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Home My WebLink AboutNORTH WOODS UNIT 4 BLK 16 LT 14 i ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE /.~-~N EW :ESS. , LEGAL DESCRIPTION Absorption are% '<~ Z Manufact~ ~O/4~ ~'~* Mat~ee / - No. of compgents ~ ~ Liq. c~ac~ln~allons .. Inside length Width Liquid depth / ~ ~O Ir HOMEMADE: ,Oz~ ' DISTANCETO: Well Dwe~ /~ PERMITNO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ DISTANCE TO: / ~ ~ ~ No. of lines Length of each line T h of lines Trench width Distance between lines ~ ~ ~ Top of tile to finish grade M/teria] beneath tile inches Total effective absorption area ~ inches ~ ~[~ ~ype of crib Crib diameter C~ib depth - ~ DISTANCE TO: We~O0 ¢4 Buildi~'~ nO¢~on Nearest p~n e ~ Class Depth Driller Distance to lot line PERMIT NO. ~ ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIALS ' SOl L TEST INSTALLER REMARKS A ~ ' DEF':'ARTMENT OF::' I'"IE:AI.mTH AND ENVIRC)NME::NTAL ):::'ROTE~CTION 82?.5 L. STmF;.'tEE:T, AhE]I"'!ORAGE:, AK 9950 2,:f:~,q...... 4720 F:'ERM t T r'40: C:OIqTAC:T "I IC.;Iq[::,: S(:)LFT'H F:'O!::;~K CCHq.~i~TF(',, E::/C] S F;,' B 196X I!:T. AG~I.... ii!: R :I: V 'iii:J::;:, qK 995'7:7 694-2979 L..EC'h~t~L. ))ESCR I I:::' ~: SUBD I Y ! S I C)N: N(:)I::;:"!"Fit.',IC]EIDS :l:!:zt. LO'T' :: ]. 4 SECT]:ON:: 3 "r'CiWNSF!IF:': 15N RANGE.:: :l. !....CYT S I ZE~ ;.2.8Cx}0 (SQ. F:'T. OR ACRES) MA X BE:':DFd,.']C)MS: ','.1. DEPTH '!"El F:':EF::'E Bo"r']"(.')H (F:'T,,) 3,,0 'x"~."' GF:;:AVEL DE!]::'TH (F::'T,,) 0 ,, 5 "FOTAL.. ;C"E!:F:'TH (F::T :' ::!.r,,, 5 GRAVEl.... WIDT'H (F::'T.) ;:?.0~ 0 GRAVF. i:L. LENGTH (F:]".) 38,: 0 GRAVEL VL]LUME (CU, Y:C)S,, ) 28,, 2 TANK S J: ZE: SOIL. RA'I"ING (SD,,F:T, /BR) 125 '~-'~'DIEF:']"H r'o F' I F:'E BO'I"'!"OId < 3 ,, 5 F:VT'. F.iIEQL.I I F;:ES .T. NSULAT I (.'.'.,,Ix! .i,[..x., DEF:']"H TO F:' ]: I:::'lii!, BOTTL]M < ~t, ,, 0 F::T' ,, MAY RE[;;!U I F?E q !.... I F'T .?FAT ]: (IN ,)~..~. (3F~'.AVEI. L.ENGTH > 75 F:'T, F:~'.!E£;!U Z F:t'.ES [*'l(..J L.T I I:::' I,... !E RUNS (NC)T I!!!:X CEIE.f.) I NE~ 75 F'"r'. Ei:ACH ) · ~..~. TANK MUST l...hr:~VEi: AT L. IEAST TWC) (];O.fflF'ARTMENTS t (::: e ~- 'L :i fy that:: f'cH"'Lh by 1:.he Mur'licJ. pa].:[ty (::if' Anchor'ag~:~ (MOA) arid 'Lhe State c:)f' Alaska, 2,, :l: wil 1 :i. nst. al ]. the system :J.r'i atc:c:c)r'dar'~c:~e ~/,~j.-l:.l"~ al. ]. MOA and :i.n compl :i. ance ,/.~J.'Lh the ,:::!e)sJ. DFi c:* :i.t~,r' ia of th:i.s per'mit ,, :~,, I ~.~,:i.!] adher'e to ali PIOA and St,ate (::~{' A].a~;ka r'equ:i.r'emerrLs .['cm the set bac:k ~:!ie~¢,~(.z,H"a(;]e ~;y~!i't'..(,:~,)Jrl c:H] 'LhJ. s of any adjac:eFYt:, of r'i((,~ar'by [ L.tF1CJ6er'~BCa:¢d"JE} 'J:.hat 'it. his i::)ePn1:J.t :i.s v4:~tZ:J, cJ ¢(:]I" a~. ~)laXJ. ffILu~] C)~' 4. b(:?(::lr'c)c)ms ar'id any er'~:l, aPgen'~en'(: wi].! p,:(.:.)clu:i. Pe ar'~ a(::ld:i.'Lic]r'~al tF A LIF:'T STAT[ON ]:S :[NSTALLE~D !:N AN ARE:A COVECF~'.IED BY IdOA BU:[LDING CC)DE:S,, TI,..IE~:N(:[~ hN EL. ECTF~]:CAL.. F:'EF;:M]:T AND ZixISF::'EC]"]:ON MUST BE C)BTA]:NED; (2) AS-BLJIL..T'S WIL. L NOT BE AF:'F:'F:ROVED NI'T'HOUT AN E]..IEC;TRICAL. INSF'EE;T]:ON F:;:E]:::'C)RT~; AND (3) THE PERFORMED FOR: LEGA' DESO.,PT,ON: 1 4 7 9 MUNICIPALITY OF ANCHORAGE D£PARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE I SOILS LOG [] PERCOLATION TEST SITE PLAN lO 11 12,-- 13 14 15 16 17 18 19 2O COMMENTS A. Sh~r WASGROUND W^TER //,.) t ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND .~ FT CERTIFIED BY: DATE:. 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING t'~'~ ~-/~ to ~-I - r-~,(~ HAA # I~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 14; Block 16; North Woods #4 (b) Location (address or directions) 21645 Sheltering Spruce Property owner .~%:P~i,~-% ~L,~.