HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 17 LT 2
Municipality of Anchorage Page., I 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:
Name:
~A~ ~.~J ~FF~-~ Wastewater System: ~ New ~pgrade
Address:
~t ~i 5~J~-~Ex~ ~P ~- ABSORPTION FIELD
Phone: ~ 7~ INO' Of BedrOOms:
-- ~ ~ Deep Trench ~hallowTrench D Bed ~ Mound ~ Other
LEGAL DESCRIPTI O N so, Rating: Total Depth from original grade:
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: I Range: ~ Section: Fill added above original grade: Gravel length:
I
I
~ New ~ Upgrad Gravel width: ~ Ft. ~ ~ ~/O t Ft.
Classification (P~,C): Total D~ ~ased To: Total absorption area: Pipe material:
~ Ft. Ft. I~O~ SQ. Ft. P~ I~
Driller: ~~ ~ate Drilled: Static Water Level: Installer: Date installed:
Yield: ~~mp Set at: ~ing Height Above Ground:
~EPARATION DISTANCES~
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity In gallons:
From Tank Field Station Tank Sewer Lines
Well Material: ~ ~"~{~ ~ Number of Co~artments:
Surface
Water ~1~~ ~1¢O' ~/~o' LIFT STATION
Lot ~ ~s: ~Manufacturer: -
Line
.oun.a,io.
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
~,~~AL
Inspections performed by: C
2nd 5{~/o~ ~,. CE:~0337' .
Department of Health and Human Services approval ~;.. ...... ..- .....
Reviewed and appr°ved bY:
72-013 (Rev. 9/91) MOA 25
Permit No. SW040034 Page, 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
of
Legal Description: NORTHWOODS UNIT 4, BLK 17 LT 2
PID No.: O51-O64-51
2
~ING 'nFS
A 13
C 15.5' 42.0'
13 54.5' 32,0'
E 65.0' 49.0'
TR - TRENCH
[] - TEST HOLE
· - MONITOR TUBE
o - SEWER CLEAN OUT
+ - WE:LJ.
~-- NEW LEA~H F1EID
SNOWFLOWER LOOP
N 90'00'00' E 175.00'
15' T~XCO~ & EI.[CTR~ [~T.
LOT 2
,.,, 3
7
(NDT TD SCALE)
TOP STEP AT BACK ~IZ]R
ASSUNED L"t~V mlO0.O'
/ DRZGXNAL GRI3UND
/ LEVEl.. AT,
/ TR! ~.2
,/TR~' 93.9
............. ......... 11.117
?N~( ............
TEST
HOLE
93.3'
HO G.V.T,
80.3'
4-/6/0,1-
ENGINEER'S SEAL
ASBUILT
! HEREBY CERTIFY .THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED. PROPERTY:
-,,,~, ,nm .u ~.~OACHMENTS EXIST ~CE~ AS
INDICA~D. IT IS THE RES~NSlBILI~ OF THE
OWN~ TO D~ER~INE THE EXISTENCE OF ANY
E~EMENTS~ COVENANTS, OR RESTRICTIONS
WHICH DO NOT ~PEAR ON THE RE~D~ ~BDI-
VISION PLAT. UND~ NO CIRCUMSTANCES S~
~Y DATA H~EON BE US~ FOR CONSTRU~ION
OF FENCE LINES~ OR FOR EST~LISHING ~ND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING
SCALEs~ ?~,,
GRID."
FB:
DRAWN~
694-082
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Mar 23, 2004
Expiration Date: Mar 23, 2005
Permit Number: SW040034
Legal Description: i~IO~_T.._H.~.~DS~.UNIT~;4~ Bi¥(~"~T.~ 2 ;,
Design Engineer: 0848 Eagle River Engineering Services
Owner Name: Michael & Susan Jeffers
Owner Address: 21611 Snowflower Loop
Chugiak, AK 99567-5645
Parcel ID: 051-064-51
Site Address: 021611 SNOWFLOWER LP
Lot Size: 31728 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field r~ Septic Tank [] Holding Tank [~ Privy
Private Well
Water Storage
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Issued By: ~
Date:..
