HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 12Onsite File North Woods Unit 3 Block 12 Lot 12 #051-732-21 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201447 PID Number: 051-732-21 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DOUGLAS & CYNTHIA HENIE ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 23137 GREEN GARDEN DRIVE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot NORTH WOODS UNIT 3 12 12 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface water 100'+ -- Material Number of compartments Lot Line 10'+ __ NA HDPE 2 Foundation *6,5'+ __ LIFT STATION Manufacturer Capacity Remarks Outside soil bearing prism. 3-br house 4-br syst. Gal. Alarm location Electrical installed by Installer QRS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CC/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection 1�' 11/3/20 2nd 1/6/2021 Location and description 3`d 4'h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional O .� • • • Approval: Date .i� TH '• •• •••• •••••••••• Septic System Approved - •.• Curtis Huffman •`:4- CE 20991•����� Date Q� � r°' (� c��1.2/2 �PROFESSO .� Note: this approval does not include well permit requirements. ���,����'�• /D-,, nr/nOH o\ PID: 051-732-21 PERMIT: OSP201447 X N x I x LOT 11 Ix -X-X-XJ UJ O O O O O O z A -C=27.0' B -C=17.5' A -D=29.1' B -D=19.5' A -E=30.9' B -E=21.4' Lo N EXISTING FIELD 12.0' SHED 25.4' DECK110 CF 131 CL4"1 j I 1 FCO 2' CANT FOUNDATION EXISTING 3BR HOUSE 5.0' CONC CONC PAVED 2'x7.5' D/W BW CANT APPROX. WATER c� LINE KEYBOX INSTALLED NEW 1250—GAL HDPE SEPTIC TANK WITH DCO. LOT 12 BLK 12 15' UTILITY ESMT N90 00'00"E 100.00' GREEN GARDEN DR ST MT-\ SCALE, 1' = 90 TANK OUTSIDE FOUNDATION'S SOIL BEARING PRISM SEPTIC SECTION SCALE, NTS NORTH WOODS UNIT 3, BLOCK 12, LOT 12 PREPARED FOR: DOUGLAS & CYNTHIA HENIE 23137 GREEN GARDEN DRIVE CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK®gmail.com SUPPORT@ SERVICES: OF AL,4lk � • �� r * 9TH DATE: 2/3/2021 rtis Huffman �x SURVEY: JLSr� CE 128991 DRAWN: FWCS 2/3/2021 SCALE: 1 " = 30' Pvsstol; ' , N90°00'00"E 119.46' x 30' —X—X—X—X I! 1 Ix x 3' REMAINDER OF 33' SECTION LINE ESMT xI ! X x 15' UTILITY ESMT —�-! � x In LOT 12 I o Y, BLK 12 X ( I N > 1 12.0' m e SEPTIC I SHED o ® (typ) o i ibi � O LOT 11 o > x ® I I25. MH x W 20.7' 0 DECK 2' CANT O Z —X—X—X� c� 20.7' o�- cv 20.7' X—'"'_XI---X ' O o o N EXISTING ! o 10 HOUSE o 06 z 5.0' 62.0' _ CONC CONC 2' CAN ! Z'x7.5' BW CANT PAVED ! D/W a __j KEYBOX 15' UTILITY ESMT N� 20 N90°00'00"E 100.00' R N GREEN GARDEN DR _ ANCHORAGE RECORDING DISTRICT, ALASKA w AS -BUILT OF: NORTH WOODS SUBDIVISION UNIT III LOT 12 BLOCK 12 PLAT 83-68 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, strictures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DAZE scAu E -MATE• FEB 4, 2021 1"=30' 20-077-2 DRANK BY: CHECKED BY GRID NUMBER: I BODK/PAGE: JLS I NW1459 { 210118 ���.. OF ' 49TH .:.. ... ..;. ..... .JOHN L. SCHULLER. �el LS -10408 0 fessionat mr ADL NDR���" v o r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax UNI IPAL1TY OF ANCHORAGE Ori-SWater & Wastewater Program PO 3n "966 0 4700 Ehnre Road Anchorage, Alaws 9961 MGM Phone: (907) 343-790A fax: (907) W-7997 hup•+fw►wr•+Yvfli.0r�ronms 0n#Site Wastewater DisPDsaI System Permit Permit Number: OSP201447 Work Type: SepticTinnk Upgrade Tex Cola NurnIyer: 051 73221 000 Site Legal Addr4ss- NORTH WOODS KNIT 3 BLL 12 LT 12 1459 Site MaiIing Address; 23137 GREEN GARDEN DFS, Chugiak Owner: HENCE DOUGLAS S & CYNTHIA G Design Engineer: FIRSTWATER CONSULTING This permit is for the construction of: EffectIve Date: Explra#lon Date: Lost Size in 5q Ft= Tota l Bed rooms: '10712020 1071242 1 22975 ❑ Disposal Field LSI Septic Tank Q Holding Tank D Privy ❑ Private Well Irl Vater Storage All construction shall be in accordance wftfi: 1. The attached approved design. 