HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 7 LT 15Thund
rbird
Heights
lock 7
Lot I
051 - 581
-15
On-Site Wastewater Disposal System
OSP101203
05158115000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
Tax Code Number:
Work Type: Upgrade
Permit Effective Dates: September 24, 2010 to
Design Engineer: ANDERSON ENGINEERING
Subdivision: THUNDERBIRD HEIGHTS #3A
September 24, 2011
Site Legal Address: THUNDERBIRD HEIGHTS#3A BLK 7 LT 15 G:1865
Owner/Address: BREWER THOMAS B & FLORESTENE M
24327 THUNDERBIRD DRIVE CHUGIAK AK 995675127
Site Mailing Address: 24327 THUNDERBIRD DR, Chugiak
Permit
Lot Size in Sq Ft: 22423
Total Bedrooms: 4
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site 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. 051-581-15
Property owner(s) Thomas and Florestene Brewer
Mailing address 24327 Thunderbird Drive Chugiak, AK
Site address 24327 Thunderbird Drive Chugiak, AK
Day phone
Zip Code 99567
Zip Code 99567
Legal description (Sub'd., Block & Lot) Lot 15, Block 7, Thunderbird Heights No. 3A
Legal description (Township, Range & Section)
Lot Size 22,423 Sq. Ft. Number of Bedrooms Four (4)
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
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 owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
NEER NG
ANDERSON ENGI I
P,O, BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
September 16, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 15, Block 7, Thunderbird Heights Subdivision No. 3A
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The septic tank on Lot 15, Block 7, Thunderbird Heights Subdivision No. 3A is near
failure and must be replaced. We are proposing to replace the tank with a new 1,250-
gallon steel septic tank to serve the four-bedroom home on the lot. We are therefore
requesting a permit be issued for the construction of a new septic tank to serve the
home. The attached Site Plan and backup documentation identify the location and
configuration of the existing septic system and the location of the new tank. Also
identified on the plans is the existing water service on the lot. The subdivision is served
by a community water system. The existing tank on the lot will be properly disposed in
accordance with Municipal code. The drainage patterns on the property will be
maintained after construction.
The ground surface on the lot slopes to the southeast at a 1% grade in the area of the
new tank. The new septic tank will be constructed near the location of the existing
septic tank and tied in to the existing service line. The tank will be constructed parallel
with the contours of the land as much as possible in conformance with Municipal
requirements.
If the tank is constructed in accordance with our design the following statements apply:
o
The tank, if constructed as designed, will have no adverse impact on the wells in
the area or those to be constructed in the future.
The tank, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lot 15, Block 7, Thunderbird Heights No. 3A
September 16, 2010
Page 2 of 2
The tank, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The tank, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
THUNDERBIRD
LOT
HEIGHTS SUBDIVISION
15, BLOCK 7
22,423 S.F.
NO. 3A
\
\
\
Four
Bedroom
Home
Lof 9
z
Existing 50' Long x
3' Wide x 6' Effective "-~..
Depth Absorption
Trench.
Dispose of Existing Tank
In Accordance With
Municipal Code.
Place New 1,250 Gallon
Septic Tank, and 2 Post
Tank Cleanouts.
Lof 1 6
LEGEND
SV - Septic Vent
CO Clean Out
MT - Monitor Tube
FCO- Foundation Clean Out
[] - Existing
[] - Proposed
50.00
NOTE:
Subdivision Served by Community
Water System. No Conflicts with
Adjacent Septic Systems.
SITE
PLAN
SCALE 1" = 50'
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 15, BLOCK 7, THUNDERBIRD HEIGHTS SUBDIVISION NO. 3A
GENERAL:
The scope of this project includes the pumping, crushing and backfilling of
the existing septic tank on the property or disposing of the tank in accordance
with Municipal Code. Work also includes the procurement and placement of
a new 1,250-gallon septic tank at the location shown on the Site Plan. Work
also includes the placement of two new post tank cleanouts. The new
delivery line must then be tied into the existing outfall line to the absorption
trench. The new septic tank must be placed 10' from all water service lines in
the area and 100' from any surface water in the area. A minimum of 4' of
cover is required over the septic tank.
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.
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 Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 15, Block 7, Thunderbird Heights No. 3A
September 16, 2010
Page 2 of 3
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: - EXISTING ABSORPTION TRENCH TO REMAIN IN
SERVICE
1. The drainfield shall be constructed to.the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
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 ground must be perforated.
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.
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.
