HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3 BLK 6 LT 7 /--~ 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
LEGAL DESCRIPTION
LOCATION
I Well
DISTANCE TO:
Manufacturer
DISTANCE TO:
Absorption area
IF HOMEMADE: / Inside length
l
Dwelling
W dth
Well
No. of lines
Top of tile to finish grade
Length Width
Well ~.~(~_~ Foundation /~-/ /Nearestl°tline/~ /
Length of each line th of lines Trench wid~
Depth
PHONE ~NEW
~-2~'~( ~]UPGRADE
'NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
inches
Liquid capacity in gallons
Distance between lines
Total effective absorption area
PERMIT NO.
rib diameter Crib depth tal effective on area
Nearest lot line
DISTANCE TO:
Driller Distance to lot line PERMIT NO.
Build~n9 foundation Sewer llne tank Absorption area(s)
DISTANCE TO: ~7~
OTHER
PIPE MATERIALS
SOl L T EST RATING
INSTALLER
R EMAR KS~ M/2r-S~'
DATE LEGAL
72-013 (Re~/3/78)
PERMIT NO.
RPPLICRNT
LOCBTION
LEGBL
SKRGGS CONST
L7 B6 THUNDERBIRD HTS
PO BOX D
688-28_~:L
LOT SIZE 9999~9 SQURRE FEET
TYF'E OF SOIL RBSORPTION c,,c IS:
CT_.TEM TRENCH
MR,',IMLM NUMBER OF BEDROOI~S = ~ SOIL RRTING
THE' REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:.EPTH= - LENGTH= GRR",,/EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET;) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION <IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION <IN FEET>.
REL~LilE:ED 5EF'TIC TRt~; SIZE= ~ GRLLOt~S
PERMIT RPPLICRNT HMS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY 8ND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
TW(] ( 2 ) I t'4SPECT I OlqS RF-.'E REG~U I RED
BRCKFILLING OF RNY S'¢STEM WITHOUT FINRL INSPECTION RND 8PPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SENRGE DISPOSR~ SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MR¥ RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
PERr*I I T E;~F' I RES DECE~IBER ~l., i982
I CERTIFY THRT
' l: IRM FFIMILIRR WITH THE REQUIREMENTS FOR CN-=,ITEI '- SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL ~¢~STRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES.
~: I UNDE~RNC, THRT T~ ON-SITE SEWER S'~STEM" MBY REQUIRE ENLRRGEMENT IF THE
RESIDENCE,~iGNED~~~~S REMOD [: 0 INC:LUDE MORE THRN ~ BEDROOMS. ,~~~ '
O & E .EN~.~ EERING & DEVELO. ,VIENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774or688-2280 , ~vl / ~ /X.~'
Russell Oyster ~ Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for: Name: ~----/--~'-~ C-'-J / ~~ ~ Tel. No.~g~"~ ~ /
Mailing Address: ~ ~ ~ U~1~1~, ~ ~X
Legal Description: L~'~ ~ ~ ~ / '~'4~~ ~'~
Depth (feet)
Soil Characteristics
2
3__
'4
5
6
7__
8__
9__
___._-- 10
PLOT PLAN
11__
12__
13__
14__
15~
PERC. TEST
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
No ~ If yes, what de
Drain Field /
th
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.muni.org/onsite
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date:
1. GENERAL INFORMATION
Cdmplete legal description Lot 7, Block 6, Thunderbird Heights Subdivision No. 3
Location (site address or directions) 24712 Teal Loop
Current Property owner(s) Michael & Helen Kueckelhan
Mailing address 24712 Teal Loop Chugiak, AK 99567
Lending agency
Day phone 688-2965
Day phone
Mailing address
Real Estate Agent
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four (4)
Day phone
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 1'7'1~
Individual Holding tank []
Community On-site []
Public Sewer []
II
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 prolserties served by a privafe or Class C well and may be 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 responsible 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 beic~w, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-~ite 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 ..
Address P.O. Box 240773,'Anchoraqe; AK. 99524
Engineer's Printed Name Michael E. Anderson
bedrooms.
DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
, Phone '522-7773
Date 1/30/04
bedrooms, with the following stipul~iions:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Original certificate Date:
(Rev. 01/02)
Ce
Legal Description:.
WELL DATA
Well type Class A
Date completed
Total depth
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Rox 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CH ECKLIST
Parcel ID: 05t-582.35
Lot 7, Block 6, Thunderbird Heights Subdivision No. 3
ft.
IfA, B, or C provide PWSID # 211156
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground).
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mi.
Date of sample:
SEPTIC/HOLDING TANK DATA
Tank Type/Material .. Septic/Steel
Tank size 1,250 gal.
Foundation cleanout (Y/N) Y
Date of pumping ._1211612003
ABSORPTION FIELD DATA
Date installed 811811982
Length 43
Total depth 9 ft.
g.p.m.
Other bacteria
Nitrate mg./I.
Collected by:
g.p.m.