2. All requirements specified in An orage Municloal code Chapters 15-55 and 15-65 and the Stake of Alaska Wastewater Disposal Reg ulatipn:� (1 XC72) a nd Drin king Watie r Regulations (18AAC80) 3. ThC w &Azwotcr codc req uims inapec�on:s during the irnefialWtion. The engineer ahalI notrF the Develapment Services €department per AMC 1S.6 S. Provide notification by calling (907) 343-7904 (24R). 4. Fiom October 15 to April 1S. a subsurface soil absorption system under construo:ticn during Freezing weather shal I to either: a. Opened and Closed on the same day, or b. Covered, sealed, and heater to prevent Freezing Received By: Issued By; J�J-k= L 1 D127l2D20 Date; Dote: 10 7 961po Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-732-21 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) DOUGLAS & CYNTHIA HENIE Day phone 9072422670 Mailing address 23137 GREEN GARDEN DRIVE, CHUGIAK, AK 99567 Site address 23137 GREEN GARDEN DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS UNIT 3 B12, L12 Legal description (Township, Range & Section) Lot Size 22,975 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank El Upgrade FX1 (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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 Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: � I ( 7 5(CQ V I Ij - 11) Waiver Fees: Date of Payment: 10 ^ 2- - Z 0 Receipt Number: tom) 2W3 Permit No. n S Pa 01 y 149 Date of Payment: Receipt Number: Waiver No. GADevelopment ServicesOuilding Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com October 21, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: NORTH WOODS UNIT 3 BLOCK 12, LOT 12 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank 6’+ from foundation per the attached design to serve the existing 3-bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201447, Rebecca Carroll, 10/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201447, Rebecca Carroll, 10/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201447, Rebecca Carroll, 10/27/20 /~-~ 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 MAILING ADDRESS ~NEW [] UPGRADE LEGAL DESCRIPTION P T rs 6r= g area Dwelling DISTANCE TO: I Wel'~, Absorption Iu 'e"' 's'reeJ Inside length Liq, IF HOMEMADE: I Width Well Dwelling DISTANCE TO: Well DISTANCE TO: Length Df each line No. of,nes :E. Top of tile to finish grade Length Type of crib Width Crib diameter F°undati°n2 j~ ~t~' Tot"al I e n gt h~=~es .~.r' Material beneath tile Depth Crib depth Material INearestlotline~.~ 1~":~ Trench width ~ inches inches NO. OF BEDROOMS PERM IT N~. ~(~ y No. of compartments ~_~ Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines T ° t a I e f fec t i v~.~b s~;~P~° n .a~ R PERMIT NO. Well Building foundation DISTANCE TO: Class Depth Driller PERMIT NO. DISTANCE TO: Building foundation Sewer line Absorpt on area(s) ITotal effective absorption area Nearest lot line Bistance to lot line Septic tank OTHER PIPE MATERIALS SOIL TEST RATING iNSTALLER REMARKS APPROVED DATE LEGAL Zo'r 72-013 (Rev. 3/78) Permit Applicant: Location: Legal Description: /0~-' '~,~ ~/A Type of Soil Absorption System Is: Trench: /~ Drainfield : Maximum Number of Bedrooms: ~ Department~'~f Health and Environmentc~Protection 825 ~ Street, Anchorage, AK. 99501 264-4720 ~._ ~ ~_ f~¢~ Mailing Address: hon?/ u er : -~/ ~/ II/~]~/~; Lot Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) /~ The Required Size of the Soil Absorption System Is: DEPTH /~; I LENGTH ~' GRAVEL DEPTH ,S'--! WIDTH The length dimension is the length(in feet) of the trench or drainfield. 