A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. All pockets of unacceptable materials must be removed and
replaced.
Lot 15, Block 7, Thunderbird Heights No. 3A
September 16, 2010
Page 3 of 3
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, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor or owner shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as-built of the completed
system.
/~'~ 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
MAILING ADDRESS
LEGAL DESCRIPTION
L
LOCATION
Well
Manufacturer (~(c~ ¢~___ '~' (~)Absorption area
Lq. capacty riga ons
IF HOMEMADE: Inside length
Dwelling ~
PHONE ~
/~z//~,~)S .~, :~ [] UPGRADE
Width -
PERMIT NO.
Liquid depth
PERMIT NO.
DISTANCE TO:
Manufacturer Liquid capacity in gallons
Foundation
DISTANCE TO: ~f]// ~ O
No. of lines Length of each line
Top of tile to finish grade · (
Length Width
Type of crib Crib diameter
Well
Materia]¢./O
Nearest lot line~
Trench width
~.~inches
DISTANCE TO:
Total length of lines
Materla] beneath~tile
Depth~
Crib depth
Building foundation
PERMIT O. ~
r~,~/11o
PERMIT NO.
Total effective absorption area
Nearest lot llne
Driller Distance to lot line PERMIT NO.
DISTANCE TO Building foundation Sewer line Septic tank Absorption area(s)
I OTHER
PiPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)~ ~
PERMIT NO.
RPPLICBNT GBR",'
LOCRTION
LEGBL L15B? THUNDERBIRD HTS
TYPE OF SOIL RC_-.~RFTI_N SYSTEM
MLif-4 [ ,]: I;~ "RL I T'~ OF Rf-4CF, .JRRGE
DEPBRTMENT OF HEBLTH BND ENVIRONMENTBL PROTECTION
825 "L' STREET., BNCHORBGE., BK. 9950t
~64-47~0
SEb~ER: PERfq I T
MRXIMUM NLMEER OF BEDROOMS
SRB BOX 61058~ 99645
LOT SIZE
TRENCH
99999'9 SQURRE FEET
SOlE RRTING (SQ FT,."BR)= 85
THE REQUIRED SIZE, OF THE SOIL RB_,ORFTtCN _~TEM IS:
[:'EPTH= '_lL e, L E t'-.i C-~ T' H = "-' '~--'
.==.~ ~-~ R Fi %.' E L
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR~INFIELD.
THE DEPTH OF B TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFACE OF THE
GROUND RND THE BOTTOM OF THE EXCRVBTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFBLL PIPE
8ND THE BOTTOM OF THE EXCRVRTION (IN FEET).
RE[:' SEF'T
F'ERMIT RF'PLICBNT HRS 'THE RE_,PuN_,IBILIT¢ TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THFIT THE WELL WILL SERVE.
,:: 2 :) I ~'-~5PEC:-T 'ir O~S R~:E REC-."L! I REC,
' - ..... ~"~ , '- ' F' -I
E, RuP:.FILLIN~.~ OF RNY _'r_TE£1 WITHOUT FINRL IN=,FE--TILN RND RPPROVRL BY THIS
"-II ' ' - ~
DEPRRTMENT WILL E:E =,~E, JECT TO PROSECIITIAN.
MINIMUM DISTRNCE BETWEEN R WELL 8ND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY BPPLY. SPECIFICRTIONS BND CONSTRUCTION DIRGRRMS 8RE
RVBILRBLE TO INSURE PROPER INSTRLLRTION.
F'EF-:f4 I T E.~-( P I ~:ES [)ECE~"IE:EF-: --?--'~., -]LL:~- :B2
I CERTIFY THRT
i: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH B~ THE MUNICIPRLIT9 OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH TME CODES.
~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MBY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
Russell Oyster
694'2774
O & E EN~.NEERING & DEVELO, ,~IENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Performed for:
Legal Description:
Depth (feet)
· Earl Ellis
SOIL LOG 668-2280
Name: ~-~77..--~--,~ L_. ~-~/~./j~.% 'J-~'" Tel. No.
Mailing Address: ~, ~ ~ ~&~' ~;
0
1
Soil Characteristics
5__
6__
7__
8__
9__
PLOT PLAN
14
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
No //'''' If yes, what depth
Drain Field
PERC. TEST
Performed by: Date:
PERH ]' 'f' ."J '"
FIF'PL i CF¢',t"F
L. 0 C R T Z 0 N
LEGRL
b,' -tH Nr,P'~,ETRD HT'.5
Lr"T _- ,. ~_E
:2.2E~EiE{ SL::iLIFiRE F:EET
TYPE 01::' _,L I .........
