: Subdivisiort: NORTH WOODS ~5 Lot: ~
Sect:J. on: 4 Township: 15N Range~ 1W
Lc::rL Size 49000 (sq. Ft, or acres)
B ]. ac: I-:: ,~ 12
SEPTIC "l"Al~ll-:::iJ M:i. nimum 'Lotal sept:Lc tank capacity". .1.,,:::,~. (~la]].ons. !ii:ach septic
rani..', mu, s{ have at least 2 campar'Lments. Depth to tc.)p i:~J' sept:Lc {ankCs)
Feet requires insula{:i, on c',~ver tank(s).
I:::'EI:R ENG]:NEERS I)ESIGN~ WIDE DRAIN FIELD .... LENG'TH: 2 ~g '7:]:'~
WiD"I"H:~ 5'; GRAVEL. DIEP'T'H: :I.'; TOq"AL DEF"I"H: :3' .
NO'TIF'Y DF'IHS PRIOR TO lEACH INSF:'ECTION. THIS F:'ERMIT EXPIRES :1.2/31
OF :l. 988,, THIS IS AN EtqL. ARGEMENT F:'I::IOM :3 'T'O 4 BEDROOMS, I:::'F/OVIDE
RESERVE AREA WI'TH AS-BUIL. T.
I CERTIF'Y THAT:
I,, I am Fam:J.l:l,.=ffr with 'Lhe requirements For c)n.....site sewers and wells as set.
[c,r"Lh by the Municipal~.ty i:::,f Anchor'age (MOA) and the S{ate of' Alaska.
2. I w:i.].l install the sy~;tem in accapdance ~gi{h all MOA codes and regLlla'L:i.c)ns,
and :i.n complianc:e ~,~i'l:.h the des:Lgn criter:La oF this permit,,
3,. I w:i. ll adhere t.o ali. MOA and State (::~f' Alaska r'equiremerrLs For' the set back
al:is'Lane:es f'r'om any exis'l:.:i, ng well, was'Lewater disposal, system (::,r' publ:[c
~F;H,~H¢~e?i"agE.) !~y!B~.,erA 01"1 'Lh:i.S or any ad.jac::ent or nearby lot,,
.q.. I unct6~Land 'l:.hat 'Lhis [:)er'mit is va].:i.d For a maximLJ, m of' 4 bedroc:~ms,, I
also L~(::lerstand 'Lha~. the capacity oF {he to{al system :i.s 4 bedraoms arid
an v' e,"F~emen t ~, ,/l~clu :i. ," e an add i { ,. ona 1 ,:, er, mi 'L., ·
(Own~i') DAVID KEL. L..Y
/
/
/
/
/
/
/
~LDPE~ LOT 3
* 30'
~EPTIC
DRAINFIEL~
73' EACH - 5' WI~E #1
GRAVEL - 1~50 O
EASEMENT
£XISTIN~ LEACH FIEL
NEW LEACH FIELD
CLEANnUT -
SCALE, 1' =
~/ELL AND SEPTIC SITE PLAN
_EGAL: LDT 2, BLK 12, NDRTHWDDDS ~ 3
[]WNER:MR, DAVID KELLEY
CDNTRACTr]R, RASHUSSEN
6EAGLE RIVER ENGINEERING SERVICES
PD BX 773294
EAGLE RIVER, AK. 99577
94-5195
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 4, BLOOK i2, NORTHWOODS ~5
A#
GENERAL
1. The well and septic plan are for'a single family residence only,
2. The drawing and or site plan shall be a part of this specification.
5. All materials and workmanship shall meet the Anchorage Department of'
Health and State Department Of Environmental Conservation require-
ments.
4. All soil tests~ are advisory to the design and are to be verified or
modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified oF
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental OonseFvation requirements.
6. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
DRAINFIELD
1. The drainfield
2.
5.
4.
5.
6.
7.
8.
is to follow the natural land contour to maintain
uniform total depth of the trench bottom.
The bottom of the drainfield shall be level, plus or minus 1.5".
The total depth of the drainfield excavation is not to exceed 5' at
any point.
