HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 5 LT 2Thunderbird 'D Heights #1 Block 5 Lot 2 #051-581-03 .. Municipality of Anchorage ''' Development Services Department i Buliding Safety Division ' • ' On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page of www.cl.anchorage.ak.tis (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: W o � 4 PID Number. CS 1— 5-V— Q r Don J0�1n50✓► Wastewater System: ❑New ®Upgrade 4r q945q ABSORPTION FIELD O Deep T..h O shah- nwdl I( Bad O m -d 0 oe, Sol Rtkv S Total Depth fom edVnel prle: LEGAL DESCRIPTION • Gpome Block r` Lao aWJNNon fl YM ! r * Depth b P" bottom fan "'a' •� Fl. epth roNn pipe: G.G,"EW 0, 5FL Tw^Nwp" Rrpe: Serliere FA edMd Naw rp'c.el pedes I +r,lle " Lery� Ft. FI. Well: ❑ New ❑ Upgrade r„�.epp� I5 Fl. HunDeLpl lYwe: 3 Dlelend MlWeen xnef: Fr pr�o�� (Pdve TaW Dope[ b. FI. F11 Tobi ebamp o NOW 5�o e FI Pq M O,tia. J H *r,) �- 1 LI1G q D~ Ne Orlbd: SWC W«er LwM: (iT `// sea D«. YWNIed 1 FL G eft YHId Pumps«N: w^a TANK GPM Fl. Fl SEPARATION DISTANCES []Septic 0 Homing k9S.T.E.P. 13 Other. To Septic Absorption U Holding Pubacmdcat I""" amaaf neho� Telnk ew.aN aso Gk From Tank Field Sla6on '+ Tank Sewerllne a 5 `+ S I a w cpmprpn.w,: Wee po' I OD+ 100 ee e t LIFT STATION sudace WNr WOOo '004- ' l.atfn if Lf 5' ��1' 1aSOGN. <7oa ge Ta ri k f�nc�' Found«on 8, I �', �, •Pampa N:� In 'PvT Nr IevNN 30.1Hqt. wlr Nrm T� Curtain Bain _ Alali e ,NO --' pM q a mom ®SI Q 514H EWI," Neper , pada, br r e TC" J--r%e Rem-.e 'rR1ss-n,zEo Lth i+r--I¢�e — BENCH MARK laaoon red Dewabac t , �o CJ St 10 !0 Nelet CLIC 1-.d-r-tA.4-c M ENveuon: 3 1-Arh.. -1 L S 30 ror4=l N,s t7 r ;q - t 100 F` 3//c 01 tial,'i £xrtrr a stars T•t,K IOM/eIt. A s/ *s• „0;� MM........ N. cif',,. . ti'•y; �Jg,.-oF.vetA 5 8 5 ENGINEERING 17034 Eagle River Loop Road, No,?" 1 - l a; -0oaa 66 Inspections performed by: ales: _ ed 2 .0R, OBERT C. COfiWrAYtFj Development Services Department Approval 0-% CE•8801y Reviewed and approved by: !J erC Date: raev PERMIT No. SW020034 PACE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEAUH 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 LOT 2 BLOCK 5, THUNDERBIRD HEIGHTS #1 P.I.D. NO. 051-581-03 10 � 2 APPROX. L WATER LINE W� x LOT 3 oo-4 �0 Z LA rnO0 Irl B 4 FCO N TSM A STI NEW 1250 CALLON S.T.E.P. TANK LOT 1 NT2 MTI; - W m ABANDONED ~SYSTEM W _ SCAL', 1. 40' r, t r + � %•, »........... ` ROBERT C. COWAN z i I��CJ'.�LCE • 6801 _f •�Z\1�Z_� PERMIT NO. SW020034 PACE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HELTH 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 LOT 2 BLOCK 5, THUNDERBIRD HEIGHTS #1 P.I.D. NO. 051-581-03 FINAL GRADE 1 ST2 100.2III' MH 95.5'/ NEW 1250 GALLON S.T.E.P. SYSTEM 99.7' MT1 96.2' A 8 STI 33.5 20.5 ST2 31.5 26.5 MH 31.5 28.0 MT1 24.0 47.0 MT2 49.5 84.0 MT2 FINAL GRADE 95.7' 95.7' 95.3' A WATER FOUND ® 91.2' 87.2' B.O.H. 99.5' 2" INSULATION N. T. S. 07/17/2002 FED 10:30 FAX 907 522 3995 RAVEN ELECTRIC INC rZ001/001 avers electric inc July 17, 2002 ATTN: Tammie and others Concerned RE: Lift Station Electrical Wiring This letter is to confirm that the electrical work pormed by Raven Electric Inc. on the sewage lift station at Lot 2 Block 5 Thunderbird subdivision for Four Seasons Construction was installed to the latest N.E.C. (national electrical code). The work performed was not permitted or inspected by any A.H.J. (authority having jurisdiction) due to being out of the Municipality of Anchorage. The journeyman electrician who performed the work is licensed by the State of Alaska as a journeyman electrician and the installation of the electrical was installed to the highest of trade standards. If you have any further questions regarding the above matter please feel free to call me at Raven's Anchorage office at 349-9668. Sincerely Arthur Stemcn Electrical Estimator A&x 8015 Schoon Street Anchorage, Alaska 99518 Phone: 907-349-9668 Fax: 907-522-3995 Emall: ravenelectric@ravenelectricinacom MUNICIPALITY OF ANCHORAGE 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 yd J•`S��c'/� L/E /CLQ /.a,) �%2/aa• leAVI -7/a /oma Tp Date Issued: Mar 13, 2002 Expiration Date: Mar 13, 2003 Permit Number: SW020034 Parcel ID: 051-581-03 Legal Description: THUNDERBIRD HEIGHTS #1 BLK 5 LT 2 ' Design Engineer: 0003 S & S Engineering Site Address: 024832 THUNDERBIRD DR Owner Name: Donna Johnson Lot Size: 28254 SQ. FT. Owner Address: 24832 THUNDERBIRD DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567-5132 This permit is for the construction of., ov 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. S-/22102 1N TR, If UP re 7 r ' ow S/2%2 E'V QRnv�ia6 P0re"I of SYSTEM GP TO 3 � fleVM 3.j_0 a IAPIA�G A ticr SraTiay. Received By: Date: 3- 20 '10 y Issued By: Date: 3 /S OZ 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.enchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6,51-591 -03 Permit Number SW 02003¢ Property owner(s) T')o na Ir ah ns an Day phone Mailing address (1) 'Z S Z I ARIA -LA 51 R.LLt Mailing address (2) W a51\\& A\ Zip Code 9 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 213 ,, ZV*:I- Cres q.Ft. 02$ .qsy THIS APPLICATION IS FOR: Number of Bedrooms _7, 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. Z (Signature of property owner or authorized agent) S & S ENGINEERING 17034 Eagle River Loop Road No. OD Permit Fees:Waiver Fees: Date of Payment: -�'-%- b a Date of Payment: Receipt Number: gg I _ Receipt Number. (Rev. 12100) 11gmeeallIG ROBERT C. COWAN, P.E. 7 X11 7 CMLENGINEERS 9. NAW (907)694-2979 FAX (907) 694-1211 MARcq S 12002 !WALTHALITI-Ko"N ArPn01N$ MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWEns WATEn Anchorage, AK. 99519 LAINUTENSIONS REFERENCE: Lot 2, Block 5, Thunderbird Heights S/D sEwEn S WATEn INSPECTION It is requested that you issue a permit to upgrade a septic system to serve the existing three bedroom dwelling on the referenced property. ENGINEERINGs1UDIES A test hole was excavated and a percolation test was performed. The approximate location ANOnEPOn1S of the test hole is located on the attached site plan. At the time of excavation on 2/YY/c •s /t N0 4r_riZ ChVeA4� n4V1 oe ce4vm4w„4rst nI ,>oR.