HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 25
Municipality of Anchorage Page ~ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~t~{5~:a4~ /5~1,4~ PID Number: ¢:::~
Name:
~ff~ ~ ~ Wastewater System: ~ New ~pgrade
Address:
~1 ~~ ~ ~~ ABSORPTION FIELD
Phone:
~__ ~ J No. ofae~oms: ~ Deep Trench D Shallow Trench ~ Bed ~ound ~ Other
LEGAL DESCRIPTION so, Rating: Total ~epth from original grade:
t Block: bdi Depth to pige bottom from original grade: Gravel depth beneath pipe
Fill added above~riginal grade: Gravel length:
To~:~ ~ [Ran~ ~ I S~ ~ ~ -- ~' Ft. ~ Ft.
WELL: D New ~ Upgrade Gravel~_, ~ :J~
Number o ines: Distance between lines:
~[~ ~ Ft. ~ Ft.
Classification (Private, A,B,C): J Total Depth: Cased To: motar absorption area: ~ipe material: ~ ~
Driller: Date Drilled: Stat~cWater Level: ~r' ~ Da~ ins~e~
Yield: Ft. ~ ~ 7;~[
J Pump Set at: [ Casing Height Above Ground: ~H
~ ~'. I ~,. ~ ~ TANK
SEPARATION DISTANCES n Septic olding ~T,E.P.
To Septic Absorption Lift Holding Public/Privat~Manufacturer: Capacity i~ gallons:
From Tank Field Station Tank Sewer Lines
X Material: Number of Compartments:
Surface
Water ~ ~ ~ ~ ~ LIFT STATION
Lot
Line ~1~ ,.~ ~;~ ~ ~ Size in gallons: Manu~ ~ ~
I ~ "Pump on" level at: J "Pump off" level at: I J High water alarm at:
Foundation ~ ~t ~ ~ ~ ~
Curtain ~ ~~ P.~pMake&Mode, JE'ectrioa',,,pection~perfo~m~aby:
Drain
Remarks: BENCH MARK
Location and Description:
~[~ J AssumedElevation:~ ~ ~,
Inspections performed by: s & s ENGINEEEING ~ ~.~ ~ ~-~
Department of H es app val h ~/;,,.
Reviewed and approved by: ~~ Date: ~ 2~-~ ~ ~-' ...... ~'~
72-013 (1/91) MOA 25
Permit No. '~/'~J~IOD~-
Page.
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: I,,~ ~I_G ~)~-,,"r'k~l/Joo]::::~ ~
PID No.:
10'
72-013 A (2/91 I MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SWg10044
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:NEILSON STEVEN A &
OWNER ADDRESS:P.O. BOX 670902
CHUGIAK, ALASKA 99567
PAGE 1 OF 1
PARCEL ID:05106457
DATE ISSUED: 4/03/91
EXPIRATION DATE: 4/03/92
LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK
25
LOT SIZE: 27108 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
16 LT
THE ATTACHED APPROVED DESIGN.
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0).
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~
ISSUED BY,'~~~~
DATE:
DATE:~__~__~/
· Pern~t No. ~ ~lo,O~z}
Page_ ~-' of_ z-
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, AlaSka 99519-6650 · Telephone: 343-4744
On-Site Waslewater Disposal System and/or Well Inspeclion Report
Legal Description:
PID No.:
'c
. Municipality of Anchorage Page ~ of '7_.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: c~ ~ C;~c:~,dr~ PID Number: c:~l ~
Na~.~ ~
~ ~1~ ~ Wastewaler System: ~ New ~Upgrade
Addre~
~ ~~ ~, ~~ ABSORPTION FIELD
Phone:
~ -- ~1 ~ ~ No. of Bedrooms:
/
~ D Deep Trench D Shallow Trench D Bed ~ound D Other
LEGAL DESCRIPTION so,..~.~: ~,~ ~.D/Sq. ,~. ~o~.~ ~,~ ~,o~ o,~.a~:
LO~ Block: Subdivisiop: [
~ ~ ~ ~ ~~ ~ ~~ ~epth to pipe bottom from original~,grade:~Ft. Gravel depth beneath pipe~, ~t,
· o~~ J~.n~:~ ~ ~.~~ Fill added above original grade:Gravel length:
~, ~'~ f~. ~ ~t.