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 = /~b-~ 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 31~ 1 9 8 3 * . ~ 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 that the on-site sewer system may require enlargement if the residence is remodeled to include more tha/ ~be~ooms/. / /Q Signe~:~~- ~-'~' ~ ,~C~2k~'-~ Issued by:~_ ~ ~~~ ~ Date: ~/' ' ~"' --~ ~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A!aska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:,, 1 3 4 5 6- 7 8 g SLOPE DATE P E R FOR M E D: ,,~,f~ SITE PLAN I WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date t Gross ! Net Depth to Net Time Time Water Drop 10 11 12 13 14 15- 16 17 19, Russelt L. Oyster 20 - No.. 4286-E COMMENTS ~.->z; PERFORMED BY: 72-008 {6/79} PERCOLATION RATE (minutes/inch) TEST RUN ~ETWEEN .T ~ND -- FT CERTIFIED BY; ,~5 /~/, ~'~ 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 Parcel I.D. # 433--/ ?32- Z~/ 1. GENERAL INFORMATION Complete legal description Lot 12; B.Lock 12: North WOods Subd~.v~zon ~3 Location (site address or directions) 'Property owner, Jerry Stout Mailing address '."P.O. Box 670927 23137 Green Gardens Drive Chug iak, AK Day phone Chuaiak, AK 99567 688-5801 Lending agency Mailing address Day phone Agent Bob Wambolt / Remax of Ea~le River Ad dress Day phone 694-~200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: z~ TYPE OF WATER SUPPLY: Individual well Community well ×,'.Ix Public water MUNICIPALii ¥ O~ A . ENVIRONMENTA, .... N{'~u,~b "~c,~vICEs DIVISION RECEIVED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer 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 #21 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm. S & S ENGINEERING Phone CW ¥--~--0 '7 c/ ]7034 Eagle River Loop Road No. 204 Address Eagle River,,A~aska 99577 /. Engineer's signature ~//~/~i.~/Z ~.2)'~&~-~ Date 3-- / .:~, /'ff (~ DHHS SIGNATURE Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) 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 } Back MOA ~21 DEPARTMI Envir 825"L" Street, Room $02 · Am Health Authority Approva Check st A. WELL DATA .,., . Well type ~ IfA. B. or Log present (Y/N) Total depth Sanitary seal (Y/N) Date .of test Static water level ~. Date completed Ca,ed to FROM WELL LOG AT INSPECTION Well production WATER 'SA/VIPL. f~4~SULTS:- C01iS.~/ -Nitrate .~fftate of sample: ..- B. ~OLDING TANK DATA g.p.jn. Collected by: Other bacteria Dat~ in'tailed ~7~ a!. 25 ~".' :.~/Soil;rating (g.p.&/ft2 o~ ft2/bdrm) ltx> ~/~$'~ sYStem type Lengthen. b'o t , Widfli Gravel thickness below p~pe .Total depth Effective absorption area Monitoring Tube presentl~ ~ Depression over field (Y/~:} Date of adequacy test $~-~t&~g{,, !iResul~ail)i: t~- For q bedrooms Fluid depth in absorption field before test (in.); D Immediately after~o i g~' water added 0n.): /6, Fluid depth '~ '~ (,ins.) Minutes later: /o Absorpti6'n rote =' ' ~ Peroxide treatment (past 12 months) (y~ A JatO ,~/t-.~)~oo~ If yes, give date Date ,nstalle{~ . ..-',~ % Tank s,z~. I Z-~'0 Number of Compartments 2~ Cleanouts~N)'~ E°un~{0~.;~e~out~;::'?~.~ ~: Deoression(Y~ ~ Highwateralam~, ~[& Date ofPumping ~- ~ 9'~:? ':~, Pumper ~5' ~t~ LiF]' STATION · Date installed Manhole/Access fyi) · "Pump Size-in gallons' High water alarm level at* E. SEPARATION DISTANCES SEPARATION .DISTANCES, FROM WELL ON LOT 'TO/'- Septic/holding tm~k on lot ,gl;On adjacent lots Absorption field on lot ~ - Public sewer main :~ -: Lift station SEPARATIOI~ Building foundation '~ ' P~6perty line /0 t 4' Absorption field Water main/service line tD Surface water/drainage ! 6 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD 'ON LOT TO: ~l( . Water main/service line /~o . Building foundation Surface water Curtain drain ,2~{p F. ENGINEER'S CERTIFICATION Driveway,:parking/vehicle storage area Wells on adjacent lots Z~,~ ~ 4- Properly'line 1 certify that I have ~ in conformanae with MOA HAA guidelines in effect on this d~tte. Signature ~.