HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 7 LT 18Thunderbird
Heights #3A
Lot 18
Block 7
#051-581-12
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:Hwww.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211487
Work Type: SepticTank Renewal
Effective Date:
Expiration Date
Tax Code Number: 05158112000
Site Legal Address: THUNDERBIRD HEIGHTS #3A BLK 7 LT 18 G:1865
Site Mailing Address: 24419 THUNDERBIRD DR, Chugiak
Owner: BANNISTER TYLER C
Design Engineer: ARC TERRA CONSULTING INC
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
`ill nr
i�
1)eparrment
12/3/2021
12/3/2022
Lot Size in Sq Ft: 21225
Total Bedrooms: 3
❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:Date: %a
Issued By: Date:
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 051-581-12
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Property owner(s) Tyler C. Bannister
Mailing address 24419 Thunderbird DR, Chugiak AK 99567
Site address 24419 Thunderbird DR, Chugiak AK 99567
Day phone
Legal description (Sub'd., Block & Lot) Thunderbird Hights #3A Block 7 Lot 18
Legal description (Township, Range & Section)
Lot Size 21225 Sq. Ft. Number of Bedrooms 3
Phone: 907-343-7904
Fax: 907-343-7997
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) Q
(w/wo ADU)
Septic Tank
ElUpgrade
0
Duplex (D) ElHolding
Tank
❑
Renewal Q
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: -
Date of Payment: i 9 Z3 -2 621
Receipt Number: 06 CM 7 G
Permit No. 05P 2-1 1 H 87
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
o� �+RCTERRq e -
e
R�bfNSUL7I NG • ye4
December 1, 2021
CONSULTING, INC
20441 Ptarmigan Bld, Eagle River, AK 99577
Office (907) 696-6111, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: OSP201465 Permit RENEWAL— Thunderbird Hts. #3 Blk 7 Lot 18
The owner has requested we proceed forward to obtain a renewal permit to
upgrade the aged STEP septic tank on the subject lot. The proposed upgrade will
serve the existing 3 -bedroom house. The existing perameters on site have not
changed from the original application and permit.
The adjacent lots are all served by public water with no wells within 200 feet. There
is no surface water within 100' of the proposed tank. We do not expect there to be
any adverse effect on adjacent lots by the development of this tank. It you have
any questions, please contact me at 696-6111 /FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kenneth M. fus, P.E.
Attachments: On -Site Sewer Application
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201465
Work Type: SepticTank Renewal
Effective Date
Expiration Date:
Tax Code Number: 05158112000
Site Legal Address: THUNDERBIRD HEIGHTS #3A BLK 7 LT 18 G:1865
Site Mailing Address: 24419 THUNDERBIRD DR, Chugiak
Owner: BANNISTER TYLER C
Design Engineer: ARC TERRA CONSULTING INC
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
mcnr
Department
10/30/2020
10/30/2021
Lot Size in Sq Ft: 21225
Total Bedrooms: 3
❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By: C&" C&XX'UU
Date:
Date: �b 02
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-581-12
Property owner(s) Chase Bannister Day phone
Mailing address 24419 Thunderbird Dr, Chugiak, AK 99567
Site address 24419 Thunderbird Dr, Chugiak, AK 99567
Legal description (Sub'd., Block & Lot) Thunderbird Heights #3A Block 7 Lot 18
Legal description (Township, Range & Section)
Lot Size 21225 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
Septic Tank
F�
Upgrade ❑
(w/wo ADU)
Holding Tank
❑
Renewal �
Duplex (D)
El
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Dea Duffus
(Signature of property owner or authorized agent)
Permit/Rush Fees:.t 1 ug"7 5 (Coqib-11) Waiver Fees:
Date of Payment: 10/301,2 Oa 0
Receipt Number: 0 70 5 Mj_
Permit No. 0 3 P2 61 L4(0 5
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
MUNICIPALITY OF ANCHORAGE
,„0,,„f7}.._.-� of .,cent
%,. • \ On-Site Water&Wastewater Program . S ;
PO Box 196650 4700 Elmore Road = `�
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 n
http:/Iwww.muni.org/onsite ..
1 epartment
9NCNOR�VE
On-Site Wastewater Disposal System Permit
Permit Number: OSP191488 Effective Date: 10/31/2019
Work Type: SepticTank Upgrade Expiration Date: 10/30/2020
Tax Code Number: 05158112000
Site Legal Address: THUNDERBIRD HEIGHTS #3A BLK 7 LT 18 G:1865
Site Mailing Address: 24419 THUNDERBIRD DR, Chugiak
Owner: BANNISTER TYLER C Lot Size in Sq Ft: 21225
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Ad / l ,� Date:
Issued By: ,el t eC ar.A. 11 Date: /O '7
MUNICIPALITY OF AN amu - E
Development Services Department �• ` HQ / °- OCT 2 y Z019 g one: 907-343-7904
p
On-Site Water & Wastewater Section � Fax: 907-343-7997
c
��0168t
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D.
051-581-12
Chase Bannister. Dayphone
Property owner(s)
Mailing address
24419 Thunderbird DR, Chugiak AK 99567
Site address 24419 Thunderbird DR, Chugiak AK 99567
Legal description (Sub'd., Block & Lot)
Thunderbird Rights #3A Block 7 Lot 18
Legal description (Township, Range & Section)
21225
Lot Size Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field I I Initial Single Family (SF) x
(w/wo ADU)
Septic Tank IxI Upgrade
Duplex (D)
Holding Tank ❑ Renewal I I
Multiple Dwellings I I
Privy ❑ (SF and/or D)
Private Well I I
Water Storage I I
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: ( 5 Waiver Fees:
Date of Payment: 1 UI aQ ` (9 Date of Payment:
Receipt Number: p„ 1-1(41-1q2 Receipt Number:
Permit No. (_)5e`" Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
�RCTE Req
•
ARcT>,;><zRA
4 ? CONSULTING, INC
' 0 ;e 20441 Ptarmigan Bid, Eagle River,AK 99577
;f9 �. 1 Office(907)696-6111, Fax(907)868-3793
fQvsulrl NG•`�l�
.077-
October 29, 2019
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
0s A BGS 7
Subject: Septic Tank Upgrade Permit-94 — SCr
R-3 E '5 of 126- �f /�
The owner has requested we proceed forward to obtain a septic permit to
upgrade the aged STEP septic tank on the subject lot. The proposed upgrade will
serve the existing 3-bedroom house.
The adjacent lots are all served by public water with no wells within 200 feet.
There is no surface water within 100' of the proposed tank. We do not expect
there to be any adverse effect on adjacent lots by the development of this tank. If
you have any questions, please contact me at 696-6111/FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
/ I
efOir
Ke - . Duffus, P.E.
Attachments: On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
THUNDERBIRD NIGHTS #3A BLOCK 7 LOT 18
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WELL RADII & EASEMENTS PAGE 1 OF 2
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PRIOR TO CONSTRUCTION
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z NOTES:
P.
1, INSTALL 1250 (OR 1500) GAL. STEP TANK & INSULATE TANK IF <4' COVER.
P. 2. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK.
3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
NO PUBLIC WELLS WITHIN 200' OF WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
o PROPOSED SYSTEM. 4. WELL LOCATIONS DEPICTED ARE APPROXIMATE ONLY. CONTRACTOR
a NO PRIVATE WELLS WITHIN 100' OF IS REQUIRED TO VERIFY SEPERATION DISTANCES PRIOR TO
PROPOSED SYSTEM EXCEPT AS NOTED. COMMENCING WORK.