~t Mailing Address Telephone: (home) . Business (c) Lending Institution Mailing Address Telephone (d) RealEstate Company and Agent JACK WHITE COMPANY ATTN: Lqnda Banner Address 10928 Eagle River Road Eaqle River, Ak. 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here,V~, if hold for pick up.) List contact person and day phone number below: S & S ENGINeERiNG 1 ;'024 E-~gle River Loop Road Eagle Riverl Alaska 99577 2. TYPE OF RESIDENCE Single-FamilyCX Number of bedrooms 4 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-sitexE;~ 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. 72-025 (Rev. 7/88) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMAT'i~ AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigat~ Health Authority Approval shows that the on-site water supply and/or wastewater disposal system'~ funct ona and adequate for the number of bedrooms and type of structure indicated herein. I further veri~ based on the informat on obtained from the Municipality of Anchorage files and from my investigation% inspection, the on-site water supply and/or wastewater d sposal system is in compliance with all Municipal State codes, ordinances, and regulations in effect on the date of this inspection. Telephone 4~'~ ~" ~'¢~ ¢ Name of Firm Address __ Date S & S ENGINEEr. lNG Eagle Eiver, Alaska 6. DHHS APPROVAL Approved fo~ z~ bedrooms by Approved ' ~'' Disapproved Terms of Conditional Approval ~'¢A FrIN- Date Conditional 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 M un ici pality of Anchorage is not responsible for errors or omissions in the professional eng'neer s work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ENVIRON'V'v MENTAL sERVICt~'~J~N Lega Descrpton ~ /~; JUN 1 4 1990 ~],~ ~ ~ ECJ,~V E ~ "A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Total Depth Static Water Level Cased to __ Depth of Grouting Pump set At Casing Height Above Ground Electrical Wiring in Conduit(Y/N) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~-~ "~ · , On Adjoining Lots To Nearest Edge of Absorption Field on Lot 2. CO -k ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~_~-/I-~_~" Size ~ No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) DepreSsion over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ~ ~ ! /O/iA ;for M/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / To Water-Supply Well ~ O~ 'J' To Building Foundation To Property Line I 0 '/' To Disposal Field To Water Main/Service Line To Stream, Pond, Lake Or Major Drainage Course NJ/~q Comments ~ ~p ."~'r__~ ?)~a~.d io 72-026 (Rev. 7/88) Front Page 1 of 2 : C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata.- Date installed ~"- / ~ - ~5 Width of Field ,2.~ ~ Square Feet of Absortion Area Depression over Field (Y/N) ~ Results of Last Adequacy Test 1.5 -~ £ - ~ (Jtoo SEPARATION DISTANCE FROM ABSORPTION FIELD: / z-~O ~/~,;~ TYpe of System Design Length of Field _ ~o~ Depth of Field ~ ' Gravel Bed Thickness - (~ / ~ 1 2_ ~ Statndpipes Present (Y/N) /~) Date of Last Adequacy Test To Water-Supply Well _ ~_,OcP /-/- To Property Line / O "/- 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 ; On Adjoining Lots .~0 "(' ! 0/'/- _ To Cutback (if present) -- ' To Existing or Abandoned System on Comments D. LIFT STATION Date installed Size in Gallons .