HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 8 LT 2Thunderbird
's
Heights #1
Block 8
Lot 2
#051-582-27
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Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Pago 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231342
PID Number: 05158227000
Dwelling: E Single Family (SF) L_ with ADU ❑ Duplex (D) ❑ Two Single Family Project: Ll New C Upgrade
Name
MURFIN LIZA
ABSORPTION FIELD
Deep Trench Wide Trench ❑Bed ❑Mound
I
7127712
Site Address
RAVEN CT
❑ Other
Phone
Number of Bedrooms
Soil Rat ng
Total depth from original grade
727-1130
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel cepth beneath pipe
Ft.
Subdivision Block Lot
THUNDERBIRD HEIGHTS #1 BLK 8 LT 2
Fill added above onginal grade
Ft.
lGravel length
Ft.
Township Range
Section
Gravel width
Ft.
Beds: Number of Lines
-
Distance between lines
- Ft.
SEPARATION
DISTANCES
To
Septic ! Absorption
Hdding Sewer
Total absorption area
Number of trenches
Dist between trenches
From
Tank Field
Lift Station
Tank Line
Ft=
Ft.
Well
Elo10+
na
na j25' +
TANK F# Septic E:S.T.E.P. ] Holding ] Other
Manufacturer (Capacity
GREER (deep) jI
1250 Gal.
Surface Water1
QO'+
na
na
Material lNumber
Plstc l
of compartments
2
Lot Line
10'+
na
na
NA
Foundation1
0'+
na
na
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location JElectricA
installea by
PIPE MATERIAL I►ouse to tank D3034 Tank toD3034
drainfield
Insta'ler
RS
Drainfield Co1MT D3034
Inspector North Rim Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspection 1,� 10/141,'24 10/15/24
Location and description
dates: 2`1
deck
3v 4ir
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stamp
Conditional Approval:
Date
i* :49TH *fit
i4 % Steve Eng 0
�,;
Septic Syste
Approved ���
CE -6256_+
Dat
Note: this approval does not include well permit requirements.
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AS—BUILT MEASUREMENTS
A B
C❑1 20 26
T1 20 28
T2 19 33
DCO 18 35
Utility Easement
Standpipes
Located
wed
NOR THRI M
ENGINEERING
SteveEng, com
PO Box 770724
Eagle River, Alaska 99577
907.694.7028
New 1250 Gallon
Septic Tank w/DC❑'s
Decommissioned ❑fid
Septic Tank
PER UPC
THUNDERBIRD HTS #1
BLOCK 8 LOT 2
WASTEWATER
UPGRADE SEPTIC TANK
1" = 20'
RECORD
LAYOUT
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231342
Work Type: SepticTank Upgrade
Tax Code Number: 05158227000
Site Legal Address: THUNDERBIRD HEIGHTS #1 BLK 8 LT 2 GA865
Site Mailing Address: 27712 RAVEN CT, Chugiak
Owner: MURFIN LIZA
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
cnt
�°
i
Department
10/9/2023
10/8/2024
20250
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• Prior to installing the tank, locate and repair the standpipes located at the east end of the field in order to
locate the field and ensure that the proposed tank meets the required separations.
f'U
Date:
Issued By: ��.�/ yaz� Date: �l Z
4
MUNICIPALITY OF ANCHORAGE
Development Services Department p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 05158227000
Property owner(s) MURFIN LIZA
Mailing address 27712 RAVEN CT
Site address same
Day phone 907 903-9629
Legal description (Sub's., Block & Lot) THUNDERBIRD HEIGHTS #1 BLK 8 LT 2
Legal description (Township, Range & Section)
Lot Size 20,250 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(M all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
(w/wo AD U)
Septic Tank
0
Upgrade El
(D) El
Holding Tank
❑
Renewal ElDuplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
certify that the above information is correct. I further certify that this is in accordance with
applicable Is
Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: ..225 Waiver Fees:
Date of Payment: l o/y�2'� Date of Payment:
Receipt Number: 21'f 7D Receipt Number:
Permit No. DJ PZ3 I �&y2 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com Thunderbird Hts #1 B8 L2
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current septic tank has failed- the seepage trench still
functions. This lot is close to a half-acre and on public water . No adverse impacts are
expected from tank replacement. Easements are depicted on the lot. The slope is
negligible in the area of the septic system. No conflicts to neighbor properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.
