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Home My WebLink AboutTHUNDERBIRD HEIGHTS #1 BLK 4 LT 2AThunderbird Heights #1 Block 4 Lot 2A #051-721-43 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151071 PID Number: 051-721-43 ❑ New ❑✓ Upgrade Name: Susan Connell ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed E] Mound Address 24839 Thunderbird Dr, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPDISF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade FL Gravel depth beneath pipe Ft. Subdivision Block Lot THUNDERBIRD HEIGHTS #1 4 2A Fill added above original gradeGravel Ft. length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Fe Ft. Well 200+ 200+ 200+ 1 N/A N/A TANK []Septic I] S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity ISOO t261Gal. Surface Water 100+ 100+ 100+ N/A Material Number of compartments Lot Line 42.1 16.6 41.0 N/A STEEL 2 NA Foundation 9.7 25.2 20.6 N/A LIFT STATION Manufacturer - Atilt O2�a Capacity S(DC)Gal. Curtain Drain 50+ 50+ 50+ N/A Remarks TANK REPLACEMENT ONLY. REPAIRED Pump on level at 'f `''1 3 in. Pump off level at ` � - y 0 in. High water alarm at 45 in. CLEANOUTS AND MONITORING TUBES. ADDED 2" INSULATION AND 1'+/- COVER FOR DRAIN Pump make and model 2c Electrical Inspections performed by FIELD.to Installer -- PIPE MATERIAL Housetotank 303qdrainfield n eld 3034 J R's Septic Pumping Drainfleld 3034 COIMT 3034 Inspector PANNONE ENGINEERING SERVICES BENCHMARK (Assumed elevation) 100ft Inspection � 1 4/27/15 Location and description dates: 2M 3,d e BOTTOM OF TRIM SE CORNER OF STRUCTURE COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp ConditionalA Date r" OF. Isllt pp royal: .. ,.TMto '*. � ... .. . . ....... % . iteven f� f�annorae ApprovedAW Date 5 -1.� /,' CE a , l " ' Py ygp impaction Repotr t-t-YC.dpC� o z 0 B - FC a J 0 0 F Z z DCO 7.6 U W w � 10.5 31.1 Z J J 36.0 LS o EL 104.0 J -MTI 27.7 z 4.7 26.9 J EL. 100.0 28.2 36.1 CO1 43.4 59.9 -- CO2 t I \ s8. 1500g S.T.E.P. \. TANK (P) ✓ PROFILE NO WELLS W/I 200" OF PROJECT pol THUNDERBIRD HTS S/D SERVED BY COMMUNITY CLASS "A" WELL i 11 4 BR HOUSE \f ABANDONED 1250g TANK (E) AND GRINDING PUMP(E) PER MOA CODE INSTALLED 1500g S.T.E.P. TANK(P) !' W/ DCOs BEFORE AND AFTER TANK ,°`P'ti/ !/ REPAIRED CLEANOUTS INSULATION AND AND ITORING 1'± COVETUBES' \ —� ADDED 2" INSULATION AND i'f COVER FOR � DRAIN FIELD NOTES: DRAWN I JRL PLAN DRIVE PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 THUNDERBIRD HEIGHTS #1 B4 L2A SUSAN CONNELL 24839 THUNDERBIRD DRIVE CHUGIAK, AK 99567 H,gs� A B - FC 0.3 26.8 DCO 7.6 29.5 T1 10.5 31.1 T2 18.7 36.0 LS 20.6 37.4 -MTI 27.7 44.9 DCO2 26.9 43.3 MT2 28.2 36.1 CO1 43.4 59.9 -- CO2 43.4 59.5 NOTES: DRAWN I JRL PLAN DRIVE PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 THUNDERBIRD HEIGHTS #1 B4 L2A SUSAN CONNELL 24839 THUNDERBIRD DRIVE CHUGIAK, AK 99567 H,gs� 05/11/15 .V. Scale * 49TH *�/ 1„=50' ' • • • I P.I.O. NO •.' 51-721-43 Steven Pannone PERMIT N0. P CE 8149.•e-/ �� OSP151077 Sheet........ �� FROFEss1 `� 2 of 2 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151071 Tax Code Number: 05172143000 Work Type: Septic Upgrade Permit Effective Dates: April 18, 2015 to April 17, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: THUNDERBIRD HEIGHTS#1 Site Legal Address: THUNDERBIRD HEIGHTS #1 BLK 4 LT 2A G:1865 Owner/Address: CONNELL SUSAN 24839 THUNDERBIRD DRIVE CHUGIAKAK 995675131 Site Mailing Address: 24839 THUNDERBIRD DR, Chugiak This permit is for the construction of: Lot Size in Sq Ft: 39643 Total Bedrooms: 4 N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: 1 %0�� 61 S U13MITTA MUNICIPALITY OF ANCHORAE APR 08 2015 Gretchen Stuller Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D- a721-43 Property owner(s) Susan Connell Day phone Mailing address 24839 Thunderbird Drive, Chugiak, AK 99567 Site address 23849 Thunderbird Drive, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) THUNDERBIRD HTS #1, B4 L2A Legal description (Township, Range & Section) Lot Size 39,643 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS,AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑x (w/wo ADU) (D) Holding Tank El Renewal❑ ElRenewal Multiple Dwellings Privy ❑ ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Codes. Municipal (Signature of property owner or authorized agent) Permit/Rush Fees: If 5369Waiver Fees: Date of Payment: 411/7//6 Date of Payment: Receipt Number: 041/22 -, Receipt Number: Permit No. CSP/5/13/ Waiver No. Permit App_.::- :L..:c- Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveftanen¢ak.com 7 April 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road PO Box 196650 Anchorage, Alaska 99519 Subject: THUNDERBIRD HEIGHTS #1 B4, L2A Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request a permit to install a new septic tank be issued for this property. The proposed system will serve an existing four (4) bedroom house. Currently the lot is developed. The proposed system will utilize a 1500g SXA.P. tank. The surrounding developed lots are served by a community well. There are no wells on surrounding lots within 100 feet of this system. 1. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. 2. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 O / _ ABANDON 12508 TANK (E) AND GRINDING PUMP(E) PER MOA CODE INSTALL 1500g S.T.E.P, TANK(P) M �� o '1 DRIVE NOTES:PANNONE -ENG SVC LLC �~` OF`"\� Date l FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 'C�••" A �'qSl�) o4/t7/ts PHONE (907) 272-8218 FAX (907) 272-8211 %y�P. !y f) Scale *: A -1••=40• .... .. ... . ...... P.I.D. NO THUNDERBIRD HEIGHTS #1 B4 L2A 051-721-a3 Steven R. Pannone SUSAN CONNELL / PERMIT No. DRAWN JRL PF', CE 8149 .'�`� j OSP151071 24839 THUNDERBIRD DRIVE �+cys�•,,�� PLAN CHUGIAK, AK 99567 <<\itDRp ss*" � Sheet 2 SPECIAL PROVISION'S TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT.EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALL NEW SEPTIC TANK DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = MPI SOIL RATING: GPD/SF AREA ROD: SYS. TYPE: BED MIN LENGTH: z 1500g S.T.E. P TANK (P) PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ABBREVIATIONS CU O DIP DUCTILE IRON PIPE TH TEST HOLE O Q T# TANK CLEAN OUT N0. z u~) M# MONITOR TUBE NO. w � DCO DOUBLE CLEAN OUT O J 1500g S.T.E. P TANK (P) PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT N0. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE Date OF A/_,j kkk 04/17/15 *.. ...... .. NTS ty - ,d P.I.D. NO THUNDERBIRD HEIGHTS #1 B4 L2A21-43 SUSAN CONNELL S'teven'R. 'nno•e / PERMIT NO. 24839 THUNDERBIRD DRIVE DRAWN JRL f PF.•, CE 8149 .'4`r/� OSP151071 �' cs DESIGN DETAILS CHUGIAK, AK 99567lEp'pROSpE—' Sneet ``� 2 OF 2 n MUNICIPALITY OF ANCHARArF 72-013 (Rev. 3178) /// 5-/ MUNICIPALITY OF ANCHORAGE ,1�LIH 4K ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION NOV 5 1979 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 — ' ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION NAME HONE NEW ck V 5 7_33 — 01 1:1 UPGRADE MAILING ADDRESS 3qS-/ 4 Lot d4 ro LEGAL DESCRIPTION t .,r . , 1 ` F r- /j�T�`or' pIN LOCATII / NO.OF BEDROOMS tit V M DISTANCE TO: Well Absorption elea •� Dwelling O PEf-7 O 17q F 2 Manufact er Mater's No. of comps tments N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6 x DISTANCE TO: Well Dwelling PERMIT NO. Jaz _ IQ„ Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well N A Foundation 2 Nearest line Fi P RM N d e .W.1 u. Z No. of li es Length of each line Total lengthof lines Trench width Distance between lin p. Top of tile to fi ish grade Material beneath tile Total effective absorption area C3 — inches .s�i Length Width Depth PERMIT NO. W l7 F CL W° Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line JCla ss Depth - Driller Distance to lot line PERMIT NO. J W 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING ;, � r - i INSTALLER i1 <f / REMARKSkWl G r J � h APPROVED ^ DATE LEGAL B Lk 4 No,de,&,t M 11,Y -C 72-013 (Rev. 3178) /// 5-/ 0 f December 29, 1978 i Dick Voves 3951 Apollo Drive Anchorage, Alaska 99504 0 Subject: 1780973'Lot 1 Block 4 Thunderbird Heights Subdivision 0780974;Lot 2 Block 4 Thunderbird Heights Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. i If you have drilled the well, a well log should be sent to this department to docunent the installation date. If there are any, further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist I2TB/l jw one: copy of permit lt MU" I G I F 4L- I T'-' of tir-4oH 1! nGE!�� 7`c� f'`L DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 CIN-f�- I TE S;EWEF= F'EFZM I T PERMIT NO. C 780974 ) APPLICANT DICK VOVES 3951 APOLLO DR. 333 8682 LOCATION THUNDERBIRD DR LEGAL L2 B4 THUNDERBIRD HEIGHTS LOT SIZE 30000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = 4 SOIL RATING CSO FT/BP,)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EF='TH= •a FLEr-FGTH= :E�4 (3FZn%-'FEE L- DEPTH= 3t THE LENGTH DIMENSION IS THE LE14GTH 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 1•40 SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIFJ FEET). F<E:IMU I RE13 '--EF='T I G TIFi" K � 12E= 1.2 E -i GAL -L- D" PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF A14Y WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TW(D <;2> RFZE MEC- U I REGI --- SACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A 14ELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND COIJSTRUCTIO14 DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=>EFZM I T EXF=' I FSE' C7EiGEMF3EF;,I 1S=4?L I CERTIFY THAT 1: I AM FAMILIAR 14ITH 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: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDE14CE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. N7 -z f SIGNED: -LU--- ----1�------------t-------------- APPLICANT DICE: VOVES l ISSUED B4' ---------- ----DATE Z L ---Z--- V3. 