✓ NO SEPTIC SYSTEMS WITHIN 100' OF
CO PROPOSED WELL EXCEPT AS NOTED.
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opo -,1i 24419 THUNDERBIRD DR. �+
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r, / - 469-407-23724/011‘6
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FIELD BOOKS COMPUTED: ; x
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1% ti$ - STAKING: N/A CHECKED: KMD / ''ti;7
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ACAD FILE: FILE ''OB No.: 19-065 R, AK.99577'
WASTEWATER DISP❑SAL SYSTEM DETAILS
THUNDERBIRD HIGHTS #3A BLOCK 7 LOT 18
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10)/3 0 Sn l) STEP TANK
AND CONNECT TO
DIVERTER),S\
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_ PRIOR TEl CONSTRUCTION scale: 1'= 30'
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• AW�� '1' 1 CHASE BANNISTER AR RRq
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ACAD FILE: FILE 'IDB No.: 19-065 1,f% AK. 99577• 6
Municipality of Anchorage P~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska gg51g-6650 · Telephone: 343-4744
On-Sile Waslewater DiSposal Syslem and/or Well Inspection Report
Permit Number: 16 PlO Number:
O~1~ Waslewaler Syslem: B New ~Upgrade
A r
dd ess'
~1~ T~.~[J);r~ ~r;Vg ~;~,~ ~7 ABSORPTION FIELD
Phone: {NC. Of B~droom~:~ ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ OIher
Numberofli~: lDislancebel enlines:
~,. r,. TANK
SEPARATION DISTANCES u Seplic ~ Holding ~.T.E.P.
From Tank Field Slat,o. Ta.R Sewer Lines ~ ~
Water ~t~_ ~00~ ~(.~- LIFT STATION
Lot
Line a~ ~' 30' Sl~e in gallons: {Manufacturer:
Remarks: BENCH MARK
'Z"
· i
17034 ?glo Ri~r Loop Road, No. 2~ ~._~ {_ ~
inspections performed by ~,- m..... ~..~ ~s77 Dates: 1st
Deparlmenl ol Heallh and Human ~erwces approva~
'~"' ~"ST' ' ~'~
Reviewed and approved by: ~ ate: ~-
PERMIT NO. SWO0001 6 PAGE 2 OF 3
DEPARTMENT OF HEA~:TH SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 196650 OAnchorage, Ataska 99519 6650 O Tetephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL [NSPECTION REPORT
LEGAL LOT 18, BLOCK 7, THUNDERBIRD HEIGHTS #$A~.I.D. NO. 051-581-12
/
/
/
/
LOT 1 9A
VC1 (VALV[ CASING)
SCALE: 1" = 40'
NEW TRENCHES
EXISTING
SYSTEM
ROBERT C. COWAN
CE-8801
PERMIT NO SW000016 PAGE 3 OF 3
Municip. oJ, it, oF anchor'o, qe
DEPARTHENT OF HEALTHAND HUMAN SERVICES
ENVIRONHENTAL SERVICES DIVISION
P.O. Box 196650 OAnchop~ge, /~[aska 99519 6650®Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT
LEGAL LOT 18, BLOCK 7, THUNDERBIRD HEIGHTS #3A°.I-D. NO. 051-581-12
FINAL GRADE MH /-2" INSULATION
~:::::::z::::::::~ A B C
EXISTING 1250 FCO 14.0' 28.5' -
"96.2' ST1 12.5' 51.5' -
GALLON S.T.E.P. ST2 10.0' 58.0' -
sYSTEM ¢Cll9.0' 42.0" -
¢C2 10.0' 43.0' -
vlH 9.8' 39.5' -
~vlT1 56.5' - 137.0'
vlT2 31.5' - 34.0'
MT4- MT3 vlT3 67.5' - 51.0'
'1 [ /-MT3=103.4' MT2 MT1 dT4 48.5' - 48.5'
MT4=104.5'~. !/MT2=IO4.e'~GRADE r
~ ~FINAL %,/-~/MI1=103.9'
ia" INSULATIONx,,~ '
' ~DISTRIBUTION PIPE-
lO0.O'J ~ I ~ i~100'2'
MT2=98.2' - '
PRESSURE DISTRIBUTION SYSTEM:~......t~.
-¢4%" /,%'"',,".~'~-
I ~ ;~ ROBERT C, COWAN
'~,~,",, ca-88o~ /.4:'.~
'~, ~2 · .... ~.,~
PUMP = 20 0SI 05HH - 5 STAGE (~30 GPM)
2 LATERALS ", 40' LONG EACH
15 HOLES/LATERAL (2.5' O.C.) = 30 HOLES TOTAL
3/16"¢ HOLES FACED DOWNWARD
1 1/4"¢ LATERALS
A
NO WATER FOUND
90.0' B.O.H.
A B C
FCO 14.0' 28.5 -
ST1 12.5' 51.5' -
ST2 10.0' 58.0' -
¢C1 9.0' 42.0" _
¢C2 10.0' 43.0' -
vlH 9.8' 39.5' -
vlT1 56.5' - 137.0'
vlT2 31.5' - 34.0'
vlT3 67.5' - 51.0'
dT4 48.5' - 48.5'
ROBERTC. COWAN, RE.
ROBERT A. SHAFER, RE.
Date:
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-12'J 1
SEWER&WATER
INSPECTION
WEI.L INSPECTION
& FLOWTEST
ROAD OES[GN
SOILTEST
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
~nchorage, Alaska 99519-6650
The septic inspections for the referenced property w~re
performed on ~7~[7'-~ and ~'-[~'-~ . Prior to submitting
the On-site Wastewat~ Disposal Syste~and/9~.Well Inspection
Report we are waiting for the ~$~6~/[~5~£~ to be
completed.
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP . SUITE 204 ° EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORA GE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Feb 15, 2000
Expiration Date: Feb 14, 2001
Permit Number: SW000016
Legal Description: THUNDERBIRD HEIGHTS #3A BLK 7 LT 18
Design Engineer: 0003 S & S Engineering
Owner Name: Jay Goodie
Owner Address: 24419 Thunderbird Dr.
Chugiak, AK 99567-5127
Parcel ID: 051-581-12
Site Address: 024419 THUNDERBIRD DR
Lot Size: 21225 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank L~ Privy
[] Private Well
[] 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Net 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 By: ~L'/~ ~'~ Date:
ROBERT C. COWAN, P.E.
February 8, 2000
CIVIL EFIGIN1EE[t.~
(907) 694-2979
FAX (907) 694-121
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 18, Block 7, Thunderbird Heights 3A
It is requested that you issue a permit to install a septic system upgrade to serve the
existing three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate
location of the test hole is located on the attached site plan. At the time of excavation
2-4-00, no water was found. After seven days of ground water monitoring, no water was
found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
17034 NORTH F~GLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,/'fL
1
2
3
4
5
6
7
8
9
10
11
12
13-
14L
15-
16-
17-
18-
19
2O
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? N 0
IF YES, AT WHAT ~-
DEPTH? OAt./// pO
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
S & S ENGINEERIN~'/'//'
I,' ~.,'~ ~--~ ......... . CERTIFY THAT THIS ~ ST WAS PERFORMED IN
(Rev, 4/85) .
ROBERr C. COWAN, P.E.
CIVIL ENGINEERS
(g07) 694-2979
FAX (g07) 694-12! !