5 minimum between the tank and trench. 5 to property lines & 10 to house.
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10 from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field. Manhole Riser required in 1 st tank compartment.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231342, Deb Wockenfuss, 10/09/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231342, Deb Wockenfuss, 10/09/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231342, Deb Wockenfuss, 10/09/23
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
-- ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME/�
� A le /e/� w I � l� s'C /` 6' C
Fix— �:- 3 %- 1A
NEW
❑ UPGRADE
MAILINGA7KSS ,
✓�jGK��E�
LEGALDESCRIPTION/J�� '/% r
/JKA
�—� �1�/
LOCATION p e .6
NO. OF BEDROOM
UY
DISTANCE TO:
Well
/O.
Absorptionarea
/�
Dwelling /e
T *
PERMIT NO. 6
O % 'L
d4
W I.-
Manufacturer /'� —�� r /J
hlaterialrs—
No. of compartmer
/
hLiq.
capacity in&'&
/ -I-
IF HOMEMADE:
Inside length
Width
Liquid depth
O Y
Jaz
DISTANCE T0:
II
IM
Dwelling
I
PERMIT NO.
S F
Manufacturer
Material
Liquid capacity in gallons
O
-+=
W
DISTANCE TO:
WellFoundation
�'
i
SAO 'f
Nearest to e f
/
PERMIT NO.
-i LL z
Z W
No. of lines
Length of eacta'tirlr
.} /
Total length of I' s /
Trench width
inches
-
Distance between lines
-CL
F
a
Top of rile to finish grade
4
Material beneath tile ry 11
O inches
Total effective x arm
t'
w
Length
Width
Depth
PERMIT NO.
a
F
CL
Wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
�+
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
r
PIPE MATERIALS
a
SOIL TEST RATING 0
41.
INSTALLER
REMARKS
f
APPROVED �J /J DApTE LEGAL
72-013 (Rev. 3/78)
I F=• H L- I TT r_. F ' A r-4 01-f Fi r E `_IQ
DEPARTMENT O'^ -iEALTH AND ENVIRONMENTAL r" _ITECT I Oro
825 ' L • STREET, ANCHORAGE, AK. 995, -!
264-4720
eta—= I TE--1-=wEFa> F'EF_r-1 I T a �.
PERMIT NO. C 8IC1767 )
APPLICANT LARRY WITASCHEK. 1698 BLUE SPRUCE 99567
LOCATION
LEGAL L 2 B 8 THUNDERBIRD HEIGHTS LOT SIZE
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
- RI/
•
I! 3u
688-3249 re - -0
-,iA rvrn
20250 SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SS! FT/BR)= 90
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
f�Er=•TH= - LEr-.Iv3TH= 4!5 G•EF:1'TH= -4-
THE
THE LENGTH DIMENSION I S THE LENGTH ( I to FEET) OF THE TRENCH OR DRA I NF I ELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCA'vATION CIN FEET).
THERE IS NO SET 14IDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
_•EF'T I l::: -Fn"K _• I ._=E_ - 15o rani Cit
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT [:'URING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- Tt•Ir_�
C
� > I r-4_',F�'E�T I Clr4:F. nF?E
F< ENAT U I RECy ---
BACKFILLING OF
ANY
SYSTEM WITHOUT FINAL INSPECTION AND
APPROVAL BY THIS
DEPARTMENT 14ILL
BE
SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL 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.
MINIMUM DISTANCE 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 CON=TRUCTION DIAGRAM'_ ARE
AVAILABLE TO INSAIRE PROPER INSTALLATION.
F=>EFz:_*MIT EXF=� I r --E=• G•E0ErlE:EF;l* ==1: ::L01=1E3�L
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.
I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED: ----------------------------------------
APPLICANT LARRY WITASCHEK L
ISSUED BY ------------------------------ DATE_ -1 gAj------ Its ti/4.0
(,-"UNICIPALITY OF ANCHORAGE r^
Department . Health and Environmental rotection
825 L Street, Anchorage, AK. 99501
" 264-4720
* * * HANDWRITTEN PERMIT
WELL AND/OR ON-SITE'SEWER-PERMIT
Applicant: 'a Mailing Address: JV)2 It x 0-
Location: y��R,r ��<�� �� (� 2� e� Phone ..Number:.
