HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 6 LT 1Thunderbird Heights #1 Block 6 Lot 1 #051-582-04 Municipality of Anchoraje Development Services Department Building Safety Division - On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page/ of 3 www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW 4 5 O 1 4ir PID Number. Qom" - O Name723 A kgEgl r5f?Wastewater System: KNew ❑ Upgrade A""s" HC Sri K ABSORPTION FIELD nW r— Q MBab D oap TaCn D snw Tral e.o OPtm --t5 z4.// � LEGAL DESCRIPTION SN Rating ToWDapMit= w.mtg,e GPD1F12 FI. stock La SuWmwn' . DapP ro Ppe bonpm 1,017 v:p—a arae Graval 6-017 bwwam PN FI. FI Tow++sntp RW94 Seam FO W0 above w9" 9181a y TF1. Gr.vN LOV.h FI. Well BUC❑ _w Upgrade Ga alwmrt N,rn,1,ara. 2 Dwane b.iwaan tiles Ft. FI DlaasA,teoM (Pmate, Ik 9, CI Tole: Cassa 10 Taal aosorpum raa ,r. 5�Q P:pe Matanal FI. FI Fls C r0 -t Driller D Dnl:eO Stat p W Laval1 W— Date ktv" M FI I%J r Q YtalO Pump Sat nbovaC4a TANK GPM FI.Casn' Ft SEPARATION DISTANCES 9septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ubhcPnvatejos ".. ^ (l '�^v OGal From Tank Field Station Tank Sewer Line N AE wan Laale: it Nurtpar M Carysnmama e— Uelwce Watesd / a /�. .— ^ LIFT STATION La Lala Se iaJN FoWnm FL /Ny y ^ 'Pump on Laval al 'Pump otr Neal ot Npn caner al S T in in In C~ Drnn _ ^ Pomp Maka & M al E WanW hspecwn 'lames by Rlm z LU L&41F W / BENCH MARK r)L— C Louuon an0 DasatPon F acE udoti 6 IP4. iq C AsaumeO EMwoon /00Ft • L. Lin�F ,✓AontEQ . • �`ao+Qtil�oA C p OF A4Rxt +P(E �� •eseNasiNesaS,f.I Inspections performed by: NOC h 12Irs. 4, Dates: 1" 2 AS '71f3jas.W. to P 2nd ' Development Services Department Approval Oj J �.e SraPEn z6 56 0 Reviewed and approved by: Date:- '� It j aFp •'•• • �a PR,FtSE•�"' .'' m� awlO'Alzri1 N, N N 0 rq M CA O w M •�A 7d 7d m r- fTl C") C m Z O (7 t:j Z M td C 1--1 r td --i r= ac C) Z 7C t_J m ON 70 tcl r� od -i m to C+ 2 O m m m P h 0 3 u CD in m �NAN DN£NN� W E�� hE Ph+hZ h £ m m h (D P 3 �ncEF -Im N P m 7C•3 O nh<; rZ N h htf,nhnm'h R.3 a�3ry3 � 1"D NS m V O0 W57M N c 0h ;33mN Ln h h 3 N O C O C: N n F:. 3(D S 13 Nim >Z P h Ul'0 S h 3 H P 0 n D O O< N >Z A a Z 3 n iw n P o m� 0 3 m o n< v10 (o S n P m � D � 3 t7 v z m a s 0 O Z h O 3 7 m m 3 n s m m C+ m O � .P+ m n < 0 h II 3 < <O m 11 3 %D M 11 D 3 3 N O 3 7C o �n O O P z m .A m 0 h m z m E m 3 A s C+ II O � 3 (n II %D m D 3 3 N O 3 7C o Z O O P d O 3 to � P f'1 O< m m P X,O n c C+ m .A m 0 h m z m E m 3 A s F.C.O. S.T. 1 S.T. 2 D.C. 0 C.O. 1 C.O. 2 M.T. AWWU Booster Station ✓Y V, 48 54.5 59 6/5/ 6 75.. 1. Total Depth of Trench is 7.5'. Terrain relatively flat. 2. Sewer Service Line minimum 2% slope. 3. Lots Served by Public Water System. '20 23 11 29 31.5 Abandon EAkssting Septic Tank H Replace w/1250 M Hous Double C. F.� a• T.H. \ A\\0 er Key Box _6 lion Septic Tank 's / C. o. 2 - Absorption Trench Septic System Construction Does Not Preclude Adjoining Lots From Sanitation Improvements, 1' = 40' NORTHRIM 11 THUNDERBIRD HTS ENGINEERING %*'49m AS -BUILT 17237 &*or Pow C/relo = £o9/e91MosOko 99377 a LAYOUT 07. 1 - BLOCK 6 LOT 1 7/22/05 IL of MUNICIPALITY OF ANCHORAGE Development Services Department11� On -Site Water d Wastewater Program 4700 South Bragaw Street ^ l P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 30, 2005 Expiration Date: Jun 30, 2006 Permit Number: SWO50196 Parcel ID: 051-582-04 Legal Description: THUNDERBIRD HEIGHTS #1 BLK 6 LT 1 Design Engineer: 0838 North Rim Engineering Site Address: 024707 THUNDERBIRD DR Owner Name: JON KEHLER Lot Size: 22544 SO. FT. Owner Address: HC 79 BOX 407 Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , AK 99567-9514 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: —2' ! —DS - Date: 