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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3 BLK 6 LT 8,~~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LOCATIQN NO. OF BEDROOMS J Well I Absorption area Dwelling PERMIT NO. DISTANCE TO: I ~ ~ Manufacturer Material No. of compartments Liq. ca city in gallons Inside length Width Liquid depth ~ ~ DISTANCE TO: Well ~l Dwelling PERMITNO. O ~ ~ Manufacturer Material Liquid capacity in gallons P MIT O. Nearest ~: DISTANCE. i TO: .~l~/~ 1o~o[ lines Trench wi th ~ --' No. of lines Length ~f~t~ line Total ~, ~inches Dista~bet~s Q~ Top of tile to finish grade Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~rib depth Total effective absorption area J Building foundation Nearest lot line Well DISTANCE TO: ~ Building founda~n Se~r line Septic tank Absorption area{s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER PM. 694-29~9 DEPARTMENT OF HEALTH AND ENVIRONMENTAL F1ROTECTIGN 825 L S]:REET.~ ANCHORAGE, AK 99501 264-'4720 PERMIT ND: DATE ISSUED: 08 / 1 ~/85 APPLICANT: C/O S & S ENG'G KEN BARBER ADDRESG: SRB 196X EAGLE RIVER, AK 9957,7 CONTAC] F'HONE: 694-2.979 lEGAL DESCRIP: SUBDI~2ISISN." THUNDERBIRD HEIGHTS LOT~ 8 BLOCK". 6 SECTION: 215 TOWNSHIP," 16N RANGE: 1W LOT SIZE: 2'.0()00 (GQ.FT. OR ACRES) MAX BEDROOMS: ~ Listed below are the options available t.o you in designing yeup septic system. Choose the option that best ~its yeu~ site, I)EF:q'H TO PIPE BO'I-TOM (FT.) 4.0 GRAVEr_ DEPTH (Fl'.) 3.0 TO"I'AI_. DEF'TH (FT.) 7.0 GRAVEL WID'I"~ (FT.) 5.0 GRAVEl_ LENGIH (F'F.) .~ ~, o GR~VEL VOLUME (CU.YDS. ~ ll. :t f'ANK c~IZl= (GAL..~) ' "~"' '" SOIL RATING (SQ.FT. /BR) ~ .~l~],~ '~"m TANK MUST HAVE AT L.EAST :FWO COMPARTMENTS cert. i £ y that.: 1, I am Familiar f'or'Lh by the Municipality of Anchorage (MOA) and the State of' Alaska. I will install the system ~.n accordance wit. h all MOA codes and ~egu].at:[ons, and zn compliance with the design criteria si this pePmit, 3. I will adhere to al-] MOA and State o~ Alaska ~equirement. s fop the set back distances {r-om any existing well, wastewater disposal syst. em or public sewerage system on this or any adjacent or nearby lot. 4~ I understand that. this permit ~s valid fop a maxzmum ol I bedpooms and any enlaPgement will 'equipe an additional pepmit. IF A LIF'T STATION IS INSTALl-ED IN AN AREA COVERED BY MOA BUII-DING CODES, THEN ~1) Aht ELI.:..CTRICAL. PERMI'F AND INSPECTION MUST BE OBTAINED; IR) AS-BUILTS WILl- NOT BE APPROVED WITHOUT Ah~ EI-ECTRICAI- INSPECTION REF'ORT; AND (,3) THE E1.ECF'FR I (:]AL_ WLRI-.. MUST BE DONE BY A LICENSED ELEC'FRICIAN. DATE: DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS W dth Liquid depth PERMIT NO. DISTANCE TO: LEGAL DESCRIPTION HOMEMADE~ ns de ength WellIF ~Z/j / ~welling Manufacturer Material DISTANCE TO: Well /4~ '~ Found~?.,~ -- Nearest~g~ne [ ~. No. of lines /' ¥idth / ~ ~- ~ O inches Top of tile to fin Material beneath tile~'_3/f) ~ inches Length Width Depth Type of crib Crib diame~e~r.) Well DISTANCE TO: Class No, of compaFt~e~s Liquid capacity in gallons Crib depth Total effective absorption area foundationSeptic Nearest tank lot line Distance to lot line foundation Sewer line DISTANCE TO: OTHER LOT :, .,~E [ ,~-'P:. ! HF I E_C :!~(}IL...F-.[F!T;[N!] ,::E;E;! F I,- Fi,-.. -., THE L.EENGTH DI!dENS;-~ON ~TS THE LEHGTH ,::I.i',! FEET) OF THE TRENCH OR DRAZNF!EL.E:,. "rile DEPTH OF' R TREiqCH OR PiT iS THE DISTANCE DETHEEN THE SLIRFi::tCE ElF THE GROUND Ri'.,][::, THE BOTTOM OF TFiE EXCRVF-T'i-ION (iN FEE'!"). I"HE GRRVEL DEP'i"H ]:S THE MINIi',IUi'I [:,EF'TH OF GRF:!VEL E:ETtqEEi'..i THE OU]"FAL!_ PIPE FIND THE BOTTOM OF THE EXCFiVR-FZON (I!'..l FEET). ?,~:.?l','!T",r I:IF'P[ ]["FI['IT 14g!''7, ]'!..l~',~.*...::,r-?,!::,.