HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 7 LT 5"3A
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Municipality of Anchorage '°•.,
er'`.
1 Development Services Department :
Building Safety Division +. .
- On-Site Water and Wastewater Program. 4700 Elmore St.
P.O. Box 196650 Anchorage. AK 99519.6650 Page / Of 3
www.ci.anchorage.ak us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: PID Number: .. ,SS— 4
Wastewater System: ❑ New PZUpgrade
ndar.,.L 3 R
ABSORPTION FIELD
Plxw� 32- S Z 9 Na r a B.maom,
sap Trench O Snsllor TnnUI D Bea Cl Mount O Omer
LEGAL DESCRIPTION
SNI RWno
GPDIFI•
Tout Depm "M onanal era
I il.
SIXk SP��ppp
W"M em p,
ZCFt.
Gl" depth E.n..m Pp.d5
E FI
To ,vp Ranps secOon
Fe added above anginal aaft0 FL .
6S
Greta Length:
-30.-5-FI.
Well:/ fWWV ❑ Ne ❑Upgrade
Gray.Iwdm.
Numaaroflabs
Dm.noet an lees
I
Ft.
IFt
Diasalcaw (Pmais. A B Cl.
Total Depth
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/&3LI
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Dal. ON".
$tabs W.t.r Lay.I
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/
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'.7O /
h
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Pumps.ln
CaNnaRbpmAb "G'Wrld
TANK
GPM
FI.
FL
SEPARATION DISTANCES
eptic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
ubliCrPnvatea
Sewer Line
a.., n
ln: N, Rd /r/
_&P
2m Gal
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anel
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nm.N
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eR
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_
LIF STATION
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to
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n .Aurar
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'Pump ptr is N 91
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�
—
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Pump Make a N
ElOM W Its woon, ps y
Remak
BENCH MARK
Loudon" D..mpum.
Wnwl brabon
14100 FL
Inspections performed by: r Co Dates: 1" // D—�
Engineefi ;tamp
. `Za,
'-; Or AL
L'
- rznd0
a
.........
r
.�
�z
Development Services Department Approval
;•�..
j K r•J � ��
: �� T. L
Conditional Approval Date:
✓ ..... .""""'
LI• t`• St dr1 �'C 9 • • r`
LfF J PE 6:56
� / ate:F'70FE5s1
Reviewed and approved byL��/
�� p
,
� �Q7'
t �.•.��
25% Slope
I
1250 Gallo Septic Tank
Double
Lot 6
Septic Site Z/,,-00/MT C.O./MT
5% Slope New Trench
C.O.
Old Septic Tank/Tren
Abandoned/Decommi ioned
CY
RECORD NOTES:
1. Total Depth of Trench is 11'.
Septic Site is About 5% Slope.
2. Sewer Service Line minimum 2% slope.
3. Old Septic Tank/Trench Abandoned/Decommissioned
4. Lots Served by Public Water System.
THI
O
T C01
11.5 24
TCO2
18 16.5
CO
23 12.5
01
56 61
0/MT
33.5 66
Lot 4
Septic Site
.....
THUNDERBIRD HTS #3A r = so
NOR THRIM y�<'
ENGINEERING .... •"• BLOCK 7 LOT 5 RECORD
PO Box 770724.. ... .. ... DRAWING
Eaq�a Pi~, Alaska 99377 `~ NEW TRENCH/TANK
907.e94.7028°p SEPTIC SYSTEM 8/20/09 2 of 3
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MUNICIPALI7YOFANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 06, 2009
Expiration Date: Aug 06, 2010
Permit Number: SW090141 Parcel ID: 051-581-10
Legal Description: THUNDERBIRD HEIGHTS #3A BLK 7 LT 5
Design Engineer: 0838 NORTH RIM ENGINEERING Site Address: 024344 THUNDERBIRD DR
Owner Name: DOUG HERRING Lot Size: 34431 SO. FT.
Owner Address: 24344 THUNDERBIRD DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567-5126
This permit is for the construction of:
E Disposal Field ❑? 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.
Received
Issued
c�
By: Date: C
By GC ll, 411t, Date:
Municipality of Anchorage O
-:Development Services tDepartment
Yid Building Safety Division =�.j♦y '� ',.�,�"'
/ On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. n 57 — 54?1 � 16
Property
Mailing address Z 3
phone 49��- SZ 9/
Code 9 qZL
Site address C Zip Code
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size Sq. Ft.