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 SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. to 57 - 5F'q-al - Permit Number SW Property phone Mailing address .241 70 7 T� w *Ad4r 6 fV'J A rI VQ Zip Code % % -fit; % Site address Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot SizeZ(6140 - Acre to THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 6— (Signature of property owne C�authorized agent) Receipt Number: &g93o Receipt Number: 99� (Rev. 09/04) ` FROM :NORTFRIM FAX NO..:9076947026 Jun. 30 200 02:0t?PIt..P1 VEERING ��� FAX Steve Eng, PE, PH 17237 Bear Paw Circle. Eagle River AK 99577 (907) 694-7028 tel (907)694-7026 fax NorthRimEng®aol.com Date: 6/30/05 To: Joe Goodall On -Site Water & Wastewater Program Subject: Thunderbird Hts, Block 6 Lot 1 Joe, Number of Pages: 1 Fax: 249-7847 After speaking with State DEC & following up at AW WU, it has been discovered that there is no water well in the vicinity of the subject property. The AW WU Booster Station has no water well associated with it. Don Keefer (5642717) confirmed this just minutes ago. There are no conflicts to water wells for the proposed septic system on the subject lot. Thanks -Steve Sic ..n W. Eno P! 6256 A r FEN _INEERr N�GL— NoftRim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907.694.7028 June 24, 2005 MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Septic System Replacement Design, Thunderbird Hts, Block 6, Lot 1 The septic system has failed on the subject property. The owners wish to replace immediately. The soil test was excellent. A special trench configuration is required due to limited available area. A lot line waiver is requested. Most of the neighboring lots are developed. This site should not negatively impact any of the other area lots. The slope is relatively flat, slightly sloping to the northwest. Please review the wastewater system design for the 4 bedroom single family home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sine Steve Eng, PE, PH Design Enclosures f� �N INE+ERING Thunderbird Iits S/D, Block 6, Lot 1 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing single family home @ 4 bedrooms. The system is in a failure mode and is about 26 years old. The septic system will be replaced. This requires a new 1250 gallon septic tank. The lot is about 1/2 acre in size as are neighboring lots. Most of the neighborhood lots have been developed. The entire subdivision is on a public water system. An AWWU Booster Station is located across the street. Don Keefer @ AW WU stated that "water wells associated with the booster station are inactive and slated for decommissioning". Therefore a well waiver will not be persued for septic system replacement. No adverse impacts are expected from septic system replacement. The neighboring wastewater systems are located on the drawing. A special configuration design was required due to lot size constraints; a lot line waiver is requested to 1 foot between Lot I & Lot 24. The lot is relatively flat, with a minor slope toward the northwest. No conflicts to any neighbor lots is anticipated. The test hole revealed a sandy soil with a percolation rate below 1 min./inch; over 50% of the soil is sand. An application rate of 1.2 GPD/Fr2 with 0.5 reduction factor for utilizing a 5' wide trench was utilized. The old system will be properly abandoned. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment, 1250 gallon septic tank. • Watertight couplings on inlet & outlet. • 5 foot minimum between the tank and bed. 10 foot to property lines. • 3 feet of cover or insulation is required for trench; an equivalent of I" insulation for each foot soil cover. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required I to 4 feet from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 feet from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain - rock. • Drain rock to be'/2 inch to 2'/2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier (filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • Backfill over drain rock must not be less than 36". Y �INE+EKING JNA Thunderbird Hts S/D, Block 6, Lot 1 • The finish grade must be mounded to promote drainage over the trench. • 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 or equal) • The existing septic system will be abandoned; the septic tank will be pumped, crushed, and filled with sand/gravel or removed and properly disposed of. AWWU Booster Station jr 8 Driveway 4 0 w m 3� \ \ �h 1 1. Total Depth of Trench is 7.5'. Terrain relatively flat. 2. Sewer Service Line minimum 2% slope. 3. Lots Served by Public Water System. Ho Abann Existing Septic Tank Replace �w 1250 Gallon Septic Tank yGd ater Key Box 65 / Absorption Trench Septic System Construction Does Not Preclude Adjoining Lots From Sanitation Improvements. 1' = 4 0' NORTHRIM THUNDERBIRD HTS ENGINEERING �50PLAN 17237 Bear Pow Ckcl �,.o, ., 99577 9�•5, fop's90 LAYOUT 7..894028 - BLOCK 6 LOT 1 -6/24/05 11 of 4 mss 4' / ^ :: s� v Septk System Constructior93 Does Not Precede Adjoining ?6 0 �V \ots From Saratatlon Improvements. SEPTIC + !� SYSTEM do / 99 / SS 9y we ti R oy0 6 mot RelativeSEPTIC O / Flat. Slopes SYSTEh�� <ry1 R>2borthwest. J `• �`y " ��' 28.24 V. kP 23 EPTIC SYSTEM i \ � a LA NEP�I��, o uA\ Sy E AWWU BOOSTER STATIDN\ s.:. `ri'\.� \ ss�xa !� o EPTIC / O \ Svc -TEM 3, , � o � A 6� • A o 0 Pty .°F k %s THUNDERBIRD HTS NORTHRIM ENGINEERING BLOCK 6, LOT 1 AREA PLAN 17237 Door Pow Clrelo a•; r..w CoVe 907. 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Wet Depth 1 Water Depth After Monitorino.None Date: A/IA/05 # Date Gross Time Net Time Depth Net Drop 1 6/16 0 -- 12.5' -- 2 6/16 1 1 min. 14' 1.5' 3 6/16 3 -- 13' -- 4 6/16 4 1 min. 14.5' 1.5' 5 6/16 1 6 -- 13' -- 6 6/16 7 1 min. 14.5' 1.5' Percolation Rate <1 min./inch Perc Hole Diameter 6' Test Run Between _3' and 4' Comments:-GrPntar then SO% snnd Performed By NorthRim Eng. TG Performed in Accordance with 4 ON THIS DATE. DATE: 6/24/05 Z CERTIFY THAT THIS TEST WAS I State/Municipal Guidelines in Effect NOR THRIM ry�.:a ,.�!� ENGINEERING t� TESTH❑LE LOG T. H. 1 17237 Bsor Pow CtrN o .. £oplo River. Alaska 99377 .. a ' ' 90Z694.7028 �.........' GE❑TECHNICAL 6/24/05 11 of 1 Municipality of Anchorage Development Services Department • Building Safety Division On -Site Water and Wastcwatcr Program 4700 Bragaw Strcct P.O. Box 196650 Anchoragc, AK 99519-6650 www.ci.anchomgc.ak.us (907)343-7904 Waiver Review Worksheet WR#: 050054 PID#: 051-582-04 HA/Permit# PERMIT: SW050196 Date Received: July 26, 2005 Legal Description: Thunderbird I[eights #1 Block 6 Lotl Engineer. Northrim Engineering Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 Applicant: Waiver Requested:1 foot lot line waiver Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: .....................................°°°°.°........ geneses .... ............ Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date: 7/205 By: Joe Goodall Name of Reviewer e...... .engeeeeee.e........ .esseeeeee.e.... assesses ........ .nseeeeg....... Rec#: 69938 Amount: $175 Date Paid: 7/26/2005 �• .0 MUNICIPALITY OF ANCHORAGE CEPARTMENTOF HEALT/14 ENVIRONMENTAL PROTECTION i},/� ENVIRONMENTAL ENGINEERING O!VtS10N P 823LSVtpt•ARcllneap,AINka 89501 TNeon 2644720 ONSITE SEWAGE CISPOSAL SYST EM AND/OR WELL INSPECTION REPORT NAME, � '—/ -_I�sc-cr lS•____- J.((,!