~,.,L.,-F: ]"0 !i"!F'OiZE'h'I THIt.F.', L:'b.F'MR]MEi"tll [)UR :[ i",!I] TdE .!.t".!:::,],~I[..I...HifUN tN.z,,-ELt~, r.,':: L!? I:~i'..ty HELLS FiDJRCENT iit "[HI';:J F'ROPERT'¢ FINE:, THE ...... :;':':' -' - ~'" '"" ;' THE; I'.IEL. L .... ?',!Ut'"iE:E;R U~' .,~..._, i .. ,...! .. h..., 'f'HFiT _ i'!:[ N i MUi,i D :£ E;TF!NCE E:E"I'i4EE[N Fi HELL. RND C:iN'T' 0i',~'":~; Z TE :SENF!GE t:::, I SF'OSRL E;YSTEM ]: S ;:iJbE! FEET FOR i::i PR?,,"A"FE FE:L.L OR :LS~ TO 2E~([i FEET FRO?I R PLiE',L. IC: WELl... DEPENDING UPON THE ]'~'PE OF PL!BL!C i.,.!ELL.. HINZHL1H DISTFiNCE F'RO?i R PRI'v'RTE i.4ELL 7'0 R PR!",,'R'T'E SEi.qER LINE IS 25 FEET F'!ND TO Fi COMMUNZT'¢ SEHER LINE IS 75 FEET. OTHER REiE:!UIREMENTS MF!':" RPF'LY. SF'ECIFZCFIT!ONS FiND COi",!STRUE:TZE~N D;fFIGRRMS FIRE iq","FIILF:IE:LE TO ZI'4S[J~]'.E PROPER iNSTf~LL. RTION. FOi:~:Ti4 P,'¢ ]'HE ?i[..IN I C I F'RL. T T%' OF FhNCHOF.:.'F!GE. 2: i I,!!LL ZNSTFILL ]"HE S'¢E;TEH IN RCE:ORC, Fii'.~CE 14l'f'H THE E:EiDES. Z~:: i Lii-.,E:,ERSTRh!D 'T'HFf]" THE ON-SITE SEHER S'-,.'STEH ,~.'IR%' RE~J:!(.I!RE EI'.~!....RF:~fZ.~EHEi'.,!T IF' THE RESIDENCE :ils REi'dE,'DEL.ED i'O ]:NCL. UDE h!ORE THFIN 3: BEDROOMS. F F'F'L ][ ;~Fi" ' ~;~:F..,i::!l'.;i r':ot,,!::: "!" ....... r~. ! l' i 'I"HF!]" T RI',1 FFlt'!iI "Ri4' HITH THE .I~ ........ . ........... t ............... - .... r;,: '~'~i" r,-,: FOE: ON-SITE ':F'hIF'P'~ FI!".!D HELLS c,,= ::,b.i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PEREORMEO FOR: LEGA~ OESCR,FT,ON: 2 8 9 10 12 13 14 15 16 17 18 19 20 COMMENTS DATE PERFORMED: Gross Net Depth to Net Reading Date Time /ime Water Drop / PERCOLATION RATE /~'1 //^ (minutes/inch} TEST RUN BETWEEN -- F~A~D FT SLOPE $ITE PLAN ENCOUNTERED? pO E iF YES, AT WHAT DEPTH? Municipality of Anchorage {a On -Site Water and Wastewater Program (907) 343-7904 s E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-582-34 1. GENERAL INFORMATION Expiration Date: � 0 V a Complete legal description Thunderbird Heights #3 Block 6 Lot_8 Location (site address) 24636 Teal Loop, Chugiak, AK Current Property owner(s) Jason & Diane Gifford Day phone Mailing address 24636 Teal Loop, Chu�iak, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual M Individual Well ❑ Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System M WaiverNariance request for: Distance: Received by: _ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _ 550 _ Waiver Fee $ Date of Payment////6Z I Date of Payment7'1- Receipt Number"G Receipt Number COSA # 0 _56,2116 7 0 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _ARCTERRA CONSULTING, INC, _ _. Phone _ 696-6111__- Address 20441. PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS __...___ _____ _ _ Date (4La�A__ Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and 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 occupants or can ArcTerra guarantee that no unseen eif OF 44 encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE A4, 0/ / KENNETH \r. 1!' Vs 1 .! System #1 Approved for bedrooms. , ,g System #2 Approved for _ bedrooms. I��\ . Disapproved. Conditional approval for bedrooms, with ltt�Tj jff ng stipulations: OF �yO�?r,i _ 0 ___._.... gY_.._..__ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site 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 _,1. _. COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: Thunderbird Heights #3 Block 6 Lot 8 Parcel ID: 051-582-34 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA li log is filed with Onsite (or attached) Date drille Total depth 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 B. TANK DATA Age of tank(s) 6 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/25/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/14/85 ra ALL standpipes present per record drawing Total measured depth from grade 7 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field V Monitor tubes go to bottom of effective. If not, state depth into effective 01 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet 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) genic ug/L ❑ Arsenic less than MRL (ND) Collected-llrl� Date of Sample C. LIFT STATION wired maintenance completed Age of lift sta years Lift station material Comments: Adequacy test date 11/11/21 Results Q Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 2 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) nklLift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' [:]Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ft Animal o nt > 50' ❑ Yes if No ft ❑ Yes if No ft if No ft Community Wells > 200' ® Yes if No ft Manure/Animal Excreta Storag Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes I ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 8.3* ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No 2** ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ® 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' 0 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' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS * Per 10/9/15 Inspection Repot meet code at time of installation. ** Waiver OSV151140 granted 10/9/15 G. ENGINEER'S CERTIFICATION i certify that / have determined through field inspections and review S -' Y ' of Municipal records that the above systems are in conformance with A `f 4 V1It MOA COSA guidelines in effect on this date. KENNETK M- us ♦+ S, CE 71 W COSA Checklist yellow sheet 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~lS1 -~R?-R4 HAA# ~.~ ~ ~ 2~ .~..,, ~ ~;~,, GENERAL INFORMATION Complete legal descriptiOn Lot 8 Block 6 Thunderbird Hts. Addn #3 Location (site address or directions ?a~ Tr~l I nnn Property'owner~n~-n~Carlile/ KND Enqineerinq Dayphone 696-6111 Maiing.address ?,q4~l ?,~,~r,;'i~*" .q3..~.-~ F.~.r Lending agency Day phone Mailing address Agent Address R~ver Day phone 69,~-~20'0 Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 4 '~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XX NOTE: 4. ' TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system.. '.~ .. ~::,,,, \ ,., - If community wastewater system, provide wri~on confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-~25 (Rev. 1/91) Front MOA~I 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.. NameofFirm KNr) Engineering Address 20441 Ptarmiaan Engineer's signature Btvd Eanle Phone '6'96-6111 River,AK Date DHHS SIGNATURE .7 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments \,~";'~he ~u~ni,~ pality of'./~¢~orage Department of Health and Human Services (DHHS)issues Health Authority *,,~,pproval Oertific~'ti~' b~sed only upon the representations given in paragraph 5 above by an independent profesmo,nal en, gmeer registered m the State of Alaska. The DH H8 does th~s as a courtesy to purchasers of homes and theft fending insbtutions m order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 12-025(Rw. 1/91) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescdption: Lot 8 81 k 6 Well Data Log [ Total depth __ Sanitary seal (Y/N) Thunderbfrd Hts. Addn #3 ParcelI.Di 051-582-34 If A, B, or C, attach ADEC letter. ADEC water system number. Date completed Driller Cased to Casing height Wires properly protected (Y/N) Date of test Static water level Well flow .g.p.m. ATINSPECTION g.p.m. ~ Pump level1 ROM WELL TO: , / ; On adjacent lots ~ ; On adjacent lots _ Absorption fi~ld on lot ~ .... Public sewer main Public sewer ma~ Sewer service line Petroleum tank Colif~ · Date of