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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3A BLK 4 LT 16Thunderbird Heights #3A Iot16 Block 4 #051-582-44 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191010 PID Number: 051-582-44 Dwelling: ® Single Family (SF) ❑ Duplex (D) [' Multiple (SF and/or D) Project: [' New ® Upgrade Name: ABSORPTION FIELD - EXISTING Jack Nims & Jessie Wade Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 24723 Teal Loop, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. THUNDERBIRD HEIGHTS #3A 4 16 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. -- -- Ft. To Septic Absorption I Holding Sewer Total absorption area s Number of trenches Dist.between trenches Lift Station Ft From Tank Field Tank Line -- -- Ft. Well 200+ -- -- NA -- TANK ® Septic El S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- -- NA Anchorage Tank 1250 Gal. Material Number of compartments I Steel 2 Lot Line 5'+ -- -- NA NA LIFT STATION Foundation 10'+ -- -- NA Manufacturer Capacity Gal. Curtain Drain NA -- NA NA Pump on level at Pump off level at High water alarm at Remarks Old ST decommissioned and new 1250-gal Septic Tank installed per code. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer Dirtworks drainfield Drainfield CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspection 1 1/17/191/18/19 Location and description dates: 2" 3rd 4°' Bottom of Siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En in OF Az \ Conditional Approval: Date A�`�� 6, IT l / X 49TH' 0 -� �✓'� / KENNETII ,Sa FFUS / I ''''',,,t, 71 k ^I Q ` o i .42 / °,i Approved 1 ( tti...,--------------7:- /e- ( Date }—z /l X °P• pf.: stO�a� .i J — Ilk Nqk '11111.-'41P. eer's Stamp Inspection Report_9-1-12.doc AS-BUILT SYSTEM DETAILS/SITE PLAN Permit OSP191010 THUNDERBIRDS HEIGHTS #3A BLOCK 4, LOT 16 PID#051-582-44 OC 2.0 0 WATER LINE L X M = .. `�: � o 3-BRHOUSE M S Y ST. '�� PTI C ) N -BR SE 4 Asphalt II • 39.0 ti Nisismastiria 06 2.0 OH 'p,,,,tLot 16/Al M1I1 �1 i/!\mow f>7��1\ W r:�r A g. BI 43 SUMP EXST. FIELD FCO hain lir COs oD Co co CO CO M NEW 1250-GAL S.T. SCALE: 1"=20' 100.81 100.2 A-C=20.3' s B c=22.s' WE8 rid rid A-D=18.2' 7 . u -- FINAL GRADE o =' _ B-D=30.0' o VARIES Cr g 1250-GAL os J N SEPTIC Q TANK EXISTING FIELD 94.78 94.61 �F \\ SCALE: NTS Az A / <S� • , .6. 1 PREPARED FOR: ROTE j?� /��. `', „7 , JACK NIMS&JESSIE WADE a°1 ��AVI4.\� fs% * 9TH iN * + 24723 TEAL LOOP r - - / / CHUGIAK,AK 99567 a- �Milli\ 3 / KENNETH M. D ' S / FIELD BOOKS COMPUTED: Z 1111111111111 Q ` Ilk.'. CE-711 W / BOUNDARY:BOUNDARY DRAWN: BMW > 1112 �/A�=:�1j 1 Lam- tiQ`:, STAKING: STAKING CHECKED: KMD ! • �5: •ar 2 •'1�°' 1 s V-9.'?/. /..„A,F SSIO� " ASBUILT: WAL DATE: 01/22/2019 ` ,� '�...4�9C- \ X60 \ DNC. FILE: GRID. C Com., C '�l �`__� NW1865 F-,P°NSULnNG • , 6`90 ACAD FILE: FILE No.: 19001 FR• AK. 99577-613 0 MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program � 1 -N.d`1 PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite . 1)(1mi-uncut 4 NCR ORA�'� On-Site Wastewater Disposal System Permit Permit Number: OSP191010 Effective Date: 1/10/2019 Work Type: SepticTank Upgrade Expiration Date: 1/10/2020 Tax Code Number: 05158244000 Site Legal Address: THUNDERBIRD HEIGHTS#3A BLK 4 LT 16 G:1865 Site Mailing Address: 24723 TEAL LOOP, Chugiak Owner: NIMS JACK A& Lot Size in Sq Ft: 22172 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 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 Special Provisions: The new septic tank shall be at least 10 ft from the building foundation or outside the soil bearing prism of the foundation. Received By: , J f l / i Date: -1/ / / '( 1 1 ) 0 (9 Issued By: j`, JjUl e Date: r Jr. • MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water& Wastewater Section — f Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. (957– in (77 Property owner(s) Jct !V l WtS > IA)a)- , Day phone Mailing address „-/72 3 re/L�Dp y rA4 _,t, Site address /,, 1 Legal description (Subd., Block & Lot) Mu., �O /SIS ' 3A z 'u� 7 joi Legal description (Township, Range & Section) Lot Size po� /7� Sq. Ft. Number of Bedrooms '/ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) fgi (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ • 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 •s /r or authorized agent) Permit/Rush Fees: O�aJ Waiver Fees: Date of Payment: if Wig Date of Payment: Receipt Number: QR1251) Receipt Number: Permit No. OS Pig IOI t Waiver No. G:\Development Servlces\Suilding Safety\On Site Water and Wastewater\Forms\Client Forrns\Permit Application.doc • 01 tsRCTE RRq • � ARC ERRA CONSULTING, INC b " 212 E.51st Ave,Anchorage,AK.99503 NGS Office(907)868-3791, Fax(907)868-3793 cf 4,,,g4g Y7iNG. del cusp-• January 9, 2019 Municipality of Anchorage Development Services Department On-Site Water &Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit—Thunderbird Heights #3A, B4, L16 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 4-bedroom house. The adjacent lots are served by public water as noted on the design. 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 868-3792/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. A)ii) fliW , 00e1V erne i ► 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 WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN THUNDERBIRD HTS. #3A BLOCK 4, LOT 16 N Shed Gre LINE LOC, cr , OX. WATER APPR 2.0 0 Ill = .. _ 58.0 0 a) 4-BR House .. Asphalt :',. > :,.: Asphalt 39.0 Noragasisignit LP ca 2.0 ( Lot 16 i .o ,,w , , N FCO d' 23.0 PPR _.,_ ADD COs \ COs EXIST. FIELD " ° ° SUMP DECOMMISSION EXISTING S.T. PER CODE oi & INSTALL NEW 1250-GAL SEPTIC TANK "' 10' FROM FOUNDATION, 5' TO FIELD ADD FCO. & PROPERTY LINE. N89°58'50"W 197. 14 Scale: 1"= 20' NO PUBLIC WELLS WITHIN 200'OF PROPOSED SYSTEM. PAGE 1 OF 1 NO PRIVATE WELLS WITHIN 200'OF /� PROPOSED SYSTEM EXCEPT AS NOTED. DESIGN DETAILS NO SEPTIC SYSTEMS WITHIN 200'OF PROPOSED WELL EXCEPTAS NOTED 1_INSTALL 1250 GAL SEPTIC TANK& INSULATE TANK IF<4'COVER. 2. MAINTAIN 10'FROM FOUNDATION,5'FROM EXISTING FIELD&LOT LINE. 3. CONTRACTOR WILL ENSURE MINIMUM 2%SLOPE INTO SEPTIC TANK. 4 CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT .. '6.--1"."‘N, WELLS,SEPTICS EASEMENTS,PROPERTY LINES,ETC... <Sv O•F 1 4 1 PREPARED FOR: .ROTER �� JACK NIMS&JESSIE WADE ti A -q P I� V 24723 TEAL LOOP ''Q' �/��`\ sem,, * .4 ••TH 'z * 1 CHUGIAK,AK 99567 ss. 1-C- 41° / • llE)l•3II11I11 / •' KENNE D ' S FIELD BOOKS E J x %1 .. . .� 11�1�' .11 1 � - w BOUNDARY'BOUNDARY °RAWN: BMW Z '� �I N 1 `!' ,A.�r/ ti� STAKING: STAKING D"Eacm: KMD • �`a `Wig',� '1" . // I•yAL-,� ASBUILT: WAL DATE' 1/9/19 -4�9_. \ ',/�/ 0�� ``_� DWG. FlLE GRID: NW1865 c`s"7!