HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 4 LT 54 0s\-dga- C)3
I
~ MUNICIPALITY OF ANCHORAGE I
�• DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264A720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ,Q
Av,eK y ALAS/li9N 45611=V E.e S
PHONE
N EW
695�-35�93
0 ❑UPGUPG RADE
MAILING ADDRESS
,o o, fox 7/5�, E.441-,6 ALf9S164 -7-7
LEGAL DESCRIPTION
.Co T- -:5-d iigt_4c1e_ 4, Ttlivl�E,eB�/L� yrs . SUED,
LOCATION
NO. OF BEDROOMS
Y
DISTANCE TO:
Well
/t//iq
Absorption area
s
Dwelling
14
PERMIT NO.
O 9
6Z
h
Manufacturer 62EE�2
Material
6r,EEL
No. of compartments
Liq, capacity In� gallons
2 S
IF HOMEMADE:
Inside length
Width
Liquid depth
6 Y
DISTANCE T0:
Well
Dwelling
PERMIT NO.
10
=?,a„
Manufacturer
Material
Liquid capacity in gallons
=
DISTANCE T0:
Well
/v/fj
Foundation
Nearest lot line
PERM T O.
d?
W
Fig
j LL Z
No. of lines
Length of each line
Total len lines
W
•
th of
Trench width
Distance betvjen tines
P <
30
inches
$
H
Top of tile to finish grade,
Material beneath the
Total effective absorption area
inches
800 -54:p. f T,
W
Length
Width
Depth
PERMIT NO.
C7
CL F
Wd
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W
ti
DISTANCE TO:
Well
Building foundation
Nearest lot line
Depth
Driller
Distance to lot line
PERMIT NO.
W
F!LDISTANCE
TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS 4'/ C.Z Q'r�►iC $ EV✓�C„
,
SOIL TEST RATING
/oo :�'d0, Fr.
d.
INSTALLER
,�1dea4 ,9c,�rrc�ti C3a�c o �,es
.o
„
REMARKS
7-j��l�W SYS i%
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APPROV DATE LEGAL �• ! ��„r+
21117,e LoT .6, 13cK, 1,qaAlp,e ncl'"
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no -Li oaj
Mulr4I 0I F_iL I TY OF= 1-4"O3Hf- .s Fi(3E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET; ANCHORAGE, AK. 99501
264-4720
0t -4—S; I TE S}EWEFZ F=l'EFRI'M I T
PERMIT NO. C 780969 >
APPLICANT KURKA ALASKAN BUILDER I PO BOX 214 694 3493
LOCATION PETERS CREEK
LEGAL L5 84 THUNDERBIRD TERRACE ae..,, LOT SIZE 20852 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
I7EF�'TH= :S L_E:" 0 -rH= 5:1_ C3FRnVE:L_ F3EF:'TH= 4
THE LENGTH DIMENSION I5 THE LENGTH CIN 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 CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MI14IMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
A14D THE BOTTOM OF THE EXCAVATION CIN FEET).
Fc.EQU I F? aE> Ef=''T I O3 TFitti1K '15+ 12: E: 1�225C-+ 13nL_t- 0 r-J:S
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 C ^' > nFZE FR'EO?U I FREF�i ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BET14EEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC 14ELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO I14SURE PROPER INSTALLATION.
FJEFRM I T E FS I FEES} F3EO3EMFDEFZ 31.. 18l=17:D
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 THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:
APPLICANT KURKA ALASKAN BUILDER INC
ISSUED BY ------------------------------DATE--------------- V3.2
:f. t tl.,, ,t 'µ.'{ f 1 IY .:a p�1"+• "n.tro• ...:.,.1 n ,. -'
.. _ .. :I . Y, .'• •p is
_Conic �...:_
Municipality of Anchorage
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �� eT'CJtii
ONSITE SEWERMELL PERMIT APPLICATION
NAME OF APPLICANT: Ll rka f Ct�>�- & J----------------
/7ti
MAILING ADDRESS:_pp 0_2 1L ) LPHONE:—La-LI - 3C�Cc 3
INSTALLATION LOCATION:_
LEGAL DESCRIPTION: L 8 C _TkI
1 �l r y� r �� i(_C4 CC -J
METES & BOUNDS:
LOT SIZE: ci ur oco SQ. FT.
TYPE OF PERMIT: /SEWER UPGRADE
WELL
COMBINED
NUMBER OF BEOROOh1S:SOIL RATING: (� [ri
HANDVJRITTEN
(Number only)
TOTAL DEPTH: FT, PIT
TRENCHRAVEL DEPTH: FT.
GRAINFIELD
I
FOR UPGRADE ONLY ADD TO LENGTH ANO/OR ADD
{ GALLON TANK.
FEE: COLLECTED BY: Lir.
-- L { OFFICER•
72 012 rnn —" XT
•x c�
11:
` 1 w� -Ia K IY '1141 •.
u.r
L- So
n �= y-
i1 1
N
Ir '.Y. ....1 .,. .l .I tl � j I •
0,& E GEO'0`7.CHNICAL F:\D.EVEL"PMENT CO.
Box 90vis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
6942774 SOIL LOG 688-2280
Soils & Foundations Land Development
Performed for: Name: Tel. No.
Mailing Address:
Legal Description: -
Death (feet) Soil Characteristics
0
1
2
3
_.
4
5
6
7
8
9.
