HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 17 LT 1North Woods
Unit #4
Block 17
Lot 1
#051-064-50
8c- F
Municipality of Anchorage Page I of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW49o171 PID Number: !IS/o�4so
Name:
Wastewater System: 2�New ❑ Upgrade
kop,7-owency
Address:
ABSORPTION FIELD
70q W. ZUi Ei ri0,u ac as P,0, *7-00
Rhone
No. of Bedrooms:
Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other
ve"a? 4 A 995/? --//23
3
LEGAL DESCRIPTION("Ig-
Soil Rating:
Total Depth from original grade:
.t15 GPD/S . Ft.
�'S
Lot: Block: Subdivision:
Lot:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
1 17 A)0XTY WOO 4>S S/,A AJ,
- Ft.
. Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
Ft.'-
/17 Ft.
WELL:❑New ❑ Upgrade
pg
Gravel width:
Number of lines:
Distance between lines:
•
S Ft.
2.
/Z» Ft.
Classification (Private, A,B,C): EXIST
Total Depth:
Cased To:
Total absorption area: _
Pipe material: F P/o 111CP_F
(fom vtU,cJ/TY
Ft.
Ft.
/ O%3.3 SOIL
As-ro? /73032
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft
Oct140M&-S-
-ZS-9y
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
Oseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
�
(7 -p_,56 -A 7,—qAj.#-
/Z.Sa
t
Materials
Number of Compartments:
Well'
2�',F
ZM (t
—
ZS +
TEEL
2
Surface
--
LIFT STATION
WatLotS¢
Jodi-/-/L)0'+-
Ilons:
Manufacturer:
Line
/0't
/0 ,IL
--~
--
"Pump on" level at:
off' level at:
High water alarm at:
Foundation
/t7 r
) 7 1
_._„
___,
Curtain
AWAJ 6
KNd
WA)
Pump Make &Model
Electrical Inspections performed b .
Drain
BENCH MARK
Remarks:
Location and Description:
T ,4 lr l4z.4.
Assumed Elevation:
/OU.Oa Ft
ENGINEER'S SEAL
�t
ew
Ajar O?;,5 ti �1
S & S ENGINEERING
IM4 Eagle River Loop Road, No. 204
Inspections performed by: F glA River, Alaska 99577 Dates: 1st 6; -2v-94
2nd -2s-9N
ALM..,A. 4.1- ,
Department of Health and Human Services approval
u Date:¢
Reviewed and approved by: ��!sv av—[-1
72-013 (Rev. 9/91) MOA 25
Permit No.SW940171 Page 2 of 2
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
NORTH WOODS SUBDIVISION, UNIT IV, 05106450
Legal Description:BLOCK 17, LOT1 PID No.:
pCp01 CpO2 FINAL GRADE;
II i-98.4' H ':; �C04�am1 97.9' 97.7 Co'
94.91 1000 GAL
SEPTIC
TANK
N.T.S.
SEPTIC
co
SCALE I" = 40'
72-013 A (1/93)'
T BDRM
94.1 R94.0'
............................. I...............
90.4' 90.
A84.4':NO WATER
MT2
FCO 19.5 20.0 —
001 23.0 23.0 —
0O2 28.0 28.0 —
0O3 63.0 37.0 —
004 — 29.5 'i16.
C0.5., .82.a 54:0..1...._...
C06 — 34.0 36.
MT1 — 25.5 `17.
1am9 — aP F as
kr q
tt
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE �Lkp l
DEPARTMENT OF HEALTH AND HUMAN SERVICES Lo_aLi_c14
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940171 DATE ISSUED: 6/09/94
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/09/95
OWNER NAME:NORTHWOODS INC
OWNER ADDRESS:709 WEST INTERNATIONAL AIRPORT RD #200
ANCHORAGE, ALASKA 99518-1123
PARCEL ID:05106450
LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 17 LT
1
LOT SIZE: 35886 (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:
1. THE ATTACHED APPROVED DESIGN.
2. 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
ISSUED BY:
BY: P DATE: /
DATE:
May 18, 1994
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTHAUTHORITY
APPROVALS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
SEWER &WATER
Anchorage, Alaska 99519-6650
MAIN EXTENSIONS
REFERENCE: Northwoods Subdivision #4; Lot 1; Block 17
SEWER & WATER
INSPECTION
Request you issue a permit to install a septic system to serve
the
proposed three bedroom house on the referenced property.