Number of Compadments 2_
Depression over tank (Y/N) N
Pumper JR's Pumping
Date installed 811811982
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Soil rating (g.p.d./ft2 or ft2/bdrm) 122 SFIBdrm. System type .Deep Trench
ft. Width 3 ft. Gravel below pipe 6
Eft. absorption area 516 ft2 Monitoring tube _Y Depression over field N
Water added651 gal.
Absorption rate >= 600
Date of adequacy test 111012004 Results (Pass/Fail) Pass
Fluid depth in absorption field before test _0 in.
Elapsed Time: Z min. Final fluid depth 0_ in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
in.
colonies/100 mi.
For 4 bedrooms
New depth_0 in.
g.p.d.
If yes, give date
LIFT STATION
Date installed
"Pump on" level at~
Datum
in.
E. SEPARATION DISTANCES
size in gallons
"Pump off" level at
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots:
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line. >5' Absorption field >5'
Water main 510' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 0'***
Water Service line >10'
Curtain drain None Noted
COMMENTS
Building foundation >10'
Surface water >100'
Wells on adjacent lots >200'
Water main >10' '.
Driveway, parking/vehicle storage >25'
Absorption Trench Crosses Properly Line into Municipal Riqht of Way. See Encroachment Permit..
ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records' that the above systems are in
conformance with 'MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anrierson, P.E.
Date 113012004.
HAA Fee $ 4 ,~O '"'
Date of Payment ;~~
Receipt Number f~-~'
(Rev. 1~00)
Waiver Fee $
Date of Payment
Receipt Number
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
ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET
To: N~ike Anderson
Legal description: Thunderbird Heights #3 Block 6 Lot 7
The attached paperwork has been reviewed and is being returned for the following reasons:
[--I Original signature or stamp missing on
r'-I Calculation error in design. ~
~] Additional soils information needed.~
I'-i Water monitoring results inadequate. ~
r'-I Discrepancy in information submitted.
[--I Topographic information missing or inadequate. ~
I~ Incomplete; missing Need to notify and secure approval of the director of Public Work~
for the septic system located in Teal Loop Road.
['-] Incomplete; missing
[-] Additional adequacy test information needed.
[--I Water sample unacceptable. ~
['-I Measured/proposed distances/dimensions missing.
[-I Locations of all soils, percolation and water monitoring tests not shown.
[--I Proposed system too deep for soils information submitted.
[--I Well log required.
[-] Omission in narrative.~
[--I Insufficient fill over tank or field.
I'"] Other.
Name of reviewer: .,Tell Date: 2-4-04
Please supply the necessary information and re-submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
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M nicipality of Anchorage ._
' DeVelopment Services. Department .
· .. - ~ On-SlteWater&W~te~'aterpr~gra~,-: : ',' '~ :
., CERTiFiCATE OF.HEALTH AU:I:HoRI':I'y,i. ,PPROVAL'. .....
' FoRA SIN'GI'E F MiLY:DWEL[ING"
Complete'legal description ".THUNDERBIR[~ ' ' ...... : ' ' '"
HEIGHTS SUBDMSION ~3; 'I'OT:~;BLOCK .... .6," '~ ..
Location(~Iteaddrossordiracflons) - ,2,~712;.TEAL,LOOP,* CHUGIAK,,.AK,99567 ....... :. ......
Current Pmporty owner(s)
Londing egon~ ;' -
Malllng eddross.
Real Estate A[~ent
Mailing address
WILLIAM EISSL[R Da ne
' c/o OF DON McKENZIE w'/ RE~.'PROPEFrI'IES
- - ' ..... . Day pnono
DON McKENZIE'w,/-REUAX PROPERTIES . Day ph0ne~42-1689/694'4200
16600 CENTERF1ELD DRIVE * EAGLE RIVER~ AK 99577
Un/ess ~then~4se requested, HAA wi~lbo held by DSD forplckup.
· 2. ~ NUMBER OF BEDROOMS: 4
' 3. TYPE OF WATER SUPPLY:
- Individual Well [~
Individual Water Storage --
Community Class 'A" Well ~
Public Water System
II
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
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 5 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval ara 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 sample results less than 30 days old. (Cer'dficetes may be reissued for a period of
up to one year with valid water samples.) Certificates ara 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
professlonal engineer's work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be palc~ $~ at, or prior
to dosing for the engineering sen/~es provided... ~. . ~ ~
' STATEMENToF INSPECTION BY ENGINEER. ~ :, . ,- ~
As cer~fied by my seal affixed hereto and as of the velidaUon date shown below, I verify that my :
inveStigation, ~based on'pn:~edur~s but#~d in:the Hsalth' A~thority'Approval Guidelines for this application,
shows that the on-site water suppfy and/or wastewater disposal system Is(are) safe, fu~'onal and adeqUate
for the number of bedrooms and ~ of structure Indicated herein: I further verify that based on the
Infon~ation obtained from the Municipally, of Anchorage files and from my Investigation and In~pection, the
on-site water Supply and/or wastewatar disposal system Is(are) In compliance w~th all applicable Municipal
and State codes, ordinances,,a, nd regulations in effect at the time of Installation.
'Name of Rrm
Address
ALASKA WATER &: WASTE'WATER CONSULTANTS, INC.