WELL: D New ~ Upgrade Grave~ depth: [ Et Number~nes: jDistanceb~en~ lines:Et
Classification (Private, A,B,CJ: Total Depth: Cased To: Total absorption area: Pipe material: ~
Yield:
{ Pump Set at: Casing Height Above Ground: -- ~
GPM J k Ft ~ ~t. ~ /' { lANK
~E PpaAT' 'N D'STANCE~ ~ 4t~tic I~ ~HolOing Z ~S.T.E.P.
Fr~- T~ ~epdc Ab, ,tion Lift , ~ ~u~va,~ M~tur~r: ~ [, Captain 'gallons:
.... - .ank . d Station V/~nk Sewer~i~; mlC~. - I ~
Well~ ~ ~ J~ ~'~ 7~ ~,~, '~ Mater;~~ ' ~f[ ~be;:~;erofCompartments:
Surfac ~ ; t [ ~
Lot ~ I . .
~X'~ I (~ ~// Slzein~onA: IManufa~t~r: /~ I
Curtain ~ ~ Pum~ ' L , I
. ~ X~XJ , t , [ / / I ~ pMake/~del Elec:rrcallnspectlons performed by:
Drain ~ON~[~ ~ ~'~ ~'~ ..dJ~ I
Remarks: ~~ ~~ BENCH MARK
~ ~O ~ A I) ~, J Assumed Elevation:
ENGINEER'S ~EAL
Inspections performed by: ~7034EagleEi~"L"pReaa~1St ~'l~-~[ ~~;
Eagle River, Alaska ~5~ 2nd ~1~-~
Department of e~h and Human Services approval ~
Reviewed and approved by: Date: ~ ~+~ V~,,-,~,~
72~13 ~1/91) MOA 25
Permit No.
Legal Description:
~l° ~)~Z~ Page ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
of 2.-
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
t
SEAL
72-013 A (2/91) MOA 25
March 29, 1991
ROBERTSHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 25; Block 6; North Wood~ Subdivision #4;
"PEWIT REQUEST NARRATIVE"
Request you issue a permit to upgrade the septic system serving the
referenced property.
For financing purposes we performed a septic adequacy test on March
12-14, 1991. Unfortunately we found the absorption capacity of the
leachfi~ld to be approximately 200 gallons per day.
In viewing the Municipal file it appears the leachfield may have been
installed too close to a nearly dmpermeable soil layer as shown in a
soil t~st performed by Alaska Environmental Control Services
(A.E.C.S.).
On March 22, 1991 we p~rformed soils testing toward the north of the
property. In these test holes we did not encounter the poor layer of
soil found by A.E.C.S. Percolation rates were found to be 20-27
minutes per inch.
Although the groundwater depth in the area is not extremely shallow at
this time, we have designed a shallow bed requiring a lift station
because the area is known for fluctuating groundwater depths that tend
to be shallow during spring and fall months. We are also aware of s~mp
pumps installed within the crawl space of the home.
The area around the proposed absorption bed is generally flat. Care
should be taken to grade around the mounded bed to allow adequate
surface dr~nage away from the system.
Since the properties in this area arc larg~ and s~rved by a Community
Water System, we cannot foresee any negative impacts to surrounding
properties by the installation of the proposed system.
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Page Two
Lot 25; Block6; North Wood~ #4
March 29, 199~
If yo~ have any questions,
please co~a~ u~. or require additional information for your review,
//~x~r ~. s~[~, p. ~.
Igm
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
2
3
4
5
6
7
8
9
10
11
12
13,
14
15
16
17
18,
19
2O
SEAL)
Township, Range, Section: ~[-t~:~ ~ j__~Z_\
~ SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? O
Depth lo Waler After
Monitoring? ~ Dale: ."'~-"~--~1-'~1 I
Reading ~ Gross Net Depth to Net
uate I Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER _ ~ cf
EC CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE T ON THIS DATE. DATE:
72-008 (Rev. 4/85) y
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
PERFORMED FOR:
LEGAL D ESCR I PTIO N:, '~_'~... ~
1
2
3
6
7
8
9
10
11
12
13
14
15
16~
17
18
19.
20
DATE PERF [ I
Township, Range, Section. ,,'"¢"-~,
~¢f,~ SLOPE SITE PEAN '
WAS GROUND WATER
ENCOU.TEREO /4-5
il~ YES, AT WHAT h
DEPTH7 O ~
E
Oeptl~ to Water Alter ~
Moniloring? ~ ~ . Date: ~ '~-~ ~
Date
Gross
Time
Reading
Net Depth to
Time Water
Net
Drop
PERCOLATION RATE '~ ''~ (minutes/inch) PERC HOLE DIAMETER ~' '~
COMMENTS. ,..." /
-¢¢ ........ · ........... ~ ' I~/_/ V CERTIFY THAT THIS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUlDELI~T ON THIS DATE. DATE: TEST WAS PERFORMED IN
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
MAILING ADDRESS I i I~~ J ~ UPGRADI
LEGAL DESCRIPTION I
NO. OF BEDROOMS
~; lA ¢/¢~Ve Oep Absorpt,o. area Dwel PERMIT NO.
