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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 27  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 [] UPGRADE LEGAL DESCRIPTION ] We~ ' I A6sorption area Dwelling i PERMIT E ~ Manufacturer ~._ t ~,. /~ Material -- &, No. of compartments ~ ~ Liq. capacity in gallons J Inside length Width Liquid depth /~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons Q Wel~ I Foundation Nearest lot line PERMIT NO.  1 Distance between lines No. of lines ~l Length of each line Total length of Trench widt~_~, _ ~ Top of tile to~ 3,~' '~ Material beneath tile Total effective absorption area ~ Q '_ ~, ~-I inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ 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 i ct INSTAELER REMARKS - , F ~ / DE,F. C HEALTH & / 4 / D:F~ ~i-r APPROVED ~ DATE LEGAL DEPFIR. TMENT OF HEFIL.'TH FIND EN'v'IRONMENTFIL PROTECT I. ON 825 L. STREET., ~NCHORFtGE., FIK 95~50± 264-4?20 PERM I T NO: [:,FITE ISSUE[:,: RPPL. ICRNT: RDDRESS: CONTRCT PHONE: L. EGRL [:,E:SCRIP: LOT .'.SIZE: P'IRX BEDROOM:E;: STE',/IEN L. SKF~GGS CONST. PO :FJO',:':', 67'06:D0 C I,-I U G i FI K., R K 9 :.:.} 5 ~:.:; 7' 68828];± 5;I:.IBDIVISI(]N: NORTPII.4OOD ~.4 SECTION: 27::L2:..':=: ,:;Si;!. F'T. OR FICRES) ]: LOT: 27 P..P 1'.4 .~E: :LH E:LOCK: :!_6 I....ISTE[) E:EI...OH FIF..:E THE OPTIONS Ft',/FIIL. FIBL. E TO "r'OU ]:N DES II]iNIi"4G 'T'OUR :,EF] I-. ::,~.:TEII. CH']..-.:EE THE OPTIOI",t THFIT BE;ST FITS '¢OUR SITE] T' ti"-;:-::: EE iP.4 nE:::: IP"It E: EE IE.> ~.,.-#. DS:" ~-~: n:::~ ][ DEPTH TO PIPE BOTTOM ,:.'FT. ) 4. 0 4. 0 4. 0 GRF4",,'EL. DEPTH '::F"T. ::, 4. C~ 0. 5 ]:. 5 TOTRL DEF'TH (F"].'. ':' 8. 0 4. 5 - 7. 5 GRFIVEL. HI[:,]"H ,::FT. ::, 2. 5 12}. 0 5. 0 GRRVEL. LEf'.,IGTH (F:'T~ ::, ¢2;0. I-Zi ]:8. 0 52. 0 GRFtVEL. VOLUME (CU. ","BE.:;. ) 25. IE~ 26. 7 ]:8. 5 TFINK SIZE (GRL. S) ::L., 000. 0 :+::+: :]..., 000. C1 $:+:' :l.., E'iO0. 0 :-i.::.i.: SOIL RF:I]'IN(]i ('_'-];IS!. F:"T'. ,:-"DR) :1.59 :].59 ::L59 :+::+: TRNI< li.I::,T HFIVE FI]" LEFIST THO I]:CIMF'FIF,;:TMENTS I C:ER]'IF'T' TkrFIT- ~I.. I BM FRMtLIFIR .L,.IITH THE REOI...IIREMEt'.~TS FOR CiN-SITE SEHERS F-IND HELLS RS SET FORTH B'.r' THE ~"iUNiCIPFIL. IT'¢ OF:' FINCHORFIGE: (MOB) FIN[:, THE STRTE OF RLRSKFI. 2. I HIL. L INS]"RLL THE S'¢STEM :[1.4 FICCOR[:,FINCE HITH FILl.. MOR CODES RND REGULFITIONS., FIND IN CCJMPL. IRNC:E HITH ]"HE 'DESIGt",I CRI]"ERIFI OF' ]''HIS PERMIT. ]:. I HILL FIDHERE TO FILL MOF:I FIND STFITE OF' RL..FISKF~ REL.]UIREMENTS FOR THE SET BFICK DISTFINCES FROi"I l":lhl'T' EXISTING HELL, LIFISTEI.'.!FITER DISPOSFIL. S";'¢STEi"I OR PUBLIC SEI4ERFIGE S'T'STEP1 ON THIS OR RN"r' RDJt'3CEI",IT OR NEFIRB'T' LOT. 4. I IJNDERSTFIN[:, 'FI"iRT THIS 'r'"ERt'IlT IS; ',/FILID FOR la MW,:':: I MUM OF ]: BEDROOMS FIND FIN"r' ENLFIRGEMEN]" t4ILL. RE6).UIRE FIN FIDDI]"IONFIL PERMIT. IF R LIFT STRTION IS INSTFILLED IN F~N FIREF! COVERED E:'T' MOR BUILDING CODES, THEN (:1_) FIN ELECTRiCFIL PERMIT FIND INSPECTION M!..IST BE OBTFIINED.~ (2) FIS-BUILTS 1.4'ILL NOT BE RPPRO'v'ED HITHOU]" RN ELECTRICRL INSF:'ECTION REF'ORT.~ FEND (3) THE ELECTRICFIL HORK MU::'~;T E',E DI]Ii",IE B'T' FI LICENSED ELECTRICIFIN. ,._-_: FIFF'Lit]:FI~T. :S'T'E',,,'EI'. '.SI.:::FtGCi'.S C~IN'ST.~ ' ........ ...... ALASKA CTUIROFIm¢ITAL COFITROL $ I6ES, IFIC. ~ncjin~rincj ~ ~nuironmcnlal Slucli~s ~OILS LOG - PERCOEATION TEST· PERFORMED FOR: ,<~--~r~._ S ~-,g qc:~ ~ LEGAL DESCRIPTION: Nor*~Wo~A ~ ~1o~ I~ Lot2~ SLOPE 1 4 6- 7 8 9- 10- DATE PERFORMED: 1 1 WAS GROUND WATER ENCOUNTERED? ~ O SI. o 12 P E IF YES, AT WHAT 13 - DEPTH? 14 15 16 17 18 ~9 PERCOLATION RATE T~E~, RUN ~IETWEEN COMMENTS _qo,'/ ,-,~-~J ~ 15~'Z7/~ -/~o~, 2 Reading Date Gross Net Depth to Net Time Time Water Drop ~ERFORMED BY: ,4~/~l~q CERTIFIED BY: 1200 "~'sl 3:~t~ ~urnU~. ~uite ~ · ~r~c~lO~o~ ~l~sl(o L~r'~.,03 · ~?'d7'~ 276-1~61 DATE: I i i 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 ~/~',~//~ d~/7/'",.