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HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3 BLK 4 LT 22Thunderbird Heights #3 Lot 22 Block 4 #051-582-41 Municipali+.y of Anchorage Peg. 1 of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990410 PID Number: 051--582--41 Name: BRIAN HUWE WastewaterSystem: [] New · Upgrade Address: 25455 TEAL LOOP, CHUGIAK AK, 99567 ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907) ~57--~0~ ~ D Deep Trench B Shallow Trench B Bed B Mound LEGAL DESCRIPTION .o,, Rating:~T°t~l Dap~ f~m o.gino, / 22 4 THUNDERBIRD HEIGHTS ~t. ~~t~l~:er ~V~ Total absoft[ .... SEPA~TION DISTANCES = s.p,~ ~ ,o~,, ~ s.~.E.~. From Tank Reid Station Tank S~w.. U... ANCHORAGE TANK 1250 Well 200'+ - - - 25'+ STEEL 2 SudaCewater 100'+ - - - LIFT STATIuO~ Lot 5'+ - - - Srze tn gallons: ~:~a~ Foundation 5'+ -- - - Drain - NONE KNOWN I I Remarks: TANK INSTALLED BY SOUTHFORK EXC. BENCH MARK BOSOM OF FRONT DOOR THRESHOLD. Jaumad eevotlon: 100.00 Ft, Inspections performed by: AWWC, INC. Dates: 1st 11/~6/99 ~ ~{~ ~ ~/~i Iff, 'y A. garness. Depa~ment of Health and Human Se~ices approval Reviewed and approved by: ~ ~ Da(e: PERMIT NUMBER: AS BUILT Di[~W.~N'G PARCEL ID NUMBER SW990410 ' 051-582-41 I THUNDERBIRD HEIGHTS I><J I ,OT 2,, BLOCK 4 I I EXISTING TRENCH GALLON ~ I SEPTIC TANK I I i DB~ 0 J EXI~ING FOUR ~ ~-.--.~ ........... -~-m~ BEDROOM HOUSE FCO 16.6 ~ 5.0 '.'.",.' }.~' .-~' ~/ .... . . ,'". ".',."',,~ ' ST1 ~6.5 ~6.5 ~ . ~'," '. 4'EXISTINO DRI~AY~ . '. · ~ ~ ' ,'-'-%~'-.'. ', "'.". f ST2 2~.7 ~9.2 K~ BOXI /~ DBL2 OF WATER LINE I THUNDERBIRD HEIGHTS SUBDIVISION; LOT 22, BLOCK 4 ~PE OF WORK: 'REP~ED FOR: PHONE NUMBER: ~~1~ orness. ~ BRYAN HUWE (907) '" DATE: F~WN By: SCALE: IPA~E: 11/19/99 K,D,W, 1 = 30' 2 OF 2 On-Site Se~ices Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~9-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 15, 1999 Expiration Date: Nov 14, 2000 Permit Number: SW9904t0 Legal Description: THUNDERBIRD HEIGHTS #3 BLK 4 LT 22 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Brian Huwe Owner Address: 24531 TEAL LOOP Chugiak, AK 99567-5113 Parcel ID: 051-582-41 Site Address: 024531 TEAL LP Lot Size: 19714 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] 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 ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. This permit is for a collapsed tank. Received By: Issued By: Date: Date: Alaska Water & Wastewater Consultants, Inc. 6901 DeBarr Road~ Suite 2B ~ Anchorage~ AK ~ 99504 (907) 33%6179 ~ Fax (907) 338-3246 Consulting Engineers November 15, 1999 Municipality of Anchorage Department of Health & Human Se~wices Division of Enviromnental Se~wices On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 Reft Septic Tank Replacement for Lot 22, Bk 4, Thunderbird Heights Subdivision. 24531 Teal Loop, Chugiak, Alaska. To whom it may concern: The existing 4 bedroom house is served by private septic system, and public water. The existing 1250 gallon septic tank has collapsed and must be replaced immediately. The excavator will crush and fill existing tank and abandon it completely. Attached is a 1" = 30' scale drawing which show the location of the new septic tank. There are no surface waters within 100 feet of the proposed upgrade. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. Sincerely, ~ ~ ess, P.E.,M.S. THUNDERBIRD HElOHTS I I LOT 18, BLOCK 4- ~ LOT 8, BLOCK 6 I I I LOT 19, BLOCK I LOT g, BLOCK 6 I ~ THUNDERBIRD HEIGHTS I I LOT =o, GLOCK 4` I I ~O~OS~O S~,C K UPG~OE. SEE WATER SYSTEM, PAGE 2 OF 2 FOR / I ~K~ BOX D~AILS LOT 11, BLOCK 6 I SYSTEMI ' ~""[~ '~- BEOROOg HOUSE ~UNDERBIRD HEIGHTS ~ ~ THUNDERBIRD HEIGHTS LOT 12, BLOCK 6 I I I LOT 23, BLOCK THUNDERBIRD HEIGHTS )]m m THUNDERBIRD HEIGHTS LOT 13. BLOCK 6 [ [ ~ LOt 2~, BLOCK ~AS~ WATER ~ WASTEWATER CONS~T~TS, ~C. ~o~ ~[~ ~o~, su.[ t~. ~c.o~o~, ~. **so4 ~r O~ A/~. LEGAL DESCRIPTION: THUNDERBIRD HEIGHTS SUBDIVISION; LOT 22, BLOCK 4 ~PE OF WORK: S~TE P~AN ~ . ~..~ P.~P~ED FOR: PHONE NUMBEm ,uw toov) 11/15/99 K.D.W. 1 = 100'~ 1 OF 2 I LOT 21, BLOCK I I EXISTING TRENCH~ . ~ ~ ~--PROPOSED 1250 I ,'~' /GALLON SEPTIC TANK ~ o INSTALL FOUNDATION ~ I o g OL~,NGUT 0 EXI~INO FOUR ~ ~-~.-..,~,~..j,,~ ...-:~"-~.