6901 D£BARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
· Englneef. s Printed Name J~RL-Y A. CARNESS, P.E.
In oonduc#ti~ thla ~l~Ja~n, AWI4~, Inc~ o~t~mpted to .t~o~do a
consclen#ous englneadng analysis of the system In acco~anse w/th ADEC and MOA
DSD Gulde#nea & Regulations. The reported results deac~fbed the perfon~ance of the
* system underthe conditions encounteredat the time of the test, andseparation
distances measured to readily Iden#fiab~e features. The operaEonal lifo of ail wefts and
Phone 337-6179
septic systems depend o~ the Iocal solls condiCon, groundwater levels lhat may.
fluctuate during the ~ear, and the weter usage of the family being ea~ed by the systern. .
These conditions 'are out~'de the control of the e~aluator of the system. Satisfactory test
results do not guarantee fufure potformance of the system, nor do they guarantee that
them are no hlddal de.~. or ~nc~a~hmente. AWWC, Inc. can theref~'e not provide
any waman~y or [uture ostimate of how long the system wTI continue to meet the
operational requlrernonts'of the ADEC or MOA DSD. The content of this report Is for
the solo benefit of the owner listed above. Any reF~anue upon or use of this repo~ by any
other person or parb./ Is not authorJzed, n~ ~ll lt confer aey legal #ght what,.~oever.
5. DSD SIGNATURE
~ Approved for L{- bedrooms.
Disapproved.
Conditional approval for .__
bedrooms, with the fllowlng stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Ortgtnal Certificate Date: ~ ° ~:~ ' ~) /
Municipality of Anchorage
Development Services Department
On-Site Waler & Wastewater Program
P.O. Box 196850 AncO, AK 99519-6650
Legal Description:
WELL DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
THUNDERBIRD HEIGHTS S/D ~3; LOT 7~ BLOCK 6, Parcel ID: 051-582-;35
Welltype 'A' IfA, B, orCpmvldePWSlD~2H~ ~ ~
Date completed Sanitary ~eal pmpedy protected (Y/N)
T Cased to .ft. Casing height (above ground) In.
FROM WELL LOG
AT INSPECTION
Date of test
~ .O.P~. .J g.p.m.
WATER SAMPLE RESULTS:
Coliform _ colonies/100 mi. Nltrate__ mgJL. -~- c~,r,;~00 ,~.
B. SEPTICfltOLDING TANK DATA
Tank Type/Material STEEL Date Ir,stalled 8/18/82
Tank$1ze 1250 gal. NumberofCampertmente 2 Cteanouts(Y/N) YES
FoumJatlon cleanout (Y/N) "~ Depression over tenk (Y/N) NO High water alan'n (Y/N) N/A
Date of pumping ~.~.Z~~t Pumper JR'S PUMPING
C. AB$ORPTION RELDDATA I**PER INSPECTION REPORT DATED 8/1R./R2i
Date installed 8/18/82 Sol) mfing (g.p.d~ 122 System type TRENCH
Length **43 ,ft. Width *'5 ft. Gravel below pipe *.6 It.
Toteldeplh ','~-e.5 fL Eff. absorplionama**5161t" Monltodngtube YES
Cate of adequacy test 6/6/01 Results(Pass/Fall) PASS
Fluid depth In eb~3~plion field before test 0 In. Water added 925 gal.
Elapsed Tlrna: 5 min. Final fiuld depth 6
Any rejuvenation tmalment (past 12 mo.) (Y/N & type)
In. Absorption rate >-
NONE KNOWN
Depression over field NO
For 4 bedrooms
New depth 17 In.
600+ g.p.d.
If yes, give date -
D. UFT STATION
Date installed Size in gallons ~ __
'Pump ~k~at ~ '~ High water alarm level at in.
~ Cycles tested Meets etsrm & circuit requlmmanta?
E. SEPARATION DISTANCES COMMUNITY WELL
SEPARATION DIS'rANCE~ FROU WELL ON LOT TO:
Sep~c tanMIft station on lot
At)eerption field on lot
Public sewer main
On adjacent lots
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Water main ~:~0'+
Wells on adjacent lots 200'+
Property line
Water esMce llne.
5'+
10'+
Absorp~on field. 5'+
Surface water. 100'+
*SEPTIC SYSTEM IS OFF THE
Property line *0'
Water esndns line l(tt 10'+
Curtain drain NONE KNOWN
PROPERIY. SEE A.S-BUILT SURVEY
AND ENCROACHMENT PERMIT 19981220
Water n~n 10'+
Driveway, pa~hlcie storage ,1'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 200'+
F. COMMENTS "*SEE ATFACNED DWGS ON H20 MAII~ &: KEY BOX.
G. ENGINEER'8 CERTIFICATION
mvfew of Municipal recoils eat the ebov~ ~y~err~ are In ~'
HAA Fee $ ~O~:)-°°
Date of Puyment <5'/~j ~!
Receipt Number ~ L~ ~. C~
(R~v. 12m0)
Waiver Fee $
Date of Payment
Receipt Number
77.19.