•4 7'Kf- "arta A-tvrt h,AJ A7 91'4 F4ttr 044P. WELLINSPECTION We do not anticipate any adverse effects on neighboring wells, septic systems, reserve a FLOW TEST areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITE "S If you require additional information, please contact us. W"DESIGN Sincerely,? sot TEST `Owan P.E. - RCCTJhm PERCOLATION Enclosure TEST STTILICTLNIALA MECHANICAL INSPECTIONS CNSITE WASIEWATEn CISPOSALSYSiEM DESIGN 17034 NORTH EAGLE nrVER LOOP • SUITE 204 • EAGLE nrvEn, ALASKA 99577 SYSTEM DESIGN UPGRADE 1" = 50' SCAT c [• Tr'jM c K �• 0 mm •o'� a 1 l kv OHO CtiZ 1u�g �.Skv � a �ntlo rAiZO C: �. 0-1 IA D � ss.mm � Oi;01 v' m an rnm> z'a I m Ca9 W O O y\O (V Q En tTj myno 4A:) r•ry O n>w + W x5 �O m 9 C o 6 p I o C: ` a � T �• tlM3Nti� n U� %oto W C)N,L5�X3 .c 'O � x•••z En � W O O �.K.•yys (^ f n Honor \til Oq �Lr ry,r •li i Z t•` Ry O OEan z 0 o `J y/*ym0 `� •h4� \>�N �yc I I •1• �^ 1 nyKm CZm I C �N�yy = I %%yy�ySm tai n �m�C•1 f'y> 'Om%.•L Gym Oym Kmm `-; yi=n 9z i _ oo KZw o OD�zO Cc+l_z,z Pa 0011 OM =raj OOy NN�O // �Z DD .r�VIN C r.� / 2m OD�3. u O w / zm mr w oAtn II sm= G / a.,omo��..e... ;r Dom.-•Op / rj OzmoIt Z 1^000n !n .Z1y / xALA .'.'1ti•,.+"�•- '•.j/,tal ry ll yy "• O coZ F O •�rK-N t Art +o C) 0'o ?.l� / / / SITE PLAN DETAIL I N.T.S. W .PEnw d o-©r� C IIXci �' noncn z Q wno N A\ -Eno W �i N } O n rJ A � n Y Z I N O I cz N 0 .L :3 n o N .A CI Performed For. t Legal Description: L Depth NMw o.• 3- 4- 5- 6- 7- 8- 9- .0 4- 5- 6-76 9.0 13- 14- 15- 16- 17- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 wwwcf. anchorage. ak.us (907)343.7904 Soils Log - Percolation Test Q p -am o VW C: -?- ROEERT C. COWAN e~ C°-5301 /ZZ Date Performed: d Township, Range, Section: WAS GROUND WATER ENCOUNTERED? / 5 H? O IF YES, AT WHAT DEPTy L Depth to Water Aller P !OO Moniloring7 ii e � Dale:3 5 PERCOLATION RATE i.y' (n IesAnm) PERC HOLE DIA6IETER C-2� �- TEST RUN BET WEEN • 5 FT AND FT COMMENTS ��i rry O%o' �iV M/ �I �%Es'S%�S D O -JA - r. PERFORMEDBY:CERTIFYPERFORMED N ACCO ANCE WITH ALLSTATE AND MUNICIPAL S IN� N THIS DATE• DATEIS TE3T -r/c Z _�WM�Eafflrlm _-�z 1 EMIR PERCOLATION RATE i.y' (n IesAnm) PERC HOLE DIA6IETER C-2� �- TEST RUN BET WEEN • 5 FT AND FT COMMENTS ��i rry O%o' �iV M/ �I �%Es'S%�S D O -JA - r. PERFORMEDBY:CERTIFYPERFORMED N ACCO ANCE WITH ALLSTATE AND MUNICIPAL S IN� N THIS DATE• DATEIS TE3T -r/c Z S& nG ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907)694-2979 FAX(907)694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES HEkTHAUfHORRV and APPACNALS MATERIAL SPECIFICATIONS SEWERSWATER REFERENCE: Lot 2, Block S, Thunderbird Heights Subdivision MNNDDENSK" June S, 2002 GENERAL: SEWERS WATER INSPECTION 1. The scope of this project includes the installation of a 1250 gallon wastewater septic tank & lift station, with an absorption bed to serve the existing three bedroom residence located on the referenced property. ENGINEERNGSTUM ANOREPORTS 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. WELLNSPECTION + FLOW TEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible SDEPIANS for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. ROAD DESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their SGILTEST own systems must also receive prior approval from the Municipal Health Department. TE TEsST SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. ST IICTURAI.B WCHA rA INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONSITE WASTEWATER DGPOSALSTSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 Pege 2 Lot 2. Block S. Thunderbird Hts SID June Q 2002 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement. 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel depth below the distribution pipes shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. 4. The distribution piping must be as shown on the design. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Silt barrier material must be installed between the final gravel layer and the native soil backfill, unless insulation is used, then the silt barrier should be installed over the insulation. Ensure the silt barrier covers the entire gravel surface before placing backfill. 6. Monitor tubes shall be of four (4) inch diameter, installed at the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. Pege J Lot 2. Block S. Thunderbird Hts SID June S. 2002 MINIMUM MATERIAL SPECIFICATIONS: 2. 3 4. 5. 7. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of PiDc Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mimfi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever specifications applies. Pape 4 Lot; Block S. Thunderbird His SID June S. 2001 INSPECTION'S: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to cavy out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage Development Services Department • Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet Criteria: r I nt • r It -L. .