~ Manufacturer~ t-' - ~1 Materia~¢~
~¢ ~iq ca aclt ,~¢~ ~¢ W~ No. ofcompartmonts
'7~ s iF HOMEMADE: Inside length Width ' Liquid depth
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ Manufacturer
Material Liquid capacity in gallons
~ Well Foundation
~ DISTANCE TO: Nearest lot line PERMIT NO.
~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
~ inches
Top of tile to finish grade Material beneath tile
D Total effective absorption area
m Length Width Depth ~ ~ inches
~ ~/~ ~/ PERMIT NO.
~ OJas. ~th ' ~ucdation Nearest lot line
~ ~~ 11 Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: B¢ildlng foundation Sewer line Septic tank Absorption area(s)
OTHER
P~PE MATERIALS ~
b3o3
SOIL TEST RATING
INSTALLER
REMARKS ~ ~
J I 94 -~
~' / . 18'. ;'; ;.,' r :,- :' ,,
APPROVED DATE LEGAL LO?~
L':~EPI::!F.'YTHENT OF:' FIEF::tLTH FIND E'N'v'I RONHE1'.,ITRL PR"3TEr::T.T. (;)1'.4
.... ='... L :, Rrz. E T., FINCHF~DR GE, - RK =~ :~ .....
;21E;4--47'28
F ERi".I F NO:
DFITE I SE. Er.:,:
FI F' P I. '[ C FI N T:
I. 1[:. [: N,'-"..:,:.', '
C'" NTB' T PHONE
STEVEhl L. SKFIGGS CONST
PO BOX
CI...:UGtRK., FIK 99577
I,...EGFIL E:,ESCR I P ·
:5. E: I'" I ',/1:5 ]: CtN - NUF, THI.. UI...! ..,
:;, :.L..]' ~ ON · ::.~: TOWNSH I F' ' ..t._ TI
;;:.~}:':i,.,'..'-.'~,'.-.']: ,:: :'::;g!. F:T. OR Fu:::RES)
L. OT: ¢:,,
RFINGE: :lJ.,.I
BLOC:K: 46
I,.......:,TE[. EIE]_.O!4 FIRE: THE CIF:'TIONE; F'l', .... ,- ., F'
",~ ZLME,L.E TO h.'~- IN [:'ESIGNING VOLIR =,EFTI_.
....... :. ]' EH. CH :]OfE;E THE OF:']" T '" l'-i ]"HFIT BEST F I'TY_; 'T'cll Ij~' :..=., I TE.
DEP]'H 'TO PIPE BOT]"OH ,::FF.
GRFtVEL DEPTH ,:.'FT.
TOTRL DEF'TH ,:.'F'T.
GRFI',/EI,.. 1.4IDTH (FT. ::,
GRR'v'EI,_ LENGTH (F'T
GRR',,,'EL 'v'OLUHE ,::CU. "r'DS. ::,
TRNt< SIZE (Gf;:lL.S)
SOIL RRTING (SgL FT. ,."BR)
4. E~ 4. t-3 4.18
5.'-3 ~.'3. 5 ]~.5
9 I.:._'~ 4.5 7.5
25 27 ~ 5.~
:t.':L8 E~ '+'-'+, 5:1... 8. 127. 8
6E~ 8 5:1.. E'I ':4,4. 8
±, 0G0. 0 :+::+: ::L., 000. 0 :+::+: :2, 008. 0 :+::+:
3 ::.';d_ ]:05 2.':9q.
:+:m ISRWv'EI,_ LENGTH. :::. ~=, ._ F:'T. F::EC)LIIRE:S HUL.'T'IPLE r4" .INc,, .... ,'Nr3T E,:.:,L..EE[.' '-' ' '",lNG' 75 FT. EFICH)
~::+: TRNK MUST FIFI ,E FIT L. EFiST TI40 COHF'FIF:YTMENTS
I CER]"IF'.r' TFIF'IT.
