HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 4 LT 1Northwoods
Block 4
Lot I
#051-741-36
· ' ;~ 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 ~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Dwelling ~ PERMITN~
~ ~ Manufacturer Material / No. of ~mpartments
Liquid depth
Liq. cap~ity in gallons Inside length Width
~ /~¢O IF HOME'DE:
Well Dwelling PERMIT NO.
DISTANCE TO:
Manufacturer Matorial Liquid capaciW in
~ DISTANCE TO: Foun¢i; Nearest lot lin, PER~T NO.
Trench wi~
~ ~ ~ Too of tile to finish ~raOe Material beneath tile Total offafitive absorption ~rea
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
~lass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: ~ Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOILiNsTAELERTEST RATI ~¢/O~ ~2-~ X ~em
REMARKS t ~
APPROVED DATE LEGAL
72:013 Rev. 3/78
PERMIT NO.
]
[)EPRRTMENT Or HERLTH AND ENVIRONMENTRL H,..OTECTION
,32...ff "L"' STREET., RNCHORRGE., RK. 99501
264-4'720
( 83:063:6 )
APPLICANT
LOCATION
LEGAL
HRMRNN CONST
NORTHWO0[:,
Li B4 NORTHWOODS PHRSE II
PO BOX 6i7 99577
LOT SIZE
6942776
555555 SQUARE FEET
'TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD
MRXIMUM NUMBER OF BEDROOMS = -?.
SOIL RATING (SQ FT?BR)= ±00
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH ':.'IN FEET) OF THE TRENCH OR DRFIINFIELD,
THE DEPTH OF R TR. ENCH OR PIT IS THE DtSTRNCE BETWEEN THE SURFRCE OF THE
GROUN[:, RND THE BOTTOM OF THE EXCRVRTION ,:lIN FEET).
THE GRAVEL DEPTH iS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
5
RED, ~';. EZF" T ][ C: TIFIi~-.~I-c] ~--:; t ZEE=
PERMIT RPF'LICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTRLLRTiON INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
........... T ].-J~C, ( 2 ) I I'--I51F:'EE:T ][ ,--"NS Ri~:E F-: E ~%,tLJt :I.
8RCKFiLLING OF RNY SYSTEM WITHOUT FINAL INSPECTION RN[:, RPPROVRL BY THIS
DEPRF-':TMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN A NELL RND RNY ON-SITE SEWRGE DISPOSRL. SYSTEM IS
i00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM A F'RIVATE WELL TO A PRIVATE SEWER LINE IS~._,~ FEET AN[:,
'TO A COMNUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAIdS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THRT
±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE COPES.
]:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
.[,HTE ....... Z ........... .
V4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street. Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR .,~'"~'./'e.,. ,,~ i~:~dj C,,
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6
DATE PERFORMED:
SLOPE
SITE PLAN
10
11
12
14
15
16
17
19
20
COMMENTS
WAS GROUND WATER ~ SL.
ENCOUNTERED? O
P
IF YES, AT WHAT / E
DEPTH? JO
Gross Net Depth to Net
~Reading,. Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch}
FT AND ~ FT
TEST RUN BETWEEN
PERFORMED BY: '--'"~.r-,-- ~)
CERTIFIED BY:
72-008 (6/79)
APPLIC:"- T FILLS OUT UPPER HAL '"DNLY
Buyer ~ /'~//~ ~4 ~:~
Lend ng nst tut on
Address ~.-'~/n,
Realty Co. &Agent
Type of Residence ·
Phone
Phone
Phone
I~Single Family
[] Multiple Family
[] Other
No. of Bedrooms
Water Supply
J~;t~ivid ual
II~"Comm unity
[] Public Utility
Sew~er~'osal
Ll~qndividual
[] Public Utility
[] Holding Tank
ATTACH WELL LOG. A w~l log is required for all wel~s drilled since June 1975.
For wells drilled prior to that date, give well depth (attach leg if available).
