HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 4 LT 15 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
~A~L~N~ AdUfiES~
LEGAL DESCRI~TI~ - I ' -
DISTANCE TO: Absorption ar~ Dwelling
~ ~' IL,q ~c~gallons IF HOME,DE. Inside length Width Liquid dep~
~ ~ ~ DISTANCE TO: Weld Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
Q Wel~ ~ Foundation 'o, Jlne~d ,~
-- Total~y~f~ nas Trench~inches Distance b ,ines
~ :T°p°ftile~finishgrade~ Materlal beneath tile ~ Z inches~.~
Length Width [ Depth PERMIT
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
DATE LEGAL
PERMi"F N']
Fff:'F'L t C:FINT
LOC:FFE I 0 I'.,I
LEGRL
..r-.r~ r I4I F[ ~..,HL:.F,. '!,693 BL. UE c, PR. :E
L 15 B 4 THUNDERE~IRD HEIGHTS LDT
I~ I Z E
6,=3Z,-"Z24.E
· .'L800EI E;QUFIRE FEET
H.E,_uF.E I].t.d'~ ~....,IE. I1 t=,. TF. EN..N
MFINIMUM NUHE]ER OF EE. ERt. LH:, = 4
'SOIL.. I~'FITII'.,IG (SC! . ,-R.-
-I'HE REQUIRED qTZF'; !DF' THE 50IL RL,_,URFTIUN
THE LENGTH DIMENSION IS TFIE LENGTFt (IN FEET) OF THE TRENCH OR DRRINFIELD.
TNE DEPTH OF R TRENCH OR PiT IS THE DISTRNCE 8ETNEEN THE SORFRCE OF THE
GRE)L.IND FIND THE: BOT'TOM OF TNE E~'::CR',/RTION (IN FEET).
TFIERE iS NO SET klIDTH FOR TRENCHES.
THE: GRRVEL DEPTH IS THE MINIMUM [:,EF'TN OF GRFIVEL E:ETNEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE E::.:',CRVRTION (IN FEET).
F'ERMIT HFF..I .ItNT HFI$ THEr~"..T..rr~"""-r"'""l'--'[~-'"'.,F',.T.,-D. AL~A?-¢''/T "1"0 INFORM. THIS DEPRRTMENT DURING THE
' "'~" -''- FHI_, c;'F
~NSTRLLFIT~ON ~N:,F,__.T.[LN:, OF ~N'¢ HELLS FC)JFICENT TO ' "c , r~.r~r,.~ FIND TNE
NUMBER OF RE_,IEENLE_, TNRT THE HELL HILL .... ,-.,,_.
BF~CKFILLING CF FINV _,~_,TLH I,.!ITHOUT FINFIL INSF'E:TIGN RND bF. ~:. HL E,~ THIS
E:,EPRRTMEN]' HILL E:E ~:USJEC:T TO F'ROSECUTION.
MINtMUH DISTFtNCE BETWEEN R WELL RND RN'¢ ON-SITE SENFIGE DISPGSFtL ':;'YS]"EM IS
±00 FEET FOR R F'RIVRTE I.,.!E[...L. OR ±50 TO 200 FEET FROM R PLISLIC HELL DEF'ENDING
UPON THE TYF'E OF PUBLIC: WELL
MINIMUM DIE;'TRNC:E FROM R PRIVRTE HELL TO R PRIVRTE SEWER LINE: IS 25 FEE'T FIND
TO R COMt,IL~NZT'¢ SEWER LINE IS 75 FEET.
OTNER REQUIREMENTS MR'T' RF'F'L'T'. SPECIFICRTIONS FINE:, CONSTRLtC:TZON DZRGRF~MS RRE
FWRZL. RBLE TO ZNSUP. E PROPER ZNE;TRLLRTZOF,!.
