The URL can be used to link to this page

Home My WebLink AboutNORTH WOODS UNIT 4 BLK 16 LT 5 Name '~" MUNiCiPALITY OF ANCHORAGE /-'h DEPa.,dTMENT OF HEALTH AND HUMAN SERVIUE$ Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEI~VAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 'PhOne(s) [ Permit No. / lNG. of Bedrooms DISTANCES WELL SEPTIC ABSORPTION TANK FIELD WELL LOT LINE ~'O ,~ /~ AS-BUILT DIAGRAM ~ [~SEPT~C [] HOLDING TYPE OF SYSTEM [~I~ENCH ~ BED [] W. DRAIN [] OTHER Depth tO pl~e bonom Irom original grade ~, ~ Fall added above original grade Gravel lenglh ;Gravel wldlh 77 /o7 Installer Dale Inslalled [] PRIVATE ~OTHER (Identify) FT RE MAR KS: ~':~ NO, CE 5~07 I Ihis inspection was performed ace, ording Io all Municipal and Slale Ouidelinea in eflecl on this date: .~ **~' ,C::~,~,~,~" ~.~'. -/~ ~::~'/ Vernon L, Roelt Ho, unicipaL Yot Anchorage P.O. E~'-'%, 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNO WI. ES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 Robert C. Johnson PO Box 670852 Chugiak, Alaska 99567 Subject: Lot 5 Block 16 North Woods Subdivision Phase IV On-site Sewer Permit ~860362 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Since%e lY C/~7, R.W. Robinson Program Manager On-site Services RWR/ljw eric: copy of permit LC)T~ ','~3 ~.1-: (](,F..' "' '"" lA I-u4 N(:~IS: :I.W 3.0 .~.te q. ,, 0 4. ,, 0 7.0 0.5 :.;.;. 5 10 ,, 0 4. ,, 5 7 ,, 5 ;?.. 5 2 7 ,, 0 ~t~i. 0 7 7 ,, 0 .~..~. ~'5 4.. 0 I 1A ,, 0 .~..~- ESS ,, D 1,2f5(). 0 .~-.~. t, 2.50 ,, 0 -~-.~. 1,250.0 .~'.~. 2.&B Z'.4.2 · i<"x' DEt:::"T'H "FC) F' I !:::'El:B(]'T'T'CIM < 3.5 F:rT' ,, I::i'.ti!i:C.)U ! RESi I Iq,%LIL..~.YF I C')N 'i~'¢l' DE:F::'!"H 'l"C) PtF'E BOTTOM <: ¢~¢,.'- EiI::;¥:~VtSL. L. 1.'.:::I',![-:iTH > '75 l::"f'. '~-~' TANI< MUST I-'1(:~671!ii: AYT' L.E(~ST 'T'NO COMF'~.~I::i'.TMIE:NT'S I c:ert, if'y t. hat.~ I. ]: ,:am f~'amili,:aP w~:['t:.t"~ 'Ll"tf:,~ requ:i.r,:~:,merrL~ f'or c)r'v....~:i, it.e) s(.:¢.~v~¢,r~ and ~,~f:.:¢,:l.:l.~ as ~f:¢.)t. f'c:,rt.h l::~y the:, Munic:ip~aI:i. ty of' ;':~ru:::h,:::m~g~z, (l"lO~q) arid t. he) State 2,, I ~,~:i.].l in~it.,'al! t. he~ ~iy~rt:.e~m in ~r,c:cc/rdanc:e~ wii'..l"t all t~!(:)(:~ c:cx::h.::.:,~i~ and re)gulat, iclns, ~:~r'lct in c:c;,'np].:i, ar~c~ ~w:i.t.l-i i:.h~:~ di.:~.igl'l c:rit.~:~:m:i.~t of' t. ln:i.s 3, t ~,~J.].:l. acll"?re~ 'Lc~ all lqOF:~ arid Sit. ate of F-~:t.~d~d<a r'ectL~ir,~:(.~mi,~n'L~s for 't:.he~ sexL bat:l< d :i.'~.taru::~s from ~il't/ ~:,>i :i.!B~; il'i~j i~{.:{,]. :L ~, P~:~ilt. l~,i~).t.~21" l:]:i.~ipc)!B~]. !By~t.~,Ftt i::)P ~;etwe:q"age ~s'y~rt..~m on i:.t"~i~i~ (:r' any acljace~r~t c)P rli.~i~tr'by ].c~t.,, Zl.,, :[ Lu'lc:l~:~r'~t.a. rtd i:.h~,~i:, t. his pe:,r'mit. J.~ii v~l].id For' ,~t m,:~xJ, mum ~:){ zt. l::)e~dr'oc:ims ~;d'i¥' e~i"~].~:d"g(.~:.)lii~:.~,r;t, wl:L].], r'(.z~quir'e an add:Lt:i, clnal per'mit,, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~'~'~~' ~'r' $ 4 7 8 ~0 ~2 14 ~7, ~8 20 DATE PERFORMED: (ENGINEER'~ S~AL) . SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? . p E Depth to Water ADer ~/ Date. MonitorinD? . Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~'-7, ~ ~ (minutes/inch) PERC HOLE DIAMETER __ COMMENTS ~b?-~ ~q*~//~Z "/~/~' ~ ~ //,~' ~ ~. I ' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUiDELiNES iN EFFECT ON THiS DATE. DATE: ?~/7'''''~'~ 72-008 (Rev. 4/85) · ID o~ mz m r-- z o 'n I11 Ill ffi o ffi .