2 ! SIEVE__ AVA�'I X15 1 C.�q �f77 2. Slack 4 %. 6ird I � No. � PROJECT I SAMPLE No. DATEBORING No. No. WEIGHT WEIGHT WASHING ORIGINAL AFTER LOSS PREWASHED t YES NO SAMPLE PREWASHING • SIEVE OPENING U. S. STANDARD SIEVE size OR NUMBER 3 -In. SIEVE WEIGHT SIEVE t SAMPLE WEIGHT WEIGHT RETAINED ON SIEVE INCHES MILLIMETERS 3.00 2.00 25.4 2 -in. 1.1/2 -In. 1 -in. ,z� 3. %• '2 1.50 1.00 .2 1. 2.0 .�. % -goo- .2. eJ 0.8 p 2• � I �• 40-T 0.750 0.500 0.375 {9.1 12.7 9.52 3/4 -In. 1/2 -In. 3/8-1n. 0.250 6.35 No. NO3 0.187 4.76 No.4 PAN 0.132 0.094 3.36 2.38 No.6 No.8 /, oo6 . OIL- /.00 0.079 2.00 No. 10 0.047 1.19 No. 16 0.033 0.84 No. 20 No.30 0.023 0.59 0.0165 0.42 No. 40 0.0117 0.297 No. 50 No. 70 No. 100 0 801p 152 .1-4 0.0083 0.01159 0.210 0.149 0.0041 0.0029 0.105 0.074 No. 140 No. 200 • 018 PAN 8 . O.2 •9 TOTAL WEIGHT in proms 9,Qg/ ERROR (Oflplaol wt. - total wt. of tractions ) ( Stoma) OESCAIPTiON OF SAMPLE PERCENT ERROR • Error lam•) a 100 REMARKS: Ofig iin�olWeight (9m.) EOM'1IOFF ?A ASSOCIATES, INC, TECHNICIAN ENGINEERING - PLANNING 4 SURVEYING CHECKED By ANCHORAGE ALASKA PASSING SIEVE WEIGHT PERCENT ( Ar- X00 ;.9/O x.538 G3. . i. :2 fq i y ' 1 m A p I ! � � 0 2G0 � m N o I 100 ^J 1 o e0 , �0 401 ni_• i :J I I y aI "• '' i I I I D ( 20 illy, to C ! j It'll m G G ly, 1_ .G ! _ `• 1 {` ! .2 t oc .0'. i C1 I� ?^j IDiI i .01 I i i m, ►I� G .00 00 .00 .00 .00 {III, �Iljl 'I I p, I'! Ili I ,yl r 1 1 ,jZ),.,riUt r 6 ASSOCIATES, INC. i I ENG;NEERING J013 Led 2• P Ie)e � 9 PLANNING ' LOCATION-TA;)Pd,-,rllrrr' FiP_ia%1�.5 �U�rY SURVEYING Anchorage Alaska COMP BY ,' DATE OZ11 CHECK BY DATE JOB NO. Iasi SHEET OF - _ 4, I 1 Foojtng' I "1 i ..iVGrCA i _ -_ L _ _L_1 t I. iQVl1iP.1 ; !.. I i-�.t ,.I •_ �I i -.i i I-. ,nom y14I47 ?-+�•- t I t'.i J._ I 1 `.,_. I i I : _i i ; ; t., I_t— r I_, 1= +I art : I L }rt ' I , ii 171r. t- - � -+' 1. I I �-• I, �. - - - - 5�. 1 _. . 6'a g, IJ :i I 17 T ahk.�, I r, b t 1 1 ` i I ^ , rI, r 1 � :., - I I ' r _ r - _ I I• , 1 I • Municipality of Anchorage RII On -Site Water and Wastewater Program (907) 343-7904 MAY y 4 `14 Gretchen Certificate of On -Site Systems Approval Parcel I.D. 051-721-43 1. GENERAL INFORMATION Expiration Date: _3 - a 5- L7_ Complete legal description Thunderbird Heights #1, Block 4, Lot 2A Location (site address) 24839 Thunderbird Dr Current Property owners) Susan Connell Day phone Mailing address 24839 Thunderbird Dr. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Indiv'idtaal Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Vadance request or: Distance: Received by: Date: COSA to be released to the en ine r, unless otherwise requested by the engineer. COSA Fee $ :2 (49'S -0 Date of Payment JA;t As Receipt Number &gg4G COSA# QSCl5/alp, Waiver Fee $ Date of Payment Receipt Number _ Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems 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. - In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test resultsdonot guarantee future. performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of. the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6, DSD SIGNATURE --v" System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms Phone (907)272-8218 Date 05/11/15 ON .. _r .. ##�� $iev�i li. fear none . s CE -8149 bedrooms, with the following stipulations: By: 0,e,� Original Certificate Date:�� .� - /s� Theni ' i of orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. _ ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other . COSAbluesheet f I., c If more than 1 septic system is on the lot: COSA Checklist #? �,of Structure served by this system i Certificate of On -Site Systems Approval Checklist Legal Description: Thunderbird Heights #1, Block 4, Lot 2A -Parcel ID: 051-721-43 A. WELL DATA Well type A If A, B, or C provide PWSID # 211156 Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) - in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. 