"FHE LENGTH DIMENSION I% ]'HE LENGTH (IN FEE7') OF :"HE "FRENC:H OR DRRiNFIELD.
]'HE DEPTH OF R TRENCH OR F'ZT IS THE D!STFtNCE BET!.4EE:N THE SURFFICE 0F :"HE
GROUND RND THE DO'TTOM OF THE EXCR',/RTION <IN FEET).
THERE !% NO SET kIIDTH F'OR TRENCFIES.
THE GRR',,,'EL DEF'TH ;[% THE MIN:[MUh'I DEPTH OF GRFP/EL 8ETHEEN THE OU]'FRLL PIPE:
RND THE E~OT'TOM OF' THE ENCRVRTZON (IN FEET).
PERHiT RPF'LIC~N]' HF!S THE RESPONgtS~L.!T'.F 'TO ZNF'ORH THIS DEPRRTMENT DURING THE
iN:i;TFflLLR"I'ION iNSPECTIONS OF RNY HELLS RDJRCENT TO ]"HZ'2; F'ROF'ER]~'¢ RND THE
NLff'!BER OF RES;ZDENE:E:% THF!T THE NELL HILL SERVE.
.... LK, .[ ..... ~.N._, OF F~,N'¢ ::,.~..-: ,,:.H P-.,'I]'HCIUT FiNP, L TN':%':'FK:T'P]f.~ Rf.,iE:, F, PPRu',,,'.,'--iL E?'¢
DEF'F!RTMENT Ni'LL EE SLiELYECT ]'0 PFT"?$EZUT_TEN.
Hi?.,!IHUH DI:STRNCE BETHEEN Fi HELL RN[:, RNb' ON-S!'TE fSEI.,.IRGE DISP05RL.. '.'S'?'S';"¢EH its
fl..EiE,~ FEET FOR F~ PRI'-.,,'R'FE NELL. OF<: :250 TC, 29E1 FEE]" FROM ..'::l PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC kIELL..
MINZMUM E:'ZSTFINCE FROH R F'RIVRTE HELL TO FI PRIVRTE SEHER L. ZNE IS 25 FEET FIND
TO F:i COMMUHZT'?' SEHER L. ZNE ZS 75 FEET.
OTNER REQUiREHENTS MR'¢ FIPPL'¢. SF'EC~FZCR'!'ZONS KiND CONSTRUC"FIOf.,I D!RGRRH'S RRE
RVRZLFIE4LE -to ZNSURE PROPER ZNSTRLLFIT!ON.
I C:ERTZF"r' THFCr'
1: ! FIN FF~HILi'FiR HiTH THE REQUIREfdEN¥'S FOR ON-SITE S;ENERS FIND NEI._.LS F~S SET
FORTH E~'¢ 'THE NUNICiPRLIT',:' OF' RNE:,'-4ORF~GE.
;2: ! P,~iI...L. IN~:T!~I._L. THE S'¢STEH If.,l RCCORDRNCE NiTH ]-HE C0[:,£S.
:;.:'.:: I UNDER:STFIND T.,'.4RT THE ON-L;ITE SEHER SYS',rE]"[ h'IF~? REQUIRE ENL.FIRGEHENT iff "FHE
RE'_'T..IDENCE IS; REHODEL. E[':, 'FO iNCLUDE MORE "f'FIFIN 4 DEDRC~OHS.
'-" .... -"' "-FIF'F
- ......................................................
Z S5;UED ............................... ~
V4. EI
O & E EN~'NEERING & DEVELG?MENT CO.
Box gO, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Depth (feet)
Soil Characteristics
0
1
2__
3__
5__
7__
8__
'-----~30
14
PLOT PLAN
PERC. TEST
15__
161
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit__
Comments:
No P' If yes, what depth
Drain Field
Performed by:
Date: */7/
.MAY- ~-97 FRI $:13 AM
GRUENING MIDDLH SCHOOL FAX
-i'He"R£BY CERTIFY .THAT I HAVE SURVEYED THZ
FOLLOWINe DESCRIBED PROPERTY, ~O~
~d~btr~ Eei~hts ~u~. ,Ad~.~o 3A,~lk, 7
~ ~ ~RNINE T~ ~lSTgN~ OF ANY
~1~ ~ NOT ~ ~ TH~ RE~ ~1-
:l"-30'
DATE'
8-26-90
1~ 1865
$~OCIATI~$ IA~ Sb~AVl~I~g 688'
WASH
• MUNICIPALITY OF ANCHORAGE �"
Development Services Department \• -/ Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
051-581-15 7-15- - 26?EParcel I.D. Expiration Date:
1. GENERAL INFORMATION
Complete legal description THUNDERBIRD HEIGHTS #3A BLK 7 LT 15
Location (site address) 24327 THUNDERBIRD DRIVE, CHUGIAK AK
Current property owner(s) THOMAS & FLORESTENE BREWER Day phone
Mailing address SAME
Real estate agent Day phone
,�� 12AM
2. TYPE OF DWELLING:
r pM
0 Single Family (w/wo ADU) c�
t.
