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HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 4 LT 29Thunderbird Heights #1 Block 4 Lot 29 #051-582-20 Municipality of Anchorage Page of —� DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Z'L,"O `/D 373 PID Number: ©6_/ - 0�$'2 -a • Name: Wastewater System: El New pgrade Tom` E Address: ABSORPTION FIELD Phone: No. of Bedrooms: _ 53y 3 El Deep Trench ❑Shallow Trench D Bed ❑ Mo d ❑Other LEGAL DESCRIPTION Soil Rating: epthTotal f original grade: 2!! GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gr depth beneath pipe 11 FL Ft. Township: Range: Section: Fill added above original Gaya Gravel length: Ft. Ft. WELL: ❑New ❑ Upgrad Gravel width:/\' Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): 11 - V al DePT5Cased To: Total absorption area: Pipe material: it W w L� :q (i(yG Ft. Ft. SG. Ft. Driller: v j Date Drilled: Static Water Level, Inst er: Date installed: �V Ft. Yield Pump Set at Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines• 'I �( (� Well t, 7/00 Material: -'l.. Number of Cc Rrtments: i p0. loo G tiv©' +foo` *foo' LIFT STATION WaterSurfac Lot I Size in gallons: Manufacturer: / ` �' Line /.Sr•'.... Z.I tZa 1� 1 "Pump on" level at: u p o.ifi" level at: High water alarm at: Foundation v l o Q Curtain . f S J dsoI Pump Make el Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: _ Assumed Elevation: Ivs 'S ^nJ /tea Ft ENGI SEAL � ...p.F....... • �. tea. H Inspections performed by: Dates: 1st 2nd -a CHIMIMPHERP.WOOD jr Department of Health and Human Services approval '• CE:10�8i [.�v Reviewed and approved by: — Date: - fir- o 'mss"s..N...-° 1 72-013 (Rev. 9/91) MOA 25 Permit No. SW040375 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: THUNDERBIRD HEIGHTS #1 BLK 4 LT 29 PID No.: 051-582-20 N 89'59'00" W 209.66' C 3 12.5' D 21.3' a n � E 27.0' 62.2' 0 o 0 z C A M B D 6O�e 9. .,n. �y 'O e a' z SWING TIES SCALE: 1 "= 40' R=50.00 L=73.40' R=50.00' L=22.24' RAVEN CT SEPTIC TANK REPLACEMENT ONLY LEGEND: - 100' WELL RADIUS • - MONITOR TUBE - EASEMENT - DIVFRTER VALVE 0 - SEWER CLEAN OUT - LEACH FIELD 0 - TEST HOLE ¢ - WELL - DRIVEWAY NOTES; I . NO KNOWN CURTAIN DRAINS 2. NO KNOWN SURFACE H2O 9/10/04 ELEVATIONS ENGINEER'S SEAL (NOT TO SCALE) 000�Op� o' OF q��0000 S.E. CORNER OF STEP o • • • • • • • • ASSUNEO ELEV =100.0' ' • • • • ��O*oo _ —_ _ *��P� 4 O INSULATION 91.4' _i. rJ 91..4' �....:. .. .. ......: ..O -- ------ ---- ----- .. ....... .......... .� INLET ___.._._._. _.______.__ ❑UTLE'I O ••CHRISTOPHER WOOD w O QQ 9019• %J NEW ].,2 i0 cs'._ CE -10387 GAI.. TANK 90.7' ��F� ••......... �Fo� .............-............... 4 PROFES9 ��00000�� A B C 26.5' 12.5' D 21.3' 18.8' E 27.0' 62.2' MUNICIPALITY OF ANCHORAGE 3 Z 00 I Development Services Department On-Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 03, 2004 Expiration Date: Sep 03, 2005 Permit Number: SW040375 Parcel ID: 051-582-20 Legal Description:�SSfR 4 2 Design Engineer: 0024 Eagle River Engineering Services Site Address: 027927 RAVEN CT Owner Name: STEPHEN & MARGARET WILSON Lot Size: 20046 SQ. F.T. Owner Address: 17146 MEADOW CREEK DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER , AK 99577-8131 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: I 3/o . Date: �A/('Nzj 09/03/03 11:27 FAX 9073438457 MOA LAND. USE ENFORCEMENT Municipality of Anchorage Development Services Department Building Safety Division on -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage; ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. M4; I OZ - Zo Permit Number SW 51iiP1 PN Property owners) t- ^1 Day phone �°f 6 Mailing address (1) 1714 G M EA�ia to mR D Mailing address (2), eUL1; (C1`Jt'R /� K Zip Code Legal description (Lot, Block & Sub'd.) T-f�Nep26J-Rb di`}I L29 y Legal description (Section, Township & Range) T 161U R I L -J Sh G 5 Lot Size 7. Acres Sgf-t Number of Bedrooms doNLD a THIS APPLICATION IS FOR: Sewer Only Well Only, ❑ Sewer and Well ❑/ Water Storage ❑ Sewer Upgrade (T+Jse 12A.) L7 THIS