9 - p.m -WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L bate of sample: Collected by: B. SEPTIC/HOLDING TANK DATA G/� 7/AO 1 rj Tank Type/Material Septic/Steel Date installed IS 00 2 Y Tank size gal. Number of Compartments _ Cleanouts (Y/N) Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping / V e ,.0 Pumper IIIA C. ABSORPTION FIELD DATA Date installed 11/05/79 Soil rating (g.p.d.tft2 orftz/bdrm) 125 Sf/br System type Deep Trench Length 34/34 ft. Width 3/3 ft. Gravel below pipeA�4 fL Total depth 6 ft. Eff. absorption area 544 e Monitoring tube Y— Depression over field N Date of adequacy test 03/25/2015 Results (Pass/Fail) PASS For 4 -bedrooms Fluid depth in absorption field before test 0 in. Water added 614 gal. _ New depth 5 in. Elapsed Time: 220 min. Final fluid depth 0 in. Absorption rate >= 600+ . g.p.d. No Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFT STATION Date installed y 27 20).s Size in gallons "Pump on" level tVel at �� in. "Pump off' level aat� D in. Datum .DC 761,A Cycles tested ru E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Manhole/Access (YIN) 9 High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 1.0+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO Property line 10+ Building foundation 10+ Water main 10+ Water Serviceiine- Surface water 10+ 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots. 100+ F. COMMENTS *Verified 2" rigid insulation G. ENGINEER'S CERTIFICATION I certify that l have determined through Aeld inspections and review of Municipal records that the above systems are in. conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 05/11/2015 COSA canary sheet 2-6-15.doc Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us / 21 (907)343-7904 `/ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-721-43 COSA# LSci a/l� 1. GENERAL INFORMATION Expiration Date: T ' .2 ® " % J Complete legal description - - - Location (siteaddress) THUNDERBIRD HEIGHTS #1• BLOCK 4 LOT 2A 24839 THUNDERBIRD DRIVE *CHUGIAK, AK 99567 Current Property owner(s) SCOTT & CONNIE RITTER Day phone 862-2175 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 24839 THUNDERBIRD DRIVE *CHUGIAK. AK 99567 Day phone BARBARA BOWDEN W/ PRUDENTIAL Day phone 562-3300 Unless otherwise requested, COS4 will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3: TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site I� Individual Water Storage ❑ Individual Holding tank ❑ Community Class A yyeti Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 Certificate of On -Site Systems 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA --- - DSD Guidelines & Regulations. The reported results described the performance of the - system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate 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 person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for bedrooms. Disapproved. Conditional approval for 337-6179 Date t+111L 12 bedrooms, with the following stipulations: Attachments: / COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report f ey Gaco.6as. C 7P53 , ON-SITE WATER AND WASTEWATER PROGRAM Nitrate Advisory Other R' By:y�� Original Certificate Date: T 'oZ 0 -f (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: THUNDERBIRD HEIGHTS #1; BLOCK 4, LOT 2A A. WELL DATA Well type A Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE PUBLIC WATER 4a: Parcel ID: 051-721-43 If A, B. or C provide PWSID# 211156 Well Log (YIN)_ Sanitary seal (Y/N)_ Wires properly protected Cased to ft. Casing height (abo rc FROM WELL LOG AT IN CTION ft. ft. Coliform /colonies/100 ml. ug./L. B. SEPTIC/HOLDING TANK DATA g.p.m. Nitrate mg./L. Date of sample: Collected by: Tank Type/Material SEPTIC/STEEL Date installed 11/5/79 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES Date of pumping 11/17/11 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA fol Date installed 11/5/79 Soil rating (g.p.d./ftor � 1125 System type TRENCH Length 2 @ 34=68 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth *7.06 ft. Eff. absorption area 544 ft' Monitoring tube YES Depression over field NO Date of adequacy test **4/12/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 993 gal. New depth E in. Elapsed Time: E min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date **WATER WAS ADDED TO LIFTSTATION. IT IS ASSUMED THAT IT WAS EVENLY DISTRIBUTED TO BOTH DRAINFIELDS. SEE ATTACHED LETTER DATED 4/16/2012. D. LIFT STATION Date installed 11/5/79 Size in gallons UNKNOWN "Pump on" level at 7.5 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES "Pump off" level at 15 in. Manhole/Access (Y/N) YES