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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3 BLK 6 LT 11Thund rbird H ights Block 6 Lot 11 #051-58; -31 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 LEGAL DESCRIPTION LOCATION gallons IF HOMEMADE: Inside length DISTANCE TO: Well Dwelling NO. OFBEDROOMS Manufacturer DISTANCE TO: IAbsorption area PERMIT NO, No. of compartments Foundation No. of lines Length of e ch line Total length of lines Material Nearest lot line Top of tile to finish grade Material beneath tile .~ f Width Depth Driller Sewer line Length Liquid depth PERMIT NO. Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Class Depth DISTANCE TO: Building foundation Liquid capacity~/~ PERMIT NO. t Distance between lines inches inches Total effective absor tion area PERMIT NO. Total effective absorption area Nearest lot line Septic tank Distance to lot line OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS DATE LEGAL ,. DEPFIRTMEi'4T L HEFILTN RND ENVI.R. ONMENTfiL -.- ~, .925 "L" STREET, RNCMORFIUE~ FII<, flPF'L~CflNT O.S.K. CONST. ~fl GlO~ L. OCflTION RflVEN$ LP. LEGRL LOT 15 ELK ~ ~HLINDERBZRD HFs,. LOT TYPE OF ';~OIL .... flB~;ORPTIoN SY'STEH I~.~" TRENCH '. BEDROOH.;, = SOIL RfiTINO ~flXIMUM NUMBEr. CF 4 THE RE~;IRED SI~P THE ~OIL 8B~O~TION.~b~STEM IS~ THE LHNOT~ DIMENSION iS THE LENGTH (IN FEET) OF THE TRENCM OR DRfl~NFIEL. D. I'HE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETNEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE 'EXCRVflTION (IN FEET), TWERE I~] NO SET NIDTH FOR TRENCHES. THE OR,VEL DEPTH IS THE MINIMUM DEPTH OF ORR'dEL BETNEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E~,~CRVRTION (IN FEET). PERMIT RPPLICRNT HflS 'THE RESPONSIBILITY TO INFORM THIS DEPflRTNENT DURING THE INSTflLL.RTION INSPECTIONS OF tiNY WELLS flDJfiCENT TO THIS PROPERTY fiND THE NUMBER OF RESIDENCE~ THflT THE NELL WILL. ~ERVE. BROKFILLING OF RNY SYSTEM WITHOUT FINRL. INSPECTION RND RPPROVRL. BY THIS DEPflRTMEMT HILL BE g';UBJECT TO PROSECUTION. * MINIMUM DISTflNCE BETWEEN R NELL fiND 8NY ON-SITE SENflGE DISPOSflL SYSTEM IS i00 FEET FOR fl PRIVWFE NELL OR 1~0 TO 200 FEET FROM fi PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTflNCE FROM R PRIVRTE WELL TO fl PRIVRTE SEWER LINE IS 25 FEET fiND TO fl COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MflY flPPLY, SPECIFICRTIONS fiND CONSTRUCTION DIBGRRMS fiRE RVRILRBLE TO IN~URE PROPER INSTRLLRTION. I CERTIFY THflT i: I OM FflMILIflR WITH THE REQUIREMENTS FOR ON-SITE Ir]EWERS fiND NELLS tis SET FORTH BY THE MUNICIPflLITY OF 8NCMORGGE. R: I MILL INSTRLL. THE SYSTEM IN flCCORDflNCE WITH THE 3: I tJNDERSTRND ]"Hill' THE ON.LSITE $EMER ~¢S~STEM f'tFtV REC4UIRE ENL. flRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THEN 4 BEDROOMS. ," ,/I ~"" .,.., :~ ~ / / . O & E ENG!,.,IEERING & DEVELOF .,,;'lENT CO. Box 90, Davis St,, Eagle River, Alaska 99577 ' 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Performed for: Name: Tel. No. Mailing Address: Legal Description: ~'r /[ / .x~-~/~_ ~'/ ~'-/~.~/~ll~.~ /t~) Earl Ellis 688-2280 Depth (feet) 0 2__ 3__ 4__ 5__ 6__ 7__ 8 9 13 14__ 15__ Soil Characteristics PLOT PLAN PERC. TEST Ground Water Encountered: Yes Proposed Installation: Seepage Pit.__ Comments: No ~' If yes, what depth Drain Field.__ Performed byi _ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-582-31 GENERAL INFORMATION ComPlete legal description Location (site address) COSA # Expiration Date: Lot 11, Block 6, Thunderbird Heights Subdivision No. 3 24532 Teal Loop Chugiak, AK 99567 Current Property owner(s) Norton and Michelle Hargis Mailing address 24532 Teal Loop Chugiak, AK 99567 Day phone Lending agency Mailing address Day phone Real .Estate Agent Mailing Address Unless otherwisere'quested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: ............... indiVidual Well Individual Water Storage Community