PROPERTY CONTAINS: Hot Tub [] Jacuzzi ❑ Swimming Pool ❑; Water Softening Unit ❑ Therapy Pool ❑ I certify that the above informatio is correct. I further certify that this application is being made for a Single FarVY Dwellin d is i coordance with applicable Municipal Codes. (Signature of property o r or authorized agent) Permit Fees: Yto Waiver Fees: Date of Payment: 4L/fyj - Date of Payment: Receipt Number: '727 Receipt Number: (Rev. YL00) Eagle River Engineering Christopher R. Wood, P.E. 10421 VFW Road Suite 201 Eagle River, AK 99577 September 2, 2004 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Thunderbird Heights #1 Lot 29 Block 4 Narrative & Permit Application Dear Mr. Roth: Services (907) 694-5195 tel (907) 694-3297 fax The proposed septic tank replacement will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are all connected to community water supply, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance, and wells +200', 3. This permit is for replacement of the septic tank only. 4. Drainage will not be affected and is not a major consideration in our design. The existing septic tank is corroded and needs to be replaced. Drainage will not be affected, and is not a consideration in our design. This work will not affect the reserve area on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RI R ENGINEERIN SERVI S Christopher R. Wood, P.E. Principal \2003\04-080SEPTICNARRATI V E.DOC Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Rd. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax www.eagleriverengineering.com SEPIJG. `iAOjr 4iG'a? r. 'P1�BvT SyrC t�G✓4�/ +30. M �4\,.. .. i i S 2� l PI RePEh�EjT ec T C .i• , I YL r Sj.P 3 0 825 "L" S fREET ANCttORAGE, ALASKA 99501 (907/ 2644111 GEORGE/VL SLq L/MA/V. January 4, 1982 Gary Kockler 724 E 15th Ave. Anchorage, AK 99501 Permit ~ 810224 Subject: Lot 29 Blk 4 Thunderbird Falls A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. any further questions, please call this office If there are at 264-4720. Sincerely, ProgramBt~aChnha~~ Sewer and Water Program Enclosure: Copy of Permit PERMIT NO. RPPLICRNT LOCRTION LEGRL DEPRRTMENT ' HERLTH RND ENVIRONMENTRL ;OTECTION 825 "L" STREET., RNCHORRGE., RK. 9950± 264-4720 ,~4 ER_,T ±._TH. RVE ~ ~%o\ GRRYKOCKLER ~" '= ~ '-'~'-' RRVEN CT. LOT 29 BLK 4 THUNDERBIRD FRLLS LOT SIZE 28046 SQUBRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MRXIMtJM NUMBER OF BEDROOMS = S SOIL RRTING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEE]'). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). ~:Elg~L~ ~:E[:, SEF'TI~]: TR~-~s: S ZZE=: 1E~BEl PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DLIRING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL HILL SERVE. BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS %00 FEET FOR R PRISRTE WELL OR ~50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL ~' ' LINE IS o~ FEET RND MINIMUM DISTRNCE FROM R PRIVRTE WELL TO B PRI'¢RTE _,EWE~ .... TO R COMMUNITY SEWER LINE IS 75 FEET. OTNER REQUIREMENTS MBY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RMRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT _EWER_, RND HELL_, Hz, _,ET ±: IRM FRMILIRR WITH THE REQUIREMENT_ FOR ON-SITE ~ · c, - = -,~ ,= FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. SIGNED: .......................................... RF'F'L I C~* GRRY KOCKLER V4. 0 /-~ :'~ Z:~ SO~LS LOG 1 2 3 __4 5 6 7 --~-8 10 11 12 13 14- 15- 16- 17 18 · 19 2O COMMEN}S MUNICIPALITY OF ANCHORAGE ~] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SLOPE SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? S Reading Date Time Time Depth to Net Water Drop PERCOLATION RATE (minutes/inch) DATE: / ' 72 008 (6//9) /00%1 f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPHONE =Zs33 EW ❑ UPGRADE o .Gle S MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ZI Absorption area Dwelling / PE ITN DISTANCE T0: ` �. ` UY WZQ Manufacturer /l�� A� 6 Mat / No. of co partments 7J w F (� C Liq.c �c'it�ons IFHOMEMAD : Inside length Width Liquid depth O ie DISTANCE TO: Well Dwelling PERMIT NO. JV2 S? FQ- Manufacturer - - - Material- -- - -- - Liquid capacity in gallons --- - m= DISTANCE TO: N .