High water alarm level at 24 in. Cycles tested 3 Meets alarm & circuit requirements? YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment On adjacent lot, On adjacent lots Public sew Holding tank _ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption field 5'+ Water main **10'+ Water service line **10'+ Surface water 100'+ Wells on adjacent lots 100'+PRIVATE/200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line **10'+ Building foundation 10'+ Water main 'R 10'+ Water service line ^* K 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+PRIVATE/200'+ PUBLIC F. COMMENTS -9. MMINZIa■ G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date q/b /r 2 COSA Fee S q`f 6. Date of Payment Receipt Number (?Z/296 (Rev. 11105) Waiver Fee $ Date of Receipt Number April 16, 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Potential Deficiencies for Thunderbird Heights 41; Block 4, Lot 2A To whom it may concern: Garness Engineering has been retained to perform a septic adequacy test on the subject property in order to receive a COSA from your department. During our site visit on 4/ 12/12 it was noted that the only pipe located in the drainfields was a 2" steel monitoring tube which was installed in 1993 in order to perform a septic adequacy test and receive a COSA (HAA) at that time. It is believed that the steel MT is installed in the north trench segment of the drainfield. In short, because there are no clean -outs or other monitoring tubes installed in the drainfield we are not able to verify the following; • Separation distance between tanks and drainfields. • Separation distance between drainfields and lot lines. • Seperation distance between foundation and drainfields. • Liquid depth in the second segment of the trench. • Separation distance between septic system and water service line. It should be noted that there has been two previous COSA'S (HAA's) (1993 & 1995) approved by the MOA regarding this system in the past and per our inspection it appears no modifications have been made. If you have any please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Pb: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com a u L/L zM-60-b0 'W,e£GZ0:60 lA/all4M 13ef lei}uapmd STREET 31-a59 aizml KEY BOX AND SERVICE LINE LOCATION BY SKETCH -IL14U r'b's p 1�2 Rjj ba-, +,!ICATt H NOR7H ALLEY s MUNICIPALITY OF ANCHORAGE 1 WATER CONNECTION _ Lwlti n Record ACCT. ND. ti �._ �. ? 1 Gb 1,•» I_ NAME _ ADDctEss `�4Q_f/�'la,v�ck RrR?i LOT _... BLOCK HA ADDITION PATE MADE s'O +2,j+ NEW CONN. R-9-2912 11:32 FROM:JR'S SEPTIC PUMPING 9973449821 J.Rs Pumping PO Box 773415 Faglo River, AK 49577 (907)694-6454 Billing Information Connie & Scott Ritter 24839 Thunderbird Drive Chugiak, AK 99557 (907) 688-2027 Job Description! 1250g P.O. Number: Terms: Net 30 Salearep. Nikole Map Book: TO:3383246 Service Agreement Number 035048 Order Date: 17 -Nov -2011 Service Date: 17 -Nov -2011 Technician: Mike Tax %: 0 Job Type: Repeat Map Grid: 07 - cross stroas: Sandpiper Court Job Site Inforrnetlon. � t Mark w/ Nl & W Job Comments: Last Sery `06!604/2009' 125 24839 Thunderbird Drive Destiny caregiver 0916-757-3011 Chugiak, AK 99567 (907)688-2027 Scott 259-5833 Additional Location Comments: P.1 Diagram: S:1Qiacrama116,5gt.bmo Gallons Planned: 1250 #'s on cedar home w/ prow front & wrap around deck Gal. Actual: Pipes on right hand side, toward the Hose Length: retaining wall Double Tank. f 1 H Pump System: Wj ^r^ Baffles Inlet: L Baffles Outlet: LJ Service Type Qty Price Each Tax? Extension Actual Septic Sery 1250K 1 $85.00 No $85.00 Same Day Call Out Fee 1 $75.00 No $75.00 NonTaxabla Total Taxable Total Tax Total Grand Total Estimated Charges: $160.00 $0.00 $0.00 $160.00 Actual Chargee: Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT Title or Cuslon or Re s talive Date 14�e 02 NMI 1 11 111 JRa Purn g Date Accepted For yo added. wnv o we accept; Diwver, Visa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. $30.00 For NSF Checks Returned. J 'fif 7i , li!�, , 14 iY: "4 ICIPALITY-,OF ANCHORAGE ORHEALTH &HUMAN SERVICES v I' isl I on of Environmental ronmental Servi On -Site Services Section zi�_ji: i�" P.O:lit" 'Ari6horag6, Alaska';' 1 665 1 6650' 343-4744 1,� 4 - -P CERTIFICATE OFHEALTH AUTHORITY,; APPROVAL FOR A SINGLE FAMILY DWELLING APPRO ..... . ...... J,7, HAA # Pa. 7ZI - -q3 .. rcel I.D. # Zr i il J4 L _GENERAL INFORMATION ...... .... ....... Lot 2A,- St a @F V a�TrrQd H ;ir�-A Complete legal description -3,:. ..... exitde,%b��&4 ,D LocationjsiWiddress or directions) 24839 -.,Th 6*8 fa ...... Property owner' Babcock 4 irner:�411P_66 -9.:Soh Dayy-phone 8-`0425 D '.,.,..