10
12
13
14
15
16
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: Date:
1l1l-7/03
Municipality of Anchorage ji 441C
"*,
Development Services Department Building Safety DivisionOnsite Water and Wastewater Program4700 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. OS/ - S8 Z- 03 HAA # n 3fls1-1
Expiration Date: _/1-17-0
1
I -/%-O1. GENERAL INFORMATION
Complete legal description A c f S,
t3 /Gc k '/,
T4kO 'C/ei- 5ira
141z fr,
Location (site address or directions)
E y 7 3 7
Current Propertyowner(s) DiecXre Shu//ink Dayphone ' KF8-fca79
Mailing address Z Y 7 3 7 776 wo e,-&- bie-ee or; Cd, w ,u 4 +(c 99567
Lending agency flo1,o1,e4 A4s a Day phone 2 ZZ - c9f o�
V V
Mailing address iYOO w f3 aroma C�/�.r A.+cha��ru, hk 996a3
Real Estate Agent A/v.,a - Fst ep Day phone
Mailing Address
Unless otherwise requested, HAA wilt be held by DSD /or pickup. Pleare Cal/ alir %<< Clbnn el/
2. NUMBER OF BEDROOMS: 3 27 e-- S008 wben A6,9-,4.r«dy .-
lo'e 4- up
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class A Well
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ED
Individual Holding tank ❑
Community On-site ❑
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 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.
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 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 F/a fY6p rccS/7,'cQ/ Eff"'"I Phone 3 yS--
Address /y530 G—cyo Sit., ACr 996,16,
Engineer's Printed Name Asa �� T 1`1co--Y Date IV&e-1 /0, X0.3
5. DSD SIGNATURE
1Z Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
49!H-
THEODORE F. MOORE
CE -3589 �;
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
(Rev. 01/02)
Municipality. of Anchorage o
• "1 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
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:I-5i �f, -7A(4,)c .er`61rc( Ne (KA Parcel ID:OS'/-sfZ-o3 1
A. WELL DATA
Well type C fart ,'A If A, B. or C provide PWSID # 1 / S 415r Well Log (YIN)
Date completed _ Sanitary seal (YIN) Wires properly protected (YIN)
Total depth R Cased to ft Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test.
Static water level fL ft.
Well production 9•p•m• 9 -p.m.
WATER SAMPLE RESULTS: Ill. A-.
Coliform colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml.
Arsenic: mg./l. Date of sample: Collected by:
B. SEPTICIHOLDING TANK DATA
TankType/Material Sga F, c S fYP/ Date installed I 1 / 7Ar
Tank size 1 ZS'O gal. Number of Compartments 2 Cleanodts (YIN)
Foundation cleanout (YIN) N Depression over tank (YIN) N High water alarm (YIN) IV. A.
Date of pumping 10 l Z / 03 Pumper Z' 13 SeP c
C. ABSORPTION FIELD DATA
Date installed 12/ I /76 Soil rating (g. p.d./e or ft'Ibdrm) I00�r;3 System type 6ec(
r3vR�-r
Length 3 Z' tt Width 2 S ft. Gravel below pipe 40 ft.
Total depth 3.2 ftEff. absorption area 8°a eMonitoring tube Y Depression over field N
Date of adequacy test II /l v / O 3 Results (Pass/Fail) Part For 3 bedrooms
Fluid depth in abscrpticn field before test O in. Water added 909 gal. New depth_( in.
E!apsed Time: Q min. Final fluid decth G in. Abscrcticr, rate >_ `TSO g.p.d.
k"10if les. c.1e date
Any rejuvenation' treatment (pas; 12 mo.) (YIN 3 type) None u,-, �%• A.
.`
D. LIFT STATION Al. A-.
Date installed
"Pump on" level at_ in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N)
'Pump off" level at,_ in.
Cycles tested
High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO: N. /f, Co m m •.n.Itj, iim a,
Septic tankAift station on lot
Absorption field on lot
On adjacent lots
On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation It' Property line 3,;'- Absorption field S
Water main > to' Water service line > 10' Surface water > trio '
Wells on adjacent lots > z&o '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 17 Building foundation Z S"' Water main > to
Water Service line > !o' Surface water > tclo ' Driveway, parking/vehicle storage 60 '
Curtain drain None Seen Wells on adjacent lots >> 24,
F. COMMENTS
%na olae-, C'rw 0PC, ( rn r cv/ Sp&re rgrr` y/Z/99 HgA
Sefic sy.r en, rr2n�.0 far Y- belr,., .�t�✓.dr�i^� 64�`�h:� � haJ o�/�
G. ENGINpEER'S CERTIFICATION fc,
:..
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in # = . •� ; t� `;,� �,
.r
conformance with MOA HAA guidelines in effect on this date....
Engineer's Printed Name 76ieoc.Po� F• /`rCscw-e { al .••.�.......'-.� .;i
�THcODCRc. F. IdOORE;"� 1C`
Date Nuv.e10 4er- lel,Zr✓o 3 ?;1C,, :�� E-3589
HAA Fee $ 3 75- —�' Waiver Fee S
Date of Payment U / 13 /0 3 Date of Payment
Receipt Number L+q 4 "69e Receipt Number
f Rev. 12.'C 1)
• � t w i r...... t
l �Y
J ',t
t
� �SPl1 •L r 7� .,., • -- � l r 30
bti t v.�
• 75mawals
41,0c
Eric Ujsf7
'0 V �.•a.w1
• •s ., j t,...: �,, � In
V � � b t,•t/.a• � .
O Its $f{cwN
STrrL P1PR
r ice.- `1>,✓.t �� .� ,.t,r° SLm tt0
PlYk'-
!< ^ 2- i 4.10 . I v Lr A5.13UlL7
�HK ✓•� el L.iy Pte,;
I Hereby eetltly that 1 have Surveyed the louowlnt
deudbcd propor}rt LA'r• -rt >yiv�t!*. ►hl
7`IL /V, R /-w L.Y.-1/
Anclioratt ltccordllur Precinct, Ahakn, and that the
..;•� :��., Improvcnitnu •ltuoted thrteon are vtttldn iho property
•,1% 11nct and Ile not evertap or encroach on the ptoptrly
lying ndlotenl therelo, thet uo ImprovemenU on prot�
crly lying ndleceut thetelo tiKroae 1 an the premUet in
•:'• r nntlot• and tient Ihary are no randwave. tnnrn,ttrlon
Hca Cir utlior vbibll Cartlotnle on Said properly exctpl
' ,: ns 4uilcnitd hcteun. ,
..
