HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 24
~-'X MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONNIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE I ~' NEW
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATIQN NO. OF BEDROOMS
~ OlSTANCETO: I{,¢mmun l I 5' Dwelling
Liq. cr~a3~in gallons I~ H;MEMAD~: Inside length Width Liquid depth
~O ~ DISTANOE TO: Well Dwelling PERMIT NO.
~ - ~ Manufacturer Material Liquid capacity in gallons
Q Wel ~ Foundation ~ I Nearest lot line PERMIT NO.
~--=~ ' ' ~ ~0 inches Distance botween lines ~1
No. oflines ~ Lengt~ of each .e~5j Total length ofl, , Trench
~ F Top of tile to finish grade I Material beneath tile Total effective absorption area
~ ¢0' ~ inches 7~
~ ~ Length Width Dept~ PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m DISTANCE TO: Well Building foundation Nearest lot line
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
b~p OF HEI
APPROVED DATE LEGAL
DEPSF..:TPiE"NT OF' HEFILTH FIND EN'v'IRONMEN'FFIL F F..UTEL. TION':':"' -"
......... L. STREET., FINCHOF.:FtGE., FiI< 99501
~. _,4 -4 r' ,~-M
F'ERMI t" NO-
DFtTE I$SLIE[:~:
84 0 ::L E: 3
04.,..":'L 0 ."S4
RFF L I L.l. li'~ r.
FIDDRESS:
C:ONTFICT PHONE:
_, rE, ENL.. SKFIGGS tgOI",ISTRUCTION
P 0 E;O;~.:; 6':?'06'S~0
LEGFIL DESCF~::i' p:
LOT SIZE:
L. OT LOCFII-~i]N:
rl~,,.., BEDR ]OMS -
SUBDIVISION: NORTHHOODS IV
SECTION: 3 TOWNSHIP: iSN
2705<4. ,::E,Q. F'T. OR RCRES)
SNOHFLOHER LOOP
LOT: 24
RHN.~E: ±H
E:LOCK' :;L6
GRR'v'EL DEF'TH ,::FI". )
TOTFIL DEPTH ,.'.'FT. )
GRFIVEL. WIDTH ':.'FT. )
GRRVEL. L. ENGTH (FT.)
GRFtVEL 'v'OLUME (CU. '¢DS. )
TFINK SIZE (G~LS)
SOIL RRTING (SQ. F'T ,.'"BR)
5.0 0.5 2.5
9.0 4.5 7.5
2.5 20.0 5.0
52.0 29.0 56,0
26.4 28. 8 41. 4
i~00~ 0 ** 1,000. 0 ** t, 000. 0 **
172 172 172
*:+: 'FFtNK MLIST-HR'v'E AT LERST THO COMF'FIRTMENTS ,
.'i: C:ERTIF¥ ]"HFIT-
1. I RI'"I F'RHILIRR HITH 'I"HE REQUIF.'EMENT':; ....... Ff]F.'_ . ON-SITE _,E!.IE~.=,'-': ' '- FIND HELL:,, '"' FIE'; '-=;ET
F'ORTFt [.:.:'¢ THE HUNICIFRL. ZT,¢ OF FINCHORFtGE (MOR) FINE:, THE STRTE OF FILFISKFI.
;2. Z HILL IN:TTFLL THEE }";"FSTE~' IN FIC':CFIRDFIN-"E_ ... WITH FIL. L I"IOFI CODES RND REt~JLHTZLN~.,' '1 ....
FIND IN COMPLIFIHCE I.,.IZTH THE DES.ZGN C:RZ]"ERIFI OF THi.=,
· '- ERflZT.
Z.. Z HILL. FIDHERE TO FaLL HOFI RND F:;TFI'I"E OF FIL. FISKFI REgtJZREMENT:S FOR THE '--';,ET BFICK
DISTRNC:ES FF:..'Ohl F!N"r' E;:'::I:S'TING P.IELL, HR':];TEI.'JRI"ER [.I--,FU.:,FIL" '- ' - '-' :"'"- " OR '1 -.
-,~ :,TEl1 F ~IBL ]u
SEP~ERFIGE S'¢STEM ON T'HZS L")R FIN'¢ RDJKtL-ENT 3F.' NEFIRB'¢ LOT.
4.. I UNDERSTKtND THFIT TH~S F'EF.:M~T ZS '¢FI[.ZC, FOR FI MFIXIMUM OF' 3: B.F~£:,F.:OOMS FINE;,
FIN'Y ENL. FIRC¢:EP1ENT HILL I;..E.b!UZRE:' :"- ' FIN FIDDZTIONFIL F'ERMIT.
~F' Ft I..]iF'T STFIFION ~['_-"; INSTFILLED IN FIN FIREFt C:O'v'ERED B'¢ MOR E;LIZLC,~NL3 CODES;.,
-HEN (:L) FIN ELECTRIC:FrL. PEF:!M~T t'qND INSPECTION MJ:,T
~ZL.i.. NOT BE FIPPR'OVEF.. HITHOUT I~N ELEC'TRICFIL. INSPEC:T~ON F..EFLRT.~ FIND :."2) THE
]....ECTRICFIL HORk' MJST BE DONE B"r' FI L-ICENSED ELECTRI.~IFIN.'
; I G N E C,
F'F'L I CI'3NT:
'-'- ''-'~ E'~'
-:,.:,UE[ ......
L. ISTE[:, E,'ELOP.! F:IRE THE OF'T'ICINE~ FI',/FIII_FIBL. E 'TO '¢OLI IN DEL=;IGNING '¢'Z .R ':. "" ~
.... _,EF 1 I U
:,~:,TEIi. E:F]-r:..]E TFt[C OF'TION THR]' BEST FITS-'; "r'OLI.F..: SITE.
