HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 6 LT 5Thunerbl'ord
Heights #3A
Block 6
Lot 5
#051-582-50
Sul`"AL
FEB 26 2015
Municipality of Anchorage
Onsite Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: SW090174 PID Number: 051-582-50
Dwelling: M Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade
Name:
James and Bonnie Wisniewski
ABSORPTION FIELD
❑ Deep Trench X Shallow Trench ❑ Bed ❑ Mound
Address
24808 Teal Loop Road Chugiak, AK 99567
❑ other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
6 GPD/SF
4 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.1
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Thunderbird Heights #3A 6 5
Fill added above original grade
1-2 Ft.
Gravel length
20 Ft.
Township Range Section
Gravel width
-7 Ft.
Beds: Number of Lines
Distance between lines
I Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
1
From
Tank
Field
Tank
Line
114.9 Ftp
1
Ft.
Well
>200'
>200'
NA
NA
>25'
TANK ❑ Septic ❑ S.T.E.P. ❑O Holding ❑ Other
Manufacturer
Advantex Treatment System
Capacity
1,500 - Gal.
Surface Water
>100'
>100'
>100'
NA
Material
Number of compartments
Lot Line
>5'
>10'
>5'
NA
Steel
Two
NA
Foundation
>5'
>10'
>5'
NA
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
I Gal.
Remarks Existing Septic Tank Decommissioned
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
in Accordance with Municipal Code. Existing
Absorption Trench Abandoned in Place.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tanklo
drainfield D3034.
Installer
Guaranteed Services
Drainfield 63034 Co/Mr
Inspector T. KimbroUgh
BENCHMARK (Assumed elevation) 100.00 ft
Inspection
V 9/8/09 9/25/09
Location and description
2"
3p 9/26/09 a'^
Finished Floor.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
-'P�.0..•q�ll,
�S+r�
Conditional Approval: Date.77
�`P.•.
� �
49
ON .. ...
r�0...� ...... .....................
:P�* MICHAEL E. ANDERSON
CE -4381
Approved Date ( 5�
I10 f0FEss o N,
ila0`®s,�
Inspection Report_9a742.doc
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
Permit Number: SWO90174
LOT 5, BLOCK 6, THUNDERBIRD
HEIGHTS SUBDIVISION, ADDN. 3A
22,018 S.F.
Page 2 of 3
PID No. 051-582-50
a
A
A B
1 19.1' 37.3'
MH 29.0' 30.5'
C2 38.1' 32.4'
M1 35.9' 30.T
A' M2 50.2' 23.1'
aQ C3 52.T 26.9'
X00 06
NOTE:
Drawing not completed
from Surveyor as built.
Locations are not exact.
PLAN AS BUILT
SCALE V = 30'
� ti
A
ryp.
Four Bedroom
C ry
Fco Home
S1
hed
MH a
M1 Four Bedroom
S stem
C2 TH3 TreatmentPo�
® w /Al(20
M2
LEGEND LEND:
Proposed
TH2 A\�
C2 — Cleanout
S1 — Septic Vent
Garage
®
FCO — Foundation Cleanout
MH — Manhole
\
DO
®TH1 O
M1 —Monitor Tube
A B
1 19.1' 37.3'
MH 29.0' 30.5'
C2 38.1' 32.4'
M1 35.9' 30.T
A' M2 50.2' 23.1'
aQ C3 52.T 26.9'
X00 06
NOTE:
Drawing not completed
from Surveyor as built.
Locations are not exact.