H 0'01't0'[ 209.32*
L = 25.08
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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
RECEIVED
APR 17 1998
MUNICIPALITY OF ANCHOP~OE
ENVIRONMENTAL SERVICES DIVISION
ParcelI.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
':~ ~: ~--" ~-~ HAA #
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone.
Day phone.
Mailing address
Agent it'~;'~T'?
Unless otherwise requested, HAA will be held for pickup,
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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,
ordnances, and regulations in effect on the date of this inspection.
Name of Firm , .., ~. /,.~ Phone -
7320 East-'~est~r
' e ~s 99
Engineer's Signature ~fd'l,.q ~ ~,~ Date
DHHS SIGNATURE
'~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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.
Legal Description: ~.-~'~'
A. WELL DATA
Well type ~.~-A~.
Municipality of Anchorage R E C E I'V
DEPARTMENT OF HEALTH & HUMAN SERVICES APR 1 7
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ~c~[~f~ oF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Health Authority Approval Checklist
~V.., ~ ~ "~I,~O~:~E~O Parce[I.D.: O~J'-..~
If A, B, or C, attach ADEC letter, ADEC water system number
Lo Date completed
Total depth Cased to
Sanitary seal (Y/N) ~
Date of test / ~.
Static water
g.p.m. ~
WATER sAMpLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~- I°~'-~~- Tank size. I~,{~..~ Number of Compartments ~,. C eanouts (~N) ~'F_-,.~
Foundation cleanout (Y~) ~.)~ Depression (Y~,~ {,-.~o High water alarm (Y~.~)
Date of Pumping /'~'-I~l'-~ Pumper ~l.o /1~1c~.~3
C. ABSORPTION FIELD DATA
Date installed
Length ~k./.j ,~ I Width ~;~__
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.); ~)~ Immediately after (.~1~ gal water added (in.):
Soil rating ~ or ~ I~-"~. System type. 'T'r~er.l~.A
Gravel thickness below pipe Total depth
Monitoring Tube present L(~N) '~/~; Depression over field (Y~) tt~°
Results (Pass/Fail) P/~<-5 For /~ bedrooms
Absorption rate =
If yes, give date
.g,p.d.
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y~
72-026 (Rev. 3/96)*
D. LIFT STATION
Date ~¥rstalled Size in gallons ~
Manhole/A~~mP off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELLON LOT TO: ~---~'~¢~l~dN~'r~
Septic/holding tank on lot On adjacent lots
Absorption field on lot '~---..,. On adjacent lots .-------
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation .~,. ~1 Property line IO i + Absorption field
Water main/service line lei'+ Surface water/drainage I0e~+ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line O Building foundation, i Z ~ Water main/service line lo
Surface water foe 1.+ Driveway, parking/vehicle storage area
Curtain drain ~o~- [Z ~,,,~ Wells on adjacent lots ~
F. ENGINEER'S CERTIFICATION /J ~F~. ~ As-~ul~
I certify that l hav~t~ne~r~field inspections and review of Municipal recor~lhbt 't~~re
In conformanc~ffh ~ ~ideh~es in effect on this date ~'r' //// ~J,,~
' '
Signature ~-~~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
N
I h*,reby ~.erlffy thai I heys. Sul~,ey~l the I~dluwinR
m~l] ~11~1~,~ th~ ~ willli~ lh~ p~p~y li.~ and dn
~ia.,_~.:,:: -' ROBERT C, JOHNSON ~ ~
1" .~" ~i77~, Eagle Rlvw, Rlas~a ~7~
AI~ASKA WATER & WASTEWATER
SE~TZO ~E~AO~ TEST gATA
' - ~]...I c~
~UMBER OF BEDROOMS
o,~ o~ .u..,.~: */'U'" .u..~.:~
SYSTEM ~PE: '
~ CONVENTIONAL
~ DRAINFIELD ~ PRESSURIZED
~ co.w~o.~ ~.ou~[.
DEPRESSIONS: YES /~
IF YES, WHERE?
~ERE ALL STANDPIPES AND WATER T~HT CAPS FOUND THAT
ARE ON THE INSPECTION REPORT? ~/ NO
IF NO, WHICH ONE/S?
METER GALLONS SEPTIC TANK MONITORING TUBE AMONITORING TUBE
TIME READING ADDED LIQUID LEVEL LIOUID LEVEL LIQUID LEVEL
IO:z~ 16alq 15q/q~O
RESULTS: ~ PASSED: ~Yffe~ M~uu A~ge ~FAILED:
COMMENTS: ~ ~
.vor-- gE- Sg-~'J '
M'UNICIPALITY OF ANCHORAGE
, . .... ? De~artmentn
Public
Works
~ Street Maintenance Division
ENCROACHMENT PE IT 19981228
PublicWork~
THIS A@REEMENT, matte this 7_t.h_ day of May, 199._~8, by and between MICHAE., AND !
PERMITTE_.E , !
MARJORIE BARRY and their heirs, administrators, and assigns, hereinafter called" ' " t
and the Municipality of Anchorage, a municipal corporation organized and existing under its Ch,'u-ter ~
and the taws of the State of Ataska, hereinafter called tt, e "PERMFi'TER". i
WITNESSETH:
WHEREAS, PE~MITTEE is the owner of the following described real property:
LOT 7, BLOC 5, TIIUNDERBIRD HEIGHTS NO. 3
SUBDIVISION, according to the official records t~ereof,,
on file in the office of the District Recorder, Anchorage
Recording District, Alaska,
and;
WItEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows: ..
.A 15 foot utility easement located to the east side mtd a
dedicated 60 foot right-of-way known as Teal Loop
located to the east of Lot 7, Block 6, Thunderbird Heights
Subdivision No. 3, as shown on Plat #80q 16 ,. on file
in the office of the District Recorder, Anchorase Recording
District; Alaska,
and;
WHEREAS, PERMITTEE has placed septic system upon the above-described real property
which encroach(es) upon the PERMITTF~R'S 15 foot utility easement and dedicated 60 foot right-of-
way known as Teal Loop·
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
The PERMITTER, acting through the Director of Public Works, hereby grants to
the PERMITTEE tim privilege of' allowing their septic system to encroach upon
the PERM[TTER:S 15 foot ntility easement and dedicated 60 foot right-of-way
known as Teal Loop, as sho~m on "Attachment A", included herewith.
~ro0~] $~1 qv~q~t V,LglA qVlJ,NHrd_q~td 0PI, 8 8,~8 LO6 XWA 8~:6[ ~6,';O/gO
The PER.M~£TEE agrees forever to indemnify, defend, save and hold harmless,
the Mmficipality, its officers and employees, from any and all lawsuits, claims or
aations brought by m~y person for or on ~ccount of damage to proper¢' or injury,
disease, illness or death of persons, including all costs and expenses incident
*.hereto, arising wholly or in part from or in connection with the existence of,
alterations, ma/n~enance, repair, renewal, reconstruction, operation, use or
removal of the encroaching , as placed upon tg~e PERMI'FTER'S 15 foot utility
easement and dedicated 60 foot right-of-way known as Teal Loop.
The PERMITTEE shall not assign or transfer any of the rights granted herein to
another irdividua] or company without first notifying and sera.ming the approval of
the Director of Public Works.
4. This Agreement and Permit grams PERMi'[TEE no interest in PERMITTER'S
real property whatsoever, except only ~he encroachment rights described herein.
The PERMITTER reserves the right to revoke this permit upon ¢;venty days (20)
written notice to the PEPdvlITTEE. The PERMITTEE agrees upon such notice of
levocation, to move said encroachment(s) from the 15 foot milfty easement and
dedicated 60 foot right-of-way kno~vn as Teal Loop in which it is/they are placed.
Sho'uld tim PERMITTEE refilse or fail to comply with said wriitcn notice, the
PERMITTER, may without fial~ther notice to the pERMITI'EE, remove or cause
to be removed the encroachment(s), and the PER~\/dTTEE hereby agrees to
reirnburse the PERMITTER for all costs incidental to die remov~ thereof.
In addition to the mutual promises heretofore made.~ the PERMITTEE hereby promises to
pay the PERMITTER a one-time pem~it fee of one hundred dollars ($100.00).
iN WITNr~,SS WHEREOF, the parties hereto have herelmto set their hands and seals fl~e day
and year f~rst he~einabove m~ritten.
Grantee: f3rantor: MIJNICIPALIT¥ OF ANCHORAGE
19981228-05/07/98
2
0~9 ?Z~ ~06 XWg 6~:8I ~6/LO/gO
STATE OF ALASKA )
THIP~D .JUDICIAL DISTRICT )
Tills IS TO CERTIFY tl.at on this ~,~_~ _ day of~ __, 197~ before
me, [hg m~dersigned, a Not~' P~I[c in and for the State o~as~a, duly co~iss~oned ~d sworn
, kno~ to me
~ such, personaly appeared __~._~ ~,tJS~ aooC -
to be the ~ght of Way Pemit Manager for the Muni~ffpality of Anchor~e, Alas~, who executed
the ~bregoing instrument, ~d he ao~owledged to me thru he executed said instr~uent as the free
and voluntary act and d~d of said corporation for ~he uses md p~oses there~ men~oned, ~d that
he was au~orized to execute saki iustmment.
WrlNESS my hand ml~o 'ffici.al seal on the day and year first above written.
~'OT~P--'I_IBL.IC~n an~f6r/Al~aska " .~'~
.lvly Commission Expires: ~//5//,~F--~.. i*~{ ':
STATE OF ALASKA )
'THIRD JUDICIAL DISTRICT )
me, the undersigned, a Notary Public ill and for--tie Stat/e of ~ia,ska, duly cormnissioned and sworn
as such, personally appeared ~.~}~¢. ,/~2~ i/ kno~:n to me
to be the individual(s) named herein who execm*.ed the foregoing instrument, and he/she/they
acknowledged that he/she~they did so freely and voluntarily for the uses and purposes therein
menfioned, and on oath stated that he/she/they was aurhorizec[ to execute said instn~ment.
WII~ESS my hand and official seal on the day and year in {his certificate first above
written.
199S1228-OStO?~98
3
;.