::L. I FIM F'FIMII'_IFIR I.'.tITI"'I THE REQLI!REMENTS FOR ON'""SiTE SEI,4EF.:E; FIN[:' NELL'.L--, FIX SET
FORTH F3"r' THE MUNICIPFtLIT'T' OF FINCHOF.':FtGE (HOF'I::' F:IN[:' THE E;TFITE OF" FILFIE;KFI.
2. I HII'...L. INSTt::tLL. THE S'T'S'TEH IN FICCOR[:'FINC:E WITH FILL HOF:I CO[:'EL:; f':lN[:' 'REGULFITIONS,
FIN[':' IN COHF'LIFtNCE !.'.tITH THE DESIGN CF;-.'ITERiFI OF' THIS PERHI]".
:.:.::. I I.'JILL.. IqI:::'HERE TO FILL I'1OF~ FIND STFITE OF FILFtSKF' RE~!UIREf'iENTS F'OF;..' 'THE SET BFICK
[:'I':T, TFII",ICES FROM F:lt",Fr' EXI'_:'71:ING HEL.[ .... HI:::t5]'E~'~FFFER DISPOSFIL S'¢STEf'I OR PUBLIC
SEHEI'T.':FIGE SV'-:~TEH ON THIS OR F'tN"r' FI[:'..TFtCENT OR NEFIRB'T' LOT.
4. i UNDEF:'.E;TF1ND THFTT' THIS F:'EF:d"IIT IS 'v'FILID I::'OF.~ FI MFI::'::IMUH OF:' :2-': BE[:'F.:OOHE; FtND
!:IN"¢ ENL. FII:~:GEI',IF:]~.~T 14 11'...i,... RE':~:!I,.J ]' I':'F FIN F:IDD I 'T' I ONFIL F'ERI't I T.
F R I,..IFT STFI]"ICdq IS INSTFII,...L..ED IN FIN F:IRE:R ..... ',,,'ERE[: B'¢ MOFI BLIILE:,tNG CODE,_=,.,
'HEN (::i,.) FIN ELI,'.':'):TF.::IE:RL PERMIT FIND"II',L.:FEL. I'--. ' '-' .... Ir]N MUST BE: OBTFIINED.; (2) ~'- ,I '
-- 14 _-:,-E, _11 LTS
IILL NOT. E]E = F'F'F:'"',,,'P[',. . HITHOUT FIN ELEETI;.'ICFIL II'.,I=,FE ..~ I E~N" '--' "-' ' REF _F.'] .~'"""-' ]'"' ' FIND ,".:- ':,._ THE
:LECTR I Cf::tL P.IORK HLL=.,T E:E: [:,ONE: B'¢ Fi L I CEN'E ED, ELEf::]' R I C: I FI
IGNED _.._ "' /% ..... _~.. ....... - _. DFITE:
:KF:IGI: T - - - ........
ALASKA , lROnmenTAL OnTROi se Jices,
SOILS LOG - PERCOI~ATION TEST
PERFORMED FOR:
SLOPE
InC.
DATE PERFORMED: 2. -2. -- ,~/'~
SITE PLAN
12
13
14 ~
15
16
17
18-
19
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading D~te Gross Net Depth to Net
Time Time Water Drop
353 /o ·
PERCO~TION RATE ~ ~-O ~
{minutes/inch)
TEST RUN BE~EEN ~ ~l
FT AND FT
CERTIFIED BY:
PERFORMED
DATE:
ALASKA ulUIROllm~I1TAL CONTROL St~s'UIC6S, IflC.
I~n~]ine~rinl~ & I~nuir0nm~nt01 $ludi~s
PERCOLATION TEST DATA SHEET
CLIENT ~ !,Eve
ADDRESS ' ' -
DATE
ZIP CODE
LEGAL LOCATION
TOTAL DEPTH OF HOLE /~ ft.
ZONE TESTED ~- ft TO -~ "~-- ft
READING // CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in)~
DATUM
' 3'. ~0 5- , ,t.~- ,o3
,%. No. '251-E ...'
FINAL PERCOLATION RATE .~ 6.0 '~""~, .,..'?:~J ~
PERFORMED BY ~¢rm ~---
276-1361
Parcel I.D.
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
GENERAL INFORMATION
Complete legal description
Lot 25; Block
16; North Woods Subdivision #4
Location (site address or directions) 21610 Snowflower
Property owner
Mailing address
Lending agency G.M.A.C.