sample: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 9 / 82 * Cleanouts (Y/N) y High water alarm (Y/N) N / ^ Date of pumping 5 / 1 6 / 95 Tank size 1 250' Compartments 2' Foundation cleanout (Y/N) y Depression (Y/N) Alarm tested (Y/N) N / A Pumper JR's PumpinQ Foundation Water main/service line ~0~+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N / A On adjacent lots N / A TO property line 1 0 ' + Absorption field 5 ' +.,~i~ k' Sudace water/drainage ] 0 0 ' + * Information from records on file w/ DHHSI~0A CONTINUED ON BACK PAGE 72-026 (3,93)* Frcnt Manufacturer Size ia gallons ~ Manhole/Access (Y/N) Vent (Y/N) ~evel at , "Pump off" Level at - alarm level ~~ Cycles tested High water Meets MOA electrical codes (Y/N) __ D. ABSORPTION FIELD DATA Date installed q.Ig? .pfirarl~rl t-n*Soilrating(~l)/~) 1275~c,/hH~,rn * System type 5' wide trench* Totaldepth 7 ' * .Depression over field (Y/N) for 4 Length60,. 4 bdrmv~i/dt~5 5'* Gravelthickness Total absorption area 517 s f* Cleanout present (Y/N) Y Date of adequacy test 5 / 16 / 95 Results (pass/fail) P a s s Water level in absorption field before test ~ 3 . 5 " to bottom of MT°Aftertest ]5" tn b~tt~m ~f °Water observed runnino in laterals n~ior to testing Peroxide treatment (past 12 months) (Y/N) ' N If yes, giv6 date N / a. N Bedrooms ~To SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N ./A To building foundation 1 I~' On adjacent lots "ii.0 ' Surface water 1 00 Curtain drain N / .~, E. ENGINEER'S CERTIFICATION On adjacent lots N / A Property line To existing or abandoned system on lot Cutbank N / ,a. Water main/service line Driveway, parking/vehicle storage area 1 ~ ' + * ii,?urmra-t-4-on fwo,m I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ~ Engineer's Name K e n n e t h M f u s Date 5/1 8/95 Kemzelh M, Du CE 7116 HAA Fee $ ~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel A. WELL DATA Well type If A, B, or C, attach ADEC letter, ADEC water system number Log present(Y/N) Totaldepth Sanitary seal(Y/N) Date completed Driller Date of test Cased to Casing height Wir. es pr~ FROM WELLLOG ~~ AT INSPECTION Static water lev~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot g.p.~,~) ; On adjacent lots Absorption field on lot Public sewer main Sewer service line WATER SAMPLE R~ Coliform Nitrate Da~mple: ; On adjacent lots Public sew~anout ~PeI~oleu m tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed c~ ~ \ ..~?.~ Cleanouts b/N) ~ High water alarm (Y/~ Tank size \ '7..-~ O Compartments Foundation cleanout Q/N) ? Depression (Y/I~) Alarm tested (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: / Well(s) on lot ~-oo ~*~'~ On adjacent lots '~/,~ To propertyline ¢~c, I-h Absorption field ~-- f Surface water/drainage ~ ~ O Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ Meets MOA ele~ Manufacturer Manhole/Access (Y/N) ~ ~vel at Cycles tested Surface water D. ABSORPTION FIELD DATA , Date installed ,/~ 2/ Length /~'O ~ Width Total absorption area ,5-~/ Depression over field (Y,~ Results ~/fai I) Peroxide treatment (past 12 months) Soil rating Gravel thickness System type ~)/-.,4- Total depth Cleanouts presentd~/N) Date of adequacy test '~- ~ -~"~ for ~ ~-- bedrooms ~'/.'./o ~/,~/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~--~E:> (2 [ ¢- To building foundation On adjacent lots Surface water Curtain drain /"//,4- On adjacent lots /'-"('.~ Property line ,/o To existing or abandoned system on lot Cutbank A/(/~ Water main/service line /~ / Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidefines in e 5 & $ ):~NGINEERING 17034 t-:agie River Loop Road NO. 204 '.¢."