PLAN AS BUILT
SCALE V = 30'
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit No.: SW090174
N
U
Existing Grade
94.1
PID No. 051-582-50
N
985 M
/ 97.1 lul
Finished Grade //
x
ti
Geotextile Fabric
Drain Field Rock
20' Trench
PROFILE AS -BUILT
Scale: NONE
94.1
77.3 -4
Bedrock @111177.3'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 5, BLOCK 6, THUNDERBIRD HTS. 3A
PERFORMED FOR: GUARANTEED SERVICES
DATE: 9/24/09 PROJECT No.: M0926
PARCELID#: 051-582-50 TECHNICIAN: T. L. KIMBROUGH
TEMP: 55°
DEPTH TEST HOLE 3 Type of Test: ® Percolation ❑ Visual
(feet)
IIZI
READING
OB/OG
LOOSE, WELL GRADED, DRY
NET TIME
(MINUTES)
2
NET DROP
(INCHES)
SANDS WITH GRAVELS
GW -SW
3
BOH
1
4
10
8.25/.50
5
6
1420/1430
10
7
7.50
8
3
1431/1441
9
8.25/.75
7.50
SLOPE
0%
2%
WAS GROUND WATER ENCOUNTERED? No
I IF YES t@ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING:
I I I DATE OF MONITORING:
-
I
1
1
I
I
I
2-5% < 2%
0%
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH OE
WATER
(INCHES)
NET DROP
(INCHES)
9/24/0
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1409/1419
10
8.25/.50
7.75
2
1420/1430
10
8.50/1.00
7.50
3
1431/1441
10
8.25/.75
7.50
4
1442/1452
10
8.50/1.00
7.50
5
1453/1503
10
8.25/.75
7.50
6
1504/1514
10
8.50/1.00
7.50
PERCOLATION RATE: 13 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: TEST CAVITY PRE SOAKED PRIOR TO PERCOLATION TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: __ 2/2/2015
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
9-9--0q e, /:
q/2 C,/C, N s"loon»,
7%2G%aq ice' ��
Date Issued: Sep 04, 2009
Expiration Date: Sep 04, 2010
Permit Number: SWO90174 " Parcel ID: 051-582-50
Legal Description: THUNDERBIRD HEIGHTS #3A BLK 6 LT 5
Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 024808 TEAL LP
Owner Name: JAMES & BONNIE WISNIEWSKI Lot Size: 22018 SO. FT.
Owner Address: 24808 TEAL LOOP RD Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567-9521
This permit is for the construction of:
❑✓ Disposal Field ❑Q Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
i., eYeAvlt�r.i" &,7- C,VH-e✓ r7- �O(%Sc_.
rnjti
t��ZS Ue"irl Clw.ige A��Ir've.(�� ,/1e.eA5 6AAiiG++q) PcrG fG51.
M
A1e.eA l A kdv-r'
Received By:
Issued By:
Date: 9/L[/09
Date: y
#1 Municipality of Anchorage
Joe
CHANGE ORDER
PERMIT #�• _) 0121 1
PID 05/ -.5 W_ 50
SUBDZ twk .sol N�3q (16 L TRACT BLOCK LOT
CONTACT PERSON AA r, G PHONE 14q) -W6 FAX
PLEASE GIVE A DESCRIPTION OF THE CHANGE
CUSTOMER SIGNA
Reviewer: N/ 'y
Reviewer:
DATE
TOTAL HOURS (30 minute minimum, 15 minute Increments thereafter)
HOURLY RATE
TOTAL TO BE PAID:
Review Time 1 hr -
Review Time
RECEIPT # 2504-I 1
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-582-50
�Il
830' 8 iO I a'� cctr
Property owner(s) James & Bonnie Wisniewski Day phone 6 2b-753 `d
Mailing address 24808 Teal Loop Chugiak. AK Zip Code 99567
Site address 24808 Teal Loop Chugiak, AK Zip Code 99567
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size 22.016 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
El
Septic Tank
El
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Thunderbird Heights Subdivision, Addn
Number of Bedrooms
Four (4)
THIS APPLICATION IS AN:
Initial
❑
Upgrade
0
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S 3 t7 Waiver Fees:
Date of Payment: F- 31 -0 y Date of Payment:
Receipt Number. d 72 3 Receipt Number.
(Rev. 11/05)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
September 23, 2009
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: Lot 5, Block 6, Thunderbird Hts. Subdivision, Addn. 3A
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption system on the subject lot has failed and must be upgraded to
prevent a health hazard. We are therefore requesting a permit be issued for the
upgrade of the septic system to accommodate the four-bedroom home on the lot. The
attached Site Plan and backup documentation identify the location and configuration of
the existing and proposed septic system. The existing 1.250 Gallon septic tank will be
pumped, crushed and backfilled on site. A new four-bedroom Advantex Treatment
System will be placed at the location shown. The existing absorption trench system will
be abandoned in place. The new absorption trench will be placed as shown. Also
identified on the plans are the locations of the existing water service on this lot and
adjacent septic systems. No conflicts exist between the proposed septic system and
the water service on this or adjacent lots. The subdivision is served by a community
water system. Drainage arrows are shown indicating the current drainage patterns.
The drainage patterns will be maintained after construction.
The test holes recently placed on the lot indicated sand and gravel with some silt
(GW/SW). The percolation rate was determined to be 1 to 5 minutes per inch. We
have designed the system to an application rate of 6 gallons per day per square foot.
We are proposing to place a 20' long trench by 5' wide with a 1' effective depth. The
total depth of the system will be 4'. Groundwater was noted in Test Hole No. 1 at 14'
and is now at 8.0'. Groundwater in Test Hole No. 2 has dissipated and the hole
remains dry.