� li of✓/ Z G Fouytio Nearest lot line PERMIT NO. tu wZ No. of lines Length .acff.' Total le h of lir .s Tre idpr( Distanc t e lines 77 ? w ,� inches TopJ3f irrsh erial ene file // Total eff rive absorption area fes.. filet gre f y a �S L Z t ✓<1 c.4 CO inches Length Width Depth PERMIT NO. W Q F Type of crib Crib diameter Crib depth Total effective absorption area 0. W 74 W Well Building foundation Nearest lot line DISTANCE TO: j Class f`!/J f Depth Driller Distance to lot line PERMIT NO. /� W 'Building foundation DISTANCE T0: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS )1/ SOIL TEST RATIN /) OAv INSTALLER REMARKS Z Robert A. S..':r kv' a5% ' ]ILI f 1 APPR E DATE LEGAL G .L (S & S Encrineerin 72-011 (Rev. 3/78) V F A t-1 0 H t=t F? 17=1 C3 E DEPARTMENT 0.7;, HEALTH AND ENVIRONMENTAL rOTECTION 825 't STREET, ANCHOP.AGE, AK. 99:91 264-4720 w_�t�i— ITE EWEM F~EF?M I T PERMIT NO. C 800505 ) APPLICANT GARY S. KOCKLER SRA 6105 A-3 PALMER, AF:. 745-2553 LOCATION KRAVEN LOOP LEGAL i,LOT.29 BL1'4'THUNDERBIRD HTS: LOT SIZE 21000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 90 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L�EF�TH= So I F?EF=`TH= THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRE14CH 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 MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F? EG�t_t I FSEF? :SEF„T I iG TF=1t+IK 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. --- -ri.40 C � > AF a F;,>KMG!U I MEF> --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE I -JELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTA14CE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EFRM I T aXF=> I MESS I?ECEMMaM = 1 .• 141=10 0 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREPIENTS 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. =: I UNDERSTAND THAT THE 011 -SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: ISSUED V4. 0 PERFORMED r, SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST lqo Cl [ e -x DATE PERFORMED: ` C CJ e p ry LEGAL DESCRIPTION: L P H � (F -1-0F -j/ �' ,S Cql L� 1 dp 2 �U GG J 3 t,- Ci C 1 C D� / 6 v U 7 J 0 J� --8 , � y ti 10 D /d/eLtINCOU AS GROUNWATER 11 /�NTERED?. 12 �r IF YES, AT WHAT DEPTH? 13 14- 15- 16- 17- 18- % a 151618 >~ 4' rf� SLOPE �ld F-2t,"A(S SITE PLAN / b i ==mmm� mmmmm� 20 % in, Robert A. Shafer 4 %•• No. 11571 . • -Z' O PERCOLATION RATE (minutes/inch) �4 IOROFESSiOe1N TEST RUN BETWEEN FT AND FT COMMENTS ,<�OtiR�! 1=1 0 -.i - PERFORMED BY:—5S(•S Engineering CERTIFIED BY: 72.008 (6/79) DA I ' UATE RECEIVED INSPECTION APPOINTMENTS Heights Subdivision TIME TIAfE TIME -TE DATE DATE 5A l 0 Two ❑ Five ❑ MULTIPLE FAMILY _ INSPECTOR INSPECTOR INSPECTOR V since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY NJE�RA ` k ARh9 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8 (NMENTAL P.".OTECTION --- DEPARTMENT OF HEALTH &ENVIRONMENTAL PROT (. 825 L Street • Anchorage, Alaska 99501 � MAY 5 1981 • ENVIRONMENTAL SANITATION DIVISION ER INDIVIDUAL/ON-SITE" \ Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts oaf Page 1. Incomplete requests will not be processed. Please allow ten (101 days for processing. ----- -- PHONE 1. PROPERTYOWNER MAILING ADDRESS , PROPEH-TY RESIDE;T (It different from above) _ HONE Lot 29, Block 4, Thunderbird Heights Subdivision PHONE 2. BUYER Stephen S., & Margaret F. Wilson _ - MAILING ADDRESS 3. LENDING INSTITUTION PHONE W - !'�! UBA / M,011 nvs .?—�'i/�—�-�'- MAILING ADDRESS PHONE 4. REALTOR/AGENT 2720571 Bill Schle al MAILING ADDRESS Totem Realty 5. LEGAL DESCRIPTION Lot 29, Block 4, Thunderbird Heights Subdivision STREET LOCATION Raven Court 6. TYPE OF RESIDENCE NUMBER OF,I3EUROOM1IS ❑ Other. ❑ One ❑ Four (I SINGLE FAMILY 0 Two ❑ Five ❑ MULTIPLE FAMILY Q Three ❑ 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 DISPOSAL SYSTEM 1980 YEAR ON-SITE SYSTEM WAS INSTALLED. ER INDIVIDUAL/ON-SITE" ❑ PUBLIC UTILITY FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION 72 010 (riev G/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE O OTHER r ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ TWO O FOUR ❑ SIX . 