HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 7
' 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
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
p~_~ ~'J' C ~ ~ NO. OF BEDROOMS
Well ~ ~ Absorption area / Dwel PERMIT NO.
DISTANCE TO: ~..;~) ~p ~
~ z Manufacturer
~ ~ Sateria~ ~ ~
~ ~ ~ ~ ~ No. of compartments
Liq. capacity in gallons ~ Inside length Width
/~ O j ~F HOMEMADE: ,~ Liquid depth
DISTANCE TO: jWell Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
~ Well ~ Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO: ~ ~ ~*~ ~o ~ /
~ Z No. of lines Lengt~ of eac~ line Total length of lines Trench width Distance lines
--Z~ / ~, ~O' ~'O inches
~ ~ ~ Top of tile to finish grade Material beneath tile
Total effec~ve absorption ar~
Length Width Depth
~ PERMIT NO.
Type of crib Crib diameter Crib depth ' ~¢~
' ~ DISTANCE TO: Well Building foundation ~~k~ ~E~TION
~ Class Depth Driller Distance to lot line PERMIT NO.
~ AIIO ~
~ DISTANCE TO: Building foundation Sewer line Septic ta~U~ ~ l~ ~bsorption area(s)
PIPE MATERIALS
SOl ~ T~S~TING
......
iNSTALLER ~ ~ ~ ~
REMARKS [
~ O~ A~
APPROVED ~ ~ $ DAT~ -
72-013 (Rev. 3/78)
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
~DEPARTMENT GF HEALTH AND E ' -
NV I RONMENTAL PROTECT I ON
G25 L STREET.~ ANCHORAGE, AK 99501
264~ -4720
O~,,11 .... ~S ][ TE SE~WEF.:R PERM
840653
08/01/84
HAMMAN CONST.
BOX 6'72
EAGLE RIVER, AK
694-2776
99577
SUBDIVISION: NORTHWOOD PH ~4
SECTION: 5&4 TOWNSHIP: 15N
.SA (SQ. FT. OR ACRES)
5
LOT~ '7
RANGE: 1W
BLOCK: 16
Listed below are the options available to you in designing your septic
system. Choose the option that best fits youe site.
TRE~C~
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0
GRAVEL DEPTH (FT.) ~.0 0.5
TOTAL DEPTH (FT.) 7.0 4.5
GRAVEL WIDTH (FT.) 2.5, 17.0
GRAVEL LENGTH (FT.) 63.0 34.0
GRAVEL VOLUME (CU. YDS.) ~0~4 ~1.~4
TANK SIZE (GALS) 1~000.0 ** 1~000.0
SOIL RATING (SQ.FT./BR) 125 125
'~ TANK MUST HAVE AT LEAST TWO COMPARTMENTS
iD R A I Nt
4..0
5.0
7,0
5.0
44,.0 ·
28.5
1,000.0 **
125
I certi£y that:
1. I am familiar with the requirements for on-site sewers and wells.am set
£orth by the Municipality o~ Anchorage (MOA) and the State o~' Alaska.
2. I will install the system in accordance with all MOA codes and re~ulations~
and in compliance with the design criteria o~ this permit.
5. I will adhere to all MOA and State o~ Alaska requirements for the set back
distances £rom any existing well~ wastewater disposal system or public
sewerage system on this or any adjacent or nea~,by lot.
4. I understand that this permit is valid £or a maximum o£ 5 bedrooms and
any enla~gement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED. WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED ~" DATE:
PERFORMED FOR:
LEGAL DESCRIPTION:..
1
2
8
9
1,1
12
13,
14
15
16
17,
18
19
2O
COMMENTS
~.-~
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
SLOPE
~4
ENCOUNTERED? _
O
D^TE PERFOR.EO:,
SITE PLAN
P
IF YES, AT WHAT E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
$ I .'~o I0 f. I~. O. ?_ 7
~- ~ :/I IO /, I: o.~Z
PERCOLATION RATE 7~'''~ (minutes/inch)
TESTRUN BETWEEN '~ FTAND ..... ~ FT
Iff5
CERTIFIED BY:
DATE:
72-008 (6/79)
Permit ~
· ~_~M~UNICIPALITY OF ANCHORAGE,..
Department( f Health and Environmenta' 'protection
825 ,, Street, Anchorage, AK.264_4720 u9501 ~
WELL AND/OR ON-SITE SEWER PERMIT
Mailing Address: /?O, g~' 77-/~o ~-,/~.
