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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3A BLK 7 LT 6Thunderbird Heights #3A Block 7 Lot 6 #051-581-18 Municipality of Anchorage /" p� On -Site Water and Wastewater Program • (907) 343-7904 ITTA ■`•UJ ON-SITE WASTEWATER INSPECTION REPORT SEP 2 7 2016 OSP161262 051-581-18 Permit Number: PID Number: Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: Parker Dalla ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 24328 Thunderbird Dr, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 269-370-3576 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Thunderbird Heights #3A 67 L6 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well * TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250 Gal. Surface Water 100+ Material Number of compartments Lot Line 5+ Steel 2 NA Foundation 5+ LIFT STATION Manufacturer Capacity Curtain Drain None Known Gal. Remarks Pump on level at in. Pump off level at High water alarm at ' 200+ to the nearest well (Class A) in. in. ** D3034 used to tie into existing pipe Pump make and model Electrical Inspections performed by Installer to** PIPE MATERIAL House to tank ** d Tanain k ld Flintstone Enterprises Drainfeld CO/MT Inspector Crewdson Engineering LLC BENCHMARK (Assumed elevation) 100.00 ft Inspdatesn ec 61 1 9/26/16 9/26/16 Location and description - zm 30 4th Bottom of siding to right of front entry door COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL `��mp F q��'t' O00 Conditional Approval: Date 9 / mes A. Crewdson ;� u C115 7 Approved r� d;EC �- (� DatetiIOFESSIONP�— A ILL mspeciion nepon_y-riz.aoc Lot 7 t � I ENCHMARK 100.00 (bottom of siding) 13 wall o i 0 0 co ST1 Lot 5 ST2 DCO lsphalt 1) Deco rf existing 1250 -Gal y septi 1 cod f 2) Installed 1250 -Gal a AP -septic tank and Mph double cleanouts. ' 3) Three deck supports shown to clarify /� PLAN V location is not over the tank.mmissioned SCALE: 1 "=30' { { Swing Ties: A -STI : 43.0' B -STI : 24.6' e Note: This property is served 1s, by a public water system. INISH GRADE 100.20 (mounded to achieve 2' cover depth) FCO ST1 ST2 DCO PROFILE 1250 NO SCALE _„r' Septic Tank \,jf �Insulation 97.62 97.45 Thunderbird Heights 3A, Block 7, Lot 6 Septic A 1-41, Record Plan and Profile Civil & Environmental Engineering "O Bm 671389 Chugiak AK 99567 . cellc.A@o fl ak.a Cell/TeA 907-280-N93 . Fax: 907-688-2295 Prepared for: Parker Dalla Permit: OSP161262 Date: 9/27/16 Sheet: 1 of 1 Wames dson •. atveavw� ALLC #112279 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161262 Tax Code Number: 05158118000 Work Type: SepticTank Upgrade Permit Effective Dates: September 22, 2016 to September 22, 2017 Design Engineer: CREWDSON ENGINEERING, LLC Subdivision: THUNDERBIRD HEIGHTS #3A Site Legal Address: THUNDERBIRD HEIGHTS #3A BLK 7 LT 6 G:1865 Owner/Address: DALLA PARKER J & ALLISON C 24328 THUNDERBIRD DR CHUGIAK AK 995675126 Site Mailing Address: 24328 THUNDERBIRD DR, Chugiak Lot Size in Sq Ft: 42740 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By �- z6 � ((p7 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-581-18 Property owner(s) Parker Dalla Mailing address Day phone 269-370-3576 Site address 24328 Thunderbird Drive, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Thunderbird Heights #3A B7 L6 Legal description (Township, Range & Section) Lot Size Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank X❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) X❑ Upgrade X❑ (w/wo ADU) Renewal ❑ Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the ab ve information is correct. I further certify that this is in accordance with applicable Munical Codes. owner or authorized agent) Permit/Rush Fees: �a/s 40 Date of Payment: Receipt Number: Permit No. Dt✓1° I lot 94 el Permit App_-'-:. Waiver Fees: Date of Payment: Receipt Number: Waiver No. CIA & Emlronmmtal Engineering September 20, 2016 Municipality of Anchorage