HomeMy WebLinkAboutTHUNDERBRUSH LT 7
~ Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal'System and/or Well Inspection Report
Name: Wastewater Systom: ~ New ~pgrade
Address:
I1~ ~~~ ~¢ ~q~ ABSORPTION FIELD
Phone: INo. ofB~oms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION Soil Rating: ~' ~ GPD/Sq. Ft. ~
Lot~.l ~ ~ ~ Block:~~ ~ ,Subdivisi°n: Depth to pipe bottom from original, grade:/~ ~ravel depth beneath pipe ~ / Ft.
Township: ~ Range: ~ Section: Fill added above original grade: Gravel length:
I
Number f lines: Distance betweenlines:
WELL: D New ~ Upgrade Gravel width: ~ / ~ :~
Classification (Private, A,B,~): Total Depth: Cased To: Total absorption area: ~ipe material: ~[~
Driller: / Date Drilled: StaEcWaterLevel:Ft. =~'~lnstaller: ~ Datei~stalled: ..~,~.
SEPARATION DISTANCES ~Septic~ m Holding U S.T.E.P.
TO Septic Absorption Lift Holding Public/PrNate Manufacturer:__¢ ~ Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~~
Well I~[ ~ / ~- ~ ~ Materia~ NumberofCompartments:
Surface [~'~ ~,+ -- ~ ~ LIFT STATION
Water
Foundation [~ ~¢ -- ¢¢ ~ "Pump o~p off" level at: I Hie~ wa,~r a'~rm ~t:
CurtainDrain ~~ ~[~ )~{ Pur~ke&Model I Electrical lnspections performed by:
Remarks: BENCH MARK
Location and Description:
I Assumed ElevaDon: /~ FI,
ENGI~E~EAL
Dopartmont of Hoalth d Hu vices apprgval .....
Reviewed and approved by ~- . Datey~ 3~
72-013 (Rev. 9/91) MOA 25
Permit No. SW950022 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box .196650 · Anchorage, Alaska 995'19-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LegaIDescription: THUNDERBRUSH SUBDIVISION, LOTS 7 & 8 PIDNo.: 01514264
CO1
88X~I NEW
lO00 GAL
SEPTIC
TANK
C02
/, FINAL GRADE
;80.4~
MT C04
5,4.
· 74,4'; NO WATER FOUND
3 BDRM
DECK
C04
A E
CO~ I sT.s 116.81
cog 133.1 1 ~5.41
d03]36. ]43.5I
C04 7Z.9195.61
MT 70.2 92.0
THUNDERBRUSH CIRCLE
72 013 A (Rev. 9/91) MOA 25
' INSPECTION REPORT
MUNICIPALITY OF ANCHORAGES, BUILDING SAFETY DIVISION
TL/OOR ROAD ....
3500 EAST " '
INFORMATION (907) 786-8211
INSPECTIONS (907) 663-3464
/ PERMIT NO. ' '
/PHONE
' ~ ~; / ~ /DATE
FOOTING PLBG. UNDGR.-
FOUNDATION __ PLRG. ROUGH --
BOND BEAM -- GAS TEMP. --
FRAMING [] GAS .
INSULATION- [] MECHANICAL
SHEETROCK -- [] MECH. FINAL
STRUCT. FINAL -- [] PLBG. FINAL --
OTHER [] OTHER
LOT / ~ BLOCK / ~ SUBDIV. ~
[] ELEC. TEMP, ~ [] []
[] ELEC, SEnVlO£ -- [] []
[] ELEC. ROUGtt ~-- [] []
ELEC. ELNA[:/ - ~[] []
OTHER ~. ~' ~ _ [] []
FIRE FINAL .---~-- [] []
ZONING --~.-~-- [] []
[~1 ~:ORRECTIONS ESSENTIAL AS
~XPLAINED BELOW
~ ..WILL REEXAMINE AT NEXT INSPECTION ['l ,OO NOT CONCEAL UNTIL REINSPECTED
COMMENTS -
~T
? '/' LL
WHEN '~'~ORRECTIONS ARE MADE, PLEA~I~ ~,A FOR INSPECTION-
,~ · ' I~O NOT REMOVE 1.HIS NOTICE
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
,q
PERMIT NUMBER:SW930022
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:APPLEGATE RICHARD L &
OWNER ADDRESS:il400 THUNDERBRUSH CIR
ANCHORAGE, ALASKA 99516
DATE ISSUED: 3/01/93
EXPIRATION DATE: 3/01/94
PARCEL ID:01514264
LEGAL DESCRIPTION: THUNDERBRUSH LT 7
LOT SIZE: 15471 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~
ISSUED BY:~
DATE:
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECT~ON
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOtL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
~'eDruary 1~, 1993
~unicipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.Oo Box 196650
Anchorage, Alaska 99519-6650
ROBERT SHAFER, P.E
ROGER SHAFER. P E
CIVIL ENGINEERS
(907) 694-2979
FAX 694 1211
RECEIVED
FEB 2 3 1993
Municipality of Anchorage
D~pt, Health & Human Services
REFERENCE: Thunderbrush Subdivision, Lots 7 & 8
Request you issue a permit to upgrade the septic system
serving the referenceQ property anQ issue a Con4itional Health
Authority Approval.
