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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3 BLK 4 LT 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 NAME ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRiPT~c~ . Liq. cai IF HOMEMADE: inside length Well Dwelling DISTANCE T NO. OF B~OOMS No. of co'mpa~_~ents Liquid depth PERMIT NO. DISTANCE TO: ~ ~//~O~, ~/O~ No. of li~es Length of each li~ ~ Top of tile to finish grade Foundation Nearest lot line /~) / PERMIT NO. Total length of Ii Trench width Materia] beneath the Length Width Depth PERMIT NO, STANCE TO: DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RA~5~ G INSTALLER DATE LEGAL APPLICANT G.S,K. CBNST. LOCATION RAVENS LP. LEGAL SRR 63.05 R--~ PRL. MER AK. LOT 21 BLK 4 THUNDERBIRD HTS. LOT SIZE II;IS- 20000 SGURRE FEET TYPE OF SOIL, RBSORPTION SYSTEM I$: TRENCH MR?:IMUM NUMBER Of BEDROOMS = 4 ~OIL RATING (SQ FT?BR>== 90 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION I~ THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD, THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND TI4E BO'FfOM OF THE E~:CRVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE ORRVEL DEPTt4 I~ THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OtJTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. PERMIT APPLICANT H85 THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSI'RLLFITION INSPECTIONS OF RN~¢ WELLS ADJACENT TO THIS PROPER'PC AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BRCKFILL. INO OF RN~ S~STEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT MILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCE BETWEEN A NELl. AND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS t00 FEET FOR R PRIVATE WELL OR i50 TO 26)0 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DIS'FRNCE FROM R PRIVATE NELL TO R PRIVATE SEWER LINE IS 25 FEEl' AND TO R COMMUNIT~ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIRGRRMS RRE AVAILABLE TO INSURE PROPER INSTALLATION, I CERTIFY THAT i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WEL,Lc; RS SE"T FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I MILL INSTALL THE 5~'STEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-~ITE SEWER SVS'rEM NAY REQUIRE ENL. RRGEMENT IF THE RESI[)ENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. .... . ....... ................... O & E ENG,.,~E. ERING & DEVELOF.MENT CO. Box 90, Davis St., Eagle River, Alaska 99¢~7 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Name' SOIL LOG Tel. No. Earl Ellis 688-2280 Mailing Address: Legal DescriPtion: ~/~7' Depth (feet) Soil Characteristics 0 2__ 3__ 4__ 5__ 6__ 7__ 8__ 9__ 10__ 11__ PLOT PLAN 12__ 13 , 14__ 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~ If yes, what depth Drain Field PERC. TEST Performed by: Date' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & 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 Parcel I.D. 051-582-40 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address or directions) 24545 TEAL Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THUNDERBIRD HEIGHTS SUBDIVISION #3; LOT.21~ 'BLOCK 4~ LOOP * CHUGIAK~ AK. 99567 MA'Fr LOVERN Day phone 227-8596 24545 TEAL LOOP * CHUGIAK~ AK. 99567 Day phone Day phone Unless othe/wise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well r-'] Individual Water Storage [~ Community Class Well D Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of ~,nchorage 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' be reissued with new water samples: (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 responsible for errors or omissions in the professional engineer's work. MuniCipality .of AnchOrage Development Services Departmen,t . Building Safety Division o~Site Water & Wastewater Program ' .' . 