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY ❑ PUBLIC UTILITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE'DISPOSAL'SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified DATE INSTALLED ❑Septic Tank or ❑Holding Tank Sizer If Tank is homemade give dimensions: INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL / 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL T0: Absorption Area to nearest Lot Linc _ --- 5. COMMENTS APPROVED FOR BEDROOMS 70/ CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED DATE OY 72-010 (Rev. 6/79) Municipality of Anchorage �- Development Services Department AML Building Safety Division On -Site Water and Wastewater Program ,. ... 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-582-20 COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description Thunderbird Heights No. 1 Block 4. Lot 29 Location (site address) 27927 Raven Ct Current Property owner(s) Andrew Adamich Day phone 580-1134 Mailing address 27927 Raven Ct. Chugiak. AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested. COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ 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 On -Site 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 Onsite 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 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 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. 1 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 Pannone Engineering Services. LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 4-30-07 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. SS%%% jj The operational lila of all wells and septic systems depend on the local soil condition, ground water •••� C aa�a levels that may fluctuate during the year, and the water usage of the family being served by the system. .•tp� These conditions arc outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that J a�� there are no hidden defects or encroachments. PES can therefore not provide any warranty for future •^^00 performance nor give any estimate of how long the system will continue to meet the operational 0 ;{• requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed �o t� Steven R. Ponnone? above. Any reliance upon or use of this report by any other person or party is not authorized nor will it # I '% O t 9 f confer any legal right whatsoever. ��� "^ - �• 5. DSD SIGNATURE �4.ssta:o t/ Approved for __ L— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �/�iZ � Gf/. �C� Original Certificate Date: tnev.lmNS) ..��,.. Municipality of Anchorage .� Development Services Department °w Building Safety Division On-Sfte Water & Wastewater Program 4710 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Thunderbird Heights No. 1. Block 4. Lot 29 Parcel ID: 051-582-20 A. WELL DATA Well type A Date completed _ Total depth ft. Date of test Static water level Well production If A. B, or C provide PWSID # Public Sanitary seal (YIN) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION CoItform colonies/100 mL Nitrate mg/L Other bacteria Arsenic: _ ug/l Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic / Steel Date Installed 9/4/2004 Tank size 1250 gal. Number of Compartments 2 Cieanouts (Y/N) ril g.p.m. oolonies/100 mL Foundation cleanout (Y/N) YM Depression over tank (Y/N) ly-q High water alarm (Y/N) N/A Date of pumping 4/30/2007 Pumper IR's Septic Pumping C. ABSORPTION FIELD DATA Date installed 11/6/1980 Soil rating (g.p.d./ftZ or fe/bdrm) System type Deept trench Length 40 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth M ft. ER. absorption area 49kfe Monitoring tube Yqj Depression over field No Date of adequacy test 4/27/2007 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth kr