•,t • rrs i-1 1M, �4 A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Peril#: SW020034 Points: Waiver is Granted: x Waiver is not Granted: List Conditions or Reasons for above: S fZE EA41*f e e '1 A? 7Ii9• CMCQ �rTEn at TusMC/ c19.r'PA/ DpT,dD 6//ofaZ Date: 6 /2 02 By: ZWA/ Name of Reviewer ............................................................................... S& ROBERT C. COWAN, P.E. ROBERTA. SHAFER PE. CMLENGINEERS (907)694.2979 FAX(907)694-1211 June 10, 2002 HEALTHAUTHORRr MUNICIPALITY OF ANCHORAGE APPROVALS Development Services Department P.O. Box 196650 Anchorage, Alaska 99519 SEWER& WATER MAINEI(TENSIONS REFERENCE: Lot 2, Block 5, Thunderbird Heights Subdivision Request you grant the following waiver for the existing three bedroom house on the referenced property: a waiver for the separation distance from the proposed SEWER&WATER INSPECTION bed and the west lot line of the above referenced property at one foot. The mitigating factors involved which support the issuance of the waiver is as follows: ENGINEERINOSTLVES ANOREPOARS 1. The existing drainfield trenches are saturated and an alternate system needs to be installed for the existing three bedroom house. 2. Soils to the east have a slower percolation rate & would require installation WELLINSPECTION & PLOW TEST of a larger absorption bed. 3. Slight changes in elevation prevent placement to the east of the existing system without substantial sand material for leveling. SITE PLANS We therefore recommend a waiver for the separation distance between the proposed bed and the west lot line at 3 feet. ROADCESIGN We do not anticipate any adverse effects on the neighboring properties by the granting of this waiver. SMTEST If you have any questions, please contact us. Sincerely, PERCOLATION TEST -- /.// 1� 2_ / Robert C. Cowan, P.E. RCC/jhm STRLICRIAL& KCNANICAL WSPECTIONS ON SITE WASTEWATER DISPOSALSISTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUFTE 204 • EAGLE RIVER ALASKA 99577 _ Municipality of Anchorage e °gym 1r George P. li'uerclt, Mayor Bttilding SafctY Di-*7sion P.O. Box 19676750 • 4700 S. Bragaaa Street Anchorage, Kaska 99519.67650 • (907) :343•&301 h tt p://e�a�e.ci.undinrn4c.uk. us 6/12/2002 Robert C. Cowan, PE S & S Engineering 17034 North Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Thunderbird Heights #1 Subdivision Block 5 Lot 2 Waiver Request #WR020024 Parcel ID 4051-581-03 Construction Permit Number SW020034 Dear Mr. Cowan: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, � Z � �- wo— Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program A) J L 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 SUBMITTAL COMMENT SHEET To: 5 h 5 ENGINEERING Legal description: THUNDERBIRD HEIGHTS #1 SUBDIVISION BLOCK 5 LOT 2 The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on — ❑ Calculation error in design. — ❑ Additional soils information needed. ® Water monitoring results inadequate. NEED A 6 FEET SEPARATION TO WATER TABLE MONITORED IN MARCH ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. ❑ Incomplete; missing _ ❑ Incomplete; missing _ ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: DAN Date: 3/11/02 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK I \ i MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION � I 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME nPHONE /`•a�''U- s 77 ,� - EW ❑UPGRADE MAILING ADDRESS161 LEG Le)7- PTION 6 r LOCATI NO. OF ROOMS D Y DISTANCE TO: We Absorption area Dwelling/� PEHMI O. W< Manufacturer , ✓L Materia( No. of partments W Liq, ca y in gallons IF HOMEMADE: Inside length Width Liquid depth 6 Y Jt7Z DISTANCE TO: Well Dwelling PERMIT NO. _? f Manufacturer Material Liquid capacity in gallons O W = DISTANCE TO: Well Fountlation I Nearest lot line �js / 0 PERMIT N 6, J W 2 f Z W No, of lines Length of e,ch line• Total I i pi lines O Trench width Inches Distance be p lines , ' 't F... p / Top of the to finish grade i / Material beneath rile inches Total elfec�}t1�/yy�$��absorwion area C;C —�— W Length Width Depth PERMIT NO. Q H Wd Type of crib Crib diameter Crib depth Total effective absorption area y 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 PIPE MATERIALS 3 U SOIL TEST RATING INSTALLER REMARKS lit APPH DATE LEGAL , 72-013 (Rev. 3178) L�/ J, / ' PERMIT'NO. 1 .. , . . t•7t_lr4I C I F:=FtL- I TV' ID F= Fi"CHCRRr E DEPARTMENT►r+F HEALTH AND EFJVIFOFJMErITAL/-" TECTION 825 STREET, ANCHORAGE, AK. 5�.:.. 254-4720 '' �-1t�1—SITE SEIJER PEF:t•7I T ( 811105 ) APPLICANT SADLER CONST CO LOCATION THUNDERBIRD HTS LEGAL L:> 65 THUNDERBIRD HTS a:J�Pn� I0/Zlo 161 S KLEVIN L03d 110 -A 9-9 277-4543C� LOT SIZE 8500 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 1� LEt�FCTH= 1E• CRFiti� EL DEPTH= 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 (IPJ 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 (IPJ FEET). i REC?l_� I RECD SEPTIC Ttat-a FC S I LE= 2EICE+C�v GF:ILLrJt-45 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE { NUMBER OF P.ESIDENCES THAT THE WELL I -JILL SERVE. C ^ 7 I MSPECT I Ot-aS fiRE REC LI I RECD -- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION APJD APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SE14AGE 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. i OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES C•ECEME"ER 2�:1r 1..ErlC1 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 1M H tiUKUHfVL.t wi i M IMM wvcil. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: ---------------------------------------- APPLICANT SADLER CONST CO ISSUED B ----- � ----DATE_ I � _ I j_g I __ V4. 0 -� r i►_rr, �:��'t-• r it L -r•a rzF ► irar_:Tw»t- �,�_, or-por ary i or wo- rH t;tlo srry I, c��rr 1<_rl rnL Pr o rer: r / �JN 8Z*; •L • _. Tr -t: T, t,t8'.I40Ri7t: . t'It _ y..gt, t Fviz. t r no. < :aitur; ) )-vrttcnur sFibu:i coirsr co ini .; M -!