Legal Description: of Size:�rn
Type of Soil Absorption System Is:
Trench: �_ Drainfield: r Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) G%
The Required Size of the Soil Absorption System Is:
i
DEPTH LENGTH _.GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE= &O C GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(Z) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen•
will be subject to prosecution.
Minimum -distance between -a well and any on-site sewage disposal system is 100 fee -
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a`community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9.3 1
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may req ire enlargement if
the residence is remodeled to include more that ,9 edrooms.
Signed: Issued by:
Applicant
Date:
SWP/024(1/81)
' 1
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
825 L Street; Anchorage, Ax. 99501
254-4720
HANDWRIrTEli PERMIT :
c�
WELL AND/OR ON-SITE SEAR PERMIT l
Applicant: 5f(2A A_._ �Lt), c 2d�1+,1t � _ Mailing Addresc: �.c.-t JJ4) J q
Location: i{� t{j .: t� - Phone Number:
Legal Description: 13 � _�.t-x
Type of Soil Absorption System is: ;
Trench: DrainEteld: _ seepage sed: nolding Tank.
Maximum Number of Sedroocac: —f— Soil Rating(sq. ft,/br) qe
The Required Site of the Soil Absorption System Is: Z
r.
DEPTH _ LENGTH t- GRAVEL DEPTH �_ _ WIDTH
_
The length dimension is the length(in feet) of the trench or drainfield. 11
depth of a trench or pit is the distance between the surface of the ground s
the bottom of the excavation(Ln feet). There is no set width for trenches,
The gravel depth is the minimum depth of gravel between the outfall pipe ate
the bottom of the excavation(in feet). -,
f ; REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS f 2
Permit applicant has the responsibility to infoLn this department during the If
Installation inspectLone of any wells adjacent to this property and the numbax
of residencen that the well drill sorva.
Two(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final Inspection and approvai by this depao
will be subject to prosecution.
Mintmum distance between a w$LL and any on-aite sewage disposal system is 101'
j for a Private well or 150 to 200 feet fron a public well depending upon the 11
OC public well. Minimum distance from a private wall to a private sewer lite
is 25 feet and to a community server Iine is 75 feet. Well logs are requireel
and crust be returned to this department within 30 days of the well completicj
Other requiremento may apply. Specifications and construction diagraacs are
available to insure proper installation.
s PERMIT EXP I RES DECEMBER 31; 1 T 3 1
E ratify that:
(1) I an familiar with the requirements for on-site aawors and wells
set forth by the Municipality of Anchorage.
(2) I vLll install the system in accordance with codes.
(3) t under d thathe on -cite war system may r
t r cc re _ ed itNLude more that �r�
I C.
S lgne'1: �/ Is sued by :
p icaat
Date:
SW/02 d (1/S L)
l
ac
ire enlargement
edmotns.
�7
• SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 2644720 TEST
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: %.;I f
?
LEGAL DESCRIPTION:_ it
� 2 jGAr-k s' Tl,.�,,t dQrJ.r
1f
WAS
Date
Gross
Time
2
)i
Net
Drop
3-
4
4-
-
sad
5
�i'
�� P,
�
P
6
i�
7-
8910 8-
9-
10
11
�•
12-
21314151617181920
13-
14-
15-
16-
17-
18-
19-
20-
SLOPE
WAS GROUND WATER 71 '
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DATEPERFORMED:
45z-
G
SITE
I
Cwk5w-
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
J PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS k) -z' (OV/1,4z.
