HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3 BLK 4 LT 19 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
PHONE
[] UPGRADE
Weg Dwelling ~ PERMIT NO.
DISTANDE*O: ; I Absorptlonarea ~ , ~
Liq. capa;i~3ns IF HOMEMADE: Inside ]e~ Width Li~ depth
, ~ Well PERMIT NO.
~Oz DIST~E TO: ~ Dwellin9
"Mate~ I '~uid cap~c[~ in gall~h~~
~ BISTA~OETO:t WP ~O ~n~O TrenchwidtS~ ~
~~ ~ ~ No. of li~es Length of each line Total length of
-- ~ ~ ~ ~ ~inches Distance bet ee lines
~ ~ Top of tile to finish grade Material beneath tile
, Total effectiv, absort~o~r~
Crib diam
~ ~ ' . ~h~ T~t~ ~sorption~
~ Class~ Depth Driller Distance to lot line PERMIT NO.
~OU ~t~ Se~er line Septic ~ Absorption
OTHER
PIPE MATERIALS
SOIL TEST RATING
72-013 (Rev. 3 /~/f'~
F'ERM I ]' NO.
DEPRRTMENT /~'~ HERLTN RND ENVIRONMENTRL/'""%:OTECTION
825 "L~' STREET., RNCHORRGE., RK.
264-472¢
C~-~--S Z 'Ti SE~.,-IE~: F'E~:f'~ I T
BOX 2524 PRLMER
RPPL I C:RNT
LOCRT I I-IN
LEGRL
KLEIN CENSTRUCTION
RRVEN LOOF'
Li9 84 THLINDERBIR[ HEIbHT_,
LOT _,I
745-272 ~
SQLIRRE FEET
,-.~ - ,,=- , - ,- ,c* IS:
T'¢PE OF =a_llL HE,_uRFTIuN .~,~_,TEM TRENCH
MFIXIMUM N.MBER OF BEDROOMS
SOIL F."RTING (SD FT,..BR.- ....
· ' ~ ' ', '- -' OF --,uIL RBSORPTION SS'STEM
THE FE. UIF. EC --,I~.E THE '--
[.. EF TH---
]'HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE E~'~CRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OtJTFFILL PIPE
RND THE BOTTOM OF THE EXCBVRTION (IN FEET).
~:El2gt I RE[:, SEI2T I C: TR~-~'~ S I ZE= 1EiffEl ISI~LLC~P-~S
PERMIT RPPLICRNT HRS THE RESPONSIBILITb' TO INFORM THIS DEPRRTMENT DURING THE
INSTFILLRTION INSPECTIONS OF 8NM WELLS RDJRCENT TO 'THIS PROPERTY RND THE
NUMBER OF RESIDENCES THBT THE WELL WILL SERVE.
T ~..4Cn ( 2 ) I ~-~LSPECT I: Cn~-~2S RRE ~:E~;IL~ I RED.
BFICKFILLING OF BNM SMSTEM WITHOUT FINBL INSPECTION BND FIPPROVBL BM THIS
DEPBRTMENT WILL. BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETWEEN R WELL RN[:' RNY ON-SITE SEWFIGE DISPOSRL. SYSTEM IS
i00 FEET FOR Ft PRIVFiTE WELL OR i5~-] TO 2E40 FEET FROM 8 PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTFiNCE FROM R PRIVFiTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO Fi COMMUNITY SEWER LINE IS 75 FEET.
O]'HER REQUIREMENTS MRY FiPPLY. SPECIFICFiTIONS FiND CONSTRUCTION DIRGRRMS FIRE
RVFIILFiBLE TO INSURE PROPER INSTFiLLFiTION.
I L._RTIFT THRT
H_
±: I RM FFIMILIFiR WITH THE: REQUIREMENTS FOR uN-_-,ITE SEWERS FiND WELLS -q 'g '
FORTH E,~ THE MUNZCZPRLZTY OF HNL. HURH~E.
'z,: ~ HILL ZN_4RLL THE _,~=TEM ~N RCCORDRNCE WITH THE L. uDE_.
S~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLR~EMENT IF THE
RESI[:,ENCE IS REMGDELED TO INCLUDE MORE THRN 3: BE[:,ROOMS.
SIGNE[:: ......................................... ~
RPP~-' KLEIN CGNSTRUCTION
.,:,= .., ,,, _ V4. e
/
PERFORMED FOR:
LEGAL DESCRIPTION:
,,r-.~ ~ .~ SOILS LOG
2--
~ 3
4,
7
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
11
13=
14-
15-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
[] PERCOLATION
TEST
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE .(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
,'¢,9..///
C ERT,E,ED'¥:
72-008 (6/79)
ANCHORAGE/~ESTERN DISTRICT OFFICE
3~0~ C STREET, SUITE ~334
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: September 8, 1988
PWSID: 211156
To Uhom It May Concern:
According to the records on rile in this orFice,
THUNDERBIRD HEIGHTS SUBDIVISION Uater System is in
~,Jith the State o¢ Alaska Drinking Uater Regulations.
t he
compliance
Siocape] y,
Distr'ict Of'lice SupervJc, r
BEE:Pkk
F ~] DJ RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
.SPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~PAUTY OF A~CHO~AGE
~ 825 L Street - Anchorage, Alaska 99501 DEPL OF ' ~AL~'H &
~ ENVIRONMENTAL p~OTECTiON
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 00T 1 4 1981
· REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND
DIRECTIONS: Complete all parts on page ~. Incomplete requests will not be processed. Please allow ten (10) days fo~ p. rocessing,
MAi'LING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. ~UYER PHONE
MAILING ADDRESS
3: LENDI GINSTITUTION PHONE
MAILING ADDRESS
4, REALTOR/AGENT PHONE
MAILIN~ ADDRESS
STREET LOCATION
6, TYPE OF RESIDENCE NUMBER OF BEDROOMS
SINGLE F~MILY ~ One ~ Four
~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
7, WATER SUPPLY [] INDIVIDUAL`<.
COMMUNITY
[] PUBLIC UTI LITY
[] Other
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, g~ve well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
. ~ INDIVIDOAL/ON'SITE** /q(~,/ YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
I. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLF. ~AMI LY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Coonection Verified
3, SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Compaction Verified
E~]Septic Tank or [] Holding Tank
Si~ze: If Tank is homemade --
give dimensions:
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE r)RILLED
LOG RECEIVED
PERMIT NUMBER
DATEINSTALLED
INSTALLER
SOILSRATING
TYPE OF TANK MANUPACTURER , .
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank lAbsorption Area Sewer Line Nearest Lot Line
WELL TO: [ :
Absorption Area to nearest Lot Line ..... , . , ,
5, COMMENTS
DATE
APPROVED FOR BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell. D.# (~2-7A"/ ~Z'"~¢~2 '~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Imf'. 19; ~.~ 4; Thund~bZrd H~iqhts #~
Location (address or directions)
133 T~.¢..~
(b) Property owner Adams, Gar~f Telephone: (home)
Mailing Address S,R, 2 Box..,!$$ Rav6n Vi6~ Loop (3hugi~
(c) Lending Institution K6y Bank Telephone 5A4-~7
Mailing Address 101 W~t Beton Blvd.· A~e. ho~g~. A~A~
(d) Real Estate Company and Agent F~.~
Address 16600 C¢~erfZ¢~.d D~u~. _~.
Telephone 694-2004
(e) Mail the HAA to the following address: (or check here ~, if hold for pick up.)
List contact person and day phone number below:
Business 344-_~? 25
2. TYPE OF RESIDENCE
Single-FamilyD Number of bedrooms .~;
3. WATER SUPPLY
Individual Well [] Community I~ Public []
Note." If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site E] 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.
72-025 (Rev. 7/88} Page 1 of 2
~ ~o ~ e6ed
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NOI.LVlNEIOJNI aNY V.LVa 'HOt:IV=IS =111_4 '.~;.LS=1.L 'SNOI.LO=1dSNI 9NlalAOad I~Ell_4 IDNII:Ia=1NIIDN=1 'g
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
'"J'J'J'J'J'J'J'J'~ICJPALJ~Y OF ANCHORAGE 343-4744
ENVIRONMENTAL SERVICES DIVISION
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
R'ECEI E
D
Date Completed
Cased to Depth of Grouting
Legal Description:
Casing Height Above Ground
Electrical wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WEL~:
To Septic/Holding Tank on Lot ' '~"O~/~
To Nearest Edge of Absorption Field on Lot ~ ~
To Nearest Public Sewer Line
If A, B, C, D.E.C. Approved~N) V
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
; Date
B. SEPTIC/FrOL-DtN~ TANK DATA
Date Installed '~ -I~'~1 Size
Standpipesd~N) y
I ~ No. of Compartments ~
Air-tight Caps(~N) ~" Foundation Cleanout (~N)
, T~ Water;Supply Well
To Property Line
To water Main/Service Line
Depression over Tank (Y~
PumPing/Maintenance Contact on File (Y/N~_~
Holding Tank High-Water Alarm (Y/N) 1
· SEPARATION DISTANCES FROM SEPTIC/.I=7~g~,=m~u~TANK:
To Stream, Pond, Lake or Major Drainage Course
Comments "'~'~ ~-->
Pate Last Pumped
r"Y/,~'- ; for
Temporary Holding Tank Permit (Y/N) r--./,~,
To Building Foundation
To Disposal Field
72-026 (Rev, 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed '¢~ ~' \~ ~-~
Width of Field
Type of System Design
Length of Field
Depth of Field
Square Feet of Absortion Area
Depression over Field (Y/oN~
Results of Last Adequacy 'l'est
Gravel Bed Thickness [~
"~t. cc::P kC Statndpipes Present(~i~l)
r---~ Date of Last Adequacy Test
To Building Foundation
Lot ~//~-
TO Water Main/Service Line
To Stream. Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Y
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well "?--4::;:;'c~ I-F' To Property Line
To Existinlg or Abandoned System
; On Adjoining Lots '"-'~'::::'
~, '~ ["Y To Cutback (if present)
on
D. LIFT STATION ~-~ / .~
Date Installed
Size
"Pump On" Level at ~ -'~.
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
dequacy Test
**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
S & 5 ENGINEERING
17034 Eagle River Loop Road No. 204
Eagl. ~va~, A,,ta~.k~- 99~77
inspection.
Signed
Company
Date
MOA No.
Receipt No. (~
Date of Payment
Amount: $
Receipt NO;
Waiver Fee: $
Date of Payment
Page 2 of 2
78-026 (Rev 7/88) Back