On-site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Attention: On-site Engineer Reference: Thunderbird Heights #3A, Block 7, Lot 6 Septic Tank Permit Application Design Narrative James "Jay' Crewdson, P.E. Email: CELLC.1@outlook.com Cell/Text: (907) 280-9493 Fax: (907) 688-2295 The owner of the subject property would like to replace the existing septic tank (1983 1250 -gallon steel) with a new 1250 -gallon septic tank. The existing tank will be removed from the property in accordance with the code and the proposed tank will be installed in the same location. The soil cover over the existing tank is mounded to provide the required 4 -foot cover depth. The proposed septic tank shall be covered with 2 -inch approved insulation and 2 -foot minimum soil cover. Per AMC 15.65.030 C3, the existing septic tank is: 1. S+ feet from any property line or building foundation; 2. 10+ feet from any water main or water service line; 3. 100+ feet from any surface water; and 4. Greater than the separation distances required by 18 AAC 72 from water supply wells. Please feel free to contact me if you have any questions. Thanks, Crewdson, P.E. q(4Ik raj,• V *::49 ......'� . es A. rewdson C11527 115a PO Box 671389 • 18368 Amonson Road • Chugiak, Alaska 99567 MUNICIPALITY OF ANCHORAGE V M D h ST P•S G�4 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 PHONE rNiIEVV S= e-jc'_ S K -V...7' S EJ—UPGRADE MAILING ADDRESS �j I p Vo BU ." C 11 V� i0.}•=- 1\`�' LEGAL DESCRIPTION V"Ljr,Afl'i-d N Ply -_ice �� LOCATION NO. OF BEDROOMS Well ,w�`_ Absorption area Dwel�ng PERMIT NO. O DISTANCE TO: C�In/n '� � L �E Y 1— Z Manufacturer Material S'�� No. of comRartments � H Lin. capacity in gallons Il L y-� IF HOMEMADE: Inside length Width Liquid depth O Y DISTANCE TO: Well Dwelling PERMIT NO. JDz _ F Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot ,li a PERMIT NO. w2 DISTANCE TO: Cvii�m J} J LL Z No. of lines Length of each lie Total len th of lines Trench width Distance between lines zw ~ 5 .t ,sj. 7� 73.jnches - H Top finish Material beneath tile Total effective absorption a)ea -� ¢ of tile to grade p 21 inches /'}_ Length Width Depth PERMIT NO.. - -- -- -- - w Q F Type of crib Crib diameter Crib.depth Total effective absorption area W a ti Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J w � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATI NG INSTALLER CU REMARKS 0 'CX<c:vctf�— �as fk)00',dea uve,- t Sa ere `S vY Cave 5 '-k'h a OAS iO APPROVED DATE LEGAL 72-013 (Rev. 3/78) Permit _4UNICIPALITY OF ANCHORAGE Department( Health and Environmental^Zrotection 825 i Street, Anchorage, AK. '3501 264-4720 # # # HANDWRITTEN PERMIT # # # # �' ON-SITE SEWER PERMIT r Applicant: Mailing Address: %J(ii Y/ D Location: Legal Description: --t Phone Number: / Lop ,6 "42 Lot Size: 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 t e Soil Ab orpti n System /Is:' DEPTH LENGTH f 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(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(1166BING) 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 bythisdepartment 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 u 3 # # # 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 re uire enlarge t if the re idence is remodeled to include more that bed ms. Signed: _ Issued by: Applica Ll '77 Date: SWP/024(1/81) MUNICIPALITY OF ANCHORAGE ,. fifes; Development Services Department ' Phone: 907-343-7904 On-Site Water & Wastewater Section '--" Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-581-18 Expiration Date: - 2.t 2.OZc 1. GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS#3A BLOCK 7, LOT 6 Location (site address) 24328 THUNDERBIRD DRIVE, CHUGIAK,AK 99567 Current property owner(s) GRANTHAM ELLIS THAYER Day phone Mailing address 24328 THUNDERBIRD DRIVE, CHUGIAK, AK 99567 Real estate agent Day phone 2. TYPE OF DWELLING: ® 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: Private Septic Private Well ❑ Holding Tank ❑ Water