I C:ERT I F"/ THRT
!: Z BM F'F!HILIRR I.,!ITH THE REQUIREMENTS FOR ON-SITE SEWERS RND NELLS RS SET
FORTH BY THE MUNIE:IP,~LIT'¢ OF FINCNORRGE.
2: I HILL INSTFtLL THE :E;'T'STEM IN RC:C:ORDFflNC:E 1.4ZTH THE CODES.
Z'::: I UNDERSTRND TFIRT THE:ON-SITE SEWER S'¢STEM MR'?' RE[.:!UiRE ENLRRGEMENT IF TNE
RESIE:,ENCE IS RENODELED i'0 INCLUDE MORE THRN 4 BEDROOMS.
S ! GNED:
F~F'F'L Z CF!NT LMEF. ? H I TFtSCNEK
:~UNICIPALITY OF ANCHORAGE/'~
Departmentl . Health and Environmenta~ ~rotection
825 L Street, Anchorage, AK. 99501
264-4720
Wj~,~[D/OR ON-SI'TE SEWER PERMIT
Applicant: LOrry ~xDL:~ Sc~c~ Mailing Address:
Location: Phone Number: ~-~ '
Type of Soil Absorption System Is:
Trench: ~-~ Drainfield: Seepage Bed; __ Holding Tank:
Maximum Number of Bedrooms; .~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH I/ LENGTH ~.~9% GRAVEL DEPTH ~ WIDTH
The length dimension is the Iength(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ ~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
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. Minimum distance from a private well to a private sewer line ~
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may ~equire enlargement if
the residence is remodeled to include more that~ bedrooms.
S igne~: Is sued by: ~
Applicant
SWP/024(1/81)
z 'q ' /'4UN~C~PAL~T¥ QE ANCHORA(t~J~
f~r~nch ~ __~ Drain fteld ~ Se~pa~e ~d ~ , , Hold
- ,:.~ Length dnnans~on L~ kha l~nq~h(~n ~ee~;) 0f ch. k~mach or
~be boat. om oE ~ha azeava~ion(ta a~e), ~ere is no ~et widkh
~ ~ Ra~UIR~D ~PFIC(HOi~I~KS) YANK S{.j~ ~ /.-~..5' ~LL,O~
.. ~.,, -applicator l~as t:h~ r~pon~b~Ziby to i~o~.~ ~hk~ dapart~n~
-~ ~ a '~qO(2) INSP~CI'ION~ ARS REQUIRED ~ 9
ava~ab~ to ~nSUU~ prOP~ inska~J, akion, '
a ~ ~ PERMfT MXP~R~S D~CM~R 31, 1 9 8 1 ~
I ~'tL~y that:
PERFORMED FOR:
LEGAL DESCRIPTION:
/ ~ LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
L c. y
[] PERCOLATION
TEST
SLOPE SITE PLAN
10
11
13-
14-
15-
16-
17
18
19
20
COMMENTS
ENCOUNTERED?
0
P
IF YES, AT WHAT
DEPTH?
PERFORMED BY:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
,(minutes/inch)
FT AND -- FT
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED BY~~--
72-008 {6/79)
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 i5; Bloc~ 4; Thu,nds¢%,~rrd :
'' H~g,¢~s
Location (site address or directions)
24739 Te¢¢, Loop
Property owner J~try Ad~s
. Mailing address' ' ~'(~:' 8oz 6F1165
Chugiak, AK
Day phone
~,zu~z, AK 99567
688-0133
Lending agency ~ Day phone
Mailing address :'
Agent Sharon Minsch/ R~ax o~ EAGLE RIVER
Address
Day phone
694-4200
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 ~,
TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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.
(Rev. 1/91) Fronl MOA #21
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 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.
Phone
Name of Firm $ & s ENGINEERING
17034 Eagle River Loop Road No. 2[~4
Address EacJle River, ~Alaska 99.~ 77 /
Ena neer's sianature '¢P[,~¢ ~
bedrooms.
DHHS SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: .-. .