'Dated at River. Alafkn
..•, LA ,. 'u�ix�• = _day o ..r�:.•I.—..r_�_.. � r�.
';; ' • Itol;tit r~ JOHNSON
•�J
SCAM ilei flerrd Iaiwl Surveyora. DOO-LS
•'t' j: t
1"=30 ' [tole 450, laitle Itiver, A.Luka
�� •'� 1'1 nr Ong 1513 '
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # L'4N1 - - I '.-)
HAA # 11,11-\`\ (',1
011 N\
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ,2y7'7 �, ��.va�,cc.,P� �✓d�' L�'r: v e✓,c
A�,Qs.� 9y.sd7
Property owner �H �'�� ��^'�"^' ��'�-- ��� Day phone S'sz - zze/
Mailing address .Z1/7-7-T-,%d�rlOc��d.eo e -Z, �'-a�c� off. ,� 9V-4' 7
Lending agency
Mailing address
Agent
Address _
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: g '�
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-=(Rrv.V91) Front MOA121
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
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.
Name of Firm Phone!���
Address y4Gv�97r.� 9�✓G sib
Engineer's signature I Ill
;'��ESYSTcciye 1,—O TEO FCC
yd�o eovHs. rr e r d-ri ut .rd, ,v .ys
.o .�11�vc>_noH yv.-sG
O,.q Fie't0 Auu.T .e'Cf'o'�"�iS
O.v
Odr/.L T.gitJic ANO TNo'i90�.%1^,t�v7'i o,c,�'
FiGGO,
6. DHHS. SIGNATURE
Approved for_ H-1 bedrooms.
Disapproved.
Date Z . 2, • `�
TH moi
%. •sem
do
. • �J
S T.' f,.NLEY.'
�dR1.CE 6176 '
. •(!•.�y'"
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
Date 4.2-,99
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 courtesyto 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 engineers work.
72-= (Rev.191) Beck MOA e21
RECEIVEL
j
.� Municipality.of Anchorage
MAR 22 1999
DEPARTMENT OF HEALTH & HUMAN SERVICESAuNiCIPAunr'OFAN
Environmental Services Division' ENVIRONWNTALSERVICE
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority ApprovalChecklist .
,LegalDescription: 'Lor�s�•�,�`'��f�'.vo�c�'�'�rs'�� Parcel I.D.:
A. WELL DATA I
I !
I
Wella✓ac rc i
typ ` If A, B, or C, attach ADEC letter. .ADEC water system number .2i i°'
Log present (Y/N) Date completed j
Total depth Cased to Casing height (above nd,
Sanitary seal (Y/N) Wires properly ected (YM)
I
FROM WELL LOG INSPECTION
Date of test j !
Static water level
i
1 Well production
I
P g.p.m. g.p.m.
WATER SAMPLE RE S:
Coliform Nitrate Other bacteria
e cf sample Collected by: '
B. SEPTIC/HOLDING TANK DATA I
Date installed z111 -74C ! Tank size Imo' •"'I Number of Compartments z Cleanouts (YM) y
Foundation cleanout (Y/N) Depression OP/N) N High water alarm
Date of Pumping `;XX AP Pr , Pumper
C. ABSORPTION FIELD DATA
Date installed i Z����' Soil rating (g.p.dAt' or ftz/bdrm) '/°O System type 6w
Lengthy Width 9z Gravel thickness below pipe / Total depth' '.9
Effective absorption area IRoo F? Monitoring Tube present (YM) Y Depression over field (YM)
,I
Date of adequacy test �' y7 • Results (Pass/Fall) For y bedrooms
Fluid depth In absorption field before test (in.); Immediately afterdyO gal. water added (in):
Fluid depth (ins) Minutes later. Absorption rate a p.d.
Peroxide treatment (past 12 months) '(Y/N) If yes, give date j
72-026 (Rev. 3/96)'
I , i
D. LIFT STATION
Date Installed Size in gallons
Manhole/Access (Y/N) "Pump on" leXgI atm` =Pa level at'
A
High water alarm level at' 'Datum
ested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot On adjacent lots
Absorption field on lot On adjacent 1p3s
A
Public sewer main Public sewer manhole/cleanout
eptic service line Lift station
SEPARATION DISTANCES FROM SEPTIC ON LOTTO:
Foundation io « Property line �o �F� Absorption field
Water main/service line -Z�Surface water/drainage BOO �Ff Wells on adjacent lots 0 "17/
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line Building foundation Water main/service line
I Fig Driveway, parkin ehicle story 50
Surface water Y 9w e area 9
Curtain drain Wells on adjacent lots
i
F. ENGINEER'S CERTIFICATION :i���\\\\
OF di -11.
I certify that I have determined thru field inspections and review of Municipal recorie ab' g�gfs are
11
in conformance with MDA H guidelines in effect on this date. ± yA ,. ••: 0
TH
Signature ...•' i V,
Engineer's Name .ea,v
DOUG
S .KENLE
Date 2' 3 .I� �' CEai76
'��, .
HAA Fee $ �D `
Date of Payment
Receipt Number
72-026 (Rev. 3/96)'
Waiver Fee $
Date of Payment
Receipt Number
M
02-26-96 12:00 Ply
11
.jce
P002
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i
3,o
AF�1
! oi33`LT 3CNMOJ'S
�j yld5 by
6 S/,p� `Y
al��l9�
Dom. 9t7r, (,sn
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7lg ,7�r0 OUN
Ljo�r=Lew
61?4uNP
c
R��3ti.lo�
I � Y /`i I"r� t � •l • '� tel%) ,.rtrti'
AS•DUlt r
I hereby cerll(y that i have surveyed the IOUowing
described
property-te.--..