~'~'~ NAA # //7/'/~ ~'~//~/7 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 27; Block 16; Northwoods #4 Location (address or directions) 21650 Snowflower Loope (b) Property owner MailingAddress John Buckner Telephone:(home) 1856 Beecher Drive Eagen, Minnesota 55122 Business (c) Lending Institution Seattle Mcrtg~g¢. (d) (e) Telephone 562-5626 Mailing Address Attn: Dick Do£ma~ Real Estate Company and Agent Re/Max of Ea~le River Attn: Audrey Mason Address I/~/~00 ~n~f~'~d D~iu~ _~ui~ #¢nl ~ag~ RZve~, A~. 99577 Telephone 6 94-4 ¢0~ Mail the HAA to the following address: (or check here I~if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING ....... ~ ........... ~ Road No. 2~4 Eagle River, Alaska ~9577 2. TYPE OF RESIDENCE Single-FamilyY~: Number of bedrooms 3. WATER SUPPLY Individual Well [] Community r~x 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-site [~z Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 , i 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 th is.. Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 'safe, functiona 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./* ~T~.-,~_~'~ ~' Telephone --- ~P Z ~ Name of Firm 5--& ~, 17034 Eagle River Loop Roacl No. 204 Address ~E-ag~r, Date 6. DHHS APPRO'~'AL Approved for_ ,~ Approved-- ~ . Date bedrooms by · Disapproved _ Conditional 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 inspe, ct!ohs or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professiona engineer's work. Page 2 of 2 72-025 (Rev. 7/88) Back 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) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / z~O./1~ 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 MUNICIPALITY OF ANCHORAGE (MOA) MU k~ ~.~,~ ~11~ikr~o~o v a I (NAA) 343-4744 MAY 8 ]990Legal Description: Date COmpleted Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) ~1 Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ! '-,--o _ ; On Adjoining Lots TO Nearest Public Sewer Cleanout/Manhole ;Date SEPTIC/HOLDING TANK DATA Installed ~ -4-~/-~Size !c of.I NO. of Compartments Date 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) . I~ Foundation Cleanout (Y/N) ~ Date Last Pumped ~-'--- ~2.~ ~ 0 , for ~ Temporary Holding Tank Permit (Y/N) ~ To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lak,e or Major Drainage Course Comments -~.'~D~/'C~/~O ~ ~O~°~ ~)~ _J ~;~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ! .~_E~:)C;) "~ To Building Foundation ~""O To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 c. ^BSOR"T O" Soils Rating in Absorption Strata _ - ! ~ ~ i~' -Type of System Design- .~-~'~ Date Installed I~ - ~ ~ ~ ~ _ Length of Field ~ ~0 / _ _ -/ Width of Field ~ ~ Depth of Field - Gravel Bed Thickness ~ - ~ ~ Square Feet of Absortion Area ~ ~ Statndpipes Present (Y/N) ~ ~_ ~O Depression over Field (Y/N) - ~ o ~ _ Date of Last Adequacy Test Results of Last Adequacy Test ~ ~ - -~- -~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ ~ To Building Foundation - .~ ~z Lot ~/~ To Water Main/Service Line ~ © To Stream, Pond, Lake, or Major Drainage Course - To Driveway, Parking Area, or Vehicle Storage Area -- Comments To Property Line ~ ~ To Existing o~r Abandoned System on ; On Adjoining Lots - ~ ~ TO C~tback (if present) D. LIFT STATION Date installed ~x Dimensions "~. Manhole/Access (Y/N) Size in Gallons ~ /~ . "Pump Off" Level at "Pump On" Level at _ ,J~ ~ _ Vent (Y/N) - High Water Alarm Level at ~ _ Pumping Cycles during Adequacy Test. Tested for _--- Meets MOA Electrical Codes (Y/N) ~ Corn me nts _ **Check Permitted Bed room Rating Against HAA Request*' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed _ Company .- Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 rBev. 7/88) Back of this 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 $~'EVE COWPER, GOVERNOR 563-6775 FOR: S & S Engineering. Attn: Rodney April 23, 1990 PWSID: #~_~_~ According to the records on file in this office, the Chuoiak Utilities/Northwoods/Deerhorn S/D Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental fficer VEC: gd MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & -.- DIV]:SIC~ OF J~i'V~~ ~TH ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AU17iORITY APPROVAL CERTIFIC~ 1. in .,,.tion plication (a) Legal D~scription (include lot, bZock, subdivision, section, tcwnship, range) , . . ./ .. ho~a_ tion~ ~aaaress or' cirect~ons; ~ ' '~ ~/'/n~.t:!~/,J(../i~ Telephone~Z~/ (b) Applicants Nam~ ~Jf'~/~] ,/~, ~u Applicants Address ~,[>, ~)~ .~,~.)~.~ /~/~(.~/~../g, (c) Applicant is (check one) Lending Institution ~; Owner/builder ~-~; (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Tele phone 2. Type of Residence Single-Family ~ Number of Bedrccms 3. Water Supply ~lti-Family ~ Other (describe) Note: If community well system, must have written confirmation frcm the State Depar:u~ent of Envi~oPm~ntal Conservation attesting to the legality and status. Is the %~11 adequate fo~ the number of bedrocms specified in this'HAA (Y/N) ~ Sewage Disposal Onsite ~ Public ~ ~nity ~-~ Holding Ta~R ~-~ Is the wastewate~ disposal system adequate for the number of kedrocms (Y/N) ~$ [Page 1 of 2] 2-15-84 En.gineering Firm Providing Inspections, Tests, Data and Information :,, I certify that I have checked,, verified, c~ confo~t~d to all M3A ~AA Guidsl! effect on the da{e of this inspection. Date Te le phone (ENGiNEER SEAL) 6. DHEP Approval for ~ bedr oa~ Approved approved~ Disapproved ~-~ Terms of .Conditional Approval The Municipality of Anchorage D~pa~tment of Health and Envirorm~ntal P~otection dce~ not guarantee the continued satisfactory performance of the water supply and/c~ the wastewater disposal system. This approval indicates that, as of the validation date 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 fo~ the rnmber of bedrocms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/dS/s [PaGe 2 of 2] 2-15-84 We 11 Classification (!(',QT')DQ/I[7 ! Well Log P=esent (Y/N) Total Depth. Cased to Static Water Level Casing Height Above Grcund Electzical Wiring in Conduit (Y/N) Sepa=ation Distances frcm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C leancut/Manhole Water Sample Collected By Water Sample Test Results C~nts . MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUI~ORITY APPROVAL (HAA) - CHECKLIST - FEBRUARY 1984 Norfhw'oocl~ Subd./~hcl~e · U¢?l: kot ~7, ~lock t~,, Sec'f~on T'o~n,sh;? I.,SN, 2cJrqd~e l~ If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Dep=ession A~ound Wellhead (Y/N) ; On Adjoining Lots . ; On Adjoining Lots To Nea=est Public Sewer To Nearest Se~r Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~;-4-~ Size lOoP ~,1. No. of c~,~ar~nts ~ Standpipes (Y/N) ~/% Air-tight ~ps (~) ~ F~ndation Cleanout (Y~) ~ ~ession o~ Ta~ (Y~) ~/[7 ~te ~st ~d ~ ~15+~ P~ing~inteDmn~ ~n~a~ ~ File (Y~) '-- ; fo~ - Holding Ta~ High-Wate= ~a~ (Y~) ~ ~rary Holdi~ Tank ~t (Y~) ~p~at~on Distan~s ~'~ptic~olding Ta~: To Wate=-Supply ~11 '+200/ To ~ilding F~ndation ~ TO Property Line To Water Main/Service Line Course To Disposal Field To Stream, Pond, Lake, o~ Major D~ainage Cements, [Panel of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION / SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501. PWS i.D. BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom It May Concern: cording to ~ecords Water Regulations. on file in this office the kl~-(~JJ~b,~ Water System is in compliance with the State Drinking Sin?rely,~~_~