Storage ❑ Community ❑ Community Well A ® Public Sewer ❑ Public Water System ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ S S Q Waiver Fee $ Date of Payment ,-J d - 19 Date of Payment Receipt Number ( )(o.2 Cl 7,D Receipt Number COSA# CSC ( a ( 22'f 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4641 SHOSHONI DRIVE, ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 06/08/2019 Comments:This investigation was completed in compliance with MOA guidelines,regulations, `\ and best industry practices I methods. The assessment of the condition of the well and septic ,L'_ ` applies only,to the conditions as of the day tested.The flow and absorption rates may change OF � l due to subsurface conditions that may not be observed from the surface,changes in land use, A � • .".`.• 1 local soil characteristics,groundwater levels that may fluctuate during the year,quality of construction(workmanship&materials),the water usage of the family being served by the / system and maintenance. The operational life of all well and septic systems are subject to * :49 Ili * these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore,any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments,deficiencies or discrepancies exist can be given by Fmand Anderson Construction&Engineering. # .MICHAEL N. ANDERSON: , ' •.6/No.8/19 CE 9489 6. DSD SIGNATURE t\ � "'1'ESSIOtw Y System #1 Approved for 11 bedrooms \oo..`46:411.` System#2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: �i��ttutur(trrrr Athe 041.s 1:5 wgs7. ,i„, m� pRpeWgTFR Rib/ �• /1)i) l SERVICES"��`�1``` 111)))»Ill� Original Certificate Date: NO2 Z `1 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 COSA Checklist Legal Description: THUNDERBIRD HEIGHTS#3A BLOCK 7, LO 6 Parcel ID: 051-581-18 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA—CLASS A ❑ Well log is filed with Onsite (or attached) Well production at time of test_gpm Date drilled Water storage tank volume_gallons Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to_ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate_mg/L❑ Nitrate less than MRL(ND) ❑Wires are properly protected Arsenic_ug/L ❑ Arsenic less than MRL(ND) Casing height(above ground)_in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test _ft. Comments B. TANK DATA—9/26/16 1250-Gal C. LIFT STATION -NA Age of tank(s) 3 years ❑ Required maintenance completed Tank type/material SEPTIC/STEEL Age of lift station years Measured operating fluid level in septic tank 50" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 6/7/2019 D. ABSORPTION FIELD DATA— 60'L x 31'W x 0.5'ED—@ 295 sf/br= 1770SF Which system tested (date installed) 1983 Adequacy test date 6/7/2019 ® ALL standpipes present per record drawing Results IE Pass For 4 bedrooms Total measured depth from grade 4.3 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade "3_7 ft(min) Water added 640 gal ❑ N/A—pressurized field New depth 6 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 15 min depth into effective ® Code-required soil cover over field Final fluid depth 0 in System presoaked Absorption rate 600+gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) N date of test) If yes, enter date Gallons introduced _gallons Comments/Deficiencies Appears to be per visual observations between ST post-tank Cos& MT—no field COs. • FL CS COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot> 100' ® Yes if No ft Holding Tank> 100' ®Yes if No ft Neighboring Absorption Fields > 100' Animal Containment>50' ®Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ®Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ❑ Yes if No 5+ ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells> 100' ® Yes if No ft Absorption Field > 5' ® Yes if No ft Community Wells >200' ®Yes if No ft Water Main > 10' ® Yes if No ft If septic tank is under driveway comment below Water Service Line> 10' ® Yes if No ft Surface Water> 100' ®Yes if No ft 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' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS AP-. ) oF Az;X 40,G. ENGINEER'S CERTIFICATION ,�.'