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 18, Block 7, Thunderbird Heights 3A
February 8, 2000
GENERAL:
The scope of this project includes the verification of a 1250 gallon S.T.E.P.
system and installation of an upgrade leachfield trench for the existing three
bedroom house located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page 2
Lot 18, Black 7, Thunderbird Heights 3A
February 8, 2000
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 fl. fi:om the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the d'anensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot 18, Block 7, Thunderbird Heights 3A
February 8, 2000
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt banSer (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current MOA or ADEC requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
· Page 4
Lot 18, Block 7, Thunderbird Heights 3A
February 8, 2000
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct
or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached MOA permit. There will be no contractual
arrangement existing between the contractor and S & S Engineehng. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons perfonuing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/iNSTALLER
Municipality of Anchorage Page '/ of 'z----
DEPARTMENT OF HEALTH AND HUMAN SERVICES
,~,ENVIRONMENTAL SERVICES DIVISION
P.O. Box, 196650 · ~Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: .~1~ ~'5~¢0..5'' t~
LEGAL DESCRIPTION
WELL: a New ~ Upgrade
Wssification (Private. A,B,C): Total Depth: J Cased TO:
Drillec Cate Crilled: Static Water Level:
Yield:
PID Number:
Wastewater System: [] New .~Upgrade
: ABSORPTION FIELD
Deep Trench ~Shallow Trench rq Be [3 Mound [3 Other
SEPARATION DISTANCES
Frorn
Well
Sur[ace
Water
Lot
Line
Foundation
Curtain
Drain
Remarks:
Soil Rating:I t Z. GPD/Sq. Ft.
Depth lo pipe bottom from original grade:
,¢ ~'
Pill added above original grade:
Total absorption area:
..~;~.5- SQ. Pt.
Total Ceplh from original grade:
Gravel de~th beneath pipe
~ravelle~gth:
tumber o,'f lines:J Distance beiween lines:
~ J / ~ Pt.
Pipe material: ~ ~/,~- t Yg"
TANK
[] Septic [~ Holding ' ~%S.T.E.P.
Material:
Capacity in gallons:
Number of GompaHments:
. -LIFT STATION
'Pump on" level at: I "Pump o f' evel at: High water alarm at:
~ump Make & Model by:
BENCH MARK
Location and Description:
ENGINEER'S SEAL
Inspections.perfdrmed by:- ,r,-,,,,,---,::~; .' ,' Dates: 1s!
.-_ ~ ' - ChUg|ak, Alaska ¢gSS~--~' · ' 2:nd '~t~/¢ ¢'
: . , .-, ~,. /.~ 2.' ~ . ¢/,,/~
Department of Healt~¢ Hum¢¢~¢¢vices approyal,
bt:x
72~13 (1191) MOA 25
Permit No'. ~'~'~-/¢,c~ Page 'Z-- of ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES '.
ENVIRONMENTAL SERVICES DIVISION
P~O. Box 196,350 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
PID No.:
72-013 A (Rev. 9/91 ) MOA 25
The electrlc~ work done at [Zlock #?, Lot #~i8 on the septic ~ystem wa-~
done by a journeyman electrician, Alaska license number 112299. The
work was done according to the l~atlonal Electrical Code standards.
RECEIVED
t~AY 1 ~ 1994
Municipalhy of Anchorage
Dept. Health & Human Services
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940050
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:GOODIE JAY A & DEBORAH S
OWNER ADDRESS:24419 THUNDERBIRD DR
CHUGIAK, AK 99567
DATE ISSUED: 3/16/94
EXPIRATION DATE: 3/16/95
PARCEL ID:05158112
LEGAL DESCRIPTION: THUNDERBIRD HEIGHTS #3A BLK
7 LT 18
LOT SIZE: 21225 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY:
/
D.'R; DAYTON, P.E., R.L.S.
~ Chugiak, Alaska 99567
20210 Donalar ~
(907)~
· . 696-2417
Lot 18, Block 7, Thunderbird Heights #3A
The design presented is an upgrade to ~replace a trench which is in
ground water.
The new absorption system will be a pressurized shallOW trench located on
the rear of the lot, uphill from the old system. The septic portion will
be a S'l'~l~ tank replacing the old septic tank.
The subdivision is served by a Public Water System, therefore well
contamination is not a critical factor.
The proposed system will have no measurable impact on reserve space,
surface or subsurface, or on drainage.
!
!
David R. Dayton
2'J210 DoAaJar St. -:
J
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
2
Z.,$ 3'
5
8
9
10-
12
14-
15-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
'~ COp '"
~ ROFESSX~
DATE PERFORMED:
S
L
IF YES, AT WHAT O
DEPTH? p
E
Township, Range, Section: ~x_~/ ~'-/~,,1~/~'/4..
SLOPE SITE PLAN
Monitoring? ~NO.U~v" Date.
Gross Net Depth to Net
Reading Date Time Time Water Drop
,M/e,/ '~-'~
~ ,, z~r -Z~ /~ ~,/~ -- /~
PERCOLATION RA~-E ~/~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN - ~,,~ FT AND ~;$.~0 FT
· ' THAT THIS TEST WAS 15ERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '.~1~.~..~ ~/,~,
72-008 (Rev. 4/85) · ~',
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Tbwnship, Range, Section:
SLOPE SITE PLAN
10
11
12
13
14
15
17
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT O
DEPTH? p
E
Deplh to Water Alter /
Reading Date Gross Net Depth to Net
Time Time Water Drop
¢~/¢ ¢
~ z~-~ 7~ E~ -/~ ~.
PERCOLATION RATE ~ ~'-~ {minutes/inch) PERC HOLE DIAMETER ~--~
TEST RUN BETWEEN ~ FT AND ~ FT
PERFORMED BY: '~-"'~-~"~ ~- ~,%Y~'~O ~,~. I CERTIEY.THAI~THI$ TEST WAS PERFORMED IN
ACCORDANCE WITH AI~L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~¢//¢'¢ ....... "~ *
72-008 (Rev. 4185) -,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~ QN-SlTE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME / )/ o /'-' I~ONE I/~'NEW
MAILING AMDRdSS' ~
LEGAL DESCRIPTIO~ ~ // / u / / / /
LOCATION ~ '(~ NO. OFBEDROOMS
' W~l/
I I~//T I
~ ~ Manufacturer M [ No, of comp~ftments
I Liq p~i'~ga'l'~ IF HOMEMADE: I Inside length I Width Liquid depth
DISTANCE TO: Well ~/ I Dwelling PERMIT NO,
Manufacturer
Material
DISTANCE Th: Fou nO~O~
No. of lines Total
inches
Top of tile t~ ,g~de/ ~ ,,
~ inches
Length Width
Liquid capacity in gallons
Distanr~ b e)~e2b,~'~_~
Total effective absorption area
PERMIT NO.
Type of crib
OISTANCE TO:
DISTANCE TO: Building fo~ation
OTHER
Crib depth Total effective absorption area
Building foundation Nearest lot line
Distance to lot line
Septic tank
PERMIT NO.
Absorption area(s)
SOl L TEST RATING
INSTALLER
I~c~:~rt A.
~ cid ed,
/5
APPROVED r
72-013 (Re~. 3f78) ~
PERMIT NO.
[:,EF'AR. TMENT 0F-.... HERLTH RND EN, IF_NHENFt-.IL 825 '"[ 'STREET., RNCHORRGE., FIK.