{,J'JL// (r � LLS DV.ORADE MAILING ESS LEGwL DESCRI.TION�h�u�� .4 her L NO.C. BE08j1OMS • VIWN���m. OY DISTANCE ro: ` Ampyl. Yyy .. I D.r'•rys, N7 fY•�li .E D. O UPI. ManplS"..W GQ��] 4Y•. IP HOMEMADE: Ince le..T�n IH-I:n LwWd eeYln VIY• Uvw'.rop 6 OISTANCETO'. PERMIT NO. a+e _ - -- Ot�.•V.•wM��p�_— 2j=2 Lw4fPOW�n waYlpn t DISTANCE TO. D ) «sC/`—J r L.IUM141.u. � w+'..1 W Hp. of enn LYY n o1 1 Te.« T.eKe .wmn MI e O+I •w . xR n^ i— Pe, /7 p1Y a I�INMI YN T..l ple le Nnnl Oeee I N^ell o • ` D ,Knn L."'.W.em i. I NMI U. t� ww 1.N M+In T..UI eliK 1,N PMpp4pIIMN �� feM •1 MY.WIW O1iM G p NWI u1sTANCE To: bpan�^y'IM.LI•o.� IMwnr lnlLK DINe ONlln (Io141 Dnren(e 1p 1o11.N .ERMIt NO. OIS7ANCETO' w'w'+p lounen,On Sewn nn �Sw,l.e lra AplWnlan aeNbl OTHER--'� MA EN LST `--1 IL TEST RATING I INSTALLE I o.cJ74Ac�n2• • ----i i .5 11 RE RKS DlftmLt4 Lu w vED D.OE •[..+. lJUIJI n.blfll J yPj5-,CuJt+t Z c it*l'aL_ I TY OF' nr-Icv:&FRROE (1 Iuiy-) DEPARTMENT Qt HEALTH AND ENVIFONMENTAL PPOTECTION -' 825 'L' STREET, ANCHORAGE. A!'. "501 ` - 264-4720 /+C) OtJ-S 2 TE SF_t<ER PERM I T',�LY�• PEPMIT NO 1 730470 1 APPLICANT JFK CONST/JOIN ✓INSELLA CHILKAT CT POI{ 2511 694 31SII� LOCILIIO'r THVNDEF'BIPD HTS } LEG..L Li Bn THLRIDEPSIPD HTS LOT SIZE 21780 SOURRE FEET TYFE OF SOIL APSORBTION SYSTEM IS. TFENCH MA::IMUM NUMBER OF SEDPOOMS - 3 SOIL PATING <SO FT/BR)- 125 THE PEQ1!IPED SIZE OF THE SOIL FIBSORPTIOIN SYSTEM IS: L�EF`TH- ? L-ETJG-r"- x=20 C312Fi'v'F_L- ESEF�TH- 3 THE LENGTH DIMENSION IS THE LENOIH (IN FEET) OF THE TFFFF_.+ OR DRATH'IELD. THE DEPTH OF F TRENCH OR PIT 15 THE DISTAMCF BETWEEN T-7 SURFACE Cr- THE OFOLRJD FIND THE BOTTOM OF THE EXCAVRTIOV CIN FEET THCF.E IS NO SET WIDTH FOR TPENCHF.S TNF GRAVEL DEPTH IS THE MINIML41 DEPTH OF GrPvCL E'ETWEEN THE OUTFAI.'.. PIPE_ RNO THE BOTTOM OF THE EXCAVATION 014 FEET Fd E:i4!L_1 I F;ZEE7 SEF^T I C TFiN1G S 7 =CC -a :1.171012% OF11-.L-ONS �LR:.IT APPLICFw1T HAS THE RESPONSIBILITY TO INF01,1- THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJPCENT TO THIS PRMPEPTY AND THE r NUNBFF; OF PESIDENCES THAT THE WELL WILL- SEPYE ---- T140 <2> INSPECTiI?tJ- Ftt?E REOU IREC --- EAC4FILL ING OF ANY $%STEM WT TROUT FINrlI. 1NSFECTICnJ AIID APPROVRI. RY THIS DEPARTMFNT WILL BE SIBJECT TO PFOSECUTION I MINIMUM DISTANCE BETWEEN A WELL AND ANY ON -SITS. SLWAGE D1SPf15F"_ SMSTEM IS 100 FEET FOR A PRIVATE WELL: OF. 15? TO 200 FEET FROM A PUBLIC WELL DEPENDIr.r: 'JPINJ THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPr-Y. SPECIFICATIONS AND CONSTPIKTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION F CFZMIT E?<F�XF2E5 LSF>Clchi C'•1 l;! 1.9.79 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REOLNPEMENTS E0Q 0r,-'.IIE SL14EPS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHOFAC.E 2: 1 14ILL INSTALL THE SYSTEM IN ACCO?^.VN':E WIT$•. THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SY'--TEM r:aY REQUIRE ENLARGEMENT IF THE PESIDENCE IS REMODELED TO INCLUDE MOPF THAN _ ;!:1•POntS. SIGNED:__�_^_^__� ----------- APPLICANT _______--APPLIICANT, JAK CONST/JOHN 1"IN5El LP ' ISSUED BY--- -- --- FATE.- _J 1. �.(P(-d-�- V3.2 1 I r 0 & E GEO""ECHNICAL & DEVEL"e_ePMENT CO. • • eo. 90. Do -As St, E694 Rim. Ai.0 89M . • ( 694.2124 a 8862290 Runts Orttw w m 69. 2.74. $OTL LOG LW Ds..topnwN Perforse' fcr: Name: 74-K. `'Nrri?Oer/o.J Tel. No. G9�'3lY/ Nailing Address: /'Nic.rar On /�tx 29-// Lo" A&A Ate. Legal Cescription: Lor / BaK Ti+uNOE�!er„Co //moo. Sox_ DevtA {feet) Sol; Charecterlstics D li ML Star Tv seta i 7�'Qj�P 3S 2_ 3— e. l,c4vr& f 4 CrenasE –AMSC lore t 5- 6 7 ' I 8- 9 _ r.