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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3A BLK 6 LT 4Thund rbird Heights lock 6 Lot 4 051 - 582 -49 tNev uoiuu 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201091 PID Number: 051-582-49 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Michael and Elise Burtrum ABSORPTION FIELD ❑ D� Trench ❑Wide Trench 1771 Bed ❑Mound Site Address 24824 Teal Loop Chugiak AK 99567 ❑ Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 4 PD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from origin rade t, Gravel depth beneath pipe Ft. Subdivision Block Lot Thunderbird Heights #3A 6 4 Fill added above original grade Ft. ravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines istance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Lift Station Sewer Total absorption area Number of trenches Dist. be en trenches From Tank Field Tank Line Ft2 Ft. Well NA NA NA TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water > 100' NA ( NA Material + plastic Number of compartments 2 E Lot Line >10' NA NA NA Foundation >10, NA NA LI STATION Manufacturer —_.Capacity Remarks Gal. Alarm location Ele installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer ARM Services Drainfield co/MTD3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 1'' 4/30/2020 5/5/20 Location and description ectio 3`d 5/6/2026 2�d 4111 garage slab ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date o.. TH .....; % 4' .6000: .... � 0 Q�fB �T ..2 Lry No.CE11904 .•V�`�,�'� Septic System Lx—acs•. av Approved Date 5!11,= �� lF�EpP • • •'oi,AX: ROFESSI Note: this approval does not include well permit requirements. f tNev uoiuu 10) THIS LOT AND ALL NEIGHBORING LOTS ARE SERVED BY A PUBLIC WATER SYSTEM AND THERE ARE NO WELLS WITHIN 200' OF THE SYSTEM, NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE A) V y \ T \ \(SEPTIC Lot 4 NEIGHBORIN\ IS > 10' FROM PROPERTY LINE ' � of NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE ! I 0 THERE ARE NO STEEP SLOPES WITHIN 50' OF THE PROPOSED TANK. \ �o \ 0 R PHRLT FLAT SLOPE \ AVEM� � M \ \ DCO DCO EXISTING 28-',x 36'\ 60" EFFECTIVE DE TRENCH 4 BR A HOME !� 0 v 1250 GAL PLASTIC SEPTIC TANK NEIGHBORING SEPTIC 15 > 1 D' FROM PROPERTY LINE SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,250 GALLON SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH A NEIGHBORING SEPTIC MINIMUM 20" v MANWAY R)SER SERVING IS > 10' FROM THE FIRST COMPARTMENT. �O/ PROPERTY LINE 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS / �, 15.55 AND 15.65. Septic As Built Drawings Prepared for MICHAEL AND ELISE BURTRUM 24824 Teal Loop Chugiak, Alaska 99567 THUNDERBIRD HEIGHTS #3A BLOCK 6 LOT 4 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGfAK, ALASKA 99567 (907) 355-9820 OSP201091 DATE: 5/11/2020 DRAWN: CLT SCALE: 1 " = 40' PID: 051-582-49 SHEET 2 OF 3 . OF q( �5��♦i 49TH .•;1� ......... ...............:......� 0. CUR .IS TOWNSFND: ci s *� No. C 1904 iAV MARK A B DCO 12'-11 " 15'—B" SV] 15'-6" J U 16'-11 " SV2 20'-11 " 20'-0" Lij DCO 22'-5" 21'-0" Ow MT 58'-11 " 55'-2" CJ ozZ z Z a W f w O0 L' D J U J U D O Uj m z Y Lij {ISI 0_j Ow n 0 Un 1��¢O '_Lm � __M.80 CJ 1,250 G 1 98.0 PLASTIC TANK TANK WAS INSULATED WITH 2" RIGID INSULATION. INLET AND OUTLET LINES WERE ALSO INSULATED AT THE DOUBLE CLEANOUTS. EXISTING 28' x 36" x 60" EFFECTIVE DEPTH TRENCH Septic As Built Drawings Prepared for MICHAEL AND ELISE BURTRUM •�� DF �� i�♦ 24824 Teal Loop Chugiak, Alaska 99567 `? •'♦♦♦ THUNDERBIRD HEIGHTS #3A BLOCK 6 LOT 4 '� 49TH `; �f OSP201091 .............' ........................' EKLUTNA ENGINEERING LLC �� DATE: 5111/2D2D ��, CURTIS TOWNSENb: � �Ci No. E 1 1904 A, 0 19162 MOUNTAIN ROAD DRAWN: CLT ♦ � S�lr CHUGIAK, ALASKA 99567 SCALE: 1 112" = 1' ♦�� "' (907) 355-9820 44:r PID: 051-582-49 SHEET 3 OF 3 Lot 23 1 I � PLOT PLAN AS BUILT X SCALE -11= 40' GRID NW 1865 Project No. 20-145/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang Inc Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors kenOlangsurvey.com lonatha n OI o