Anchnrage ltecordinll Precinct. Alnvkn, and that lha
11111 ovale its Situated Ihetton are within Iho property
lines nod tin not overtop at encroach on the property
lying ndlotent thereto, lht!l no Improvements on proms
erly lying ndlacent Iherclu t�leroacl1 an the premixes 111 I
1lhttlon and Ilial there are no tood.-ays, trann
rn.ttelo
1�11ca or ulht•r visihle encelnenlx on veld properly except
ns 4u11Calr,J hereon.
i
Paled It Pt;le River. Alaska /
lhit:�•--_Jay o �':.IC..-. IoxraL.
ItUill:tt C, JOl1NSON'X�!"t:�•.
SCALM ltelererl (,and Surveyor fla
tiv'.`OWLS
1 em 3 p' Buz 450. 1a1810 lover, AI:uk11
I'Iohr, 001.25��
02-26-96 12:00 PM
P001
FROM: JANETTE R. CARON
2550 DENALI ST, #1406
ANCHORAGE, AK 99503
907-276-4250 - PHONE
907-276-4275 - FAX
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DATE: ; 2 - �2 1
TO: P4 LJ I L L r •9 u
MESSAGE: 0-S c 0i LT'--rt4unJDu2Q>iaD.
SPE ro" LDy el-?Aj RE -PL-) 7?W S
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH ti: HUMAN SERVICES AIL
Division of Environmental Services - so
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-582-03 HAA #
1. GENERAL INFORMATION
Complete legal description
Thunderbird Heights 91 Lot 5, Block 4
Location (site address or directions)
24737 Thunderbird Drive
Property owner Cecil & Catherine Shtunan Day phone 563-6436
Mailing address 24737 Thunderbird Drive, Chugaik, AK 99567
Lending agency Norwest/ Jeanette Caron Day phone 27b-1250
Mailing address P a anx 1 ui47, 7lnshe age, AN 99514
Agent N/A Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water X
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rw. 1/91) Front MOA F21
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 furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investl!C ation 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.
Name of Firm Eagle River Engineering Services Phone 694-5195
Address
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
By:
Disapproved.
Conditional approval for
Additional Comments
Date -1 - /r's,r--
bedrooms, with the following stipulations:
�l
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(A/.. 1/91) Back MOA 421
............ . . . . .......
Municipality!, of Anchorage
DEPARTMENT, OF HEALTH & HUMAN SERVIRKEIVED
Environmental Services Division
825"L" Street, Room 502 a Anchorage, Alaska 99501 • (907)aI47:
Y 6 1996
Municipality of Anchorage
Dept. Health & Human Services
Health AuthorityCklist I'
Approval Che
Legal Description: e;1'7"`!7.Y4-/ Parcel 1.
D p-1�
A. IVELL'MTA "T
Well type' U /3 C C-- If A. B, or tt. attach ADEC letter.: ADEC %vatcr system number
Log present (Y/N) Date completed
Total depth Cased to
Casing height (abovc ground)'
casing licig,
Sanitary seal (YIN) Wires proper, p
Wires properly
protcC IN)
FROM WELL LOG
T
T INSPECTION
Date of test
Static water level
Well production
g.p.m.
I.
g -p -m -
WATER SAMPLE RESULT
Nit
Coliform rate
Other bacteria
sl c:
Date of ,
..
, C
Coll6ctcd by.
B. SEPTICaiQLWNG TANK DATA
Date installedOJ 0
T.nk s Number of C mpatrtments 2, Cicanouts(Y/N) Y6$
Founds itio'n'�16'a"n"o�ui'(.'Y/N�,104A/,o b c, pression (YM )' H,1
ig h water alarm (Y/N)
Date of Pumping Pumper per
C.� ABSORPTION FIELD DATA
Date installed Soil rating (g --.T. r ftl/bdrm)
Svstcm tvl)c
Length ZS
Width
Gravel thicknessti
I)CIO,%1" p,ipe Total dcp i
Effective absorption area Monitoring Tube 1), r'6scnt(Y0 Y45S Depression over -cr held (YIN)
Date of adequacy test Results (Pass/Fa I ;R/� (Z For
q bedrooms
Fluid depth in absorption field before test (in .): Immediately after gal. water add I cd (in:):
Fluid depth 4J (iris.) Minutes lal, Absorpti6n rate
cr: -t p.d.
Peroxide treatment (past 12 months) (Y/N)
J Ifyes, give date,
D. LIFT. STATION ,111
Date installed
Manliolc/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
Size in
ori' Icvel at* "Pump off' Icvcl at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO: 1414
Scptic/liolding lank on lot
Absorption field on lot
Public sewer main
Sewer /sewic 'scrvice line
On ad' cxH6(Ts
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/H6tDiNG TANK ON LOT TO:
i
Building foundation /n Property line -3 Absorption field 5
t � �
Water main/service line /—/D Surface water/drainage X100 Wells on adjacent lots f"7 -OD
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Building foundation 7 S t Water main/scrvicc line t/O
Surface water � � 00 / Drivew:ry, parking/vchicle storage area
NINE�
Curtain drain �9Pf ���MT Wells on adjacent lots r- 7-400 Property line *7
F. ENGINEER'S CERTIFICATION
/certify that I have determined thru field inspections and review ofAfunicipal record t th,abAi;r-s"Vns are
N. -I
in conformance with HOA A guidelines in effect on this date.ow p ��.7 "' 4�• .,'w^, �j!
Signature:6s'�� �'ti t
Engineer's Name GDU/S B!l/E/# PE r •. ••
d Louie A. Eu!ero 4W /•
CE -6736
Date a -�S'- 5 s 0 s •�
HAA Fee S Waiver Fee S
Datc of Payment A-kcc-`�IkLo Date of Payment
Receipt Number Receipt Number
Rev. 8/95 OSS: haa.wk.doc
® Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Uper16 V;1 ' 1W7hr�,�o i�s�I Parcel I.D.