The ground surface on the lot slopes to the northwest in the area of the absorption
trench. The trench will be placed parallel to the contours of the ground as much as
Lot 5, Block 6, Thunderbird Hts. No. 3A
September 23, 2009
Page Two
possible and in conformance with design criteria. A minimum of 100' will be maintained
between all components of the septic system and any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely, E(4—L'-�
Michael E. Anderson, P.E.
Attachments
12
I
\ 13
P T�
C CSO 14
3 A
O RO 15
�Q
a.Puc kw 9
4
6
2splu Ams 16
1
23 17
7
22
NOTE; No Conflicts with Wells or Septic Systems in the Area.
Surrounding Lots Served by Public Water System.
No Slopes Creater than 25% Within 50' of the New Absorption Trenches.
OF
49th♦♦
�.....: .......... .. i
......
AREA MAP
;MICHAELANDERSON i
♦1 f°:, No. CE -1381_
♦♦♦ •.,1.• 2J'Vf i SCALE 1' - 100'
♦#4 'Raissl ���
LOT 5, BLOCK 6, THUNDERBIRD
HEIGHTS SUBDIVISION, ADDN. 3A
22,018 S.F.
0;0
l
Q'
Gj Qry�
Exist septic rank
Pump. 8M, and
Place.
Four Bedroom
Home
Backlill n
%
sv
Shed
LIH
Fourr�Bedtroom em �t
Podrn \
4ett���►R
/AX20
•
\�1 \
20',Long x S' Wide
CO x 1 Etlecliw Depth
Absorption french LEGEND,
Proposed
CO — Cleanout
•TM2 SV — Septic Vent
Garage
A FCO — Foundation Cleanout
VH — Manhole
fi •TML
QQ
�ry
Q
/
Do
'ySR,
700
00
0
MICHAEL LCE-4D3
SITE PLAN ERSON
•.. .2s;4A 'F
SCALE 1' = 30' ••��,,P�;;r"
ra
LOT 5, BLOCK 6, THUNDERBIRD HEIGHTS NO. 3A
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 4 Bedroom Advantex Treatment System
Application Rate: 6 GPD/SF 1' Drainfield Rock
4 Bedrooms X 150 GPD/6 GPD/SF (Application Rate) = 100 SF Absorption Area
100 SF/5 SF/LF-.87 (Red. Factor) =17.4 LF Trench Length
THEREFORE: Construct an Oversized Trench 20' Long x 5' Wide x 1' Effective Depth.
Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be
4' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trenches.
Natural
Backfill
2-6" Geotextile
Fabric
6-• I Q 4" Perforated
t PVC (Holes Down)
1'0" 1 I ,>--t— Drainfield Rock
5'
TYPICAL DEEP TRENCH SECTIOP'
NOTE:
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 200' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 ELMORE ROAD ANCHORAGE. AK 99519-6650
DEPT}I
Iran
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 5, BLOCK 6, THUNDERBIRD HTS. 34
PERFORMED FOR: GUARANTEED SERVICES
DATE: b/[[/uy PROJECT No.:
PARCEL ID#: 051-582-50 TECFLYICIAN:
TEMP: 55°
TEST HOLE I
OB/OG
LOOSE. WELL GRADED, DRY
SANDS WITH GRAVELS
LITTLE FINES
GW -SW
MED. COMPACTED DRY
SILTY SANDY GRAVELS
SM -GM
BOH
MuyZ6
T. L. KIMBROUGH
Type of Test: ® Percolation ❑ Visual
WAS GROUND WATER ENCOLTN7ERED?
Y's
IFYES jd WI IAT DEPTH"
11•'
DEPT11 OF WATER AFTER MONTFORIN4.
13.5'
DATE OF MONTfORING.
8/29109
0% 2-5% < 2%
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
NET DROP
(INCHES)
8/23/09
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1130/1140
10
10.13/1.63
8.50
2
1140/1150
10
11.25/2.875
8.375
3
1150/1200
10
11.0/2.69
8.31
4
1200/1210
10
10.75/2.375
8.375
5
1210/1220
10
11.0/2.69
8.31
6
1220/1230
10
10.75/2.44
8.31
PERCOLATION RATE• 1.2 (MIN/INCtI) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 5 FT. and 6 FT.
COMMENTS: TEST CAVITY PRE SOAKED PRIOR TO PERCOLATION TEST. GW/SW LAYER IS THE SAME
AS IN TEST HOLE N0. 2 WITH THE SAME PERCOLATION RATE.
