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
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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