~~ i'i~ Engineer's Name /~ 0~.~ r' ~ ~a ~ Date ~ /~ t /q6 h ' HAA Fee $ ~- ~ · Receipt Number Rev 8/95 eSS: ltaa.wk.doc Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~,~-J'"~ ""),.'.'~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 12; Block 12~ Northwoods Phase III May 15~ 1987 Location (address or directions) Property Owner Ala,sk~/. Ho~,54~tg Telephone: Home Business Mailing Address. (b) (c) (d) Lending Institution Ce~t~st Mortgage Mailing Address Telephone Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Eva Loken Address P.O. BOX 772849, Eag£e River, Alaska 99577 Telephone 694-4200 (e) Mail the HAA to the followina address: or; Check here ~, if hold for pick up. List contact person and day phone number below. S ~ S ENGINEERING 17034 Ea~le River Loop Road, Suite 204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-FamilyJ~ Number of Bedrooms Ordered by Eva Lokcn WATER SUPPLY Individual Well I"'1 Community [] Public J~( Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite)~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from tJ~e State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 IRev 8/861 Front '>i JaM s,Jaeu!buo IBUO!SSajo~d oqi u! suo!ss!uJo Jo s Jo J Jo Joj olq!SuodsaJ ~ou s! ebBJoqouv JO A),!lBdla!unl/N eqJ. 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LuelsAs IBSOdS!p JalBMS].SBM Jo/puB Alddns JalBM el!s-ua aql 'uoBoedsu! pu~ uo0,Bl:3!lsa^u! ,~uJ uJoJj pu~ SalB eSBJoqouv Jo ,~l!lBd!o!unlAi ami LUOJt paU!Blqo UO!IBLUJOJU! e41 ua pasBq 1B41AJ!Ja^ Jaqpnj I 'u!aJaq pal~o!pu! aJnlonJ~s Io adA1 pu~ suJooJpeq jo JaqLunu aql elBnbepB pub IBUOBOUnJ 'aJBS S! UJelSAS IBsOds!p JelBMe~SBM Jo/puB ,~lddns JelBM ells-ua eql 1Bql SMO4S IB^oJdd¥ Al!Joqln¥ q~,lBaH s!qj jo uoBBL~!tSaAUf Aw ~Bql AJ!JGA I 'MOIOq UMOqS o1Bp ua!iBp!lB^ @41 JO SB pUB OlaJaq paxyjB IBas ALU Aq pafJ!lJOO sv NOIJ.'~IN~IO-INI aN~¢ '¢.U¢Ci 'Hal:IriS =1114 'SJ.S=1J. 'SNOIJ. O=1dSNI 9Nll31^Oldd INI:II-I 9NII~=1=1NIaN=1 WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF AN~-KLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4744 ENVIRONMENTAl. Legal Description: 1'~]~ ~.~'> RE:iVED /L If A. B, C, D.E.C. Approved Y~) 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 Cleanout/Man hole Water Sample Collected by Water Sample Test Results Comments ~ 'v~,' cp Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~'"'~P// ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed £ -¢-~B Size f~.~c~ No. of Compartments Standpipes (~i3'N) Air-tight Caps,/N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well TO Property Line To Water Main/Service Line Course /"'"/.~ Foundation Cleanout (~1) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) · To Building Foundation To Disposal Field To Stream, Pondl Lake, or Major Drainage Page I of 2 72-026 (Rev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~"/~//~ ~ 3' Width of Field Square Feet of Absorption Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present~/N) Depression over Field (Y(~ Results of Last Adequacy Test 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 Date of Last Adequacy Test To Property Line /~/''/ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons /~//,.~ 'Vid "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 checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ & ~ E,.,;C. | ,.., _~,~..~ .~.G Date ~'-'~//'J~/~ ''~ Com pan,l/034 Eagle RJYel" II ~ Eagle Ri~r, Alaska Receipt No. ~ t - Date of Payment ~ Amount: $ Page 2 of 2 72-026 (Rev 8/861 Back II, L Telephone: (90?) Address: 274-2533 DATE: May 1S, 1987 PWS I.D.# 213001 To Whom it May Concern: According to records on,file in this office the ..... CHUGIAK UTILITIES (Northwoods) Water System is in compliance with the State Drinking Water Regulations Sincerely, Michael p. Lewis Environmental Engineer