~ . BEDROOM HOUSE I I I THUNDERBiED HEIGHTS ~ LOT 2~, BLOCK I ~AS~ WATER ~ WASTEWATER CONS~T~TS, ~C. .'... IH~D[RBIRD H[IGHIS S~BDIVISIO~; kOl 22, BkOCK 4 DESIGN OF SEPTIC TANK REPLACEMENT ~..J.~ ~REPARED FOR~ PHONE NUMBER: BRYAN HUWE (907) 457-5044 voA~..;. ~-79~ ..' /1 5/99 K.D.W. 1 = 30' 2 OF 2 Al;PT~C, Inc., November 1999 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B - Anchorage ~ Alaska 99504 Phone (907) 337-6179 -Fax (907) 338-3246 Onsite Wastewater Disposal System Standard Construction Specifications I. REFERENCE PROPERTY: Thunderbird Heights Snbdivision; Lot 22, Block 4 II. DEFINITIONS: 1. Property owner: The legal property owner or his/her representative. 2. Engineer: Alaska Water & Wastewater Consultants, Inc. or AWWC, Inc. 3. Contractor: The conrpany hired by the property owner to install the septic system. 4. A.D.E.C.: Alaska Department of EnvironmentalConservation III. RESPONSIBILITIES: Property Owner Responsibilities: 1. The property, owner shall cona'act with the conh'actor to perfornr the wo~ outlined in these specifications and plans, in accordance with A.D.E.C. "Certificate to Construct". There is no contractual relationship between tlre contractor and the engineer. The engineer shall inspect the work as, reqnired by A.D.E.C. to document the installation. Final acceptance &the contractor's work rests with the owner and the A.D.E.C. 2. The validity of the design site plan is limited by the accuracy of the as-built survey provided to the engineer by the prope~V owner or his/her representative. The property owner shall notify the engineer regarding any known inaccuracies associated with the as-built smwey. The engineer assumes no responsibility for the accuracy of the survey. 3. The propet~y owner is responsible for notifying the engineer of any unplatted easements, not shown on the as-built survey, which the new well or septic system may encroach into. 4. The property owner shall notify the engineer of any seasoual groundwater or surface water runoff conditions, kdmwn to him/her, which could potentially effect the operation of the septic system. The proposed septic system must be at least 100 feet fi'om any streams, ponds, creeks, swamps, bogs, or any other surface water as defined by A.D.E.C. 5. The property owuer is responsible for notifying the engineer if, to his/her knowledge, any of the adjacent properties are used as a duplex, business, or multifamily dwelling. The new holding tank must be at least 75 feet from any private well, 100 feet fi'om any class "C" well, and 200 feet from any conununity well, unless appropriate waivers are obtained. 6. The property owner and/or his contractor shall report to the engineer any observed condition which would put the septic syste~n in violation of State regulations. 7. Unless specifically agreed upon otherwise, the property owner is responsible for final grading of the areas which settle after construction. Prior to awarding the contract, the propm~y owner should communicate to the contractor any expectations regarding, but ~lot limited to, post construction site cleau-up, re-landscaping, and restoration of any asphalt, fences, trees, decks, etc. that are effected by the consm~ction. l of 3 AV/V/C, ]'nc., November 1999 8. The property owner is responsible for payment of all the engineer inspection charges. The number of inspections will vary depending on the actual field conditions encountered and the construction methods used. · Contractor Responsibilities: 1. The contractor is responsible for locating all buried utilities, easements, property lines, and surface waters; and shall ensure that all setbacks are flagged by a registered land smweyor prior to construction. 2. Construction shall be in accordance with the approved site plan and design drawings, and any special provisions directed by A.D.E.C. The contractor is responsible for notifying the engineer of airy discrepancies noted on the design plans or drawings, prior to starting work. The installation, materials, and workmanship shall comply with all applicable State regulations. 