PERFORMED BY: /4v— /itIt CERTIFIED 8
p
72.008 (6/79) '
DATE:
MUNICIPALITY OF F ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section —' Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-582-27-000
Expiration Date: 10/15/2025
Legal description THUNDERBIRD HEIGHTS #1 BLK 8 LT 2
Site address 27712 RAVEN CT Chugiak AK 99567
Current property owner(s) MURFIN LIZA
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
a
Original Certificate Date: 10/22/2024
his Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovaIjune 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 05158227000
Complete legal description
Location (site address)
THUNDERBIRD HEIGHTS #1 BLK 8 LT 2
27712 RAVEN CT
Current property owner(s) MURFIN LIZA
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
727-1130
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units X Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass
Age na - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: FM
-1
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 0 UJ Waiver Fee $
Date of Payment 1, �' i 17 02 Date of Payment
COSA # S Z % c/ 3 y Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: THUNDERBIRD HEIGHTS #1 BLK 8 LT 2 Parcel ID: 05158227000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Well production at time of test gpm
Date drilled Total depth ft Water storage tank volume gallons
Cased to ft Well disinfected for coliform test? ❑ Yes 400066
❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative
❑ Wires are properly protected Nitrate mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) in. Arsenic ug/L ❑ Arsenic less than MRL (ND)
Date of flow test for COSA Collected by
Static water level at beginning of test ft. Date
Comments No Well On Lot- Water Provided By Community Well
B. TANK DATA C. LIFT STATION
Measured operating fluid level in septic tank na ❑ Required maintenance completed
Date of pumping new Age of lift station years
❑ Required maintenance completed, if AWWTS Lift station material
Comments: Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/81
0 ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
0 Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficienci
COSA Checklist June 2022
Adequacy test date 10/15/24
Results Q Pass
Fluid depth prior to test 0 in
Water added 600 gal
New fluid depth 5 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 48
Effective depth used 0 in
Effective depth remaining 48 in
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
Z] Yes if No ft ❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' [:]Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft
❑ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes if No ft 71 Yes if No ft
❑■ N/A— Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
■❑
Yes
if No
ft
Surface Water > 100'■❑
Yes if No ft
Tank to Property Line > 5'
■❑
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑■
Yes
if No
ft
Private Wells > 100'
❑■ Yes if No ft
Water Main > 10'■❑
Yes
if No
ft
Community Wells > 200'
❑■ Yes if No ft
Water Service Line > 10'
Q
Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm NorthRim Engineering
Engineer's Printed Namc Steve Eng
COSA Checkpst June 2022
Phone 694-7028
Date 10/17/24
AV
Ar0 0 49 IE
�1
Steve Eng 644
7,
�± GE -6256?
10' Utility Ease.
T
J-X.Gr_114 D
49th Star Surveying
Lot
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Shed
Roof OH J
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N 89`36'45" E 150.00'
-All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. 78-19.
-49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no
circumstances should any data hereon be used for establishment of property lines.
-It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed
AS BUILT SURVEY
J-X.Gr_114 D
49th Star Surveying
Lot 2, Block $,
Thunderbird Heights
� Fire Hydrant
Tele-comm Pedestal
PO Box 738
Girdwood, AK 99587-0738
(907)891-6111
Subd., NO. 1,
g water valve Septic Lid
Jeremy@49th5tar5urveying.com
Chuglak, AK
® Septic Clean Out/Vent
w-0. 2469 DATE: 10/16/24
SCALE: 1"-30'
Municipality of Anchorage
4Kt
Development Services Department
Building Safety DivisionOn-Site Water and Wastewater Program s
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. 051-582-27 COSA # OSC ('Z I L39
Expiration Date: i3
1. GENERAL INFORMATION
Complete legal description Thunderbird Hts #1, Block 8, Lot 2
Location (site address) 27712 Raven Ct, Chugiak, AK 99567
Current Property owner(s) lack Frost Day phone 240-0385
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
same
Day phone
Susan Bickman Day phone 240-0385
Dynamic Properties
Unless otherwise requested, COSA 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
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
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 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 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 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. 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 NorthRim Engineering Phone 694-7025
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 3/9/2012
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septiq&Jeems are
subject to these various and dynamic characteristics and are outside the control of the®® 1
evaluator of the well and septic sstem. OF Al, -%`
5. DSD SIGNATURE
_Az� Approved for bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
X
Steven W. Eng '�rv`•v:
Pe 62 6
bedrooms, with the following
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
)ther
Original Certificate Date: 1
A
Municipality of Anchorage s
• Development Services Department e
Building Safety Division
On -Site Water & Wastewater Program s " ETY
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Thunderbird Hts #1, Block 8, Lot 2 Parcel ID: 051-582-27
A. WELL DATA - Public Water
Well type na If A, B, or C provide PWSID # _ Well Log (YIN) na
Date completed na Sanitary seal (Y/N) na
Total depth na ft. Cased to na ft.
FROM WELL LOG
Date of test
Static water level na ft.
Well production na g.p.m.
WATER SAMPLE RESULTS:
Coliform NA colonies/100mL Nitrate NA mg/L
Arsenic: na mg/I Date of sample: na Collected by: NA
B. SEPTIC/HOLDING TANK DATA
Wires properly protected (Y/N) na
Casing height (above ground) na in.
