HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 4 LT 26�Vu�.ncLnh�.�i \�f7A6hA% 4' In N., s &a, kwi Municipality of Anchorage Can -Site Water and Wastewater Section + (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Numbec OSP191054 PID dumber: 051-582-17 Dwelling: O Single Family (SF) ❑ with ADU ❑ Duplex (a) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name PORZ10 ROhI ABSORPTION FIELD F] Deep Trench 0 Wide Trench ❑ Bed E] Mound Site Address 27811 Raven Gt El Other Phona Number of Seclrooms Soil Rating Total depth from original grade 206-459-9914 4 GpDisF Ft', LEGAL DESCRIPTION .depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot THUNDERBIRD HEIGHTS 91 BLK 4 LT 26 FIC] added above original grade Ft. �Gravet length Ft. Towerizhip Range Section Gravel vfidth Ft.l Beds: Number of Lines. - Distance between limes - l=t. SEPARATION DISTANCE T€s; Septic Absorption _ R Holding Lrft Station Sever Total absorption area Number of trenches Dist. between trenches From Tank Field I Tank Line Ft z Ft, Well n TANK. K Septic ❑ S.T.E.P. ❑ Holdin ❑ Other P g ?ulanufactvTer Career Capacity 1 250 Gal, i Surface 4Water 1001+ na na Material Steel Number of compartments 2 i l Lot Line i 10'+ I na na NA FCattrrtjata4r5 �^y, 10' -l- �� 3 I1 LIFT STATION. Capacity ! ilan��far�urer Remarks eptiG Tank Replacement- Cleanout Gal, added before tank Alarm location electrical installed by PIPE IVIATERIAL Hou ;eta tank :1�3t�34 Tank to drainflald D3G34 Installer Stuart Gilbert Drainfield GO)P TD3034 Inspector N o rth R i m Eng. BENCH MARK (assumed elevation) 100 ft Inspection 1.: 4r1 eel 9 4/16/19 Location and description Z r, ,31kl 41" ISN -SITE WATER AND WASTEWATER SECTION APPROVAL, � OF�_N +♦ Conditional Approval: Date Arc'�P� q`s'% #♦ :49TM� *ft ��. c...... Steve Eng to ` CE -6256 147 Septic System / Approve'� - �y Data Note: this aonroval does net include well normit ronuiraments. Flat Slope New 1250 Gallon Septic Tank w/DCO's L24 Decommissioned Md Septic Tank PER UPC Septic Flat Slope Trench Location � d L25 3 Bdrm � Septic `oN `o �, \ Q ►vR XPi Flat Slope 10' Uiility Eas,(--ment Raven Court L27 Septic Flat Slope Public Water Well NOF? THRIM a-��� OF. °°�44 THUNDERBIRD HTS #1 1v 40' ENGINEERING �RECORD SteveEng.com $•�'49m tf BLOCK 4 LOT 26 ..... ..... f.. . PO Box 770724 Eagle River, Alaska 99577 fk cE-case $ 907.694.7 �4� •..• ��... d WASTEWATER UPGRADE LAYOUT 028 / 1 / 2 0REPLACE SEPTIC TANK e: Dat/1/20 rEU: 8 2 of 3 A B DC01 34 14 ST1 35 16 ST2 40 23 DCO2 42 27 Flat Slope New 1250 Gallon Septic Tank w/DCO's L24 Decommissioned Md Septic Tank PER UPC Septic Flat Slope Trench Location � d L25 3 Bdrm � Septic `oN `o �, \ Q ►vR XPi Flat Slope 10' Uiility Eas,(--ment Raven Court L27 Septic Flat Slope Public Water Well NOF? THRIM a-��� OF. °°�44 THUNDERBIRD HTS #1 1v 40' ENGINEERING �RECORD SteveEng.com $•�'49m tf BLOCK 4 LOT 26 ..... ..... f.. . PO Box 770724 Eagle River, Alaska 99577 fk cE-case $ 907.694.7 �4� •..• ��... d WASTEWATER UPGRADE LAYOUT 028 / 1 / 2 0REPLACE SEPTIC TANK e: Dat/1/20 rEU: 8 2 of 3 Ar Fri -0 ;;u C-) m 0 F— D> :> z m 7'\- m < -0 m 70 z F -I m 05 td —I F— M O ;;u � 7-\ tJ m td m M m :K x P n :5- rr) (D Q - m rD rD rD Q to I m ED ro W n rD M< 5- 0 ro 41- -3 3 rD m W rD'D> U P C+ -9 -9 --- i ro F 0- m 0 -0 0 3 p C0 C+ :2 Q p -3 — 0 !:- nCJJ n )U) ro :3 0 < m 0 Q rD rD rD :3 0 0 c c LA C+ td m m r2 M< 5- 0 < p 0 O C+ ro 0 :3 ro O LA ro 0 C0 aD 0 Cil 1 :2 !:- nCJJ m p :5 0 c . f - LA td rD C+ rD T --q M 0 n rD -q :5 p n 90 ro :3 n D- Lot 24 E Lot 25 0 d M Unsubdivided S 89'59'00"E 146.75' Lot 26 ,.6x,2.2 20,045 s.f. SHED 12.3'x16.3' DECK CHAIN-LINK FENCE x PIPES I x 4.5'x8.3' COVERED DECK TRI—LEVEL RESIDENCE 493 2.0x5.4' CANT 19.2' 41 9.6' PORCH _CONCRETE WALKWAY '(a RETAINING WALL -.N N 89'59'00"W 146.75' RAVEN LOOP ROAD FENCE 2.2' SHED Lot 27 CHIMNEY WALL LF - 10' UTILITY EASEMENT NOTE: LOT IS SERVED BY A COMMUNITY WATER SYSTEM PLOT PLAN ___ AS BUILT _X_ SCALE _1=_= 40__ GRID _ NW 1865-- Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000�p�O (907) 522-4625 Fax oF A p04 Professional Land Surveyors kenolangsurvey.com o ......... . . jonothanOlangsurvey.com 70 S I hereby certify that I have surveyed the following described property: LOT 26, BLOCK 4, THUNDERBIRD