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in 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.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343'474c4~iI~lONMENTAI'$EI~ISlON
Legal Description:
A. YVELL DATA
Well type
Health Authority Approval Checklist
E~'/--~ '~¢,o~v,¢_.c~,¢4:;, Parcel I.D.:
JUL 15 199B
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary. seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE/I~S~TS:
l~fte of sample:
B. ~OLDING TANK DATA
Date completed
Cased to Casing h~)
Wires,pj~ly protected (Y/N)
FROM WELL L~ AT INSPECTION
Nitrate Other bacteria
Collected by:
Date loC'ailed ~c~ ~\ . .
Length ~.,~ I . Widths,':;' "~ ' Gravel tlfickness below pipe
Effective absorption area 57~ r---4q~, Monitoring Tube presentlY) ~
Date of adequacy test ~ -- Za ~11,. Results~ail) ~,~-~
Fluid depth in absorption field before test (in.): S'-~ '~ lnunediately ,after ~:> gal. water added (in.): __
Fhfid depth 5-6. ' (ins.) Minutes later: J,,?5'"" Absorption rate = ~,~o 4' g.p.d.
Peroxide treatment (past 12 months) (Y~ t,/o~J~ /~,D~,~/If yes, give date '"/t/~
~>~/~ System type "¥-F--~r-M
'7 ~ Total depth 1 { '
Depression over field (Y~)_ ~
For ~/ bedrooms
Soil rating (g.p.d./fi2 or fl2/bdrm)
Date installed lq. ~, l Tank size 1~5;~22> Number of Compartments '7~ Cleanouts ~N) x~
Foundati~n;.?ean0~t~q~l) x/ Depression(Y{~j~) ~ High water alarm (Y/N)
Date oi7 Pumping /,,o ~ ~cl ~q ~ Pumper ~_~-, O0'MPv~ q
ABSORPTION FIEI~D DATA
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) "Pump oa" level at* ~F' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sower lnaill
: On adjacent lots
Lift station
SEPARATION DISTANCES FROMI~-~C_C)HOLDING TANK ON LOT TO:
Building foundation '7 t Property line I O ~ ~ Absorption field
Water mai~ffsen, ice line /o ~ ~ Surface water/drainage /oo / 4 Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surfi~ce water
Curtain draio
Water mairffservice liae
Driveway. parking/vehicle storage area /~
Wells on adjacent lots "'/.~o t 4- Property line
F. ENGINEER'S CERTIFICATION
m coq/ormance w~th ]vJOA IIAA gmdehne.y, m effect on thts date.
~--~ ~
~:
..........................................................................................................
HAAFee $ ~'~J Waiver Fees
DatcofPayment ~ )~ ~ Date of Payment
Receipt Nunlber ~ ~? (5'~) Receipt Number
Re;,. 8/95 eSS: haa.wk.doc
IMUNICIPALITY 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
A,,licationoate
GENERAL INFORI~IATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(c) Applicant is Ich~¢k one): Lending Institution I-I; Owner/builder ~'; Buyer []; Other [] {axplain); .