-:V1" L!x.p r r i]N !r! IIJti7EF:8 I Rn Hr*:; LEl3 7_ t g S 5 THUNW..Rtt tRD HN.: U] r S I F t�SL]0 mi)IJAh'F �c� ) 1}F _ov Hfr;Or.'?Tton : rsrL•M I5. rREtA,H i•tfl.:Iwri tviri £R iv c:--opLoi•r. s SOIL Pnrino cso Fre,eR)- ;n TI -C_ t: Fi.tJ I;aEO[ �7F rl '��) [1. H8 _�Oi tP r i Oti s -es ma I r' • L'rt--=;"'t"1-i� •t.:. I__L_:Ji;"1'1-i- ?_r ':3f•`f=t'•:•r--'r._- 1.:.�1=•'t'I.I�_ r ', W. L0113TH D UT.71IS I ON t t TW. Le -.Nu rN i [ N t'L" m 4t P•#' TF.F KH OF ORA U F MLD. '= n oi DEPTH rJF A TFFtX I t OR F t f I5 D c c TMP 8c TI•F=FN rH _ •4U3.•Ft•MX IX-- rl-7 riRUUtIG ANu I'M rJOTTQM rX�' Ttfi ",o9 Fir[UN <IN tl%0. .rti Nn 5 -Er 1•tIorH FOR mar,'—s TFF. MIPTH I5 TIIr: MINENlitt C�:`•rH iX: i{<RIVF-7_ e+ rDTrr'N TIS OUrfiILL FIF 1 sno 1'}i` t]orrom irm ,re:=r) r- t_r�r � I: [?Ft-� ::t _S=`7 X t_ Tl�r:i}': _: [ :--t= i :1.�=.r>•=et_t t3t'1l_f__t_17�i':= F:?RMtr Wl" i-M,ANr H.,r; 'rmi > ',SljW_Ib[ [rY ru [tiruRN rHtS cra-,m. mair olipan unrRi-ArioN crm -crmrr_ or, HttY 1'tiy_t.5 Au1ra� Ilr ru rmrl . 'R11F ?.TY IiND THF__ I tpJlq�t:� ir, v��tGErM S rliAT r!!E !40-1- r •!0_L= rsi p t'r cU_ I NG 6F ►i t rl lour I!npEc r i lim Hmil w,r':l vii- cY r: i l : Cr>>S�QTPI tii HILI_ P.F •3u0.r%cr rO ?Ri7 :c-uriort (III NIMuti Gt;iHtkx e* rbCcTi A I.110-11- Ivi£• r111Y t)n-•itrr .. smm Is tOt+ r=£F r FQR fi OjR tsa rO 2170 FF? ---T nn ow rt P! t'_�. c. l.", l'> .►ita t t>'3 ; :racNCMt.tr+ [i[sraato Ix�]n H Yi<tw:;l> ltZr_ TO A PPIV.ITE 50-P:R UM. is z—o FsEr Arit..- TO n � I)MURIETY t5 rs ►= *:r. R.,-QUIRP-1, 1PS MAY tiPPI-7. 'Ftctrtcttttnrt. N10 :�]rr;rN!N:rti17irtr,�v�rtrrs sig owiti-ABCs: ro PROF:=R tN�rtll_Ltlrtnu f-•E_F-:rl r T e=: tit~ r r-: F=. n, = r_ F r•r tt_s� :: s_.. y•: :L I ll PTLFY THAT t: t Fir, �Httrt_wk IJirH rti:: ro-.,]Uthet'1airS FI]R oU-;trF _i=t'►5f.'S IIND l.tct_I_� r{j :=.s_r For?rti eY rtir ImJrjIctpt-p_IrY l� IVA.H'lR'H+;F I !!ILL IMP9.t!_ iri; s"=r: rt IN t9�_r iJxi�ritr�• all rH reit ojM_•;. a : [ I!ti!�CFti TNri4 THfI r THF. oN - _: I r� rFJ� spiv Pooi t t ra - t-�ra.A}trg'_r•� tt r IF ri � ''• >«._3rc»=:t>'� t� ..rinn.�f::o ru uNx.tto� rm;R� rt4;ti � A:'v;���r•r�. t .. •arC�hk a: - - -- --------- t _I':fiNY- 5fl ER •:�]ItSr c0 . -~rF Y4. t4t_fn y:VNIGIPACITY OF.ANC: ORAGE .�. ' rPERcoLAnDN } DEPARTh7EN. dFHEALTH.'A%DE%VIFONmENTALPh_ LOTION_ � .,;TEST .a Pouch.6650; And\ore9e, Alma 95502 '2762711-- SOILS'LIOG - PERCOLATION TEST .(..Q /•�...:..lY lA / %112D -DATE PERFORMED: PERFORMED FOR: 7/�(t�^�'�'� r n� - � —7 • IiGAt"DESCRIPTION: ^�� �t/t �< I �1 V(1�P� �t(`(n �PICIRA� - --- •. rLOPE SITE PLAN _ DEPTH � ,'a _ • - (FEET? j 7-77 .. .. ^ �,. �3 10 F. 4 i - SR�"���p�� 7 LCW� �• It i9 10 ; WAS GROUNb WATER• N �._. _. L 1 �,••. • ..ENCOUNTERED?-.' ,O 12 ' _ E r " IF YES, AT WHAT' DEPTH? '�13 15 - Ct 16 Jtc•c�j _. 08 .. Grine ..", Not - . I Depth to . ,. Net x Reeding Dole '.Tints,-. Time Water, . ;Drop o 14 ' c' �. vC" ,T►�� ,t �� P •• a10M.3 Y 3.d:•h • � U . 201hONAeN iMlih %• I �• t.. 22db.-E �• PERCOLATION RATE v•�•.ZV, h0lrr ..•••� � TEST RUN DEIVAEN FT ANj� FT COMME !RFOoieC 'V' ^ , ^^ �Ir� •i�• CER':FIED S G 66, EKe�o�. \v 0 Iqt9 i D = " 31 %I-AXA,� cl, h 7 e J pct ,etnu - iD L'�l :i..' rac-L , -L' 5 c be has. zo' over, Municipality of Anchorage �� ✓� • Development Services Department Building Safety Division .. -� On -Site Water 8 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. 52 L US __ COSA# (7$0,83 1. GENERAL INFORMATION Expiration Date: — y Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THUNDERBIRD HEIGHTS #19 BLOCK 5 LOT 2 24832 THUNDERBIRD DRIVE 'CHUGIAK AK 99567 MARK KLUCKMAN Day phone 24832 THUNDERBIRD DRIVE *CHUGIAK, AK 99567 Day phone 854-2164 CONNIE HEYWORTH W/COLDWELL BANKER Day phone 240-0406 3000 CENTRE STREET 101 * ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site N 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 On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION SY 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 riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG. LLD. attempted to provide a thorough, conscientious engineering anaWs of the system in accordance with ADEC and MOA DSD Guidelines & Regulations The reported results described Me performance of the system under Me conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during Ne year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden detects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system wilt continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSDSIGNATURE y Approved for _ 3 bedrooms. Disapproved. Date 01 *?"00 .......... 9S;�p0 49 yA •• ......... •ess.: A �• V '• E-7953 Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Othar ON-SITE WATER AND WASTEWATER : PROGRAM Original Certificate Date: 9 —.2 /" 0 5 Municipality of Anchorage Development Services Department. Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: THUNDERBIRD HEIGHTS #1; BLOCK 5, LOT 2 Parcel ID: Our/ —0 3 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform _L PUBLIC WATER If A, B, or C provide PWSID# _ Well Log (Y/N) Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG colonies/100 ml. ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate mg./L. Date of sample: Wires property protected Cas=CTION n AT 1 in. Other bacteria colonies/100 ml. Collected by: Tank Type/Material SEPTIC/STEEL Date Installed 6/12/02 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N' YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 6/A/2008 pumper JR'S PUMPING C. ABSORPTION FIELD DATA ]-BELOW EXISTING GUD7E Date installed 6/12/02 Soil rating (g.p.dMo /bd 0.8 System type BED Length 38 ft. Width 15 A. Gravel below pipe 0.5 ft. Total depth •4.08 ft. Eft. absorption area 570 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/8/08 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added 500 gal. New depth 7 In. Elapsed Time: 210 min. Final fluid depth 5 In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump oft" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line areas PUBLIC WATER On adjacent lots On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 'S' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *WAIVER G. ENGINEER'S CERTIFICATION ogL v!.. I certify that I have determined through field inspections and- Ye u� review of Municipal records that the above systems are in 0"""" """" "' 0 conformance with MOA COSA guidelines in effect on this date. O p .J a A. Garne s- Engineer's Printed Name JEFFREY A. GARNESS Q� r CE 953 `Fo0 4 1 Date �I 1 1) �Dp.ed�t+I o o\F �o �oreeslo� �040000�0 COSA Fee S Date of Payment 4; ?),009 Receipt Number a�3 (Rev. 11/05) Waiver Fee $ Date of Receipt Number 08/14/2008 14:52 9073449821 JRS SEPTIC Ms Pumping Po Box 773415 Eagle River, AK 995'1 (907)694.6454 Billln Infcrmatlon_� Mark Kluckman Job Description: 12508 24832 Thunderbird Drive P.O. Number. Terms: Net 30 Chuglak, AK 99587 salesrep: Karlia (907)1388.1 S70 Map Book: Job Site In(orrrlBhOn Cross Streets: Thunrinrhlyd Drive Mark Job Comments: 24832 Thunderbird Drive Chuglak, AK 99567 (907) 888.1570 PAGE 01 Service Agreement Number. 026120 Order Date: 03 -Jun -2008 Service Date: 10 -Jun -2008 12:00 Technician: Butch Tax %: 0 Job Type: Repeat Map Grld' 07 Last Sery 003/0612008' 12508 pumped & checked tank = clean Additional Location Comments Diagram: a•tdtaaramsN9299 b" Cedar house w/ AI's above garage door. Inside dog. Pipes In back - Back up on gravel pad easter access to tank 01Jh 4)Teek Grovel *,a Gallons Planned: 1250 Gal. Actual: Hose Length: 1 Double Tank: ❑ Pump System: Baffles Inlet: Baffles Outlet: ❑ Service Type Qty Price Each Tax? Extension $0.00 Septic Service 15K 1 $0.00 No Fuel Surcharge 1 $0.00 No $0.00 Actual NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charges: Actual Charges: Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT. Signature and Title or Customer Representative Date Acceptad by JRs Pumping Date Accepted For your added convenience we accept; American Express, Dlcover, visa and Master Card payments over the phone. After 30 Days accountw19 be turned overt* COLLECTIONS. $30.00 For NSF Checks Returned. Municipality of Anchorage Development Services Department Building Safety Division Onsite 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. 051-581-03 COSA# ©uom 1. GENERAL INFORMATION Expiration Date: 4 - .3 - o 7 Complete legal description Lot 2; Block 5; Thunderbird Heights Subdivision ill Location (site address) 24832 Thunderbird Dr. Chupiak, AK 99567 Current Propertyowner(s) Robert Savage Mailing address Lending agency Mailing address Real Estate Agent Mailing Address same Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 14_ 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System a Day phone 688-2485 Day phone Day phone 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 Onsite 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 We 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. NameofFirm S & S Engineering Phone694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name R8/316J C . C01-Mej Date 31 &-3 /D C E OF r ?s i ROBERT C. COWAN 5. DSD SIGNATURE �lf`gti4 CE -8801 Approved for 3 bedrooms. ++t�`-' . „...•,; Disapproved. 1iit�aii-a,��' Conditional approval for bedrooms, with the following stipulations: '• IWStTE WATER ANn Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other BY `� Original Certificate Date: Y-2-060 (Ray.,,M5) Municipality of Anchorage • Development Services Department Building Safety Division ` On -Site Water & 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 CHECKLIST A 1 Legal Description: (•.a7 arcel ID: OSI- SSI -d� A. WELL DATA"j�60C. to;t q Well type _ Date completed _ Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform mgA If A. B, or C provide PWSID # _ Sanitary seal (Y/N) — Cased to ft. FROM WELL LOG g.p.m. mL Nitrate mg/L Well Log (Y/N) Wires properly protecled-MN) Casing above ground) in. ft. Other bacteria colonies/100 mL Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T, Uj Date installed Tank size (7-50 gal. Number of Compartments 2 Cleanout.&) �r Foundation cleanLl!T>) ' ES Depression over tank (Yg) 1� High water alarm4BW) �E S Date of pumping O(7 Pumper 71V S �U WtP 10Ct C. ABSORPTION FIELD DATA Date installed �, 11 Z Soil rating p.d. r ft2/bdrm) J2_,_!b System type � t � Length gds Width ! S ft. Gravel below pipe 019 ft. 1 Total depth ft. Eff. absorption area 5704t` Monitoring tube ES Depression over field -11-0 Date of adequacy test I U O Results(jPas ail) 6S For '5 bedrooms Fluid depth in absorption field before test OCL in. Water added_gsNew depth gL" in. �� uSO4- d. Elapsed Time: +°min. Final fluid depth � in. Absorption rate >= 9•P• Any rejuvenation treatment (past 12 mo.) ` (SA type) N If yes, give date D. UFT STATION Date installed Size in gallons l 2 -GO Manhole/Accesso) y(r S 'Pump on'levelat in. 'Pump ofr level at 32' in. High water alarm level at 41(� in. Datum 7.� ITo VVI Cycles tested -'45 Meets alarm & circuit requirements? \/F--, E. SEPARATION DISTANCES PL)RC.ic� LA3 14-T6(? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Uft station on lot Absorption field on lot Public sewer main Sewer /septic service On adjacent lots On Public sewer manhole/cleanout Holding tank Anima ment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S I+ Property line S I+ Absorption field S '4 - Water fWater main `tial F Water service line 1014" Surface water 100 / Wells on adjacent lots 26)0 4 - SEPARATION DISTANCE FRO.IM��AWRPTION FIELD ON LOT TO: Property line � 1 711Building foundation / Q + Water main 7S /+ Water Service line 16 + Surface water (6(q 1+ Driveway. parking/vehide storage / 6 F Curtain drain Ll X- Wells on adjacent lots 7-4CXD I -+-- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field ins All _ 1; f, % ` review of Municipal records that the above systems in r conformance with MOA COSH guidelines in effect on this date. .0 .01 R06ER1t: MNA f Engineer s Printed Name E�� �• l `%�'� CE-s6of Date_ __ _';� C r Z\� •iL��. yy1 COSA Fee $ 4 '� Date of Payment Receipt Number i!D�it3 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number this -f5 _.. day U:_ !�t V C. e> - ROBERT c. jo1INSON i'I 0 G�- - SCALE: -Registered Land Surveyor No. 81;Y -LS -61 Box 451, Fagle River, Alaska . - - - Phone. (DCG) C94-2543 - .. 15 ao P, cN �' `t . • - _ _ ! _ .. - ' ry [fin. AS -BUILT . I hereby certify that I have surveyed the following described .property: Anchorage Recording Precinct, and that the Improve-., ments situated thereon are within the property lines and do not overlap or encroach on the propertv lying adjacent there- '+ to,'that no improvements on property lying adjacent .thereto encroach an the premises in question and that there -are no - .. roadways, traa.misaion lines or other visible easements on said property except as Indicated hereon. -•�_� Dated at Eagle River, Alaska this -f5 _.. day U:_ !�t V C. e> - ROBERT c. jo1INSON i'I 0 G�- - SCALE: -Registered Land Surveyor No. 81;Y -LS -61 Box 451, Fagle River, Alaska . - - - Phone. (DCG) C94-2543 - .. \ Municipality of Anchorage • ---1 Development Service's be' jiattment 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 —581 —03 yt(eat� HAA# NA 0a00-73 Expiration Date: %- 2, O Z _ GENE( AL INFORMATION Complete legal description Lot 2; Block '5; Thunderbird Heights Subdivision f/1 Location (site address or directions) 24832 Thunderbird Dr. Current Property owner(s). Dona Johnson Day phone 862-6417 j. 'Mailingaddress 2389 Althea St. Wasilla, AK 99654 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, NAA will be held by DSD forpickup. �Izr � /;2 -,L/ o 2 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System :0 Individual On-site U 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 5 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Cerliricales are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION by ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Dale 7 A 9 /c /Zta.,i sr VNCJnd• 714...► L h/%N244 SCCA r r c s ysr't, 144,S 1344... vP(,A4.oF�j-�+r,+............:-rs.,rll �N jf '1 GINEE '''.ts i �..,rN A..,r ti .Swo loo 3y fz i4.tNAAD 5. DSD SIGNATURE \10e\ ROBERT C COWAN Q, CE 8801 Approved Disapproved. ? bedrooms; Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other ON-SITE • ��, VGAiLKAND m WAST WATER PROGRAM �i w e By: Original Certificate Date:40 fpw Ulm) Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 47W South Bragaw St. P.O. Box 198650 Anchorage, AK 99519.8650 www.ci.anchorege.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT '2 QWcoc S rNa�oj4l;Ao yLI6Nrj-#/Parcel ID: OSI -Sg/-o3 A. WELL DATA P U bL�, c wowr 4 R Well type _ If A, 8, or C provide PWSID t Well Log Date completed _ Total depth R. Data of test Static water level Well production WATER SAMPLE Coliform mg.A. Sanitary seal (YIN)_ Cased to ft. FROM WELL LOG n g.p.m. TS: es/100 ml. Nitrate mg.A. WUes pWaN protected (YM) height (above ground) in. AT INSPECTION Other bacteria Date of sample: _ Collected by: a colonies/100 ml. B. SEPTIC/HOLDING TANK DATA Tank Type(Materfal ' M P/ S 4 t L- Date installed Tank site U} r0 gat, Number of Compartments z Cleanouts &I Y¢ s Foundation cleanout ©N) -Lf JJ Depression over tank (Y,0 N 0 High water alarm &l) VE s Date of pumping Pumper C. ABSORPTION FIELD DATA Date instaned 6 r 1 o z Soil ratingg..d rft'Axirm) 0' System type g E D Length 39 ft. Width / S ft. Gravel below pipe �•s" ft. Total depth _L fL Eft. absorption area r70 fe Monitoring tubeYFs Depression over field '00 Date of adequacy test - pit Results (Pass/Fai For -3— bedrooms Fluid depth in absorption field before test Water added_ gal. New depth_ In. Elapsed Tune: _ min. fluid depth _ in. Absorption rate >- g.p.d. Any rejuvenation nt (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed l z I -L Size in gallons ( > r0 Manhole/Access JqN) YE J 'Pump on' level at _�J in. -Pump of r level at 7 a in. High water alarm level at in. Datum (3oT rom Cycles tested ?- Meets alarm & circuit requirements? *Yf J E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot Absorption field on lot Public sewer main Sewer On adjacent lots On Public sewer manhole%ieanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 8 Property line "t Absorption fieldfro Water main fl) 4- Water service line %D 4' Surface water % a 0 "-A- Wells t Wells on adjacent lots N /A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line r V4 O 06AV)Building foundation ) 3 Water main Water Service line I b + Surface water. 0 0 t Driveway, parking/vehicle storage -ro Curtain drain M64- k ^ww^+ Wells on adjacent lots )%'/4 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and 4 t review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. g cwt •. Engineer's Printed Name /?a 6 tA-% C. Date /! � f 7 fl �? �? HAA Fee $ 1-7 5. 