HEIGHTS SUBDIVISION—ADD. No. 1 (PLAT No. 78-201) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as indicated hereon. Dated this the ��`� _ Day of __`1�:��s�P_,_t____, °t_��l`� at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH— . A •. KEN N HN t 12 4, l / Lct ` 04 44Fo'•-.LS-5202.'' gJOG a ... apo 0�,'OFfSS10NAL �o MUNICIPALITY OF ANCHORAGE H \ � 111 l IIYI On-Site Water&Wastewater Program PO Box 196650 4700 Elmore Road _ . ' ° Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 .. t http://www.muni.orglonsite Department 4"'CNOR"6t On-Site Wastewater Disposal System Permit Permit Number: OSP191054 Effective Date: 3/15/2019 Work Type: SepticTank Upgrade Expiration Date: 3/14/2020 Tax Code Number: 05158217000 Site Legal Address: THUNDERBIRD HEIGHTS #1 BLK 4 LT 26 G:1865 Site Mailing Address: 27811 RAVEN CT, Chugiak Owner: PORZIO RON & NANCY Lot Size in Sq Ft: 20037 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ./ Date: /� / Issued By: � / Date: 1,7 MUNICIPALITY OF ANCHORAGE Development Services Department * Phon- _907-343-7904 On-Site Water & Wastewater Section 'a': 90 -343-7.97 MARIICO; ON-SITE SEPTIC/WELL PERMIT APPLICATION �a 3 c ti Parcel I.D. 051-582-17-000 01 6 8 9 c) Property owner(s) PORZIO RON Day phone 206-459-9914 Mailing address 27811 Raven Court Site address same Legal description (Sub'd., Block & Lot) THUNDERBIRD HEIGHTS #1 BLK 4 LT 26 Legal description (Township, Range & Section) Lot Size 20,037 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field U Initial n Single Family (SF) (w/wo ADU) Septic Tank ❑ Upgrade x Duplex (D) U Holding Tank ❑ Renewal IMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well n Water Storage THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. _ / (Signature of property owner or . thorized agent) 6 Permit/Rush Fees: t225.Oti Waiver Fees: Date of Payment: °3/11411 Date of Payment: Receipt Number: 61W-1gb Receipt Number: Permit No. OSPIQIDS4 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc TH IM ENGINEERING SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 3/9/19 Number of Pages: To: MOA On-Site Services Subject: Thunderbird Hts #1 Block 4 Lot 26 Septic Tank Failure The subject septic tank has failed-a new tank will replace the old one. The existing trench appears to be working OK. Please issue a permit so the tank can be replaced. The existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks-Steve \ERIE ENGINEERING SteveEng.com Thunderbird Hts#1 Block 4 Lot 26 SPECIFICATIONS& DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom home.Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are near a half-acre and are served by the public water.No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2-compartment, 1250 gallon septic tank. Watertight couplings on inlet&outlet. • 5' minimum between the tank and trench. 10' to property lines. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank& solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron,PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) c ..J • r "ek, 30// DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Trench. 4. Lots Served by Public Water. 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line— Replace If Necessary. 7. Add Double Cleanouts Before Tank If No FCO. Flat Slope New 1250 Gallon Septic Tank w/DCO's L24 Decommission Old Septic Tank PER UPC Septic Flat Slope rench Location d L27 L25 1 3 Bdr -_ rn #--. Sep-tic Septic o Q �Q Pr, Flat Slope Flat Slope k 10' Utility Ea rnent Public Water Well Raven Court NOR THRIM +�+�����' - :•'\� °F ' THUNDERBIRD HTS #1 1 40 ENGINEERING ir4 .. . *• ,i steveEn 1.. . *''$ BLOCK 4 LOT 26 DESIGN PO Box 770724 amen - - LAYOUT Eagle River. Alaska 99577 1/4.. ct-. ..• ?, WASTEWATER UPGRADE 907.69 4.7028 4 Date: EET: REPLACE SEPTIC TANK 3/9/19 r2' of 3 Foundation Cleanout Tank Cleanouts Fin ^amide Deposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal 1250 Gallon To Trench SEPTIC TANK MOA-Approved lid Pipe Match Elevations To DESIGN NOTESExisting FCD & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 27. Slope & 3' Cover. 4. Water-Tight Couplings. 5. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC. 8. If No FCO, Install DOD's. NOR THRI M _.•��� """, ENGINEERING ='�".'