-I '~ [31 '\ R 17 Parcel I.D. # 1, 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 051-064-17 GENERAL INFORMATION Complete legal description Northwoods #4, Lot 5, BIock 16 Location (site address or directions) 21857 Sheltering Spruce Property owner Robert C. Johnson P.O. Box 670852, Chugiak, AK Mailing address 99567 Day phone 688-0644 Lending agencyN/A Mailing address Day phone Agent Address Audrey Ma~nn./P~Maw Day phone 16600 Centerfield Drive, Eagle Ri~er, AK 99577 Unless otherwise requested, HAA will beheld for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: X 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. x 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 an~ 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. 694-5195 Phone Name of Firm Eagle River Eng~eering Services Address P.O. Box 773294, E_a~_le River, AK Engineer's signature DHHS SIGNATURE _/~ Approved for ¢ Disapproved. Conditional approval for 99577 Date ~3//~-~' 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /~'/~'-'/~-~,~'"~¢~=~/ ,~,%~ ~"/,,,k/'o" Parcel I.D. ~ 5 J- ~'//-/~' / ~ A. WELL DATA Well type ~'~ ~ Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG ...... ~ AT INSPECTION ~t~c° 'wt~tr level ~ ~'"/'~ Well flow ,~' g.p.m. Pump level // ' SEPARATION DISTAN C ES.~M WELL TO: Septic/holding tank °n/~ ; On adjacent lots Absorption field .o,~ _ ~; On adjacent lots, Public sewer,~ Public sewer manhole/cleanout Sewer servi~ line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) ~'~ Date of pumping ,-~---~m~' ~'/?-~ Tank size /..zj-~ Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot TO property line Surface water/drainage On adjacent lots Absorption field /~ Foundation /.?" Water main/service line ~,'~ ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) Manufacturer .. Manhole/Access (Y/N) "Pump on" level at "Pump off" level at. Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D, ABSORPTION FIELD DATA Date installed /~/~-//,~/~ Length 77 / Width. ~ z Total absorption area /~ ?~ ~ Depression over field (Y/N) Results (pass/fail) ~ ~ for Peroxide treatment (past 12 months) (~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,~//~¢t o'n adjacent lots To building foundation On adjacent lots ~'-~-'> ~ Cutbank Surface water /'~ ~ Curtain drain '"'~'"~ Surface water Soil rating ~'~ '~ System type Gravel thickness ~/ Total depth / -~, 5' / Cleanouts present (Y/N) Date of adequacy test If yes, give date Driveway, parking/vehicle storage area Property line To existing or abandoned system on lot Water main/service Ii ne bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~ : :'~' ~" °" ...... ~'~ ~ Engineer's Name ~--~'~' ~.,~,~c-~ ~' ~'~ '''~ ~'~'"'~% ~'~ ' Date ~/~-7/~ ~ ;~ HAAFee$ /7~)' Date of Payment Receipt Number. 72~026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 R ~ C ~- IV ~- ¢ ANCHORAGE, AK 99503 jUt~ ,~ 0 199~. M~ntcipality et AnchO~'aga Dep[. Health & Human service~ WALTER J. HICKEL, GOVERNOR June 23,1992 FOR: Eagle River Engineering PWSID # 213001 My review of the records on file in this office reveals that the Northwoods Subdivision Class "A" Public Water System is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling (nitrate (as nitrogen) only) listed in Table B of 18 AAC 80.200. Sincerely, Rachel Clark College Intern RC/cf printed or~ recycled paper b y Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) (b) (c) (d) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES OERT, F,O^TE OF ,NSPEOT, O. FOR .EALT. AUT.OR,TY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Legal Description/_~.) 