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
$ & $ Eugln¢or~ ~[J
TYPE OF RESIDENCE
Single-Family ~ Multi-Family
Number of Bedrooms ~7
Other
WATER SUPPLY
Individual Well [] Community J~ Public
[]
Note: tf 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 ~ave written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
~NGINEERING FIRM PROVIDIN~ ~NSPECTIONS, 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 end 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 ~ 9, .~ En~li~eerJ~ Telephone
Date /
Approved for __/-~A¢~ bedrooms b
Approved __~'~ Disapproved
Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy.to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
WELL DATA
Well Classification
Well Log Present (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA)
MUNI ........ HEALTH AUTHORITY APPROVAL (HAA)
~'~r'~'UY OF ANC~L,~/i~T BRUARY 1984
DEPT. OF HEALTH ~&n~..... .... - FE
ENVIRONMENTAL P'~OTECTiON 264-4720
~EC 2 6 10~5 Legal Description:
RECEIVED
~ I( A, B, C, D.E.C. Approved~N)
Date Completed
Cased to
Yield
Depth oI Grouting
v,~ /PumpSetAt
ta~ary Seal on Casing (Y/N)
Depression Around Wellhead (Y/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 '7-"c-~='~ Jf
To Nearest Public Sewer Line
CleanouVManhole
Water Sample Collected by
Water Sample Test Results
Comments ~:~, \~.-), ~, ~ ~.- I J ~ ~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/~OL-~IG TANK DATA
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Date Installed td'~ CZ--~' ~l
Standpipes ON) Air-tight Caps/~/N)
Depression over Tank (Y/~)
Pumping/Maintenance Contract on File (Y/N?,,
/
Holding Tank High-Water Alarm (Y/N) /~
Separation Distances from Septic/H~M~i,~ Tank:
Size VT--,~'"~) No. of Compartments ~--
Foundation Cleanout ~¢~N)
Date Last Pumped
)
/~ ; for
Temporary Holding Tank Permit (Y/N) "'~/,&
To Building Foundation "/~
To Disposal Field ~ i
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well "Z--~c~I'~ To Property Line ~ I..~
~?~"¢P']I~cL-., Type of System Design
1
Length of Field ~-~
Depth of Field ~, \
Gravel Bed Thickness ~ l
Standpipes Present ~N)
Date of Last Adequacy Test
To Building Foundation
Lot ~
To Water Main/Service Line ~ t4,
To Stream/Pond/Lake/or Major Drainage Course
To Driveway. Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots
~.~//~To Cutbank (if present) ~.
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
t/,an hole/Access (Y/N)
Pump Off" Level at
Vent (Y/N)
Tested for
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 MOA and HAA guidelines in effect on the date of this inspection.
Signed ~.~& !~ E~gle~rln¢ Date
~B 196x
Company ...........
Receipt No. ~(~ ~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD~ GOVERNOR
Telephone:
Address:
274-2533
MUNIciPALiTy
Etu,. DEp~. O. OF AIVcHm~
'.'~L p,~OTE~.TiON
RECEIVED
To Whom 'it May Concern:
~ ~jL___~ Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
APPLI(?'~NT FILLS OUT UPPER HAI'-~ONLY
Proper,y Owner Phone
Address': - Zip Code
Phone
Lending Institution ~ ~ ~/~ ~ ~7~
Address
Legal Description ¢~ ~ ~ /.~ ~ y ~
Type Resi~nce
Water Supply
~ Individual A~ACH WELL LOG. A wall Icg is required for all wells drilled since June 1975.
For wells drilled prior to that date. give well depth (attach Icg if available).
~ Community
Public Utility
Sewe( Disposal /~ff~
?ndividual Year Individual Installed:
~Public Utility When Connected to Public Utility:
~ ~lding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE. EST BEFORE ~OOESSlNG CAN BE INITIATED.
Inspector Inspector Inspector
Field Notes:
...... ~""-~Y
( APPROVED BEDROOMS z *CONDITIONS OF APPROVAL tz,~:~ ~ ~'~ .~
( ' ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer installed Well To Absorption Area Well Log Received
~,~({~ Well to Tank Septic Tank Size
Time Time .... ;e
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
~ Phone
P~opertYMailing AddressOWner ~/ ~/~C~
Buyer
Lending Institution ~ ~ ' Phone
Typ~ Residence
~Single Family
~ Multiplo Famil~ ~o. of Bedrooms
D Other
Water Supply
~lndividual A~ACH WELL LOG. A well log is required for all wells drilled since June
Community 1975. For wells drilled prior to that date, give well depth (attach log if
~ Public Utilit~ ~vailable.)
Sewa~ Disposal
~ individual Year Individual Installed:
~ Public Utility When Connected to Public Utility;
~ Holdin~ TanE
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,