~!" ~;v~* Alar, ka 99577 Signature Engineer's Name Date HAA Fee $ Date Receipt Number Waiver Fee: $ Date of Payment Receipt Number 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 8; Block 6; Thunderbird He~ght~ #3 Location (site address or directions) ~4636 T~al Loop ~hu~iak~ AK 99567 Property owner Mailing address Lending agency Jame~ 0arlile 24636 Tex~ Loop Day phone 688-5018 Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 4 ~ Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1/91) Front MOA #21 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 verifythat 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 170.34 E,~gle River Loop Road No. 204 Address Engineers signature DHHS SIGNATURE ,~- Approved for Disapproved. Conditional approval for /~--2_.~-~/~)' bedrooms. Phone bedrooms, with the following stipulations: Additional Comments By: Date ////~.~' Z7',~., , 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 DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 Mr. Ray Shafer S & S Engineering March 26, 1993 SUBJECT: Thunderbird Heights Class "A" Public Water System, PWSID 211156 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 1, 1993. This d~oes meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on September 14, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water'-~gulations. The last Radioactive Contaminants sampl~ 'results were submitted to the Department on December 1, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water ReguTa~n~. ..... ' The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 4, 1992. Based on analysis of . the previous VOC samples results have been satisfactory. This d__o_e~s .rnee___~t~ the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II MUNICIPALITV 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 u¢/l"~/~- GENERAL INFORIVIATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~ Applicant Address Telephone: Home ~°r/¢- ~'¢ 2~__ Busing. ss (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain}; Telephone (d) Lending Institution Address (e) Real Estate Company and Agent Address ~-'/'~ Telephone (f) .~the 14AA to the following address: SRB Ig~( PH. ~94-2978 TYPE OF RESIDENCE Single-Family'~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] Public/~ Note: If community well system, must have written confirmation from the State Department of EnvironmentcJ Co~se~,atio~ 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 Er~viroemental Co~$erv : , attesting to the legality and status. , ,: Pagelof2 : ',' '..: *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 my investigation and inspeotion, 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 Address Date DHEP APPROVAL Approved for ~t~'~4 ~/¢~] bedrooms by Approved _. :'<~ Disapproved Terms of Conditional Approval Date Conditional 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 A)aska. 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 cooduct 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 (MOAI HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: WELL DATA Well Classification Well Log Presem~/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample_..ColF~ed by Water aS~mmple Test Results IfA, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At ~ Sanitary Seal on Casing (Y/N) ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments SEPTIC/HOLDING TANK DATA .~'~' ¢~_ ~,.~ ~_~ ~¢ ,.¢' -~ Date Inst~ Size No. of Compartments Standpipes (Y/N)~""'~ ~ Air-tight Caps (Y/N) __ Foundation Cleanout (Y/N) Depression over Tank (Y/N)---'~~'-~. ~ Date Last Pumped Pumping/Maintenance Contract on~ ~ __~ ~.;-J Holding Tank High-Water Alarm (Y/N) "*-~-~--- ~..emp_o~rary-H-ol~ing Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~'¢ To Building Foundatlom ~ To Property Line To Water Ma~e Cour..me~ ~__~_'4~ments To Disposal Field To Stream, Pond, Lake,'~or M~nage Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ' I f Width of Field ~"O ~t Type of System Design Length of Field ~'O Square Feet of Absorption Area ..