nasu rvev. com I hereby certify that I have surveyed the following described properly: LOT 4, BLOCK 6, THUNDERBIRD HEIGHTS - ADDITION No. 3A (PLAT No. 82-332) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the properly adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold ��l1pLLroperty except as Indicated hereon. S�J Dated this the 1- Day of M J Z z- at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-582-49 Property owner(s) MICHAEL & ELISE BURTRUM Day phone 907 688 4478 Mailing address 24824 Teal Loop Chugiak AK 99567 Site address 24824 Teal Loop Chugiak AK 99567 Legal description (Sub'd., Block & Lot) THUNDERBIRD HEIGHTS #3A BLK 6 LT 4 Legal description (Township, Range & Section) Lot Size 22,029 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single o A (SF) (� (w/ o AD Septic Tank ❑ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: I certify that the above information is applicable Municipal Codes. Distance: I further -certify that this 0 in accordance with 0—C, nature of property owner or Permit/Rush Fees: 4Q a 5 Date of Payment: autti6rized agent) C7C,Dv\t) pISC-Ou� kI7 , Z5 2777 aiver Fees: Receipt Number: 411�5J Permit No. ()SP ao� 09 1 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201091, Rebecca Carroll, 05/01/20 /~'%' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONNiENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MA'L'NGADDRESV'o' :. LOCATION NO. OF BEDROOMS DISTANCE TO: I Well - Absorption area ~/-d~l¢~, PER~-~O~ No. of compartments ~-~- Liq. c~..~ ! t~_y~i~.n}g a I I o n s IF HOMEMADE: Inside length Width Liq .id '~ept'~ , ~ Well Dwelling PERMIT NO. O ~ <~ Manufacturer Material Liquid capacity in gallons I~ DISTANCE TO, W.I ,~.~/¢//.~ Foundation ~, N ea rest/~i n_/e ~; No. of lin~s Lengthr~. e ~/'ine T°ta' i.¢~°~ Trench ~t~ inches Dist 8 n ~¥/b.~een I(~i ne~s ~''//' ~- .i~ Top of tire to f~s~ grade ~ Material beneathlinestile ~ (~ inches Total e fD~.~o n. area Length Width Depth PERMIT NO. ~ ~- Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line m DISTANCE TO: .a 31ass Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 72-013 3/78) PERMIT NO. 825 'L~ STREET, ANCHORAGE, 264-4720 C~--S~'TE SEWER ( 8~00Z± ) APPLICANT LOCATION LEGAL PlLi~-~ Z C: I F-'RL · T~" OF R~-~C:H'~'~:RGE DEPARTMENT L 'HEALTH AND ENVIRONMENTAL .OTECTION AK. L~. ~50t BOX D. STEVEN L. SKAGGS P.O. LOT 4 BLK 6 THUNDERBIRD HETS. TYPE OF SOIL ABSORPTION SYSTEM IS; TRENCH CHUGIRK RK. ~,~,~.-~.~.~ ~. LOT SIZE ~3:000 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = -'.': SOIL RATING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [~EF"TH= E: LE~STH= 26' GF:fl~"EL [)EF'TH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE E~CAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE AND THE BOTTOM OF THE EXC8VRTION (IN FEET). F-:E L).Li I F-: E [:. SEPT I ~2' T8 ~'-~ b'Z S I ZE= ±¢--'~00 ~]iFt LL C~I',~S 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 THR~ THE WELL WILL SERVE. Ti--lO ( 2 ::. I i%~SPECT I (]~"4S ARE F:E~7~.Li ][ REC. BACKFILLING OF FINY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BV THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUbl DISTANCE BETWEEN R NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIVATE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNIT~ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS fiND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT ±: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALIT'¢ OF ANCHORAGE. 2: I WILL/~STflLL THE S'~'S~Et"I IN flCC:IDRDflNE:E WITH THE COC'~S. 3:: I UNDE~:~RN[:' THRT THE gN-SITE SEWER SYSTEM I"~R'¢ REQJIRE ENLRRGEMENT IF THE RESI[:,ENCEI I¢ REMOE:,E~D/T¢ INCLLIDE MORE THRN 3: BEDROOMS. StoNED: ..... .