- ''Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments - Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/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 inspection. Signed S & $ ENGINEERING 17034 F. agle RD/er Loop Road No. 204 Company .., Date - UOA.o. Date of Payment _ (~ ~ / 5/-~ Waiver Fee: $ Amount: $ / ~ t/~ Date of Payment 72-026 (Rev. 7/88)Back Page 2 of 2 I i DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 June 12, 1990 STEVE COWPER, GOVERNOR 563-6775 S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Attn: Roger Shafer PWSID: #213001 According to the records on file in this office, the Cbu~iak Util~ies/Nortbwood Deerhorn Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Richard Sunder Environmental Field Officer RS:bas MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 ~AL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Name ~ '~J ~'t'/'~-'/.,~c~-P~Pr~bone: Home ~p ~ ~ '~7~/ Business (b) Applicant - ~ ~'~ ~ ~N~iNEE~I~ Applicant Address . ~ SRB 196X ~ (C) Applicant is (check one): Lending I.~a_~~ner/build~; Buyer ~; Other~ (explain); (d) Lending Institution .-.t/_./¢-~ ~ ~ Telephone Address (e) Real Estate Company and Agent Address Tel.ephone (f) '.~1~1 the HAA to the following address: 2. TYPE OF RESIDENCE Single~Family,~ Multi-Family [] Other Number of Bedrooms ~ WATER SUPPLY IndividUal Welt [] Community r-I Publicx Note: If community well system, must have written conf rmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL O~site/{~ 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. 72-025 (11/84) Page I 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 regulations in effect on the date of this inspection. Name of Firm Address Date Telephone Approved for F43 ~(~drOOms b Date Approved ..._ .~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~-'/ ¢ MUNICIPALITY OF ANO'IOIV~E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION D r't"i: I 11: I~l=~L-I V ~AdP Well Classification ~2 Well Log Present (Y/N) Total Depth Cased [o Static Water Level Casing Height Above Ground Electrical Wiring m Conduit (Y/N) Separation Distances from Well: To Septic/Hehi~i.~j-'Tank on Lot If A, B. C, D.E.C. Approve~ (Y//2~ Date Completed Yield Depth of Grouting Pum p Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ ~ / : On Adjoining Lots To Nearest Edge of Absorption Field on Lot 2.~ '~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ~ ~ To Nearest Public Sewer To Nearest Sewer Serwce Line on Lot ; Date Comments SEPTIC/~TANK DATA Date Installed (-~////~ 'j'''' Size /Z~ NO. of Compartments StandpipeON) '/ Air-tight Cap:(~4) Foundation Cleanolut (~) Depression over Tank (Y~ Date Last Pumped /'J ~ Pumping/Maintenance Contra'ct on File (Y/N) /'d ///~' for -- Holding Tank High-Water Alarm (Y/N) ~//A_~ ,Tern porary Holding Tank Permit (Y/N) Separation Distances from Septic/H~Tank: To Water-Supply Well To Property Line To Water ~,~dService Line Course To Building Foundation ~¢- / To Disposal Field .,,/42 ! To Stream. Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorp.~t~on Strata Width of Field Square Feet of Absorption_Area Depression over Field (Y/¢ Resu [ts of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ To Water M~q/Serwce Line /O t.¢_ To Stream/Pc nd/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments //~t. Type of System Design Length of Field . Depth of Field Gravel Bed Thickness Stand0ipes Presenl~) Date of Last Adequacy Test ? o/~ /0 To Property Line To Existing or Abandoned System on : On Adjoimng Lots ,~O To Cutbank (if present) D. LIFT STATION Date Installed S~ze in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes [Y/N) Dimensions Manhole/Access (Y/N) /2Pump/Off" Level at lA/ / ~)¢~t (Y/N) . /Pu~pin~'~g Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bed room Rating Against HAA Request '" I certify that l have checked, verified, or conformed to allc~OA ~:~ HA~A g uidelines in effect on the date of this inspection. ~ ..,~,.c~l:ltlk, i~. Date ' ~//' ~d Signed ~'& =. _;.-.J ....... : ~ / ,/ Receipt No, Date of Payment Amount: $ Page 2 of 2 72-026 11/841 DEPT. OF ENVIRONMENTAL CONSERVATIO ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the~~.//~ Water Regulations Water System is in compliance with the St.ate Drinking