00 Date of Payment aj-I6 - 6 q Receipt Number L 40 $6 1 (Rev. 12MI) Waiver Fee $ Date of Payment Receipt Number \ Municipality of Anchorage • -- Development ServiCC$ beocit-tMent Building Safety Division On -Site Water and Wastewater Program " 4700 South Bragaw St. P.O. Box 196650 Anchorage, AR 99519-6650 www.ci.anchorage.ok.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. _ (? 5/- / -03 HAA # 1,4 3 Expiration Dale: 1. GENERAL INFORMATION Complete legal description r Location (site address or directions) 24t8j2-1lreadeel3#sd 9c Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Dona Johnson 2389 Althea St M Dayphone 862-6417 Wasilla, AK 99654 Day phone Day phone 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 Water Storage ❑ Community Class Well 0 Public Water System P9 Individual On-site 9 Individual Holding lank ❑ 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. 5 by an Independent professional civil engineer registered in the Slate 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 ohd/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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certiric es are valid tot 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 dale shown below, I verify Itiat my Investigaltoh, based on procedures outlined in the Health Authority Approval Guidelines for this application, show's that the on-site water supply and/or wastewater disposal syslerri 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 Slate codes, ordinances, and regulations in effect at the time of installation. Name of Firm S 3 S ENGINEERING Phone Gef y -a 9 71 Address 17034 Eagle River Loop Road No. 204 iagle River, Alaska 49577 Engineer's Printed Name Rnbprt r- Cnvan Dale This is to request a conditional HAA. Septic system to be upgraded per S&S design. There is no eminent health hazard created by this approval, no obvious code violation, and no adverse effect as a result of granting this conditional approval. 3 /S•/o Z `, OF Q 5. DSD SIGNATURE �l�`cr• ROBERT C. COWAN / CE -8801 Approved for bedrooms. Disapproved. ltl�tl�idz�~� XX Conditional approval for 3 bedrooms, with the following stipula((,�'o s: Money in the amount of 1.5�Imes the high bid of a minimum of t�lree bids o-eonstrua; a new attached. —Money in escrow shall not be released until this office has given final approval. Construction shall be completed no later than June 15, 2002. Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory .ly ..,....,, ,yo ., ON-SITE �r�� EWATER . : PR� OGRARI - •: Maintenance Agreements Supplemental Engineer's Report Other_ BY � Original Certificate Date:_,3//,j G rn«. 12M) Municipality of Anchorage • Development Services Department Building Safety Division On-site water & wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /Zr2' J9rLY IL. 6_; J h4?JAA/6bG 6hL6 Parcel ID: A. WELLDATA Rj�L Well type Date completed Total depth n. Date of test Static water level Well DrodudiocY If A, B, or C provide PWSID # Sanitary seal (Y _ Cased to ft. FROM WE OG n. AV WATER SAMPLE RESULTS' Coliform col x/100 mi. Date of sampi g.p.m. Nitrate mg.A. Collected by: Well Log (YIN) Wires properly protected (YM) Casing height (above ground) in. AT INSPECTION n. 9— p.m-Other bacteria coionies/100 mi. B. SEPTIC/HOLDING TANK DATA Tank Type/Material rrt, Tank size tQQ;) gal. Number of Compartments 2 Foundation deanout (YIN) -.4y— Depression over tank (YM) IV Date of pumping Pumper Date installed v Cleanouts (YIN) 7 High water alarm (YIN) T C. ABSORPTION FIELD DATA ' Date installed Soil rating (g.p.d.fW rj n$1bd -8'5 System type &0 z 't Length Z Z ft. Width n. Gravel below pipe ft. Total depthn. En. absorption area Monitoring lube � Depression over field ni Date of adequacy test 47/ Results (Pass/Faii) _�(, For � bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ In. / Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N t7 If yes, give date N -Q SYsrarm �ro A t?&6L(PA1- C-6,-JAr i yd�AL fiviq REQJF174D, D. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N) "Pump on" level at )n. 'Pump off* level at _ in. High water alar level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 1 Absorption field on lot Public sewer main Sewer /septic Meets alarm 8 Bradt requirements? A/ /4 AW L,4 C, On adjacent lots On sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/l•10E0101 TANK ON LOT TO: in. Building foundation _6; *-_ Property line 15;* Absorption fieldsly -o- Water Water main L0 Water service line /Q '0'- Surface water / Q "f Wens on adjacent lots _ oZ o f1 t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �'� Building foundation _ Water main Water Service line / Q / F Surface water 100 / Driveway, parkinglvehide storage Curtain drain /1%n/4 FAh N11NVells on adjacent lots?~ F. COMMENTS G. ENGINEER'S 1 car* that I have detemuned through field inspections and review of Municipal records that the above systems are in conformance, with MOA HAA guidelines in effect on this date. Engineer's Printed Name ROatRr C Cdi✓4r1 Date HAA Fee $ 4;7 5 - Date Date of Payment Z, - to - O J. Receipt Number 11 621KI (Rev. 12/00) Waiver Fee $ _ Date of Payment Receipt Number ?f � iNifNl'{Y�1CVY yi3 CE -8801 .e�% MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIROMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIROIMNTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date April 25. 