RPPLICRNT
LOCRTION
LEGRL
< 8±0S45 )
KLEIN CONST
THUNDERBIRD DRIVE
Li8 87 THUNDERBIRD HTS
264-472(1
5E,..-,EF-, F'E.Z'F: f-1 ][. T
BO',:',', 2524 F'FtLMER
LOT SIZE
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTING (SQ FTZBR)= ±45
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:, F.'] [:) 1- H---= ::LE~ L_ E ~"-~ r_..~ T Fl = _~:7 ~_S R ~'q"-2 E L_ D-, E F" T' lq = 6
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
'THE DEPTH OF R TRENCH OR PIT IS 'THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCFIVRTION (IN FEET).
'THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFIYEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFFILL PIPE
RND ]'HE BOTTOM OF THE EXCFIVRTION (IN FEET).
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE
INSTRLI_FITION INSPECTIONS OF RNY WELLS FIDJRCENT TO THIS PROPERTY FIND THE
NUMBER OF RESIDENCE:~, THRT THE NELL WILL SERVE.
-r~....~o ,:: 2 ::. T h~SF'EC:T' I C,I'-.IS RF:E F-:Ef2-.~L! ir F-:E[:.
BFICKFILLING OF' FINY S'¢STEM WITHOUT FINFIL INSF'Er:TION FIN[) RF'PROYFIL BY THIS
DEP~RTMENT WILL BE SUBJECT TO F'ROSECUTION.
MINIMUM DISTRNCE BETWEEN Fi WELL RND FINY ON-SITE SEWRGE DISPOSRL SYSTEM IS
±RE'~ FEET FOR R PRIYFITE WELL OR 150 TO 200 FEET FROM Fl PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTFINCE FROM Fi PRIVRTE WELL TO Fi PRIVFITE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MFIY RPPLY. SPECIFICFITIONS RND CONSTRUCTION DIRGRRMS FIRE
RYFIILRBLE TO INSURE PROPER INSTFILL. FITION.
CERTIFY THRT
I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
I
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTFILL THE SYSTEM IN RCCORDFINCE WITH THE (:.'ODES.
"-':~: I UNDERSTFIND THRT 'THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT tF THE
RESIDENCE IS F.:E~b~]DE~EE~/f~ INCLUDE MORE THRN ';~ BEDROOMS.
Lq I C1NED; ....... ~'~-~ .... ~ .... ~ ......
HFFLI~ KLEIN L. uN_,]
'0 & E ENG,.NEERING & DEVELO, ~vlENT CO.
Box 90, Davis St,, Eagie River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for:
Earl Ellis
SOIL LOG 688-2280
Name: ~'~:V/~-A/' Z, ~'~,/~/~('"'-~-75 ~A/$'7': Tel. No
Mailing Address: ~-~X D ~ ~/~/~/~/ ~/~,
Depth (feet)
Soil Characteristics
0
1
5__
6__
7__
8__
9__
13
14
15
16
PLOT PLAN
PERC. TEST
Ground Water Encountered: Yes No J If yes, what depth
Proposed Installation: Seepage Pit
Drain Field
Comments:
Performed by; ~~ ,~/
1� v„67 8 g 10 ,
ti t � „k•
Municipality o nchora •• M '.'17
•` '� On-Site Water and Wastewater Progra a- AUG 2 7 2019 it.l.l I a
(907) 343-7904 - � t TY
CERTIFICATE OF ON-SITE SYSTEMS A'i' ' •VAL hc-
9, 68L95
Parcel I.D. 051-581-12 Expiration Date: g 7 .2
1. GENERAL INFORMATION
Complete legal description Thunderbird Heights#3A Block 7Lot 18
Location (site address) 24419 Thunderbird Drive
Current Property owner(s) Kyle & Elizabeth Jackson Day phone
Mailing address 24419 Thunderbird Drive,rChugiak, AK 99567
Real Estate Agent P4444-A/ za/er5 _ —_ Day phone ciiv? - 47I 7
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
I I Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well n Holding Tank I 1
Individual Water Storage n Community I
Community Class A Well . 1 Public Sewer I J
Public Water System
WaiverNariance request for: Distance:
Received by: Atari Date: _ / y
COSA to be released to the engineer, unless other i. ested by the engineer.
COSA Fee $ �O t� Waiver Fee $
Date of Payment g D O•T Date of Payment
Receipt Number 1 Receipt Number
COSA# OS C., I41L10O Waiver # __
.,, i' !
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 ARCTERRA CONSULTING,INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 8/23/19
Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics,groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future �_
vik
occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. ��, OF ``1L�\1
4• TII * +
6. DSD
SIGNATURET;VA
System #1 Approved for bedrooms. KL. El „
System #2 Approved for bedrooms. , 'n � is f�' i
Disapproved. ‘k
16 4.
Conditional approval for bedrooms, with the following stipulations:
tis N(SOF« {rtii
= ON-SITE �
WATER AND
_75-0
WASTEWATER o^
PROGRAM
� 1
)) T S50
»m»,o,
•
By: 0100-/Slat _- Original Certificate Date: $ a 7 1
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.
1�s
7. ATTACHMENTS: 1� i,
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory ' ti�
Well Flow Advisory Other 7—punk
COSA blue sheer 70.10-12.doc
COSA Checklist
Legal Description: Thunderbird Heights #3A Block 7 Lot 18 Parcel ID: 051-581-12
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1
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 II 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 A w
B. TANK DATA C. LIFT STATION
Age of tank(s) AT years • Required maintenance completed
Tank type/material S.T.E.P./Steel Age of lift statior a+c years
Measured operating fluid level in septic tank 77 Lift station material ST
II Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 8/21/19 Maint. Log attached
D. ABSORPTION FIELD DATA
Which system tested (date installed)8/22/2000 Adequacy test date 8/23/19
II ALL standpipes present per record drawing Results Pass For 3 bedrooms
Total measured depth from grade 5.9 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade ft(min) Water added 450 gal
N/A-pressurized field
New depth 7.5 in
Monitor tubes go to bottom of effective. If not, state
depth into effective Elapsed time 140 min
Code-required soil cover over field Final fluid depth 0 in
System presoaked Absorption rate 450+gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced 458* gallons If yes, enter date
Comments/Deficiencies:*Presoaked and tested northern (downhill) trench of 2000system only.
j itp,ey 1/itC�s�7lJ� we£HS • /3 e ied_ /' SGS
d
ann �a-wrt $ 27//9 &—
�y /
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' 0 Yes if No ft Private Sewer/Septic Line >25' ❑Yes if No ft
Absorption Field on Lot> 100' 0 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' 0 Yes if No ft ❑Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if 1 ss than r quired)�! / b F 5 � —�/
iF Alec t c vre_ 4-T 1-
Building Foundations> 10' 1 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' ® 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' ® 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 *�,F (47 ( ql.
I certify that/have determined through field inspections and review :
MUNICIPALITY OF ANCHORAGE
Development Services Department it 7 Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
Owner Street Address a,4,1 Thu h6ef`so`c, A
Septic Tank:
•Sludge level e inches •Pumping: required yes no •Pumping completed yes no
Lift station:
•Pump basket cleaned yes N -/ 'Effluent filter cleaned yes a Nc+e-4.