34,43t
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial ❑
Upgrade
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 own"r authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: 02,414 Receipt Number:
(Rev. 11105)
r
2TF-I
FEN(zINEERING
Northitim Engineering
PO Box 770724
Eagle River, AK 99577
907-694-7028
July 31, 2009
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Thunderbird Lits #3A, Block 7, Lot 5
Failed Absorption Trench
The referenced property has a flooded absorption trench. The design calls for a new
trench, new septic tank & private sewer lines. Public water serves the area lots so no
water well conflicts are present.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
Steve Eng, PE, PH
Design Enclosures
.t.
r
�N ,INFER NG Thunderbird I Its #3A, Block 7, Lot 5
SPECIFICATIONS & DESIGN Gl11DELINFS
Wastewater System Sizing: This is an existing 4 -bedroom, single family home. The
absorption trench was flooded. A new design is submitted for a new trench & new septic
tank. The neighboring lots are developed as indicated in the drawing. New soil tests were
conducted. An 1 V deep trench will be excavated with new septic tank. The old tank will
be removed or properly abandoned in place. No water wells are in the area. Public water
serves all the neighboring lots. No adverse impacts are expected from septic system
replacement. No conflicts to the other lots will take place by this septic system
construction. The easements are located on the drawing and are not encroached upon. The
soil tests revealed a clean sand soil. A conventional septic system will be used,
application rate of 1.2 GPD/FT2. Trench Length = 500 FTI/8.5'x 2 = 30'; 1 line @ 30',
8.5' effective depth, with I" insulation.
Specification Requirements: All components and work must comply with the Municipality
of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and
Wastewater Regulations.
• Two compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.
• 5' minimum between the tank and bed. 10' to property lines.
• 3' of cover or insulation is required for trench; 1" insulation maybe substituted for one foot
soil cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required V to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from the
tank positioned to provide cleanout access towards the tank and towards the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -rock.
• Drain rock to be V2 inch to 2 %2 inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36", 24" with 1" insulation.
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam III or equal)
• Old Septic Tank to be removed or pumped, filled with sand/gravel, crushed, & buried.
IaP3
DESIGN NOTES:
1. Total Depth of Trench is 11'.
Septic Site is About 5% Slope.
2. Sewer Service Line minimum 2% slope.
3. Abandon/Decommission Old Septic Tank
4. Lots Served by Public Water System.
25% Slope
New 1250 Gallo Septic Tank
Abandon 01 qr4B
Tank Q
Double C O.'s
Lot 6 Old System I
Septic Site 5% Slope
T �
hGha� \
CY
4H
New Trench
Lot 4
Septic Site
qay
ti�°Fk
NORTHRIM•,'
THUNDERBIRD HTS #3A
V = 50'
ENGINEERING ••4916 '
BLOCK 7 LOT 5
WASTEWATER
vo Box 770724
Eo91e Plvw. Alaska 9957 _-<.f
907.694. 7028 �-��`
LAYOUT
NEW NEW TRENCH/TANK
SEPTIC SYSTEM
7/31/09 Wof 3
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FE1��NEERING
S❑ILS LOG - PERC❑LATI❑N TEST
Performed For: Doug Herring
Date Performed: 7/24/09
Legal Description: Thunderbird Hts #3A, Block 7, Lot 5
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Organic
SW
w/Gravel
T,H. Location: See Attached Design
-5% Slope
Groundwater? No
Depth
Water Depth
After Monitorinn. Nnna nntoz 7/11/na
#
1 Date
lGross Time
Net Time
Depth
Net Drop
1
7/24
0
--
11'
--
2
7/24
10
10 mir.
16'
5'
3
7/24
12
--
11'
--
4
7/24
22
10 mid.
16'
5-
5
7/24
25
--
1 11'
--
6
7/24
35
10 mid.