• '‘ SEPTIC TANK PROFILE THUNDERBIRD HTS #1 :49m SteveEng. corn ••••• •$ • PO Box 770724 Strom Eagle River, Al ska 99577 , BLOCK 4 LOT 2 6 ' 907.694.7028 4•41 TANK REPLACEMENT Dote:3/9/19 By: SLScale: 1, 5 , SHEET:3of3 'Drawn I I SE i Ii 41-/(ifii‘ Unsubdivided ■ 1 IAN V\ Lot 24 S 89'59'00.E 146.75' I - .. _ • " • 11111110. CHAIN—LINK Lot 26 . q. : .! FENCE 20,045 s.f. ►N _P` 0 �'. 8.2'x12.2' SHED 112.3'x16.3' DECK o • Z • J., (n O x 1 O O k - 1 O U1 1 —CHAIN—LINK 14' 25.0' N . • •. J t (,, x FENCE 30.3 ' ' 1 w Lot 27 rif N TRI—LEVEL Lot 25 1SEPTIC T RESIDENCE 0 v, x PIPES it " 19.8' co L` x x 18.3q3.0'x6.0' CHIMNEY 49.7' o RETAINING WALL • n 2.0'x5.4' CANT 19.2' ;4'•8' 9.6' PORCH • / 1O,— UTILITY EASEMENT CONCRETE WALKWAY _ RETAINING WALL .N N 89'59'00"W 146.75 O K RAVEN LOOP ROAD NOTE: LOT IS SERVED BY A COMMUNITY WATER SYSTEM PLOT PLAN — AS BUILT X SCALE 1* II 40' GRID NW 18¢5 Project No. 18-153/A1 pp�� 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang Associates , inc . (907) 522-6476 Phone (907) 522-4625 Fax 0x Professional Land Surveyors kenOlangsurvey.aom C . 4 jonathanOlangsurvey.comI hereby certify that I hove surveyed the following described property: 491 *LOT 26, BLOCK 4, THUNDERBIRD HEIGHTS SUBDIVISION—ADD. No. 1 (PLAT No. 78-201)Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed ,premises and that there are no roadways, transmission lines or other visibleeasements on said property except as indicated hereon. �•••.L.S-5202.••' 4n4 Dated this the 2, Day of APR.�� , 2b lb , at Anchorage, Alaska Ll11 ,00 '' moo kl �ssloNAL a It Is the responsibility of the owner to determine the existence of any easements, ,40Oc��a covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 n10 �►-Arr�l Qo r ,I MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I • ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME S c PHONE `(q,_5 Z tKNEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION o LOCATION(� K vW NO.OF BEDROOMS Ar - U Y DISTANCE T0: Well CDc11tt1UNl Absorption area \mo Dwelling PERMIT NO. "($Oqq Z � ZQ Wl' Manufacturer � Vx-� Material. No. of compartments 2 h Liq. capacity in gallons IF HOMEMADE: Inside length to14 Width Liquid depth C Y Jaz DISTANCE TO: Well Dwelling PERMIT NO. _? F Manufacturer Material Liquid capacity in gallons D W = DISTANCE TO: Well M Foundation 3t'� Nearest lot line \s PERMIT NO. "I 80CA 1, , F M w No. of lines Length of each lin , Total length of lines Trench Wi DN inches Distance between lines CH Top of tile to finish gradeOt\ Material beneath tile O t inches Total effectivegbssrptition area ".J� W a Length Width Depth PERMIT NO. ct F W Type of crib rib diameter Crib depth Total effective absorption area L" DISTANCE T0: Well Building foundation Nearest lot line J JIm lass Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIP MATERIALS SOIL TEST RATING 8 S 1c� INSTALLER -o L'ga IJK REMARKS U AP D DATE LEGAL 72.013 (Rev. 3/78) ..� MU" I iG I L I TV' 0F Fit+liCnimF= DEPARTMENT Or -HEALTH AND ENVIRONMENTAL Pt;OTECTION *825 'L' STREET, ANCHORAGE. At;. 99501 264-4720 0 r4 I -ra n5 EWEFZ F=m EFct'1 I T PERMIT 140. 4 780992 ) APPLICANT SOMHOFF & ASSOC. 1020 W. INTL AIRPORT RD 279 5522 LOCATION RAVEN COURT LEGAL L26 B4 THUNDERBIRD HTS -LOT SIZE 20045 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM 14UIIBER OF BEDROOMS = 4 SOIL RATING CSO FT/BR)= 05 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C7EF=STH= SO �ZT- GFZA•vF=L_ E>UF'TH= a 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 CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F;:E=C!U I FBF=F? E~F=P T I C -rn"K � I =1 1:2Z50 GRLL[�ttil= PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUP16ER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWE7 C 2 ] nFRE F; l-_— 0U I MF=F> --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EFZM I T F7F=GF-M0aFR 3-t1 • 1SO?L_� I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM Its ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED APPLI CArM BOMHOFF 4 ASSOC. ISSUED B4 ��m2�-DATE_ _Z� ll!_ V3. 