TEST PERFORMED BY ANDERSON ENGINEERING. 1. MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 5, BLOCK 6, THUNDERBIRD HTS. 3A moi''�•,N—°'
PERFORMED FOR: GUARANTEED SERVICES
DATE: 8/22/09 PROJECT No.: M0926
PARCELID#: 051-587-50 TECHNICIAN: T. L. KIMBROUGH
TEMP: 55°
L ANDERSON
DEPTTI TEST HOLE 2 Type of Test: ® Percolation ❑ Visual
(rcet)
OB/OG
LOOSE. WELL GRADED, DRY
SANDS WITH GRAVELS
LITTLE FINES
GW -SW
SLOPE
2%
2-5% < 2%
0%
DATE
WAS GROUND WATER ENCOUNTERED' YES
GROSS TIME
(MINUTES)
IT YES g WHAT DEPTH^ 13.5'
DEPTH of
WATERNCHES)
(INCHES)
DEPTH OF WATER AFTER MON7TORC:G: NONE
8/23/09
DATE OF MONTTORTNG: 97231 99
WET POORLY
GRADED SANDS
WITH FINES
SP -SM
1305/1315
10
11.75/2.125
BOH
2
2-5% < 2%
0%
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH of
WATERNCHES)
(INCHES)
INFT DROP
8/23/09
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1305/1315
10
11.75/2.125
9.625
2
1315/1325
10
10.875/1.375
9.50
3
1325/1335
10
11.12511.50
9.625
4
1335/1345
10
11.00/1.50
9.5
5
1345/1355
10
11.125/1.625
9.5
6
1355/1405
10
11.25/1.69
9.56
PERCOLATION RATE; 1.05 (MIN/INCH) PERC. HOLE DIA. 6 (INCITES)
TEST RUN BETWEEN: 6.5 FT, and 5.5 FT.
COMMENTS: TEST CAVITY PRE SOAKED PRIOR TO PERCOLATION TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:_
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 5, BLOCK 6, THUNDERBIRD HEIGHTS NO. 3A
GENERAL:
The scope of this project includes the procurement and placement of a
new Four Bedroom Category III Nitrate Reducing Septic System as
manufactured by Anchorage Tank and Orenco Systems to serve the
existing home on the lot. The system will be placed at the location
shown on the Site Plan. The new septic system also includes the
construction of a new 20' long X 5' wide absorption trench with 1' of
drainfield rock under the distribution pipe at the location also shown on
the Site Plan. The distribution line in the bed will be placed 3' below
the existing ground surface. The new system must be placed a
minimum of 10' from the water service on the lot and those on
adjacent lots and 100' from any surface water located near or on the
lot. The existing septic tank must be pumped, crushed and backfilled
on site. The existing absorption trench must be abandoned in place.
Provide a minimum of 4' of cover over the septic tank and 3' over the
absorption trench.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines. The southern lot line and the 100' well radius
must be staked prior to construction to insure the system is
constructed on the property.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Development Services Department, Building Safety
Division, On -Site Water and Wastewater Program for system
installations. Owners installing their own systems must receive prior
approval from the On -Site Water and Wastewater Program before
beginning system installation.
Lot 5, Block 6, Thunderbird Heights No. 3A
September 23, 2009
Page 2 of 4
SEPTIC TANK INSTALLATION
The Category III Treatment System must be installed in conformance
with specifications and regulations furnished by the manufacturer.
Upon completion the manufacturer must inspect the system and certify
the system it is ready for use. No variances from the manufacturer's
specifications will be allowed without permission from the
manufacturer and Municipal representatives.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the bed shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below the distribution line must be
perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Lot 5, Block 6, Thunderbird Heights No. 3A
September 23, 2009
Page 3 of 4
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cieanouts and
insulation. No backfill should be in place at the time of inspection.
Lot 5, Block 6, Thunderbird Heights No. 3A
September 23, 2009
Page 4 of 4
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
DiEMORANDUM OF UNDERSTANDING .
BETWEEriKUNICIPALITY OF ANCHORAGE
AND
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
�y�of2,5 y and between�S,J/J/W,-Ll
.
herein the "OWNER," and the Municipality ofAnchorage, herein the .
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED R'ASTEAVATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as c.._ ----•- located .
at 7"6W X24L /-14 �arld lC Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AWWTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design: Prior to . .
performing any alterations to an AWWTS the owner must.obtain a
Wastewater Disposal Systerri Construction Permit from the Municipality'
pursuant to Anchorage Municipal Code (hereinafter,"AMC'D,15.65.
B. Certificate of On -Site Systems Approval An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with A -MC 15.65."
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system . .
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On-Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the .
requirements of the On-Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
.3. Fee. Owner shall pay to Municipality an annual fee of Afon1 E
(S O .00), payable on or before the issuance of the operating permit and annually
there-after. ..Ile annual fee is due on or before the anniversary date of the approval by the i..