16'
5'
7
7/24
37
--
-
7/ 4
47
10 mi
1AI
5'
7/24
50
--
III
--
0 17/24
60
10 mir
16,
5'
Percolation Rate 2 Min./inch Perc Hole
Test Run Between 3' and 4'
Comments: Presoaked
Performed By NorthRim Eno. I _
Performed in Accordance with E
ON THIS DATE. DATE: 7/24/09
Diameter 6'
CERTIFY THAT THIS TEST WAS
tate/Municipal Guidelines in Effect
+,,p** %%
OF
NORTHRIM y:
..49 •
ENGINEERING •••• '••••
TESTHOLE L❑G
T. H. 1
PO Box 770724 �••••
Eagle 907. Alaska 99577 •.�q�ryr�
907.891.7028 l �
GEOTECHNICAL
Me:
7/31/09 1
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 PHONE EW
5' ❑ UPGRADE
MAILING ADDR S
D. &-�/ b 9 9Scc`7
LEGAL DESCRIPTION
�.5 l3'7 i2cl fS
LOCATION NO. OF BEDROOMS
ell I Absorption area Dwelling / / PERMIT NO.
DISTANCE TO: / PX 7RS-_
U y
w
�
a Q
Manufacturer /1
Material �� /
No. of compa�rti
WF
(J
C
Liq. capacity in gallons
Inside length
Width
Liquid depth
.Z S -U
IF HOMEMADE:
—�
y
Well
Dwelling
PERMIT NOl
DISTANCE TO:
0z
z
Manufacturer
Material
Liquid capacity
Fa-
O
We
Foundation
Nearest lot line
PERMIT NO.
w=
DISTANCE TO:
3.2!
r
LL z
No. of lines
Length of each line
Total length of lines
Trench width
Distance betwe[
H-ry
inches
I < H
Top of file to finish grade � �
Material beneath file �
Total effective
Length
Width
Depth
PERMIT NO.
La
U
Q 1-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w a
r
0
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
J
W
Building foundation
Sewer line
Septic tank
Absorption area
DISTANCE TO:
OTHER
REMARKS V /
a
ons
area
A��Ef ,/
ATE LEGAL
�
72-013 (Rev -3/72)
M�itti1 2 0_ a r}�oL a T° -r r�F Fit-a�_H_ �F�FIt�E
.. DEPARTMENT L -HEALTH AND ENVIRONMENTAL r—gTECTION
b.25STREET, ANCHORAGE, AK. �3
264-4720
tJC 1—_.ITE �-EWEF: F•EF;ZPl I T
PERMIT NO. 820795
APPLICANT
LOCATION
LEGAL
SKAGGS CONST PO BOX D 99567
L5 E7 THUNDERBIRD HTS
LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 120
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
CdEF TH= iii ate+ :3FRRn EL C:mEF•TH= IS
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 (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOMOFTHE EXCAVATION CIN FEET).
F°F=QU I F:EL} = EPT I r_: -UF:l aFP = 12'E= 310C+I _'3nl L_13" 5
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER. OF RESIDENCES THAT THE WELL WILL SERVE.
--- -IFWC3 <> "F E F EG!U I F E:L} ---
BACK.'FILLING OF ANY SYSTEM WITHOUT FINAL INSPEC_.TION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 290 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EF M I T EXF=* I F:E'_==; E_NECEMEi F=F_ Z3:::L 1'K+:D'._
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IPJ 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 3 BEDROOMS. ^ r
SIGNED: ----------------------------------------
APPLICANT SKAGGS CONST
ISSUED BY--- -- -- _- )ATE_2�7�Q_ V4.0
Oyster
for:
-® & E ENG AEERING & DEVELOP oAENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
SOIL LOG 688-2280
Name: �����i . tcau� �fsc_, it,� Tel. No-6—OP'l
Mailing Address:
Legal DesCriptiiin / I r— � ""� -7T.
�•�/Q��/'i�ll �> :�/�T�
Depth (feet)
0
Soil Characteristics
1 Yl�e0,GA ft) 14-
z
3
4
6
7
8
9
10
11
12
13
e e=� �; a /�
15 —6,a�_ !�
16 —
/G ae
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field •
PLOT PLAN
PERC.TEST
Russell L. Oyster
Performed by:L �� �\�� ����' Date: ;4& ��
Time
APPLI(',NT FILLS OUT UPPER HA( �') ONLY
Time
Property Owner
T & D Construction
Phone
Time`\
Box 2524, Palmer, Ak - 99645
745-2731
Mailing Address
_ zip Code
Buyer
T & D Construction
—1
S� "ICiLXj
Box 2524 Palmer, Ak 99645
745-2731
Address
zip Code
Lending Institution
Alaska Pacific Bank
Phone
Inspector
P. 0. Box 420 Anch Ak. 99501
276-3110
Address
zip Code
Inspector
Realty Co. & Agent
Totem Realty, /William J. Schlegel -
Phone
724@i& 15th Avenue 99501
272-0571
Address
zip Code
Legal Description
Lot;; 5.- Block 7 Thunderbird Heights
Thunderbidd Dr.
h'
Street Location
Type of Residence
V
W Single Family
4
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
^ Individuals
-
WELL LOG. A well log is required for all wells drilled
FForwells
since June 1975.