❑ Duplex to ti
e cntfl
Ln
H Multiple Dwellings (Single Family and/or Duplex) 3c\s,... oti •
3. NUMBER OF BEDROOMS: 4 /4 y �,o&
WdZ1
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well ❑ Private Septic 0
Water Storage ❑ Holding Tank ❑
Community Well 0 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 $ 4 2,6 Waiver Fee $
Date of Payment 1115/t9 Date of Payment
Receipt Number &-f 10445 Receipt Number
COSA# 05C1(4/361e3 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE. ANCH AK 99516
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-3-19
q�q
" .\p1�•▪ OF s��,
6. DSD SIGNATUREoo
` � /
,C. System #1 Approved for bedrooms �'�•
..MICHAEL N. ANDERSON :ZIF
System #2 Approved for bedrooms Jr. • CE-94
tif
Disapproved 1��FD p• 7•• %IA.
k\ R FESM L4"�
Conditional approval for bedrooms, with the following stipulatlo�t�"
itik�C1PtAUTy0F r/.
041.
1.6%
7.11 474,
s�R�/CES�0\s���\\
By: _. Original Certificate Date: r " ( c^I 7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
•
COSA Checklist
Legal Description: THUNDERBIRD HEIGHTS #3A BLK 7 LT 15 Parcel ID: 051-581-15
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Well production at time of test gpm
Date drilled Water storage tank volume gallons
Total depth ft Well disinfected for coliform test? ❑ Yes ❑■ No
Cased to ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height(above ground) in. Collected by
Date of flow test for COSA Date of Sample
Static water level at beginning of test ft.
Comments CLASS A WELL
B. TANK DATA C. LIFT STATION
Age of tank(s) 9 years ❑ Required maintenance completed
Tank type/material STEEL Age of lift station years
Measured operating fluid level in septic tank 48 Lift station material
❑� Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 6/18/19
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1114/82 Adequacy test date 6118/19
❑■ ALL standpipes present per record drawing Results E Pass For 4 bedrooms
Total measured depth from grade 9.75 ft(max) Fluid depth prior to test 2 in
Measured depth to pipe invert from grade 3.75 ft(min) Water added 600+ gal
❑ N/A— pressurized field New depth 8 in
❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective
❑U Code-required soil cover over field Final fluid depth 2 in
Absorption rate 600+ gpd
❑ System presoaked UN
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑Yes if No ft ❑ Yes if No ft
Neighboring Tank > 100' ❑Yes if No ft Private Sewer/Septic Line > 25' E Yes if No ft
Absorption Field on Lot > 100' ❑Yes if No ft Holding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft
❑Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes if No ft ❑Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑✓ Yes if No ft Surface Water> 100' ❑✓ Yes if No ft
Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓❑ Yes if No ft
Water Main > 10' p Yes if No ft Community Wells > 200' ❑✓ Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' p Yes if No ft Private Wells > 100' 0 Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100' ✓❑ Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION �� OF At N
I certify that 1 have determined through field inspections and review o y41 AN; '4 f'94�
of Municipal records that the above systems are in conformance with :49TH �` •• ��
MOA COSA guidelines in effect on this date. 1....'�..• 4•00/�K . � F
ft
O. MICHAEL N. ANDERSON• :� 1#
`1gi'frF•'•.7E �t. 69..••.0.k•O�i
t!O pROFESS1Grk ''1:
aw
COSA Checklist yellow sheet ‘‘\�•��'•:.
THUNDERBIRD
,/ \ 0 lis
1-110,9. R-1Z0 00, EDGE OF ROAD
/ • . . • .
RETAINING' -�• S
WALL
APHALT'•
15' UTILITY EASEMENT oRIVEwAY•
r " .cb. o
-,> ,i, moo.