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be inadequate.
No health hazards exist or are anticipated by the issuance of
a Conditional Health Authority Approval.
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
We do not anticipate any adverse ef~eclrs---on neighboring
properties by the installation of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
jSi~cerely~ , II
~am__~uam~s P. Williams, C.E.
Roger J. Sh~fer, P.E.
JPW/RJS/LSU/lsu
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
I"= $0"
SCALE
UPGRADE
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lots 7 & 8 Thunderbrush Subdivision
11400 Thunderbrush Circle
GENERAL:
The scope of this project includes the installation of a
leachfield trench ugrade to serve the 3 bedroom residence
located on the referenced property. The existing septic
tank is to be excavated to verify integrity. If the
integrity is found to be poor, the tank is to be
replaced. The existing seepage pit is to be excavated,
crushed, filled with soil, and abandoned in place.
Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling. On all leachfield mound
systems, the property owner shall be resposible for
ensuring a satisfactory vegetation growth over the
mounded area.
Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 4"
cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
3. Ail standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
page 2
Construction practices
4. Septic tanks installed with less than 4 ft. of cover
shall be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the
tank and the leachfield there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DR~INFIELD INSTALLATION:
Excavate the proposed trench to the diminsions shown on
the design. The bottom of the excavation shall be within
2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched ruffed-
up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter and
installed approximately in the locations shown on the
design. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as
noted on the design.
Backfill over the final gravel layer must not be less
than twenty-four (24) inches. Insulation must be
installed when the backfill depth is less than thirty-six
(36) inches. The finish grade over the trench must be
mounded to prevent the formation of a depression after
settling.
page 3
Construction practices
MINIMUM MATERIAL SPECIFICATIONS~
Any septic tank
constructed by a
manufacturer.
proposed for installation must be
Municipally approved septic tank
The following
septic system
Anchorage:
pipe materials are approved for use in
installations in the Municipality of
Type of Pipe
Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
e
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi
140N, or equal) must be installed between the final
leachfield gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
When sand is being used as a filter material, it's
gradation specifications must conform to AMC 15.65.060D.
INSPECTIONS~
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic
tank may be set in place, but may not be backfilled
before this inspection.
page 4
Construction practices
2 o
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-
construction meeting will take place on-site.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL OESCR,FT,ON:/ . 8
1
3
5
7
8
14
17
19
20
OATE PERFORMED:
~-"~/~(]..~ownship, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES. AT WHAT O
DEPTH? P
E
Data: ?'~- 17-~
SITE PLAN
Depth t0 Water Alters_
Moniloring?
Gross Net Depth to Net
Reading Date Time Time Water Drop
Illq6 ~- ~'&" --
I;R:IO ~3 ~,~ ~" ~'tfftt
/~o ~o' ~ ~ ~/~" ~/~"
1~:~ I0 . ~ ~lg~' V~~
PERCOLATION RATE ~-'~ (minutes/inch) PERC HOLE DIAMETER ~ ~'~
TEST RUN BETWEEN ~'~ FTAND
COMMENTS
S & S ENGINEERING ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY: ~/~.:'"~ ~*~l~ ~,.,v~,, ~..,,~1~ ~,.,a,~ ~. ~ V
ACCORDANCE WITH A[~N~UIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
GREA 2 ANCHORAGE AREA BOR'
~.~1~/ Department of Environmental Quality
'~ 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~Z~7~ ~)~J_~zT~-~ MAILING ADDRESS ~¢X /~0 ,~A PHONE
LOCATION ~/~X/~/}~7('~. ~ I/~q~ LEGAL DESCRIPTION -...~t-~3'~3/~'~'1 ~-~-.
SEPTIC TANK:
~)//~ ~'~- /0{0~/ NUMBER OF
DISTANCE '~
FROM WELL MANUFACTURER ~.~A~ MATERIAL/)~- COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH ~ LIQUID DEPTH -- LIQUID CAPACITY /~'O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER ~ OR WIDTH v/~ , LENGTH I~, DEPTH q
LINING MATERIAL~I~m ~, CRIB SIZE: DIAMETER ~tDEPTH ~ / DISTANCE FROM:
~ TOTAL EFFECTIVE
BUILDING FOUNDATION ~ r NEAREST LOT LINE~'Oz~- .