Community
2.Q L L- 020
drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
R Individual
Year Individual Installed: 1982
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
Soils Rating
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
orption Area
Time
Time
Time
Time`\
(
—1
S� "ICiLXj
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
'.
h'
V
( APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( L-rOISAPPROVED
(a -a
gvL
( ) CONDITIONAL APPROVAL' Q -� - U+.�
�
Rp�ryA1 ,I i/LILI
--
2.Q L L- 020
7(— "2-
_L
DATE
BY: -\yt
/
�' 011 lit
�%
qb Li� (0 -
�S
Soils Rating
Date Sewer Install
orption Area
Well Log Received
1
�'..' f
Well to Tank
Septic Tank Size
222023(382)
MUMUPAUTY DF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-581-10
1. GENERAL INFORMATION
Expiration Date: 5--t7-2u2_3
Complete legal description THUNDERBIRD HEIGHTS #3A BLOCK 7, LOT 5
Location (site address) 24344 THUNDERBIRD DRIVE, CHUGIAK, AK 99567
Current property owner(s) ADRIANA & STEPHAN HICKMAN Day phone
Mailing address
Real estate agent
24344 THUNDERBIRD DRIVE, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550 Waiver Fee $
Date of Payment. I Date of Payment
Receipt Number 50)225 Receipt Number
COSA # O.5 G -2- \ 128 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and 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.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/18/2021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to rClf _ ,�q�lt�
these various and dynamic characteristics and are outside the control of the evaluator of the i
well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • • • '1.9,��
for current or future occupants or guarantee that no unseen encroachments, deficiencies or _ J
discrepancies exist can be given by First Water Consulting & FWCS * • 9TH , , , , ;* r
6. DSD SIGNATURE :• Curtis Huffman e
System #1 Approved for Ybedrooms VIP. , CE 128991 PROFES ONP�'�,�����.�
�i ��r
System #2 Approved for bedrooms ���e�\\SS~`
Disapproved
Conditional approval for bedrooms, with the following stipulation `-lll(tcl(((((f��
WATE:R%N AD
�
m WASTt�-I ATE o
�"'Jim .. SER��G��;;'`.
B Original Certificate Date:_6 Z��y
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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: THUNDERBIRD HEIGHTS #3A BLOCK 7 LOT 5 Parcel ID: 051-581-10
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA — PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 12 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50"
® Standpipes/foundation cleanout per record drawing
Date of pumping 5/17/2021 -
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/12/2009
® ALL standpipes present per record drawing
Total measured depth from grade 11.3 ft (max)
Measured depth to pipe invert from grade 3_3 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 8' OF THE 8.5' ED
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 5/17/2021
Results M Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 14 in
Elapsed time <10 min
Final fluid depth 0 in
Absorption rate 600 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
FWE5
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'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields > 100'
Water Service Line > 10'
® Yes
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes
if No
ft
❑ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
*5+ ft
Surface Water > 100' ® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No _
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*PER CODE AT TIME OF INSTALL.
G. ENGINEER'S CERTIFICATION
l certify that l 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.
low
law
f 7H
' Curtis Huffman '
�� �'��, • CE 128991 .• i4�i
lti:°p oFEssioNP`��w
ft
ft
ft
ft
ft
ft
ft
ft
•
•
.-6- Municipality of Anchorage i<
On-Site Water and Wastewater Program Alia a .;
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-581-10 Expiration Date: G-2° —C 7
1. GENERAL INFORMATION
Complete legal description _THUNDERBIRD HEIGHTS #3A BLK 7 LT 5
Location (site address) _24344 THUNDERBIRD DR CHUGACH AK
Current Property owner(s) _ANTHONY CARTER Day phone
Mailing address _PSC 80 BOX 10491 APO AP 96367
Real Estate Agent Day phone
2. TYPE OF DWELLING: 3 G 5 6 78970 ,
® Single Family (w/wo ADU) >>
❑ Duplex , " .