... . .,f. d %.. 7 I certify that/have determined through field inspections and review / * :49 T1i * VI of Municipal records that the above systems are in conformance / ��,/ , with MOA COSA guidelines in effect on this date. G��f DdICHAEL N. ANDERSON: �� No. CE 9469 w COSA Checklist.docx 1 .•••6/8/.19.-../.1 lk bFEssto111 i = praE. eo • Municipality of Anchorage On -Site Water and Wastewater Program 4' ' '' (907) 343-7904 5 A f E T Certificate of On -Site Systems Approval Parcel I.D. 051-581-18 Expiration Date:' 1. GENERAL INFORMATION Complete legal description Thunderbird Heights #3A Block 7 Lot 6 Location (site address) 24328 Thunderbird Dr. Chugiak, AK 99567 Current Property owner(s) Parker Dalla Day phone 269-330-3432 Mailing address 24328 Thunderbird Dr. Chugiak, AK 99567 Real Estate Agent Laurra Davis Day phone 907-406-0250 2. TYPE OF DWELLING: Il Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class A Well El Community ❑ Public Water System ❑ . Public Sewer ❑ WeiverNariance request for: Received by: a Date: 0 (1 COSA to be released to the engineer, nle)s otherwise requested by the engineer. COSA Fee $ Sa& (0 O Waiver Fee $ Date of Payment 26 Date of Payment Receipt Number. _;2 ca Z Receipt Number COSA # Waiver 4 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 Alaska Rim Engineering Phone 907-745-0222 Address 9131 E Frontage Rid... Palmer, AK 99645 Engineer's Printed Name l G9,D1/L/2/, �� --- Date / / -5 v �o��SO4Q9.0&@P;tlf 6. DSD SIGNATURE:LQTH .. :* System #1 Approved for bedrooms �,.,....... System #2 Approved for _ bedrooms E ym : Mary Shreves ;r R ��iPj�'.• CE 9351 Disapproved e� Fq •.,, E� o 6��rF� PRO FE S S 10tdP��q�� Conditional approval for bedrooms, with the following st�i�l$�ictrlgkb®� The Municipality of Anchorage Development Services Original Certificate Date: _1Q— (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r '. 7: c ' If more than f septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Thunderbird Heights #3A Block 7 Lot 6 Parcel ID: 051-581-18 A. WELL DATA Well type If A, B, or C provide PWSID # A Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. ft. g.p.m. g.p.m. Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1250 gal Number of Compartments 2 Foundation cleanout (Y/N) -Y Depression over tank (Y/N) N Date ofpumping N/A - New Pumper. C. ABSORPTION FIELD DATA Collected by: Date installed 9/26/16 Cleanout' (Y/N) Y High water alarm (Y/N) N Date installed 1983 Soil rating (g.p.d./ft2 or ft22/bdrm) 295 sf/bdrm System type Bed Length 60 ft. Width 31 ft. Gravel below pipe '5 ft. Total deptf! :4`5 ft, Eff. absorption area 1770 ft2 Monitoring tube Y Depression over field N `9/6/16 Pass 4 Date of adequacy Pest Results (Pass/Fail) For _bedrooms Fluiq`de$ih in absorption field before test 0 in. Water added 1244.1 gal. New depth 9.5 in. Elao" ed Time:.24 hours min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Manhole/Access(Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? in. Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTICIHOLDING TANK ON LOT TO: Building foundation >51, Property line >5 Watermain >10 Water service line >10 Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Absorption field >5' Surfacewater >100, Property line Building foundation >10 Water main N/A Water Service line >10' Surface water >100, Driveway, parking/vehicle storage >10, Curtain drain None Known Wells on adjacent lots >200' F. COMMENTS Septic tank is new. Absorption field passed adequacy test prior to septic tank replacement. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ��•P(F.� t't',��♦ \ Engineer's Printed Name yYVV G✓ G�;' 4 ZV y�S Date i!