3. The conla'actor is responsible for field verifying the separation distances to all adjacent wells and septic systems, shown on the design drawings, prior to starting construction. Any encroachments that would effect the installation, for which waivers do not exist, should immediately be brought to the attention of the engineer. 4. Eusure that all materials being used are iu compliance with the most current guidelines established by the A.D.E.C. 5. The coniractor shall ensure that the septic tank, lift statiou, or holding tank purchased has a burial depth rating suitable for the actual installation. 6. Notify the engineer at least 24 hours prior to starting construction. If deemed necessary, a preconstmction site visit shall take place. The contractor shall coordinate with the engineer any inspections which will be required during weekends, holidays, or before/after nmanal wo~ing honrs (8:00 am to 5:00 PM). Tlre property owner may incur additional charges for inspections wbich do not occur during normal business hours. It is the cont~'actor's responsibility to notify the engineer a least 2 hours prior to any inspection. 7. The contractor shall report to the engineer any obsetwed condition which would put the septic system in violation of State regulations. 8. The contractor is responsible for final grading so as to ensure that surface nmoff does not adversely effect the septic system constructed, adjacent septic systems, or adjacent structures. 9. The contractor is respousible for obtainiug approval from the propm~y owner for any additional construction costs associated with design modifications or changing field conditions, prior to doing the work. · Engineer Responsibilities: 1. The engineer is responsible for inspecting the installation of the septic system and preparing as-built doculnentation, to the satisfaction of the A.D.E.C. Inspections are perfm~ned as necessary to document the construction of the system to the satisfaction of the A.D.E.C. 2. The inspecting engineer has no direct authority over the contractors activities or construction practices. Should the engineer identify conditions which dictate a design change, he or she may recommend that work be stopped,, and/or the design be modified. If design modifications are necessary, the engineer shall notify the property owner or his/her representative. 2 of 3 A 14'WC, Inc., November 1999 IV. CONSTRUCTION GUIDELINES: · General Construction shall be in accordance with the approved site plan and design drawings, and any special provisions noted by A.D.E.C. All materials, components, and conslruction practices shall comply with the A.D.E.C?s latest ordinances regarding wells and septic systems, as well as A.D.E.C. policies. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such a deficiency. · Septic Tank, Holding Tank, or Lift Station Installation: 1. The burial rating of the tank shall be adequate for the actual burial depth encountered. 2. The tank shall be level and sufficiently bedded to prevent sei~ling or shifting of the tank. 3. All standpipes on the tank shall extend a minimum of 12 inches above final grade. 4. Tanks installed with less than 4 feet of cover shall be insulated. 5. The sewer service line from the facility to the tank shall be sloped a minimum of 1/4" per foot, unless prior approval is obtained from the engineer. 6. The inlet and outlet lines from the tank shall be bedded in drainrock or the soil shall be adequately compacted to prevent fnture settlement of the soil. 7. A foundation clean-out will be installed, 1-4 feet from the structure, if one does not cun'ently exist. 8. All tanks shall be anchored to resist buoyancy forces in high groundwater areas. This applies when there is not adequate soil cover to resist buoyancy forces. Engineer shall make this determination. 9. The final soil cover shall be graded so that there is positive drainage away fi'om tank. 10. All holding tanks and lift stations shall have an audible and visible alman inside the residence. 11. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electr'ical Code. 3 of 3 t MUNICIPALITY OF ANCFIORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage. Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME -°~ PHONE NEW LEGAL D ESCRI,PTION ..X~ . J] -~ /', LOCAT( ;"'X I Well / I Absorpti~ar~a Dwelllnn- ~, Manufacturer ...:.--.. -., ~ .~, Mated, .