ENGINEERING STUDIES
ANDREPORTS
Test holes were excavated and percolation tests performed.
The
approximate locations of the test holes are located on the attached
site plan. The monitoring tubes within the test holes have
been
WELL INSPECTION
checked and found to be dry.
& FLOW TEST
This property has enough area for a future septic upgrade which can be
seen on the attached site plan.
SITE PLANS
This property is served by a Community Water System. We do
not
anticipate any adverse effects on neighboring properties by
the
installation of the proposed septic system.
ROAD DESIGN
If you have any questions, or require additional information for
your
review, plea ontact us.
Sinc ely,
SOIL TEST
o A. Shafer, P.E.
PERCOLATION
TEST
�LSU�]k
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Northwoods Subdivision #4; Lot 1; Block 17
GENERAL:
1. The scope of this project includes the installation of a 1000 gallon
septic tank and two 5' wide drainfields to serve the proposed three
bedroom residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and
design drawings, Municipal permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater Disposal
Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the
mounded area.
5. Contractors installing wastewater disposal systems must be certified by
the Municipal Health Department for system installations. Owners
installing their own systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
4. Septic tanks installed with less than 4' of cover shall be insulated.
Page Two
Northwoods Subdivision #4; Lot 1; Block 17
May 18, 1994
5. A foundation cleanout shall be installed one to four feet from the
building foundation. In the line between the tank and the leachfield
there shall be two adjacent cleanouts (unless an effluent pumping system
exists within the septic tank). These cleanouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the leachfield. The second cleanout
shall be to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope
exists away from the septic tank.
ABSORPTION TRENM/DRAIWIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed -up) before gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to be installed
level with the perforations faced downward. Gravel is then to be placed
over the distribution pipe to provide a minimum of 2 inches of cover
over the pipe.
3. A silt barrier must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel
surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. The portion of the
monitoring tube extending through the gravel shall be perforated from
the bottom of the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as noted on the
design.
5. Backfill over the final gravel layer must not be less than twenty-four
(24) inches. Insulation must be installed when the backfill depth is
less than thirty-six (36) inches. The finish grade over the trench must
be mounded to prevent the formation of a depression after settling.
MINIMUM MATERIAL
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
Northwoods Subdivision #4; Lot 1; Block 17
May 18, 1994
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe
Perforated
Solid
Cast
Iron
Yes
Yes
ASTM
D3034 (PVC)
Yes
Yes
ASTM
F810 (HDPE)
Yes
No
ASTM
D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be installed between the final leachfield gravel layer and the
native soil backfill.
6. Ali leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel
with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C. requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
1. The first inspection must be conducted after the excavation of ditches,
pits, trenches, or beds and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled before this
inspection.
2. The second inspection must be conducted after the placement of the silt
barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Page Four
Northwoods Subdivision #4; Lot 1; Block 17
May 18, 1994
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution
systems, etc. Thus, the inspecting engineer is to be contacted at least 24
hours prior to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in
these specifications and plans and in accordance with the attached M.O.A.
permit. There will be no contractual arrangement existing between the
contractor and S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to document the
contractor's activities. Final acceptance of the contractor's work rests with
the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
////1
PERFORMED FOR:C/FT SCAJ-7'r-tZ, 7.
LEGAL DESCRIPTION:U16Ue 4L$k Gj-S `7O I Township, Range, Section:
�ili(pA-NIGy SLOPE SITE PLAN
----- _-
1 I•I •
2 �'•
3
4
5
6
7
r
8
r
9
0
w%
LI -776Z Gvwrf-
10 WAS GROUND WATER Nb
ENCOUNTERED?