Year individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: ~-~' ~-" ~ ' MuNiCIPALiTY OF ANCHORAGE
ENVIRONMENrAL pROTECTiON
RECEIVED
_~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
(
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE /~.,,. 'il" ~ -,~
Soils Rating Dat~,~Sewer Installed Well To Absorption Area Well Log Received
/ ~ I~/~ / '""~t-~(~ Well to Tank Septic Tank Size ~
72-023 (31~2)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & 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. 05 t-741-36
'1. GENERAL INFORMATION
Expiration Date: / / - ~--" ~) '~
Complete legaldescription NORTHWOODS #2; LOT 1. BLOCK
Location (site address or directions) 23012 NORTHWOODS 0RIVE
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
GREG & JO HOBBS Dayphone 688-4622
23012 NORTHWOOOS DRIVE. EAGLE RIVER, ALASKA 99577
Day phone
FRANK STEVENS C/O PRUDENTIAL VISTA Day phone 689-6480
16635 CENTERFIELD OR. EAGLE RIVER, AK. 99577
Unless otherwise requested, HAA will be held by DSD fcr pickup.
2. NUMBER OF BEDROOMS: ,:3
3. TYPE OFWATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site []
Individual Water Storage [] Individual Holding tank
Community Class A Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
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 wastewater 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 samples. (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.
4. 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, 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 ia(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 end inspection, the
on-site water supply and/or wastewater disposal system ia(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WAST-------'------~ATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORACE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date
,337 - 6179
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. 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 perfon'nance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all we/ts and
septic aystems depend on the local soils condition, groundwater levels that may
fluctuate durfng the year, and the water usage of the family being served by the aystem.
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. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how 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 peraon or pady is not authorized, nor will it confer any legal right whatsoever.
$. DSD SIGNATURE
/'/"' Approved for -.~ bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms, with the fllowing stipulations:
..-,-- ~
WASTEWATER .' =
Manitenance Agreements
Supplemental Engineer's Reort
Other
(Rev. 12,'01)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-S~ Water & Wastewater Program '~
4700 ~ Br~ ~L
P.O. Box 196650 Anchorage, AK 99519.6650
www.cLenchmege.ak,us
(eo )
Legal Description:
WELL DATA
Well typeCOuuu~m'
Date completed
Total depth
HEALTH AUTHORITY APPROVAL CHECKLIST
NORTHWOODS #2; LOT 1, BLOCK 4 Parcel ID: 051-741-56
If A, B, or C provide PWSID# A Well Log
COMI UNITY
Sanitap/seal (Y/Nt Wires pmpedy protected (Y/N)
Cased to ft. Casing height (above ground) in.
FROM WELL LOG
Date of test
Static water level ..
Well p,cdu,,Uun g.p.m.
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform colonies/100 mi. Nitrate mg./L
A~,~nin' ,,,u.~. Date of ~lmple:
B. SEPTIC/HOLDING TANK DATA
Tank Tybe/Material STEEL
Tank size 1000 gal. Number of Comparlments 2
Foundation deanout (y/N) YES Depression over tank (y/N) NQ
Date of pumping 9/14/2002 Pumper
C. ABSORPTION FIELD DATA
Date installed 7/~ ~/83
Length 40 ft.
Oth&r t,~erla __
Collected by:
COMMUNITY
colonies/lO0 nfl.
Date installed
Cleanoute (Y/N)
High water alarm (Y/N)
JR'S PUMPING
I'MT EXTENDS ,%5.25" BELOW INVERT.I
Soil rating (g.p.d./ff~) 100. System type
Width 5 ft. Grovel below pipe
7/11/1983
Absorption rote >=
Total del:~t 5.9 ft. Eft. absorption ama 312 fl2 Monitoring tube *YES
Date of adequacy test 10/10/2002 Results (Pass/Fall) PASS
Fluid depth in absoq3tion field before test 28 in. Water added 505 gal.