Class Well Public Water System Day phone TYPE OF WASTEWATER DISPOSAL: [] : Individual Omsite [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (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 below, I vedfy 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 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 Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE [J Approved for Z/L Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~d_.,~'- Original Certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety DiviSion On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 Legal Description: A. WELL DATA Well type Date completed Total depth ~ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Lot 11, Block 6, ThUnderbird Heights Subdivision No. 3 ¸ft. IfA, B, or C provide PWSID # _ Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~colonies/100 mL Arsenic: ug/I B. SEPTIC/HOLDING TANK DATA g.p.m. Nitrate ~ mg/L Date of sample: Tank Type/Material Sepac/Stee~ Tank size 1,250 gal. Number of Compartments.Two Foundation cleanout (Y/N) Y** Date of pumping 3/5/2010 ABSORPTION FIELD DATA Date installed 10/15/81 Length 80 ff. Total depth 9+ ft. Date of adequacy test 5/28/2010 Fluid depth in absorption field before test 0 Depression over tank (Y/N) ... N Pumper JR's Pumping Soil rating (g.p.d./ff2 or ft=/bdrm) !50 SF/BDRM Width 4 ft. Eft. absorption area 6o0 ftz Monitoring tube Results (Pass/Fail) Pass in. Elapsed Time: 0 min. Final fluid depth 0 Any rejuvenation treatment ,(past 12 mo.) (Y/N & type) Parcel ID: 051-582-31 Well Log (Y/N) Wi.res properly protected (Y/N) Casing height (above ground) AT INSPECTION g.p.m. in. Other becteda Collected by: ~ colonies/100 mL Date installed 10/15/81 Cleanouts (Y/N) Y High water alarm (Y/N) System type .Deep Trench Gravel below pipe 5 ft. Y Depression over field .,,,N For 4 bedrooms Water added 647 gal. New depth. 0 in. in. AbSorption rate >= 600 g.p.d. N 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: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main N/A Sewer/septic service line N/A Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? Building foundation 3 .... Water main >1o' Wells on adjacent lots>200' On adjacent lots N/A On adjacent lots N/A PubliC sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >10o' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line >5' Absorption field >5' Water service line >1o' Surface water >1oo' Water main >1o' Driveway, parking/vehicle storage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >1o' Building foundation >1o' Water Service line >1o' Surface water >1oo' Curtain drain None Noted Wells on adjacent lots >2o0' F. COMMENTS: **Foundation Cleanout is Located in the Crawl Space. ***A Waiver has been Issued Allowing the Septic Tank to be Less than 5' From the Foundation. in. G. ENGINEER S CERTIFICATION · "-"-'~ ~' %'T'~ I ~ that I have datelined though field inspections and ~view of Municipal ~s that the above systems am in confo~ance wEh MOA COSA guidelines in effe~ on this date COSA Fee $ ~ ~ 0 Waiver Fee $ t Date of Payment, ~ / / Receipt Number 0! ~'' Et/~'~ ~ (Rev. 11/05) Date of Payment Receipt Number 3Rs Pum PO Box 773, Eagle River, (907) 694-64'. Anderson~ Po Box 241 ATTN: Mil{ Anchorage (907) 522~' Ext # 2005 Mike 24532 Tee Chugiak, ~ (907) 522~ lng 5 K 99577 Engineering Job Description: '73 P.O. Number: Terms: /NK 99524-0773 773 Salesrep: Map Book: Site Information --[ Cross Streets; Job Comments: Loop ( 99567 '773 Additional Location Comments: Cedar Red Trim - W-~'s Fence &Il late Septic {~ :)ack Of home Diagram: 12509 JRS SEPTIC PAGE Service Agreement Number: 032761 Order Date: 05-Jan-2011 * Service Date: 05-Jan-2011 10:37 Technician: Mike ~_.')pieq?ams~2@9~ .bmD Net 30 Tax %: 0 Karlia Job Type: Repeat Map Grid: 07 - - Old Glenn Hwy !L~i'Sen/ ...... *05i07/2009' 12§09 eked .... SERV & BILL----.