2 ® BOMHOFF & ASSOCIATES, INC. Engineering - Planning - Surveying 1020 WCSt International Airport Road • Anchorage. Alaska 90502 • 1elephone (907)279.5522 PO. lox 800 Palmer, Alaska 99045 0 Telephone (907) 745.4201 October 16, 1978 Mr. Les Buckholtz Municipality of Anchorage Department of health & Environmental Protection Agnecy Environmental Engineering Division 825 L Street Anchorage AK 99501 RE: Septic System Design Project No. 1657 Dear Mr. Buckholtz: Please find enclosed the soils information for Lot 26, Block 4, Thunderbird Heights Subdivision. The home to be built is a four bedroom house. Also, the trench depth shall be 11 feet with 6feet of screened gravel backfill. Thank you for your attention in these matters. Sincerely, BOMHOFF & ASSOICATES, INC. bz-� / r� Rick Koch Civil Engineer RRK/pnk Encl. highways • airports • drainage • planning • shopping centers • subdivisions • streets • water • sewage SIEVE ANALYSIS PROJECT: Loi .26 a 1 K 41 T' 8; rd No. - /6J54 BORING No. SAMPLE No. d DATE 10/& Z -7B WEIGHT WEIGHT XY ORIGINAL AFTER WASHING PREWASHED: YES NO-& SAMPLE PREWASHING LOSS SIEVE OPENING STANDARD SIEVE SIZE OR NUMBER SIEVE WEIGHT SIEVE t SAMPLE WEIGHT WEIGHT RETAINED ON SIEVE PASSING SIEVE WEIGHT PERCENT ( %) INCHES MILLIMETERS 3.00 3 -In. Jr 0 2.00 2- In. 1.50 1 -1/2 -In. 1.00 25.4 1 -in. 0.750 19.1 3/4 -in. s 0.500 12.7 1/2 -In. .J, 5% .J 0.375 9.52 3/8 in. ,f (p /-1786 533 0.250 6.35 No.3 0.187 4.76 No.4 Z -:2 O 2.4,33 22-0 PAN 0.132 3.36 No.6 0.094 2.38 No.8 0.079 2.00 No.10 LoZo 1-472. 0.047 1.19 No. 16 0.033 0.84 No. 20 0.023 0.59 No.30 0.0165 0.42 No. 40 6-87-5 or 0.0117 0.297 No. 50 0.0083 0.210 No. 70 I 0.0059 0.149 No. 100 % 0.094, 1 0.0041 0.105 No. 140 ' 0.0029 0.074 No. 200 Q, 0. 04.1 oy 0. %a PAN O. Q. 04 2 - TOTAL WEIGHT In grams ERROR (Origisol wt. - totol wt. of troetions ) ( groms) 0.0 DESCRIPTION OF SAMPLE PERCENT ERROR + IErtor (9m•) ■ 1001 Oriq lnol Wslqnt (qm.) 4.D REMARKS: BOMHOFF & ASSOCIATES, INC. ENGINEERING - PLANNING - SURVEYING ANCHORAGE ALASKA TECHNICIAN CHECKED Br 61301MI-1OFF & ASSOCIATES, INC. Engineering - Planning- Surveying io20 west International Alrport Road Anchorage, Alaska 99502 Telephone(907) 279.5522 LOCATION 10f 2� ,�51k 4, %.Birol I/er'a�,7�s BORING NO. ! L BORING NO. STATION 240 B�6 n1 STATION ELEVATION ELEVATION r w W L6 r zi x F - w 0 highways • airports • drainage • planning • shopping centers • subdivisions • streets • water • sewage 0 0 0 0 _ »' :0' ^a li 71 0' 1 1 I l 14^.I I� � SIG v 1 VI' VI � O� J c —I� CIC II F l 3 n --- ou m N o ■ � son 0■ Ion oil n 0 0 0 0 _ »' :0' ^a li 71 0' 1 1 I l 14^.I I� � SIG v 1 VI' VI � O� J c —I� CIC II F l 3 n --- I, r W O' T4s- a ZO/ Gu ►�cf C5 -y-, G 9� WIM -i7iLo t:irFALL r� F3 n NMA 1'1 \ \ ■' Development Services Department On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Phone: 907-343-7904 Fax: 907-343-7997 Parcel I.D. 051-582-17 Expiration Date: -7-2S-2- Q ?_ _Z_ 1 2S2-QZz- 1. GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS #1 BLK 4 LT 26 Location (site address) 27811 Raven Ct Current property owner(s) Portio Mailing address Real estate agent Kelleigh 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 206-459-9914 Day phone 301-5873 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Li 1 g.5D (covit, Waiver Fee $ Date of Payment V D Date of Payment Receipt Number Q - C4 ' 2000 Receipt Number COSA# 0sC�_O I � DD 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 lvlunicipality 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/17/20 iG)�P; •.. 'y�� s * 49�i� •'• *yf 6, DSD SIGNATURE : •••• f System #1 Approved for bedrooms i�yyy 7�17� 0°3t `�"; System -1412 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: l�llllllllf r _9J��i1 7CES Dw\S\ , I/M 11 � I I 1')��)Nl��,, Original Certificate Date: ��-C-z©Z The bduniciplily of Anchorage Dovoloprnent Services Division (DSD) issues Cortificates of On -Site Systems Approval (COSA) ba!