A. Well Data
Well type A If A, B, or C, attach ADEC letter. ADEC water system number 2l tksG
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (YM)
FROM WELL LOG
Date of test
Static water level
Wires properly protected
Well flow / g.p.m.
SEPARATION DISTANCES FROM WELL TO:
AyiNSPECTION
ry
g.p.rrM
.r
<
rn_
Septic/holding tank on lot ?ti 01 k ; On adjacent lots -
Absorption field on lot 200 t ; On adjacent lots
Public sewer main Public sewer
Sewer service line
WATER SAMPLE RESULTS:
Coliform
Collected by:
B. SEPTIC/HOLDING TANK DATA
Other bacteria
Date installed t2- t —1 r Tank size ) Z-Sk- Compartments `Z
CleanoutsON) 4 Foundation cleanout (Y& iJ Depression (Y�
High water alarm (Y& _ _ rJ Alarm tested (Y/N)
Date of pumping 45' ,-Z-3 -C14 Pumper _ S(t (�SSPa a L,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on tot 'L00 �� On adjacent lots r�1nr Foundation to'
To properlyline ) n � Absorption field I
S Water maiNservice line 1 c
Surface water/drainage k 0-10 %
72-026r=l•Fmnt CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pum on" level at "Pu at _
High water alarm level c es tested
Meets MOA electrical codes (YM)
SEPARATIOSTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water.
D. ABSORPTION FIELD DATA I
Date installed 2 t,-1 Soil rating (GPD/Ft2) 1ot�%V{6y System type
Length 2 S" Width Gravel thickness ( Total depth '� r
Total absorption area g D o Cleanout present &N) _Depression over field (Y® .�
Date of adequacy test -9+ Resufts fail) P&cs for Bedrooms
Water level in absorption field before test o After test
Peroxide treatment (past 12 months) (y6p r^joAll r� I4,,-1oJ,J If yes, give dater
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1'0 01 On adjacent lots '_4' Property line /01 41
To building foundation /'0 1.4-
r To existing or abandoned system on lot 4
%� r A Watermain/service line
On adjacent lots _J-_> c Cutbank
Surface water 1 o D t Driveway, parkingivehicle storage area
Curtain drain A k
E. ENGINEER'S CERTIFICATION
1 certify that f have checked verified, or
Signature
Engineer's Name 170 Eagle
Date
HAA Fee $ 3�rdta_ I
Date of Payment
Rece%t Number
72-026 (3I93)a Back
orf,.:
MOA and HAA guidelines in effect a to of this inspection.
r✓(k Y
k„
V.
>i
k"M ix
�^, ~aaa Mrala, �V iC
Waiver Fee $
Date of Payment
Receipt Number,
MUNICIPALITY OFANCHORAGE A
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-582-03
1. GENERAL INFORMATION
HAA # -
Complete legal description Thunderbird Heights #1, Lot 5, Block 4
T16N R14; Section 25
Location (site address or directions)
24737 Thunderbird Drive, Chugiak
Property owner AHFC Day phone 561-1900
Mailing address 520 E. 34th Ave., Anchorage, AK 99503
Lending agency NSA Day phone
Mailing add
Agent Lee Scantlin, Great Land Realty Day phone 694-9125 `
Address 11411 Old Glenn Hwy., Eagle River, AK 99577
Unless otherwise requested, HAA will b:; held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water X
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status o.` system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOAe21
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lou op SHHO to saaAoldw3 •sluawailnbai alels pue l uepal ulel,ao Alslles o3 aapio ul suollnl!lsu! 6ulpual alayl pue
sawoylosiaseyojndolAsalJnooaseslylsaopSHH❑ayl• MWIVloa3e3Say3ulpaialsl6aiiaoul6uoleuolssalad
luapuadepu! uv Aq anoge 9 ydei6eied u! UDA16 suolleluasa.)dai ayl uodn Aluo paseq saleollpia0 lenaddV
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IN
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swooapaq aol panoiddV X
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•uo!loodsul slyl to alep ay3 uo loalla ut suollelnBei pue 'saoueulpao
'sapoo a3e3S pus lsd!olunn Ile yl!M aouelldwoo ui si welsAs lesodslp aalumalsem jo/pue Alddns
aalem ails-uo ayl'uolloadsul pue uolle61.lsanu! Aw woal pue salla a6eaoyouy to Al!IsdlolunlN ayl
wal paulelgo uollewjolul ayl uo paseq leyl A;!aanjagpn; l •ulaaay palsolpul ainlonils to adAl pue
swooapaq to aagwnu ayl aol alsnbaps pus leuollounl'ales si walsAs lesodslp aalumalsum jo/pus
Alddns aalum alts-uo ay3 3eyl smogs uollsolidde leno.iddV AllaoylnV ylleaH sly3 to uolle6llsanu!
Aw 3ey3 Al!aan I 'molaq umoys alsp uollep!Isn ayl to se pus olaiay paxllle leas Aw Aq paippeo sV
S33NIJN3 AS N01103dSNl d0 LN3W3lVl.S 'S
Municipality of Anchorage
Department of. Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 712PAL 9&9P /1Q6H7'5 #YJ Parcel I.D. '03
LD> $ '61-6C9 /f
A. WELL DATA T/GN Pup SEC Z$
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Date completed
Total depth Cased to
Sanitary seal (Y/N)
Casing he
Wires properly protected
FROM WELL LOG
Date of test
Static water level
Well flow p.m.
Pump level
SEPARATION DISTANCES FROM W LTO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Driller
�yrinsrtcI 1Vn.
L'
g'' o
TOO T
� � 9
rim
On adjacent lots
On adjacent lots _
Public sewer manhole/cleanout
Sewer service'I' Petroleum tank
WATER AMPLE RESULTS.