~ . No of come, eh s ~ Liq. capacity in gallons Inside length Width Liquid depth , ~ Well Dwelling PERMIT NO. S Well/X Foundation ~ Nearest lot lin~() (' J PERMIT NO.~ Length Width[' Depth PERMIT NO. ~ ~ Type o~rib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ OISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line SePtic tank Absorption area(sD DISTANCE TQ: OTHER PIPE MATERIALS SOIL TEST RATIN~ 0 {~'1 DATE LEGAL APPROVED 72-013 I 3~78) PERI'ii T NO. RF'PL IC'RNT LOCI:If I O1',1 LEdlAL dj. 5. K. C'ONST, 5;RFI RFIVENS LF'. LOT R;:2. BLK 4 TI'-It,,INDEI,;~[~IRE;' NTS. 6::L0,5 R'".T¢ PRLHE:R RI*',. LOT SIZE TYF'E OF SOIl. FIBE';ORPTION .'.E;YS'f'EM IS: TRENCH MRN);MUM NUM[.4ER OF BEDF,".OOHS = SOIl.., RFrT'INI:] ES;6! F'T,.'8t[~)~,, ~0 I"HE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I$: I'HE LEN~'.ITH DIMENSION IS I'NE LENCfT'H ,'.:IN FEET.',, OF THE TRENCH OR DRRINFIEI,..D. THE DEPTH OF [~ TRENCH OR PIT IS TNE DISTRNCE BETNEEN I'ME SURFACE OF THE 8ROUND RI'4D TNE BOTTOM OF THE EXCRVFtTION (IN FEET). THERE IS NO SE'T P,IIDTH FOR TRENC:I4ES. 'THE (tRRVEI_ DEPTH IS THE MINIMUM DEPTH OF 6RFIVEL BETI.IEEN THE OUTFFlL, L PIPE RND TME [3OT'fOM OF THE EXCRVF~TION <IN FEET), PERMIT f-IPPLICFtNT HFIS THE RESPONSIBILITY TO INF'ORM TFIIS DEPF:IRTMENT DURf, N8 THE INSTFILLRTION INSPECTIONS OF RNY t4ELL2.1 R[:'JRCENT TO THIS PROPERI'Y FIND TME' NUME)ER OF' RESIDENCES THFIT 'THE HELL HIL. L. SERVE. ................ TI,-,IO (: ;;;:.] ,'.'> ~t: I'-,L~!;ll:"EOl''' BF:IC'KFIL,L. INC'i OF FINY SYSTEM 14II"HOIJT FINFll,,, INSF'E'CTION RND FII)PI~OVRL Et¥ THIS DEPf:IRTMENi" NILL, BE SUBJECT TO MINIMUM DISTMNCE I~ETI,IEEN A HELL. FIND [,'4NY ON-SITE SEI*IFIC~E DISPO~;FIL SYSTEM IS ~,OO FEET FOR FI PRIVFff'E HELL OR 2.50 TO 200 FEET F'ROFI R PUDL, IC I,,IEELL DEPENDING UPON Tt4E TYPE OF PUEII,.It]: 14Et,.L MINIHUM DISTRNC:E FROM R PRIVFITE NELL TO FI PRIVFITE SEI4ER LINE IS 25 FEET fiND 1'0 F4 COMMUNI'FY SEHER L. INE IS 7.*'5 F'EET. OTHER REQtJIREMENTE¢ MAY RPPLY. SPEC:IFICRTION.S ['aN[) CONSTROCTION D.I:RL"]RflMS FIRE RVRILFIBLE 1'O INSURE PROPER iNSFTRLLFrrIoN, CERT IF'Y THAT I ElM F;'FINILIRR HITH THE REOUIREMENTS FOR ON-SI'I'E SEHERS FIND HELLS AS SET I FORI'Et DY THE MUNI¢IPRLIT"? OF RNCHORRqE, 2: I HILL. INSI'FILI,, '1't4E 5YI:5'EEM IN FICCORDRNCE WITEt THEE CODES. ;]:: I UNDER~5'T'FIND TNR'T TttE ON-SITE SEHER E';YSTEM MR'¢ RE~QtJIRE ENLt:tRqEMENT IF 'THE RESIDENCE IS RE~MODEI.,ED TO INCL. UDE MORE 'f'HRN 4 BEDROOHS. (") z, ,~.' B// ~ / .~' /' /./'~ J/.'2/ fl2~,'/ '='F E'"' "/ ~ ~ '" ' " ' _I~N..~......_..~__, ....... .~ ........ ,,. ..... ,~.,,_,¢.,.~..,..,:.,..~,. .......................... .-,./- ,,, ., .-/ x --, ', ,....<.,E,:, ,.~,4~.~.,....~_~ ....... ~X-~,..-~-~'.-.~-.:%---'.'"'E,,. ...:,./..._~ / ,,.~.. ,'.., (.,,' ,. .... ,: / / O & E ENG.NEERING & DEVELO~ MENT CO. Russell Oyster 694-2774 Performed for: Name: ,~E Mailing Address: Legal Description: Box 90, Davis St., Eagle River. Alaska 99577 694-2774 or 688-2280 SOIL LOG Tel. No. Earl Ellis 688-2280 Depth (feet) Soil Characteristics 0 1 2__ 3__ 4__ 5__ 6__ 7__ 8__ 9__ 10__ 11__ 12 13__ 14__ 15__ 16__ PLOT PLAN PERC. TEST Ground Water Encountered: Yes__ No r If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 vnNw.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O-~ I - t~--- - t~ ~ 1. GENERAL INFORMATION Complete legal description. Location (site address o~' directions) HAA# Expiration Date: Current Properly owner(s) Mailing address Lending agency Mailing address Real Estate Agent .,.. ~. I'~ 5 ~'~I "~C-~. A L I~'1° Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ 3, TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class A Well I~£ltlS~, Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank . [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representaticns given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authcrity 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 served by a private or Class C weft and may be reissued with new water sample results less than 30 days cld. (Ce.'lificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not respcnsible for errors or omissions in the professional en[;ineer's work. e STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verif7 that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(ara) 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 inspect[on, the on-site water supply and/or wastewater disposal system Is(are) in compltance with all applicable Municipal and State codes, ordinan(Jes, and regulations in effect at the time of installation. Se Name of Firm Address ~a, .