Elapsed Time: 1051 min. Final fluid depth 29 in.
Any mjuvenaUon treatment (past 12 mo.) (y/N & type) NONE KNOWN
YES
N/A
TRENCH
2.5 It.
Depression over field NO
For 3 bedrooms
New depth36.2~n.
450 + g.p.d.
If yes, give date -
D. UFT STATION
Data installed Size in gallons
'Pump on' level at in. "Pump o~ I~,~_1 at
Datum Cycles tasted
E. SEPARATION DISTANCES
ManholelAcc~'~; (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/llft station on lot
Absorption field on lot
Public sewer main
Sewer Ite~,ho~wtce line
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacent lots
Public sewer manhole/cieanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Pmberty line 5'+ Absoq~flon field $'+
Water main 10'+ Water service line * 10'+ Surface water 100' +
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Pmpen'y line 10'+ Building foundation 10'+
Water sewice line * 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
Water main 1 O' +
Driveway, parking/vehicle storage
10'+
F. COMMENTS
*SEE A.W.W.U KEYBOX LOCATION ON CONNECT CARD
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspec~ons and
re~4ew of Municipal records that the above systems em in
conformance wfih MOA HAA guidelines in effect on this date.
Engineer's Printed NaT
Dete fO/~
JEFFREY A. GARNESS
Date of Payment 10-- ~
Receipt Number
(Rev. 12~ol )
Waiver Fee $
Date of Payment
Receipt Number
· s ~- "-~<(~'>:~ s'~ ~'~' <. -:-.-:... <. ~:- <--:~-:':-:':',;-:~-'---'-:~--'---~- ~,'-:- ~, MUNICI~ALI~ OF ANCHORAGE
::-~:~?-~-:-:--;--'.'-::.~;:~-:~:~.~:::-~-:-'<--:~-~ ;~:~:.~::~:~:- ~.<--:.~ ,~, WATER CONNECT ON -- L~ Re,rd
:"" ":'" ' ""' :'"': ":'
LOT ! BLOCK ~
SIZE CONN, DATE MADE
LOCATION: ALLEY [] STREET I~
CORP STOP
CUR8 STOP C TO C
CURB STOP C TO I
CORP CONNECTOR
COUPLING C TO I
X BRASS BUSHING
GALVANIZED BUSHING
2 PART UNION
3 PART UNION
SERVICE CLAMP X
LOCATION *~/ ~ ~ '~ ,~ p/_
CONNECTION MADE BY
3[-058
ADDITION
NEW CONN. REPLACEMENT CONN.
)SHOW SKETCH ON REVERSE
THAW PLATE
KEARNY WIRE CONNECTOR
OTHER:
COMMENTS: BROKEN MAIN, EXT. CONNECTION,
CASING, DELAYS, ETC.
DISCONNECTS
EXCAVATOR
APPOINTMENT TIME:
TIME READY.'
TYPE OF MAIN
SIDE
PERMIT NO.
CONN.
PERMIT
TOTAL
EXTRA PIPE
FT.
[] PAID PREY.
[] PAID CASH
[] IMP.
[] EXT. AGREEMENT
10/25/02
FI/I 13:39 FAX 6896499
VISTA REAL ESTATI~ £R
I~001
ASBUILT
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY~
AND THAT NO ENCROACHMENTS EXIST E:X,.EPT AS ..,-~//~'.z.~.~
INDICATED. IT I$ THE RE.~PON$1BILITY OF THE:
OWNE]R TO DETERMINE THE EXISTENCE: OF ANY GRID:
EASEMENTS, COVENAN'rS, OR RESTRICTIONS . .,,~/-~,'~'...s-g"~
WHICH DO NOT APPEAR ON THE RECORDE]) SUbDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOM..D
ANY DATA HEREON 8E USED FOR CONSTRUCTION ·
OF FENCE LINE,.~ OR FOR E:STABLISHIN~} BOUND- DRAWN:
ARY LINES.