1985 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Block s5 Thunderbird Heinhts Subdivision 01 Location (address or directions) 309 Thunderbird Drive. Chu iak Alaska 99567 (b) Applicants Name Clinton Kelton Telephone — Home 680-992 business Applicants Address 309 Thunderbird Drive Chugiak Alaska 99567 (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer E:::l ; Other � (explain); Seiler (d) Lending Institution Alaska mutual Bank Telephone 694-9571 Address Parkgate Professional Building Eagle River (e) Real Estate Co. d, Agent Gallery of Homes Hearthside Inc (peon Peen) Address 603 West Tudor Road, Anchoraqe Alaska 99503 Telephone Buss 563-3655 Res: 337-7967 (f) Mail the HAA to the following address: Clinton Kelton 309 Thunderbird Driv Chugiak Alaska 99567 2. Type of Residence Single—Family EE� Multi—Family Other (describe) Number of Bedrooms 3 3. Water Supply Individual Well Community 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 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 21 5. Engineering Firm Providing Inspections, Tests, File Search, Data and 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 ny investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Ocean Technology Telephone #248-3888 Address 2502 Date April 25, 1985 (ENGINEER SEAL) 6. DHEP Approval Approved fort iG t bedrooms By Approved Disapproved Terms of Conditional Approval CAUTION itional F 409TH /A-4 :y • Petrick A aewgaN L%_ CE -3:95 - THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EiWIROILMENTAL (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 FEDERAL. AND STATE OR ANALYZE DATA IS NOT RESPONSIBLE PROTECTION REPRESENT - REGISTERED HOMES AND REQUIRE - BEFORE A FOR ERRORS [Page 2 of 21 7-19-84 MUMCIPALI T ! C; ;-..Ci IORAO: N MUNICIPAUTYOO , iAOE ". MUNICIPALITY OF ANCHORAGE (Mq�kDEtt; C>Fx+�Atir� a I,y0. TICN IRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) APR 2 91985. CHECKLIST - FEBRUARY 1984 APP ; I- A. WELL DATA Legal DescripticREFEGWgED /-7 7Aty,fe-,?Frrr Alm '41 Well Classification ''If A, B, or C, D.E.C. Approwd(Y/N) YC --S Well Log Present (Y_/N_ A Date Cacgleted N�i9 Yield Total Depth N A Cased to //X? Depth of Grouting Static Water Level Pun Ip Set -At IV � Casing Height Above Ground Sanitary Seal on Casing (Y ). 4 Electrical Wiring in Conduit (Y/N) NSR Depression Around Wellhead (YM) n Separation Distances from Well: To Septic/Holding Tank on Lot Z,65 � On Adjoining Lots ,AI ' f To Nearest Edge of Absorption Field on Lot ,2w ' ; On Adjoining Lots ?a D'+ To Nearest Public Sewer Line g/,q To Nearest Public Sewer Cleancut/Manhole A( /P To Nearest Sewer Service Line on Lot A Water Sample Collected By Al /A ; Date Water Sample Test Results Camle nts B. SEPTIC/HOLDING TANK DATA Date Installed /n -a4 -R/ Size /006 .5.,q e, No. of CaTpartments Z Standpipes (YIN) x/65 Air -tight Caps (Y/N) Vd'S Foundation Cleanout (Y/N) Vee Depression over Tank (Y/N) TVD Date Last Pumped Pumping~ntenance Contract on File (Y/N) N14 ; for 4M Holding Tank High -Water Alarm (XM) &Z Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 7_66"` To Building Foundation A To Property Lire /oA To Disposal Field /-4/� To Water Main/Service Line Top To Stream, Pond, Lake, or Major Drainage Course Comments 11� c {� ?J jli(a-1 1 Lt [Page 1 of 21 2-15-b4 C. ABSORPTICN FIELD DATA Soils Rating in Absorption Strata F2S 1" &DPf1t Type of System Design 7-Rc wie-,4 Date Installed /o 9 - Y / Length of Field ed Width of Field Depth of Field 5 Gravel Bed Thickness 2 Square Feet of Absorption Area o?S Standpipes Present (Y/N) \/CT Depression over Field (YM) No Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Fater -Supply Fell ,?nn' " To Property Line /,r � 7` To Building Foundation To Existing or Abandoned System on Lot &/fi? On Adjoining Lots SFr) To Water Main/Service Line �O �'` To Cutbank (if present) Al /4 To Stream/Pond/take/cr Major Drainage Carse N //} To Driveway, Parking Area, or Vehicle Storage Area 3d Caswnts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm level at Tested for Electrical Codes(Y/N) Comnents Dimensions Manhole/Access (YIN) "Paw Off" Level at Vent (YM) Pining Cycles during Adequacy Test. Meets MDP, Check Permitted Bedroom Rating Against HAA Request ** I certify on the da Signed _ Company KBl/d5/s [Page 2 of 21 I have checked, verified, or conformed to all MOA HAA WiZATs in effect this inspection. ��,.r llS%s �S No. sr orS^ ow- `P�.�.......�' TH ...��y .......:. ... .... 0 Petr;ck A Doaog �'. CE -3995 : a Ar 2-15-84 i ��n U E or 'BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTALL CONSSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: 3 — -.2 G — ft' PWS I . Z ///S P To Whom it May Concern: �7/ / ' According to records on file in this office the £ek / ,� 6L0". 'd Edea c SIS Water System is in compliance with the State Drinking Water Regulations Sincerely, Time APPLIC IT FILLS OUT UPPER HAL'"�NLY Property Owner �r�;� K;-jr))S/vQCfe G' ✓Wei Phone Mailing Address i ♦ -44CZip Code 0 Date Buyer Inspector Address Zip Code Lendlnif Institution Field Notes: 1 Gk 0•�u Phone Address — Zip Code D Realty Co. 6 Agent-% (,r1 Phone r'flUn!cipaiity of Archoraj:" "Dept. of Flevh A Address 'CONDITIONS OF APPROVAL To Code (( ) DISAPPROVED ( ) CONDITIONAL PPR Legal Description !) DATE Street Location BY: Type of sldence Soils Rating Ingle Family Well To Absorption Area ❑ Multiple Family - No. of Bedrooms_ Septic Tank Slze Cl Other I d V Water Supply ,O Individual IA07ACH WELL LOG. A well log Is required lot all wells drilled since June 1975. �] Community wells trilled prior to that date, give well depth (attach log If available). ❑ Public Utility ' Sewer Disposal ❑ Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: 1 Gk 0•�u I�C� (UUNf 1 rGc�, �— ����9 I)IUrLjjfLJlll o�'E✓ D JUN 061983 r'flUn!cipaiity of Archoraj:" "Dept. of Flevh A (�Q) APPROVED BEDROOM 'CONDITIONS OF APPROVAL (( ) DISAPPROVED ( ) CONDITIONAL PPR DATE BY: Soils Rating Date Sewer Installed � aped Well To Absorption Area Well Log Received Septic Tank Slze I d V Well to Tank