11 CC/�` of I,PI. S
IF YES, AT WHAT p
12 ' DEPTH? P
Depth to Water Ager
13 Monitoring? (L� Date: 5 `1
14
15
16
17
18
19
20LJ IL_ JI PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEENGFT �ND Lf FT
COMMENTS
5 & S L" 17Ri11YGG/E1'Tv
PERFORMED BY: 17034 Eargla River Loop Road No.20
ff6� pp�,� Alaska 99577 //
ACCORDANCE WITP'r9'cSTXf'AND MUNICIPAL GUIDEtrf
72-008 (Rev. 4/85) 111 ���
CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
ry y (ENGIN SEAL)
e +.� Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
,WN! A, '1'4 -
SOILS LOG — PERCOLATION TEST
au
PERFORMED FOR: DATE PERFORMED:
LEGAL DESCRIPTION: L11 ,�C)j fr jtA1QU� /o
bl�n'Township, Range, Section:
DEPTH SLOPE SITE PLAN
. 4
2
< St6,y Sr4ra� w� C IT c
3 CtP�rWr=�•
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
a
i
WAS GROUND WATER
ENCOUNTERED?
b�/7r7/f S
L
IF YES, AT WHAT O
DEPTH? p
E
.0. f- Depth to Water After g��`�
Monitoring? t " Date: sl-• 94
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
1 ESd
k—P,
10
53114
YL/
.�
1V
Y
Vit II
PERCOLATION RATE 4{Q (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN AND 11
FT
J C[J Y.W.. •
PERFORMED 817034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577 //
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI13
72-008 (Rev. 4/85) CCC���
V
CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904 -
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-064-50 Expiration Date: Sy✓ "� �n
1. GENERAL INFORMATION
U,n+�
Complete legal description NORTH WOODS SRP.#4; BLOCK 17, LOT 1
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
21447 SNOWFLOWER LOOP, CHUGIAK, AK, 99567
JOSEPH & JANICE WERCKLE Day phone
P.O. BOX 670548, CHUGIAK, AK, 99567
Day phone
;dI IICYI:0;
2. TYPE OF DWELLING:
SUB
j iTAP Single Family (w/wo ADU) �
F-1DuplexJUL 0 7 2614 y
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
Public Sewer
❑
W aiverAlariance request for.
Received by: �3 ,,/
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52_�.
Date of Payment I �
Receipt Number b2_5 3_
COSA # OST 1 75O�
Date:
r s
Waiver Fee $
Date of Paymen
Receipt Number
Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site wafer supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, LH). attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life ofall wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate ofhow long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
B/ System #1 Approved for 3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
337-6179
Date
bedrooms, with the following stipulations:
��LlU�ittiif(((l(ff
OF A/yCy/i��xi
j ON-SITE G>m r
WATER AND
�o WASTEWATER o^
oRnGRAM
By: Original Certificate Date: �% o
The n' pat y ori orage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
1p- 101191191
l�
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description:
A. WELL DATA
Well type _
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
NORTH WOODS S/D #4; BLOCK 17, LOT 1
PUBLIC WATER
If A. B, or C provide PWSID#
_
Sanitary seal (Y/N)_
Cased to ft.
FROM WELL LOG
g.p.m.
Coliform __-�- colonies/100 ml. Nitrate mg./L.
Vinic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments z
Parcel ID: 051-064-50
Well Log (Y/N) _
Wires properly protected
Casing height (abo n
F -W
Collected by:
Date installed
Cleanouts (Y/N)
M.
6/24-25/1994
YES
in.
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NIA
Date of pumping 10/21/13 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 6/24-25/1994 Soil rating .p.d./ rObdrm) 0.45 System type DUALTRENCH
Length 117 TOTAL ft. Width 5/5 ft. Gravel below pipe 3.5/3.5 ft,
Total depth `7.251' 4'5ft Eff. absorption area 1083 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test "5/16/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 4_5 in. Water added 1540 gal. New depth 29 in.
Elapsed Time: 170 min. Final fluid depth 24.5 in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
"'TESTED EAST TRENCH ONLY. WEST TRENCH HAD 33.5' OF LIQUID IN IT ON 5/16114
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off" levelel a
E. SEPARATION DISTANCES
Manhole/Access (Y/N)
level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lrft station on lot
Absorption field on lot
Public sewer main
Sewer /septic service
PUBLIC WATER
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 104 Surface water, 1001+
Wells on adjacent lots 20V+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 101+ Water main 101+
Water service line '10' Surface water 109+ Driveway, parking/vehicle storage 10'+
Curtain drain NONEKNOWN Wells on adjacent lots 200'+
F. COMMENTS
NO WATER OBSERVED IN ANY CLEAN-OUT (IN EITHER TRENCH) PRIOR TO, OR DURING THE ADEQUACY TEST.