~ ~ Engineer's Printed Name SP~'~/~.hAN~3 ~-~ Phone ~7~-~.~/~ ~t~.~ Date. tkx~%~ .' '" · ?~[~ ~"4 ~ ~.~,.. .~= ~ .ENGINEERS . h~Hrnnm~_~,e(~, ..... ~.q~xh~~ bedrooms, with the followin~ stipul,tions: DSD SIGNATURE Approved for Disappr(~ved. Conditional approval for Additional Comments Attachments: HA.& Checklist Septic System Advisory . Well Flew Advisor7 X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Soulh Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (so?) 343-79o4 HEALTH AUTHORITY APPROVAL CHECKLIST LogalDescription: L~ ¥'q ~I~HT-~ 12...~ ' ParcolID: O~l"~'~-'~q/ A. WELL DATA Well type Date completed Total depth __lt. Date of test Static water level Well production If A, B, or C provide PWSID # ~///~'G Well Log (Y/N) . Sanite~ seal (Y/N) FROM WELLLOG ~ AT INSPECTION ~Jlt. g.p.m. Wires property protected (Y/N) ~ height (above ground) g.p.m. In. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ Tank size ~ gal. Number of Compartments Co Foundation cieanout (Y/N) __~ Date of pumping ~'~/~/ O ! ABSORPTION FIELD DATA Date instelled 'Ol~,/~'[ Length /.~Z ~'-- ft. Other bacteria Depression over tank (Y/N) . . colonies/100 mi. Soil rating (g.p.d./~ or ft2/bdrm) ~O Width '~ lt. Date installed [~!I~1 ~ ~ el Cteanouts (Y/N) ~ High water alarm (Y/N) ~1~'/ Tota depth7_ / · ~Ot~ Moflitorinotube lt. Eft. absorption area Date of adequacy test ~ Results (Pess/Fail) Fluid depth in absorption field before test ~ in. Water added<~g~gal. Elapsed Time: fmin. Final fluid depth ~)~ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type ~ Gravel below pipe /'~ ft. Depression over field I~ For y bedrooms New depth ,~in. Absorption rate >= ~,~'-~ g.p.d. If yes. give date J D. UFT STATION Date installed "Pump on" level at in. Datum Size in gallons ~ Manhole/Access {Y/N) off' I~el~ in, High water alarm level at 'Pump Cyclos,~gted Meets alarm & circuit i~quimments? in, E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation I// Holding lank Properbj line ~/O Watermain ~,,~) I Water service line ~' ~O Wells on adjacent lots ~ ~.g~-¢~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line J O I Water Service line ~' ~ Curtain drain ~ 1 {~ Absorption field Surface water Building foundation I Surface water ~ Driveway, paddng~ehide storage Wells on adjacent lots ~, F. COMMENTS (3. ENGINEER'S CERTIFICATION '"~" -' . -. · I cerdfy that I have determined through field inspectJons and ...... ' review of Municipal recoMs that the above systems are in ~'~ conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 14.~ Date ~',~., · ' - · HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) £oo 'o%¢ 7 Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE ~'" ' 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 FAMIL~ DWELLING 1. GENERAL INFORMATION Complete legal descri prior L~oT' Location ~site address or directions) property owner I~i;i'ii~g address _ Lending 'agency ~iling address Agent ' ~'~ Address' ' Day phone Day phone '~1~ ~, Day phone Unless otherwise requested, HAA will be held for pickup. · 2. NUMBER OF BEDROOMS: /'TZ 3. 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. 72-025 r, Rev. 1/91) Front MOA#2~ 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. Phone Date SIGNATURE D,~S Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with th'e' following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. RECEIVED Municipality of Anchorage OCT 18 1999/ DEPARTMENT OF HEALTH & HUMAN SERVICIL~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 843-4744 Health Authority Approval Checklist Legal Description: 'J JOND £BtP..'P lA- le t~'VcTE) ~ Parcel I.D.:. O~ I" ~-~,.' L.lf I Weil type ~ If A, B, or C, attach ADEC letter. ADEC water system numbei: c.~.lJJ Log present (Y/N) Total depth Sanitary seal (Y/NJ Date Of test Date completed Cased to. FROM WELL LOG Casing height (above grouna] Wires properly protected (Y/NJ. AT. INSPECTION Static water level ' ' Well production . g.p.m, g.p.m. 