-- : & Pumped Tank L's Normal Gallons Planned: 1250 Gal. Actual: Hose Length: 3 Double Tank: [] _._.... Pump System: [],, Baffles Inlet: [] ~ Baffles Outlet: [] ~ 01 Service Qty Price Each Tax? SepticSa 1250K I $165.00 No Extension Actual $185.00 NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charges: $185,00 $0.00 $0.00 $1B5.00 Ac-f. ual Charges: Customerl; ;lrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT, Signaturei~ Representative Date For After JRs Pumping ~ete Accepted ed convenience we accept; American Express, Dlcover, Visa and Master Card payments over tho phone, account will be turned over to COLLECTIONS. $30.00 For NSF Checks Returned. ~u,o~o~i JRS SEPTIC PAGE JRs Pumping PO Box 773415 Eagle River, AK 99577 (907) 694-6454 B~inq Information _j Michelle Hargis Po Box 671113 Job Description: 1250g P,O, Number: Chugiak, AK 99567-1113 (907) 088-5477 [Job Site Informa__.t[0n Michelle 24532 Teal Loop Chugiak, AK 99567 (907) 688-5477 Terms: Salesrep: Map Cros~ Street,: Job Comments: Service Agreement Number: 030606 Order Date: 01-Mar-Z010 Service Date: 05-Mar-2010 12:0 Technician: Mike Net 30 Dawn-Dawn Old Glenn Hwy Tax %: 0 Job Type: Repeat Map Grid: 07 - - Last Serv *05/07/2009' tank normal back flushed 2 times=clean 1250g Additional Location Comments Diagram: Cedar Home - W/#'s - w/Red Trim - Fence and Gate Dogs Will be contained Septic (~ back of Home · c~o Gallons Planned: 1250 Gal, Actual: Hose Length: 3 Double Tank: [] ~ Pump System: ~], Baffles Inlet: [] Baffles Outlet: [] Service Type Qty Price Each Tax? Extension Actual Septic Serv 1250K 1 $0.00 No $0.00 NonTaxable Total Taxable Total TaX Total Grand Total Estimatecl Charges: Actual Charges: Cust;)mer agrae~ ~o the terms and conditions shown. THIS tS A BINDING AGREEMENT. /S~~~ture a~d TI' of Customer Re tative Date Alter 30 be~Jmed ever to COLLECTIONS. $30,00 For NSF Checks Returned. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-79O4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Expiration Date: /- 1. GENE~ INFORMA~ON ~mplete legal description . Lo,lion (site address) ~ ~ / ~w~ ~, ~Z~¢,~ ~, ~/~ Cu~entPmpe~o~e~s) ~,'//,~ ¢. ~ ~ ~/~ Dayphone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Dayphone ~ z Un/ess otherwiso requested, COSA will be hem by DSD for pickup. 2. NUMBER OF BEDROOMS: .z._._/ ........... 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (Certificates may be reissued for a pedod 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 Se DSD SIGNATURE Approved for /../L Disapproved. Conditional approval for 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 Ihe 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 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 D~t~w/~ ~./~'¢~/~f Phone(~d?~)2'z/~/'/~?-~ Address ~ ~l~-~/~ ~'t~ ~/r,z /~/~t~, Engineer's Pdnted Name ~,,,,~./w,.~- ~7. ,~/~.w · ,.~. · -I ..... ,~ ,v.~.. bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory ,~--.. .. 0N-SITE VVAIb~ANU . WASTEWATER PROG~M .' Maintenance Agreements Supplemental Engineer's Report Other '~:~)d~Original cortificate Date: /- ~/-~7 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bregaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ,4'~'//,/~/~¢/~'~'i 7~,'/~,~/~'~'~'/'~///7~/~;~/~5H~-T Parcel ID: O-5"'] A. WELL DATA W~Jl type ff A, B, or C provide PWSID # Well Log (Y/N) Da~ Sanitary seal (Y/N) Wires propady protect~,~?'_,~)/ Tolal depth ~ Cased to fl. Casing hei~round) in. _ FROM~ ~.N~SPECTION Date of test ~~ ~ Star, water levei ~/~"-.,.~,,~ ~ ff. wWA~;~~ ~ g.p.m. Coliform ~ colonids/100 mL Nitrate mg/L Other bacteria '"'--,, colonies/100 mL Amen~'. mg/t Date of sample: Collected by:. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size /~ ~"~ gal. Number of Compartments Foundation cleanout (Y/N) .y Depression over tank (Y/N) Date of pumping ,~'/~, ~4 Pumper Date installed Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed , ~',~P-/,¢'/ Soil rating (g.p.dJft2 or,~,.