�ud only upon the rep resenlations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. The Mvnlclpolity of Ancmrage Is not respons'5le for errors or omissions in the professional enc;neer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CGs4C?r•:Y.lat blue etw.Kd Legal Description: THUNDERBIRD HEIGHTS #1 BLK 4 LT 26 Parcel ID: 051-582-17 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Public Water B. TANK DATA Age of tank(s) 1 years Tank type/material sep6clsieel Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA 11 /78 Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective of Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 71"12' Results 0 Pass For 4 bedrooms Fluid depth prior to test 5 in Water added 600 gal New depth 24 in Elapsed time 60 min ❑ Code -required soil cover over field Final fluid depth 7 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) unk date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances H less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No It 0 Yes if No ft Neighboring Tank > 1001 Yes if No ft Private Sewer/Septic Line > 26 ❑ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' n Yes if No ft [:1 Yes if No ft ft If septic tank is under driveway comment below - Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No It n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' ID Yes if No ft Property Line > 5' Yes if No it Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' nv Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10! Yes if No ft Community Wells > 200' R Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS Ar& G. ENGINEER'S CERTIFICATION s � :49Ik1 T4s certify that I have determined through field inspections a ar. .0 Air Eng of Municipal records that the above systerris are in conform wit,91 i1r, *" A MOA COSA auidelines in effect on this date. '%', &, I I$ i�/ 1, 0 • Municipality of Anchorage =" Onsite Water and Wastewater Program a `, (907) 343-7904 5': E CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 057-582-17 Expiration Date: 1. GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS #1 BLOCK 4 LOT 26 Location (site address) 27811 RAVEN COURT, CHUGIAK AK 99567 Current Property owner(s) NANC K. SCOVEL Day phone Mailing address Real Estate Agent 27811 RAVEN COURT, CHUGIAK AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ WaiverNariance request for. �r� . Received by: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $�2 �o . 0-0 Waiver Fee $ p Date of Payment C7 Receipt Number be j6q O- COSA# 0SC-/6/00J Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone -868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 t Engineer's Printed Name KENNETH M. DUFFUS 6/2/16 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ! r OF A.L� \ occupants or can ArcTerra guarantee that no unseen i v encroachments, deficiencies or discrepancies exist. N117- 10" 4P,,T�1 6. DSD SIGNATURE Y % KEir14ET�IrM' DVF -U 1 ,System #1 Approved for bedrooms. oil System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ( OF ANC TER AND WAgTE_ - 42 By Original Certificate Date: h _ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10.12.doc If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system , Certificate of On -Site Systems Approval Checklist Legal Description: THUNDERBIRD HEIGHTS #1 BLOCK 4, LOT 26 Parcel ID: 051.582.17 A. WELL DATA – CLASS A Well type A If A, B, or C provide PWSID # 211156 Well Log (YIN) Date completed Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth ft. Cased to _ft. Casing height (above ground) _in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. 9.p -m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: ug/L Nitrate _mg/L Date of sample: B. SEPTICIHOLDING TANK DATA TankType/Material SEPTICISTEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 5123/2016 Pumper JRs Collected by: Date installed 1111978 Cleanouts (Y/N) High water alarm (Y/N) N C. ABSORPTION FIELD DATA - Date installed 1111978 Soil rating (g.p.d./ft2 lbdrm) 85 System type DEEP TRENCH Length 37 ft. Width 4 ft. Gravel below pipe 5 ft. Total depth 10.5 ft. (Measured 5/23116) Eff. absorption area 370 ft — Monitoring tube Y Depression over field N Date of adequacy test 5/23/2016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth -in absorption field before test 0 in. Water added 630 gal New depth 24 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date D. LIFT STATION Date installed "Pump on" Ievel at _ in. Datum Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manholetcleanout Holding tank Manure/animal excrete storage areas Absorption field 5'+ Water main 104 Water service line 101+ Surface water 100'+ Wells on adjacent lots 2001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 504 (NONE KNOWN) Wells on adjacent lots 2001+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 01212015 -. i COSA canary sheeL,2-6-15.doc OF AZ "A �EsstoN�' i in. MUNICIPALITY OF ANCHORAGE . •� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services` y On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C2 S'I— r J 3• — r 7 1. GENERAL INFORMATION HAA # sA f�Cl S Q -, Q, Complete legal description L e XV r3 Le c K y Location (site address or directions) a 7 // RA vi ev .c ; F tev7 N Q Property owner C YNTH(A rn C �a HDay phone`"`� ``I 1 ' 4" ` S Mailing address - Lending agency Mailing address. Day phone Agent FNY LU S iSn-? .t.i — m4" -sic itF L PLt"¢S -7l r S`:y / 2 Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well x Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02$ (Rov. 1/91) Front MOA 121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S& S ENGINEERING Name of Firm19'834 Eat lu RIM t0up Raad'No. 204 Phone C y Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE 1,'� Approved for Fy lJR bedrooms. Disapproved. _ Date OF� 4•m.• RCB:Ri C. COWAN r st cE-8801 law Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date g - 2 0 - 909 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not rssponsible fcr errors or omissions in the professional engineer's work. 72-025 (Rev. L91) Back 1.10A 1n1 ------ ....................................................... ............. 'Pt' VI 11 ........... ...._......... ........ .... .. .. EIVED Municipality,of Anchorage AUG 17 1998 DEPARTMENTiOF HEALTH & HUMAN SERVICE,%UNICIPAUTYOFANCH Environmental Services Division �NIPCINMENTALSERVICE 825 L Street, Room 502 ;• Anchorage, Alaska 99501 • (907) 343-4744 j Health Authority Approval Checklist O Legal Description: LoT 2(aI �C o c.c ; y Parcel LD.: S7 Tilvr�Ot.Q 6.K 0 ' f•: E /FHr S I ' A. WELL DATA j � I Well type 4i If A, B, or C, attach ADEC letter. ADEC water system number R 11 / S fo Log present (YIN) Date completed Total depth Cased to C ' g height (above'Iground) ! Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG . AT INSPECTION Date of test Static water level Well production M WATER SAMPL SULTS: Coliform ! j D of Sampler I Collected by: � I B. SEPTIC/HOLDING TANK DATA I 0 Ceanouts �N)Date Installed /r 7 Tank Size Number of Compartments YE l II j II Foundation cleanout (61'/N) =- Y E 3 Depression (Y& 1� 0 High water alarm (Y/&� ^' ° Date of Pumping $ I �S �Q6 ,',:,Pumper 7 Q J C. ABSORPTION FIELD DATA Date installed r!'(� g Soil rating (g.p.dJft2 or 2/b m, rg 5 System type Length "•' Width `/ ' Gravel thickness below pipe S Total depth fol Effective absorption area 3 70 �; 2 Monitoring Tube present &N) YES Depression over field (Y10 N 0 Date of adequacy test i619 Y Resultsas Fail) PAfs For bedrooms .� Fluid depth In absorption fieldbeforetest (in.); Immediately after�y'/ gal. water added '(in.): a �S Fluid depth f (ins) Minutes later: a G I Absorption rate 6° 0 -i- g.p.d. Peroxide treatment (past 12months) (YIN) N o"E- /`^'° ur' { If yes, give date 72-026 (Rev. 3/96)' 1 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level a ` High water alarm level at` *Datum Cycles teste E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On "Pump off"level at' Absorption field on lot On adjacent lots Public sewer main _ Public sewer manhole/cleanout Sewer/s erviceline Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S Property line S 4 Absorption field S Water main/service line to 4 Surface water/drainage 00 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line o I` Building foundation I D 4 Water main/service line /01/ Surface water ° ° Driveway, parking/vehicle storage area Curtain drain P1 0 I C k NC W ri Wells on adjacent lots a• 10 4 F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal in conformance wi O gut elines in effect on this date. Signature n Engineer's Name Date 8 / 1'q V '3 A ` ROBERT C. COWAN �c�•ti CE=8801 tt rF^..............