WOODEN FENCE I
I ` 14
e �^
I pOR
Cay \ \
29.6' ?os o 1 \
.' +.,
TRI-LEVEL \
.*.."s" RESIDENCE 9.&
L',J `O�s
10.2'x20.2' SHED '"`° M
'1?
,moi I 1.5'x16.3'—
N CANT '90/`°//
FCk q// 8,
N I 9,0. 3.
g '---SEPTIC ,.?.DEC•
Lot 9 I •
PIPES
g 1.0'x3.0' CANT
EDGE OF NEIGHBOR'S
Z IASPHALT DRIVEWAY
Lot 16
hs
hg
Lot 15
22,423 S.F. 4'
b)
h
co
CHAIN-UNK FENCE
'x_ N 89'59'00`W 50.00' NOTE: LOT IS SERVED BY A
COMMUNITY WATER SYSTEM.
Un subdivided
PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 1865 Project No. 19-230/R1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates inc .
(907) 522-6476 Phone o1•40p. ,._
(907) 522-4625 Fax :O F i ,
Professional Land Surveyors kenOlangsurvey.com v ,9
JonathanOlangsurvey.com 0'� s
I herebycertif that I have surveyed the followin described roe Qo�P �iN �O�
LOT 15, BLOCK 7, THUNDERBIRD HEIGHTS — ADDITION No. 3A (PLAT No. 81-264) �.. q gTH �� •*X0J Anchorage Recording District, Alaska, and that the Improvements situated thereon are
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 �'• ' ".KENNETH••• •• •G •
premises and that there are no roadways, transmission lines or other visible O�c' . oQ
easements on said property except as indicated hereon. Q '� ( it 4.1
.,At,
� �� L —5 02. �J�O
Dated this the Day of i, i', '_, at Anchorage, Alaska Qt� o �Oo
�QRO�SSIONA�\o
It is the responsibility of the owner to determine the existence of any easements, �44000��
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
-.-,.~,~/~ MUNICIPALITY OF ANCHORAGE ,-
'~':' (~,/ '; DEPARTMENT OF H~ALTH & HUMAN SERVICES
' , \~:-e.~.~.~.~.~.~.~.~/ i, Division of Environmental Se~ices
~,. · _ . ,~n~'~e~ces~ ~,.~ ,
Section
P.O. BOx 196650 Anchorage, Alaska .99519-6650
' ' 343-4744
, ~ . . CERTIFICATE OF HEALTH AUTHORITY
' : ~~ ~ ~- APPROVAL FOR A S NGLE FAM LY DWELLING
1, GENERAL INFORMATION
Complete legal description -lot
· . Location [site address or directions)
Proparty owner
24327 Thunderbird Drive
Chugiak, AK
Dale Seay Day phone 264-3015
C/o Seattle Mortgage 4300 "B" Street Anchorage, AK 99503
Attn: Jennifer Smith
Day phone
Mailing address
Lendihg'agency
Mailing address
AgEnt
Day phone
Address
Unless otherwise reqbested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Community well y, xx
Public water ' ·
RECEIVED
APR 1997
Municipality of Anchorage
Dept, Health & Human Services
NOTE: If community well system, provide written confirmation from State ADEC attest-
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank~ -
ing to the legality and status of system.
xxx
Community on-sit
Pubhcsewer . .
NOTE: ', 'If community wastew'ate~' ~YStem; brOvide w?iiten "f! mati6h fr°m State ADEC
attesting to the legality and status of system.
STATEMENT. OF INSPECTION BY ENGINEER.
As certified Dy 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 safs, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
s & $ ENGINEERING
Name of Firm 17034 Eagle River Loop Road No. 204 Phone (~
Eagle River, Alaska 99577
Address
Engineer's signature ~¢ ~J~/Z, ~-V,,~ Date
DHHS SIGNATURE
Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certific¢,tes based only upon the representations given in paragraph 5 above by an irldependent
professional enCiPher registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending i~stitutions in order to satisfy certain federal and state req uirements. Employees of DNHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
reeponsible for errors or omissions in the professional engineer's work.