Phone Number
Location:
Leqal Description: /~ ~ ~/~ ~/~/-~/4~ .~--/~,~ Lot Size:
Type of Soil Absorption System ,Is:
Trench: ~/ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of, Bedrooms: ~ Soil Rating(sq.ft/br) ~E~,
The Required Size of the Soil Absorption System Is:
DEPTH ~'/ LENGTH //~
GRAVEL DEPTH /7/'
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 = ,,/~d 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.
~ ~ ~ TW0(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 * *
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 that 3 bedrooms.
SigneR:
Applicant
S-WP/024 (1/81)
Permit
Applicant:
Location:
Legal Description: L'--? ~l ~
Type of Soil Absorption System Is:
Trench: Drainfield: . Seepage Bed: / Holding Tank:
Maximum Number of Bedrooms: _~ . Soil Rating(sq.ft/br)
~-.MUNiCIPALITY OF ANCHORAG~.~
Departmen.' ~f Health and Environments' ,Protection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * *
AND/OR ON-SITE SEWER PERMIT
Phone Number:
The Required Size of the Soil Absorpt~opFSystem Is: '
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 = AC"~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
[nstallation inspections of any wells adjacent to this property and the number
3f residences that the well will serve.
* *,* TWO(2) INSPECTIONS~RE REQU~* *
~ackfilling of any system without final insp~ctio~-~n~/~j~rovat b~s departmen'
~ill be subject to prOsecution. // ///
4inimum distance between a well and any on-~/te s~ge/~al ~stem is 100 fee'
~or a private well or 150 to 200 feet from~ pub~c ~ dg~e~n~-upon the type
~f public well. Minimum distance from a/~rivat~j~ll to i-~rivate sewer line
[s.25 feet and to a community sewer line ~s 75 fe~j~- __~11 logs are required
ln~ must be returned to this department within 3~3~F~ o~ the we~l completion.
)ther requirements may apply. Specifications~~s~tr~tio~ag~ms/are
~vailabte to insure proper installation. /~~_,-//
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 re~ire enlargement if
the residence is remodeled to include more tha~/~Aedrooms.
Date: /--~/t5 -- ~
SWP/024 (1/81)
I
Permit #
Applicant:
Location:
Phone Number: ~ ~~~
Legal Description: &---7 ~-~ ~ ~ A9~/3-~--~~lze:
TYpe of Soil Absorption System Is:
Trench: __ Drainfield: . Seepage Bed: ~ Holding Tank:
~_MUN~CIPALITY OF ANCHORAGE~...o
DePartment/ ~ Health and Environmenta;' ~.rotection
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
~ ~v% ~_~ O~)~V Mailing Address~a,~), ~
7 7-/q6- ~__,4~
Maximum Number of Bedrooms: _~ Soil Rati~sq.ft/br)
The Required Size of the Soil AbsdrptIop6System Is:
The length dimension is the length(in feet) o~ the ~rench or drainfield. The
depth of a trench or pit is~he distance between th~ surface of the ground and
the bottom of the excavati~(in feet). There ~ no/set w~th for trenches.
The gravel depth is the m~imum depth o2~ grave~ between ~e outfall Pipe and
the bottom of the excavation ( ~f~et) . %~
Permit applicant has t~e ~espo~ bi/ity/~o~for~is department during the
installation inspection~ ~f a~y~ e/ls/~djacent t~his property and the number
of r~sidences that the %~1 w~l ~T~e. '
* *. *¥TWO(2')- NSPECTIONS 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-* * *
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 re/q~ire enlargement if
the residence is remodeled to include more that/3 ~edr?oms.
Signe~: ~~ ~ ~~ Issued by:~
A~piic~ - ~-~Date:
SWPI024 (1/81)
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:
1
2
4
5
6
7
8
9
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE
DATE**R*ORMED:
51TE PLAN
-' wS;m~D WATER
dY H.).~ee;~ E.CO~NTERED?
:0;
P
E
IF YES, AT WHAT
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ :o~ /~ /, IS o. t ~
~.~ ,
/~0 '~"
PERCOLATION RATE r-'~ (minutes/inch)
TESTRUN BETWEEN ~ FTAND ~ FT
PERFORMED BY:
72-o08 (6/79)
CERTIFIED BY: DATE:
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3-
10-
13-
· 16
,18 '
20.
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
S~~ LOG
PERCOLATION
TEST
SLOPE SITE' PLAN
WAS GROUND WATER ~ :S
ENCOUNTER ED? iP~
~IF YES, AT WHAT :,E
,DEPTH?