NpJ£&n~ Day phone
.--2501 Banbu~y Drive, Anchorage. Ak. 99504
Day phone
Mailing address. A,¢hn~g¢; 4Ynxkn
Agent.Lo,ti Crowder JACK W_HITE COMPANY Day phone.
Address I0928 Eagle River Road, Ea¢le River Ak. 99577
Unless otherwise requeste~ HAA willbe held forpickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
694-5500
XX
NOTE:
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.
72-025 (Rev. 1/91) Front MOA #21
s~,uewwoo leUO!~!ppv
:suop, elnd?,s §U!MOIIOj eq~, q3!M 'swooJpeq
'SLUOOJpoq
Joj le^oJdde leUO!~!puoo --
'pe^oJddes!a
JOJ pe^oJddv X
31:InlVNglS SHHO
'9
EI=I3NIgN3 Ag NOI.I.O~dSNI 40 INqlN~]IVIS
I
~nlclpahty of Anchorage
_ [3a~artment of Health & Human Services
~I~A~h AUTHORITY APPROVAL CHECKLIST '
Legal DescriptionR ~ ~, ~L~IZ-, I U Parcel I.D.
A. WELL DATA
Well type A
Log present (Y/N)
Total depth
sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
Cased to
ADEC water system number
Driller
Casing height
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date 'of test
Static water level
Well flow
Pump level
g.p.m.
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed '~ '~ [ ~ - ~ t
Nitrate
Collected by:
Other bacteria
Cleanouts ~'N) ~7/ Foun~t~,n cleanoutd~/N) V Depression (Y/~
High water alarm (Y/N) // /A-~ Alarm tested (Y/N) _ " '
Date of pumping . /~/~.A// '
Tank size [ '~'~L~(.~?~ )Compartments
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~'//~)/v/~ On adjacent lots
To property line
SUrface water/drainage
Foundation /
Water main/service line
72~026 Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent~N) ,,(
"Pump on" level at
High water alarm level .. ~
Meets MOA electrical codes~/N) 7
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
Manufacturer
Manhole/Access~/N),~_~l ' Y .
"Pump o~at
Cycles tested
On adjacent lots ~ I~ Surface water
D. ABSORPTION FIELD DATA
Date installed
Length "~ Width "'~c~ ~
Peroxide treatment (past 12 months) (Y/~
Total absorption area
Depression over field
Results (pass/fail)
Soil rating ,/r~, z/
Gravel thickness / Total depth
Cleanouts presentd~N)
Date of adequacy test ""
for
~ If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots "~-.--¢--~ ! ~- Property line
· To existing or abandoned system on lot
Cutbank /~ r~ j~.~ Water main/service line
Driveway, parking/vehicle storage area
I
E. ENGINEER'S CERTIFICATION
verified, or conf~prme~d t~ll MOA and HAA guidelines in effect on the date of this inspection.
I
certify
that
I
have
checked,
S gnatu,~ . . /'/
170:34 P~a~le ~,ver ~d~o. 204
Engineer's Nar~gle River, Alaska 99577_
Date ¢//
HAAFee$ / 70 ~
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
WALTER J. HICKEL, GOVERNOR
563-6775
April 15, 1991.
FOR: Ray
S & S Engineering
PWSID #213001 Northwoods--Deerhorn Park S/D--ER/Chug
My review of the records on file in this office reveals.that the Northwoods--Deerhorn Park
S/D Class A Public Water System is in compliance with the provisions of 18 AAC 80.060,
State of Alaska Drinking Water Regulations.
Sincerely,
T~arnowski
Environmental Engineer
MUNICIPALITY OF ANCHORAGE
oF nTH
APPLICATION FOR HEAL/I4 AUTHORITY APPROVAL CERTIFICATE
1. C~r~ral Info~nation Application Date
(a) Isgal E~sc~iption (include lot, bl~, su~ivisic~, 'sec~cion, tc~nship, range)
Lo't' 2~' l~/~e ,~
~ation (address or directions)
(b) Applicants Nam~~~
Applicants Add. ess PD
(c) Applicant is (check one) Lending ,Institution ~-~; Owner/builder ~-~;
Buyer ~; Other
(d) Lending Institution Telephone
Address
Telephone ~ ~/-283/
(e) Real Estate Co. & Agent
Add,ess
Te le phone
2. Type of Residence
Single-Family ~ Multi-Family ~ Other (describe)
Number of Bedrocm~ _____~j~
3. ~ater Supply
Individual W~ll ~ Conmlunity ~ Public ~
Note: If coTaunity ~11 system, n~ast have varitten confirmation frc~ the State
Department of Environr~ntal Conservation attesting to th~ legality and status.