7~25(Rev, 1/91) Beck MOA#2"
MUNICIP,ALiTY OJ= ANCHO~G~'
ENVIRONMENTAL SERVICES DIVI~IO~
of Anchorage APR 3 0
Municipality
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division 43J~..~7~4~ l ~V'. E
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3
Health Authority Approval Checklist
Legal Description: Z~'r ~ ~,l~.k '-'~'., I~."'~er~t~j 1'~¢~!4~5 H~,/[Parce] I.D.: 0
A. WELL DATA
Welltype C!c~ .~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
// If A, B, or C, attach ADEC letter. ADEC water system number
Date of test
Static water level
Well production
/Date of sample:
Date completed ~
Cased to __ Casing height (ab~~
Wires properly~ted (Y/N)
/ i,/,UNJC~PALtTY OF ANCHORAge:
FRoM WELL LOG ~ iNSPECTiI~iRONMENTAL SERVICES DiVISiON
05 1997
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout {~)
RECE"'"
IvLD
g.p.m.
Date of Pumping ~//~ '~ ?
C. ABSORPTION FIELD DATA
Date installed Jl/0o ~
Nitrate Other bacteria
Collected by:.
Tanksize I~O Number of Compartments ~ C,~anouts~)~-~
ii/¢ ~' Depression (Y.~) /(-~O High water alarm (Y/N) .~/~
Pumper ~""~,
~ ,..j
bedrooms
Soil rating (g.p.d./fF ~
~J"~ / System type
Length '-~' Width '~o'~
Gravel thickness below pipe /--__-_-_0 ~
Total depth. ~ ~'~ /
Effective absorption area ~ '~ Monitoring Tube present (~) ?,'5 Depression over field (Y/N~.
Date of adequacy test ~-.2/~ ~' ? Results (~ail) P~.$$ For
Fluid depth in absorption field before test (in.); _~ Immediately after ~Z)gal. water added (in.):
Fluid depth t~/~ (ins) Minutes later: · ~'~,*IM Absorption rate = ~' g.p.d.
Peroxide treatment (past 12 months) (Y/N) /~4¢ ~Ou)~ If yes, give date /f//.4I
72-026 (Rev. 3/96)* r : . : ' : : : ~ '
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High wa~'~'~ *Datum
..~y~ested
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~' ~ '~' Property line /O ' +' Absorption field
Water main/service line
~On adjacent lots
Public sewer manhole/cleanout
Lift station
Surface water/drainage 200 ~/' Wells on adjacent lots
200'%
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ' ,~' Building foundation 1(9 4' Water main/service line / (J ' +
Sudace water r~OO~ ~ Driveway, parking/vehicle storage area ~'O '
Curtain drain -'~Ae ~','to~,a~ Wells on adjacent lots TOO ' '/-
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
Date 7
HAA Fee $_ [~'~ , ~
Date of Payment '-~-~/~- & ~t/~b,~ ~
Receipt Number ~'(~'~ L~-~'~/
72-026 (Rev. 3/96)*
Waiver Fee $ '7/,~~' ~ ~
Date. of Payment ~/'~-/,/~ ./~Z.
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
ENGINEERINGSTUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAI*&
MECHANICAL
INSPECTIONS
May 2, 1997
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
Request you issue a Health Authority Approval on the referenced
property and grant a waiver for the horizontal separation distance
between the leachfield and the property line at five (5) feet.
We do not anticipate any adverse effect on the adjacent properties.
The neighboring property's septic system is 25 feet away.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
~NCLOSURE
J~UHICIPAL[TY OF ANCHORAGE
ENVIRONMENTAL SSRViCE$ DIVISION
05 1997
RECEIVED
17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577
Parcel I.D. #
~ MUNICIPALITY OF ANCHORAGE ~
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744. - : , ,: ,..
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ·
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, bio?k, subdivision, section, township, range)
Thunderbird Hts. Lot 15 Blk 7 T16N RZW Sec. 25
Location (address or directions)
24327 Thunderbird Dr.
(b)
Property owner
Mailing Address
HUD Homes Telephone: (home)
222 W. 8'b.k Ave. Anchorage, AK 99513
Business 271-4342
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate company and Agent N/A
Address
Telephone
(e)
Mail the HAA to the following address: (or check here ~, if hold for pick U~).)