�.24839,;ThundeAbi)td--.Ditiii� , -f;C aiak --niiial" 7. Mailina'address..: - I I ..7 .Lending ageilic ;-.-Ma�iin"9 'addriE TER SU water,'. pity well system, -"pr iei� and status 'ATER DISPOSAL: dual on site ng,,,, "A 4 31 ` NOTE :T.1JfcomrriunJ ':!:;-!,-`attesting to n -OM (R".1/91) Fmt MOA92i sewer the legal and star ta; •---Day phone 7' " nnA694-9035 ;i n 4�lL 'T , I"'I l4 A'1 �A -7 7777-7777 4!J provide written coniirma'tJo'n`-f i of system'. -1 All VA 4. il .U, 5. STATEMENTIOF INSPECTION: BY,: ENGINEER ell a.l,''s below,) t. I. As certified by -my seal affixed hereto and as of the validation'date A shownbelo investigation of this Health. Authority Approval application shows that the* i on at *f d and/or wastewater disposal system is safe, and adequate for the ' u er of be and n."Ifurtili f6rimation obtalt ,type of structure indicated Ill f� that bhiid '6n the in the Municipality of Anchorage files:and from my' investigation -and inspection, the `6ri*__S_ supply and/or wastewater disposal system is in compliance- with all Munl6iliAl and Stat ordinances, and regulations in effect on the'date of.this "In inspection. S & S ENGINEERING Name of Firm —Phone - agle Kiver oop Road __110VIL No. 204. Eagle RI ilak�qqAddress Engineer's signature Date .4 t, S�. A L'_ I. ..... -�Z 7'-A CE 6. DH14S':SiGNATURE .,. Ar 1 Comments 'A-::'-'' Additldnal' Zll' lril� tj P Dat I:-- 1 4 ...... CAUTION The of Anchorage Department of Health and Human Service's (DHHS) Iss6bi Health Authority p ro ifi .- tes based only representation Ps glviii'ln paragraph 5 above by an Independent ro 7- p fe i;ral engineer registered in the Stia-t.-eo� ofAlaska. The DHHS does! this as courtesy to purchasers of ho -m -es -and theirlending Institutions InOrd erto satisfy "in je�deral and state requirements. Employees of DIIIIHSdonot ,11""!" conduct Ins ions or analyze data before a certificate Is Issued. -The Municipality of Anchorage Is not omissions In'the professional engineerswork.i-.�,;-, responsible for errors or All* 1.1 r2'M5MW: 1 -1 1 A�w .�_ Municipality of.Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES F,t ti% Environmental Services Division Z/fo, 14 625"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-4744 'tiLzF��i�yo F Health Authority Approval Checklist I'lec / /99U, �1/0' Legal Description: Lof-LDr S3 ,t/.. %A -PwJ gf_iw it%v �m Parcel I.D.: 05-1 - 72/ - f1l.11,11- A. WELL DATA Well type N If A. B. or C. attach ADEC letter. ADEC water system number a /1/5'G Log present (YM) Date completed Total depth Cased to Casing height (above grow Sanitary seal (YM) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE Coliform Nitrate g.p.m. Wires properly ctcd (YM) AT INSPECTION of sample: Collected by: B. SEPTIC/IIOLDING TANK DATA Other bacteria g.p.m. Date installed I - S- 7j Tank size Number of Compartments w7- Cleanouts (ON) i Foundation cleanout CDN) Depression (Y40 #J High water alarm (YO .� Datc of Pumping //-27-5S- Pumper J`1L. ✓rt/��5 C. ABSORPTION FIELD DATA Date installed //-57-7S Soil rating (g.p.d./R' or ft2/bdrm) S -4 1L System type N Length w $ Width 3 r Gravel thickness below pipe J/ Total depth 71 Effective absorption arca S y1 Monitoring Tube prescnt( N)__!�_ Depression over field (Y� ts®/ Date of adequacy test I(�.1�-yr ResulFail) P,ess For Y bedrooms Fluid depth in absorption field before test (in.). O ~ Immediately atier38e gal. water added (in.): 7 � v )'. h'G ', r.: :, p .i: y.)., ,n''. } �. rrihf... i .r .;•5..� �. � l Fluid depth ' z (ins.) Minutes later: /o Absorptioii�rate;_ �� r.p.d. Peroxide treatment (past 12 months) (Ya? IJ 0 If yes, give date 10_1A • I 1 LIFT STATION Date installed Size in gallons 04 Manholc/Acccss OM Iia - 6JAgeo "Pump on" Icvel at* /.S7 I� ` "Pump off' Icvcl at*, 00,90 r Tit High water alarm level at* 119 *Datum 'Pitt_ Jioos Cycics tested Z I I E. SEPARATION DISTANCES I SEPARATION DISTANCES FROM WELL ON LOT TO: F. Septic/holding tank on lot Absorption field on lot On adjacent lots I QW eden Public sewer main Public sewer manhole/cleanout Sew•e service line Lift 'station a f SEPARATION DISTANCES FRO SEPTI OLDING TANK ION LOT TO: Building foundation S-1, Property line / o t Absorption field /0 i Water main/service line /a Surface water/drainage /00 Wells on adjacent lots Z o "� SEPARATION DISTANCE FROM ABSORP'T'ION FIELD ON LOT TO: M i Building foundation /b t f Water main/service' line i !o t Surface water too Driveway, parking/vehicle storage area S" Curtain drain tJ Ar Wells on adjacent lots i Zoo t Property line /o t Y ENGINEER'S CERTIFICATION 1 certify that f have determined thru field inspections and review ofdfunicipal records that in conformance with dfOA 1f4A quid h sin effect on this date. Signature�� , C. a � Engineer's Name Ca WO/.,j E Date /1 Cl 9 �r HAA Fee $nn Date of Payment �(7 a-7/% j Receipt Number Rev. 8/95 OSS: h�^Iaa.wk.doc -5 /50 —) I Waiver Fee S Date of Pavmcnt Receipt Number'. F/ r, th4det.Rwp(�m.r are .r � OF, < tkt 1l A R09_21` C.:COWAN CE -8601 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 l.D. # �� 1 — -1 �� - 13 HAA # 1A Q 5 SO 12L P 1. GENERAL INFORMATION Complete legal description Lor %.4 PJB llz' '--' Location (site address or directions) ��k3� tion i�h tow,.