•JNeE�e/4.o oma. ��— F407— oOLJAI ✓. �tAcc :.3 .. a 16 Ground Water Enco'intered: Yes (/_ No__ If Yes. what depth_,[j_ Proposed installation: Seepage Pit Drain field Cornents:_ l Date' 7/7 Perform -ed OY: ✓ ✓ u i • Municipality of Anchora �� a E�, On-Site Water and Wastewater Program! JUL 0 9 2010 . Q (907) 343-7904 4 s Certificate of On-Site Systems Approval Parcel I.D�-582-04 Expiration Date: iRr]=1ILI=01MIM910u/-1 4 111[a]z Complete legal description Thunderbird Heights #1, Block 6, Lot 1 Location (site address) 24707 Thunderbird Dr. Current Property owner(s) Bruce & CriStine Bartholomew Day phone Mailing address Real Estate Agent 157 Baldwin Rd. Wahiawa, HI 96786 2. TYPE OF DWELLING: F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual lx Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance Received COSA to be released to the engineer, unless otherwise requested by the engineer. Date: %,5-0 COSA Fee $�I 0/��10^ Waiver Fee $ Date of Payment T (`T'I g Date of Payment Receipt NumberReceipt Number COSA# O5Cl5I 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, Iattempt 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 fife 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 results do not 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 ewe 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 Phone (907)272-8218 Date 7/6/2015 6. DSD SIGNATURE System #1 Approved for bedrooms feverk.•Pannone System #2 Approved for bedrooms + CE -8149 Disapproved �41�ti�OFEs9r+"� Conditional approval for bedrooms, with the following stipulations: By; a (1l1. Origins[ Certificate Date:l [ � �7 Th • i ,ty f� c orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the repre Mentations 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 Septic System Advisory Well Flow Advisory COSA blue sheet E .., c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system I Certificate of On -Site Systems Approval Checklist Legal Description: Thunderbird Heights #1, Block 6, Lot 1 Parcel 113:051=58M4 A. WELL DATA 1 Well type Public /w If A, B, or C provide PWs1b # AWWU Weil Log (YIN) 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. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: in g.p.m. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/13/2005 _Tank size 1,250 gal. _ Number of Compariments 2 Cleanout (Y/N) Y Foundation cleanout (Y/N) /Y Depression over tank (Y/N) N High water alarm (Y(N) N Date of pumping/Pumper C. ABSORPTION FIELD DATA 7/13/2005 1.2 GPD/SF Shallow Trench Date installed Soil rating {g.p.d./fts or ft2(bdrm) . _ System type Length 54 ft. Width 5 ft. Gravel below pipe 4 ft. -TqDtai depth 9.3 ft. , Eff. absorption area 500+ W' Monitoring tube Y Depression over field N Date of adequacy test 7/2/20155 Results (Pass/Fail) Piss For 4 bedrooms Fluid depth in absorption field before test 5 in. Water added 612 -gal. New depth 10 in. Elapsed Time: 130 min. Final fluid depth 5 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date•installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOTTO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main Sewer /septic sery areas Size in gallons ".Pump off' level at in. Cycles tested On Manhole/Access (YIN) — High water alarm level at Meets alarm & circuit requirements? On adjacent lots Public sewer manhole/cleanout Holding tank Manure/an' excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation- 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+®© t ABSORPTION FIELD ON LOT TO: Property line 1 * Building foundation 10+ Water Service line 10+ Surface water 1-00+ - Curtain drain 50+ Wells on adjacent lots -VO+ F. COMMENTS *1 foot waiver on file WR#050054 Survey on File Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTIFICATION I certify that 1 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 Steven R. Pannone Date 7/6/2015 COSA canary sheet 2-6-15.doc in. Municipality of Anchorage 7/ Development Services Department ;A$ Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _DS/-Ski-D� HAA #_ 