List
contact
and
day phone number below: !:... .
person
Engineer
2. TYPE OF RESIDENCE
Single-Family I~ Number of bedrooms 4 '~
3. WATER SUPPLY
Individual Well [] Community E~ Public []
: Note,:. If community well system, must have.written.confirmatio[~ from..the State Departme~tof Environmental
.:: Nole f commun ty. We system, muSt have written confirmation from the State Department of Environmental
~ c0ns~P/ati0n attesting to the' legality and'statu~:
72-025(Rev. 7/88) Page 1 of 2 '
')JJOM 8,Jaau!l~ue iBuoJssaJoJd eqJ u!
suomm~o JO sJoJJe JoJ alq!suodseJ lou s! ~)beJoqouv Jo XHled]o!u nl/~ eq.L 'pens$! s! al~o!J!lJeo e eJojaq ejep ezXjeue Jo
suoi~o~dsuj lonpuoo ~ou op SHHO 1o seeXoldLU3 'slueLueJlnba~ el~s pu~ I~JapeJ u!~lJeo XJsli~s o~ JepJo u! suo!in~,llsuj
6ulpuel JleqJ pue SeLUOq ~0 sJes~qoJnd ol XselJnoo e s~ s!ql seop SHHC3 sqJ. 'mts~lV ~o elelS eq~, u! peJels!~eJ
JeeUi§Ue IeUO!SSejoJd ~,uepuedepu! ue/,q eAoqe S qdeJl~e~ed u! ue^lD suo!le~ueseJdeJ eql uodn ,{lUO pes~q
le^o~ddv ,~lpoq~,nv qlieeH senss! (SHHC]) seo!AJeS UgLUnH pU~ q~l~eH ~o ~,ueLupedec] eb~Joqou¥ j.o/qll~d!o!u nl~ eq.L
leUO!l!puoo
· LL§66
~'6'~ELL xo~] 'O'ct sseJppv
We~ assification
Well Log Present (Y/N)
Total Depth. Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description:
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ,,/~""~ Size /~::~ No. of Compartments
Standpipes (Y/N) Y Air-tight Caps (Y/N) ,)/ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /~' Date Last Pumped
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) "//'¢
; for .~'/4-
Temporary Holding Tank Permit (Y/N) "¢/'¢
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ¢-"~¢
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation: "~
To Disposal Field ':'~- ~
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area _'3
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ¢'~_~O
To Building Foundation /' ~
Lot /- ''~ /
To Water Main/Service Line ~"/~ /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ~,¢"
Depth of Field ~'" / '
Gravel Bed Thickness ¢¢ /
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Y
To Property Line '~ /
To Existing or Abandoned System on
; On Adjoining Lots ¢' .~,¢ /
To Cutback (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at __
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guideline8 in ~ffe~t on the date of this
, o~,~,.,,,~.,n ~,,,,,-*,,-,,. ~ .. ....
Signed ~, .,. ,.~
Eagle River Engln0erlng Services
Company P.~. 5ux i~3294
Date Eagle River. AK 99577
6~l~5'r9u
MOA No. ,~-,,b_¢
e~eip, No,
ate of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
........................ :Engineer s Seal
Eagle River Engineering Services
A 11940 Business alvd, Suite #205
P.O. Box 773294
Eagle River, Ak. 99577
694-5195
Fax 694-5297
Leg al:
Owner: /-/~ Date: ~/~ ~/~
Type of test:
[] Well Flow Test ~' Septic Test Only [] Well & Septic Test [] Other:
Meter Monitor Well Tank GPM PSi Remarks'
Time Reading Level Level Level
.~;~ ~.~.... .J2~/t~ ~"' .,~'/.~ ~-~u/' .¢, F ~/~ ~ ~
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OPFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
August 22, 1990
STEVE COWPER, GOVERNOR
563-6775
FOR: Eagle River Engineering
PWSID: ~211156
According to the records on file in this office, the Eklutna
Thunderbird Heiqhts Lot 15. Block 7 Water System is in compliance
with the State of Alaska Drinking Water Regulations.