AT INSPECTION
na ft.
9 -
p.m -
Tank Type/Material Septic/Steel Date installed 81 Tank size 1250 gal.
Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N
High water alarm (Y/N) N Date of pumping 4128112 Pumper JWs Pumpin¢
C. ABSORPTION FIELD DATA
Date installed 81 Soil rating (g.p.d./ft2 orft2/bdrm) 90 System type Trench
Length 51 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth 8 ft.
Eff. absorption area 408 fe Monitoring tube Y Depression over field N
Date of adequacy test 3/7/12 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 3 in.
Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date =
D. LIFT STATION
Date installed na Size in gallons na Manhole/Access (Y/N) na
"Pump on" level at na in. "Pump off' level at na in. High water alarm level at na in.
Datum na Cycles tested na Meets alarm & circuit requirements? na
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot na
Absorption field on lot na
Public sewer main NA
Sewer /septic service line na
Animal containment areas na
On adjacent lots na
On adjacent lots na
Public sewer manhole/cleanout NA
Holding tank na
Manure/animal excrete storage areas na
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 10'+ Absorption field 51+
Water main NA Water service line 10'+ Surface water 1001+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main NA
Water Service line 101+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain (None Known) Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that I 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 Steve Eng
Date 3/9/2011
COSA Fee $490.00
Date of Payment
Receipt Number 3Q 2 8Ub
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
OF
Steven W. Eng
010
ASSUILT SEWARD
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
3GA E'
FOLLOWING DESCRIBED PROPERTY:
-Wl�lv.S✓�"A/4./d�zi e
AND THAT NO EN OACHM NT5 EX�ST EXCEPT AS
DATES .�
INDICATED. IT IS THE RESPONSIBILITY OF THE
%���z
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
�Ju/�efTr
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
Fs`
ANY DATA HEREON BE USED FOR CONSMRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BMW -DRAWN
ARY LINES.
- Wsm M k S. a'd -
'• CS -69
J-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services u
44NICIPAL1Ty OF
On-Site Services Section ANch
P.O. Box 196650 Anchorage, Alaska 99519-6650 off ersERvSpyS1CN
343-4744 JAN
l t,
CERTIFICATE OF HEALTH AUTHORITY 1931
j� RE
APPROVAL FOR A SINGLE FAMILY DWELLING '`C CE1/CD 1
Parcel I.D. # o S 1 — S- 8 - a7 HAA #�(� �1 Y L
1. GENERAL INFORMATION
Complete legal description Lot 2; Block' 8; Thunderbird Heights #1
Location (site address or directions) 27712 Raven Court
Chugiak, AK
Property owner PHH/Homequity C/O Kathi Olmstead Day phone _
Remax of Eagle River
Mailing address 16600 Centerfield Dr.
Lending agency
Day phone
Eagle River, AK 99577
Mailing address
Agent• Kathi Olmstead 694-4200
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
4
XXX
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 XXX
Holding tank
Community on-site
Public sewer s
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.'
72-025)Rfv.1121) Front MOA821
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 S& S ENGINEERING Phone G 9 y' a 9 7 `3
age River Loop Road No. 204
Address Eagle River, Alaska 995,77 :
Engineer's signature Date � �� °
_.oat.
D . j N. A�WMaoW�
IRO¢¢RTwOWAN �Q
CE -8801 }
6. DHHS SIGNATURE S �Oi1pRO $5101
Approved for
R bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
.. U— Date 12
13,1:
GCAUTION
`.... 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 orderto 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-= (PwI. veil sack Moa m
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERV&IcIP°LtTMOFANCHOR
Environmental Services Division ^ NMENTAL SERVICES DI
825 L Street, Room 502 •,Anchorage,,Alaska 99501 • (907) 7 4
1997
1 Health Authority, Approval Checklist
RECEIVED
Legal Description: l–epe) Parcel I.D.: 1
A. WELL DATA
Welt type _A If A, B, or C, attach ADEC letter. ADEC water system number _ Z(I 15
!
Lo /N
9 present (Y ) Date completed
Total depth Cased to Casing height ve ground)
Sanitary seal (Y/N) Wiro perly protected (Y/N)
i
Date of test
Static water level
Well production
WATER SAMPl,6
FROM WELL LOG AT INSPECTION
I
g.p.m.