❑ Multiple Dwellings (Single Family and/or Duplex) Q JUNc,
- . 3 y''.*
4 y Gini a
3. NUMBER OF BEDROOMS: 4 e g -�
AN ti
O0 4,
4. TYPE OF WATER SUPPLY: TYPE OF WAS ' - -"' DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ® Public Sewer ❑
WaiverNariance request for: Distance:
11.119111111111111014
AIRMIIIIIIIMINIMMInnmEmIll
Received by: /AV C Date: WZ/7/V
COSA to be released to the engineer, unless otherwise requested by the engineer.
124,6 h
ANINIIIIMEIMMIIIIMIIIIIIN
COSA Fee $ 5a-(.0 -I- 3156' 7.--, PLO bb Waiver Fee $
Date of Payment (n '2448 ck io510 1 Date of Payment
Receipt Number 0-3-(c(4 Receip l,urpber
COSA# ()SC[f 12x7 Waiver#
•
•
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and 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 MIKE N ANDERSON,P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 6/21/18
•
49jt-f "'N
497
y�A 4 0 0 0 0 0 30 J 00 030" , 0 0 0 O C P,
r.
6. DSD SIGNATURE
/' t.�z M:CHAE! N. A.ier.= . .:-':0.0System #1 Approved for Y bedrooms. CE c.%/169 :
tt?ter; ,
(1W/4,
System #2 Approved for bedrooms. . ::�� •
�':
Disapproved. '',
Conditional approval for bedrooms, with the following stipulations:
I
\\ OF
' ON-SITE cr\
WATER AND
IS)) WASTEWAI ER a
PROGRAM
0.0
Original Certificate t'at — — 16
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.1O.12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: THUNDERBIRD HEIGHTS #3A BLK 7 LT 5 Parcel ID: 051-581-10
A. WELL DATA
Well type If A, B, or C provide PWSID#211156 Well Log (Y/N)
Date completed Sanitary seal (YIN) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test _
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL /Si tc. Date installed 8-11-09
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N)Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 6-20-18 Pumper ALASKA QUALITY PUMPING
C. ABSORPTION FIELD DATA—1985 SYSTEM TESTED
Date installed 8.12.09 Soil rating (GPD/SWFT) 1.2 System type TRENCH
Length 30.5 ft. Width 3 ft. Gravel below pipe 8.5 ft.
Total depth 11 ft. Eff. absorption area 518 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8.19-18 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 13 in. Water added 600+ gal. new depth 20 in.
Elapsed Time: 1440 min. Final fluid depth 12 in. Absorption rate >=_600+_g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) N If yes. give date
•
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at in.High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 54 le- Property line 10'+ Absorption field 5'+
Water main 10'+ Water service line 25'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain (None Known) Wells on adjacent lots 200'+
F. COMMENTS
OF
AWWU WATER SERVICE 4.77 /.'":***
r (i.• • d
G. ENGINEER'S CERTIFICATION i • .49t ••. 111
111
I certify that 1 have determined through field inspections and f• = •• ...............
review of Municipal records that the above systems are in ��MICHAEL N. ANDERSON; ;r
conformance with MOA COSA guidelines in effect on this date. POay.• CE-9 q • ���
.419!4.0`y, �.•��-�
Engineer's Printed Name MIKE N. ANDERSON,PE �ti‘P`ES.S10-0�=
Date 6/21/2018
COSA canary sheet_2-6-15.doc
\ Municipality of Anchorage
1 Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Parcell.D.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051-581-10
1. GENERAL INFORMATION
ZD
COSA # D a Q 2 7 y
Expiration Date: $? -.2-
Complete
s2
Complete legal description Thunderbird Hts ft3A, Block 7, Lot 5
Location (site address) 24344 Thunderbird Drive
Current Property owner(s) Doug Herring Day phone 632-5291
Mailing address 24344 Thunderbird Drive
Lending agency Day phone
Mailing address
Cindy Wilson 694-6429
Real Estate Agent Day phone
Mailing Address RE/MAX of Eagle River
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
CF
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051-581-10
1. GENERAL INFORMATION
ZD
COSA # D a Q 2 7 y
Expiration Date: $? -.2-
Complete
s2
Complete legal description Thunderbird Hts ft3A, Block 7, Lot 5
Location (site address) 24344 Thunderbird Drive
Current Property owner(s) Doug Herring Day phone 632-5291
Mailing address 24344 Thunderbird Drive
Lending agency Day phone
Mailing address
Cindy Wilson 694-6429
Real Estate Agent Day phone
Mailing Address RE/MAX of Eagle River
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
Individual Holding Tank
❑
Community Class Well
Community On-site
❑
Public Water System 14vjwv�C]
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I 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 NorthRin Engineering Phone 694-7028
Address P.O. Box 770724
Engineer's Printed Name ste„ E g Date 2/1.3/0!D
Or Ak.1t,
5. DSD SIGNATURE
_L� Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: %� Original Certificate Date:
)ROV 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division =
On -Site Water & Wastewater Program '
4700 Elmore 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 Hts 43A, Block 7, Lot Pa5cel ID: 051-581-10
A. WELL DATA
Well type
Date completed
Total depth ft.
