HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 9
I
~. 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
/~)o r~-~ ~, j 00(~ "~-J',J C.. DISTANCES
Addres~.~ 0 (~ ~k~ '~j TL~-[~jNJ.' ~"~,'c por-~ ~0 SEPTIC ADSORPTION
,~ %~ "~Jhc'~r ~ TANK FIELD .WELL
Phone(s) ' I Permit No, ' No. oY Bedrooms ~J~ WELL
~6A~ D~scm~no. LOT LINE / ~ /~
Township, Range, Section ~
~I ~ ~ ~ ~: %~C ~ AS-BUILT DIAGRAM (Show location of well, septic system, propedylines, foundation
driveway, water bodies, etc,)
~ SEPTIC ~ HOLDING ~)
Manufacturer Capacity in gallons
Material
TYPE OF SYSTEM
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER
Fill added above original grade Gravel dep~ ben,th pipe
~ FT FT
Gravel length Gravel width
Number of lines Soil rabng 'h~ ~
Tot Depth Cas to ~,,/~ ~/
Installer Date Installed: --~ ~ ~
REMARKS:
..y Inspeo~ormed by:
S & S ENGIN .... ~ ~
- ~ -- ~ certify I~his inspeaion was pedermed according Io all 1
Municipal and 8 ate gu ae nes n effect on Ibis da e. ~ ~//~
72-013 f3/85~
I , I
82.5 I.,,, ~t.r~et.:~ Anchorage, Alaska 99501 ~4'~--4'72"~
P E R M iii T
C.,~ner, l',iam~s,: NOR'F'HWOODS, INC
Ownei" Adc'.lress~ 709 W IN'TERN. AIRI'.'.:'ORT RC. IAD
"x ..... ' ....... 995
r. t[...t"~OI"~.AbI=. ,~ AK 18
I_ot. I...e:ch',~l:... Subd:i.v:Lsior'~= NORTH WOODS~IV Lc)t,." 9 B,t.o~.k." ' '" 16
..,e.c..,.. I,.~ ,, 4 Township: :1:51'4 RaOg.¢.>: :[W
L.crL 8:i. 2(.z, 2:70C)7 (sq,, ft.,, or' acr'es)
I'la:,.( Bec. tr'.oc.~ms: 'T't"iis Per'mi'L." :]; Tot. al Capaci'Ly:.. 3
SITf:'""IC 'T'ANK: M:i.l if:qLtm '~..ot.a]. septic: t. ank capac::i.'Ly: !,0()C} gallons. Eac:h septic
t. ank must. have ,:.,.:ct. ].eats'IL 2 c:cimpar'tments. Depth to t. op of sep'Lic rani<Is) < /.I..()
~' e? ,o'L ~" (.:!..'. q u i r' e? s :i. n s t.l ]. a 'L i o n c:) v e.~ l" ',~. a n k ( s ).
F::'IEF~MIT I....XI IRI,: ....... DIECEMBIER 31, 1989.
ENG]itXtlEIEIR MUST I\IOTIF:'Y :Ot lH.S OF:' I tt.::lx "' ...... E.[.,FIC)N'" AT :2!;4:];-'4'744 []R .'~.4"~-468:i... .
MAINTAIN :1.0' SEI:::'ARATICIN T'O ,~ .... IJE'~I_IC ........... WA fEF.;' L..INE,,
S :i. !gn ex::l:
(C)wr'~e:r.)
:11 CERT!I:::'Y 'THAT:
:t.,,I am {am:i. liar~ with 'Lhe r'equ:i.r'ements for on-.s:i, te sewer, s arid wells as set.
Fcm'Lh by t. he Municit:~ati.Ly of Artchor'age (MOA) end the State or Alaska,,
2, I w:i. ll install the sys't'..em in acccmclance wit. h ali MOA codes arid r'egulat, icm~s,
ar'id ir'l compliance wit. h the d6:.:,~.:i, gl'l cr'J.t, er':[a of t.h:i,s per. Mit.,,
5. I w:i, ll adhere t.o all MOA anti Stat. e o¢ Alaska r'equir'ement~ for' t, he set. back
d:i. star]c:es {rom ai]y (.Dx:[st.:[n{;i we].].~, k0~:(s'L6:{,wa'L6~p disposal system of publ:[c
sewer'age system on t.h:i.!ii~ or' arly adjac:er'd:, of near'by lot..
Zt',, ]'. L.U"iCI{F:,PS'LaI"IEI t. ha'L this )sr'm:i.t. iS va].id {'op a ftla}(:i, ftiL,tM C){:' ;!; bedr'c:,cmls,, I
I s s u e d B y:
DA l E ,,
SCALE
PERFORMED FOR: .'~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:. ~.--~ '1~ i".~I;;:~ \~Township,d.__ SLoPERange' Section: '"'[--~'1~ , ~-~|(~ "~1'c '~- SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After~.~
Monitoring? ~ ~ ~ Date:
1
2
3
6
7
8
9
10
11
12
13
14
15
16-
17
18
19
20,
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE '~""/ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '~ FT AND ~' FT
~ CE~T T~S TEST ~AS PERFORMED IN
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D.#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
LOT 9; BLOCK 16; NORTH WOODS #4;
Location (address or directions)
SHELTERING SPRUCE' .£00P.