Other bacteria
Date of sample:
Collected by:'
B. SEPTICIHOLDING TANK DATA j
j
Date installed Tank size .Z.S" o Number of Compartments -z Cleanouts 07N) .�
Foundation cleanoutli! 1) Depression (Y,® High water alarm (Y/N)till_
DateofPumping Pumper ALI l
C. ABSORPTION FIELD DATA
Date installed 1 2r1 Soil rating (g.p.d./ft2 or ft2/bdrm) �bSystem type
Length S 1 t Width __%1 Gravel thickness below pipet' Total depth 8.S'
Effective absorption area �� Monitoring Tube presentaN) Depression over field (Y0
Date of adequacy test �q �97_ Results as Fait) _ & S For T
bedrooms
Fluid depth in absorption field before test (in.); D Immediately afferG—�'gal. water added (in.): S ~
i-
4-
Fluid depth O (ins) Minutes later: �a Absorption rate boo a.p.d.
Peroxide treatment (past 12 months) 0( If yes, give date - %4
72-026 (Rev. 3/96)' i !,
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
"Pump on"
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
line
Size in gallons
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Lift station
level at'
SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO:
t
Foundation to •5 Property line 1 of k Absorption field
Water main/service line 11c> water/drainage t rc Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line V:D Building foundation 11 k Water main/service line
Y 9N g 13,E t
Surface water 100 � Driveway, parking/vehicle storage area
Curtain drain C3 1�, Wells on adjacent lots Zo o �}
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recq_#Js,J50-the ajeM vstems are
in conformance with H guid ' es in effect on this date. f`e �'r�""� sit
Signature y �t'l.^a.� —
Engineer's Name /! 113
11oaAN
CE 3301
Date
HAA Fee
Date of Pa
Receipt Ni
72-026 (Rev. 3/96)'
1\
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
Parcell.D.# 0 S/—Sid--27
1. GENERAL INFORMATION
HAA# Aj-,Z-9/v'-ts5,
Complete legal description Lot 2: S?neh s; lhun p:zhihid HP nlitA
Location (site address or directions) • 27712 Raven Count
Property owner
Janee
V.ibbent
Day phone 688-1396
Mailing address
HC 78
Box 306 Raven Cowtt
Chug.iak, Ak. •99567
Lending agency Day phone
Mailing address
Agent Sarbara Ctitte,zden JACK WHITE COMPANY Day phone 694-5500
'ot Arun Jes!. i.e.6 PPH HOAIEQUITY/Cat i. ojtni.a
Address " 10928 Eagle, R "voh Road. E R 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well XX
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 Xx
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 (A«. 1/91) Front MOA +21
S. 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 with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Gh;'-aiN z
Phone
Address
5 & h�' , ,..42 Road "Io.
17034 : ta5t<a 5977.
Engineer's signature -3R►0 RNver, A Date
6. DHHS SIGNATURE
Approved forbedrooms.
Disapproved.
Conditional approval for
Additional Comments
7// 41-/q /
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 their lending institutions in orderto 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.
72-0250".1/91) BaCM MOA R1
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L -V7- 6> tLf'' -fa 4r-�, Parcel I.D.
A. WELL DATA
Well type K If A. B, or C. attach ADEC letter
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date completed
Cased to
ADEC water system number
Driller_
Casing height
Wires properly protected (Y/N)
2111 SCo
B. SEPTIC/HOLDING TANK DATA
Date installed 19 e)I Tank size /7-5-0 V Compartments 2—
Cleanouts &N)1 Foundation cleanout &/N) �L _ Depression (YQ
High water alarm (Y& i1i Alarm tested (Y/N) "/&
Date of pumping -7-13-11/ J e- 6"s e o� Pot vo.w, '✓
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot Zoog On adjacent lots ' Foundation L.S
Topropertyline- /o Absorptionfield S Watermain/service line
Surface water/drainage 100"
72ozs(saev.vst)Front MOA 21 CONTINUED ON BACK PAGE
FROM WELL LOG
AT INSPECTION
Date of test
f
Static water level
T
C�
{
n
r
Z
Well flowrn
g.p.m. g.p.m.