'to r ,' - - ........ :: :'' ......
...... "- -- ~- -~ - g:. F-.' 1"':~ I
· ' IFE E'.':OTTOH ,'FT. ', 4. 0. 4/0 4. 0
SOILS LOG
~U~ICIPALITY O~ ANC.ORA~E ~ ?¢0 /~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720 TEST
SOILS LOG- PERCOLATION TEST
J;'//~ ~cZ ; SLO.E -S,TEP,AN
1
2--
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net Depth to
Time Water
Net
Drop
PERCOLATION RATE
2
(minutes/ir~ch)
72-008 (6/79)
, ~ FT AND J FT
::'-h ,'~'~ MUNICIPALITY OF ANCHOP, AGE
D!~PT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
DMSION OF ENVIRONMENTAL HEALTH
D~A~MENT OF HF~.LTH AND ~V~T~L PROT~ON-
1. ~eneral ~nfo~.~tion ~pli~tion ~ate .R EC E tV E D
(a) Legal D~scrip~tion (include ~ot, block,
Su~iv~si~,
section,
townshin,
range)
Locat~0n (address o~ ai~ect~ons;
(b) Applicants Name ,.~.-/-f"bl(~iq ~.,.~/~.,.-~.J~j~' ~" ''
(a) Applicant is (check one) Lending Institution
Buyer ~ ; Other .L~. (explain); ~k/~_/~i I/.~,
(d) Lending Institution
Te le phone
Address
(e) Real Estate Co. & Agent
Add~ess
Telephone
2. Type of Residence
Single-Family [~
Number of Bedroo;~
3. Water Supply
Multi-Family ~-~
O~e=(des~i~)
Note:. If cc~mJnity ~11 system, must have w~itten confiz~Jetion f~cm the State
Department of Enviropm~ntal Conservation attesting to the legality and status.
Is the ~11 adequate fo~ the number of bedrocms specified in this' F~A (Y/N) ~((~
4. Sewage Disposal
Onsite ~ Public ~ Co~,,~nity r--] Holding TamJ< ~-~
Is the wastewater disposal system adequate .fc~ the numbe~ of kedrocms (Y/N) ~
[Page 1 of 2]
2-15-84
Engineering Firm Providing Inspections, Tests, Data and Information
I c~rtify that I have checked, verified, o~ confo£,~d to all MOA ~A
effect on the date of this inspection.
6. DHEP Approval
Approved for ~__~
Approved ~
( ENGINEER SEAL)
Disaptmzoved ~
Terms of .Conditional Approval
The Municipality of Anchorage D~pa~tmmnt of Health and Enviror~ental Protection does
not guarantee the continued satisfactory perfo~,~%3nce of the water supply and/or the
wastewate~ disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an er~irmer registered i,]
the State of Alaska, the water supply and wastewater disposal system is safe and fun~
tional fo~ the number of bedrcx~ns and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
ae
~nr. fI~TA
Well Classification
Well Log P=esent .(Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Elect~ical Wiring in Conduit (Y/N)
Sepa~ation Distances'f rcm Well:
To Septic/Holding Tank o~ Lot
To Neaz~st Edge of Abso=ption Field on Lot
To Nearest Public Se~r Line
Cleanout/Manhole
Water Sample Collected By
Water Sample Test Results
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
Nr r"fbwcocj5
.Legal: Lof ?.4, E fock tS, 8ec loo
To nsh, -, /SN, / nn. e
A, B, C~ C, D.E.C. Approved(Y/N)J ~
If
Date C~leted Yield
Pump Set At
Depth of Grouting
Sanitary Seal on Casing (Y/N)
Depression A~ound Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Se~r
To Nearest Sewer Service Line on Lot
; Date
C~,,~nts .
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-/~-~- Size I000 $,ql, NO. of Cc~pa~tm~nts
Standpipes (Y/N) ~d5 Air-tight Caps (Y/N) {6~ Foundation Cleanout (Y/N)
Depression ove~ Tank (Y/N) /~D Date Last Pumped -' /~'~,j)
Pumping/Maintenanc~ Cont=act on File (Y/N) ~-' ; for '
Holding Tank High-Ware= Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances f~cm'Septic/Holding Tank:
To Water-Supply Well + ~00
To Property Line
To Water Main/Service Line
COurSe ---- ,,
· Co~v~nts ,
TO Building Foundation ~!
To Disposal Field ~!
To Stream, Pond, Lake, o~ Major D=ainage
[Page 1 of 2]
2-15-84
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~!
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ~
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Separation Distance fTcm Absorption Field:
To Water-Supply Well .4- ~/ To Property Line /~/
To Building Foundation ~/ To Existing or Abandoned System cn
not ~- ; on Adjoining Lots -~-/~2~ !
To Water Main/Service Line /,~ To Cutbank(if present)
To St~eam/Pond/Lake/c~ Major Drainage Course
To Driveway, Parking Area, c~ Vehicle Storage Area ~!
Counts
De
Date Installed
Size in Gallons
"P~,~ 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
Cu~,,ents
** Check Permitted Bedroom Ra~inG Against HAA Request ** ~ ~f~O~% '
I certify that I have checked, verified, or conforwed to all MOA HAA Guidelines in effect
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
ENGI~E_.o
SEAL
2-15-84
DEPT. OF ENVIRONMENTAL CONSERVATION
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
DATE :~/'~ .b/U,]
PWS I.D.
BILL SHEFFIELD, GOVERNOR
~
Telephone: (907)
Address:
274-2533
To Whom It May Concern:
c~L~cording to [ecords
Water Regulations.
on file in this office the k/(x]'~,~-{/J~}/~b~.~
Water System is n compliance with the State Drinking