~.~ Length ~- ~ ft. Width ~' ft. Total depth ~ ~' ft. Eft. absorption area ~¢~' ft2 Monitoring tube .. Date of adequacy test / ~'/~'/'~ Results (Pass, Fait) .~ Fluid depth in absorption field before test -~ in. Water added ~ ~?gal. Elapsed Time: .~ ~ min. Final fluid depth / ~in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type 7~-~ Gravel below pipe ~'- ft. Depression over field ~ For ~ bedrooms New depth .,~ ~' in. ~'~ gp.d. If yes. give date -----" D. LIFT STATION Size in gallons Manhole/Access (Y/N) ~ ~ in. ' ~ Meets alarm & circuit requ~ 'Dalew~-~ Cycles tested E. SEPARATION DISTANCES ROM WELL ON LOT TO: On adjacent lots Animal containment areas 7~'-~* ~ ~. Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~" ~'.~. Property line ~ c) f'/~.. Water main ~ ~'"~" Wells on adjacent lots .~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line ~.?.~ ~' Curtain drain Absorption field .~'- Surface water /~'/' Building foundation /~ Surface water /~'~ ? Wells on adjacent lots ,~ F. COMMENTS ENGINEER'S CERTIFICATION I ce~ that I have determi~d t~gh ~ld insect, s a~ con~mance with MOA COSA gu~eli~s in effect on this date. Engine's Print~ Name ~ ~ ~ ~ [ ~ ' ~ .... '~ ~ ' ' "- ~ .~ 'Z ~ .~.~"~'; Date COSA Fea S Date of Payment / Z." ~Z. <~'- ~:~ ~ Receipt Number ~ (Rev. 11/05) /-¢-o7 Waiver Fee $ Date of Payment Receipt Number January 8, 2007 Mr. Jess Poet Municipality of Anchorage On-site Water and Wastewater 4700 Bragaw Street Anchorage, Alaska 99507 Re: Waiver for tank to foundation for Thunderbird Heights #3, Block 6, Lot 1 I Chugiak, Alaska Please accept this letter as a request for a waiver of the requirement for a five-foot separation from the septic tank to the foundation of the two-story single family residence. Attached is a drawing showing the approximate location of the tank to the building foundation. The distance from the top ofthe foundation wall to the bottom of the footing was measured at 4'-2". The grade on the outside of the house was roughly down 6- inches from the top ofthe block. The tank depth from ground level to the bottom of the tank was measured at 9'-0". The influence ofthe footing, using the 45-degree rule, intercepts the tank approximately 2'-8' up from thebottom of the tank. Theclosest horizontal dimension from the tank comer to the building foundation is estimated at roughly 36-inches We request that the separation distance be waived for the following reasons: I. The tank sits at a 45 degree angle to the building and the footing influence falls on the lower portion of the comer of the tank only. 2. The soils at the tank are granular, NFS soils (130 sq. fi. per bedroom) which offer excellent support for the tank structurally. 3. If the tank were to fail, it would be near the middle ofthe tank. We feel that a failure at the midpoint of the tank would not jeopardize the stability of the footing. If anything else is required in order to grant the waiver, please contact me. Sincerely, I /'~ Douglas T. K~~enley, P.~.~ ASBUILT-NO CORNERS SET THIS DATE I HEREBY CERTIFY .THAT I HAVE SURVEYED THE I SCALD FOLLOWING DESCRIBED PROPERTY, /~_-..~o ' .~.~ OF.A~ ND ~AT NO EN~HMENT~ EXlST~CE~ AS ~ ~ D~E~INE T~ EXISTENCE OF ANY GEID~ WHI~ DO NOT ~PEAR ~ THE RE~D~ ~BDI- VISION P~T. UND~ NO CIRCUMSTANCES S~ OF FENCE LIN~ OE ~R E~LISHING ~ND- DEAWN~ ARY LINES. 