Nitrate
of sample:
B. SEPTIC/ltif7G TANK DATA
Collected by:
Other bacteria
Date installed�Zf �/! Tank size 17,50 z
, Compartments
�/,'
Cleanouts (Y/N) yC5 Foundation cleanout (Y/N) � Depression (Y/N) NO
High water alarm (Y/N) 1414 Alarm tested (Y/N) 'VIA
Date of pumping (L�Z�'�9Z Pumper JI°S
UL(C-1fY,0LkA"
SEPARATION DISTANCES FROM SEPTIC/PIOLDIP G TANK TO:
Well(s)onlot N/A On adjacent lots zoo/ Foundation lO/
1 J
Topropertyline :39 Absorption field S Watermain/seryice line
Surface water/drainage _/NIA
72.026 (Rev. 7/91) Front, I
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
—"Pump on" level at
Meets MOA electrical codes
SEPARATION D
Well
FROM LIFT STATION TO:
On adjacent lots
nufacturer
cess (Y/N)
"Pump off" level at
Cycles tested
Surface water
i
D. ABSORPTION FIELD DATA
Date installed /2%4/��g Soil rating /gyp%� System t e E6
Length 25 Width 32 r Gravel thickness ��� Total depth .3
Total absorption area 9A2_!.t Cleanouts present (Y/N) Y&5
Depression over field (Y/N) AID Date of adequacy test 0/
Results (pass/fail) /��155 for bedrooms
Peroxide treatment (Past 12 months) (Y/N) IglA If yes, give date NSA
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N14 On adjacent lots f �� v Property line 17
To building foundation ?� S To existing or abandoned system on lot N%A
On adjacent lots Y'_ /30 Cutbank N % A Water main/service line f �D
Surface water Driveway, parking/vehicle storage area f 10
Curtain drain NDNL APPA05N
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect tq%% ate of this inspection.
OF.q E�
••� e ••.,�%a 6
Signature
En ineer'sName 1uti�J ��-'`Y•� ��
// i :� Louis A. EMera
Date `v C'
i�
HAA Fee $
Date of Payment /—a —� \
Receipt Number o7 U
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ —
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES y
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA # a] QS0 Ln
Parcel I.D. # 051-582-03 Z
1. GENERAL INFORMATION
_Complete legal description ThundPrbi rd HP; ghts #1, Lot 5. Block 4
T16N R1W Section 25
Location (site address or directions)
24737 Thunderbird Drive
Property owner AHFC Day phone 561-1900
Mailing address _520 E. 34th Ave., Anchorage, AK 99503
Lending agency N/A Day phone
Mailing address
Agent Lee Scantlin/Great Land RealtvDay phone 694-9125
Address 11411 Old Glenn 1:1w3r , Eagle River, AK 9Q9;77
Unless otherwise requested, HAA will be held for pickup. - - - -
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well X
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Hev. 1/91) Front MOA M21
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 furtherverify 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.
Name of Firm Eagle River Engineering services Phone 694-5195
Address P.O. Box 773294. Eagle River, Ak 99577
Engineer's signature Date �" s
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
�YtY•,•Na.••ea�u1 $�
ra � �. • a r 1
Y ..) �• kN '. 7
.G.........
i. .•
Louis A. Butero
CE -6736
;?OFESSIO����
7
bedrooms, with the following stipulations:
Date
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 theirlending institutions in order to satisfy certain federal and state requirements. Employeesof 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 engineers work.
72-024 (Rev. 1R1) Saek MOA 821
....., ... .... _.. ._...
Municipality of Anchorage
Department of Health &Human Services
' HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Parcell.D. 65/-5PZ-403
Gor 5 l3cOCk 4
A. WELL DATA V&/V �C/W S�CfDN ZS
Well type _I If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Date completed
Total depth Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Pub/sewerservicne
WAULTS:
ColNitrate
Da
B. SEPTIC/H0t0ttdt3 TANK DATA
Driller
Casing height
Wires properly protected (Y,
AT
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed / 7 0PI7 F Tank size / Z 5o Compartments 7
Cleanouts (Y/N) % S ' Foundation cleanout (Y/N) _ _ Depression (Y/N) .— NO
High water alarm (Y/N) AIJA Alarm tested (Y/N) /VSA
Date of pumping DyJ23�92 �l,P
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Weil(s) on lot On adjacent lots ;`" Foundation �o
To property line 3 Absorption field S Wateraiaio/service line
Surface water/drainage - NIA
rz-0ze(Rev.38t)Front MOA 21 CONTINUED ON BACK PAGE
m
72 �
c
oz
g.p.rr�
1'
_
b
N
�F
rn
o
Ao
rn
N
n
yo
On adjacent lots _r"
�+
On adjacent lots
_
w M
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed / 7 0PI7 F Tank size / Z 5o Compartments 7
Cleanouts (Y/N) % S ' Foundation cleanout (Y/N) _ _ Depression (Y/N) .— NO
High water alarm (Y/N) AIJA Alarm tested (Y/N) /VSA
Date of pumping DyJ23�92 �l,P
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Weil(s) on lot On adjacent lots ;`" Foundation �o
To property line 3 Absorption field S Wateraiaio/service line
Surface water/drainage - NIA
rz-0ze(Rev.38t)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on"
Meets MOA electrical codes (Y,
SEPARATION I
Well on
Manufacturer
Manhole/
at
FROM LIFT STATION TO:
On adjacent lots
D. ABSORPTION FIELD DATA
"Pump off' level at
Cycles tested
Surface water
Date installed Z.orLI P
Soil rating - X00 40 18 k System type A5D
Length �r Width 3 2
Gravel thickness Total depth 3
Total absorption area A
Cleanouts present (Y/N) YE 5
Depression over.field (Y/N) NP
Date of adequacy test Otz/l
.Results (pass/fail) P465
for bedrooms
Peroxide treatment (past 12 months) (Y/N)
N14 If yes, give date NSA
SEPARATION DISTANCE FROM ABSORPTION
FIELD TO:
Well on lot 1,114 On adjacent lots t 200 � Property line—,12 �
To building foundation
To existing or abandoned system on lot N12
On adjacent lots Cutbank --VIAWatermaia%sery aline 41cl�
Surface water A/ AI
Driveway, parking/vehicle storage area >`io 01
Curtain drain A765 48P4,PEi11F_
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on the -date of this inspection.