Municipality of installed system
4. Terni. The tent of this Memorandum of Understanding shall be for the life of the
AWWTS.- . .
I.
0
6. Maintenance and Repairs. „
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof; at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjust:nent(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will,all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AW WTS
Operating Permit is:
C.. Owner ackr owledges that the fine schedule for failing to maintain and repair an. .
AWWTS arc codified in AMC 14.60.
D. Owner agrees that only rnaintenance,repair personnel certified by the'.
Municipality will inspect and make any accessary maintenance, repairs or permitted '
alterations to the system.
E. - Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's'AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment:
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For. the purposes of any amendment modification or change to the terms and ,
conditions of this contract, the only authorized representatives of the parties are:..
Owner: .7,IJ
/Sn%r�,l�
Anchorage: NrcbAsinuOfficer -
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of.Alaska shall govern the'rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
R' MUNICIPALITY:
By:
Title:
Date: Date:
STATE OF ALASKA )
) ss.
THIRD JUDICIAL. DISTRICT )
TheThforego instnuncnt was ackaQwledged before me this day of by
1 by>1QrY O� S �171GPYli?(J7S�^c
8L1111fAlUU/j�yy��� .
NO ARY P L C FOR ALASKA �! F
My Commission expires: My commisslon DgArea g 'N
--November e, zotlo ,F PUBLIC
lF OF
%HIIIHn�� .
/' 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
NAME
EWEW
❑ UPGRADE
MAILING AD KESS 0
1
LEGAL DESCRIPTION%
0/
/
LOCATION
NO. OF BEDROOMS
O
DISTANCE TO:
Well
r�Gf t14,
Absorption area
/
Dwelling,
PERMIT N
_Y
F-0
Man f rer
Material
No. of compartments
ur
Liq. capacity in gallonsInside
IF HOMEMADE:
length
Width
Liquid depth
❑ 1'
J t7Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= z F
Manufacturer
Material
Liquid capacity in gallons
O
w=
DISTANCE TO:_r
Well
Foundation
Nearest lot line
PERMIT NO.
� w z
Z w
�'¢
No. of lines 1
I
Length of each line
Total lent of lines
Trench wi th
3 inches
Distance e�een lines
r
F.
❑`�
Top of tile to finish grade
Material beneath tile
--inches
Total effective absorption area
ti C/ c`J
w
(7
Length
Widt
Depth
PERMIT NO.
Q H
w
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
3:
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIA n
SOIL TEST ATING '
b
INSTALLER r�
J/ L
-(
REMARKS
6r
APPR E j
- DATE LEGAL
72-013 (Rev. 3/781 `/
r•"11_1 r -a i c: i F_=�F=1 L_ i -F v r_® F= F=i r -a a_: "A- F;_� r o ®:3 E
DEPARTMENT HEALTH AND ENVIRONMENTAL ,OTE_ T I C iN
825 'L- STREET, ANCHORAGE, AK. 99501
264-4720
C®r-4-7�-:. a -T- I—= - IFF kiI—EFS F�F=F:�rl I _T_
PERMIT NO. ( ti30140 )
APPLICANT STEVEN L SKAGGS PO BOX D CHUGIAK 99567 688-2831
LOCATION
LEGAL L56E THUNDERBIRD HTE LOT SIDE 999999 SQUARE FEET
TYPE OF =OIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOM_ = 4 SOIL EATING ( SQ FT/BR)= 90
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I`_=,:
E� E F=° -F"= :1- C -i L_ E"r -F"= s 10 r F --'n ° E t_ Fp E F=•'F t-1=
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 AND THE BOTTOM OF THE EXCAVATION CIN FEET::.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL FIFE
AND THE BOTTOM OF THE EXCAVATION CIN FEET;.
g Z F= CA 1_1 I F.'EF C-• - E Fes' T' I ®_ "F F=1"K _. I = E = ::L;2`5C-1 R7i F:9 t_ L C-® N
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY 14ELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
— — — F t •� a=e sv _ . I r t _: F= E C-3 -9- I Cl N!E; F=1 F;2 -'E: F=_ E ®_! 1_[ I F_ EE C:• — — —
EACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO i PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS .
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIf'UM DISTANCE FROM H PRIVATE WELL TO A PRI'+TATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY '=EWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
�°E�_t''t I -F E: :F' I E�_E•�. CtiEY=:Et'•�E=EF=' -:�_ �1-_�
I CERTIFY THAT
1: I AN FAMILIAR WITH THE RE=!UIREMENTS FOR ON -'SITE SE14ER`• AND WELL'S AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I MILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED: ----„ ���----�----------------
APPLICANT STEVEN L SKAGGS
'ISSUED B r'--_�-�-_.� � C,� � / --C: ATE__ �,lJd=� �_ � 'v'4. 0
O & E ENC AEERING & DEVELO, HENT 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: /EIlClJ L.. �/{l/c5, -S 6'-'IVST. TeI.No. �� 18Z�
Mailing Address: /ad X �14()c,,-li %
Legal Description: LdT S 155-ocic
Depth (feet) Soil Characteristics
0
1 �1L �`iGi /per Sov�-
2
3
4
5
6
7 l� C Off✓ P� C 51" C/2 /q V":: -C- L `r�
8 C1qrte- C'-
g 0115, , PLOT PLAN
10 — A(o Sc4l-r_
11
12 —
13 — PERC. TEST
14 130 7- 7-0,f jai T
15
16
e0
Von
Ground Water Encountered: Yes No If yes, what depth r/.'� �,'� 0a5 f
r't)i e
�yoaooeotiooaa oes
Proposed Installation: Seepage Pit Drain Field 5� '
�yo a eeoe
Earl P. Ellis .0 LQ,
� c
Performed by: �_eDate: zZ8
2A ✓F --4J /- a0 /?
LTl
25
1
g 0115, , PLOT PLAN
10 — A(o Sc4l-r_
11
12 —
13 — PERC. TEST
14 130 7- 7-0,f jai T
15
16
e0
Von
Ground Water Encountered: Yes No If yes, what depth r/.'� �,'� 0a5 f
r't)i e
�yoaooeotiooaa oes
Proposed Installation: Seepage Pit Drain Field 5� '
�yo a eeoe
Earl P. Ellis .0 LQ,
� c
Performed by: �_eDate: zZ8
MUNICIPALITY OF ANCHORAGE
• i DEPARTMENT OF HEALTH & HUMAN SERVICES M}i
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. # pS i- S8Z- 5o HAA # 10 I'A) J -A
1. GENERAL INFORMATION
Complete legal description L S i5
Location (site address or directions) Z4go8 I ezl %ooP ��, Ch «k
Property owner (1l; r h/\ t per.)
Mailing address 1 g -)4k') gk
Lending agency.
Mailing address
Agent Ka4ti H GeYzc�
_ Day phone
2 a,-"
Day phone
7 - K'7 >-G
Day phone 694-91ZE
Address Grea�l �„� Real Cs�zlc I C-�a le l?��ev
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: �-
3. TYPE OF WATER SUPPLY:
Individual well
Community well X
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 X,
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5.
6.
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 furtherverify 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 Co Phone 694-9051B
Address 9601 ;3U d W e QY 1jr J chor A',; 99.$)6
Engineers signature ,�64,44t� Date io. Z3 • 9�
DHHS SIGNATURE
/� Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
-'Mir �1�Af�• �~
i *4 ti
)40. 1732-9
Jun. 2% 1%8
bedrooms, with the following stipulations:
0 �,� _ tau ti L Date b
By: ,.
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Healt�Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an in ependent
professional engineer registered in the State of Alaska. The DHHS 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. 1�
72-=(S v.1191) Back MOAN21
Legal Description
A. WELL DATA
Municipality of Anchorage
Department of Health & Human Services M}3r
HEALTH AUTHORITY APPROVAL CHECKLIST
L�13(a -Than",,. 115 Az�_A43 Parcel I.D. 0751– 58Z- S-0
Well type-Pvf;L1L If A, B, or C, attach ADEC letter
E�_Hss A
Log present (Y/N) Date completed _
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level .
Cased to
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
.•
- -200'
4,Z60,
�r
Public sewer service line 2zo
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample:
ADEC water system number 2///5_6
Driller
Casing height
Wires properly protected (Y/N)
AT INSPECTION
MUNICIPALITY OF ANCHORAGE
^Re?W NTAL SERVICES DIVISION
25 1991
g.p.m. g.p.m.
RECEIVED.