~
�-
Pump level
c
rC> 1
SEPARATION DISTANCES FROM WELL TO:
,a-
b "
Septic/holding tank on lot
On adjacent lots
Z
Absorption field on lot
Zoe t Y
; On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Public sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 19 e)I Tank size /7-5-0 V Compartments 2—
Cleanouts &N)1 Foundation cleanout &/N) �L _ Depression (YQ
High water alarm (Y& i1i Alarm tested (Y/N) "/&
Date of pumping -7-13-11/ J e- 6"s e o� Pot vo.w, '✓
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot Zoog On adjacent lots ' Foundation L.S
Topropertyline- /o Absorptionfield S Watermain/service line
Surface water/drainage 100"
72ozs(saev.vst)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed .
Size in gallons
Vent (Y/N) -
High water alarm level
Meets MOA electrical
on lot
"Pump on" level at
— Manufacturer
Manhole/Access (Y/N)
o r level at
Cycles tested
'ANCE FROM LIFT STATION TO:
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
,,Date installed 1947 Soil rating qfl /6i� System type -rl?-S LA
Length :SI Width Bst", 3 Gravel thickness Total depth 5-5
Total absorption area 90 8 Cleanouts present (9)N)y
Depression over field (YO Date of adequacy test
Results fail) for F6 or- / bedrooms
Peroxide treatment (past 12 months) (Y.l U14— If yes, give date 1J/A'
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ?.y o� On adjacent lots 'I' �Property line I O
To building foundation /1 To existing or abandoned system on lot 01J/a
On adjacent lots 3O t Cutbank//' Water main/service line lot
Surface water loo Driveway, parking/vehicle storage area
Curtain drain 114,
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.
S & S ENGRdEERING c h\P rT' �,7 ~• ti'Q �`pb
Signature Vis.
UUJ4Laj41J1'Jv-ao. �{
Engineer's NameEagle River, Alaska 99577 °•
w
Date • • Robed A. ShoFa Iwo(
', plo 1457• a'
T •� � d
HAA Fee $ ��
Date of Payment t�
Receipt Number. �%
72-029 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
n MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH L/
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 1 I nn_QID
OF ON-SITE SEWER AND WATER FACILITY T'11525 2S n
264-4720
Application Date MAY 17, 1988
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOT 2. BLOCK 8, THUNDERBIRD HEIGHTS, SEC. 25,T16N R1W
Location (address or directions)
306 Raven Loop
(b) Applicant Name -WMAX OF EAGLE RIVERrolephone: Home - n/a Business 694-4200
Applicant Address _16600 CENTERFIELD DRIVE #201 EAGLE RIVER AK 99577
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer O ; Other ® (explain); REALTOR
(d) Lending Institution CITY MORTGAGE Telephone 907/263-7379
Address 405 W 36th quite 100 Anchorage, AK 99503
(e) Real Estate Company and Agent Appl i pant Agent — Al R a,;7.P_w_gki
Address
Telephone
(f) Mail the HAA to the following address.
Pick up by engineer
2. TYPE OF RESIDENCE
Single -Family CR Multi -Family ❑ Other
Number of Bedrooms 4
3. WATER SUPPLY
Individual Well O Community 0 Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite RJ Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11/84)
5. ENGINEERING FIRM PROVIDING 3PECTIONS, TESTS, FILE SEARCH, DAT NO INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm FLA= RIVER EPGINEERING SERVICES Telephone 907/694-5195
Address P•O• BOX 773294 EAGLE RIVER AK 99577
Dated ?irrx
tr•f.� �' r,•37 J• n..'
....... 0 P .. . I......