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. munLorg/onsite (907) 343-7904 ON-SITE SEWER/V~ELL SUBMITTAL COMMENT SHEET To: bou~ Kenley Legal description: Thunderbir~d Heiqhts ~3 Block 6 Lot 11 The attached paperwork has been reviewed and is being returned for the following reasons: Original signature or stamp missing on Calculation error in design. Additional soils information needed. Water monitoring results inadequate. Discrepancy in information submitted. Topographic information missing or inadequate. Incomplete; missing Survey Incomplete; missing Additional adequacy test information needed. Water sample unacceptable. Measured/proposed distances/dimensions missing. Locations of all soils, percolation and water monitoring tests not shown. Proposed system too deep for soils information submitted. Well log required. Omission in narrative. Insufficient fill over tank or field. [] Other. zf tank is less than 5 feet to foundation, a waiver must be applied for or tank must be moved, Name of reviewer:. ,Teff Date: 1-3-O7 Please supply the necessary information and re-submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Parcel I.D, # 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 HAA# 1. GENERAL INFORMATION Complete legal description Lot 11; Block 6; Thunderbird Heights #3 Location (site address or directions) 24532 Teal Loop Property owner Mailing address Lending agency Mailing address Greg and Jackie Cummins 24532 T¢~ Loop Chugiak, AK Day phone 99567 688-1001 Day phone Agent John Plylar/ Gre~tland Realty Address 11411 01d Glenn Hwy. Ea,~le. Riv¢~., Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: NOTE: Day phone 694-9125 AK 99577 Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev, 1191) 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 ba~ed 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. Name of Firm s& s Ef.,IGINEERING ~/'034 Eagle River Loop Roa~( Address Engineer's signature ~~.~'-~'-~ ~----~, Date ~ D/~H~S SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for 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 rc, gistered 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. ~he Municipality of Anchorage is not responsible for errors o¢ omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,-r \\ ~'~t~ L~"~'~,~,~f.~ ~'~ Parcel I.D. A. Well Data Well type ,~ Log present (Y/N) Total depth Sanitary seal (WN) Date of test Static water level pWellu~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller .Cased to Casing height ___ .Wires properly protec~ FROM WELL LOG ~-A-'F'iNSPECTION .g.p.m. g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: ~ Coliform / Nitrate Date of sample: Collected by: Petroleum tank Other bacteria B, SEPTIC/HOLDING TANK DATA Date installed ~o ~ ~ ~-~ ~\ Cleanouts~N) High water alarm (Y/I~_ Date of pumping Tank size ¥'~,~' o Compartments Foundation cleanout ~, N) ~/ De p ress,~o~(Y~ ~ Alarm tesied (Y/N) ~'1 ~ c~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation Welt(s) on lot To properly line Surface water/drainage On adjacent lots Absorption field Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) ~ Vent (Y/N) "Pump on" level at ~ Level at High water alarm level ....----'C~les tested Meets MOA electrical codes (Y/N) ~ SEP~E FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~o f Total absorption area Date of adequacy test ~ I 5"--~ ~ Soil rating (GPD/Ft2) Width Gravel thickness ½ C oanout present /NI / ~":-.Z ¢---') ¢ Results ~ail) /~, Water level in absorption field before test Peroxide treatment (past 12 months) (Y(~) -5'" / Total depth Depression over field (Y~ for After test /~, If yes, give date Bedrooms Well on lot '2--',~ ~'~' To building foundation On adjacent lots '~ ~ Surface water Cudain drain SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots ,~/~ Property line \ o ~ ~ .T(~ existing or abandoned system on lot ~'~ Cutbank ~\~- Water main/service line \ ~ t~ Driveway, parking/vehicle storage area '~o ~'~ E. ENGINEER'S CERTIFICATION 9ignatu re ~' ' ;': ¥: Engineer's NameE~gl~-' "" '-- ' - .....? ~r Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number guidelines in effect on the date of this inspection. 