The sewer line is to be connected into the existing leach line to
allow effluent switching between existing and the upgrade leachfield.
The drainfield gravel is to be covered with typar or fabric material.
Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the drainfield.
The area over the drainfield is to be finish graded to prevent ponding
of surface water runoff.
The septic tank and ieachfieid must not be cioser than lO0' to any
existing private well, 150' to any Class "C" well, or 200 feet to any
community well.
REOOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH = 5' GRAVEL DEPTH =
DRAINFIELD LENGTH = 146' Total DRAINFIELD WIDTH = 5'
Soil Rating = 209 - (Avg.) ¢~ ¢
Bedroom Oapaoity= 4
Septic Tank Size = 1250 existing
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: O~ ~/~ ~ //~'~_~f DATE PERFORMED: ~/'~/¢~¢~
LEGAL DESCRIPTION: ~--~/' /~/ /'~//'f' /"~' /L/~,~r~'.L. c4.~ooc~/~- :;~=~ ~"/~"/~f /'~lt~
SLOPE SITE PLAN
1
WAS
- ENC~
IF Y
DEP'
_ ~ OF A~, R
Lou~s A. ~utera : ~
PER,
4
5
7
8
9
10
ROUND WATER
11 INTERED?
12 ;, AT WHAT
13
S
L
O
Gross Net Depth to Net
Reading Date Time Time Water Drop
£~,~ , ,
/ ~/~ ~: ~-/. ,.~.~ ~x ;~ ~;' ,%.
~ ,~,',//,"
3 ~ .'~7 /~ ~,~ /
14
15
16
.17
18-
19-
ATION RATE
· TEST RUN BETWEEN ~ FT AND ~"-~' . FT ;
COMMENTS
Eagle River Engineering Services CERTIFIED BY: J~'- :
PERFORMED BY: ~', ~; ~X 7732~,~
Eagle River, AK 99577
69~-5195
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
DATE PERFORMED: ~/~ ~/~C
SITE PLAN
//3
1
3
4
5
6
7
8
9
10
11
12
13
ENCOUNTE
IF YES, AT
DEPTH?
PERCOLAT
WATER
ED?
tHAT
14
Gross Net Depth to Net
Reading Date Time Time Water Drop
15
16-
.17 -
18-
19
20
RATE ~0 . minutes/inch) ~-~
TEST RUN BETWEEN /-//- FT AND zzz ~ FT
COMMENTS
PERFORMED BY: ~..,~ ~ ......
P. 0. Box 773294
Eagle River, AK 99577
;il I
'"~ NIUNICIPALITY OF ANCHORAGE I'~ON ST
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONNIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
~'~ ~ ~-~3J [] UPGRADE
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
S, Pc
! Well Absorption area
~ ~ Manufacturer
~ Liq capac ty n ga ons~ Inside length
' I OOO ] IF HOMEMADE:
~ ~ Manufacturer '
~ I I Well ~ Foundation
~= I DISTANCE TO:
~ Z No, of lines ~ Length of each line Total lengt~f ]i~es
~ ~ Top of tile to finish grade ~ ~ ~ ~ Material beneath tile
I Length Width Depth
I
~ ~ I Type of crib Crib diameter Crib depth
~~ ~ DISTANCE TO:
ICJass Depth Driller
~ ~ ~uilding foundation Sewer line
DISTANCE
I
TO
Dwelling
Width
Material
Nearest lot line
I Tren h, : t
inches
inches
Total effective absorption area
PERMIT NO.
No. of com~]_~ments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. ~
Distance betw~
Total e f f~e ~,b~,r p,~Fe'~
PERMIt_NO. ~
Nearest lot line
Distance to lot line
PERMIT NO.
Absorpt on area(s)
Septic tank
OTHER
PIPE MATERIALS
p xtc..
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED
DATE LEGAL
72-013 (Rev. 3/78)
Permit
Applicant:
Location:
Legal Description:
Type of Soil Absorption System Is:
:11 I
~MUNICIPALITY 0F ANCHORAGE
Departmental Health and Environmenta~-~,rotection
825 ~ ~ Street, ~chorage, AK. .2501 ~
264-4720
~ Mailing Address: ...
Phone Nu~er:
Lot Size:
Trench: ~ Drainfield: Seepage Bed: ,~ Holding Tank:
Maximum Number of Bedrooms' ~ Soil Rating(sq.ft/br) !
· · ....
The Required Size of the Soil Absorption Syste~Is-' ~~. ~.~
The length dimension is the length(in feet) of th~ trench or dra~nf~eld. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = /ODd~ 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 departmen~
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
~ ~ ~ PERMIT EXPIRES DECEMBER 31, 1 9 8 3 ~ ~ ~
I certify that:
(!) 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 that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.~
Appl~ca~ ~ ' Date: ~ ~ ~/~
SWP/024(1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
JJ J
11-
12-
13-
17-
18-
20-
IF YES, AT WHAT
DEPTH?
COMMENTS
SLOPE SITE PLAN
Lg
Gross Net Depth to Net
Reading Date Time Time Water Drop
3 q:~ /O~. ,16
~ N~o q/fro . ~ o
TEST RUN BETWEEN
CERTIFIED BY:
ALASKA eP~RO~menTAL CONTROL SeRL'-% lng.
~line~mc~ ~, J~nuironm~ntaJ Studits
PERCOLATION TEST DATA SHEET
z~, CO~E qq~
LEaL LOCATION ~%(~~ ~~ ~
TOTAL DEPTH OF 110LE_ ~ ft.
ZONE TESTED ~ ft TO 4/
TH ~
: ~q~
ft
TEST HOLE DIAMETER ~)p
READING t~ CLOCK TIME ltET TIME DEPTH TO NET DROP RATE (min/in)
DATUM
414z0 -~:o0 '-
FINAL PERCOLATION RATE
~ ~g /'/ SQUARE FOOT/BEDROOM
4/°5 (min/in)
MOA ST83-O2Z~
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING ~'~' '~
Complete ega 'de$¢nptmn
5. STATEMENT,. OF INSPECTION .BZ~ENGINEER.~,,,,.*,,,.-,;,.,,~>,x~ ......... p~,.~-~.~..~..~.~ ~
As ce~ified by my seal aff~xed hereto and as of the vahdat~on date shown below; I ven~
invosti~ation of this ~oalth ~uthori~ ~p~[~al application ~hows that tho
and/or wastowator disposal ~yst~m i, ,afo, Junctional and adoquato [or th~ num~or of ~rooms
and ~po of structure indicatod h~r~i~"l fu~hor v~ri~ that basod on tho information o~tainod from
the Municipali~ of Anchorage ..... files and fr0m_ : ~ my.~ .-investigati°n and ins~tion, the on-site water
supply and/or wastewater disposal SYstem is in corn pliance with all Municipal and State co~es,
ordinanco~, and 'm~ulation~ in o~oct on tho dato of thi~ in~poction.
Name of ~' :;~',-- Phone
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanit ~a"~'~al (Y/N)
~.~ m'~w ~ wT~--' Parcel I.D.
If A, B, or C, attach ADEC, le er
D I Driller
._..------'--'-'~--'-"~' Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow ._._--.------- g.p.m.
SEPARATION DISTANCES FROM WELL TO:
ATINSPECTION
.g.p.m.
Septic/holding tank on lot
Absorption field on lot
Public sewer main
,~ ~O -/",~'~z. ; On adjacent lots
,~o~ ~-/~-,,z. ; On .~d, iacent lots .._..--
.~-~~ ~e'/w~r ~e anout
Se~e
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date ....... ~,,~.
Nitrate Other bacteria
'- ~/C~olle~ted by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~"~'f &? / ~' Tank size /,~5"~ ~".~z_
Cleanouts (Y/N) ~'
High water alarm (~/N)
Date of pUmping ~- - ,~_c[ ~;
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
Compa~ments ,~,
Foundation cleanout (Y/N) ~' Depression (Y/N)
/L,//'.~ Alarm tested (Y/N)
PumPer'~ ~'R~,'~ ~'
On adjacent lots "u/,/~ Foundation
Absorption field .~-"l.,zr"~. Water main/service line
72-026 (3/g~). Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Vent (Y/N). "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARA~oN TO:
Well Oh3rot On adjacent lots
D. ABSORPTION FIELD DATA
Manhole/Access (Y/N)...
