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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3 BLK 6 LT 9Onsite File Thunderbird Heights #3 Block 6 Lot 9 #051-582-33 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211466 PID Number: 051-582-33 _ Dwelling: V Single Family_(SF)_❑ with ADL ❑ Duplax_(D)_❑ Two_Single_Family P_roject:_D_New 9-Upgrade-. Name Mary Trull ORPTION FIELD rEol—D Trench El Wide Trench E! Bed ❑ Mound Site Address 24616 Teal Loop Chugiak, AK 99567 Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Subdivision Block Lot Thunderbird Heights #3 6 9 Ft. Fill added above original grade Ft. Gr I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Tank Line Ftz Well NA TANK 21 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100+ Greer 1000 Gal. Material Number of compartments Lot Line 5+ NA Plastic 2 Foundation 10+ ATION Manufacturer Capacity Remarks Field verified 10' tank to foundation separation. Gal. Field verified 5'tank to absorption field separation Alarm location Elects ' ailed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 JR's Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection dates: 11/11/21 Zia 11/11/21 Location and description p 3rd 11/16/21 4" Roof corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date E OT 4 `l�A`'"�� 'Vol Septic System Approved Date li �y,?41/ � f �, KENNETH M. US A •i�.s�y CE ��1� •+� Note: this approval does not include well permit requirements. ��t ESS��'►��~ air • SEPTIC VENT (tyP) A -C=9,3' B -C=24,6' A -D=10,3' B -D=25,3' A -E=13.4' B -E=28.6' A -F=14.2' B -F=32.9' A -G=14.7' B -G=34.2' A -H=15.4' B -H=35.5' AS -BUILT SYSTEM DETAILS/SITE PLAN THUNDERBIRD HEIGHTS #3 BLOCK 6 LOT 9 -- x DECK c x D Op I G. H X NEW 1000 GAL TANK X X X X X SCALE: NTS Awr OFAL�� * ..49 H --* NX KENNETH M. S fcE-_-_7-1' b wa Wg U W y�y� UU � J .l 000 GAL SEPTIC PREPARED FOR: MARY TRULL 24616 TEAL LOOP CHUGIAK, AK 99567 FIELD BOOKS BOUNDARY: N//A. STMNG: N/A ASBUiLT: JLS M. FILE ACAD FILE FILE — M.1. 1 Rv' 1 —m Permit ❑SP211466 PID# 051-582-33 WALL I—� a a. - DRIVEWAY. 'ed..d, WALL DECK COMPUTED: DRA11N: KSD `HES' KMD DATE: 1DATE 1 /17 MD- NW1865 JOB No' 21088 SCALE: 1' = LZ KEYBOX SCALE: NTS LOT 8 LOT 10 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: THUNDERBIRD HEIGHTS, ADD, No.3 LOT 9 BLOCK 6 PLAT 80-116 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences; structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL: NOV 15, 2021 1 "=30' schullerOok.net 21-160 DRAWN BY; CHECKED BY GRID NUMBER: BOOK/PAGE JLS NW1865 210363 30 ) z 0 0 O 0 Y V Y , ........ , 4Z 'V p,L► LAN. f R' ••.J N L. SCHULLER.• o LS --10408 • .� ' *.u."6 - .a x 1 �• �,, • , 5� , . • ��/ 1831 Talkeetna Street �C : • �a ,r,► A.Anchorage, Alaska 99508 aA 1\ ra ;'' fe (907) 227-1455 office '��, ssion�_�•■r. (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program ti° Is, PO Box 196650 4700 Elmore Road �- Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 n http://www.muni.org/onsite Depar•tnient On -Site Wastewater Disposal System Permit Permit Number: OSP211466 Effective Date: 11/8/2021 Work Type: SepticTank Upgrade Expiration Date: 11/8/2022 Tax Code Number: 05158233000 Site Legal Address: THUNDERBIRD HEIGHTS #3 BLK 6 LT 9 G:1865 Site Mailing Address: 24616 TEAL LOOP, Chugiak Owner: TRULL MARY K Lot Size in Sq Ft: 20000 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-582-33 Property owner(s) Mary Trull Mailing address PO Box 672322, Chugiak, AK 99567 Site address 24616 Teal Loop Chugiak Day phone Legal description (Sub'd., Block & Lot) Thunderbird Heights #3 Blk 6 Lot 9 Legal description (Township, Range & Section) Lot Size 20,000 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank x❑ Upgrade M Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) (w/wo AD U) Duplex (D) Multiple Dwellings (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: $2 % e i Waiver Fees: Date of Payment: 11 b a D Date of Payment: Receipt Number: 0 5 a u{ ,5 (n Receipt Number: Permit No. Dc ) P 2 119 6 F Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc X❑ ■ ■ Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211466, Rebecca Carroll, 11/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211466, Rebecca Carroll, 11/08/21 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 [] UPGRADE LOCATION . DISTANCE TO: iF HOME.DE Inside length DISTANCE TO: NO. of lines /~ I Length~ch~n~ Length Width Foundation~._~ Type of crib Crib depth DISTANCE TO: Class DISTANCE OTHER Well Building foundation )epth Driller Building foundation Sewer line Material NO, OF B~.~OMS PER ?'d No, of c~mpartments: Liquid depth PERMIT NO, Liquid capacity in gallons N earnest] ot ~.