'Control floats cleaned ft no 'Proper float settings confirmed ano
•Operation satisfactory cc no
Alarm System:
'Dedicated electrical alarm circuit C no 'Audible and visual alarm inside dwelling0__r_io
•Alarm system operation satisfactory' not satisfactory
Manhole Riser 1�
'Ground water intrusion at riser to tank connection yesno
'Ground water intrusion around pipe penetrations yes 'Weep hole functional ID no
'Manhole lid: Functional a no Insulated es no Properly Secured era no
Other
-All manufacturer required inspections and maintenance completed es no
Comments:
Qualified Maintenance Provider:
Technician L0.cCy 0.2S Date of maintenance 0.S 4(1 (1
Company L <S
Signature
Datea3 Oct. (i
Mailing Address: P. O. Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
MUNICIPALITY OF ANCHORAGE
•
DEVELOPMENT SERVICES DEPARTMENT (. 11 907-343-7904
On-Site Water and Wastewater Section " Fax: 343-7997
www.muni.org/onsite � '
Septic Tank Advisory
Certificate of On-Site Systems Approval # 0SC191400
Subdivision: Thunderbird Heights #3A Block:7, Lot: 18
The septic tank for this property is 25 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
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Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
Municipality of Anchorage
Development Services Department
Building Safety Division.
.. On-Site Water and Wastewater P?.~gram
4700 Soulh Bragaw St.- ~' :'
P.O. Box 196650 Anchorage, AK 99519-6650'
www. ci.anchorag~.ak, us
· '~ ' (907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL'
.... '~'O"0, A ~li~IGk~' FAMILY DWELLING
-ParCel I.D._ · 051-~81-12
GENERAL INFORMATION
Complete legal desc~ption
Lot 18! Block
'HAA#_
· Expiration Date:_ 3 -,,~- O ~
Thunderb~'rd Hellzhts ~3A
Location (site'address dr direcfior~s) .-. 2/~/~1 q 'l'h~mri~,~.h.i rrl 'Bt_
Current Property owner(s)Cindy Aguiar
Mailing address·
Day phone
688-2411
-Lending.agency ..
Mailing address
RealEstate Agent Hal Jack~o~
Day phone
Day phone_ 696-9312
~vmilingAddress Anchor Fortune lOOtR '.~.-glo
Unl. e. sS otherwise requ. es~ed, HAA will b'e held by DSD fo[ hickup.
NUMBER OF BEDROOMS:
TYPE oF WATER sUPPLY:;
Individual Well ...
Individual Water Storage
· Commu~nity Class~ Well
Public Water System
.. 3'
[]
[]
gel_ ~llq Eagle R'lvc, r,
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Hoiding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HA,&) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties se(~ed ~y a pdvate or Class C well and may be reissued with
new water sample results. (Cedificates may be reiss~J~c~ 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.
AK
Municipality ot' Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.'ak.us
(907) 343-7904
Ad
HEALTH AUTHORITY APPROVAL CHECKLIST
, r ~ ~/.( '
LegalDescription: ~,--O7'- I~' ~Loc~ .'7 T--.//v,,,~,,~at,tO ~-/ s ParcellD:
WELL DATA
Well type
Date completed .
Total depth ~
Date of test
Static water level
Well production /
WATER S~TS: -
Colifor~j;~ colonies/100 mi.
Arsenic: mg./I.
/O c G/...~ (_ I,,., 4.--'7' ,'~
If A, B, or C provide PWSID # Well Log (Y/N)
Sanitary seal (Y/N) Wires properl~ "
FROM WELL LOG ~....~...~'AT INSPECTION
ft.
ft.
g.p.m.
coloniesllO0 mi.
g.p.m.
Nitrate mg./I. Other bacteria
Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
TankType/Material ~E-'/~T'~ ¢-- / 5'T~¢. t~_
Tank size ) ~.,5'o gal. Number of Compadments ~'
Foundation cleanout~}_Y ~ Depression over tank (Y/~ / 0
D~te of pumping ~ I~/o ~ Pumper ~'~ '~
Date installed ~ I~'/~ Soilrating~rft~/bdrm) O-~
" ~ ft.
Length ~0 1~r4~ f(. Width
Date installed
Cleanout~¢__~)
High water alarm(~)
$/-/4 ~.ea ~
System type 7- ,l ~ ,,, ~ ~'~ .r
. Gravel below pipe ~ ;
ft.
Total depth ~ ft.
iiEff, absorption area
Date of adequacy test
Fluid depth in absorption'field before test_'~-. in.
Ela'psed Time: (~0 mm. Final fluid depth ~L in.
Any rejuvenation treatment {past 12 mo.) (Y/N & type)
Depression over field
Water added 5"c"'~ga!. '
Absorption rate >=
~'""~ ~'" '"/ If yes, give date
For, ~ bedrooms
New depth ~o' .. in.
~ ~ o g.p.d.
J
ASBUILT-NO CORNERS SET 'THIS DATE. S~'~ARD & ASSOCIATES
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE SCALE:
FOLLOWING .DESCRIBED PROPERTY; . /"--"~" .
~5. ~ .'..~%
AND ~AT NO EN~O~HMENTS EXIST ~CE~ AS ///~/~ '
INDICA~.: IT IS THE EES~NSlBILI~. OF THE
~ ~ D~RMINE T~ ~ISTENCE OF ANY GRID=
~1~ DO NOT ~PEAR ~ THE RE~D~ ~BDI- · .... ' - ·
VISION P~T. UND~ NO CIRCUMSTANCES S~ FB: '; .
OF FENCE LIN~ OR ~R ~ISHING ~ND- DRAWN:
ARY LINES. ~~ .
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (~ite address or directions) ~d~) °l 7~/u,- ,~,~ g i ,~,a ~),t~ / q4
Property owner
Mailing address
Lending agency
Mailing address
Agent /~,'~ 4~ /
Address ,) '(¢- (2 e
Day phone
Day phone
Day phone ~ ¢~ '7' - '~ ~' c 0
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: --~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 further verifythat 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 & S ENGINEERING
Name of Firm
17034 Bagie ~ver Loop i~oad No. ~u~
Address Eagle River, Alaska 99577 --!
~ (~1'''~o ~ 4 ~ .
Phone ~ ~1 z./, - ,~.¢) -7 ~
DHHS SIGNATURE
~ Approved for
bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Se~,ices (DHHS) issues Health Authority
Approval Cer[ificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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.
Municipality of Anchoragep~ F_. C F-. t VE[ ~1 ~
Department of Health and Human Services
Division of Environmental Services S~-~' (} ~ ~.[~0[~
on-site services section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us MUNICIPALtTY OF ANCHORAGE
(907) 343-4744 ENVIRONMENTAL SE~,VICES DIVISION
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type .__ IfA, B, or C provide PWSID # W~
Date completed __ Sanitary seal __ ~ Wires properly protected __
Total depth ft Cased to __ ft J~Casing height (above ground) __ in.
FROM WELL LOG ~ AT INSPECTION
Date of test _
Static water level
Well production ~ g.p.m g.p.m
WATER SAMP~TS:
Coliform ~' colonies/100 mi Nitrate__ mg/I Other bacteria colonies/100 mi
Data'sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~"/~'~. ~!:i, Tank size )~'~0 gal Number of Compartments
Cleanouts ¥'f--J Foan;d~iti~n cleanout Y~J Depression over tank ~ O High water alarm
Dat~.~f pumping /~/,~i' .? Pumper
C. ABSORPTION FIELD DATA
Date nsta,ed Soi rating or t2 bdrm/ 0,¢ Systemtype
Length ~-o 7¢t~'~ ~' Width '~- ft Gravel below pipe "~ ft
Total depth (~ ~/~- fl Effective absorption area ,C-II fF Monitoring tube ~¢~ Depression over field ~-o
Date of adequacy test _~/,~ _- _~¢w Results (P~ For ~ bedrooms
Fluid depth in absorption field before test ...-----"~in Water added __ gal. New depth in.