• • 111*`���.;E$���`' �•�" HAA Fee $ � Db ' ab Waiver Fee S _ Date of Payment ?1171 t? Date of Payment Receipt Number /Z L-1 zws:! Receipt Number 72-026 (Rev. 3/96)' are G- z.S MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 114i t -- — S-1 HAA # 1A Q01 021 1. GENERAL INFORMATION ` Complete legal description Lot 26; Stock 4; Thundenb. Ad Height6 Subdiv.i.6ion + Location (site address or directions) 27811 Raven Chug.i,ak, AK 99567 Property owner Bnenda Schdmmeyen Day phone 688-2671 Mailing address 27811 Raven Count Chug.i.ak AK 99567 343-4936 (w) Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. n-ozs (Rev. 1re1) From MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my invest�qation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm.,,,,.. Address Eagle River, Engineer's signature .3 404 6. DHHS SIGNATURE Approved for Gt0e_ ` bedrooms. Disapproved. Conditional approval for Additional Comments Phone &,7 -0%7 % Date GI �e xx r, •aay�t rJe }ya�•jr. ,wkl•��,{. bedrooms, with the following stipulations: By: &", CO3""t't- Date C/— ;)-/: 3 111Th The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-=(R".1/91) Back MOA a21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:lo'r21-. S% -v- 4 I_AjADrr.-e,eJParcel I.D. A. Well Data Well type _1�_, _If A, B, or C, attach ADEC letter. ADEC water system number -7-W65,L0 \65, to Log present (Y/N) Date completed Driller Total depth Cased to Sanitary seal (Y/N) Date of test Static water level Well flow Casing height Wires properly protecte FROM WELL LOG AT INSPECTION cn o JO rn m° a)_ g.p.m. g.p.m. C m SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Zoe , On adjacent lots Or Absorption field on lotyo ; On adjacent lots _ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Public sewer Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA 11-2--78 Date installed \"\I'& Tank size \tea Compartments rn w cO m O Z Cleanouts Q/N) Foundation cleanout WN) 4 Depression (Y/N) High water alarm (Y.6 .�` Alarm tested (Y/N) A, Date of pumping 'L �— 3 Pumper LESS i ao L_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Zb On adjacent lots ' �` g Foundation To property line / O Absorption field Water main/service line Surface water/drainage / o J> / 72•026(W3)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level Meets MOA electrical codes (Y/N) SEPARATION DISIATICE FROM LIFT STATION TO: lot at tested On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed \ 1�11 '1 S Soil rating (GPD/Fiz) 8S System type Te_S_4 LA Length -,577 Width A' Gravel thickness S Total depth I o ' Total absorption area 17i70b6 Cleanout present6?N)' Depression over field (Y6I _( Date of adequacy test 01 — K —`l3 Results ail) h'o-ss for 4 Bedrooms Water level In absorption field before test —After test Peroxide treatment (past 12 months) (Y& If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 'yb9 On adjacent lots r�l Property line t D ' l To building foundation To exi ting or abandoned system on lot ' On adjacent lots Cutbank '— A Water main/service line to a'1 Surface water 1 ob Driveway, parking/vehicle storage area .40 Curtain drain 'A k JJ�v E. ENGINEER'S CERTIFICATION I certify that I have checke erifi d, or conformed to all MOA and HAA guidelines in effect orb the. p his inspection. Ah Ry r,��V •6.Ot , of. fes Signature 9 ....:...:',,..,..' d. a <„ r s Engine a 034 Ea le River LooPE � •f.n ,4 s Ea f••Lt .�:.� ` loco A. 5hoha' yJ Eagle River, Alaska 99577 �s . ;. d '� •. No. I<S7w ? F DateQ• R t t HAA Fee $ 31)0 , CID Date of Payment Receipt Number 72-026 (393)' Back Waiver Fee $ Date of Payment Receipt Number •..- ', JNICIPALITY OF ANCHORAGE �- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 12/13/85 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 26 Blk 4 Thunder Bird Heights T16N R2W Sec25 Location (address or directions) Raven Loop (b) Applicant Name Brenda SchimmeYCA Telephone: Home 688-2671 Business 264-4474 Applicant Address 403 Raven Loop SR -2 Box 403 Chugiak, AK 99567 (c) Applicant is (check one): Lending Institution ❑ : Owner/builder EP; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Security Pacific Mortgage Telephone 276-1933 Address 2550 Denali Towers Anchorage, AK 99501 (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 1 2. TYPE OF RESIDENCE Single -Family © Multi -Family ❑ Other Number of Bedrooms g ( 4 ) 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 2 72-025(11,841 5. ENGINEERING FIRM PROVIDINL. oh..r'ECTIONS, 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 my investigation and inspection, the on-site water supply and,/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this Inspection. Name of Firm Telephone EAGLE RIVER ENGINEERING SERVICES Address F LE RIVER, AK 99577 Date P. 0 BOX 773294 694-5195 TO . t..o o°°C00000 o°•a..