7z~ (include~_.,. '~//'~-_l°t' block,/_/c.subdivision,/.'4/~''~z~/~'X''~ <~ ~'¢~ EsectiOn' township, range) Location (address or directions) Prope~y Owner ~~ ~ ~J~ Telephone: Home Mailing Address ~ ~ ~ ~ ~ Lending Institution ~- ~]¢4 ~/ ~ ~ ...... T~e.,on. Real Estate Company and Agent ~/~ ~ Address ' Telephone (e) Mail the HAA to the followino address: or: Check here ,[~'~hold for pick up. List contact person and day phone number below. ~// ~-"~/4~,-~ ~ 7./- TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms 3. WATER SUPPLY Individual Well [] Community [~'~ublic [] Note: If community well'system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [~'""'PubliC [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86~ Front EN'GINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verily 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. NameofFirm ~'/'~"---~'--- ~ '~Z~.//~,~lY~, Telephone ~'?~/" ,~ ~ Approved for / bedrooms b ~ Approved/'/.....~¢'j/'c~ -Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 (Rev 8/86) Back Well Classification ~,,,~//~%.~. z~,~ ,,~ If A, B, C, D.E.C. Approved (Y/N) ¢,~o%N MUNICIPALITY OF ANCHORAGE (MOA) ,.,~ ~'~,,~',~ ~,-~\q~ALTH AUTHORITY APPROVAL (HAA) A. WELL DATA Yield Date Completed Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Well Log Present (Y/N) Total Depth 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/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /,~/.'~ ~/'~/~'~' / Standpipes (Y/N) /Y ¢-~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /I~.~7~:~ Pumping/Maintenance Contract on File (Y/N) ~'~0Iding Tank High-water Alarm (Y/N) ~ Separation Distances from Septic/Holding Tank: Size .~-~ ~,~./No. of Compartments y ~ 5' Foundation Cleanout (Y/N) / Date Last Pumped ,,,~/~E./~ ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well ~/~.'~/~/<' To PrOperty Line ~?"~ ' "~trl-O Water Main/Service Line Course Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 (Rev 8/861 Front ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .... Width of Field -- Type of System Design ~ Length of Field ~7-~'~7'1 Depth of Field Gravel Bed Thickness ~ ~ "'" Square Feet of Absorption Area ~ ~ ~" Standpipes Present (Y/N) Depression over Field (Y/N) ~ ,~/O Date of Last Adequacy Test ---~~ '- Results of Last Adequacy Test ~ -- Separation Distance from Absorption Field: To Prope~y Line ~¢ To Water-Supply Well ~ ~ To Existing or Abandoned System on TO Building Foundation ~' ~;~.~, Lot -- ~~' ~ ; On Adjoining Lots - To Water Main/Sewice Line ~ ~ ~ To Cutbank (if present) ~/~ ¢ - To Stream/Pond/Lake/or Major Drainage Course ~ -- /~ ~ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed ~ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions --- Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certCy that I hav.~checked, verifi, e..¢, or c~o.~formed to all MOA.and H,,AA guidelines in effect on the date of this inspection. Sinned ~--~¢'~'~-'-~- Company ~ ReceiptNo. ~ ~ - Date of Paymen Page 2 of 2 72-026 (Rev 8/86~ Back DEPT. OF ENVIRONMENTAL CONSERVATION BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 274-2533 DATE: January 14 , 1987 PWS I.D.# 21300i To Whom it May Concern: According to records on file in this office the (NORTHWOODS) Water Regu]ation$ CH[~G IAK UTILITIES Water System is in compliance with the State Drinking Sincerely, ~pervisor