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number SW
Property owner(s) /'"~/c./-/.,,t-~'/_.
Mailing address (1) ..~..l~/t
Mailing address (2)
Legal description (Lot, Block & Sub'd.) ~O,"'-'f'~u,.~oo¢( -~
Legal description (Section, Township & Range)
Lot Size ,.~/, 7,.2.~_. Acre
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone
Zip Code 9"t'5'6 7-
fi-, LoP o~
Number of Bedrooms
/7
Well Only []
Water Storage []
I"-I Jacuzzi I-'1
[] Water Softening Unit []
I certify that the above information, s correct. I further certify that this application is being made for a
Single Fa.,q'dly Dwelling and is in ,ff,o'cordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
Eagle River Engineering Services
Clu'ist°pher R. Wood,
10421 VFW RD. Suite 201
Eagle River, AK 99577 (907) 694-5195 tel
(907) 694-3297 fax
March 22, 2004
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re:
Northwoods//4, L2, B 17
Narrative & Permit Application
Dear Mr. Cross:
Eagle River Engineering Services (ERES) was contracted to perform a Health Authority
Approval at the above referenced property, and found the septic system in a state of failure, and
in need of upgrade. The proposed septic upgrade will have very limited impact on adjacent
properties for the following reasons:
1. The surrounding lots are all connected to city water, allowing sufficient room for
septic sites.
2. Immediate neighboring septic Systems are all +30' distance, and no private wells
within 200'.
3. This permit is for replacement of the septic tank and leaehfield system.
4. Drainage will not be affected and is not a major consideration in our design.
The existing leaehfield will be abandoned in place. This work will not affect the reserve septic
areas on adjacent lots. If you have any questions please call our office at 694-5195.
Sineer~,~ ~.. ~
Principal
k2003\04-011SEPTICNARRATIVE.DOC
Eagle River Engineering Services
ChriStopher R. Wood, P.E.
10421 VFW Rd. Suite 201 (907) 694-5195 tel
Eagle Rive~, AK 99577 (907) 694-3297 fax
LEGAL:
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM UPGRADE
Nor~hwoods 04 Lot 2 Block 17
March 22, 2004
A. GENERAL
1. The septic system upgrade plan is for a 4 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. Any remaining open test hole excavations shall be filled and monitor tube removed.
B. SEPTIC TANK
1. Septic Tank shall be a minimum of 1,250 gallon tank of. MOA approved construction, insulated, or
place with 4' of soil cover, min.
C. DRAINFIELD
1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield
bottom.
2. The bottom of the drainfield shall be level, plus or minus 1.5", and shall be located at 5.5' below top of
ground surface as measured on the downhill edge of excavation.
3. The existing drainfield shall be abandoned in place.
4. The drainfield gravel shall be covered with typar fabric material.
5. A minimum o1'3' of fill, or a combination ofsoil and 2" extruded board insulation to an equivalent soil
depth of 2', is to be placed over the leaehfield.
6. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. Care
shall be taken to ensure that 3' min. ofnative fill, or equivalent, is placed over the entire drainfield.
7. The septic tank and leaehfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 5.5' GRAVEL DEPTH = 3' under pipe, 2" over pipe
DRAINFIELD LENGTH = 120' (2 (~ 60') DRAINFIELD WIDTH = 5'
SOIL RATING = 0.6 GPD/ft: BEDROOM CAPACITY = 4 total
SEPTIC TANK = 1,250 gallons min.
Twenty-four (24) hours notice required for all inspections.