, ; . °°•
Y'� p!
Signature
C.
a„ Gj ;
.as
Engineers Name LdU/S 30Zr
I
° • • 4 .°
��j. • •°•°
Date
�. , Lout: A. Butera t441d
CE.6736
5�z 00
.. . _
, tooPiin��net(R� �►
HAA Fee $ /7 Q ° C2
Date of Payment 6 2z_ C 'Z.
Receipt Number_(n
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ —
Date of Payment
Receipt Number
7`><- c -
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description Lot 5: 8tocfz..4: Thundenb.ind He.ight6 01
Location (site address or directions)
24737 Thundenbi,%d D i.ve
Chug.i.ak, AK
Property owner Kenneth and Jean Hunt Day phone 688-5350
Mailing address
Lending agency City Montgage/ A1anh Tnu6kett Day phone 688-5350
Mailing address 121 tU Fi orvood Land quite 120 Anehonage AK 99503
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. - NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Four (4)
XXX
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site "
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-0251R".1/91) Front MOA e21
S.
6.
By:
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
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 tkedate-F-o-folis inspection.
Name of Firm s a s
Address
Engineer's signature
DHHS SIGNATURE
/ Approved for
Disapproved.
Conditional approval for
Additional Comments
bedrooms.
204
Phone /; ZV-2 97 9
11
Date
a
bedrooms, with the following stipulations:
ItITIC
The M•-nicipality 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
profession^I 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.
nau (PW. 1/91) e.ok MOA 621
• r -I r� E
USKIA
WALTER J. HICKEL, GOVERNOR
�a
0
DEPT. OF ENVIRONMENTAL, CONSERVATION
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
January 14, 1993
Eagle River Engineering
P.O. Box 773294
Eagle River, Alaska 99577
SUBJECT: Thurnderbird Height
Class "A" Public Water System, PWSID 211156
Dear Sir/Madam:
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on January 4, 1993. This does meet the provisions of
18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on September 14, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on December 1, 1992. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations.
4. The last Volatile Organic Chemical (VOC) were submitted to this Department
on JuLY 6, 1992. This does meet the provisions of 18 AAC 80.200(a), State
Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
S�ereKeven
ly,
�e'v
K. K eweno
District Engineer
•L� jw.wid on Fecvcded paper b v C.D.
t e;
0 0 WALTER J. HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
FOR: Eagle River Engineering
April 10, 1992
PWSID # 211156
My review of the records on file in this office reveals that the Eklutna Thunderbird Heights
Class "A" Public Water System, is in compliance with the routine coliform bacteria
sampling requirements listed in Table C, and with the inorganic sampling requirements
listed In Table B of 18 AAC 80.200.
Sincerely,
Bron Ro s
Y Y
Project Engineer
BR/cf
printed on recycled paper by C.D.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION
ENGINEER FIELD AUDIT
DATE:
TIME:
LEGAL DESCRIPTION: /
C
ENGINEER: �a Yas27
EXCAVATOR:
AUDITOR: Z2, . ,&,J��;
COMMENTS:
,/ _ /e A,
SIGNATURE
AUDITOR:
APPLIe"NT FILLS OUT UPPER HAf ", ONLY
Time
Property Qwner , .
Phone
Time
Date
Mailing Address Zip Code e; <-
% �—
Buyer
Date 11
Address / Zip Code r. ar""• .<—,r !/
Lending Institution
Phone
Inspector
Address(/ Zip Code
/?."/
Realty Co. 3 Agent
Phone
Address (' % ✓ t Y I r % - i'i ' ,, > Zip Code /i
u
Legal Description
Street Location /� „i '"' / , . �' r /,., / c '�� C'
( ) DISAPPROVED
Type of Residence
( ) CONDITIONAL APPROVAL'
DATE
BY:— ~
C� Single Family
Soils Rating
(j Multiple Family No. of Bedrooms
Well To Absorption Area
❑ Other
Septic Tank Size
Water Supply
1- B
1 Well to Tank
❑ Individual p
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
10 Community
For wells drilled prior to that date, give well depth (attach log
If available).
C Public Utility
Sewer Disposal
/C;� 7 %�
Q Individual Year Individual Installed:
b Public Utility When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date 11
Inspector
Inspector
Inspector
Inspector
Field Notes: ry T��,
7
8��tt
MUNICIPALITY OF ANQiORAGE
DEPT.:OF N H` PRO t,
ENVIROti)A`TAL PROIECiIOt`1
G
RECE1V_�Q,
() APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY:— ~
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
1- B
1 Well to Tank
!L V(J IYO[I 1
O
Y
October 21, 1983
Liz Martin
P. q. Box A-5
Chugiak, Alaska 99577
Subject: Lot 5, Block 4, Thunderbird heights Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
°. The septic tank pumped.with a receipt submitted to this
OY- department.
° An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system is
adequate according to Rational Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there: are any
further questions, please call this office at 264-4720.
CW77/ej/E2
Enclosure
Sincerely,
Cory Willis, R.S.
Acting Sewer & Water
Program Manager
ADEOUACYTEST
WATER AND SEWER INSPECTION
WELL INSPECTIONS AND
FLOW TEST
' SITE PLANS
ROAD DESIGN
.. _ SOILTEST
ON SITE WASTEWATER
DISPOSALSYSTEM DESIGN
EXCAVATION WORK
Re/Max Realty
ATTENTION: Virginia Kohfield
P.O. Box 848
Eagle River, Alaska 99577
November 60 1983
ROSERTA.SHAFER
CIVILENGINEER
694.2979
NwOmGE
LES OF P
Mur11C1pp Of 11-j - - L�1JON
rE -�ZHL FF•OZ�
(\, J
R�C�`v► ED
Dear Ms. Kohfield,
Reference: Lot 5; Block 4; Thunderbird Heights Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1000'gallons. The
absorption trench was tested by a continuous flow of water over
a period of ,24 hours'without any adverse effect on the system.