S~ety, ~st
VERA E. CRAIG
Environmental
VEC:pf
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVA ,1~ ~-)_
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date ~ "~...O ~¢7
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
(b)
Location (address or directions)
Applicant Name ~,.~u~'~¢ ~ ~-- J~bCT, Telephone: Home
Business
Applicant Address
(c) Applicant is (check one): Lending Institution ~,; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address (,~ L.~'.~
(e) Real Estate Company and Agent
Address
Telephone t~¢ ~1 ~ ~ L.~ '~0 ~.~
(f)
Mail the HAA to the following address:
5 & E ENGINEERING
~agJe River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family {~ Multi-Fam?~y [] Other
Number of Bedrooms
WATER SUPPLY k
Individual Well [] Community~ Public []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ~ Public [] Community [] Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDI~NSPECTIONS, TESTS, FILE SEARCH, D~'~'-'~ AND INFORMATION
A~ certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fun~;tional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm S & $ ~,~;CI~-~EER!HG Telephone ~ ~'/--~'~-~ ~'7~'
Address 17034 Eagle River Lcx:~p Road No. 204
Eagle River, Alaska 99577 ~ - ~_..~ .-- ~ ~
Date
DHEP APPROVAL
Approved ¢4 bedrooms
Approved. ~ Disapproved Gonditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
LITY OF ANCHORA
MuNiCIP^ ..... ..C~..~LTH AUTHORITY APPROVAL (HAA)
ENTAL SERVIC~:~
ENVIRONM CHECKLIST- FEBRUARY 1984
MAR 3 1 198'/
WEL' DATA RECEIVED
Well Classification
264-4720
Legal Description,' J~,-.'T /~ ~L.../,(. /'~
If A, B, C, D.E.C. Approvedl~)
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ,'~ ~C-~/
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
CleanouEManhole
Water sample Collected by
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
~.o~" ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Water Sample T%Results
Comments ~".z',./~.~ ./~ ~ ~-I I/~'~o
SEPTIC/HOLDING TANK DATA
Date Installed //-
Standpipes(~N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N) I /'-4[ J~r ;for
Holding Tank High-Water Alarm (Y/N) ~/'~)~ TemPorary Holding Tank Permit (Y/N)
Size /~5'C) No. of Compartments ~-~
Air-tight Caps~N) Foundation Cleanout~N)
Date Last Pumped -:~ -~- -7 -'~'~ '~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course '"'"'/[ ,~'
To Building Foundation /o~
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(1~/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ,//- ~ ~
Width of Field
Square Feet of Absorption Area _
Depression over Field (Y~
Results of Last Adequacy Test ~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway. Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present ~/N)
Date of Last Adequacy Test
To Properly Line
To Existing or Abandoned System on
; On Adjoining Lots ,~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
,Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** 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.
$ & $ ENG NEERING
Sj~0a~ Eaglc P.[¥er~, .cc~ R~ Date~ ~ ~ ~
Receipt No. ~ ~O ~ /--¢O~ d
Date of Payment ~ "- ~ /~ 7
oo
Amount: $ /~ O
Page 2 of 2
72-026 (11/84)
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA ggs01
~I'EVE COWPEP~ GoV£RNOR
Telephone: (907)
Address:
274-2533
DATE: 3-23-87
PWS I.D.#
211156
To Whom it May Concern:
According to records on file in this office the
HEIGHTS
Water Regulations
EKLUTNA THUNDERBIRD
Water System is in compliance with the State Drinking
Sincerely,
Michael P. Lewis
Environmental Engineer
APPLI¢ NT FILLS OUT UPPER HA[ " ONLY
Property Owne~ Go S. K. Const~mztion
Mailing Address ~'~. BO3~ 610~ - A3 P~lm~. A~ ZIpCode 99545 745-2553
Buyer R~ggie'~and Donna Gould
Address no address kno~ Zip Code
Phone
Lendinglnstitution Alaska Pacific Bank - Mortgage Loan Dept
'~ P.O. Box 420 zip oode 995'i'~ ............ 276-3110
Address
Realty C°' & A~nt Totem Realty,Inc."'///J~/~ . ...f~yc,.) ~ ,~t.([r&g/~',~- /' Phone
William
SchA~gel
272-0571
Address 724 E. 15th Avenue Anahnr~g~ A~ ZlpCode
Legal Descript~n ~W ~
t0tgl5, Block 7 Thunderbird Heights
Street Locati~ ~underbird Drive
Type of Resi~nce
~ Single Family ·
~ Multiple Family No. of Bedroo~ 4
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed: 1982
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Tirre T i m/~(~, ~__C~,~. _~.. ~__
Date Date Cate Date
Inspector Insp~tor Insp~tor Insp~tor
Field Notes:
( ) CONDITIONAL APPROVAL'.
DATE ~ - /~ / ~ ~
~ //--~ ~ Well to Tank Septic T~k Size
January 6, 1983
G.S.K. Construction
SRA Box 6105 - A3
Palmer, AK 99645
Subject: Lot g 15 Block 7 Thunderbird Ileights
Approval for the individual se%~er and water facilities cannot
be granted until the following items have been completed:
The depression over tile newer system will need to be filled
~o//so that snrface water drains a~.~ay from the .... ~ system.
Please notify this Department for a reinspection %.~hen the
noted discrepancies have been corrected. If there are any
further questions~ please call this office at 264-4720.
olncerely,
/_/~im S. Roberts
-- opeclallot
~/ associate Environmental o ' 'o_
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