___.,_ O & E ENG.,"-"qEERING & DEVELOi~vlENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: ~7---~P'~'F~/ Z, , ;:~/~,~, $ ~/tz? ~ Tel. N0. ~" ~/ Legal Description: Depth (feet) 0 2__ 5__ 6__ 7__ 8 9__ Soil Characteristics PLOT PLAN PERC. TEST Ground Water Encountered: Yes No ~'"'lf yes, what depth Proposed Installation: Seepage Pit Drain Field Comments:. Performed by: ~'~'~ / ~~ Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 1. GENERAL INFORMATION Expiration Date:. _rn 0'm 09, 1 Complete legal description THUNDERBIRD HEIGHTS #3A BLK 6 LT 4 Location (site address) 24824 Teal Loop Chugiak AK 99567 Current property owner(s) BURTRUM MICHAEL & ELISE Day phone Mailing address 24824 Teal Loop Chugiak AK 99567 Real estate agent Lindsey Bergeron Day phone 253.302.2012 2. TYPE OF DWELLING: Rx Single Family (Aw AQ� El Duplex 0 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well E-1 Private Septic Water Storage ❑ Holding Tank, El Community Well ❑ Community El Public Water System Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless othervvise requested by the engineer, CASA Fee $ S�1-6 Date of Payment 517/;t=6 Receipt Number. &420t) COSA# 1 .8 * C 261122 1 Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-19 25% DISCOUNT APPLIED 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 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. I acknowledge that On -Site staff may visit the site to verify the information submitted, I Name of Firm Eklutna Engineering, LLC Phone 907,355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date 1 A. 6. DSD SIGNATURE V System #1 Approved for q bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms *:*Tj Pik bedrooms, with the following stipulations- )( (A h, �, j Le ?_ . k,, --Amo 0 VYV� - � L4_+ my& I tm Mv4w v\'ATER WASTI,_` By:_1 Original Certificate Date: 'IJB Z= O� 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 Checklist blue shoot COSA Checklist Legal Description: Thunderbird Hts #3A L4 B6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are property protected , Casing height (above ground) Date o>tee COS Static eginning of test ft. Commpublic water system B. TANK DATA Age of tank(s) years Tank type/material septic plastic Measured operating fluid level in septic tank Q Standpipes/foundation cleanout per record drawing Date of pumping new tank installed May 2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1983 X ALL standpipes present per record drawing Total measured depth from grade 8'-7" ft (max) Measured depth to pipe invert from grade 3r-7" ft (min) ❑ N/A — pressurized field ❑N Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-582-49 Structure served by this system Well production at time of test Water storage tank volume gallons Well disinfected oliform test? ❑ Yes ❑ No ❑ C bacteria is Negative urate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance Age of lift station y Lift station materia Comment Adequacy test date 4'30'2020 Results 0✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 655 gal New depth 17 in Elapsed time 10 min Q Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate >600 clod (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: field sized for three bedrooms, 1983 inspection report states four bedrooms, last 2 COSAs have been approved for four bedrooms COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > ❑Yes ifNo—ft Neighboring Tank > 100' ❑ Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes if No__ ft Corn 'ty5ewer Main > 75' [03 Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' if No — it Private SeweIc Line > 25' ❑ Yes if No — ft og Tank > 100' EDY ldines if No — ft Animal Containment > 50' ❑ Yes if No — ft Manure/Animal Excreta Storage > 100' Yes ❑Yes ifNo_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' ❑v Yes if No _ ft Water Main > 10' Q Yes if No _ ft Community Wells > 200' ❑✓ 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' 0 Yes if No _ ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No _ ft Private Wells > 100' ❑✓ Yes if No _ ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' 0 Yes if No _ ft Surface Water > 100' Q Yes if No _ ft 6WAINILI1=14:446101k4h4141111K [om;g Ll IILII:14:444i4:i11ly[V7_ llIs] L I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet .e"��\ ENGINEER'S qF 4 9� TM.. .. .........../ ate q S No.c it.....�.