Elapsed Time: luid depth in Absorption rate >= __ g.p.d.
Any rejuvenation tre~ent (past 12 mo.) (Y/N & type) If yes, give date
72-026 (Rev. 01/00)*
D. LIFT STATION
Date installed '-~'/~'/~¥
"Pump on' level at ~/~, in
Datum ¢o 7-:~ ~ ~,4
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at 5/ 2- in
Cycles tested
Manhole/Access ¥/¢_J
High water alarm level at '¥Y in
Meets alarm & circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/~n o-~'~
On adjacent lots
On adjacent~ r
~~c ~ewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Building foundation &-//~' * Property line ) b
Water main
Water service line ) 0 Y-
Drainage
Absorption field ~ ~' ""/-
Surface water / O O -~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line ) 0 "¢- Building foundation ~,~ Water main
Water Service line ) 0 4- Surface water / 0 ~) 4- Driveway, parking/vehicle storage ~" 0
Curtain drain /,j~v~, kw0w,,,' Wells on adjacent lots ~.o0
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date dj
HAAFee $ ~" /~
Date of Payment -'~'~ "~ ---~-~ ~
Receipt Number ~,~ ~D t~ff'~~
72-026 (Rev. 01/00)*
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.ancho rage.ak.us
(907) 343-4744
CERTIFICATE OF :HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-581-12
HAA# /L/,¢:~-~.}/~)~) ,~' /
Expiration Date:
1.. 'GENERAL INFORMATION
.c0~pletelegaldescription Lot 18, Block 7, Thunderbird Heights
Location (site address or directions) 24419 Thunderbird Drive
CurrentP?0perty:owner(s) Jay Goodie Day phone 268-6074
Mai[ingaddr~ss 24419 Thunderbird Drive, Chugiak, AK 99567
Addition #3A
:. L~n¢ing agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Remax/Audrey Mason Dayphone 694-4200
16600 Centerfield Drive, Suite 201, Eagle River, AK 99577
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
3
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
E~ Public Sewer []
The Municipality of Anchorage Department of Health end Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority 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 less than 30 days old. 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.
72-025 (Rev. 01/00)*
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 Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
S & S ENGINEERING
Name of Firm 17034 ~.~- ~ River Loop Road No,~-0'~ (~ c~ ~ _~.cj .79
.,__,.. ~a.'~? Phone
Address
Engineer's Printed Name Date '2.//~, /
Conditional Health Authority Approval is requested. Septic system to
be upgraded by June 15, 2000. There is no eminent health hazard
(no overflowing sewage) and there will be no adverse effect
result of granting Conditional HAA. ENG,~"~'OP
DHHS SIGNATURE ~...,~,../,~;~.,~
Approved for bedrooms. ~"~
~ -- ~ ~.~ ROBERT C, COWAN t ~-~
Disapproved. ~;~.., cE-8801
xxx Conditional approval for 3 bedrooms, with the following stipulations~t,~.-;'b.; ........
~to~e7 snaL~ De par ~ eSQ~O~ ~O upgrade t~e on-s~te ~aste~te~ d~sgosa~~~
se~2~ the suUject g=oge~t~ pu=sua~b to pe~m~[ ~umbe~ S~0OU0~6 (sttached). Ho~e~
~ esc=o~ sha~ be ~ the amount o~ t.5 b&mes the h~b b~d ~=om a m~&mum o[
~ds ~=om ce~t~ed 2~sta~e=s ~ the ~uQ~c~pa~t~ o~ A~cbo=~se. ~he p=ogosed
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
OtherP~.lf~fiT To ¢o~,sr~tr
Expiration Date:
Original Certificate Date: ~- -/7 -~0
Reissue Date:
75-025 (Rev. 01/00)'
Municipality of Anchorage 000~' c) [ 1~3:J ,~,~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environ mental Services Division )(~jz~4~.) ]~
825 L Street, Room 502 · Anchorage, Alaska g9501 · (90'7
Health Authority Approval Checklist
Legal Description: )-O'~' 1~ i~t~o~K- '7
A. WELL DATA
Parcel I.D.:
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level ~
Well production /
WATER SAMPLE RES/~'/S.'
Coliform / Nitrate
Da~e:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to C~u n d)
s properly protected (Y/~)
AT INSPECTION
g.p.m, g.p.m.
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~'/$/'ff~ Tanksize I~-5''~5 Number of Compartments ~ Cleanouts~/N)_
Foundation cleanoutl~/N) Y£$ Depression (Y~ ,~,/~J High water alarm ((~1)
Date of Pumping 2 ~/f, --~20 Pumper
C. ABSORPTION FIELD DATA
Date installed 5- / '~ / ~ ~/
Length ?5~ ~or4c Width
Effective absorption area ] ?
Date of adequacy test ~,/~,
Soil rating ~or fF/bdrm)
Fluid depth in absorption field before test (in.);
Gravel thickness below pipe O. $~ Total depth ,~ ~ r~ 92..
Monitodng Tube present~{~/N) ¥r,4' Depression over field (Y~ ~ o
Results (Pas~ F,g-~ ~- For "~' bedrooms
Immediately a~er gal. water added (in.):
Fluid depth
(ins) Minutes later:
Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
If yes, give date
LIFT STATION
Date installed
Manhole/Access C.~N)
High water alarm level at*
Size in gallons
"Pump on" level at* ~"
*Datum
"Pump off" level at*
Cycles tested g- .81, ~,.,rt./,~,¢.-
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: ~~
Septic/holding tank on lot ..----'""~n adjacent lots
Absorption field on lot ~..----'"'"""~-~
Public sewer main
Sewer/s~ce'~
line
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ //:~ Property line / ~ Absorption field
Water main/service line /o ~L Surface water/drainage ,/~0 '¢- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation ,.¢'0 Water main/service line
-4 - Driveway, parking/vehicle storage area
~ ,'-' ~ '*' ,"/ Wells on adjacent lots
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recor~t~t.,~,~C,,~.J ~(ems are
in conformance with MOA HAA guidelines~ effect on this date ~&~ ........ ~' ',.~,~-'~,~
Engineers Name . ~-*~ - o ,~ 4~ ' "Y'"'"~
~I-'~;" ........ C~ ~'
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site ~Z_
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 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.
Davi,'l R. Dayton P.E.
Name of Firm '~n~'m n~.~l~. ~,,.. Phone
Chugiak, Alaska 9956~
Address ~.~.~2~
Engineer's signature / Date
DHHS SIGNATURE __~
z,~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 p?ofessional engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: (..o'r- I~, /~c,r__ 7 Parcel I.D. o~/~-g'//7_..-
A. Well Data
Well type ~Hr~lC. If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth
Sanitary seal (Y/N)
Cased to
FROM WELL LOG
Date of test
static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ;~-~-/~¢¢.~ ¢:~'~\'~\'~ Tank size
Casing height
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
RECEIVED
g.p.~. Y 1 ;~ 1994
Mur~icipality of Anchorage
D:pt. Health & Human Services
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
I'z.5'-o ~,--~ Compartments
Cleanouts (Y/N) y
High water alarm (Y/N)
Date of pumping
Foundation cleanout (Y/N) y Depression (Y/N)
7 Alarm tested (Y/N) y
,¢~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~/,a,.