'WATER SAMPLE REsuLTs: O01ifo~"n Nitrate .,/ Other bacteria Date o[ sample: ~ Collected by: B. SEPTIC/NOLDING TANK DATA · Date installed'. I~,.~.~ - Tank size' :~/,P..~C) ' Number of Compartments ,~. Cleanouts (Y/N) ~" I , ' r Foundation cleanout (Y/N) ' . ~1 Depression (Y/N) /~ High water' alarm (Y/N) '. ? ~ Dat~ Of Pum~i~ "':~d/'~/~ cJ'~ "~'u,,,.et: C. ABSORPTION FIELD DATA . · Datein~tall~H '~ 10'~¢5'o"~[ Soil rating (g.p,d..uP,~3rff3/bdrm) · ~) Systemtype Length. /.-/~"~ Width '.~ Gravel thickness below pipe' ~ /-~: Total depth t~ Effective abs?rption area ;'~ ~ Uonitofingmube present (Y/N)'Y Depression over field (Y/N) 1~ Date of adequacy test ' !O/l~l/~ ,esults(Pass/F~il) ", ~) 'For ' J-/' bedrooms Fluid depth in absorption: field befol;e test (in.);' i ]' immedlately after.~O0 gal. water added (in~)~ L:~,,) · ~ ;q Fluid depth I1 (ins)Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption ra, te =' '~.,../2~D-~ q,p,d. , if yes, give date' I ~ D. LIFT STATION Date installed Manhole/Access (Y/N) High water.alarm level at* Cycles tested , Size in gallons "Pure'on" level at* *Datum "Pump off" level at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT.~ . Sep{ic/h01~ling tank oh lot / .On adjacent lots Absorption field on lot /' On adjacent lots Public sewer main / Public sewer manhole/cleanout sewer/septic service line /' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ' ~/~ Property line ~ '~' Absorption field'~ Water main/service line ,,~-,~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line J ~ Building foundation ~/-~ Water main/service line Surface water ~ l ~) Driveway, parkingNehicle storage area Curtain drain I"~ -I p Wells on adjacent 10ts . ~ '.~ Wells on adjacent lots ,,~ · ..% O + F. ENGINEER'S CERTIFICATION . I certify that I have determined thru field inspections and review of Municipal in confo, rmance with MOA H~e, lin~ ~n effect on this date. ~ignat~r~ Engineer's Name -'~'o/~' ~o '~ Date are HAA Fee' $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $. Date' of Payment Receipt Number ~.. MUNICIPALITY ~F ANCHORAGE ;/~'[%.. , ........ DEPARTMENT OF HEALTH & HUMAN SERVICES':! "'?~i'~li~ :,~;~'?' :.-".:' - ..... ~, ~On-S te Se~ ces Sect on ....... . .~ ,. " ........ ,~.~ A'PPROVAL FOR A SINGLE FAMILY DWELLING ~dd Loop (site res~ or'directions)"-~? ~4551 T~ :. 5. STATEMENT OF INSPECTION BY ENGINEER :,v,"~/~ .:~.'~, ;: - : .::v;:.~* '.'..~ · . .::}..'. '* ' As certified by ~y seal affixed hereto and as of ~[he val[dat on date shown'b~low, I veri~ that m~:,: investigation of this Health Authority Approval application shows that the on-s to water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. ! further verify that based on the nformation obtained fr0m 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 n,effect on the date of this inspectionS,~'.'' ................. ' ~'Z'. ,'~'"~ ''~ ~ ~: ~:~',:''.~'.'r'~' Name of Firm =:: ~;~,~,u~ ¢' r ' ' :, .,. Pl~one.L ~.~:~i~._~."7 '~ -- . -~- :- - _ 17034 F~,,gle Rlv~ Lee~ Read No, ~104 .......... · -..-: ,, .. ,, Engineer's signature -:: ~--~~'~ 'd.c'-2,d-~,..-~ Date' ..': Date D · ' ...... ~e,~ of. H~' .. tod Human' Se~i~es' (DHHS) i~e~e~it~.;~t'~';' ':::'' · . ,:based only up0n~the~?~[~.~tafi0ns given in paragrap~ 5 ab0~".~n:ih0ePen~nt"~;; . . ~r[egistered ntheS~eof. Alaska.~heDHHSdoesthisasac0~es~t0~ha~ofho~ '~::'. '. ~ inst~i~s 9~de~o~ptis~.c~i'~e~aJ'~dstatprequ rpments Em'p 9y~D~HSdo~ot-." ' r co,duct inspectlons:o'r:analyz~'data be~ore'a~-dY~at~' S' ~ued: The M~'~pa ~of"Ah~h0~g~ Snot"" .. res~ons~.,e errom oro~ons in the professional engmeeFswork.·: . -': :;."': . ~ . ' . - · 7=~(~,~1) ~c~ ~oA~?~.,;"' .- .... . ; : , .:. - .,,,..~-- Municipality of Anchorage Department of Hea~lth :and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~o'/'~ Z /~,~- ~/ .Parc. el I.D. A. Well Data Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow ~ If A, B, or C, attach ADEC letter, ADEC water system number Date completed Driller to _ Cased Wires pro~e'~/(Y/N) FROM WELL LOG-- / AT INSPECTION~ g.p.m, g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~--~, c:> t ~ ; On adjacent lots Absorption field on lot -z~ ~ ; On adjacent lots Public sewer main Public sew~ol]t Sewer service line P.