72-026 (3/93)* Back 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 11; Block 6; Thunderbird Heights Sub. Location (site address or directions) 24532 (140) T¢_~ Loop Property owner Mailing address Lending agency Mailing address Agent Da~ene Address HC 79 140 Teal Loop~ A. Fortune Properties '~ayphone 274-7636 Chugiak, n~ ~f~1001 Day phone Day phone_~,~-7655' 2. NUMBER OF BEDROOMS: '~nless oth-e"rwise requested, HAA will be held for pickup. 4 % 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: X~ If community wastewater systeml 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, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 1 >>34 E~.r, jle [~iver Loop Road Nh. 204 }~atlle River~ AlasJ,~a 99577 Engineer's signature Phone DHHS SIGNATURE ~ Approved for ,~-~z,'-:ZZ/,~ bedrooms. Disapproved. Conditional approval for Date 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 courtes~ 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-O25 (Rev. 1/91) Back MOA #21 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKMST Legal Description: ~ ~ ~l~t/-- L~ '~'~o~-~,~.u~ J-~ Parcel I.D. ~O~'//- A. WELL DATA Well type A Log present (Y/N) Total depth sanitary seal (Y/N) Date of test Static water level Well flow If A, B, or C, attach ADEC letter. Date completed Cased to FROM WELL LOG ADEC water system number Driller Casing height wires properly protected (Y/N) AT INSPECTION g.p.m. RECEIVED g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot "~'~ ~ ~ Absorption field on lot ~ c~ ' ~' Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /~-/~'- Cleanouts~/N) High water alarm (Y/~ Date of pumping Tank size J ~-~"'~)' Foundation cleanout ~N) Compartments ~ Depression (Y~i) Alarm tested (Y/N) '"J~.4. To property line /z::::, Surface water/drainage SEPARATION DISTANCES FF{OM SEPTIC/HOLDING TANK TO: Well(s) on lot ~-o,o ~ ~' On adjacent lots '""'///'¢ Absorption field Foundation Water main/service line 72-026 (Rev. 8/g1)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA'electrical co~ SEPARATION~..QJ~CE FROM LIFT STATION TO: W..ClPO'~i lot On adjacent lots Manhole/Access (Y/N) ~at ~ycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length '~ / Width Total absorption area Depression over field (Y(~ Results ~;~fail) p,4~5 Peroxide treatment (past 12 months) (Y~ Soil rating / .S"~:> Gravel thickness Cleanouts present ~N) Date of adequacy test for If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot__ 12~oo ~'~ To building foundation On adjacent lots ..~ Surface water Curtain drain On adjacent lots ' -/,~' Property line To existing or abandoned system on lot Cutbank '"'//,~ Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA, Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR 563-6775 April 10, 1991 FOR: Roger S & S Engineering PWSID #211156 Eklutna Thunderbird Heights My review of the records on file in this office reveals that the Thunderbird Heights S/D Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Timothy ~. Karnowski Environmental Engineer Time " Time .he Date Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size I ~ -~ I Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT JILLS OUT LOWER H~L[ ONL~ Property Owner Phone G. S, K. Cons~ruc~ion MaH~oDAddress S~A Box 6105'A3, Palmer, AK 99645 245-2553 Buyer Allen ~. & Sally R. Mayfield Add~ess ~5601~kB~utka, Ea~le ~iver, AK 99577 he,d~D~,st~tut~o~ Alaska ~u~ual Bank~ Ea~le ~iver Baaach Phone Add~ess Park~ate Professional Bldg,, Ea~le K~ver, AK 694-9571 Realty Co. & ADeut Phoue Totem Realty, Inc,/~lliam J. Schlegel Address 724 E. 15th Avenue~ Anchorage, AK 99501 272-0571 heDa~ Description Lot 11, Block 6, Thunderbird Heights Street Location Teal Loop Road Type of Residence ~ S~nD~e ~ami~y ~ Multiple ~a~J~y '~ No. of Bedrooms ~ Other Water Supply ~ ~ndN~dua~ A~ACH W~LL LOG. A we~ ~oD ~s requ~ed fo~ a~] we~s dd~ed s~ce 3u~e ~ Community ~975. For wells dd~ed ~ Public Ui~t~ available.} Sewaoe ~ ~dJv~dua~ Yea~ ~ud~v~Oua~ ~nstaHed: ~ Public Utility Wheu CoDnected to ~ Ho~d~n~ Tauk NOTE: THE ~NSPRCT~ON FEE MUST ACCOMPANY EAC~ REQUEST BEFORE PROCESSING CAN BE ~NmATED.