\~Eres~DOCS\WPDOCSX2004\04-01 ! drainficld- spec.doc
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, AlaSka 99577
(907) 694-5195
ERES Project No.: 04-011
Calculated By: CW
Date: 03/22/2004
Legal: Northwoods ~ L 2 B 17
Single Family 4 Bedroom Dwelling
TEST HOLE 1
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 600
Percolation rate = 30
Wastewater application rate = 0.6
Required absorption area = 1000
Trench width (W) = 5
Grovel depth (D) = 3
gallons
minutes per inch
gallons per day per square foot
square feet
feet
feet
Required length = Shallow trench factor* Required absorption area I W
Shallow trench factor = (W + 2) / (W + 1 +2 D)
Shallow trench factor = 0.58
Total Excavation Depth = 5.5 feet
Required length = 117 feet
04-01 l_Cal.xls 1:05 PM03/22/2004
NO SEPTIC
+20'
SNOWFLOWER LOOP
N 90'00'00" E 175.00'
15' TELECOM &: ELECTRIC ESM'I'.
OlD
I,.EACH rl'.r LD
LOT 2
5'X60' ORAtNFIELD
NO SEPTIC
+20'
IX] - WATER KEYBOX
[] - TEST. HOLE
· - MONITOR TUBE
o - SEWER CLEAN OUT
EASEMENT
PROPOSED LEACH FIELD
~- EXISTING LEACH FIELD
, ---- '~ ~ - DRIVEWAY
8
NO SEPTIC
+20'
7
1. NO SURFACE WATER +100'.
2. NO KNOWN CURTAIN DRAINS
3. NO KNOWN PRIVATE OR PUBLIC WELLS WITHIN 200'.
WELL/SEPTIC
SITE
PLAN
LEGAL: LOT 2, BLK. 17, NORTHWOODS SUBD.
OWNER: MIKE JEFFERS
CONTRACTOR: N/A
JOB#O4--O11WS J DATE: 0,.3/22/04 SCALE 1"=50'
A
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
Performed For:.
Legal Description:
2-
3-
4-
8-
9-
10-
11-
12-
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
... www. ct,a nchoraqe, ak,u,~ (907) 343-7904
Soils Log - Percolation Test
Slope
14-
15-
16-
17-
18-
19-
20-
S~LT7
was G.ou.o W^T~r
ENCOU~RED? _
IF YES. AT WHAT DEFTH? ~///~ L
Dep~ lo W~r A~r 0
Reading Date Gross Time Net Time Depth to Water Net Dr(~p
~ ~° m sL~"
[o o gU ~"
, ~ ,C~ (min~e~mch) PERC HOLE DIAMETER , ~
TEST RUN BE'IW~EN _~.S FT ^ND~FT
COMMENTS ~) H'~J~) ~--~/~l~Oul~"/'~i~E.~. 'T'~-I
PERFORUED ~ Tl~ THAT THIS TE~T WA~
N ACCORDANCE ~TH ALL STA~ AND MUNICIP~GUIDELINES I~ ~FFECT OdTHIS DATE. DATE~ ~/~/Oy
Performed For:.
Legal Description:
J,,)oCcrH ~,J oo b ~
2- 5I i:'r'! c~,{t,)b -..St'V)
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
· ,www.cl.anchoraqe.ak.us
" (907) 343-7904
Soils Log - Percolation Test
~'" [-~-.J[:::F~'~ ~ Date Performed:
Slope Site Plan
WAS GROUND WATER
E.COU~RED?
Depth to Water After
Monltodng?
s
L
0
P
E
Date:
'lION RATE I ~-~ (minu~e~h) PERC HOLE DIAMETER ~ //
TEST RUN BETWEEN "~ FT AND ff FT
COMMENTS ~k~O ~,~.~) ~'~lk}~'Ou~J"~t~- p['-'[~' rO~/~/ ,~0
PERFORMED BY: CH~
PERFORMED IN ACCORDANCE WITH ALL STATE AND M I TIFY THAT THIS TEST. WAS
UN~C~F~t"G%Tdi=-UNES IN'EFFECT O1~ THIs DATE. DATE:
Reading Date Gross Time Net Time Depth lo Water Net Drop
z / ~z ~o :~; s~" '"
~ 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
,LoP ,A ,PI, K 12 ,Va,- 04200,4 s
LOCATION NO. OF BEDROOMS
Well ~ Absorption area Dwelling / PERMIT NO.