65035] Expiration Date: :z- n-7 - O (o 1. GENERAL INFORMATION - Complete legal description 3 Location (site address or directions) ZV 70 % Current Property owner(s) _yr0 n k�� �p ,r Day phone 4<&L Mailing address Lending agency Day phone Mailing address rt— Real Estate Agerit .l C D b Y- or fs Day phone - % y Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site R Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site • ❑ Public Water System e' Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Address Engineer's Printed Name 5. DSD SIGNATURE ✓ Approved for �_ bedrooms. Disapproved. Phone 101t 70-2co Date 2Z CI _ OF A t �'>s rim V l+,�i �•.• Slev PE 6155 �•, �• Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: L✓ /,t/. Original Certificate Date:_—� 7^ (Rev 01102) C Municipality of Anchorage 4-0. Development Services DepartmentBuilding Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: UM4 cik-d s #� R� L I Parcel ID: A. WELL DATA Well type&JftC. WAe If A. B, or C provide PWSID # dja* Well Log (YIN) Date completed Sanitary seal (YIN) _ Wires pr rly protected (Y/N) Total depth ft. Cased to ft. Cas' height (above grou in. FROM WELL L INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMP ESULTS: Coliform colonies/100 mi. Ni mg /I. Other bacteriaZionieg/100 ml. A ic: _ mg./l. Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Materisl t 6r"40- Q./ Date installed Tank size Q got: ber of Compartments a- Cleanouts (YIN) Foundation cleanout 11UN) Depression over tank (YIN) _LS[ r or High water alarm (YIN) Date of pumping Pumper ;i C. ABSORPTION FIELD DATA r ; Date installed S Soil -rating (g.p.d.tfe orJI4lbdrm) [. Z System type �/DE rZ6;t/G Ff Length 5 L4 ft., f Width ft. Gravel below pipe _ ft. Total depth SR. Eft. absorption area TQO—R= "Monitoring tube Depression over field _A4 Date of adequacy test A 6.44j_ Results (Pass/Fail) __ZVf5k.0 For _44L bedrooms Fluid depth in absorption fie before test _ in. Water added_ g New depth Elapsed Time: _ mi . Final fluid depth _ in. Abs tion rate >=_;Z p.d. Any rejuvenat m t tment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Acces Y/N) `Pump on" level _ in. "Pump ofP vel at _ in. High water rm level at in. Datum Cycles t ted Meets ala 8 circuit requirement E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON Septic tank/' station on lot Absorpti field on lot Zbli sewer main er /septic service line _ TO: PUAIC LA417U —e4wjklJ On adjacent I On adjacent I Public sewer Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I � Building foundation Property line j !4- Absorption field Water main .502,f- Water service line /0 1� Surface water /Q 4 ,f Wells on adjacent lots r Pusuc- w*rm) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main %Q 0'16' f'. Property line 3 Building foundation /C�f' � Water Service line /j3 OF Surface water / O 0 , Driveway, parking/vehicle storage Curtain drain W-4 Wells on adjacent lots M ! f' CPv&,AL w,4rmoa) F. COMMENTS J`r—e G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineers Printed Name _�n:l rF✓L5 15kA, Date Z - 0S HAA Fee $ L150 - eD Waiver Fee E _ Date of Payment as rJ �r Date of Payment Receipt Number %� 3 Receipt Number (Rev. 12/01) btewe M[, ra eTSe .. �6 46. ;" l �� �T l.t. T..• ; _..w•-_ F Y '1 ,. �. ..TTn 'r .. ♦. +. ; '=.� i r , �f-i-mc-kS 4 -' left k +� r 4:. _ n I. AS-BUH.r :I it y.certify that I have surveyed/ the following descrfbed property:• �, r c-77 ��i.,�/ i�iu " ��Lt-�r1-� �Il��i ts S✓.