absorption field before test PM in. Water added¢QQ gal. New depthpM In. Elapsed Time: Q min. Final fluid depth QQ In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 3 type) None Known If yes, give date D. LIFT STATION Date Installed Size in gallons `Pump on" level at _ in. "Pump off" level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot N/A Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (YIN) High water alarm level at Meets alarm 6 circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6 Property line J$ Absorption field S Water main 10+ Water service line 10+ Surface water 100+ Welts on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 21 Building foundation 10 Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehids storage 3 Curtain drain 30+ Wells on adjacent lots 200+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in i„ a ti.. conformance with MOA COSA guldetines In effect on this date. i m �r �•Stevrn R Funnrne? Engineer's Printed Name. Steven R Pannone. P.E. Date 413012007 COSA Fee S4=3 a Date of Payment -Z 0 — D % Receipt Number 9 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number In. Municipality of Anchorage • u Development Services Department Building Safety Division On -Site Vater and Wastewater Program 4700 South Bragaw St. P.O. Box 196630 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us J • 115" (907)343-7904 : 6fHe s vj'o-a> �► CERTIFICATE OF HEALTH AUTHOR! r' APPROVAL FOR A "I GLE FAMILY DWELLING Parcel I.D. /?S/ 5Pa a o HAA #_�t Qf j Expiration Date: 1. GENERAL INFORMATION: - Complete legal.descript on '-7Aunz*a6irc/ 6i .fir 14P / e y L 2,�:j Location (site address or directions) o27q.2 -7 Current Property owner(s) 4A21 VTV 1 Day phone �_ 5 Mailing address /7 / �!o `Y1iG[ad�ezv Lending agency _ Day phone._ Mailing address . , Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class Well Public Water System Day phone _ TYPE OF WASTEWATER DISPOSAL: Individual On-site s� 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 Auihcrity 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 effectat the time of installation. Eagle River Engineering Services Name of Firm 10421 VFW Rd., Suite 201 rilGie G9�%= 5/9S Address agle River, AK 99577 Engineer's Printed Name Dateg—/'A—aU- 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the foll .......... ON-SITE _ %AIACTCIAIATFR Attachments: ..................... ... _ . . HAA Checklist - X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other by://4 (N • y (f ?/ / Original Certificate Date: (Rev. 01102) lviut Develloj / ln- W'i ►,rage GPi f artment Y IJ C x 4 iP ETY 519-6650 NO KLl Parcel ID` 057L S8a v kype �L If A l3 or C provide PWS D # e og (�7) e„�c„omp a ed _ p �i aM sea �('rv) �ires pro e ly pro eco` ) YWYa a�' ���M Crr���v✓` MMT" i atic vae7level ft. ft production . g.p.m. g P.m. rforrn colonies/100 ml Nitrate mg /I Other bacteria colonies/100M epic: mg./l. Date ofsgMple Collected by .t fr ptl')' n vi s.a, y+.t 2z A'ze6i JWa b'..xYMh n4N.m xn'�+a.» ix ,-sk .1 v6M1a.rc.,;- < ik 7ypi? a ena � CSate mstalled g' � O � ik�s�zel �.S"D "oal. Number of Compartments a- C1e ", bus N Pumper g (g p dJftZ or /bdr 2d System type; Tit,c�� er�.0 "-'2 a a ."ms"xx'`a Results as ail) For bed s�k afwaww m,,in� ,_m �..^t'�e'.-''z e ' `�'z3c �?� "Tr= 'irk,. s, ;.;a 'gym I +F in. Water added �LYI gal. � New dept /septic service line =water s (Y/N) m level at in. Meets alarm & circuit requirements? ICL ON LOT TO off-/ Building foundation 420 r Surface water ,v1.11 ; IUO _ Wells on adjacent lots + iat the above systems are in guidelines in effect on this date Water main +10, fii 111�� ee$5 _ e Date of Payment c e ifl.Aye�6/ cT ASBUILT SEF IABD &ASSOCIATES LAND SURVF,YING 694-08: 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY fro, Al y�o�n�iry^ ,/GTZ9B.y DATE: :AND THAT NO ENCROACHMENTS EXIST a6EPT SAS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB', ANY DATA HEREON BE USED FOR CONSTRUCTION n OF FENCE LINES, OR FOR ESTABLISHING BOUND- ,� DRAWN ARY LINES.