`6 Property owner Mailing address Lending agency Mailing address Agent Address Day phone 4yf' %� I% V , fox fa7 I /loF� r �9 ` Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 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. 72-025 (Rev. 1/91) Front MOA e21 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 Iurtherverify 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. David R. Dayton P.E. 1 ,l Name of Firm 20210 Donalar St. Phone ! �4 "f 7 Chugiak, Alaska 99567 Address Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Date it. OF _ /,%Ill. 4t. 'i_VFEZVN;%` 'cv- Conditional approval for bedrooms, with the following stipulations: Additional Comments By: UlTlr Date H —Z —23 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 (RW. 1/91) Back MOA 121 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: %or �.4 &4,$ Parcel I.D. A. Well Data Well type _ "/ z- If A, B, or C, attach ADEC letter. ADEC water system number 6i S! O o?///S!o Log present (Y/N) Date completed Drifter Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Cased to Casing height FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION g.p.m. g.p.m. SEPARATION DISTANCES FROM WELL TO: ,r A Septic/holding tank on lot Absorption field on lot On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: Other bacteria B. SEPTICIHOLDING TANK DATA L� Date installed_J44579Tank size Compartments 2 Cleanouts (Y/N) y Foundation cleanout (Y/N) '' Depression (Y/N) /U High water alarm (Y/N) Alarm tested (Y/N) Date of pumping Pumper TITS �cc,c� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /v On adjacent lots Foundation Ir To property line go Absorption field Water main/service line 0 -'- Surface water/drainage /oo 74— CONTINUED ON BACK PAGE 72-026 (3193)• Front c oz rn N -- n0 A �+ $rr Cleanouts (Y/N) y Foundation cleanout (Y/N) '' Depression (Y/N) /U High water alarm (Y/N) Alarm tested (Y/N) Date of pumping Pumper TITS �cc,c� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /v On adjacent lots Foundation Ir To property line go Absorption field Water main/service line 0 -'- Surface water/drainage /oo 74— CONTINUED ON BACK PAGE 72-026 (3193)• Front C. LIFT STATION Date installed —t/>' ,�7 % Manufacturer lln�t.tac�c� Size in gallons (JA*,OOW J Manhole/Access (YM) 11E5 Vent (Y/N) Y "Pump on' level at /,$7 " "Pump off" Level at 0,90 High water alarm level _ XIO Cycles tested 4 - Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot X//On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed _Soil rating (GPD/Ftz) /ZS SF 2 System type %6 Length 6K r Width 3/ Gravel thickness f< I Total depth % Total absorption area S 5,'f Cleanout present (Y/N) _ IV Depression over field (Y/N) AJ Date of adequacy test s Results (pass/fail) P415 Z—for Bedrooms Water level in absorption field before test A10AJ,5- After test AIJ A.145 - Peroxide treatment (past 12 months) (Y/N) _ V If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot iV/A On adjacent lots _��/i Property line /Lo To building foundation 2Z To existing or abandoned system on lot On adjacent lots 10 0 -r Cutbank NA Water main/service line Surface water 1004- Driveway, parking/vehicle storage area ar Curtain drain /Uoryc, E. ENGINEER'S CERTIFICATION "� Zor I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the dater this�(rispection. w� F David P, Dayton P.E. ` •�9 20210 Donalar St. c`%%� " +' Ca �� • E "a t!' '4 Signature Chugiak, Alaska 99567 • q �� Engineer's Name ' .1. F 1;,CCavld� R. ay:on c. Date Co�D�ri �i F Jj •., N0. :205•E �C11 FESS10"t, HAA Fee $ l %O.O D Date of Payment _/, ,L/- " Receipt Number �� 'Y S l r2w 72-026 (3193)• Back Waiver Fee $ Date of Payment Receipt Number , 1 L,/n�� 1, 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS STREET LOCATION TIME TIME TIME n DATE DATE DATE INSPECT R ❑ MULTIPLE FAMILY INSPECTOR INSPECTOR ❑ INDIVIDUAL" " ATTACH WELL LOG. A well log is required for all wells drilled 8F 0, r since June 1975. For wells drilled prior to that date, give well NICjrPZtjjf MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH b ONMENTAL PROTECTION depth (attach log if available.) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONENY)R • 825 L Street - Anchorage, Alaska 99501 nOV -91979 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PR PERTYOWNER � PHONE t M I ING D RESS C� 0 _ ''T^aL 1< W Y! l /- L", n / PROPERTY RESIDENT (If different from above) PHONE S 2. BUYER PHONE i MAILING ADDRESS ly ; 3. LENNG 1 TITUTION D PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE c'l4r OP ...I .. a 4)h o MAILING ADDRESS '-e— " ^d 5. LEGAL DESCRIPTION T 0 STREET LOCATION , 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS EDOne C4 Four CDOther pp�( SINGLE FAMILY r� ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL" " ATTACH WELL LOG. A well log is required for all wells drilled R COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY ! depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM g �9 YEAR ON-SITE SYSTEM WAS INSTALLED. ;Ii:� INDIVIDUAL/ON-SITE'" ❑ PUBLIC UTILITY'' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY — 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER of BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING - I - TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line . 5. COMMENTS 6,APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72010 (Rev. 6/79) 1 D. R. DAYTON, P.E., R.L.S. HUME&MM Chugiak, Alaska 99567 (907AN9MVx 20210 Donalar 696-2417 June 18, 1993 ADEQUACY TEST Legal Description: Lot 2A. Block 4, Thunderbird heights Addition #1 Date of Test: June 181 1993 Septic Tank: 1250 gallon, 2 compartment, steel tank (DHHS Records) Lift Station: Make Unknown, Pump - Zoeller Model 282 Absorption System: 4' deep x 3' wide x 68' trench (DHHS Records) Soils Rating: 125 sq. ft. per bedroom (DHHS Records) Requirements: 4 bedroom - 600 gallons per day Test: Water was run onto the pump chamber through the septic tank. Volumes and time were measured. The test was run until 640 gallons had been pumped into the field. Results: The absorption system accepted 640 gallons with no apparent rise in the liquid level in the system. The septic system absorption trench is currently functioning adequately for a 4 bedroom home. NC r'�'•s• F1 ��•s•o o �.. UN9e.••e....o•a .V.�`� L7: Y}On iAL, 5j • I �� n •� IdA. 2.Q5•E • C;r f s� •••.........'.'tip`,;, �� °!'��ress��_'� TO FROM David R. Dayton P.E. 20210 Donalar St. Ch4sk, Alaska 99567 SUBJECT ..�� ii QO 17F9T3 DATE MESSAGE SIGNED "' , r(MF<X n . 4S 468 POLY PAK (50 SETS) 0468 NO REPLY NECESSARY1:1REPLY REQUESTED - USE REVERSE SIDE carbonlems '� g LTJ /•t15T1� o•J 77VX- !a sT o.c 1, A7 /5 55T TO Sawn :o TlfcT �-�n �Lx�i rNsu4�r 0.40 �'� .rs� c -a ��- '��.�v �,cJ •'�=z�. �/fF L/AT STfiT/u�y C�nJN/STZ�C ! S A 11F/ttTtl/IC�O 09.4 � .a 8- oM L/� %ice ti v /,mss !! 3.. L' .T, �iA�+ y`lr /fu�ys t�.�� s>� Ry rr csss�ria5 w/�r c�EL a- 4ow tk:A-mr- t /JT 1Er// GtJMt ' w lTiy .tlO Ci,��stlb //.J l tJit 7 :0z. G6vBt-. OA) G/77f2W- 'Tl�srj.� � Li�1/S i%L1i72771K � a�tc� 7"17 SIGNED "' , r(MF<X n . 4S 468 POLY PAK (50 SETS) 0468 NO REPLY NECESSARY1:1REPLY REQUESTED - USE REVERSE SIDE carbonlems D Dote 19v, No. 4390 Received Of ' ' un " lN"nC��i Address. i , L4it4 • 7 For CAM fl( ,7�G H W PAID BALANCE nUErl PUMPING Xj .75- � •16718 Mcrcy Drive rtELlr-0Rn. BL820 carbon/ass By �1 TIr:7p Time ne �-1 �� V43Ck L Date Date Date Inspector Inspector Inspector 0YCA- 'e3 -—q3'— Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner t'V\'c IV,'; fY1�� vL,� Phone �6 Mailing Address J "7 ru iN1 r wl • I I Buyer Address Lending Institution I Phone Address Realty Co. &Agent f -hl `' ,4 i,PV pnQ •J Phone Address FG �4 � I 5./L a3..� G 77 C/ 9 Legal Description 177*5 'v� f Street Location Typepp�� Residence 9 ngle Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply j Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June If 19 Community 1975. For wells drilled prior to that date, give well depth (attach log O Public Utility 1 available. SewX Disposal !f InYear Individual Installed: El Public Utility When Connected to Public Utility: O Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I January 27, 1982 Stephen Young 308 Thunderbird Drive Anchorage, AK Subject: Lot 2, Block 4, Thunderbird Heights fl 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 department. ° A four (4) inch cast iron cleanout needs to be installed to the septic tank and/or leaching area. 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. Sincerely, Robert C. Pratt Associate Environmental Specialist "' "