�i Ci � Anchoraaggee Recoiding precinct, Alaska, and that the improve mends sihmerd thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying aettwent thereto encroach on the premkKe In question and tFat here are no roadways," transmission linea or other visible easements on said property: except as Indicated hereon. Dowd at E River, Alaska:' f ": this dsy of �i�j ll•• 19�I�f�,'�. MOSM C. JOHNSON R '-: N L� d' SCALE: -egistered Land Surveyor o. S 1' j• l :. BOX 77.04%, Fagle River., -Alaska 99577 .' Phone (907) 69&2543 f; p; /,54 ion MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH S HUMAN SERVICES (f -s � DIVISION OF ENVIRONMENTAL SERVICES /Jl\ /- od CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER ANO WATER FACILITY 2Ga-alae Appkaeon Onto 1avemb" 9, 1961 1. GENERAL INFORMATION (MUST °E COMPLETED PRIOR TO SUBMITTAL) la) Le4;e1 Description s.xluJe Oct ock aubdhiron, feetron, townsrap, Hoge) Lot 1; Stock 67 Tkuhdukttd Hetakta Subdivlston r / .0callon (ad&ess o, tn,eCticns) 101 Tkundet6lad 0,Uve (b) �.,P,"yOw,,, YeCoutt Telephone Home Bushes, LWbnq Add("f (C) Lend,nq Institution GUAC Telelrone 111,44wng Address_ ATTENTIONt )ulna O'Oett Id) Real Estate Company and ArntJACr SMITE COUPUYAynaf Sennet A d,m P.O. 80% 17169, Egtt Etve>t, Ataaka 99511 Ta.eOhene 691-5507 lel Mae me NAA 10 the fOnowAnn arid." Or rwC-: Iwe v, ;! w0sd tnr MI, 00 Lnl eontacl pe,sal and day pnuna millibar below . See �NoSNEERIYCL63i-t41i J10Si�agL�BLvttladaJil)».+, Glltt_10L _EagLtRlvtt�ALaak<t.49S11_.. otdeted by Lynda B:met 2. TYPE OF RESIDENCE S,ngle-FamiN b Number of Bedrooms. 5 7, WATER SUPPLY hldwldual WM O Communny ❑ Pubte. W Note R Community well system. mv.1'. vew,sten conhrmabon bon the Slate Department of Environmental Conservation attefllnq 10 the legality, and lleluf a. SEWAGE DISPOSAL Unate l) Pubhc O Communny O Hold,nq la, k C Note 11 Community"" sys,em. must have wntten conh,mat�:r mon ma State Departmanl of _m4ronrr,,jaI Confervabon attestm7 to the legshly and atnus. Pape I of 2 AeA ew., ►M haw ENGI' Aa cr Autho tortht from I west,, the da Name Addre Dale 6 DtIHS APPROVAL Approved for i14.a-(!l bedrooms by rC iC1.I" ` fire Approved _.10i__ Dfaapproyed Co"t.onsl THms of Cond,eonal Approval CAUTION Ths M!mklpathy el Anchorage Deparrmeni of Health and Human Services (OHMS) luues Hee11h Aulhorhy Appro W cenifkales based any upon the reoresr!tellons given in parttrph b above by on Independent prcfessf xtN angina, regUlred In the State of Alasse. The DHHS does This at a coW"v to purchasers of homes andthelrle" Irufftulions M order to sanely chain ladral and state Ieo,,lremenls ErrmrNoyees of DHHS do not conduct Inspechot or oma"o data before a cropule N Wusd. The Municipality of AnchMage w not rosponslble for err.m or om6 to In the phyeaelonel engineers yrora. Page 2012 R�rM aro acs MUNICIPALITY OF ANCHORAGE (MM) HEALTH AUTHORITY APPROVAL (HAA) R 1964 CHOUCE EN ry MAOWAIrAt 01vK13olOrI NOV 131987 CHECKLIST•FE2"4744RUA Y 2.►44 -RECEIVED Lpn '�1-7I�� 1:Er-1 F 41P3 . A. WELL DATA WMr Clastr5oanon � .. . K A, B. C. O EG Appoved Lyrl) — Wen Log Present (Y/N) One Compin Yield Total Depth Cased to W 4th of Grouting Static Water Level — Pump Sit At Gong H"ght aDo\e Ground Sanitary Son on Wire (Y/N) — ElectriW A fang M Ci nduil (Y:N) _ Depret on Around WenMad (YM) S.psration Datancak from Weil. To Septic/Holarq Tank on Lot I On Adpuwng Lob s l To Nearest Edge of AOaorptwn Fold on Lot "4 : On Adpne\g Lott To Net'est Putikc Sewer Law To Hearse! Pubkc Sewer ClwoutrlfanhoN TO Nearest "ewer Sew* Lim on Lot _ Water Sampia Collected by : Dale . Were Sample Tett Rtrhlb Comments ?.13,e, B. SEPTICIHOLOIHG TANK DATA Otte Installed 1 - 11' ' Sae _14:2^2No. Of Compantnenb Z _ Standptpa,15il) Air-ttght C&PIld5ll — Foundation 06anout (Y� Depression over Tank (Y(Q1j tj Date Last Pumped _10i fJ9_1-- PumpinWUaintenance Contract on Fite (VRI)— Holding Tank Hqh-Wnn .