/ 11 ��1 La * 4 T!t s* i j Mary . Shreves :, ' ♦♦��iJ�'•.'CE 9351. �� COSA canary sheet_2-6-15.doc Parcel I.D. 451-581-181 Municipality of Anchorage On -Site Water and Wastewater Program = (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Thunderbird Heights #3A, Block 7, Lot 6 Location (site address) 24328 Thunderbird Drive, Chugiak, AK 99567 Current Property owner(s) Mllferd S. Hill Jr. Day phone Mailing address 24328 Thunderbird Drive, Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex i i �( ❑ �JbMI Multiple Dwellings (Single Family and/or Duplex) L 3. NUMBER OF BEDROOMS: Four JUN 2 3 2014 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaivertVariance request for: Received by:k_ to tWengineer, unless otherwise requested by the engineer. COSA Fee $ 67i.-,%` Date of Payment (O w7bv Receipt Number 0-742, COSA # C6cf 1210 Dater Waiver Fee $ 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 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE t� System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Date 6/19/2014 bedrooms, with the followin By: Z4, 11 0 �-e.i', Original Certificate Date: 6 - 2 V—I Thev unial' ofe orage 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 COSAWI.Sheet! :, c 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 No. 3A, Block 7 Lot 6 Parcel ID:051-581-18 A. WELL DATA Well type If A, B. or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) _ 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. Well production 9.13 -m - WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA 9 - p.m - Tank Type/Material Septic/Steel Date installed 1983 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alar (Y/N) N Date of pumping 5/1/2014 Pumper As Septic Pumping C. ABSORPTION FIELD DATA Date installed 1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 295 sf/bdrm System type Bed Length 60 ft. Width 31 ft. Gravel below pipe •5 ft. Total depth 4.5 ft. Eff. absorption area 1,770 ft2 Monitoring tube Y Depression over Feld N Date of adequacy test 6/19/14 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 642 gal. New depth 2 in. Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >= 600 9 p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main Size in gallons _ "Pump off" level at Cycles tested _ _ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main Water service line >10 Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10, Water Service line >10 Surface water X100 Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS Lot is served by AWWU Water System. G. ENGINEER'S CERTIFICATION t 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 Michael E. Anderson, P.E. Date 6/19/14 COSA brown sheet 10-10-12,doc Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehiclestorage >10, 111 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak. us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING G w • x4p)a� s Parcell.D. Ds% Vis/ /'5r HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description T�� ro c s%moo �s'Ts ;A .�� k -47_'k Location (site address or directions) o'Y3a S Current Property owner(s): ,Z' � Day phone Mailing address 27.za Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 11 Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER_ DISPOSAL: Individual Well ❑ Individual On-site 19 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells_ or a public water system. The Municipality of Anchorage is not resporlible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ,��,e,� vc Fac �c va Phone Address &�� Engineer's Printed Name 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Date to/Zo/oN bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By' W �r� Original Certificate Date: /(Z_ 2 L74 (Rev. 01/02) Develo' _On- >artment z" s`m= $PF ETY )gram /pew f' Y/N) r 5th k� y i g e .y om leted Sanitary seal (YIN) W)res property pro ieptfi ft Cased Jo ft Casing t (above ground) in. " T INSPECTION , FR(_ M W EL' LO„ Y� _ pf test ft. ft. production _.. n g p m g p m .._,- `"" arm_ Other,b�co..l onles00 ml colonies/100ml. Nitrate mg./1. apleria mg./L 4 Date of sample: _ Collected by TIMOLDING TANK DATA i