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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3A BLK 7 LT 7AThunderbird Heights #3A Lot 7A Block 7 #051-581-22 ' j~ [~'~ 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 PHONE D~NEW MAILING ADDRESS ~ ~ Manufacturer ~ Materia~ ~ ~ ~ ~ No. of compartments~ Liq. capacity jn ga I s I Inside length Width Liquid depth No. of lines Length of each line_ Total length of li~e~ Distance between mines :' ' ~ ~ f ) f ~ h Tota) effective absorption area Q ~ Top o ti e to inis grade ~ ~ Material beneath tile ~ // inches Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot )ine m DISTANCE TO: j CJass Depth Driller Distance to lot line PERMIT NO. ~ ' Building foundation Sewer llne Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS APPRC DATE LEGAL 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE_ Departmental Health and Environmenta,f~protection 825 ~ Street, Anchorage, AK. ~9501 " 264-4720 ~".~) * * * HANDWRITTEN PERMIT * * * Permit WE'L ~D/OR ON-SITE SEWER PERMIT Applicant: ~~.~ Mailing Address: Location: Legal Description: LT ?/r~/~? Type of Soil Absorption System Is: Trench: Drainfield: ~, Phon7 Number: ~~, Lot Size: Seepage Bed,' Holding Tank: Maximum Number of Bedrooms: _~_ Soil Rati~g(sq.ft/br) ..The Reqp~red S~ze pf the ~o~.~s~r~on System Is: DEPTH ~ L~ 'IPJ~"~G~AV[L DEPTH ' WIDTH 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(P~I'NG) TANK SIZE = 1 5-o 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 feetl 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 3L 1 9 8 3 * * * I certify that: (!) 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 require enlar/~ement if the residence is remodeled to include more that~e~dro~/~ Applican~ ~ Date. ~/~ SWP/024(1/81) Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: 1. GENERAL INFORMATION Location (site address or directions) ~¢/~ ~/~¢~/~ b~C~¢~g Current Property owner(s) ~-,~,"~ Mailing address Lending agency Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address , Unless otherwise requested, HAA will be held by D HHS for pickup. HAA picked up by: ~/~ ~- ~',/'"-~' NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72 025 trey 01/OOF 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address ENGINEERING Alaska 9g$77 Phone Engineer's Printed Name ~ (~ ,?),Z.,&7- DHHS SIGNATURE / Approved for '~ bedrooms. Disapproved. Conditional approval for __ Date; S'"//~_Z_a ~ ~¢ ,..-) .. · '\ '., ,¢ ~ '" :" ',,'"7 ¢, ¢ "'P'." EN.~._EER S' ;.'.\ '". '~., lj¢, ,. CE- 88Ol /':7',~. bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 75-025 fRev. 01'00)* Municipality of Anchorage MAY ] 2 ~000 ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Enviroflmentaf Services Division ...... 'M~NT^ S~W,'~ r',,~P-l..Jt..I,~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription:L/'. '~j' ~ -~/' '~'-./~,,K/J~ ,;,~7/),-~ ~ Parcel i.D.: ~7~-// .- ~'~/--//df~ A. WELL DATA y~ Well type //'~//~/~(~'" If A, B, or C, attach ADEC letter. ADEC water system number Log present.(Y/N) Date completed Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ~ ~iltifeOi:sample: j Nitrate Casing~t,'(above ground) Wire.~.prdperly protected (Y/N) A'I-INSPECTION g.p.m. Collected by: Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed ~/2 //~,.?) Tanksize Foundation cleanou~/N) Depression (Y/~)) Date of Pumping / ~ Pumper x.J~,~ C. ABSORPTION FIELD DATA /~,~7_) Number of Compartments ~- Cleanout~'~N) //~/~-) High water alarm (Y/N) ,/V,~''~r Date installed /~/(~'~,~ Soil rating (g.p.d./ft2 or ft2/bdrm)~ ~' '~System type '~ Length '~,~ Width Z4~/ Gravelthickness below pipe ~ /'' Total depth ~ Effective absorption area ~7~;,~ ~ Monitoring Tube preser~/N)(?~-~ Depressio.~n over field (Y/~,~/~ Date of adequacy test ~~ Results (Pass/Fail) '~/~.~ - For ~//~-C~'-~ bedrooms Fluid depth in absorption field before test (in.); '~'! Immediately after~"~gal, water added (in.): Fluid depth (ins) Minutes later: /0 Absorption rate = ~ ~'.~'~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ,/~E?~'~',"-/~'~?4/A/If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION ' Date installed Manhole/Access (Y/N) High water alarm level at*/ / Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on" level at* *Datum On a~dja eo~ots ,/~nOn adjacent lots Public sewer manhole/cleanout Lift station "Pump off" level at* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' /'/- Property line ~/Z,_.~-/.~z.- Absorption field Water main/service line 2.~-~L Surface water/drainage/~'~ '/~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~,.~ / Building foundation ,~L ~ / ~ Water main/service line Surface water /~,) ~-) /"/- Driveway, parking/vehicle storage area Curtain drain /~/~/I/~'~ /("{A/~c74/A/ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal ~,l~'~,~stems in conformance wit~MOA BAA guidelines in effect on this date. Signature 1~? ~ are HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number APPLI~'~IT FILLS OUT UPPER HALf'ONLY Phone Property T & .D Construction Box 2524, Palmer, AK Zip Code 99645 745-3731 Mailing Address Buyer Oscar Thorson 8610 E. 10th Anchorage Ale zip Code Address Phone Lending Institution Alaska Pacific Mortgage Compaay - Northern Lights zip Code 99503 276-3110 Address Phone RealtyCo.&Ag~nt Totel~ RealtY, Inc. - William Schleg~l 724 E. 15th Avenue Anchorage, AK zip Code 99501 272'0571 Address Legal Descriptk) n Lot 7, Blk 7 Thunderbird Heights Thunderbird DRive Street Locatio~ Type of Residence [][Single Family [] Multiple Family No. of Bedroon'~ [] Other Water Supply ~-,'~'h" ATTACH WELL LOG. A wcfll Icg is required for all wells drilled since June 1975. Time Time Time Time Date Date Date Date Inspector Inspector Inspector ( ~UNICJPALI~ OF ANCHORAGE . ENVIRONJ'~NTAL PROTECTION ~,, SEP ........ RECEIVED ~APPROVED BEDROOMS 'CONDITIONS OF APPflOVAL ( ~) DISAPPROVEO ( ) CONDITIONAL AP~g~AL* DATE ~'~')~' %? ¥~ Soils Rating ~ Date ~wer~nstalled Well To ~sorption Area Well Log Received JJ ~/ ~' ~ WelltoTank Septic T~k Size