(b)
(c)
(d)
Property owner. L & ~ CONSTRUCTION Telephone: (home)
Mailing Address P..~i~n~' '770/;!7 Fag~ ~'~,~; A£axt~.a 99'S77
Lending Institution Telephone
Mailing Addres~
Business
Real Estate Company and Agent
Address
Telephone
Mail the HAA to the following address: (or check here)l~, if hold for pick up.)
List contact person and day phone number below:
$ & $ ENGINEERING
17034 Eagle RiYer Loop Roa~J No. 204
Eagle River, Alaska 995X7
(e)
2. TYPE OF RESIDENCE
Single-Family [~X Number of bedrooms $
3. WATER SUPPLY
Individual Well [] Community ~X Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE D IS/~OSAL
On-site E~X Public [] Community [] Holding Tank []
Nete; If ~ommunity well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. 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 ail Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
S & S ENGINEERIN~
Address 17034 Eagle River Loop Road No. 204
Eagle River, AlasKa
Date
Telephone
6. DHHSAPPROVAL._:~ y~~4~~ _~. //~:
Approved ~or ~_./ bedrooms b D~te
Approved/- Disapproved Conditionel
Terms of Conditional Approval ~~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 Mu nicipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72q)25 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
_r~ Health Authority Approval (HAA)
.~v~t-~,,.~j¥~\~%'3 ' CHECKLIST- FEBRUARy 1984
.~ 343,4744
' Legal Description: ~
Date Completed
__. Depth of Grouting
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static,Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
If A, B, C, D.E.C. ApprovedE~J) y
Yield
pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
~ ~ ~/ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot '"~'~::2 ! Jr'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments 'i~(~ ~ ~
; Date.
B. SEPTIC/HOLDING TANK DATA
. 7"
Date Installed '~ ~"-t~f=l Size V~"~c~ No. of Compartments ~ ~
StandpipeS~5~/N) ,,~ Air-tight Caps~Xl) ~t Foundation Cleanout~.5~/N)
DepresSion over Tank (Y/~ ~ /,~D~/ti~ Last Pu m ped -~/~_.~
Pumping/Maintenance Contact on File (Y/.Nh// ~/~ ' i,or
Holding, Tank High-Water Alarm (Y/N) /'~ Temporary Holding Tank Permit (Y/N)
SEPARATION DisTAnCES FROM SEPTIC/HOLDING TANK:
.To 'V~/ater'-~.UPply ~Well ?}: ,'z...~4::~ ~c. / To Building Foundation ~ /
:}i To Property'Lifid .... -; ~' I ,~' 4' '/ To Disposal Field '~c:~ !:~ '
:To Wate~ Main/Service L n-e j ~, I../~
~o".~ti'ea~, Pond', Lake'~r"Major Drainage Course / /20 ~c-.._:__
72-026 (Rev. 7/88) Front Page 1 of 2
Square Feet of Absortion Area
Depression over Field (Y~)
Results of Last Adequacy Test
To Water-Supply Well
To Building Foundat~.~
Lot
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~ ~ ~/'/'~ Type of System Design
·
Date Installed ~:~ '~ ~"~ ~ Length of Field ,~-I
!
I
Width of Field ,'~ c:~ Depth of Field ~'
Gravel Bed Thickness O' ~-
/Z ~:~~' Statndpipes Present ~N)
/~J Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
~ I DC To Property Line /
To Existing or Abandoned System on
To Water Main/Service Line ( (~)'(''
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
; On Adjoining Lots
To Cutback (if present)
/
Comments
D. LIFT STATION
Date Installed c~_ ~.--_ 87
Size in Gallons """-
''Pump On" Level at ~' '~ *
High Water Alarm Level at
Tested for /V/~ ~
Meets MOA Electrical Codes ~N)
Comments
Dimensions
Manhole/Access(~N)
"Pump Off" Level at
Vent ~i~N)
Pumping Cycles during Adequacy Test.
**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 5 & -~ ~NEERING
17034 Eagle Ri~er Loop Road No. 204
Company Eagl ' -' ' ~
MOA No. ~"/~ /~°'"'~"~d-~ -~
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION
/
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
October 16, 1989
STEVE COWPER, GOVERNOR
563-6775
Mr. Roger J. Shafer
S & S Engineering
17034 Eagle River Loop, Suite 204
Eagle River, AK 99577
PWSID: #213001
According to the records on file in this office, the Chugiak
Utilities/Northwoods Deer Horn Water System is in compliance with
the State of Alaska Drinking Water Regulations.
Sincerely,
Vera E. Craig
Environmental Field Officer
VEC:bas