'PER 1994 COSA BY S&S ENGINEERING, WHO ALSO INSPECTED THE SEPTIC INSTALLATION.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 6I23/1�
(Rev. MUM)
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GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
MEMORANDUM
6.18.14
Reference: Northwoods #4, Ll, B17
I completed a 2nd site visit to the referanced property yesterday (6.17.14) and observed (2 -each)
an inspection excavation (to the top of each of the drainfields). In each hole, there was what
appeared to be original filter fabric. I made a small cut into the filter fabric on top of each trench,
and found what appeared to be original insulation underneath.
I also took measurements and the grades over the drainfields currently meet the requirements of
an insulated drainfield. In addition, the owner provided a dedicated access board on the deck, to
access the foundation cleanout underneath the deck. -R.C.
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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
my investigation and inspection, the on-site water
the Municipality of Anchorage files and from
in compliance with all Municipal and State codes,
supply and/or wastewater disposal system is
ordinances, and regulations in effect on the date of this inspection. q
s a S EN91[yt1N,.G Phone 6Q
Name of Firm °
Eagle River, Alask 99 77
Address zz ey e
Date
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Engineer's signature `
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6. DHHS SIGNATURE
Approved for bedrooms. aihp ,0
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
(f o.U(A Date Z
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L6< j i3� 17 )�" -ftmsgA Parcel I.D.
A. Well Data
Well type Q If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Cased to Casing
Wires properly prote /N)
FROM WELL LOG
Well flow / g.p.m.
Pu
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on tot
Absorption field on lot 7�o `�- ; On adjacent lots
INSPECTION
Public sewer main Public sewer manhol
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Date
B. SEPTIC/HOLDING TANK DATA
Collected by:
Other bacteria
Date installed & -a r-81 Al Tank size 12 sD Compartments Z
Cleanouts 6*) Foundation cleanout &/N)� �
Depression (Y.�
High water alarm (Yi Alarm tested (Y/N) I A
Date of pumping '}=r�le-APumper J
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot Zoo t k On adjacent lots '�
Foundation /01
To property line /o ' Absorption field /6 ' 4- Water main/service line /0111 -
Surface
o111 -Surface water/drainage /06
72-026(3=)•Front CONTINUED ON BACK PAGE
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On adjacent lots
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Public sewer main Public sewer manhol
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Date
B. SEPTIC/HOLDING TANK DATA
Collected by:
Other bacteria
Date installed & -a r-81 Al Tank size 12 sD Compartments Z
Cleanouts 6*) Foundation cleanout &/N)� �
Depression (Y.�
High water alarm (Yi Alarm tested (Y/N) I A
Date of pumping '}=r�le-APumper J
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot Zoo t k On adjacent lots '�
Foundation /01
To property line /o ' Absorption field /6 ' 4- Water main/service line /0111 -
Surface
o111 -Surface water/drainage /06
72-026(3=)•Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTAWE+IfOM LIFT STATION TO:
D. ABSORPTION FIELD DATA
"Pump off'
Cycles
On adjacent lots Surface water
Date installed U - zs -- 14 Soil rating (GPD/Ft2) 0,45- System type :5,4� L ��,A4
Length III ' Width
5- ` Gravel thickness 3, ,S Total depth Z-5
Total absorption area /. D 9 3 Cleanout present WN) Depression over field (Ya "_
Date of adequacy test "1/.t - Results (pas ail) "i/a for ''�/ Bedrooms
Water level in absorption field before test `L After test J��+
Peroxide treatment (past 12 months) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
26 0 (J -
On adjacent lots
Property line 40 i f
To building foundation 1-7 To existing or abandoned system on lot
On adjacent lots -3a } Cutbank ^f/ Water main/service line /o
Surface water /00 l4- Driveway, parking/vehicle storage area /o
Curtain drain d1
E. ENGINEER'S CERTIFICATION
i certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name 16 0i A 1 C. Caw.
Date 3
HAA Fee $
oc
Date of Payment
Receipt Number �a _
72-026 (3/93)' Back
-ci WBM C. COWAN a e�
CE -8601
IAS �+� °•, `� �
Waiver Fee $
Date of Payment
Receipt Number