4700 South Bragaw St.' --, P.O~ Box 196650 Anchorage, AK 995i9-6650 ,: ~www.ci.anchorage.ak.us, " , (907) 343-7904 HEALTH :AUTHORI:TY APPROVA[' CHECKLIST '~ '~ ~ '~ l::!l, Legal Description: . :THUNDERBIRD HTS;~#3; LoT 21~ BLOCK '4, : lparcel ID: 051-582-40 A. WELL DATA · '. ' ' . " ' . ~ : ' : : : Well '~ypel; - If A;'B,"°r C pr~Mde PWSID# ' ~ ~ Well ~.q (Y/N) Date completed _ ~, Sanita~seal ~/N)' . -: 'Wires proPerly protected ~/N) Total depth ff. :. - .... Cased to ' ,~ ff. '- . ~ · Casing heigh{ (abov~~ in. ' Static water level'- ' '" :~~. : ,~ :'.,~, Well.production . ' ' ' ' " ,~'g,P~.' , : :' ~=' .g.p.m. · WATER SAMPLE RESUL~ ," :;' ' ?-?; . ' , .: '.:' ~: Col' o:;m [; _~'~00 mi._ Nit;a't'e~ '' mg.lL; '-': ;:[ ,'Othe; ba ia :colonies/100 mi. A~ ~ mg./L, , ~[ . Date of,sample: ' -. Collecte~ )y: ~E~ Ltd. a. SE T C/HOLD N TANKDATA , : ' ," ,:: Tank Type/Material ,: :.~EL ~ ~: Date ~n~t~l ,Tank s~ze ,,1250 i 'Num ro C a ments 2 , ,, .; i : ii (y/N).iYEsi i" ' i:. ,,,, Foundation cleanout Depression ~ver tank (Y/~). Clean0Ul~ High Wa e, 10/09/1981 ~/N) YES alarm (Y/N) N/A Dat~ of pt~ml~ing 10/21/2003 ', i ~ ~ ' " ' ".: ~ '~" " ' ..... " ~i' fi'. ' C. ABSORPTION FIELD DATA . , ,i ' i i~*BELOW EXISTING GRADE -"- ' i:! ' ' ' ' ' ' I ' ' ~'; ' ' ; ' ~ ' i ;'"[ .... r ' ' :'i ' i" ' ' DatEYinstaiie'd 1°/°921981: Soilr~ting~rff~ibdrm)90:~ ., ; S~s~'~e' :' TRENCH : ~ , . . ~ - ~ Length ,~: 4~ "ff. ' ~" : ~ [Width ,,:~':: '5' '. ;.:ff. ,," .: Gravel below pipe 4 ff ~ ' ¢: ~7.0~ ~.0 'i~;'~ h , ~ ' i:f" ~ ' '" '": : YES=' ~; ~ ~' Tota~ depth, ff.. abso~tion~ area~~368. ~,.., ff Momtoring' tube. DepresSion over field N0 ,. ..- . ~ . , ,. . ; ., , .:,; [ , · , .,. ...... . ...,. Date of adequacy test .' 3/11/2004 ~ ~ResultsfPass/Fal) PASS "::.. Fnr 5 h~drnnm~ ;-, : , ~ r , ; ~,'; . :; , ', [ ; ., , ' " ~ ~: . .' i~. ;. ,,~L, ' :' . , .: ~; . : . Fluid depth in absorption field befores[est ~'-10: :In. Water added 604 gal.',; ~ ;.:,.".. New depth 0 in Elapsed Time: u min.'..i Final fluid depth 0. in. · ' Absorptionrate >= 450+ g p d ., .. ... .... ~, ~ ~ ~.~,, . , . · ~ ~ ~ ..... : -. Any rejuvenabon treatment (past 12 mo.) (YIN & type) NONE.,KNOWN, :, =: If ves,'~ive date - ' 'h .- :.*,fFOUND~TION CL~N OUT IN C~WL: SPACE:~i ' ,' , ' ~ . ' , ~ ,:"~ ' . ' :, '.~ ,'.[4 ' . :l ~ . ~:~ 'i :- , . , . , , ',, ~ , .... ;' . ', ' ::.:: . ' ' .: r - : FROM = LUCY O' HARA FAX NO. ~' :~ .-.~ o ~ o.~ ~:'.:~' ~. ,~ ......... .... tqg :..'~ Mar. O1 2004 01:33PM P2 - . .:"' ;' .'. '.'4:"._= Z.'x 't" · Anchorage l~eordlng Precinct. Alas.kg. and that the improvement~ situated, lhereon ~re w?hm _.t~e property ]i~e$ and do not or. ap or encroac~ o.n. '~"'~'"""x-:""V~' lying adjacent th.e.,r~.o, tl?at no ~~' .... ' , "-^ - ",. ~:ty lying adjacent ,thermo encroach.on ~e.~rre. m~. ~" ' .. "'"' '~ '% '~;' ." .quesliatl and that there are t~o roadways,..~ra,~nmtsn/on.. : ... .. ~... --~. ,: ..~. .. · ..... ~ .... ,,.,,,., line~ or other visible ~ments on sald ~ · :.. ~. -,....:.,, . _% : . ·~r'" '" :'' '" ~y" ' . , ' ''. ~ t.ndi~ted hereon. Friday, March 12, 2004 9:01 AM Betty J. Van Boven 1.907-688-0993 p.02 SANITARY PUMPERS 20627 UPPER BOWERY LANE CHUGIAK, AK 99567 ' 907.688-4602, Fax 907.688-0993 CUSTOMER'S ORDER NO. i PHONE ] DATE ADDRESS TAX ,, All claims and returned goods MUST be accompanied by this bill. Thank. You! PRODUCT 2531 ~, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVlRONNIENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal D.~scription (include lot, block, subdivision, section, township, range) Location (address or directions).~' (b) Applicant Name/~b~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other~ (explain); Institution ~~ .~~ Telephone (d) Lending ~ Address (e) Real Estate Company and Agent Telephone: Home~.