It A. B, or C provide PWSID # _
Sanitary seal (Y/N)_
Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L date of sample:
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
P� ft.
g.p.m.
Other bacteria colonies/100 mL
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/11/09
Tank size 1 ?50 gal. Number of Compartments _P Cleanouts (Y/N) Y
Foundation cleanout (Y /N) Y Depression over tank (YIN) N High water alarm'(Y/N) N
Date of pumping N/A Pumper New Tonk
C. ABSORPTION FIELD DATA
Date installed 8/12/09Soii ratio z x 1.2 Trench
g (g.p.d./ft or ft /bdmt) System type
Length 30.5 ft, Width 3 ft. Gravel below pipe 8.5 ft.
Total depth 11 ft. Eff, absorption area 518.52 Monitoring tube Y Depression over fieldN
Date of adequacy test N/A Results(Pass/Fail) New System For 4 bedrooms
Fluid depth in absorption field before test — In. Water added= gal. New deptF in.
Elapsed Time: =min. Final fluid depth = in. Absorption rate >= — g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N/A If yes, give date
D. LIFT STATION
NA
Date installed Size in gallons
'Pump on' level at _in. 'Pump off" level at_ in.
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 4
Absorption field on lot �P
Public sewer main tiV
v
Sewer /septic service line
Animal containment areas
Manhole/Access (YIN)
High water alarm level at in.
Meets alarm 8 circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 9' + Property line 10, + Absorption field S' +
Water main 1101+ Water service line ��5!_*Surface water
Wells on adjacent lots Pnn, +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 101+ Water main
Water Service line 10' + Surface water 100' + Driveway, parking/vehicle storage 10' +
Curtain drain NA Wells on adjacent lots 200' +
F. COMMENTS
G. ENGINEER'S CERTIFICATION ?,p : ••"'; •••., S,r ��
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 Steve Eng
Date
7/28/09
COSA Fee $5*6
Date of Payment C
Receipt Number DaSyDc
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
Lot 6
\ Lot 1
� 01.
,hSCD
H/
16.0' . 32.2'
OECK ky
.2_yrca•x -
Lot 5
34,431 e.f.
Lot 2
Lot 3
Lot 4
� 15' UTILITY EASEMENT/
------
NOTE. THIS LOT IS SERVED BY A COMMUNITY WATER SYSTEM.
PLOT PLAN _ AS BUILT X SCALE 1' - 40' GRID NW 1965 Project No. 09-150
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax o4OF A
Qop
kglanglsOalaska.nef / jclanglsOalaska.net �`� ..••••••-.�.qsp��
I hereby certify that I have surveyed the following described property. �^
Lot 5, Block 7. Thunderbird Heights Add. No. 3A (Plat No. 81-241) 49 U
Anchorage Recording District, Alaska, and that the Improvements situs ed thereon are �...:........ *o
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there an easements on sold property except as Indicated hereon. no roadways, transmission lines or other visible .it
Vi KENNETH G �riii
Q LS-5202,,�p
Dated this the 13'{` Day of AUC,_sr , 'Lcr�9, at Anchorage. Alaska �fD ''$?�1�A4••' ,�5
N Is the responsibility o1 the owner to determine the existence of any easements, 4O� aNAL,
covenants, or restrictions which do not appear on the recorded subdivision plat.
address or directions)
ier ' ` Rosa Walton
Day phone 563-3026
P.O. Box 671633
� maumg auuldSS
Day phone
_Gentling agency "
Mailing address `
Virginia Kohfield - ReMax Day phone
Agent" `
694-4200
Address
3
Unless otherwise requested, HAA will be heldforpickup.
z n
2.._ NUMBER OF BEDROOMS:
Ti m v
00
C�,-'
3: TYPE OF• WATER SUPPLY:
D,
C
Individual well _ .