%Wm (Y?:1 ~ Temporary Hokbog Tank Palm" (Y� Separation Diatahces Mm Sepec^saremg Tank: •t-trylvt7H� F .l ! .. To Water-Suppty Wall ')rVn r'I To BWarq Foundation +..., •1� �.t.. ...,;. To Prepery Line 1t=> tom' To DmPosal Freid "1%�'"t :e •••:• ••wt To Water Mair/Service Line 1 r To Stream. Poral. Lake, or Myon Uralnpe Courts 1 0o r-1•- . Comments.�F-� \iAeeti a\.wN. . i i t • C. ABLORPTION FIELD DATA " Check Permhted Bedroom Rating Against MAA Request •• T -Mr- C4A Snits Rating in A`sorption Strata Type of system Design —G l s 9 Length of Field Date Installed 3 r .� r t•'t�%---�� VAdth of Field Depth of Heid ' Gravel Bed Thkkmrss1— Square Feel of Absorption Area SuM 1 4=N)Tri YtS J.o Test At t • Depression over Field (Y/©_ s!e of LZ Aoe4uacy Results of Last Adequacy Test �'-s�'•15���•�'� '>>R2. Separation DQstance from Absorption Field. Tn Water•Suppfy Well g IA- To Property Ltne 1, r To Building Foundation ...- �' r'+ = To Exis" or Abandoned System on Lot �. s : On Adpininq LOO To Wsler Min/Service Lina 1 c� l's" i To Cutbank (if prasertQ To StreaMPonc/Lake/or Major Drainage Course (^ ' To Driveway, Fark„ ng Area. or Vehicle Store" Area n Comment' 'ft 4+g nJ<+_ fyrt-1 tt 6-sSJr^f� h•?PtEc-�. bio ' PS 1sen,w, •,e.M (�-Y��f StJLE D. LIFT STATION Data Installed • �' Size In Gallon *Pump On' Level at -.— High Water Alarm Level at Tested for Electrical Codes (Y/N) Comme is r. Dimensions Manhok/Acoess (Y/N) ._ 'Pump Off" level M =!-- VOM (Y/N) - v > ,-fr-yo?L. 134. during Adequacy Test Mseb MOA i " Check Permhted Bedroom Rating Against MAA Request •• - Itertil)yI�SIj�R�Relpronned.aeonfamed to HlMO aM NAA gugN,nes In Nkat on it. data ofWa Mspecdon gg,WiTose ttayle alar Laep Red 11e. ate Z� P7 :. : • , Ryle RR—�3T/ Com Parry _MOA Ho. �Z`fJo '•% R 001- 0=1 • /'' • v}7 •. Receipt Na Date of Payment ... Amount' S loe� � el•1• ,AMwuo Page Z of Z 1sen,w, •,e.M ��}—r . ,S -Rr�rr�-•-.rte.. r i IPA, • LEG... VA f DAIE RECEIVED t!4',PECTION APPO'NTME NTS MULTIPLE FAMILY P. "ATEA SUPPLY ❑ DATi.---.IT�1ATF-_..._ X ''--- —.— IN3fCTDn IF-iSFT3 AENKPaIRY tl awl MUNICIPALITY OF ANCIORAGE ^ MI l y,.. ;N.NEV7K %,:.7:CTION DEPARTMENT Of HEALTH S FVNIAOrIMENTALPRGTECF"'. Sh l N•M � A'afw �. Ara MFl • note 61980 �. ENVIRONMENTAL $ANITP TION pVISIGN TPIphO 2644720 (� F r E I V E D 1 ` REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEFCFACI! ITIiS Don, CTIONS. Cn••VM•..i IwN a• WP 1..P[sM.x nplwN N•M rof M Iaw.A. FNM pl•tw N' I IJI UA1 tw ptC. 1 (y(iPF 11 f�r'ONM[II -_ ••�TNE� VAq.INu wGOnE44 C _ _ [9 YLO• SPI'.•"E•�• II, .Ir. w.11•M• A.•.,.• J. euuli]eEI��_- _v� MAlllt ... LY I,S4 S. lE O: A.•INIli1 N, PHONE lU %' ������ MAILING ADONESS ' .r ' I a. Al4LTORIAn NT r _ .11 MAI:ING ADURf S3 __ • LEG... VA f SINGLE FAMILY C MULTIPLE FAMILY P. "ATEA SUPPLY ❑ INDIVIDUAL' X COMMUNITY E] ❑ INCIVIOUAL,ONSITE" ❑ PUELICUTILITY 0'. ❑ Pouf Two ❑ F"e �7 TNIPP ❑ Su ❑ Dow— A 1 . A, � N E L L L4Cm. A "el, log in reRllired for NI "Nit drilled Fm "IN JNoed pior to that date, gi a "NI .Llan u • 00 d auJ�Nle.) =��,� '• PAR ONSITE SYSTEM WAS INSTALLED. :I .r NOTE: THE •OSPECTION FEE MUST ACCOMPANY EACH R: OUCST EE FORE PROCESSING CAN BE INITIATED. IT 0101.. VTFI J 1. TYPE OF RESIDENCE C'j SINGLE FAMILY ❑ MULTIPLE FAMILY 2. WATER SUPPLY Cl INDIVIDUAL 7 COMMUNITY Cl PURLICUTILITY CPRPFtIwR VwiFlwl 2. SEWAGE DISPOSAL SYSTEM UJINDMODUALION SITE [TPUBLIC UTILITY Cr M.FctnR Vwd+M ❑. FPtIt 7W a UHrNe ro TPA S." ---If TMIL nIprR ad* pn tlrm.m•onT TYPE OF TANK I 7TAL ABSORFI e. DISTANCES THIS SIDE FOR OFFICIAL USE ONLY Nt1KB[ R OF ❑ ONE C THRFE G. TWO FOUR PE RMIT NUMPES j HPIN OF WELL PERMIT NUMBER OATIIhSTALLFS &NSTALLIA- SUIURZTINF ---- -__-- MANUFACTpRER- MATERIAL rarRnM1.p ♦ 4w.+Fr Ati P APPADVF11FOR _ SEDRIIOMS ❑ CONDITIONAL AFPROVAL 11.110, mutt KCCX^ -IWWd AtFl E] DISAPPROVED 7/PI04-- MIBI (; FIVE .:.1 OTHER ❑ six 1%