~ 7- ._~4//~- Business Address Telephone (f) the HAA to the following address: TYPE OF RESIDENCE Sir~gle-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 OnsiteJ~ '~ublic [] Community [] Holding Tank Note: tf community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDINg_ ,NSPECTIONS, TESTS, FILE SEARCH, D 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 o n-site water supply and/or wastewater disposal system is sate, 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 et 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 , ¢ ~ -~':~*~¢~ . Telephone Date , ' / Approved for ,~'~:/,~-- bedrooms b Approved X Disappr°v/e~/ Conditio~o 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 ~nstitutions 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 (~1/84) I[~PT. OF ~V~@NM~NT/~L CON§~R~//~T~ON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD.. GOVERNOR Telephone: (,,o07) Address: 274-2533 To Whom it May Concern: According to records on file in this office the ~--~Z_/~ t/~ 7/umZ£/~P/'/~/ Water Regulations Sincerely, A4UI'ItCIW~LiTy OF ,'\N ..... . , I · D*.. ~ RECEIVED INSPECTION APPOINTMENTS TIME TIME . TIME ~1 DATE DATE DATE I NSP ECTO R INSPECTOR I NSPECTOF~.~[~ ~_~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & -- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~]~ONMENTAL p~,o'rECTION 825 L Street - Anchorage, Araska 99501 ENVIRONMENTAL SANITATION D~V~S~ON OCT 0 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIE DIRECTIONS: Complete all parts mi page 1. Incomplete requests will not be processed. Please allow ten {10) days for p~rocessing. 1. PROPERTY OWNER PHONE GSK Construction 745-2553 MAILING ADDRESS SPA Box 6105 A3, Palmer, AK 99645 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Gary A. & Deborah Hahn Kunow 694-3947 MAILING ADDRESS 4720 1st Street, Eagle River, AK 99577 3. LENDING INSTITUTION PHONE Alaska Mutual Savings Bank ATTN: Debbie ~..': ::. 274-2551 MAILING ADDRESS 1503 W. 31st Avenue~ AK 99503 4. REALTOR/AGENT I PHONE Totem Realty, Inc./Bill SchlegelI 272-0571 MAILING ADDRESS 724 E. 15th Avenue, Anchorage, AK 99501 5. LEGAL DESCRIPTION Lot 21~ Block 4~ Thunderbird Heights ;TR EET LOCATION 'Raven Loop Road TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other [] SINGLE FAMILY [] Two [] Five~ [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells dri'lled prior to that date, give well [~] PUBLIC UTI LITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~ Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E~APPROVED FOR , g BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~)~ DATE BY MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITy OF /"NCHORAG~ DEPT. OF HE/'kLTH & A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in (~onduit (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 Collected by ' Water Sample Test Results Comments '~LN~. ~. If A, B, C, D.E.C. Approved ~N) Date Completed Yield Cep~h of Grouting A Pump Set At I ' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service L(ne on Lot Date SEPTIC/I~L-i~J~ TANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Date Installed [~'.~'~ Stand pipes((.~/N) Air-tight Caps,/N) Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticLl~Tank: Size ['~ No. of Compartments '~- Foundation Cleanout (Y~) Date Last Pumped ~,~-'Z.-"~- ~ "~ ~ ; for ~ /~/. /,~ Temporary Holding Tank Permit (Y/N) To Building Foundation ;~ To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(]1/84) 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 ~-~c? Jr 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 Type of System Design Length of Field Depth of Field Gravel Bed Thickness f'~ f Standpipes Present~)'N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining 'Lots "~ 4- To Cutblank (if present) Comalents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions M~nhole/Access (Y/N) _,~"Pump Off" Level at , /~ Vent (Y/N) Pumping Cycles 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 , -~i~B 196X ~,¢5~'¢ uompany ' ~9~2~7e Receipt No. ,"_'~ ~-~ Date of Payment Amount: $ Date MOA Page 2 of 2 72-026 (11/84)