To property line Jf~
Surface wateddrainage
On adjacent lots '¢/¢'~ Foundation ~7.5"'
Absorption field .¢~" Water main/service line
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT = I'ATION
Date installed ~/c) ,.~
Size in gallons I ~-
Vent (Y/N) Y "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N) 'Y'
"Pump off" Level at
Cycles tested ~
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot "~',//~ On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
I ~ ~,E'
Length /
Total absorption area
Date of adequacy test
Water level in absorption field before test
~-/c2 ~ Soil rating (GPD/FF) /, ~ System type ~b'~c~o
Width ~ ' Gravelthickness o,S'(~J~.~,,~ Totaldepth
~ '7 ~'- Cleanout present (Y/N) ~ ~- p,~-~- Depression over field (Y/N)
,/t'] '~'c0 Results (pass/fail) for Bedrooms
-- After test
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
Well on lot'"
To building foundation
On adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
On adjacent lots /t///~ Property line
To ~m(isti~g or abandoned system on lot .~ "/'-
Cutbank ~ ~ Water main/service line
Surface water
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e
of this inspection.
David R. Dayton P.E.
20210 Donalar St.
Engineer's Name
Date ~/~'x//,'~' ~/
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site' Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~ ~<~/- ~/~ / 7--~,~ HAA#
1. GENERAL INFORMATION
Complete legal description
Location (site ad~lress or directions)
Property owner
Mailing address
Lending agency
Day phone.
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Individual well .:/
Community well '~, ' -
Public water
If community well system, provide written confirmation from State ADE~C attest-: '.
lng to the legality and status of sYStem.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~)25 (Rev. 1/91) Front MOAIf21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, t verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verifythat 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.
David R. Dayton P.E.
Name of Firm 20210 Dona]ar St.
Chugiak, Alaska 99567
EngineeCs signature
6. DHHS SIGNATURE
Phone
Approved for
bedrooms.
Disapproved.
5t,~. Conditional approval for --~/ bedrooms, with the following
stipulations:
Additional Comments
The Municipality of Anchorage Departmen't of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only'upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 p.rofessional engineer's work.
72-025 (Rev, 1/91) Back MOA fY21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ /°~" "~/ Parcel I.D.
A, Well Data
Well type,~ ~;u',~-
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level ,f,~,///,,~
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
ATINSPECTION
g.p.m, g.p.m.
Septic/holding tank on lot
Absorption field on lot
Public sewer main
~ 7' ; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate Other bacteria
Date of sample:
Collected by: ·
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size /¢' ~ 42 Compartments
Foundation cleanout (Y/N) ~ Depression (Y/N) ,''1//
Alarm tested (Y/N)
/
~'~:~-' ~q'~'"--' Pumper .~..~_, ~ (~w,,¢
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /['/'//7~ On adjacent lots
/
To property Pine /¢' ~' Absorption field
Surface water/drainage [~ ~ ~
72-026 (3/93)' Fronl
Foundation
Water main/service line
CONTINUEDON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical cedes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LlFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed !//~?/
Length ~ ,¢ Width
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/F¢)
''~ ' Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
.~.¢- System type
Total depth
Depression over field (Y/N)
for
After test Z~'
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Oudain drain
On adjacent lots ,~',,--/',,¢- Property line
To existing or abandoned system on lot
Cutbank -"//,¢ Water main/service line
/
Driveway, parking/vehicle storage area ~//¢
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect el
David R. D,ayton
20210 Doefalar [.
Signature Chuglak, Alaska
Engineer's Name
Date / Z~///~.~
/ /
HAA Fee $ t~(
Date of Payment
Receipt
Number
72-026 (3/93)* B ck
Waiver Fee $
Date of Payment
Receipt Number
January 6, 1994
To Whom It May Concern,
Thomas and Rebecca McGirmis will put in escrow $15,000 tomorrow, January 7, 1994
through the Norwest Mortgage Company.
Sincerely Yours,
Rebecca McG/nnis
NORWE~I' MORTGAGE
Norwest Mortgage, Inc.
Suite 101
16635 Centerfield Drive
Eagle River, AK 99577
907/694-1144
Fax 907/694-1145
Jan. 6,1994
To: MOA
Re: 24419 Thunderbird Dr., Chugiak, AK 99577
To whom it may concern:
Please be advised that Norwest Mortgage will put in escrow $15,000.00 to
cover expenses to repair septic at closing (anticipated Jan. 7, 1994).
Sincerely,
Sales Manager
D. R. DAYTON, P.E., R.L.S.
~ Chugiak, Alaska 99567
20210 Donalar
[907) ~
696-24~-
December 1, 1993
ADEQUACY TEST
Legal Description: Lot 18, Block 7, Thunderbird Heights
Date of Test: November 30, 1993 .
Septic Tank: 1,000 gallon, 2 compartment, steel tank
Absorption System: 38' long x 2½' wide x 6' effective de
Soils Rating: 145 sq. ft. per bedroom ~
Requirements: 3 BR = 450 gallons per day
3A
th trench
(DHHS records)
(DHHS Records)
(DHHS Records)
Test:
Water was pumped into the absorption trench while measuring volume,
time and water level rise.
After pumping was stopped, the water level drop was measured at timed
intervals.
The results were plotted on a graph of time and volume absorbed and
extrapolated to 24 hrs.
Results:
The septic absorption system is currently functioning adequately for
a 3 bectroc~home.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date° March 25, 1986
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
f.ot ]g Block 7 Thunde_rbird Hei~.hts Addition 43 A
Location (address or directions)
6Cz[ r~hl~n~rh~ rd Dr.
Applicant Name Tom McGinnes Telephone: Home 688-4784 Business
AppJicant Address 604 q~hf]nderbi~d Dr,.ye
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution _A..t_l~ntic Federal Credit Union Telephone
Address
563-3542
(e)
Real Estate Company and Agent Lomis & Nettleton
Address
ATTN: Shirley
Telephone
(f)
Mail the HAA to the following address:
S & S E~_uineerir~,
SRB 196x
E glo River
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms .7
Other
WATER SUPPLY
Individual Well [] Community J~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72.025 (11/84)
hUL, 'U~ ay ~,pproval shows that the on-site water~].]]]]~'""~J' -,~,e ~,,uw, below~vertty that my investigation of th s Heal
~-,~p,~' anu/or wa~[ewater d,sr !, system ,s safe, functional and adequatt~
for the number of bedrooms a/ ype of structure mdmated hereto. I further verily 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
Address __
Date Eagle
- Telephone
DHEP APPROVAL '~'~
Approved for ~_~ bedrooms
Approved _ isappreve '
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 $ 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
professional engineer's work. is not responsible fo,' errors or omissions in the
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Desc n:
Legal
WELL DATA
Well Classification ~A,['~L ~ ~-~
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
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Man~ole
Water Sample Collected by
Water Sample Test Results
Comments '-'"~ V~ ~
If A, B, C, D.E.C. Approved4~/-N~
Date Completed Yield
[ Depth of Grouting
~ I~. Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'/~
Standpipes ~ Air-tight Caps(~)"
Depression over Tank
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /'~
Separation Distances from Septic/Holding Tank:
To Water-SupplyWell ~,.~ ~-~- ~-~'~.~4...