�
Community well XXX
Q RX
i
Public water
i z
written from State ADEC attest,
NOTE: - - If community well system, provide confirmation
A,,
Ing to the legality and status of system.
/r i,
_ /
4. `.TYPE OF WASTEWATER DISPOSAL:
-:
XXX
Individual on-site "
Holding tank .
Community on-site
Public sewer,
"
system, written confirmation from State ADEC
NOTE: If community wastewater prowde
-" attesting to the legality and status of system.
_-- 72-M(Rw.1/91). Fmnt MOAM21
5. STATEMENT OF INSPECTION BY ENGINEER.:::,-
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority'Approval application `shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate.forthe 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 $ &'s Engineering Phone 594-2979
Address 17034 Eagle Rzvep hoop SuiteA204, Eagle River, AK 99577
Engineer's signature ::� L lam_ Date _
V1 -A 9 ROBERT C. COWAN ' 1
CE -8801
6. - DHHS SIGNATURE
✓ �4 �Zb a "''
.Approved' for �- bedrooms. -
Disapproved.
Conditional approval for
bedrooms,with the following stipulations:
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 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.
72.M(Rev.1/91) Beck MOA021
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "-r s- u4_ % TauAou-s," Parcel LD
A. Well Data
Well type _ r. If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump levell
SEPARATION DISTANCES FROM WELL TO:
Stic ' i
/h Idt k on lot ��`�
epo ng an
Absorption field on lot _
Public sewer main
Sewer service line
WATER SAMPLE
Coliform
Zoo k
B. SEPTIC/HOLDING TANK DATA
AT INSPECTION
M.
—:,06 adjacent lots
On adjacent lots
/blic sewer manhole/cleanout
Petroleum tank
Collected by:
C4
bacteria
Date installed - I`I - 8 2 Tank size 125-a Compartments Z
Cleanouts (,1N) Y Foundation cleanout ON)�/T Depression (Y/W- 1-1
High water alarm (YW r Alarm tested (Y/N)
`IDate of pumping I - 1 `l -9 S Pumper
SEPARATION DISTINCES FROM SEPTIC/HOLDING TANK TO:
Well(s) 0. —1 - � On adjacent lots 2• a ��
To property line /0 t Absorption field 3lo l
Surface water /drainage /(DO
1
Foundation
Water main/service line /o 14
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
oz
r-_
ti r
oe
<$
m�
Z
bacteria
Date installed - I`I - 8 2 Tank size 125-a Compartments Z
Cleanouts (,1N) Y Foundation cleanout ON)�/T Depression (Y/W- 1-1
High water alarm (YW r Alarm tested (Y/N)
`IDate of pumping I - 1 `l -9 S Pumper
SEPARATION DISTINCES FROM SEPTIC/HOLDING TANK TO:
Well(s) 0. —1 - � On adjacent lots 2• a ��
To property line /0 t Absorption field 3lo l
Surface water /drainage /(DO
1
Foundation
Water main/service line /o 14
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DIST
D. ABSORPTION FIELD DATA
LIFT STATION TO:
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
Cycles
"Pump off" Level
Surface water
Date installed 0-1 `1 - ? Z Soil rating (GPD/Ft2) (20 � System type
Length LWidth 3 , Gravel thickness S Total depth R S +
Total absorption area `t `l t7� Cleanout presentQN) Depression overfield(Y/91�)
Date of adequacy test 1 - lb -'115r Results/ ail) t'^� for `Y Bedrooms
Water level in absorption field before test 2 toII After test 3 S
Peroxide treatment (past 12 months) (Yo t� oh�r., 14-r o J a If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot_ a- On adjacent lots
To building foundation
On adjacent
to'-�"
Property line
To (existing or abandoned system on lot
Cutbank ``� Water main/service line
Surface water 1'06 kk Driveway, parking/vehicle storage area 3�
Curtain drain M A
E. ENGINEER'S CERTIFICATION
Ibt+
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect of this inspection.