WELL
ABSORPTION AREA (WALL AREA) (~ ,~::' SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH
SEPTIC
TANK
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES: ~-,$ ,5/'lol~l'q[
INSTALLED BY: ~
PIPE MATERIAL: (~ AJ],3T- IA,nfl
DIAGRAM OF SYSTEM
LOT SLOPE:
REMA R Ks:Ora~U~
Form No, EQ-031
DATE ?/~/7¥
APBROVED
N
G.A.A.B.
,j
GreaTEr ANCHORAGE Area BOROUGh
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
INSTALLATION OF: SEPTIC TANK ~/ SEEPAGE PIT ~ DRAIN FIELD
TYPE AND SIZE Of FACILITY TO BE SERVED . / /
COMPLETION DATE ANTICIPATED
OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL OUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
DIAGRAM OF SYSTEM ~.5~///~ /7'/
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK O
]FOUNDATION TO SEEPAGE PiT ~ , DRAIN FIELD
/
WELL TO sePtiC TANK (/(:~%~9
/
, DRAIN FIELD
/'
SEEPAGE PIT
ALSO CONSIDER AREA WELLS,
SEEPAGE PiT
/~-~ .,~'D RA I N P']ELD
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET iNTO UND]STLIRBeD SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
~ITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRiBeD SYSTEM IS IN ACCORDANCE WITH SAID CODE.
'R&M
Civil Engineers
ENGINEERING & GEOLOGIC^L CONSULTANTS
229 EAST 51st. AVE, -- P.O. BOX 6087 - ANCHORAGE, ALASKA 99503
TELEPHONE 907-279-0483 TELEX 090--35419
Geologists Land Surveyors
JAMES W. ROONEY, P. E.
MALCOLM A. MENZIES, P.E., L.S.
JAMES H. WELLMAN, P.E.
June 19, 1974
Mr. Richard Applegate
Star Rt. A Box 1650
Anchorage, Alaska 99507
R & M No. 462043
RALPH R. MIGLIACClO
Engineering GeologlsL
Re: Test Hole and Soil Log Report for Sanitary System
Dear Mr. Applegate:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
investigation was performed in accordance with your zequest of June 18,
1974 by Mr. Rolf Strickland of the Greater Anchorage Area Borough
Department of Environmental Quality.
A single test hole was put down within the Lots 7 and 8 area for the
purpose of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with a tractor-mounted
backhoe and the test hole was extended to a total depth of 14.0 feet
below ground surface. The final log prepared for the test hole has been
included in Drawing A-01.
Ground water was not encountered in the test hole. During excavation and
the logging of test hole, there was no indicatiom of ground water below
the immediate base of the test hole which was terminated at a depth of
14.0 feet. Since the soil was relatively dry, we do not feel that the
water table is located within the upper few feet below the test hole
base or to a depth of 17.0 feet.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do~ no~
hesitate to contact us.
Very truly yours,
R & M ENGINEERING & GEOLOGICAL CONSULTANTS,
INC.
JWR:kd
xc: GAAB
ANCHORAGE FAIRgANKS JUNEAU
TH-I
6-17-74
ORGANICS
SILT, TRACE SAND (ML)
0.0~
0-5'
1.0'
SILT, SOME SAND & GRAVEL (ML)
2-5'
GRAVELLY SAND, SOME SILT (SP)
8.OI
SILT, TRACE SAND (ML)
10.0'
GRAVELLY SAND TRACE SILT (SP)
NO WATER TABLE
14.0' T.D.
NOTE: Test hole excavated with tractor-mounted backhoe.
RICHARD APPLEGATE PROPERTY
LOG OF TEST HOLE
Engineering ~ Geological Consultants Inc. ANCHORAGE, ALASKA
AN~HORAG~ ~A~R~A"KS ALASKA JU.EAU
'"~"~' '''~""~ . '~' -- ~ .'P'O'B°;4'1224 · 1310C InternationalAirport Road
·. Well Owher
(907l 274-461
\
DRILLING LOG
Use of Well
f
Location (address of: Township, Range, Section, if known; or distance main road
L7:ES, m .... ,
.hu-d_.bru.n £u!:div, !l~th o££ Birch
Size of casing
· 'Static water level
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at 24 gallons per (~if)
of drawdown from static level. .--
Date of completion -1_1 Cc% 7~ ' ~
~,pth of Hole. ~ Z0~ feet Cased to ~ 202 feet "'
,/ll~i0 :ft. 0ibdV&) (below) land surface. Finish of well (check one) open end ( .X );
(minute) for ! - hours with
WELL LOG
Depth in feet from
· ground surface
Give details of formations penetrated, size of material, c~p~. ~u}ak~r~_c~n~ss, ·
· - 0 TO
'": ('~' ~ .TO 12
~ .TO,
'~ .TO '
Ciltv Or, vsl
_~L~K--TO 14~
~ ~'~ TO )ff':f
TO ~o~
TO
.TO
--STATE
WILLIAM'A. ~GAtl, GOVEPJ{OR
soUTHCENTRA£ REGIOIIAL OFFICE
AJACKAY BLDG.