~ ~ Manufacturer Material No. of c~partments
Liq. capacity in gallons Inside length Width Liquid depth
J~O IF HOMEMADE:
DISTANCE TO: Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
~ ~ Foundation2~ Nearest lot linh O P PERMIT NO,
~ ~ DISTANCE TO: ~j~ ~0~ /
~ ~ Z No, of lines Length of each line ~ Total length of lines Trench width Distance bgtween lines
~ ~ Top of tile to finish grade / Material beneath tile Tot e rption area
Q ~ ~ ¢ 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
SOl L TEST RATING
INSTALLER
REMARKS
,., . -. e , .
I
APPROVED D TE LEGAL
72-013 (Rev. 3/7~
Permit
Applicant:
MUNICIPALITY OF ANCHORAGE
Department .IR Health and Environmenta~rotection
825 ~ Street, Anchorage, AK 3501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
~ Mailing Address:
Location: ~~r:.,..
Legal Description: ~D7 ~ ~/t~ Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: ~ Seepage Be~: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /_~"'0'
The Required Size of the Soil Absorption System Is:
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(H~-L-DiNG) TANK SIZE : {~00 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this ProPerty and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this dePartment
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for aprivate well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewe~ line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to inc'lude more tha~ 3 _.bedroo.ms/ /1
SWP/024 (1/81)
I J i
'~'~ '--~ [] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~
PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
1
2
3
4
5
6
7
8
9,
10-
11
12
13
14
15
16
17
18
19.-
20-
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER ,S
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ a/~,',~ ~ .'~/:/o ,~.~3' ~ " Y~"
~t ~,~/~ ~,~- ;,, ~.:, ~ ~,,,," ~'4"
PERCOLATION RATE ~'~fO (minutes/inch)
TEST RUN BETWEEN ~"~ FT AND 5" FT
PERFORMED BY: ~, ~ ~*'~ t"~
CERTIFIED BY:
72-008 (6/79)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
,FOR A SINGLE FAMILY DWELLING
Parcel I.D. O .~ I "O~/-- S I
'1. GENERAL INFORMATION
Complete legal description
':~ Location (site address or directions) . Z-I ~,il
3;
Expiration Date:
";'~ CU'rrent P~0pe.rtY ~)wner(s)"-
';S Mailing address
Lendin~':agency
Mailing address
Real Estate Agent
Day phone ~;~- 7z~ ~ y
Day phone
Mailing Address
Unless otherwise reqUested, HAA will be held by DSD for pickUP.
NUMBER OF BEDROOMS: L~
Day phone ~'~/-/~//~_.~"'
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
IndiVidual On-site ~
Individual Holding tank []
Community On-site []
Public Sewer []
[]
[]
[]
I
The Municipality of Anchorage Development ~Services Department (DSD) Issues Certificates of Health Auihority
Approval (HAA) based only .upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska, Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewate~ disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
'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 investigationl
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water 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
Address
Engineer's Printed Name
· ..'~// - '. bedrooms.
DsD SI;~IATURE '
Approved for
Disapproved..
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory-
Well Flow Advisory ~
X
Maintenance Agreements
Supplemental Engineer's Report
Other
~Rev. O1/02)
original Certificate Date:
MuniCipality o Anchorage
Deyelopment Servicbs 'Department
[ Building Safety ~Division
· On-Site Water& WasteWater Program
. 4700 South~ Bra~]aw St. -..
P.0~. Box 196650 :Anchorage; AK 99519-6650
- Www.ci.anchorage.ak.us
(907) 343-7904, , : ' .....
HEALT AUTHORjTY A PROVAL CHECKEIS'F' .
A. WELE DATA '~ ~ ' .......
, ~ .:~ ~ '~,~ .. ~ ; l.~:~ , ~
Well type. ~ . - If A, B, or C provide PWSID ~
Date completed ~:: [~amta~ seal (Y/N)
Totaldepth'J ~ ft. 'J~iC~sedt6 ~;" 'ft.:
INSPECTION
Other bacteria': ' colonies/100 mi.