~jrelea~m tank WATER SAMPLE RES~ Nitrate Other bacteria Coliform Dalo o~sample: Collected by: Cleanql~tsl~N) ' ' V High y/ater alarm (Y/~ B. SEPTIC/HOLDING TANK DATA Date installed' ~ D ~-~ '~,~ ~;- g I Tank size ~ 7~¢'-~ Compartments ' ' '. Foundation cleanout ~ ~ Depression (Y./I~ i !i ,~"(/A~ Alarm tested (Y/N) Date'of pumping - 7.-/,. -~ '~,-~--- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) or;~lOt ,,' :/~ On adjacent lots ~-~o To property line / c> ! ~' Absorption field ~ ! Surface water/drainage /~o I-~ Foundation / '// Water main/service line 72-026(3/93)'Front : . ,, ·, · , CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N). "Pump on" level at "P~ High water alarm level Meets MOA electrical codes (Y/N) SECTION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/FF) ~'o ~/~'~,~-. System type ~'~,-/g/-/ Length z~.~ / Width .~ ' Gravel thickness. Total absorption area ~'~-r) '~ Cleanout present (~N) Date of adequacy test 7- X ~/_~..5~ Resultsd~ail) Total depth Depression over field (Y~[[~ ,,J for z/~ Bedrooms After test / If yes, give date Water level in absorption field before test ,/ ~ cd ~{ ~ Peroxide treatment (past 12 months) (Y/N/N/N,~~ ~ ~-- /~,~o ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ To building foundation On adjacent lots ~ ~ J'' Surface water. /~O / ~ Curtain drain '~'~ fA- 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~PC:~ct/bn. Signature Engineers Name Date / //~ / ~ j e, ...-,.,. ,,,~ HAA Fee $ ;~ ()d~ , '''E~ Waiver Fee $ Date of Payment '/7.. -/-'/-- ',2~ Date of Payment Receipt Number ,/[ Oz~/. ("?L~ ,,~ Receipt Number 72-026 (3/93)' Back 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 May 12, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 22: Block 4~ Thunderbird Hei,qhts. Subdivision Location (address or directions) ___141 Teal Loop (b) Applicant Name ~o.y M~Whorter Telephone; Home 688-2444 SR 2, Box 141, Teal Loop, ChuBiak, Alaska Applicant Address Business 99567 (c) Applicant is (check one): Lending Institution I-i; Owner/builder [2~; Buyer []; Other [] '(explain); (d) Lending Institution Alaska PatiO__ Address F.c&g£e. Rive. r: Alaska ATTENTION: (e) Real Estate Company and Agent none. Address Telephone Betsy Gardner Telephone (f) ~e HAA to the following address; S & S Engineering gRB 196X Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] Public'~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [~ Holding Tank [~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 01184) Page' 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal alfixed 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, 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 end 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 & S I~NC-INPERING Telephone ~ ~' ,'~'~- ~ ~ ~;~ Address SR B 196X Date EAGLE RIVER, A1(99577 HAY 1 4 1986 DHEP APPROVAL Approved for Approved ,.~' bedrooms by . Disapproved 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 (t 1/84) WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Dista.nces from Well: To Septic/HoMing Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~CC¢,)~Lc:::.c~L:~,c~r-~ bt, c;. MUNICIPALITY OF ANCHORAGE (MO~,i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUN,a.AmY o~ ANC~I~° ENVIRONMENTAL PRO~N~u;~; ~j'~ MAY ~ S lg8~ R E C E i % [ D c, D.E.C. Approvod~,~) Date Oompleted Yield Depth of Grouting ~ / Pump Set At /~ Sanitary Seal on Casing (Y/N) ~ ' Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ ]-F ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B, SEPTIC/.H~L-DtNGrTANK DATA Date Installed Standpipes (~N) Air-tight Capsd~N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /"J/,A! Separation Distances from Septic/Neldim:.:j. Tank: To Water-Supply Well To Property Line To Water Main/Service Line~ Course. /°/A Size t 7-'¢5Z-~ No. of Compartments Foundation Cleanout (Y/Z¢~. Date Last Pumped ~1- ¢..'Z. ; for Temporary Holding Tank Permit (Y/N) To Building Foundation 1 ¢ / To Disposal Field 'g~ ' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~.c:~ ~ ~- Width of Field Square Feet of Absorption Area '2~L¢° Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~--¢~'~ A- To Building Foundation ~'~' Lot ~[A To Water Main/Service Line Type of System Design Length of Field ¢¢'~ ~ Depth of Field '-~ Gravel Bed Thickness ~ ! Standpipes Present ~N) Date of Last Adequacy Test To Property Line 1o · To Existing or Abandoned System on ; On Adjoining Lots / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & $ ENGINEERING Date SI~ B 196X Company F~AGLE RIVIng,, AK 995~MOA NO. Receipt No ,~,~ C. (~C} Date of Payment -~ ~'- ~ I%~-%~ Amount: $ (¢~ Page 2 of 2 72-026 (H/84) ANCHORAGE/WESI'ERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BIlL SHeFFIELd), GOVERNOR 7blephone: I907} Address: 274-2533 DATE: May 12, 1986 PWS I.D.# 211156 To Whom it May Concern: According to eecords 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 ~ DATE F~CEI V ED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~ INSPECTOR I NSPECTO R INSPECTOR MUNICIPALITY' OF ANCHOgAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H~,,'.LTII ,% 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~'F~I~!o,~MENTAL PR©~ECTION 825 L Street - Anchorage, Alaska 99501 MAR '1 0 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 D g Ct REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~'F~III'~I~'S~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. I. PROPERTY OWNER PHONE Alaska Bank of Commerce 264-5436 MAILING ADDRESS Pouch 7012, Anchorage, Alaska 99510 Att: Barb Catalino PROPERTY RESIDENT (If different from above) PHONE Robert P. and Nancy C. McWhorter 264-5411 work 2. BUYER PHONE Robert P. and Nancy C. McWhorter 264-5411 work MAILING ADDRESS Star Route 2, Box 141, Chugiak, Alaska 99567 3. LENDING INSTITUTION I PHONE Alaska Bank of CommerceI 264-5436 MAILING ADDRESS Pouch 7012, Anchorage, Alaska 99510 Att: Barb Catalino 4, REALTOR/AGENT I PHONE I MAILING ADDRESS E. LEGAL DESCRIPTION Lot 22, Block 4, Thunderbird Heights Subdivision STREET LOCATION NHN Raven Loop, Chugiak, Alaska 99567 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUB LIC UTI LITY depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM [~] INDIViDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY 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 .I~]'~SI NG LE FAMI LY [] ONE ~"~E [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL E~/''COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER E~eptic Tank or [~]Holding Tank Size: ~ ~.-,.~0 If Tank is homemade SOILS RATING give dimensions: ~ ~.-.~ TYPE OF TANK MANUFACTURER ~ TOTAL ABSORPTION AREA MATERIAL,~....~- '~.~,j,~.,~ 4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~ APPROVED FOR --~ BEDROOMS [] CONDITIONAL APPROVAL (Petter must accompany certificate) [] DISAPPROVED 72-010 (Rev, 6/79} iNSPECT~ ~,~ ~OiNTMENTS D,.. E RECEIVED TIME ////~ TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES / DIRECTIONS: Complete all parts o, page 1. Incomplete requests will not be processed. PJease allow ten (10) days for processing. 1. PROPERTY OWNER PHONE GSK Construction 745-2553 MAILING ADDRESS SRA 6105 A-3, Palmer, AK 99645 PROPERTY RESIDENT (If different from above) PHONE 2. ~UYER PHONE Robert & Leslie Gross 243-6577 ~IAI LING ADDRESS 3433 W. 79th Ave, Anchorage, AK 99502 3. LENDING INSTITUTION PHONE National Bank of Alaska MAILING ADDRESS Corporate Headquarters 301 "C" Street, Anchorage, AK 4. REALTOR/AGENT j PHONE Totem Realty, Inc./William J. Schle~eJ 272-0571 MAILING ADDRESS 724 E. 15th Ave, Anchorage, AK 99501 §. LEGAL DESCRIPTION Lot 22, Block 4, Thunderbird Heights STREET LOCATION Raven Loop 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [] iNDIVIDUAL* * ATTACH WELL LOG. A well lo§ is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth {attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** 198l 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 [] SINGLE FAMILY E~] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DR I LLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I N D IVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY / ~j ~ Connection Verified INSTALLER []Septic Tanl~kor []Holding Tank Size: !.'[-_~~'~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~""~APPROV E D FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY 72-010 (Rev. 6/79)