MUNICJ PARITY OF ANCHORAGE
DEPARTMENT OF HEALTH& HUMAN SERVICES~
Division of Environmental Services
On-SiteServicesSectiom >;
P.O, Box 196650 Anchorage, Alaska , 99519-6650
~,,_ 343-4744 ' .., . ,,
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Pat(~el I.D. # f")~- zL,<~;~- '~ Z'~ :-'(
1.', -GENERAL INFORMATION.
Complete legal description
Location (site address or directions)
Property owner
;; ,:' -, 'Mailing address
He30 Box 12016G
'¢huR~k, AK' 99567
Day phone
wa~illa, AK .99654
Lending agency
Mailing address
;"~ 'Agent Alex Casanova / ~'M~KENZIE REAL.ESTATE
Day phone "
Day phone 694-9035,. ',
Address 13135 Old Glenn Hwy. Eagl~ RiVer, AK '99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water .
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
XXX
Individual on-site
· NOTE:
Holding,tan~ -., :' ,....; :__
c0mmunit~ or{:sit~-,, ,. ,' :"-'
Public sewer ' '-" '
If community WasteWatbrsyStemr'.P)ovi~le written confirmation from st
attesting to the l~gality and status of system.
72q)25/Rev. 1/91~ Front MOA *Y21
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 w~.ter
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
Address
Eng~ r~eer's signature
$ & 5 ENGli~'~EING
17034 Eagle River
Eagle
DHHS SIGNATURE.
Approved for edroema:
Disapproved. i ·
Conditional approval for
bedrooms, rWith.the following stipulations: ~ ,
Additional Comments
Date
The Municipality of Anchorage Department of Heaith 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. Th~ DHHS does this as a courtesy to purchasers of homes
and thei~ 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 profession,al.engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~'~,'C ~ t~--~-- L~ ~"',,~,~ ~:,~, ~.r>~T~ Parcel I.D.
A. Well Data
Well type
Log present (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ ~ ~ ~'
Absorption field on lot -7..-,=. c.
Total depth Cased to Casing height
Sanitary seal (Y/N)
FROM WELL LOG ~ INSPECTION
Date of test ./
Static water level
Pump I~1
; On adjacent lots
; On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank~ ~
cWoAl~oEr~ SAMPLE RESULTS: Other bacteria
Date ~ Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~ ~ ~ ~ ~'?-~ Tank size / '~,%"c> Compartments
Cleanouts(~N) ,./ Foundation cleanout (Y(~ ~ Depreslion (y~l~
High water alarm~)_ ~ Alarm tested (Y/N) ~.
Date of pumping ~-~'~ ~ ~1 ~ Pumper ~_'"~-'['~--. ~.~%~o
SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN~TO:
Well(s) on lot ~oc,~¥ On adjacent lots r~ ,~
To property line I ~ t ¥ Absorption field ~ t
Surface water/drainage ~ ,-~c>~ ~
Foundation ~',~' I
Water main/service line I c~t
CONTINUED ON BACK PAGE
72-026 (3/93)* Front
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Vent (Y/N) "Pump on" level at
High water alarm level ~s tested
Meets MOA electrical codes (Y/N)
SEPA~FT STATION TO:
Well'-on lot On adjacent lots
Manhole/Access (Y/N) _...-~"-'~
Surface water
D. ABSORPTION FIELD DATA
Date installed o.~
Length '¢~ Width
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~
Soil rating (GPD/FF)
Gravel thickness
Cleanout present (~N)
Results ~fail) ¢'/,¢z~s
\ ?.~'Z~ g?/~'~..-j System type
L,, t Total depth
Depression over field
for ,df.
After test
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots [~'~ Property line
To ~xisting or abandoned system on lot
Cutbank ~\t~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed~to.atl~A and HAA guidelines in effect
Signature - o ~ ~'.,.",~4~""¢'~- ~ :~ ~
Eng nee r,s N arno 17034 E aglo~'~"Z. '¢~"r ieFi.'.'~'.~o o/i;~/oad No, ~04 ~'
Eagle RiYer~ Alaska,-~Sil ~ ~
Date / ~/¢ - ~ ~
inspection.
HAA Fee $
Date of Payment
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
ENSTAR Natural Gas Company
A DIVISION OF SEAGULL ENERGY CORPORATION
3000 Spenard Road
P.O. Box 190288
Anchorage, Alaska 99519 0288
(907) 277-5551
March 7, 1994
S & S Engineering
Lynda Ulsher
17034 North Eagle River Loop
Eagle River, Alaska 99669
Dear Lynda:
Enstar Natural Gas Company has no objection to the vacation
of the utility easement or the encroachment of the
leachfield into the utility easement on Lot 7 Block 6
Thunderbird Heights Subdivision #3. This easement is not
needed by "ENSTAR".
If you have any questions please call me at 264-3743.