Signature
Engineer's Name �ll'i1 A� C Co 1,/
J r< Dl. ROBERT C, COWAN
Date ldf '• CE - 8801
,.
HAA Fee $ tt;�/V • o/�O
Date of Payment
Receipt Number l0
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
e _ MUNICIPALITY OF ANCHORAGE
O 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. # n2)l -69 -\C HAA # 0
1. GENERAL INFORMATION
Complete legal description
Lot 5; Block 7; Thunderbird,Subdivision r1
Location (site address or directions) 24344 Thunderbird Dr; ce
4S
- = Property owner Patrick and Elizabeth McKinley Day phone—
-------- -Mailing address
--
Lending agency
Day phone
Mailing address
Agent Carolyn McPhee - RE/MAX OF EAGLE RIVER Day phone.' 694-4200,
Address 16600 Centerfield Drive Suite 200 Eagle River Alaska 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4 4
XXX
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 XXX
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.
]2-025(R.v. 1/91) Fmnt MOA 421
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 Phone
S S & ENGINEERING
Address 17034 Eacile River Loap Road No. 2e4
Eanle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
�� bedrooms.
Conditional approval for
Additional Comments
0
ItITIC
Date g-2L'I 1
bedrooms, with the following stipulations:
Date 9
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 theirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rw. 1191) Back MOA 021
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "-r Parcel LD.
-r->.'Ar.
A. WELL DATA
Well type A If A, B, or C, attach ADEC letter. ADEC water system number 7-015L-0
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Date completed
to Casing
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ton
Driller
Wires properly protected (Y/N)
AT INSPECTION
; On adjacent lots
�k
Absorption field on lot IC�C> ; On adjacent lots
Public sewer main
Public sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Z
W g
� N
0o
U w
Q
L.0
Q >
O h
00
g.p.m. ¢
4Tu
W
WZ
w
e -LI
Z
Zo
�8�
W
Date installed �' 1`1-�31� Tank size as Z-_> Compartments —
Cleanouts®N) Foundation cleanout/N) _� Depression (YQ
High water alarm (YA 14 Alarm tested (Y/N)
Date of pumping 8-1-1-91 r/e• LEsspooc.-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot Zo " (r On adjacent lots fy It— Foundation .5 -
2
To
To property line to' Absorptionfield 3Lo Water main/service tine io i+
Surface water/drainage
,b t �-
�L�ti� L(L/x��lL SPOtit_
-026 (Rev. 3/91))Rom
ont MOA onzi CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
Meets MOA electrical
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
SEPARATLON"DISTANCE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
—' "Pump off' level at
Cycles tested
Surface water .
Date installed ) CA — aZ Soil rating 12aP�� System type T2e ,lam
Length ' " 1 Width 3L." Gravel thickness 5 Total depth
Total absorption area 990 r Cleanouts present (PN) V
Depression over field (Y& J Date of adequacy test
Results as /fail) em 5 for r-C,V,2 61--) bedrooms
Peroxide treatment (past 12 months) (YG'N A:Wcl w,141 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO
lx�
` Y
riIA
to t,
Well on lot
On adjacent lots Property line
To building foundation
l 0 To existing or abandoned system on lot
�I1�
On adjacent lots
3d Y
Cutbank -11, Water main/service line
tt5t�
Surface water
loe> t`
Driveway, parking/vehicle storage area
3o t
�`pr
Curtain drain _
E. ENGINEER'S CERTIFICATION
1 certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S & 5 ENGINEERING
Signature 17034 Eagle River Loon Road No 204
Eagle River, Alaska 99577
Engineer's Name
Date
HAA Fee $ J /U , Waiver Fee: $
Date of Payment U �/'
Receipt Number 8D `� ` �W 30 ,�J 4
72-026 (Rev. 3/91)Back MOA21
Date of Payment
Receipt Number
WALTER J. HICKEL, GOVERNOR
0F USE
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: S & S Engineering
August 23, 1991
PWSID 211156
My review of the records on file in this office reveals that the Eklutna Thunderbird
Subdivision Class A Public Water System, is in compliance with the provisions of 18 AAC
80.060, State of Alaska Drinking Water Regulations.
Sincer ,
even K. Kleweno
Lead Engineer
Purred on recycled POM 5 y C.().