To Property Line
To Water Main/~-=~4-c'e-~me
Size ( O ~'~ No. of Compar[ments
Foundation Cleanout ('"~)
Date Last Pumped ~ Z-r~'~ ~-
~ I/~_ ;for --
Temporary Holding Tank Permit (Y/N) _
To Building Foundation
To Disposal Field
Course
Comments
To Stream, Pond, Lake, or Major Drainage
Page I of 2
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed I \ ~ 2~:~
Width of Field '~
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Depth of Field
Gravel Bed Thickness
Standpipes Present~0J'4'~'
Date of Last Adequacy Test
Type of System Design
Length of Field
Separation Distance from Absorption Field:
To Water-Supply Well ~ ~ ~ <- "~-t.*'~ ~.-.', ¢._ To Property Line
To Building Foundation
Lot
To Water Main/6ewice Line ~'-<~ ~ ~'--
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
; On Adjoining Lots
To Existing or Abandoned System on
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access {Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
. .
Signed S & $ E~lglneerhlg __ Date ~//2~'~ ~//
Company ~ , ~ MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (I 1/84)
~1EP~. O~ ~N~¥~RONM~N1T/kL
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone:
Address:
274-2533
To Whom it May Concern:
According to records on file in this office the
~~. Water is in with the State
System
compliance
Drinking
Water Regulations
Sincerely,
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date ~/~_~
(a) Legal Description_ ( include .lot, ~;lockz,, sub~ivision, section, tcwnship, range )
Location Cadd~ess o~ directions)
(b) Applicants Na~s__~7~ ~
Applicants Address
Applicant is (check one) Lending Institution ~; Owner/builder ~;
Buyer ~; Othe~ ~ (explain);
(c)
(d)
Lending Institution
Telephone
(e)
Address
P~al Estate Co, & Agent
Address /~//~ ~'~ ~
Telephone
2. Type of I~sidence
Single-Family ~
Numbe~ of Bedrooms
Multi-Family~
Othe= (describe)
3. _Wate~ Suppl~
Individu, al Well
Czmmunity~
Note: If cc~unity wgll system, must have written confirmation frc~ the State
Department of Envirormmntal Conservation attesting to th~ legality and status.
Is the well adequate fo= the number of bedrooms specified in this HAA (Y/N)
4. _Se__~ge Disposal
Onsite~ Public I--~ Cor~m/nity ~-~ Holding Tar~( [.---~ '
Is the wastewater disposal system adequate fc~ the number of t~drocms (Y/N)
[Page 1 of 2]
2-15-84
~neering Firm Providing Inspections, Tests, Eata and Information
I c~rtify that~--I checke~ ver.ified, or conformed to all I4OA HAA C~idelin~.s in
effect on the"dat~/~of~hizff~/~Spectlono
S igne d~__ Da ne
Name 0~/Ffrm ..... Telephone
Add=ess ~ ~_..~. ~:~IN ,~IN[-~
Date
(ENGINEER SEAL)
6. DHEP Approval
Approved for
Approved ~
Disap~zoved ~
Conditional~
Term~ of Conditional Approval
The Municipality of ~cho~age Department of Health and Environmental Protection does
not guarantee the continued satisfactory ~erformance of the wate~ supply and/or the
wastewater disDosal system. This approval indicates that, as of the v~lidation date
shc~n above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and ~unc-
tional for the number of bed=cons and type of structure indicated.
( DiqEP SEAL)
7. Mail the HAA to the follcwing address:
KB2/d5/s
[Page 2 of 2]
2-15-84
A®
MUNJClPALI~ OF ANmOJ~k~
'~'~ DEPT. OF HEALTH &
I~NVIRONMENTAL PROTECTION
MUNICIPALITY OF ~C~GE (MOA)
- R E C [IV E D
Legal Description:
Well Classification ~1'~[ ~If A, B, c~ C' D.E.C. Appro~
Well Log P~osont (Y/N) to Cc~Pleted ~ Yield
Total Depth Cas~dVto Depth of G~outing
Static Water Level , Pump Set At
Casing He igh.t .Above Ground ~ / /
Elect~i.cal Wiring in Conduit~
Separation Distances from Wel~ 7~7
To sePtic/Holding Tank on Lo~//I,
To Nearest Edge of Absorption Field on Lot
To Nearest Public sewer Line
Cleanout/Manhole
Water Sample Collected By
Water Sample Test l~sults
Sanitary seal on Casing (Y/N)
Depression A~ound !~bllhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public sewer
To Nearest sewer service Line on Lot
; Date
Ccmments .
B. SEPTIC~ TANK DATA
Date Installed //-- ~ ~ i Size .//~00 (/4-j~. NO. of C~,~nts ~
Stan~i~s ~) Ai~-tight Caps ~) Foun~tion Clean~t ~ /
~p~ession o~ Ta~ (Y~ ~te ~st P~d ~/~L~ /
~ ' for
P~ing~intenan~ ~n~a~ ~ File (Y~) ~,
Holding Ta~ High-Wate~ ~a~ (Y~) ~ ~y Holdi~ Ta~k ~t (Y~) ~
~p~ation Distan~s ~ ~ptic~ Ta~:
To Wate=-Supply ~11 '~L/C To ~ilding F~ndation ~ ~
To Disposal Field ~-- y~-
To St~e~, Pond, Lake, c~ Major D~ainage
To Property Line /~P ~'/-
To Water Ma~i~/Service Line /O /
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
SoilS Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/~
Results of Last Adequacy Test
Separation Distanoe from Absorption Field:
To Water-Supply Wall ~JS~/C~ To P~operty Line /0 14'
/~ ~ Type of System Design
Length of Field ~
/
Depth of Field_
. Gravel Bed Thickness ~,~
~--~/~za '~ Standpipes P~esent
Date of Last Ad~=quacy Test
To Building Fo/~/~ation ~.Z ~ To Existing or Abandoned System cn
Lot ~ On adjoiningLots ~O~-
To Water Main/Service Line?~ ~.~ To Cut~(if p~esent)
To Stream/Pond/Lake/c= Major Drainage Course
To D~iveway, Parking A~ea, or Vehicle Sto~age Amea ~--~/~'
Ccr~rents
LIFT STATION
Date Installed ~im~nsions
Size in Gallons ! /Manhole/Access (Y/N)
"Pu~p On" Level at A~/ /"Pump Off" Devel at.
High Water Alarm Level at /_ / / /~ Vent (Y/N)
Tested for 7in.gAcles du]~ ing Adequacy Test.
Electrical Codes(Y/N)
Comments
Meets MOA
** Check Permitted Bedroom Rating Against HAA ~quest
I oertify th~t4~ave checked, verified, o/r conformed to all MOA HAA
on the d~f t~is~/i~stection.
[Pa~ 2 of 2]
Guidelines in effect
· Ol %%.
2-15-84
INSPECTION APPOINTMENTS
MUNICIPALITY OF ANCHORAGE DEPT.
( ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
DE£~I \/[: r~
MAI LING ~R ESS,
STREET L0~ATION ~ z ~ ~ J
6. TYPEOF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY I~ Three [] Six
[] Other
7. WATER SUPPLY
[] INDIVI DUAL* * ATTACH WELL LOG. A we!l log is required for all wells drilled
[~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~ INDIVIDUAL/ON-SITE** I YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
E~ SINGLE FAMILY [] ONE ~ THREE [] FIVE [] OTHER
f
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
~ PUBLIC UTILITY
Connection Verified TOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
E~INDIVlDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified TNSTALLER
[~eptic Tank or []Holding Tank
Size: {U~ ~ If Tank is homemade ~-OILS RATING
give dimensions:
TYPE OF TANK MANUFACTURE
TOTAL ABSORPTION AREA ~ATERIAL
4, DISTANCES WELL TO: Septic/Holding.Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
I~'~",~,P P R OV E D FOR ,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev* 6/79)