Very Truly Yours,
Right-of-Way Agent
dw
M'JNICIP,
ME
[]ATE: March 2, 1994
TO: Bri~m Hall, 1kf~,lic works Department
FRC~: ~n Keei~r, Planning Supervisor,
~ \ E~ginee, lng Division, AWWU
SUB3ECr: EAS~I'
Thur~ezbird Heights ~3 S/D, t~ik 6, Lt 7
March 1, 1994 request
The Anchorage Water & Wastewater Utility has revi~.~ed a req%~est frc~ S&S
·
Engineering on behalL.of Mr. Bruce
~ '~ ~ t as-built of
encroachment on ~e eeo]eot lot. Suhm~ttec~ witch the ~Ag~$ ~s an
the subject lot dated FeJDr~aa~Y 15, ]984, on which the encroachment of a
leachfield has been noted. This ieachfield is ~d_~nt_.fzed as encroaching, at
the widest poi~%t, approximately 6-7 ieet into Tfne utility easea~nt located on
tale east 15' of the subject prope~cy.
..... ~'~ to ~he referenc:e~, prop~-rtY·
AW%~VJ does not have sanita~7 sewer eel~'!Ce
The parcel is outside the certificated
objection to the encro3cb~ent.
Should you have any .... =e~o~. gle~Ase c~].]. Ha!!ie Mor£isor. at. 56~-2721.
cc: Lynda ulsher S&S Engineering
17034 N. Eagle Fc?,~¢:r !£.op, S~e. 204
Eagle River, Alas~u~ gg577
(907)694-2979; (907)694-12~.1 {fax)
Grid NW1865
[w~h~m.wp. easement ] 3 7
Matanuska Electric
Association, Inc.
P.O. Box 2929
Palmer, Alaska 99645
Telephone: (907) 745-3231
Fax: (907) 745-9328
March 2, 1994
Ms. Lynda Ulsher
S & S Engineering
17034 N. Eagle River Loop
Eagle River, Alaska 99577
Dear Ms. Ulsher:
Subject: Statement of Nonobjection
Leach Field in Lot 7, Block 6, Thunderbird Heights Add. #3
Enclosed is the Statement of Nonobjection you requested in your letter
to me dated March 1, 1994.
Sincerely,
Robert G. Ylvisaker
Right of Way Administrator
PRIME
March 4, 1994
Bruce Servin
24712 Teal Loop
Chugiak, Alask~t 99567
Dear Mr. Servin:
Subject to your agreement to indemnify the company' as set forth below, Prime Cable of
Alaska has no objection to the leachfield encroaching into the platted eastern utility
easement on Lot 7, Block 6, Thunderbird Heights, Addition No. 3, City Grid NW 1865.
This letter of non-objection in no way precludes Prime Cable from full use and
enjoyment of any rights it may have with)n any portion of the right-of-way, including
unlimited access for servicing its facilities.
By signing below, you agree to indemnify and hold Prime Cable harmless, now and
forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities
and injury to any person or property occurring as a result of the encroachment.
Please indicate your acceptance by signing and returning this letter to myself at the
address below.
Sincerely,
System Designer
/jb
Acceptance
Date
5151 FAIRBANKS STREET · ANCHORA(;I, ',I \!iK~\ 99503 · (907) 562-2400
STATEMENT OF NON-OB3ECTION FOR ENCROACHMENT
WITHIN UTILITY EASEMENT
Matanuska Electric Association, Inc. (MEA) has no objection with the location of
a septic ]eachfield within the utility easement
along the East boundary of the following property;
Lot 7, Block 6, THUNDERBIRD HEIGHTS ADDITION NO. 3 SUBDIVISION,
situated in Section 25, Township 16 North, Range I West, Seward
Meridian, Anchorage Recording District, Third Judicial District,
State of Alaska.
This non-objection is conditioned by the stipulation that MEA will be held
harmless from any and all damages to the encroachment that may result from the
existing and future use of said easement.
by:
Matanuska Electric Association, Inc.
General Manager or h~ Representative
March 2, 1994
Date
MEA ACKNOWLEDGEMENT
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
)
) ss.
)
The foregoing agreement was acknowledged before me this
day of March , 1994 , by Robert G. Ylvisaker
2nd
N6tary Public fbr the State~ of Alaska
My commission expires:
333,1/121#.i
RMATION
include lot, block, subdivision,
MUNICIPALITY-OF ANCHORAGE
:)EPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH ~-.
~ERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
· 264-4720 '" ":
., ~ 'r ~':';~'''' * ' "' ' Application Date
}, range)
ress or directions)
Tel~ p h o n..~i.~lo m e~4::/:~..~E,,~/'~/~/: 'd' _~ usi n es -~ -.~ ~.~
one):'Lending institution []; Owner/builder ~['; Buyer []; Other [] ,(explain);
Agent
the following address:
ICE
Multi-Family []
Other
and status
vritten confirmation from the State Depar[ment of Environmental Conservation
Community[] : Holding T k[] :
.~m, must have written confirmatio~ fr~0m the State
and status. ~ r . '. '~1 ~
Department of Environmental Conservation
72-025 (11/84)
5. ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA ,A AND INFORMATION
~. - ..i,~Ascerhhed by mysealafhxed heretoandasofthevahdahon dateshown below, I venfythat ~ny mvest~gabon of th~s Health
· .=: ?:i': ~!AuthorityApprovalsbowsthat theon-site water supplyand/or wastewater disposal system issafe, functional and adequate
· ' ' ~{: for the nLJmb~r of bedrooms and type of structure nd cared herein. I further verify that based on the information obtained
~ ? -?F.~ :'from the Municipafity of Anchorage fries and from my mvest~gabon and mspecbon, the on-s~te water supply and/or
~ ~ ~'~'"?~ wastewater d sposa system is in corn pliance with all Municipal and State codes, ordinances, and regulations in effect on
.... '~ ~* the date o~ th s nspect on _ _
- . ;~ ~:~.- ..,.:,.~,.: ;~ :~2 ~ & S ENGINEERING . ~ ~- ~ ~ ~
" '~'~:~rN ame °f Fir m ~" '~ ' '~"~'' -~. ~v ~ ~pnone ~ --
,"," ;~ '~;;~,"~'~ ~:'~-i ~L~ RIVER AK 99577
Date '. -
~ bedrooms by/~t
pprov~f/ -
~ditional Approval
ConditionalC/ /
CAUTION
Health and Environmental Protection (DHEP) issues Health Authority
solely upon the representations given in paragraph 5 above by an independent professional
enginee[ ~registered in the State of Alaska, The DHEP does this as a courtesy to purchasers ol homes and their lending
nst tut OhS n order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
'cert f cate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
ana ~Z~ ·data befo~:e~i~ , ,~,
' ': ~: "s work. . ,- -
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNIC PALITY OF ANCHOP, AcD~
DEPT, OF HEALTH &
~ENV RONMENTAL PROTECTION
. EBIVED
Legal Description:
WELL DATA
Well Classification A If~ A, B, C, D.E.C. Approved ~N)
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to ~'~'~)/L'~./ Depth of Grouting
Static Water Level Pump Set At
. Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot '~.4~ '~ ct- ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~ t~ ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date
Water Sample Test Results
Comments
B. SEPTIC'rANK DATA
Size
Date Installed
Stand pipes d~Z:N) Air-tight Caps
Depression over Tank (Y/(~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from SepticZMel~ng-~ank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
No. of Compartments
Foundation Cleanout (Y.4J~.
~ Date Last Pumped
;for
Temporary Holding Tank Permit {Y/N)
To Building Foundation '5' J'7...
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ¢- ~ ~
Width of Field ~ [.¢. c.,
Square Feet of Absorption Area
Depression over Field (Y/L.~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
Type of System Design ""'~
Length of Field ~ ~
Depth of Field ~ ~.~
Gravel Bed Thickness L~
Standpipes Present~YN)
Date of Last Adequacy Test
To Water-Supply Well
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
To Property Line / ~.~ t
To Existing or Abandoned System on
; On Adjoining Lots ~.¢~L~ J'~F-
To Cut. bank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
/~ /"Pump Off" Level at Vent (Y/N)
//~ Pumping Cycles during Adequacy Test. Meets MOA
Comments
signe~R B 196X
** Check Permitted Bedroom Rating Against HAA Request **
I certi~ ~l~ I~'J~[~ J;J~ J~JN~fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
JUN I 3 1986
Date
MOA No.
comp~2LE RIVER, AK 99577
Receipt No. '~q,o~'~)c~
Date of Payment (o- f (.¢ ¢~'~¢_.¢
Amount: $ (o .rS'g(~
Page 2 of 2
72-026 { 11/84)
D~PTo OF ENVHRON~ENTA~L ~ONSERV/~TIO~
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFI£LD, GOVERNOR
Telephone: (907)
Address:
274-~533
DATE: June 10, 1986
PWS I.D.# 211156
__~
Water Regulations
To Whom it May Concern:
According to records on file in this office the EKLUTNA/THUNDERBIRD
Water System is in compliance with the State Drinking
Sincerely,
Michael P.Lewis
Environmental Engineer
~ ~ APPLI¢'~'NT FILLS OUT UPPER HAf~ ONLY
F~;.9?erty Owner T & D Construction
MailingAddress Box 2524, Palmer, AK 99645 ZipCode qq6A5 7AS-27ql
Buyer ~ Elizabeth and Jeffrey Edmundson
1200 L. St. - Inlet Towers - I~m 103 Zip Code
G* E. Mortgage Company
Address 401 E. Northern Lights Blvd. Zip Code 99503 272-8588
Realty Co. & Agent William Schlegel ("O~) ~5¥AO~_L ~%LL%T_L~LA- Phone
Totem Realty, Inc.
Lot 7, Block 6 Thunderbird Heights
Street Location Raven View Loop Road
Time
Time Time Time \
Date Date Date Date
Inspector Inspector Inspector Inspector
MUNICIPALITY OF ANCHORA~t:
Field Notes: PFPT (~q J'~'I.T'~
ENVIg ~:11 I.,A.
SED 8/982
RECEIVED
(~/) APPROVED BEDROOM8 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) OONDITIONAL APPROVAL*
BY:DATE
Soils Bating Date Sewer Installed Well To Absorption Area Well Log Received
~ ~ ~ Well to Tank Septic Tank Size
72-023