On adjacent lots
; On adjacent lots
+Zoo
Public sewer manhole/cleanout 7-0
Petroleum tank + $o
Collected by:
B. SEPTIC/HOLDING TAN3 �DATA
Date installed �" °°�t�3 Tank size IZ z7
Cleanouta (Y/N)' Y Foundation cleanout (Y/N) —
Compartments
Z
Depression (Y/N) N
High water alarm (Y/N) N r -)r Alarm tested (Y/N) N fl
Date of pumping !9
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wei I(a) on lot kZ�' On adjacent lots +Zpo Foundation
To property line 30 Absorption field 6 Water main/serviceI
Surface water/drainage + Zoo r
Ili
+ qvt
72-028 (Rev. 3191) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) --"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
High water alarm levelCycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DIS
LIFT STATION TO:
On adjacent lots
off" level at
Surface water
D. ABSORPTION FIELD DATA
Date installed M -2C 4 st33 Soil rating go sG/be2�m System type I �cn/cy
Length 49'
Total absorption area
Width — 3 Gravel thickness �) ` Total depth 81
39 z'
Cleanouts present(Y/N) I/
Depression over field (Y/N) N
Date of adequacy test 10- i6 -9k
Results (pass/fail) —r't'15S for
Peroxide treatment (past 12 months) (Y/N) n% If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot -t- 7-00On adjacent lots
To building foundation L�
-SOOn adjacent lots _ 4 Cutbank
bedrooms
Property line 3o
To existing or abandoned system on lot
-r 100' Water main/service line_
Surface water ~2-00 Driveway, parking/vehicle storage area
Curtain drain
am
E. ENGINEER'S CERTIFICATION
l certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in
Signature
Engineer's Name
Date 10, 2,
HAA Fee $
/76).v0
Date of Payment /G .- 2cr- '711
Receipt Number %% - LR 8 7,3)
72-026 (flee. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
N
i- so'
}S -O,
ion.
S
EOFLSNWALTER J. NICKEL, GOVERNOR
DEPT. ((('jjjODUUU1F ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 "C" STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: Chuck Landers
October 22, 1991
PWSID #211156
My review of the records on file in this office reveals that the Thunderbird Heights
Subdivision Class "A" Public Water System, is in compliance with the routine coliform
bacteria samples requirements listed in Table C, and with the inorganic sampling listed in
Table B of
18 AAC 80.200.
Sincerely,
X
Byron Roys
Environmental Engineer
as�SB��o
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF bN-SITE SEWER AND WATER FACILITY
9an_a7gn
2. TYPE OF RESIDENCE
Single -Family 91 Multi -Family ❑ Other
Number of Bedrooms 4'
3. WATER SUPPLY
Individual Well ❑ Community XX Public ❑ _
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite = Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 (11/84)
IVB/W SZO-ZL
Z to Z abed
,-- T Z/ ;W/ Oleo
ssaappV
ouogda al SiMMMIS UNA.MaNioNa EEMH RrJUVE wall to OweN
'uolloadsul slgl to alep aql
uo belle ul suopelnbai pue'saoueuipao'sapoo ole1S pue ledioiunlN Ile qpm aouelldwoo ul si welsAs lesodsip aalemalsem
ao/pue llddns aalem alis-uo aql 'uogoadsul pue u011e611sanul !w woe; pue sell; a6eaogouV to Alllediolunpy aql woal
pouielgo uollewaolul aql uo poseq legl AIIjaA aaglJnj I uiejeq paleoipul aanlonals to adll pue swooapoq to aagwnu all aol
alenbape pue leuollounl'ales si wolsRs lesodslp jalemelsem Ao/pue /lddns aalem ells-uo aql jell smogs lenoaddV AjpoglnV
g1I?OH SIMIO u0l1e6lls9nul /w legl Ap9A l'molaq umogs alep uo!leP!IeA Oql to se pue olaaaq paxllle leas Aw /q paipliao sV
NOI.LVWHOdN1 aNV V.LVa'HOLIV3S 3'lld'S.LS31'SNOI.LO3dSNl'JNIOIAOHd WHI=I DNIH33NIJN3 'S
jenojddV leupippuoo lo.swief.
leuoljlpuoo
panoiddesio p #AOaddV
/q wooapaq a�; panojddy
z8 -1 z- a7Oleo
IVAOtlddV d3Ha 'S
01SS3d0yd� ®Aa
�T Dieing 'W s!noj
.... ...ee.e•
®N � FIX St"o 4t
M.