d �• ; Louis A. eurere
dd �. CE -6736
AW
6. DHEP APPROVAL rJ
Approved for 4=+=(c2 bedrooms by �Date
ApprovedDisapprovedDisapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITf O1 ,,t4CH ttIftIPALITY OF ANCHORAGE (MO. J
ENVIR0NMEWALSERVIC4M)QflNi AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
UlAY 1 % 1968 264-4720
Legal Description: �d7t - .C�/� Fl - %div-✓.ce�6i•d
RECEIVED _lleis4ex T/6 n/ R
A. WELL DATA
Well Classification - CAss "4 0, If A, B, C, D.E.C. Approved (Y/N) -- y 4e -A, --
Well Log Present (Y/N) Date Completed
Total Depth Cased to
Static Water Level
Casing Height Above Ground _
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Depth of Grouting _
Pump Set At
Yield
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
—; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Date Installed /94F/ Size 1 --2- S No. of Compartments
Standpipes (Y/N) Y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) k_
Depression over Tank (Y/N) N Date Last Pumped — M42 y I PX -S- E �T/c i
Pumping/Maintenance Contract on File (Y/N) for _des
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) ^'ls
Separation Distances from Septic/Holding Tank:
To Water -Supply Well foo To Building Foundation 6• S
i
To Property Line To Disposal Field S
i
To Water Main/Service Line To Stream Pond Lake or Major Draina e
to
Course
Comments
Pagel of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata !�� �� Type of System Design
Date Installed 1,75-1 Length of Field r�
Width of Field est• 3' Depth of Field S /
Gravel Bed Thickness
Square Feet of Absorption Area Standpipes Present (Y/N) Y
Depression over Feld (Y/N) ^/ Date of Last Adequacy Test
Results of Last Adequacy Test Sa %•fr PS, I—AP r fibro. -6 t��� k V 6� ujeti r1,
Separation Distance from Absorption Field:
To Water -Supply Well o?� To Property Line
To Building Foundation
f /o
To Existing or Abandoned System on
Lot /✓fa ; On Adjoining Lots
To Water Main/Service Line '`/° To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course IVO
To Driveway, Parking Area, or Vehicle Storage Area or /3.X,
Comments
D. LIFT STATION A%/
4
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) —
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
•• Check Permitted Bedroom Rating Against HAA Request °°
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that.I�h-avee geecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed =_�� �'-- Date
Company Eagle River Enpineerina Services MOA No.
�. Box AK 99
Receipt No. Eagle River, AK 99577577
695795 -�� -.'•, `�„ �
Date of Payment
r=::. °
a d r• , . •;EngineF, Seal
Amount: $ e
05
Cr-/Jf/J��.yJ 1
Page 2 of 2 4', �, `; Louts A. tutora �:� r
G• G',•• C[�736 �'•°�
72-026(1 U84) l�.•<Q °O•°aea°p°��,��
. r
�n6 O b b b WALTER J. NICKEL, GOVERNOR
n
U U
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: S & S Engineering
Ray
June 25, 1991
PWSID #211156
My review of the records on file in this office reveals that the Eklutna Thunderbird Heights
Subdivision Class A Public Water System, Is in compliance with the provisions of 18 AAC
80.060, State of Alaska Drinking Water Regulations.
Sincerely,
ltet44
Keven K. Kleweno
Lead Engineer
printed on recWed pap er o y Q. D
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 "C" STREET. SUITE 1334
ANCHORAGE, ALASKA 99503
DATE:
--------------
PWSIO #s ----- -- -----------
To Whom It May Concern:
563-6775
Accordinq to the
records an
file in
this
office.
the
Water
System
is in
compliance with the
State of Alaska Drinking Water Regulations.
Sincerely.
Ronald S. Klein
Environmental Field Officer
000"N,
rte,
i ime
Time
oe
d
Date
Date
Date
Inspector
Inspector
Inspector
Comments
Conditional Approval'
f'c: roomS
Date Sewer Installed
Permit No.
Septic Tank Size ( -.5'O
e—e t
Holding Tank Size
Solis Rating
Well To Absorption Area
Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner 7, /v� Phone
Mailing Address
Buyer M2l -//lC t= 7 J
Address
Lending Institution
�
Address �Ie (�%iGGGt j\
Realty Co. &Agent��y[.1/
VPhone
//C—S< Address XV/ /./ ��J�.rG�•�/
I r7-1
Legal Description!/ �yC �l'� l� '
Street Location
�+
Type,Residence
a.Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
❑ Individual I 6&,"
17 1 �14A ACH L 00. At ell log 's required for all wells drilled since June
Community L'
I 1975. For wells drilled prior to hat date, give well depth (attach log If
X� Public Utilit available.
Sew x Disposal
I Individual ear ndividual Installed:
❑ Public Utility yyhenf0nrected to Public Utility-
❑ HoldingTank�`'�
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
'i'iii asaesants thaws on thi#.'°;91�t�►tu`�f,!` ar:
AS shWM en the reeor+dd p1ikU at a sup-
pl invented with any r+tsm {aetii, {Rr
.After the plat date st 4 .1 � thln
Title •Search dtd.AU.
Under no eireulssttnta the+ . tri WOO
sa used for construction or fo* eitabi IWI
boundary or tent: lines. '
TnI imirvr um mpatwii AW the
AS4UILT
Ago,%�
- V
h
.I