· ~ ,:Gross 'J Net Depth to ' - Net
· Reading Date
· Time Time Water Drop
°0
~ ~ I, o ~o .,/,~? o, ii
:+~0 '1.'0~ . ~
!;'1~ /~ ': ./.~ .~,~
~ ~ /:z~ ~ ~ ' I,~ , 0,.0~
~ ' I
PERCOLATION RATE (minutes/inch}
TEST ~'~ FT AND
:PERFORMED BY: J/'"~ ~'~,'~_ ,'~ .
CERTIFIED BY: :lC-~
"DATE:
~2-008 ~6t79)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF ~.ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR ~.ALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal.~_ 7Descripti°n/t~//';' (include/~ "~/~ ~'~l°t' block, subdivision,~z~ ~_~ sec~on, township,~7_/~w~//~/&~/range)
Location (address or directions)
Applicants Address ~,0, gO~ '~'7-{ W~-O ,~
/ -
(c)Applicant ts (check~one~) Lending Institution ~ ; O~mer
Buyer [----[ ; Other ~ (explain);
Address ~ ~- ,~ ~ V c
(e) Real Estate Co. & Agent
Address ~
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single-Famtl~
Number of Bedrooms
3. Water Supply-
Individual We!l~'--
Multi-Family~
Other (describe)
Com~unity~ Public~--~
Note: If community well system~ must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
Onsitg~ Public ~ Community ~--~ Holding Tank ~
Note: If community well system, must have written confirmation from the State
Dcpargment of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
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, 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 regula-
tions in effect on the date of this inspection.
Address
bedrooms
Disapproved
(ENGINEER SEAL)
Telephone -~ ~'--~/~
DHEP Approval
Approved f o r-~B.~i.
Approved ~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE ~F ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 oE 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUI~{ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
Well Classification ~~?.7
Well LoG P~esent (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f~cm Well:
To Septic/Holding Tank on Lot
To Nearest EdGe of Absorption Field on Lot
To Nearest Public Sewer Line
C leancut/Manhole
Water Sample Collected By .
Water Sample Test Results
C~m~nts ~F'4~ ~ ~
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 9 1984
RECEIVED
If A, B, C~ C, D.E.C. App~oved(..Y/N)
Date Cc~pleted . Yield
Depth of G~outing
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression A~ound Wellhead (Y/N)
; On Adjoining Lots
t On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ ~/~ Size ~/~ ~-~/ No. of Compartments
Standpipes (Y/N) .// Air-tight Caps (Y/N) / Foundation Cleanout (Y/N).~/
Depression over Tank (Y/N) /~/ Date Last Pu~ped /b/~f~L~/ ~-/~.-,
Pumping/Maintenance Contract on File (Y/N)~//~ ; for
Holding Tank High-Water Ala~,u .(Y/N) /i//~ Temporary HoldinG Tank Pe~t (Y/N) /~'/~
Separation Distances f~cm Septic/Holding Tank:
To Water-Supply Well ~)~3~
To P~operty Line /O ~-
To Water Main/Service Line
Course
TO Building Foundation ~' /
TO Disposal Field ~-- /
TO Stream, Pond, Lake, c~ Major D~ainaGe
Co~nts
[Page 1 of 2]
2-15-84
ABSORPTIOn. FIELD DATA
Soils Rating in Absorption Strata
Date Installed -~/~' ~f
Width of Field ~-- ~
Square Feet of Absorption A~ea
~ Type of System Design
Length of Field ~3 ~
Depth of Field '~'
Gravel Bed Thickness ~ /
Standpipes lhresent (Y/N)
Depression over Field (Y/N) ~/ Date of Last Adequacy Test
Results of Last A~equacy Test
Separation Distance f~cm Absc~ption Field:
To Water-Supply Well ~14p -l- To P~operty Line
To Building Foundation ~ 2o / ~To Existing or Abandoned System cn
Lot /~-~- ; On Adjoin~ Lots ~ +
To Water Main/Service Line /D y- / To Cutbank(if ~esent)
To Stream/Pond/Lake/c~ Major Drainage Course
To Driveway, Parking A~ea, c~ Vehicle Stc~age A~ea /~ ~-
COx~mk'~ r3tS
De
Date Installed
Size in Gallons
"Ptm%> On" Level at
High Wate~ Alarm Level at
Tested for
Electrical Codes(Y/N)
Ccn~nents
Din~ ns ions
Manhole/Access (Y/N)
"Pump off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bed~oc~n Rating Against HAA Request
I certify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed Date ~//5--,/~ ~/
Company ~A~ ~"..,,~,.,.,-~./.~ ~ ~./~. MOA No. ~/ ?r-F.~'/
KB1/d5/s
[Page 2 of 2]
2-15-84