HomeMy WebLinkAboutTHUNDERBIRD 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)