••oi •..•n .• iJ iecf F•, e�fo - : ,� '`Engineer's Seal V. Gp ' 6. DHEP APPROVAL Approved for bedrooms byDate Approved Disapprov Condition Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANdAbWLH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 DEC 161985 Legal Description: Lo r,2 6 elm el 1.5.,��� b+�cP *IrS A. WELL DATA RECEIVED Well Classification J0 If A, B, C, D.E.C. Approved (Y/N) .1' Well Log Present (Y/N) Date Completed Yield Total Depth _ Static Water Level Cased to Casing Height Above Ground _ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depth of Grouting — Pump Set At Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ;On Adjoining Lots _ To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA ; Date AR e' - Date Installed ZZ 75f Size 14!*� No. of Compartments Standpipes (Y/N) 9 P Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) ti Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ��A ;for Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: 41 To Water -Supply Well -2010To Building Foundation S i To Property Line /4'0- To Disposal Field To Water Main/Service Line /V To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-02601184) C. _ABSORPTION FIELD DATA Soils Rating in Absorption Strata �� ���� Type of System Design ` %lr.Ac � Date Installed 1979- Length of Field • Z > Width of Field Depth of Field /o � � Gravel Bed Thickness 5 � Square Feet of Absorption Area -32V Standpipes Present (Y/N) Y Depression over Field (Y/N) Date of Last Adequacy Test ZZ -°c / 3 /iS S' Results of Last Adequacy Test Ss ^ r -r c Separation Distance from Absorption Field: To Water -Supply Well ";"' To Property Line l�' To Building Foundation ° To Existing or Abandoned System on Lot — ; On Adjoining Lots —_¢30 e To Water Main/Service Line `/v To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course yo'w w"/•t;" 'wo, To Driveway, Parking Area, or Vehicle Storage Area /4 Comments D. LIFT STATION ,/ Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Manhole/Access (Y/N) — "Pump Off' Level at " Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /e5:7�Date /-2/i VX.r- Company Z5"(! e—L'•U MOA No. 57-- �6J_ Receipt No. �LO��� I Date of Payment —( (.D 'g S Amount: $ cd�. Page 2 of 2 72-026 (11/84 yS•C.`J�}u!C • � r :.�. Engineer's Seal Cvterc j`4,,•eJ, 'r a CE -6736 " U BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: 19071 Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 PWS I.D.# (DW I To Whom it May Concern: AccorcLing to records on file in this office the Ak&z'1"6WvJ)Lj N!X4 WJ Water System is in compliance with the State Drinking Water Regulations Sincerely, Time APPLI(M*IksNT FILLS OUT -UPPER HAI--) ONLY Property Owner Il u �— t C U I t r Yi 1 n C �— Phone 5 C> y�� ��� t� Jdo� -`� Mailing Address Zip Code Buyer ft/'�j S Address Zip Code Inspector Lending Institution a �� )i r cry �}— ISS G.� tl Lj ` 5 i ` Inspector Phone AddressI d' `v (I ITS v Zip Code �� � / S I () Realty Co. & Agent — / MAy 0 61983 Phone Address Zip Code Legal Description �'J v � ,,•;,\ z-1 / / 1 -t— c>? / , / % 6 6 r � 7Ae,(r C9 1-1cJ _) Street Location (/a APPROVED BEDROOMS (� Type of Idence () DISAPPROVED Ingle Family ❑ Multiple Family No. of Bedrooms f3 ❑ Other _.. DATE +/ Water Supply BY: ❑ Individual ❑ Co unity Date Sewer Installed ATTACH WELL LOG. A well log Is required for all For wells drilled since June 1975. Well Log Received wells drilled prior to that date, give well depth (attach log If available). Dlic Utility Septic Tank Size ' posal SeFndividual Year Individual Installed: n 1 /� r"rq� qlic r/Cf � Utility ❑ Holding Tank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time , Date Date Date Date l // r Inspector Inspector Inspector Inspector Field Notes: IIIrJn �J Q R n� O W E O �� � / .i l MAy 0 61983 "Municipality of Anchorage" ` "Dept. of Health & Environmental Protection" (/a APPROVED BEDROOMS *CONDITIONS OF APPROVAL () DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE +/ BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received it z -I Well to Tank Septic Tank Size