Is the w~ll adequate for the ncunber of bedrcous specified in this HAA ~.~/N)
4. Sewage Di~sposa__~l
Onsite ~ Public ~ Community ~ Holding Tank ~
Is the wastewater disposal system adequate fc~ the number of kedrooms ~/N)
[Page 1 of 2]
2-15-84
5. Engineering Firm Providin~ Inspections, Tests, Data and Information
I certify tb~t I have checked, verified, o~ conformed to all MOA HAA Guideli~
effect on the date of this inspection.
Date
( ENGINEER SEAL)
6.DHEPApproval
Ap~oved for ~-~ bedrc~,s
Appro~d ~ Disapp~o~d ~--~
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Environmental P~otection does
not guarantee the continued satisfactory performance of the water supply and/o~ the
wastewater disposal system. This approval indicates that, as of the validation dat~
shown above, based on the data and infc~mation furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of badrocms and type of struct[=e indicated.
(D~EP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
A. ~.r.r, ~I%TA
MUN~CIPALIT~ OF ANC~O~ (MOA)
HEALTH AU~DR~TY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHOI~,(~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION[
MAY 't 1984
VED
Well Classif icat ion {,~q p/7
Well Log P=esent ,(Y/N)
Total Depth fJ/;4~ Cased to
Static Water Leal
Casing Height Abo~e Ground
Electzical Wirin~ in Conduit (Y/N)
Separation Distances f~cm Well:
If A, B, C~' C, D.E.C. ApProved(Y/N)
Date Cc~pleted //U/,,jC Yield /u/~
Depth of Grouti
Sanit~ ~al
/%¢[~ .... ~messi~ ~nd ~l~ad (Y~)
To Septic/Holding Tank ~n Lot > ~O {?[ ; On Adjoining Lots
To Nearest Edge of Absc~ption Field oa Lot >~uu~ ; On Adjoinin~ Lots
To Nearest Public Se~= Line
Cleanout/Manhole
Ware= Sample Collected By
Ware= Sample Test B~sult~
C~,,~nts
TO Nea=est Public Sewer
~Jt/~ 'TO Nearest Sewer Service Line on Lot
Bo SEPTIC/HOLDING TANK ~%TA
Sta~ipes ~'~)
/,,///~-
Holdi~ Ta~ ~g~ate= ~ (Y~) ~ /~ ~=~ ~ldi~ Ta~ ~t (Y~) ~/~
~at~ Dist~s ~ ~..~ic~°ldi~ ~:
To ~te~Supply ~tl ~/~ ~ ~ildi~ F~ndati~ ~ ~'
'Field ~ 7 '
C~ ABSORPTION FIELD ,DATA
.~ 'Soils Ratin~ in Absorption Strata ~3C~/~
. Date Installed
Width of Field ~'
Square Feet of Absu~-ption Area
Depression over Field (Y~
Type of System
!
Length of Field ~
Depth of Field ~ /
Gravel Bed Thickness //3~
/~,7'~ /~ Standpipes I~esent ~/N)
Date of Last A~quacy Test
Results of Last Adequacy ~st
'Separation Distance f~c~ Absorption Field.'
To Water-Supply Well ~ ~Oo~ To P=operty Line
To Building Foundation ~ ! ~ To Existing or Abandoned System cn
T~ot aJ/A ; On Adjoining Lots ~-.{0 ~
TO Water Main/Service Line,RH- '~ t~£,j~zf To CutbaDk(if
To St~eam/Pond/Lake/~ Majo~ D~ainage'; Course
To Driveway, ~Parkin~ Area, c~ Vehicle Stc~a~e Area
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested fo~ '
Dimensions
Manhole/A~e~ss
Vent
C~nts
Check Permitted Bed~ocm ~ating A~ainst HAA B~quest
con fc~ed %x
· dequacy ~st.
i!1
DEPT. OF ENVIRONMENTAL CONSERVATION
BiLL SHEFFIELD~ GOVERNOR
mo~ 274-2533
437 E. Street
Suite 200
Anchorage, AK
99501
April 5, 1984
To Whom It May Concern:
According to records on file in this office Northwood Subdivision (Phase IV)
Water System is in compliance with the State Drinking Water Regulations.
Sincerely,
Anchorage/Western
District Supervisor
JCA/msm
cc: Alaska Environmental
Control Services
1200 Wo 33rd Avenue
Suite B
Anchorage, AK 99503