s—�Ee bate installed Type Natena size,b gad tJumber of Compar{ments 2 Cleanouts N) %SrR 1{C 4pkt' 1 'M iifation cleahout�N) �s Depression dyer tap -Tc 'High water alarm of pumping ��T�� Pumper vvare) �/ ticrl�nnn,c Absorption field on lot /�`' On adjacent lots Public sewer main / l a Public sewer manhole/cleanout Sewer /septic se '' ' e Holding tank --„ . .. „ ggrA. c^,a o. f SEPAR%CTION'Dl'STAN'CESFROTVi'S�F'`f�C/ �' qNK OMLOTTO: Building foundation Property line 'filo Absorption field Water main 110 Water service line ! D Surface water? frso Wells on adjacent lots •t too SEPARATION'DISTANCE rRbV1`A�SOR� 10 ID O LO Property line to Building foundation +tor Water main fi 10 r Water Service line +(O r Surface water t 100 Driveway, parking/vehicle storage Z $ Curtain drain AtOAtb; XAVOwd Wells on adjacent lots */CIO r S F. COMMENT$. G. 67.F qs�= 9 /certify that I have determined through field inspections and 7k 4 review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. �! CHRISTOPHER R. WOOD Engineer's Printed Name G R �i frwpHGYr �/o� CE:10387 Date 10lZolo HAA Fee $ 43.00 Waiver Fee $ m" Date of Payment ��/ntl Date of Payment Receipt Number... I R Receipt Number (Rev. 12/01) __ ._... ......_..., , t., Sent By: RE/MAX OF EAGLE RIVER, INC.; 9076960214; Oct -19-04 13:51; Page 2/2 No r r 1 /a r� r 1 AiihR.r "•s. ,...... r. 4 f iert C. Jolt/ NO. 880-S ., AS-R1;lf.T 1 hereby certify that I have surveyed the toUowing described h7 n, en '_L4,r....4 c c. L; ze Anchorage Recording Precinct, Alaska, and that the improve. meets situated thereon are within the property lines and do not overlap or encruach on the Property lying adiacent thereto, that no improvements on Property lying adiacent theteto encroach on the premises in question and that there are no roadways, transmission lines or other visibie casements un said pcuperty except as indicated hereon. Bated at, Eagle River, Alaska this .1L 7 ,„day ofC G*' ROBERT C. JOHNSON aR r ,yy' , SCALE: Registervd Land Surveyor No. Se0-LS V. _ (f n' &it 77-1.156, Eagle River, Alaska 99577 Phone (907)694-2543 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 A' MUNICIPALITY OF ANCHOUgg ENVIRONMENTAL SERVICES DVtS)«h CF_Ri`ICICATE OF I!EALTH AL) i H0RITY APR 2 a 1997 APPROVAL FOR A SINGLE FAMILY DWELLING j� aVEY� Parcel I. D. # S/ - fi - / B HAA #,/ r� /�� s}. 1. GENERAL INFORMATION' Complete legal description ye.��lt� .v G� eH 7 Location (site address or directions) Property owner deal,'r Mailingaddress 2�l3as fiHN�e 6;, P Oma, e Lending agency Mailing address Agent 4<_ r;G, , e r Address //'Sf �eG �t�t F«4 Day phone Ltiu�.<k df� Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4/ RECEIVED 3. TYPE OF WATER SUPPLY: APR 2 2 1997 Individual well Munictpality.of Anchorage Community well " Dept. Health & Human Services 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 rr,r. ,ting to the legality and status of system. 7M25 (Rev. 1/91) Front 6i0A421 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, 1 � ordinances, and regulations in effect on the date of this inspection. Name of Firm (ladle Riv= Ffn&ee«:ng .G'eMaes Phone yr f'v--rI55' Address P.O. Boz 773294, Eagie River, AK 995773244 Engineer's signature Datei//—?-1 —`y1 —`y Z- 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 11� iry `�` n,•s �p�a4 � Oda RM }1 3 CC 6756 '°roe(:; •t�%�'''� bedrooms, with the following stipulations: ;The Municipality of Anchorage Department of ,Health and Human Services (DHHS) issues Health Authority Approval Certificatesipased only upon the representations given in paragraph 5 above by an independent professional engin'eer.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. 