.Surface water
Date installed ~"~'- ~ /~'~ Soil rating (GPD/FF) ~'77__.
Length ~,,~-/, Width ..5'",,~'/, Gravel thickness
Total absorption area ~'O Cleanout present (Y/N)
Date of adequacy test. ,-/~-~ 7' ,~ ? / ~p'- Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N) ..
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,4.///,~/ On adjacent lots
To building foundation
On adjacent lots
Surface water ....
Curtain drain
System type/--/-~/~',~
Total depth
,Y/ Depression over field (Y/N) . /L/
~.r'..~- for ~ Bedrooms
After test ///'~ ,,~j.
If yes, give date
Property line..
To existing or abandoned system on lot
Cutbank. ~,_,/,~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I ce~'fy that I have checked, verified, or conformed to al~ MOA and HAA,
Engineer's Name ..-~'~-';'~--~ -'-~,~,z.~-v'
Date "7/~:~//~'' ~ '~
Date of Payment.
Receipt Number_
72-026 (3/93) ° Back
Waiver Fee $
Date of Payment
Receipt Number
HUSTON.XLS
Douglas T. Kenley
Civil Engineer
State of Alaska C.E. 8176
SEPTIC SYSTEM ADEQUACY TEST
Legal Description
Applicant
Date of Test
SYSTEM DATA
Tank Volume
Number of Bedrooms
Absorption system
Number of Bedrooms
Absorption required (1.5 daily flow)
4
TEST DATA
TIME FLOW VOL. TANK LEVEL,~'~,~w TUBE LEVEL , COMMENTS
(gpm) (gals)
System Passed ~-~ Sysytem Failed
, APPLI( I, T FILLS OUT UPPER HAL/- ,ONLY
Phone
Propert¥~ Dy/nCr T & D Const~ltction
Mailing Address Palmer Alask~ Zip Code 99645 745--2731
Buyer
Dave and Gene Kelly
Address ..... Zip Code
Lending Institution '" Phone
Address Zip Code
Realty Co. & Agent Phone
Toeem Realty,Inc. - William Schlege!
Address 724 R. 15th Avenue Amchorage zip Code 99501 272--0571
Legal Description
Lot: J~Blk 12 Norl:h~e~ds
Subdtvitlion
Street Locatio~ ~a.~'l~hs'l:'l Street
Type. of Residence
[~ Single Family
[] Multiple Family No. of Bedrooms 4
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A wetl log is required for all wells drilled since June 1975.
[] Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal 1983
[~ Individual 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 \ z'--~
Inspector Inspector Inspector Inspector
MUNICIPALITY (Jr ^r,iCHORAG~
Field Notes'~-~ ~ ~~ DEPT. OF HEALTH &
ENVIRONMENTAL PROTECflON
RECEIVED
(~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CON DITIONALzAPPROVAL *
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~
ALASKA ENVIRONMENTAL
CONTROL SERVICE~,,INC.
1200 West 33rd Avenu~ ~uite B
ANCHORAGE. ALASKA 99503
Phone 276-1361
CHECKED BY DATE
SCALE
nchor e
P O !'~"~,-I 6-650
ANOr-IORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWL['{S,
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
September 28, 1983
T & D Construction
Box 2524
Palmer, Alaska 99645
Subject: Lot 2, Block 12, Northwoods Subdivision III
Gentlemen:
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
o The application shows the number of bedrooms exceeds the
~.~ number the on-site sewer system was originally designed
for. An upgrade will be required. Prior to any upgrade, a
permit needs to be issued from this dep~rtm~nt.~. · J ~ ~'/~//~¢~/ /~j_~ ~./
The standpipe to the sewe¢ system need caps on them.
o Since heavy equipment have been operating over the tank and
¢¢~ its insulation damaged, its integrity must be recertified
by the inspecting engineering firm.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
CW49/ej/E2
,4'
Cory Willis, R.S.
Acting Sewer & Water
Program Manager