,-- T Z/ ;W/ Oleo
ssaappV
ouogda al SiMMMIS UNA.MaNioNa EEMH RrJUVE wall to OweN
'uolloadsul slgl to alep aql
uo belle ul suopelnbai pue'saoueuipao'sapoo ole1S pue ledioiunlN Ile qpm aouelldwoo ul si welsAs lesodsip aalemalsem
ao/pue llddns aalem alis-uo aql 'uogoadsul pue u011e611sanul !w woe; pue sell; a6eaogouV to Alllediolunpy aql woal
pouielgo uollewaolul aql uo poseq legl AIIjaA aaglJnj I uiejeq paleoipul aanlonals to adll pue swooapoq to aagwnu all aol
alenbape pue leuollounl'ales si wolsRs lesodslp jalemelsem Ao/pue /lddns aalem ells-uo aql jell smogs lenoaddV AjpoglnV
g1I?OH SIMIO u0l1e6lls9nul /w legl Ap9A l'molaq umogs alep uo!leP!IeA Oql to se pue olaaaq paxllle leas Aw /q paipliao sV
NOI.LVWHOdN1 aNV V.LVa'HOLIV3S 3'lld'S.LS31'SNOI.LO3dSNl'JNIOIAOHd WHI=I DNIH33NIJN3 'S
MUNICIPALITY OF ANCHORAut:
ENVIRONFAENTAL SERVICES DIVISION}
OCT 2 01987
RECEIVED
A. WELL DATA
Well Classification
;q "
C /.,
Well Log Present (Y/N)
Total Depth
Static Water Level
Cased to
Casing Height Above Ground —
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Lal Description:
�{1((►1cIeY�)Vd NPIQ{t�5 LIII ��
'Nock (p_(� ti R 11(�i c rrn� %5
If A, B, C, D.E.C. Approved (Y/N) —
Date Completed Yield
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N) —
_ Depression Around Wellhead (Y/N)
On Adjoining Lots —
On Adjoining Lots
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
Date Installed 1 ?83 Size A"-5_0 G• No. of Compartments a
Standpipes (Y/N) y Air -tight Caps (Y/N) % Foundation Cleanout (Y/N) yFS
Depression over Tank (Y/N) N Date Last Pumped /o%y'/S7
Pumping/Maintenance Contract on File (Y/N) y� for
Holding Tank High -Water Alarm (Y/N) H_G Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well f 7OL To Building Foundation �y
To Property Line 3e To Disposal Field
To Water Main/Service Line amp / To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata y� 4ZZ3pz Type of System Design ! ✓c 4
Date Installed �9b
Width of Field
3'
Square Feet of Absorption Area �3 �`
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present(Y/N)
Y
Depression over Field (Y/N) -
Al
Date of Last Adequacy Test
7
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
Results of Last Adequacy TestI'
- /4A-- '7g -
use2FC
Separation Distance from Absorption Field:
To Water -Supply Well'tpO
i
To Building Foundation
Lot Ai
To Water Main/Service Line f/o
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
i
7
To Property Line
To Existing or Abandoned System on
On Adjoining Lots
To Cutbank (if present)
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at — Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
effect on the date of this inspection.
Signed Date
Company A��t _ MOA No. -57---2 6
O /" O d L Z
Receipt No. -O
Date of Payment —/C-��� Eagle River Enginoerin0 Servlces
-`
^� / /D d - P. 0. Box 773294
Engineers Seal `r
Amount: Saglo Itiver, AK 99577
694-5195
PageG'
2of2
7,
l r;^ outs A. EU10ra
Fv �f°o CF -6736
72-028(11/84)
STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 "C" STREET, SUITE 1334
ANCHORAGE. ALASKA 99503
DATE: - ql!4- 9-1--------
PWSID #:-------- —
To Whom It May Concern:
According to the records on file in this office, the
Water System is in compliance with the
State of Alaska Drinking Water Regulations.
Sincerely, _
Ronald S. Klein
Environmental Field Officer
APPLI(--�;NT FILLS OUT UPPER HA'_` ONLY
�•
Property Owner �"• // �c>/�fJ �-r
\
7
Phone
MailingAddress SPR
Zip Code
t
Date
Buyer
Dafe
Address
Zip Code
Lending Institution
Phone
Address
Zip Code
Field Notes:
Realty Co. &Agent
Phone
Address -
Zip Code
.r
/
Legal Description 47%( � fjL UC�� �
_ c
f�jC%1'i.��;�Ijf �� f7711�i%'/!S JCj3t
Street Location ` " 'r r,( Vie rJ
Type of pesidence
Ingle Family F,-
❑ Multiple Family No. of Bedrooms
-
❑ Other
Water Supply _
❑ IgAividual
H WELL LOG. A wall log is required for all wells drilled since June 1975.
FFor
ommunity
f APPROVED BEDROOMS C/
( 1 /
lls drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
( ) DISAPPROVED
Sewer poual
40
I liG 7 37t S
Installed: _7 (1T�] `
Individual
Year Individual ,f �h
Public Utility
When Connected to Public Utility:
❑ Holding Tank
DATE
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Dafe
Inspector
Inspector
Inspector
Inspector
Field Notes:
.r
MAY 2 51983
f APPROVED BEDROOMS C/
( 1 /
'CONDITIONS OF APPIR �' ' u"�� -�
c1N11'f1I1RICilidi
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
S RG
DATE
BY:
Soils Rating
Date Se er Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
)2023131&1