72-025(Rm1191) Back MOAN21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage APR 2 1 DEPARTMENT OF HEALTH & HUMAN SERVICES R E C E Environmental Services Division IA 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo 7L6' rf/t'7 TSH,<6,.Y! flfi SA Parcel A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number a /ISG Log present (Y/N) Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well production Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform Al 14 Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 6 — Ss 3 Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 9— p.m- Other bacteria Collected by: g.p.m. Tank size l-�,1s0 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (YIN) N High water alarm (Y/N) "114 Date of Pumping 'V—a i- 9 7 Pumper C. ABSORPTION FIELD DATA 9X'r Date installed - 3 Soil rating (g.p.d./W or ft2/bdrm) -2 9s sy System type 1&4 Length 31 Width 6o Gravel thickness below pipe Z� Total depth Effective absorption area 106o Monitoring Tube present (Y/N),�' Depression over field (Y/N) "� Date of adequacy test q-- /C- -9 7Results (Pass/Fail) 10� rf For IV bedrooms Fluid depth in absorption field before test (in.); o Immediately after6o6 gal. water added (in.): 6 Fluid depth (ins) Minutes later: 3g0 Absorption rate = Peroxide treatment (past 12 months) (Y/N) /V 14 If yes, give date 72-026 (Rev. 3/96)* t600 D. LIFT STATION "V/ Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /✓ IA On adjacent lots ^"IA Absorption field on lot /V On adjacent lots .0 /.4 - Public sewer main N /,4 Public sewer manhole/cleanout Sewer /septic service line w/s+ Lift station ^ /, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S� Property line tiv Absorption field Water main/service line y ' Surface water/drainage -tea ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /o Building foundation V �o " Water main/service line Surface water �/w � Driveway, parking/vehicle storage area Curtain drain eV A4 Wells on adjacent lots 2° ' F. ENGINEER'S CERTIFICATION 4a""'ids 1 certify that I have determined thru field inspections and review of Municipal recd 1hgt1fhe are in conformance with MOA HAA guidelines in effect on this date. /� 7E /}�'@omencae a• caoo"s: rte• Signature Engineer's Name /O H it %jtq 7�Grn ,3� i�� Loa' }:,,tom Js 4` Louis a �r gas 0.6736 °: Date /—%7 51 n Q000°oaa„»a°° Is l ' yr)Fc; tto4 HAA Fee $ 0 1 9 Waiver Fee $ Date of Payment l ! Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/96)* 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. # 0 51 ` 51W" / f! HAA # 1. GENERAL INFORMATION Complete legal description �"� y %(u r �� 2Q Location (site address or directions) Property owners �uor,J fair a,� Day phone Mailing address o ze. �u"�t� 4- 90 Gy�ll;tii`�� 1 -'Il j 9Y07 Lending agency Day phone Mailing address //�� //�� Agent !�. - ql) 0%1ZN. l7- iia 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 Public water K_ 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. 72-025 Rev. 1/91) Front 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 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 David R. Dayton P.E. Phone na ar Address Chugiak, Alaska 99567 Engineer's signature 6. DHHS/SIGNATURE Approved for bedrooms. 0 Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: 4t1TIC 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. 72-025 (Rev. 1191) Beck MOA X21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-T (,&4-171:7w�lyr� Parcel I.D. A. Well Data t-.r'tanva i.JT!urzt Welltype Puac la- If A, B, or C, attach ADEC letter. ADEC water system number FW s) V _?11%.S e, Log present (Y/N) Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot to Driller Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots On adjacent lots Public Public sewer main Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA tank Collected by: height 70 � m y ih �i7 D �O P.M. N i W o O to 0 7 - Other bacteria Date installed O, p" ��zi�b 3 Tank size / ZSR Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) / �`!