It can be concluded from this test that the waste water disposal
system serving the -three bedroom residence located on this property
is currently functioning adequately. However, the system cannot be
guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to contact
cc: Municipality of Anchorage
Department of Health and Environmental Protection
196X EAGLE RIVER, ALASKA 99577
MUNDppAL/Ty O,.
ENVIRON";.C' 1:�CHORAGE
.vl,u flO
IL UCC N
1 S 1978
REALTORS" REC
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA �i FHA CONV X_
2. Property. Owner: I& -
Mailing Address: �-Q • /3n x �iy� C��r�P r�P Day Phone(,�y
3. Name of Buyer:
Mailing Address: Day Phone
4. Name of Lending Institution: 'j",or�/1;P, 0, c%
Mailing Address: Jg30 'tc y i9r.�o�. Phone7�oa .
ni
5. Name of Realtor or Agent: SL111e rzz -sig
,h'res Phone 1095/-
Mailing Address: ,fo-,���;� .:�'y� ���<F /'���i'�
6. Legal Description:
Location: egP✓o 'Ce" r C'it c�r•if -
7. Type of Facility to be inspected: No. Bdrms. 2 -
8. Water Supply
��•y�-�� -6 y rte_ X t<,�',�
Type of Supply: 44414c Utility _CX Individual
If Individual, number of dwellings presently served _
If Individual, depth of well
9. Sewage Disposal System
Type of System:
Public Utility
Individual
(on-site) _
If Individual, date
of installation:
/971_'
113
AREA, INC. REALTORS E]Anchorage
"C" St. Office
REALIOR" 3300 C Street
(.nn71 278-?5?5
0 East Anchorage Eagle River
Eastgate Office Parkgate Office
5437 E. Northern Lights P.O. Box 249
(907) 278-2525 (907) 694.9555
Cl t�vt rti� - C�1L t s�t�c 1Lam
S. LEGAL DESCRIPTION
MUNICIPALITY OF ANCHORAGE MUNICIPALITY O ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. C. I "'dT' : C.
ENVIRONh" :vl r•. P:. 1 _CTION
825 L Street • Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION OtC 1 5 1978
Telephone 264.4720
RRFF ``''
FOR APPROVAL OF INDIVIDUAL WATER AND SEWEh""ILI14k D
REQUEST
DIRECTIONS: Complete ell parts on page t. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNERPHONE
694-3493
Walter
'ATTACH WELL LOG. A well log is required for all wells drilled
MAILING ADDRESS _'... :...:..:
Post Office Box' 214 - 99577 •'"'
PROPERTY RESIDENT (If different from above)
H NE
2. BUYER
PHONE
Liz - Martin -~ __._ ..._.........._,..,.
❑ PUBLIC UTILITY
MAILING ADDRESS
3. LENDING INSTITUTION
`'-
PHONE
276-7200
Alaska Bank of Commerce
MAILING ADDRESS
3230 ...C -Street-- 99503-i.-
0. REALTOR/AGENT
Virg ina••Kohfield••��-$:•Area 'Realtors•-- •--- - '
PHONE
694-9555-
MAILING ADDRESS
.Post -office -BOX -149-99577 '
S. LEGAL DESCRIPTION
_, . • .. _.. _ ... ._ .
Subdivision'(Phase 2)
Lot 5 Block-4-Thunderbird`Heights
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS C3t
❑ One ❑ Four Other
SINGLE FAMILY
❑ Two ❑ Five
_ ❑ MULTIPLE FAMILY": `'
`.:,`;;:` Z3cxThree ❑ Six
7. WATER SUPPLY
❑ INDIVIDUAL'
'ATTACH WELL LOG. A well log is required for all wells drilled
COMMUNITY
' since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY -depth (attach log if available.)
8. SEWAGE DISPOSALSYSTEM
_ _ 1978
elf individual/on-site, give installation date
)Xx INDIVIDUAUON-SITE**
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
a
THIS SIDE FOR OFFICIAL USE ONLY, '
INSPECTION APPOINTMENTS
14
DATE RECEIVED
1. TYPE OF RESIDENCE
"" - - NUMBER OF BEDROOMS --•
—Ll SINGLE FAMILY
❑ . ONE -' ❑ . THREE (--]-''FIVE , ❑ OTHER
❑ MULTIPLE FAMILY '
"' ❑ TWO' 'EJ. _FOUR.. ❑ SIX
INDIVIDUAL/ON-SITE
2. WATER SUPPLY -
PERMIT NUMBER
❑ _,INDIVIDUAL
DEPTH OF WELL
�E1 COMMUNITY ...
-. '
❑ PUBLICUTILITY
DATE DRILLED
_.....Connection Verified
LOG RECEIVED
Septic Tank or -❑Holding Tank- :
,..
:Rw
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
INDIVIDUAL/ON-SITE
DATEINSTALLED
❑PUBLICUTILITY'
Connection Verified
INSTALLER....._
Septic Tank or -❑Holding Tank- :
,..
:Rw
Size: i n If Tank is hom emade
,
SOILS RATING
give dimensions:
TYPE OF T K r
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL ....
4. DISTANCE_$ ' .. _
SePtic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
WELL TO:..._.,.
.. _. _.
•_:
Absorption Area to nearest Lot Line
5. COMMENTS
AP'PRO'VED'FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
4 c
❑ DISAPPROVED
DATE .. 8Y Title -
,•:
t
LEGAL D SCRIPTION
nittn (R.,. Ir-rni