~2~ t inches ~ i:~ n c:~c: :~"~ es ~r~ ~ o n area .500 PERMIT NO. Distance to lot line Septic tank PERMIT NO, Absorption area(s) PIPE MATERIALS REMARKS ,/ DATE LEGAL PERMIT N.O. APPLICANT LOCATION LEGAL ( B±OE44 ) KLEIN CONST RAVEN LOOP L9 B6 THUNDERBIRD HTS TYF'E OF SOIL ABSORPTION SYSTEM IS: [EFHRTHENT r qERLTP 8ND ENVIRONMENTRE R:OTECTION ,S25 '"L'" STREET., ANCHORAGE., AK. 99501 264-4728 BE,., 2524 PALMER .:_t,~.,~. ~ : [ ,'4.., ~, ...:[ c ~ 2~800 SQLRRE FEET LOT ...I ~E TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ F]"/BR)= :1.00 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:, E F' T ~ =: 9 L E ~ g3'Tt~l:= ]: ~Z'I ,-3 R R",,-" E L DEF'T'H== 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINF'IELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E>::CRYATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRA'./EL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 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. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPFIRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS :[00 FEET FOR R PRIVATE WELL OR :[50 TO 200 FEET FROM A PUBLIC WELL DEPEHDING 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE R',/RILABLE TO INSURE PROPER INSTALLATION. 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 BCCORDANCE WITH THE CODES. ]~: I UNDERSTAND THAT THE ON-BITE SEWER SYSTEM MAY REQUIRE ENLBRGEMENT IF THE RESIDENCE IS REMO~:,EL~ TO INCLUDE MORE THRN 2: BEDROOMS. ................... O & E ENC,;NEERING & DEVELO,'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Depth (feet) Soil Characteristics 0 Earl Ellis 688-2280 2 3 5 6__ 7__ 8__ -------9 __ 10__ 11__ 12__ 13 PLOT PLAN I 15 16__ Ground Water Encountered: Yes No /'/If yes, what depth Proposed Installation: Seepage Pit__ Drain Field.__ Comments: Performed by: PERC. TEST Date: • '- Municipality of Anchorage r4TG On -Site Water and Wastewater Program (907) 343-7904 5 A E T Y ER-T-IFICA-T-E-OF-ON-SI-T-E SYS -T -EMS -APPROVAL Parcel I.D. 051-582-33 Expiration Date: dG a I o�oa3 1. GENERAL INFORMATION Complete legal description Thunderbird Heights #3 Block 6 Lot 9 Location (site address) 24616 Teal Loop, Chugiak AK 99567 Current Property owner(s) Mary Trull — Day phone Mailing address 24616 Teal Loop, Chugiak AK 99567 Real Estate Agent ----- -- ------ Day phone_ -- -_. 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well El Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment 1 1 a U 2 l Receipt Number COSA # Z11<80 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site 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-frfrom 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 ARCTERRA CONSULTING, INC. _ Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name _KENNETH M. DUFFUS Date /3 r 2-2 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system_ The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future �•�.`�►\ \ occupants or can ArcTerra guarantee that no unseen UliL , encroachments, deficiencies or discrepancies exist. �� i�(4S; :��. �� 1 0 A n TP K_ 6. DSD SIGNATURE V System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 0N. 1,4 OF Anu;��i, �V `-- 0 -SAT _ WATPRAND o WASTr u'ATER By: Original Certificate Date j ( a Y1.20 a % The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: Thunderbird Heights #3 Block 6 Lot 9 Parcel ID: 051-582-33 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA I log is filed with Onsite (or attached) Date drilla Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft Comments B. TANK DATA Age of tank(s) New years Tank type/material SeptielPlastic Measured operating fluid level in septic tank New U Standpipes/foundation cleanout per record drawing Date of pumping New tank installed 11/11/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/27/81 ® ALL standpipes present per record drawing Total measured depth from grade 7.58 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.58' ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Com ments/Deficiencies: COSA Checklist yellow sheet Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Acwnic ug/L ❑ Arsenic less than MRL (ND) Collected Date of Sample C. LIFT STATION aired maintenance completed Age of lifts years Lift station material Comments Adequacy test date 10/29/21 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 460 gal New depth 3 in Elapsed time 15 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Ta _ Cation on Lot > 100' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Iding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ft Animal Contal > 50' ❑ Yes if No ft ❑ Yes if No ft if No ft Community Wells > 200' ® Yes if No ft Manure/Animal Excreta Storage Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes i ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION ��♦�P�� 1 certify that 1 have determined through field inspections and review ` ., of Municipal records that the above systems are in conformance with �` 491h MOA COSA guidelines in effect on this date. CE 73W COSA Checklist yellow sheet 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 9; Block 6; Thunderbird Heights #3 Location (site address or directions) 24616 Teal Loop Chugiak, AK e Property owner Mailing address Lending agency Mailing address Pam and Michael Ford 24616 T~al Loop Chuqiak, AK Day phone 688-5648 99567 Day phone Agent Kath~ G~ra~J GREATLAND REALTY Address 11411 Old Glenn Hwy. Ea~le River, AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well Community well XXX Public water Day phone 694-9125 99577 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 ×XX 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. 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, ordinances, and regulations in effect on the date of this inspection. ~ Phone Name of Firm S & S ENGINEERIN~ / Address ~~~ Engineers signature .~ Date DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health aqd Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representabons given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is 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. 72~25 (Rev. 1/91) Back MOA ¢t91 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~---,>T ~ {~t.-V--~ '~'rAo~r>~--t~,C-D Parcel I.D. A. Well Data Well type ,~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number Static water level Well flow ~ Pump levell~-~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~",:' ~ J' Absorption field on lot '7~o~ Public sewer main Date completed Driller Cased to Wires properly protected (Y/N) FROM WE~ Casing height g.p.m. g.p.mi'-rl ; On adjacent lots Sewer service line WATER SAMPLE RESULTS: ~ Coliform / Nitrate D~ Collected by: ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~ Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed '~ ~ ~ / Cieanouts (~) y High water alarm (v~ Date of pumping Tank size ,/~ ~,D Compartments Foundation cleanout-~ ,"/ Depressiop/{Y~) /J' Alarm tested (Y/N) ~,_ 15~ ~z{ Pumper :,"~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~,~ o To property line /o Sudace water/drainage On adjacent lots Absorption field /o~ 14- ~//~ Foundation & / .5- / Water main/service line /o / '"' 72-026 (3/93)' Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SE~OM LIFT STATION TO: Weql on lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~ Surface water Date installed Length ~;,-o ' ' Total absorption area Date of adequacy test D. ABSORPTION FIELD DATA Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y(~ Soil rating (GPD/Ft2) Gravel thickness Cleanout present ~N) y/ Results ,(~fail) ,,'~A-~-~ .5--/ Total depth ? / Depression over field (Y/~) .,-/ for $ Bedrooms After test if yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots ~/~ Property line /~ / 'h- To existing or abandoned system on lot Cutbank 'J.//~ Water main/service line /o / Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION cerb'fy that I have checked, verified, or conformed to all MO;c~d H~ guidelines in effect on the date of this inspection. nature , ......... HAA Fee $. ~.'~0, ~'~ Date of Payment Receipt Number Fe~$ ' ": ' '" Waiver Date of Payment Receipt Number 72-026 (3/g3)' Back , "~ MUNICIPALITY OF ANCHORAGE ~ DIVISION OF ENVIRONmeNTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEoA_LTH AUTHORITY APPROVAL CERTLFICATE ! · General Information Application Date ~ (a) Legal~Description (_include lo~ block, s~ubdivision~ section, ~owmship, range) (check one) Lending Iust ution Owner/builder ~ ' (c) Applicant is ~ . ~ ~ ; . . , (a) e ding Iust± ution ele hone (f) Mail the FAA to the following address: o T~e of Residence Single~Family~ Number of Bedrooms Multi-Family~ Other (describe) Water Supply Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° Sewage Disposal Onsite ~ Public ~--~ Community ~ Holding Tank ~ Note: If community well system, must have %r~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] 5o ~~ Fi~rm Provid__i_n~~ons Tests F~_ile _Sear~ch~h~h~Data~ 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 sho~mo 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 filea and from my investigation and inspection~ the on-site water supply and/or wastewater disposal system ia in compliance ~Fith all Municipal and State codea~ ordinances~ and regula- tions in effect on the date of this inspection° Telephone DEEP A~roval Approved for .'~ bedrooms Approve~.