~4--/'~¢ ~ Depression over Field(~q) Results ol Last Adequacy Test _~,,,,,¢ Separation Distance from Absorption Field: 2.7 + To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Depth of Field Gravel Bed Thickness Standpipes Presen(~N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,-.~'¢/,~' z~/,¢¢ / To Property Line ~ ~' /' To Existing or Abandoned System on ; On Adjoining Lots ~ ~''/-' To Cutbank (if present) D, LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Manhole/Access (Y/N) ,/ "P/mp Off" Level at / ///) V~nt (Y/N) / f'~uumping Oyoles during Adequacy Test. Meets MOA / Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed ,9 & ~¢~-~..N_G!!~t~t-~INR Date Date of Payment Page 2 of 2 72-026 (11/84} GENERAL INFORMATION (a) (b) (c) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICA-FE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~(~ Location (address or directions~, , Applicant Address ~--~-'" ~'/"~J~"'/'"~ -- ~'~' ~ Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address ~:;~,"~ ~/'/~'~ he HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family~ Number of Bedrooms Other 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 OnsitexJ~' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 {11/84) 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 tl~e 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 flies 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 inspect~r~ ~.~ E~GI~JE~RI[~ . 8R~ ~98~ Telephone Name of Firm . ·: ,~L~ R~~ Address ............ ~ ~ Date 6. DHEP APPROVAL Approved for; ~'7/4'~-~-~ (:~,]bed rooms by Approved~r ~ ,__ Disapproved ~ Terms of Conditional A,,pproval Conditional 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 end 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal D~. ,ription: Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Well Classification'~,L~O - If A, B, C, D.E.C. Approved Well Log Present (Y/N) Date Completed Yield DeC of Grouting ,//~///~ Pump Set At //~Sanitary Seal on Casing ('Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ~;;:~-~ ~ To Nearest Edge of Absorption Field on Lot ~,~:~) To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ' ; On Adjoining Lots ; on Adjoining Lots To N/earest Public Sewer To NeWest Sewer Service Line on Lot ;Date B. SEPTIC/HOLDING TANK DATA Date Installed ~'~/'" Stand pipes~.4~'~ Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments Size ~¢~.~O No. of Compartments Air-tight Caps~'~-~ Foundation CleanouCZN'J o/ Date Last Pumped ~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026(11/84) ABSORPTION FIELD DATA '.- WidthofFie,d ' 7 DeptbofFie,d ? -- :' Square Feet of Absorption Area "~f~-.~/ Standpipes Pms~nt~) Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well c~O~ I ~ To Building Foundation ~-~"~ / :~ Lot /"////J" To Water Main/Service Line ,_~'7~ Date of Last Adequacy Test To Propedy Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments .~,t~.~s.~e_r'¢'~ ,~F~.L.L. , ,",.~,~c~Oo,-~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Dimensions Size in Gallons IV~ehole/Access (Y/N) "Pump On" Level at /~ //"Pump// Off' Level at High Water Alarm Level at ~' ' / Vent (Y/N) . / // Tested for //h~'' Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M,,OA an¢ HAA guidelines in effect on the date of this inspection. Signed ~q~ff~['~. Date .~///2-'"/ , · 8nB- "' / ~- Comp~,n¢I~~m~ MOA No. ,~-' ¢/0 .~, Receipt No. Date of Payment ]gEPT. OW ENViRONMENTaL ~ON~SERV,~TiON~ , BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 To Whom it May Concern: y Water Regulations Sincerely,