338 DENALI ~TR[ET
ANCHORAGE 99501
interprefation of
contained in Section
I Conservation Waste
e you had ownership
at you intend to
use, that this particular
pplicable in your case.
existing Borough
~all cases except .
Cherry
Envircnmental
Engineer
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
ParceiI.D.# 015-142-64 HAA# HA930093
1. GENERAL INFORMATION
Complete legaldescription Lots 7/8 Thunderbrush Subdivision
Location (site address or directions) 11400 Thunderbrush Circle
Property owner Richard Applegate Day phone 346-3101
Mailing address 11400 Thunderbrush Circle Anchorage, Alaska 99516
Lending agency
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Three (3)
XXXXXXXX
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:
XXXXXXX
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.
72-025 (Rev. 1/91) Front MOA ~21
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 S & S Engineering Phone 694-2979
Address 17034 Eaqle River Loop Road, Suite 204, Eagle River 99577
Engineer's signature
Date
o
DHHS SIGNATURE
Approved for
Disappr6ved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments
been completed and approy~.
The upgrade of the on-site wastewater system has
This property has a full approval.
Date
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 DH HS does this as a courtesy to purchasers of homes
and their lending institutions in orderto 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.
79-025 (Rev. 1/91) Back MOA #21
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Sox 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~) ~_/-~' \ L~.~ - LOdl HAA#
1. GENERAL INFORMATION
Complete legal description
Lots #7 and #8 Thund~rbr~sh Subdivision
Location (site address or directions) 11400 Thund~rbru~h
Anchorag~, Alaska 99516
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Richard Appl~gat~ Day phone 346-3101
11400 Thund~¢br~sh ¢ircl~ Anchorag~, AK 99516
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3
NOTE:
XXX
· 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.
72-025 (Rev. 1/91) Front MOA ~21
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Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /~T~ "~-~8 %/-~AJ~J'/,.i~,.~d Parcel I.D.
A. WELL DAT~
Well type 'Ft/_tL)~¥'7~--'-
Log present (~N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
Cased to
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
Wires properly protected ~_~N)
AT INSPECTION
ADEC water system number
(~¢.T I1~ 1~l'7¢f Driller /~~~/~)/Z,//,Z,//U~-
Casing height
g.p.m.
/od
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample:
(~/~) J}~-'r4EcT'E/¢ Other bacteria
Collected by: ,~J;' ~ ~ ~f't-i~J]~=~l
B. SEPTIC/HOLDING TANK DATA
Date installed '-'¢__ (~_ "~L~ Tank size ~0(~ (~/~C Compartments
Cleanouts ON) (~/~E Foundation cleanout (Y/~ fl'J'O Depression (Y/~
High water alarm (Y/(~ ~/~ Alarm tested (Y/~ /"')//~
Date of pumping ~,- ~-o -~'~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO:
Well(s) on lot /Od ~ on adjacent lots
TO property line J~
Absorption field
Surface water/drainage /(~) ~
Foundation ]~
Water main/service line 4~ ¢''/-
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer J
~~ Manhole/AcCe~/(~
Vent (Y/N) "P~ J "Pump off" level at
High water alarm level ~ ..-//Cycles tested
Meets MOA electrical codes (Y/N) ~
Well on lot ~...J On adjacent lots Surface wa"~r.~..~
D. ABSORPTION FIELD DATA
Date installed ~7--~- ~ff Soil rating
Length )~, ' Width /~' ~ Gravel thickness c/ ~
Total absorption area ~0 Cleanouts present ~,J)
Depression over field (Y/~__~ /~dO Date of adequacy test
Results (pass/fail) g/~ ~:2/¢~IL for ~
Peroxide treatment (past 12 months) (Y~-~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot /(')(~
To building foundation
On adjacent lots
/ '~'c~ ,,~ ?//3~System type
Total depth
bedrooms
~k.~O i f yes, g i ve ~,~,e .~:~4¢z~
On adjacent lots /~ ~ Property line
~0 ~ To existing or abandoned system on lot
Cutbank ~/~ Water main/service Pine
Surface water /00 '¢
Curtain drain ,J/J!d/"J E_ ~rgo~tg
Driveway, parking/vehicle storage area ~-~¢ '/
E. ENGINEER'S CERTIFICATION ~ '~=(~U.~"T//~(r ~--16~0¢¢1°/'[4~-- /¢,,~.4o
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect~n.
Signature
Engineer's Name
Date
5 & $ ENGINEERING
17034 Eaale River Loop Road
Eagle River~ Alaska 99577
HAA Fee $
Date of Payment
Receipt Number
72-026 {Rev 3/91) aack MOA 21
Waiver Fee: $
Date of Payment
Receipt Number