``�� 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) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-582-49 1. GENERAL INFORMATION Gem plete legal description COSA # (2_ C101 Expiration Date: THUNDERBIRD HEIGHTS #3A, BLOCK 6, LOT 4 Location (site address) 24824 TEAL LOOP, CHUGIAK, AK 99567 Current Property owner(s) LINDA L ALDOUS REV. TRUST Day phone Mailing address 24824 TEAL LOOP, CHUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent LES BAILEY & ASSOC. - KW Day phone 694-1234 Mailing Address 11901 BUSINESS BLVD. #105, EAGLE RIVER, AK 99577 Unless ptherwise requested, COSA will be held by DSD for pickup. 2. ,;,N0' M BER,~F BEDROOM S: 4 '~':; TYpE OF:WATEASuPPLy: ~ in~li~iduai, ~ell:~'"' ' [] Individual' Water SfOrage [] 'Community Cla'ssA Well [] i PubIi~ W~,,t, er'System [] 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 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 omissionsin 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 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 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/08/2010 Engineer's 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 encroachments, deficiencies or discrepancies exist. DSD SIGNATURE b--'~' Approved for LIL' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: ~ WATER AND ~= ~ · ~STEWAT~ . = . .. ........ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / ~---- / 6 '-/O Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw 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: THUNDERBIRD HEIGHTS #3A, BLOCK 6~ LOT · Pamel ID: 051-582-49 A. WELL DATA Well.tyPe PUBLIC -A IfA,.B, or C prot~ide PWSIp # 21 1 1 56_ .Well. Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected'(~([~) Total depth ff. Cased to ff. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production WATER SAMPLE RESULTS: g.p.m, g.p.m. Coliform colonies/100mL Nitrate mg/L Arsenic: __.mg/I Date of sample: B. SEPTIC/HOLDING TANK DATA Collected by: Tank Type/Material SePtic/Steel Date installed 3/21/1983 Tank siZe 1250 gal. Number of Compartments _2 Cleanouts (Y/N) Y__ Foundation cleanout (Y/N) ¥* Depression over tank (Y/N) N__ High water alarm (Y/N) N Date of pumping 12/6/201_0 Pumper C. ABSORPTION FIELD DATA Date installed 3/21/3.983 Soil.rating (g.p.d./ft2 or ff2/bdrm) ss System type Trench Length 28 ft. Width 3 ft. Eft. absorption area 280 ft2 Gravel below pipe 5_~. Total depth 8.79 ft. (Measured 12/7/10) Monitoring tube Y Depression over field N Date of adequacy test 12/7/2010 Results (Pass/Fail) Pass For ~ bedrooms Fluid depth in absorption field before test 9_ in. Water added 650 gal. New depth 5 in. ElaPSed Time: 10 min. Final fluid depth [in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (pest 12 mo.) N (Y/N & type) _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. Manhole/Access (Y/N). High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout ManUre/~nimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5% Water main I0'+ Water service line Wells on adjacent lots 200'+ 10'+ Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water Curtain drain 50'+ (None Known) COMMENTS lO0'+ Driveway, parking/vehicle storage 10'+ Wells on adjacent lots 200'+ *FCO loemted inside crawl space. Vacant system surcharged with 1500 gallons prior to tcstin,~,~totally absorbed in 10 min.tes. O. 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 COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 12/08/201o COSA Fee $490.00 Date of Payment fr Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SURVEY ........ ............... SYMBOLS = .-~'~ ~',, Robert E Johns. Jr. ~ Assoc. 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 Parcel I.D. # ..~..5-/' - 5~ --~ - 4¢ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) / Property owner Mailing address Lending agency Mailing address Agent Address ~ ~ 5c,-.-,._. Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Y '~ 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. 4. 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 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 KND Engine~.rln9 Phone ~,,9~, - ~/// 20441 F1armigan Blvd. Address ~=f:i~, c;.