-~ __ Disapproved Terms of Conditional Approval By Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMEb?f OF ~A. LTH AND ENVIRONI~ENTAL PROTECTION (DHEP) ISSUF, S HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE, REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE 0~,' ALASKA° THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOM~ES AND THEIR LENDING INSTITUTIONS IAi! ORDER TO SATISFY CERTAIN FEDERAL AND STATE ~QU!RE- MEN~fSo EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS ~_0MISSIONS LN TttE FROFESSIONAL ENGINEER' S WORKo (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7~19~84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAAi CHECKLIST - FEBRUARY 1984 Well Classification ~ Well Log P~esent (Y/N) Total Depth Static Water Level Casing Height Above Ground Cased to MUNICIPALITY OF ANCHORAGE DEPT· OF HEALTH & ENVIRONMENTAL PROTECTION FEB If A, B, C~ C, D.E.C. Approve ) Date Campleted Yield Depth of G~outing. Pump Set At Sanitat~y Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression A~ound Wellhead (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot ~-0 -.)L ; On Adjoining Lots ~30 f To Nearest Edge of Absorption Field on LOt'ZOO .~L ; On Adjoining Lots ~nD ~ To Nearest Public Sewer Line To Neazest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on LOt Water Sample Collected By ; Date Water Sample Test Results t Cc~Luents. ~ ~ /~.~' ~ ~ zg'~/ ~ ~'~~ B. SEPTIC/R~f~N~ TANK DATA Date Installed ~/ ~(~/ Size /~ ~ NO. of Cg,~a~tments Stan. i.s~ '. Aid-tight ~p~*) . Foun*tion Cleanout ~ession o~ Ta~ (Y~ ~te ~st~d ~ P~lng~intenan~ ~n~a~ ~ File (~/~ ; fo~ Holding Ta~ High-Wate~ ~a~ (Y~)~/~ ~ Holdi~ Ta~ ~t / ~p~ation Distils ~ ~ptic~ Ta~: To Wate~Supply ~11 ~ ~ To ~ilding F~ndation ~ / To P~operty Line /~ To Water Maip~Service Lir~ Course Conm~nts ~ To Disposal Field ~" ' /~-~ To Strewn, Pond, Lake, c~ Major D~ainage Receipt Date P .aid: Amount. [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ~-~ oc~ Width of Field .~ F/690 ~/~? Type of System Design ~;c _~ Length of Field ~O Depth of Field ~ ~ ~ Gravel Bed Thickness 8O ~ Standpipes Present (~ Date of Last Adequacy Test ~..--7_-~ . Square Feet of Absorption A~ea Dep=ession Over Field (1~ Results of Last Adequac~y Test ~/~ Separation Distan~ ~ ~s~ption Field: / To ~te~-Supply ~11 ~ ~ To Building Foun~tion ~ To Existing Lot ~ ~ ; ~ ~joining ~ts To Wate~ ~/~vi~ Line ~o To Stre~ond~ke/~ ~jo= ~aina~ ~se To ~iveway, P~ki~ ~ea, ~ Vehicle St~a~ ~ea D. LIFT STATION Date Installed Size in Gallons "Pump C~" Level at High Water Alarm Level at Tested for Dimensions /le/Access (Y/N) ~ ¥ Vent (Y/N) . · Pumping Cycles during Adequacy Test. M~ets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedrccn~ Rating Against HAA Request I c~rtify that I have checked, verified, or confc~.~ed to all MOA HAA C~idelines in effect on the date of this inspection. Signed .~3 & ~' ~.I631N~F.~]N ~ Date Company PH. n,~9 ,~.~.,,,'"~7~,) MOA NO. KB1/d5/s [Page 2 of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION / / ANCHORAGE/WESTERN DISTRICT OFFICE 437 I'E" STREET, SUITE 303 ANCHORAGE, ALASKA 09501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: ~"~*~ Water System is in compliance-with the State Drinking Water Regulations Sincerely, 'l DA ,~ECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE Mt IAIIC 'kq(~ ,ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL pROTECTION r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 82E OCT 1_ 4 1981 L Street - Anchorage, Alaska 99501 '~ ' ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts o, page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MAI LING ADDRESS 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRES~ 4, REALTOR/AGENT PHONE MAILING ADDRESS 5., LEGAL DESCRIPTION ~ [] One [] Four SINGLE FAMILY [] Two [] Five J[] MULTIPLE FAMILY ~ Three [] Six ~ 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY ' [] Other I-- * ATTACH WELL LOG. A well log is required for all wells drilled since Jupe 1976. For wells drilled prior tO that date, give well depth {at(ach log if available.) 8. SEWAGE DISPOSAL SYSTEM . y,,D,V,O':'AL,O'-S,TE" [] PUBLIC UTILITY 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 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX · '~ERMIT NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY 3ATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Sep~ic Tank or []Holding Tank Si~e: If Tank is homemade SOILS RA~-ING give dimensions: TYPE OF TANK MANUFACTUR'E'N -OTAL ABSORPTION AREA MATERIAL ' . , , 4, DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line L WELL TO: Absorption Are~] td he,rest Lot Line ' ~ ., B, COMMENTS RDVED FOR BEDROOMB [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED