HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 26
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 PHONE
MAILING ADDRESS ~ !
LEGAL DESCRIPTION /
ell Absorption
m~= Manufacturer ~,}~ J ~'X Mater~J/~ r~ 'No. of compartments
Liq. cap)c~& ~,ons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer
Z -- ~ Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
~ ~ DISTANCE TO:
~ ~ ~ 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 Total effective absorption area
~ inches
Om Length ~ $ Width ~Ot Depth~g PERMIT NO.
~ TgPe°'cr'b~/~ Cribd'ameter ~ Gribd°"th ~/~ T°taleff°ctiu°abs°rpt'°nar°a
~ Clas~ ~ ~epth _ Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: ~uilding ~undetion Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
D-3o 4
SOl L TEST RATING
iNSTALLER
REMARKS I I
J
oz',/-
°F-iL I -f'* ' -~- FII'-~C:HORAGE
DEPHRTMENT OF HEALTH FIND ENVIRONMENTAL PROTECTION
825 L STREET., BNE:HORaGE, aK 9950"1
;2'64-4?20
PERMIT NO:
DaTE ISSUED:
840i8~
04./iS/84
aPPLICaNT:
aDDRESS:
CONTI"qCT PHONE:
S;TEVEN [ .... SKAGGS CONST.
PO BOX 670690
CFIuGIaK, RK ~567
688-.28S1
L..EGRL DESCRIP:
LOT SIZE:
MaX BEDROOMS:
SUBDIVISION: NORTFtWOOD ~4
SECTION: S TONNSFIIP: Z5N
;27:.t..15 (SQ. FT'. OR aCRES)
LOT: 26
RANGE: iW
BLOCK
LISTED IBELOI.,.I ARE THE OPTIONS FIVaILaBLE 'TO '.?OU IN DESIGNING '.fOUR SEPTIC
S'¢:..;TEM. CHOOSE THE OPTION THaT BEST FITS '¢OUR SITE.
DEPTH T'O PIPE BOTTOM ,::FT. ) 4. 8 5.
GRAVEL DEPTH (FT.) 4. ¢3 0. 5 3:. 5
'f'OTRL DEF'TH (FT.) 8. E1 5. 5
GBRVEL.. NIDTH ,::FT ) 2 5 20. Ei 5. 0
GRaVEl_ LENG'FH (FT ) 68. e
GRAVEL ',,,'OLiJME (CLt. "r'[:'S. ;, 25. 8 28.
TFINK SIZE (GaL'Z;) i, 808. 8
SOIL. RRTIN(] (SQ. F'T. /BR) 169
:+::+: TFINK MUST HaVE al" I_EaST 'TNO COMPARTMENTS
I C.'ERTIF'.~' THFIT:
:.1... I F1M FFIM I L I I::IF:'. 1.41 TH THE 'F.'.EL.]L I
.~.MENT..':., FOF:: ON-SITE SENERS aND NELLS FIS SET
FORTH B'.r' THE MUNICIPaLIT'.r' OF' FII'-,ICHORFtGE (MOa) I~i'.,ID THE STFITE OF 1.3LFISKFI.
2. I NtLL IN:F:;TFILL THE S'¢STEH IN FK.":CORDFINCE !.4ITH F. ILL MOFI CO[:,ES FIN[:, REGULF-ITIONS.,
FIND IN COMPLIFINCE WITH THE [)ESIGN CRITERIFI OF: 'THIS PERMI]'
]i:.I F.IIL..L FIDHERE T'O at....L I',11]11::1 iZlN[) S'I'FITE OF I::ILI::iSI-:::a REL:.!UIREMEI'.,I"FS FOR ]"HE SET BFICK
.DISTANCES FF.'.OH al'.,l:¢ EXIS]"ING HELL, NFIS]'ENaTEF: DISPOSAL :F.;'-¢STEI"I OF.: PUBLIC
SEI.,.fEF.'.FIGE S'¢STEM ON ]"HIS OF.: FIN'¢ ~::I[:,..TFICENT OR t'.,IEFIRB'¢ LOT.
,'4..I UNDEF.'.STFIN[:, THaT THIS F'EF.:MI]" IS ',,,'FILl[:, FOR FI MFI',:-:',iMUM OF 3: BEDROOMS FIN[)
FIN'¢ ENL. FIF..:GEMEI'.,IT I.,.IILL RIEQUIRE aN FI[:,I}ITIONFIL PE:RHIT.
IF F:I LIFT STATION :IS INSTFiL. LED IN FiN aREa COVERED B'¢ MOFI BUILDING CODES,
THEN (:1.) aN ELECTRICFIL. PERMI]" aND INSPECTION MUST BE OBTAINED.; (2) RS-BUILTS
WIL. L. NOT BE (~PPROVED HITHOU]" aN ELECTRICAL INSPECTION REPORT: ~ND (~:) THE
ELECTRICAL. NORK MUST BE DONE B'¢ R LICENSED EL. EC'TRtCIRN.
I
ALASKA
.IUIROFIITI6FITAL COFITROL
~ngin~¢rin(] ~ ~uir0nmc.l~l Studies
SOILS LOG - PERCOEATION TEST'
PERFORMED FOR: ,~"/~(~V'~. 51<'.e.~.~
LEGA~DESCRIPT,O": ~/ord,~oO~ ~
1
2
3-
4-
5-
7
8
9-
DATE PERFORMED:
SLOPE
10-
11
12
13-
14-
15-
16
17
18-
19-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/o
"ERCOLATION RATE f/D
TEST RUN BETWEEN "~ , FT AND
/
· (minutes/inch}
~ERFORMED BY:
..~ ~e ,,'--r~ ~. ~ CERTIFIED BY:
1700 ~¢,q 33rd ~U~'nU~' ~Uit(' ~ · ~nchoroo~ ~let~'o 9950.3 e [907'{ 276-t361
DATE:.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF I~ALTH AND F/FV-IRONMENTAL PROTECTION
APPLICATION FOR HEALTH N3THORITY APPROVAL CERTIFICATE
1. General Information Application Date ~/~/
(a) Legal Description (include lot, block, subdivision~section, township, range)
Location (add,ess or directions)
(b) Applicants Nam~ ~(~¥~Z /-. ~'~_~ Telephone
Applicants Address PO ~d~ ~?~)_~) ~,~,~ ~_/~,~'~
(c)Applicant is (check one) Lending .Institution .~--~; Owner/bu}lder
Buye~ ~-~; Other ~ (explain)~ _~d~-c.~.;O__/O~7, ~%,,~_~c,~..~t~.,.
(d) Lending Institution Telephone
Address
(e) Real Estate CO. & Agent
Address
Telephone
2. T_k~e of Residence
Single-Family ~
Numbe~ of Bedrooms
3. Wate~ Supply
Individual Well [~
Multi-Family
3
Other (describe)
Community ~-~/ Public ~
Note: If oc~m~nity well system, must hmve w~itten confirmation f~c~ the State
Department of Environmental Conservation attesting to the legality and status.
adequate fo~ the number of bedrocms specified in this HAA ~/N)
Is
the
well
4. Sewage Disposal
Ohsite ~ Public ~ Co~unity ~ Holding Tank ~
Is the wastewate~ disposal system adeqL~te fc~ the number of bedrocms ~/N)
[Page 1 of 2]
2-15-84
5. ~ngineerinq Firm P~oviding Inspections, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in
effect on the date of this inspection.
Sigr. d by
Date
',,// ~f I '
(ENGINEER SF~kL)
6. DHEP Approval
Approved for -~ kedr ocms
Approved~
Terr~s of Conditional Approval
Disap~oved
Conditional~
Date
The Municipality of Anc~rage Department of Health and Environmental P~otection dces
not guarantee the c~ntinued satisfactory performance of the water supply and/or the
wastewate~ disposal system. This approval indicates that, as of the validation date
shcwn above, based on th~ data and information furnished b~ an engir~er registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the ntunber of bedrocks and type of structure indicated.
(mmP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
ae
Well Classification
Well Log P=esent (Y/N)
Total Depth /u;//~_ Cased. to
Static Water Level
CasinG HeiGht Above G~ound
Elect=ical Wirir~ in Conduit (Y/N)
Sepa=ation Distances f~cm Well:
~UNIOPAUn, Of ,~NO~OP, A~E
MUNICIPALITY ~ ~~ (~) DEPT. O~ HEALTH&
E~IRO~ENTAL PROTE~
~ ~~ ~ (~)
~I~ - F~R~Y 1984 MAY I Q84
c,
~t~le~d ~/~ Yie~ ~/~
Pump Set At
Sanita7 Seal on Casing (Y/N)/U//~
D~7~ession a~ound Wellhead (Y/N)~4]/~
; On Adjoining Lots
To Septic/Holding Tank cn Lot .7~3~Z30l
To Nearest Edge of Abso=ption Field on Lot >',3~nI ; On Adjoining Lots
To Nearest Public Sewer Line
Clean(mt/Manhole
Water Sample Collected By
Water Sample Test Besult~
~7/~ To Nearest Public Sewer
~/A-'To Nearest Sewer se=vice Line on LOt
O, am~P. ts
BJ
SEPTIC/HOLDING TANK E~%TA
/
/ /
Date Size No. of C~,~a~t~ents ~--
~N) Ai=-tight Caps
standpipes
Dep=essio~~'over Tank (Y~ Date Last Pumped
Pumping/Maintenance Cont~actt/ on File (Y/N)'/~'/~ ~ ~ /U//~
Holding Tank High-Water Ala~u~ (Y/N) ~'/~ Tempo~a~ [{oldin~ Tank ~Permit (Y/N) ~-/~
Separation Distances f~m Sg. ptic/Holding Tank:
'To Wete~-Supply W~ll [~'~ To Building Foundation ~///~/'.
To P~opert¥ Line ~
To Watezr Main/Se~Vice .Line
Co~nts
·
To Disposal Field
To St=earn, Pond, Lake, (x Major D=ainage
[page I of 2] ':
2-15-84
C. ABSORPTION FIELD
. Soils Rating in Absor~ption Strata
Date Installed
Width df Field
LenGth of Field
Depth of Field
Gravel Bed Thick~ess
Standpipes P~esent
Square Feet of Absorption A=ea
Depression over Field (Y~.~ Date of Last Ad~_quacy Test
Results of Last Adequacy Test
Separation Distance f~cm AbSc~ption Field:
To Water-Supply W~ll Mj//~ To P=ope~ty Line
~{)~ To Existing or Abandoned .System cn
; On Adjoining Lots ~0(
To Building Foundation
~ D~te~ D~i~v/Bervice Li~e
To Stream/Pond/Lake/or Majo~ .~ Course
To Driveway, Parking Area, or Vehicle Storage Area
Date Installed
Si~e in Gallons
"Pump On" Level at
High Water Alarm Level at
~Tested fo~
. Electrical Codes
Cu~m~nts
,Manhole/A cess
Off" Level
Vent
** Check :Permitted Bedroom ~atinG Against HAA Bequest
certify that I have Checked, ~verified, c~ confcz~ed to all MOA I{%A ~uidel~nes lin effect