�!I Alarmtested (Y/N) N� Date of pumping//g/Cl Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation To property line Absorption field ..5— Water main/service line Surface water/drainage ,1U f- 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed q � 3 Soil rating (GPD/Ft') i 300 w/f-i>t System type D I 1 j�4r Length 31 Width (u0 Gravel thickness otal depth S Total absorption area n -7o cP1.,111,, Cleanout present (Y/N) Al Depression over field (Y/N) Date of adequacy test_ / � Results (pass/fail) f2i'r5 for 4- Bedrooms I Ile Water ® io Water level in absorption field before test / After test e Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots Property line J& -e - To building foundation 5UT To existing or abandoned system on lot h-%n,vty On adjacent lots 60'i— Cutbank M u „rs Water main/service line Surface water /00 t- Driveway, parking/vehicle storage area '� 7 Curtain drain A/0 N 5, E. ENGINEER'S CERTIFICATION tJ J— I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. 20210 Donalar St. Signature Ghatak, Alaska 99567, , Y Engineer's Name David R. DaYlon �� 1 Date Jf l3 2.o. 22.05-r: z• HAA Fee $ 3 Dd /9 Waiver Fee $ Date of Payment r— -24 Receipt Number �Z-b-D 46 C �'6 s2 72-026 (3/93)` Beck Date of Payment Receipt Number TO FROM o>i 4i4 iSUBJECT 6 /ate r David R. Dayton P.E. 20210 Donalar St. Chugiak, Alaska 99567 DATE 9 MESSAGE -pop C�r- C'e4+sece G�u�r✓� Pr P� �~z� d pa7�+tti- �� i�u.m,r ryo�. -rvs� �. � ��.,, A Dp P(��. m ow I rywa� ca�a0 0 tvAvr"y. L,54fk . `Trap 6igAvat- 1u Lem, *--m-L-0t 1 830 mw, - m, 'illi b, we'i 'ToA lns D,c-�Vr /:� '7'f 1U.e./�-t'sivl— �rc9 aiZY 15 >.c1 A- S J r 1-1 1 1716— UJB- (�LL�cs to 1LJ' b�o+;a -hem P+P-Cr X71Q; S�S7M ✓� AJZf-'i �z£i�f�i>LC�,�das "Z, SEP 71993 iilt.teafth & ui Anchorage �j�p_14 //z, UeDc, health � Hyman Services SIGNED d'(—'� o/" mcwortn: 4S 468 POLY PAK (50 SETS) 4P468 n NO REPLY NECESSARY REPLY REQUESTED -USE REVERSE SIDE 617 i 1 v'e,,,. e��y ,mac, i� D—t 7,. z7 +- X0-7/.- `��_- V R D. R. DAYTON, P.E., R.L.S. ` 'RWRKWo UW Chugiak, Alaska 99567 (907) MMi 20210 Donalar 696-2417 August 17, 1993 ADEQUACY TEST Legal Sescription: Lot 6, Block 7, Thunderbird Heights Subd. Date of Test: August 17, 1993 Septic Tank: 1250 gallon, 2 compartment, steel tank (DHHS Records) Absorption System: 31' x 60' seepage bed (DHHS Records) Soils Rating: 85 sq, ft. per bedroom (DHHS Records) Requirements: 4 BR - 600 gallons per day Test: Water was pumped into the absorption system while measureing volume, time and water level rise. After pumping was stopped, the water level drop was measured at timed intervals. The results were plotted on a graph of time and gallons absorbed and extrapolated to 24 hrs. Results: The system is currently functioning adequately for a 4 bedroom home. Time APPLICNT FILLS OUT UPPER HAh,ONLY Property Owner - T & D Construction Phone Mailing Address- BOX 2524, Palmer, AK Zip Code 99645 745-2731 Beyer Shephan G. Bailey Address P. 0. Box 771508 Eagle River, AIC-- Zip Code 99577 Lending Institution Date Phone Date Alaska Mutual Bank Date Address Benson Branch Zip Code Realty Co. & Agent Totem Realty, Inc. -Shari Osweiler Phone Address 724 E. 15th Avenue Anchorage, AK Zip Code 99501 272-0571 Legal Description Lot 6, 'Block 7 Thunderbird Heights Street Location Thunderbird Drive Type of Residence - Ck Single Family CENVIRONAA-INTAL ❑ Multiple Family No. of Bedrooms 4 ❑ Other 6`- Water Supply SF P 15 1963 - ❑ Individual TTACH WELL LOG. A well log Is required for all wells drilled since June 1975. J�For IN Community ( ) APPROVED BEDROOMS wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( ) DISAPPROVED Sewer Disposal Ck Individual - Year Individual Installed: 1991 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank DATE r NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ( Xl.V Date Date Date Date q Inspector Inspector Inspector Inspector Field Notes:e - DEPT. OF HFA!TH tI PROTECTION! CENVIRONAA-INTAL 6`- SF P 15 1963 RECEIVED ( ) APPROVED BEDROOMS - 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL A�qROdL4L' ,, SS DATE r BY: Soils Rating Date Sewer Ipnstalled Well To Absorption Area Well Log Received LYS' Septic Tank Size sO Well to Tank na a u,o.'