Collected~byi-' : ,. ,
:Date installed r,.~/Z.~/<3 './
Cleanouts,' '(Y/,~.); '.' y
High water rala~:m ~/N).' ~
Datetof pumping":"'~t)~'k7 1
C. ABSORPTION FIELD DATA!: i~ . ': '
Date itr~t~lled: n~g ig?~d
Totala~epth.~i~":'ft.' ' Eft
Date o~ adequacy test
Fluid depth ri'absorption field before test
Elapsed Time? ~[~ min.
Any rej~venatibn t'~eatment (p~:
~), 6 'Syst,
i. ft' Gra'
Monitodng tube,
lsJ$)F~il) '" NJ4-!
added ~J~- gal:
Absorption
'",
'i
31 below pipe ~' ft.
Depression over field A] '
" i~ ,' For. /'/ bedrooms
l,~, '.'New depth ~'[4 in.
ite . /j/,4- g.p.d.
If Ye, s,'g~ve date. /~/,4. '
! ·
Date~ortest [ ~
Static' water level
Well production
WATER sAMPLE Ri:
Coliform ~colonies/100 mi.
. ' .'.'
. ~.~Enic: : ! .mg./I. :
".'SEPTIC/HOLDING TANK DATA
Tank Type/Materi;
Tank size
- f~'l . .- , '~,, ~ , ,,~:',~'
~-ounaatlon cleanout
parcel ID: O~1-O~'¢../-~"-I
- Well
'1
Wires Ct/N)
it (a~0ve ground) -in.
D. LIFT STATION
Size in gallons Ma~
on" level at in. "Pum~ ~'~~~----~~ High water alarm level
Datum ._...~-~ Cycles tested Meets al~s?,
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lilt'station on'lot ':.On ~
Absorption field on lot djacent lots
Public sewer main Public sewer manhole/cleanout
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Bui'lding foundation .!,- ~ ! Property line ~/O / Absorption field
Watermain ~ ~D~ Watersewicelin~ ~0 ~ Suffacewater
Wells on adjacent lots ~ ~~1 · I~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
PropeAyline +1~ ~ Building foundation ~/~ Watermain -I~
Water Sewice line +lO Surface water + I~ Driveway parking/vehicle
I cea,~ that I',ave determined through field inSpoctiohs and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines I~'effect on th/~ date. ' ~~~~'~
Se
HAA Fee $ Waiver Fee $
Date of Payment (~ ~ . .. Date.of Payment
Receipt Number (...Oq ~;"'~" Receipt Number
(Rev. 12101)
MUN CIPALI OF ANC.ORAGE / b
DEPARTMENT OF HEALTH &.HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND ~ATERFACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2; B.~ock 17; Northwood~ #4
April 12, 1988
Location (address or directions)
(b) ProPerty Owner W,~.l C0v,~yz,~to~ Telephone: Home 688-4426 Business
Mailing Address
(c) Lending Institutio~.'·M&'t~ll £¢'nch Telephone
; iMailing Address
(d) 'R. eai Estate Company ai~c['Agent HERITAGE REAL ESTATE/Da~c
Ad~0.~Ea~l'~.i~r Road, Eagl~ R~v~r, Alaska 99577
Telephone 694-4994
(e)
Mailthe HAAtothefollowinaaddress:or:Checkhere ~,ifholdforpickup.
Listcontactpersonand day phonenumberbetow.
S & S ENGINEERING/694-~979
170~4 Eagl~ RZu~r Lnnp Road~ Su~. ?04
Eag~ R~u~: Alaska 99577
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
orderzd by Dal~ Pri¢~
WATER SUPPLY
Individual Well [] Community [] Public [~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 fRev 8/86~ Fronl
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 this Health
Authority Approval 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 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 Municipa~l and State codes,.ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
1;2'034 Eagle River Loop Road No. 204
Address F. agie kiver, Alaska ~YSYY
Date
Approved for ~_,j._.~bedrooms by Date ~'/~' //'~"'~' '
Approved ~ Disapproved Conditional
Terms of Conditional Approval ' Z
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates 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 inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
72-025 (Rev 8/86) Back
Page 2 of 2
WELL DATA
mEAL"rT-I AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distandes from Well:
To Septic/Holding Tank on Lot
To NeareSt Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Legal Description:
t~ If A, B, C, D.E.C. Approved(~;~N)
Date Completed Yield
Cased to Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOEDIN~TANK DATA
Date Installed ¢;~
Standpipes~N) y
Depress!.on over Tank (Y~)
Pumping/Maintenance Contract on File (Y/N) ~'"~//~ ; for '----'---
/
Holding Tank High-Water Alarm (Y/N) /~' Temporary Holding Tank Permit (Y/N)
Size ~ ~ No. of Compartments
Air-tight Caps~)N) ',/ Foundation Cleanoutd~N) y
~ Date Last Pumped
Separation Distances from Septic/~ Tank:
To Water-Su pply Well ~ 1Jr-
To Property Line
To W~te~ M'ain?Servi~e'Line \ L~ 1,..~
Course _\
I
To Building Foundation ~
To Disposal Field ~ '
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026 Rev 8/86~ Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata \ ~"C;:~ ~'~ Type of System Design
Date Installed ~;~ - ~'~ ~;~"~ Length of Field
I
Width of Fielci ~ Depth of Field
Gravel Bed Thickness
Standpipes Present(~N)
~ Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field .(Y/~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well "~¢2-c~ I.~
To Building Foundation
Lot
To Water Main/Service Line \ ~ I Jr'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~ I ~
To Cutbank (if present)
LIFT STATION ~-~ /~
Dimensions
Size in Gallons -~'~~ Manhole/Access (Y/N)
"Pump On" Level at -~"----_..~..~...~ "Pump Off" Level at
High Water Alarm Level at -~'-~-, Vent (Y/N) .
Tested for ____ ~ng Adequacy Test. Meets MOA
Electrical Codes (Y/N) ~
Corn ments ~ ~
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MO,~, and H/~A guidelines in effect on the date of this inspection.
Sign~td ..... ~_,~,c;:l)lNG Date
Com1:~).~34 Eagle Riyer L_o~_ I~oa~l NO. 21~OA No. (~,'~'~-~'~
Eagle River, Alaska
Receipt NO. 0 ¢ ¢~ ~
Date of Payment ?,~'~/ ~' --~
Amount: $ / ~)~O 0 ¢)
Page 2 of 2
72-026 (Rev 8/86) Back
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 1334
/
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: Apcil ~.4, 1988
PUSIB: 213001
To Whom It May Concern:
According to the records on ?ile in this o??ice, the
UTILITIES (Northwoods) Water System is in compliance
State o? Alaska Orinking Water Regulations.
CHUGIAK
Sincerel y,
SWE:pkk
with the
APPLIC ~.'~IT FILLS OUT UPPER HA~"%ONLY
Property Owner (~,~.,.~& 3./,~,¢_ ~.~ ~ ~.~ ~ ~ Phone
Phone
Lending Institution / ~ /~ ~, ~ / ~
Address ~D~ /'~C~ ~C ~ Zip Code
Realty Co. & A~nt ~Z ~/'~' ~, Phone
Address ~_~ ~. / '~~ ZiP C°de ~~ ~ ~ --~
Street
Locati~
Type of Resi~nce
~ingle Family ~
~ Multiple Family No. of Bedrooms
~ Other
Water S~pply
~ Individual ~ ~ ~ ~ A~ACH WELL LOG, A w~l log is required for all wells drilled since June 1975.
~ommunity For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
s~w~ o,~o~, / ~ ~
~lndividual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date/~ ._
Inspector Inspector Inspector Inspector
MUNICIPALITY OF ANCHORAGE
Field Notes: (~ C- ~3, o DEPT. OF HEALTH
O [~ L~ SC~ ' ENVIRONMENTAL PROTECTION
OCT 3
RECEIVED
(~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE /~ ~ ~
BY:
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Reoeived
i ~O 1_~_~ ~ WelltoTank Septic T~k Size l ~O