¢~, ~,~, 9.0577 9726 ,/ EngineeYs signature ~-~'~¢~'~. DHHS SIGNATURE X Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~¢- -;5--- ~'~ 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: .~/z~,. ~/.~ f~a.,/i,~F]9,~//~.~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Enwronmental Seduces D~ws~ n 825"k" Street, Room 502 · Anchorage, Alaska 99501-<907)343-474'~,? Health Authority Approval Ghecklist Parcel I.D.: ~d/-d~2 ~ A. WELL DATA Well type A IfA, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth / Sanitary, seal (Y/N) / / Date completed Date of test Static water level Well production WATER SAMPLE RESULTS/ Coliform Date of satnple: B. SEPTIC/HOLDING TANK DATA Cased to / Casing height (above ground) / Wires properly protected (Y/N) / FROM WELL LOG AT INSPECTION / / / Nitrate / Other bacteria / Collected by: / Date installed 4~/,/~.5 Tanksize 1~',-~-0 Number of Compartments 2 Cleanouts(Y/N) . Foundation cleanout (Y/N) }/~r',~l~. Depression (Y/N) fi, t/ High water alarm (Y/N) Date of Pumping .3,,/2, t9/~ Pumper ../~ '~ C. ABSORPTION FIELD DATA Date installed ~/~//~ 3 Length ~z~ ~ Width Effective absorption area 2~ D Date of adequacy test .~//~7~, Fluid depth in absorption field before test (in.); Fluid depth ~; ~(ins.) Minutes later: /tO Peroxide treatment (past 12 months) (Y/N) Soil rating (&p.d./~2 c(r ft2/bdrm~ System type Gravel thickness below pipe 3d9 ''~ Total depth /~)~, Monitoring Tube present(Y/N) y Depression over field (Y/N) t4// Results (Pass/Fail) /tx> For Y bedrooms hmnediately after ?,,ZTgai. water added (in.): ~, ,~ Absorption rate = ~ nc .g.p.d. If yes, give date D. LIFT STATION Date installed / Size itl gallons / Maohole/Acccss (Y/N) / "Pun'~p on" level at* / "Pulnp o£F' level at* / High water alarm level at* / *Datum / Cycles tested / / E. SEPARATION DISTANCES SEPAI~.ATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot / / / / / Sewer/septic service lille / Lift station ,/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /~. ~ Property lille /ti9 / 4~ Absorption field Water mailffservicc lille /O /4 Sorface water/drainage/DD t ¢ Wells on adjacent lots ; On adjacent lots : On adjacent lots Public sewer manhole/cleanoat SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Buikling foundation ~' / 4 Water main/service line /D ~ ? Sarfilce water /OO t ./. Driveway, parking/vehicle storage area ,~D ~' Curtain drain ~t9 ~ ~P Wells on adjacent lots .~ 2d9~5~) / Property line //) F. ENGINEER'S CERTIFICATION I certiJ, p that I have determined thrufield iaspections and review ofg~iunicipal re ia co~brmance with MOA II~IA guidelines in ef~ct on this date. Sigaature , Engineer's Nan,c ~ ~-~ ~ Dat~ ~ ~ HAA Fee $ ,=.~9 ,- ~ Waiver Fee $ Date of Paynlent ~-~?'~//~'?~:~ Date of Paymeat ReceiptNamber / .'~-~ ~;~t~'?::~.g~7~/) Receipt Number Re,,,. 8/95 OSS: Ma.xvk.doc APPLI("'NT FILLS OUT UPPER HAl !ONLY Phone Property Owner T & m Trico Construction 745-2731 Mailing Address HOX 2524, Palmer, AK ZipCode 99645 Buyer ;~[~;R'~;N"~ Jeffrey & Elizabeth Edmundson Box 130 Raven~iew Loop - Chugiak, AK 99567 Address Zip Code Lending Institution Phone Address Zip Code Phone Realty Co. & Agent William Schleg~l -Commonwealth Totem Realty 724 E. 15th Avenue Anchorage Address Zip Code 99501 272--0571 Legal Description Lot 4, Blk 6 Thunderbird Heights Street Locatic~ Ravmn V~mw Type of Residence [~: Single Family [] Multiple Family NO. of Bedroorms 4 [] Other Water Supply [] Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). [3 Public Utility Sewer Disposal ~ Individual Year Individual Installed: E] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQOEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ~ · Date Date Date Date ~ ~/~.~ Inspector Inspector Inspector Inspector Field Notes: ~ O~ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION RECEIVFD ( ~PPROVED B~OROOMS ~ *CONDITIONS OF APPROVAL ( ) DISAP~OVED Soils Rating Cate ~wer Inst~ Well To Absorption Area Well Log Received Well to Tank Septic T~k Size /~ ~ 72-023(3182)