-O'SULTING , l�6`-- ACAD FILE FILE JOB No.: FR' AK. 99577,073 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ z Manufacturer Liq. ca~i~ns IF HOMEMADE: Inside le~gth Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. No. of lines Length of e~ ~e ~ Trench width ~ ~ ~ inches Totaleffective rptionarea Top o~tile to finish grade Material beneath tile Length Width Depth PERMIT NO. m~-"~ Type ofc~-~ 3ribdiameter ~ DISTANCE TO: ~ Class Depth Driller Distance to lot Jine PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS APPROVED ~ , DATE LEGAL 72-013 (R~ 3/78) PERMIT FiPF!._ i CF!NT L.OCR-I' ! ON LEGRL STEYEN L. SKRGGS F'O EK]X D CHUGIAK THLiN[)ERE'. I RD HEIGHTS Eta] El,4 THONDERBZRD HEIGHTS LOT SIZE 200F~0 SQURRE FEET 'TYPE OF: SOIL RBSCIRP'Fi. Ohl :-]"?STEM IS: ]"RENCH MR::4iMUM NUMBER OF E:EE:,ROOMS = 4. ':'";OIL. RRT!NG (SL-.-! FT/E:R)= t;2!.-', THE REQUIRED SIZE OF THE SOIL FIBSORPTION S'YS'TEM IS: THE LENGTH [:,IhlENSION IS THE LENGT'H <IN FEET) OF: THE TF:'.Eh!CH OR [:,RF~INFIELD. THE DEPTH OF' R TRENCH OR PIT IS THE DISTRNCE BETNEEN TH, E SURFRCE OF THE GROUND laN[) 7'FIE BOTTOM OF THE E,'.':;E:FI',,,'RTIE~N (!N FEET). 'THERE IS NO SET !4iE.',TH FOR ]"RENCHEE;. THE GRR\,'E[L [:,EPTH I~ ]'HE hlINIMUl'"t DEPTH OF' GRFI',,,'EL BE'T!.,.!EEI".!, ]"HE OUTFRL. L PIPE Ri'.,l[::, TFIE BOTTOM OF THE E::':,'C'iaVRT:(ON '.':If',! FEET). F'ERMIT FIPPL. IC:RNT ..'--IFIS THE RESPONSIB.ILIT'Y TO tNF(]Ri"I THIS [:,EF'RRTMENT DURING THE !NSTRLLRTION iNSPECTIONS .,"_'!Fi' Rf',!',/ NELLS FIDJ'F!CENT TO THIS F'ROPERT'.r' RND THE NUMBER OF RESIDENCES THFIT THE HELL P, IILL L=;ERVE. .............. 'T il.-.!t C3 ( ;~2: .'."', :E P-~ ~E'; F' E: C: '3', '" Z CD ~'..~, ::~; f.~ E'~-" E] ~--~: E] ~Z=.:~ bil ][ !f-'~.-:_" E] E::~ ........ 8FICI<F!LL. ING OF RN'¢ S'-¢STEM HtTF!OUT F]:NF..'L INSPECTION FIND' FtPF:'RO',,"R[.. E:'¢ THIS E)EPRRTMENT NIL. L E:E SUBJECT "FO PROSECUTION. MiNiMUM DiS"t"RNCE BETWEEN R [4EL_L FIi",!D RN"r' ON-SITE SE!.,..IRGE DISPOSRL S'¢~TEM IS :[.88 FEE]' FOR R PRIVRTE HELL OR ±50 TO 200 FEET FROM R PUBLIC WEL. L DEPENDING UF'ON THE 'T'¢PE OF F'UBLiC NELL. !"IINIi'fiUM D!S'TRNCE FROhl F:I PRtVFITE HELL 'TO FI F'R!',,,'R]'E SEWER LINE 12.'; 25 FEET FIN[) 1"O F~ COMMLINiT'¢ :~;E[4ER LINE IS 75 FEET. OTHER REQLI!REMENTS i'¢tFl'.¢ RF'PL'?'. SPECIFICRTIONS FIND C:ONSTRUCTION [:,IF:iGRRM'Z."; RRE R',,,'RIL. RE~LE TO IN%URE PROPER ;[NSTRLL. R]"ION. I CERTIF'¢ THRT 1: I F!M FRMIL. IRR HITH THE REQUIREMENTS FOR ON-S::[-FE SEHERS RND !.4ELLS RS SET FORTH BY THE MUNICIPRLIT'¢ OF ¢~NC:HORRGE. 2: ~ I.,.!iL.L I~!~TRL. L THE E;'~'STEM tN FICE:OR[:,FINCE HITH THE CO[:,ES. 3:: I UNE:,EF ~]'~NE:, THFiT/~H~N-S:[TE_,, SEHER %'T':E;TEM P'FI¥ REQUIRE ENL. RRGEMEN'T IF' 'THE RE:SZE)ENC:E~"---~E;/RE:MOE:,ELEE¢ ~C¢ ZNC:LUE:,E MORE THRN 4 E, EE:,ROOM%. SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 20- COMMENTS 72-008 (6/79) SLOPE SITE PLAN GROUND WATER ~NCOUNTERED? F YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND -- FT (minutes/inch) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-582-44 Expiration Date: I— I Li- 2.02 0 1. GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS#3A BLOCK 4, LOT 16 Location (site address) 24723 TEAL LOOP, CHUGIAK,AK 99567 Current property owner(s) JACK NIMS&JESSIE WADE Day phone Mailing address 24723 TEAL LOOP, CHUGIAK,AK 99567 Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well ❑ Holding Tank ❑ Water Storage ❑ Community ❑ Community Well ® Public Sewer ❑ Public Water System ❑ Waiver request for: Distance: Received by: L '// i1 __ i Date: V.,51/ COSA to be released to the engineer,unless /rise requested by the engineer. COSA Fee $ 6-50 Waiver Fee $ Date of Payment 1! 3 f t? Date of Payment Receipt Number 0 C Receipt Number COSA# 05C19/Dig Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 01/22/2019 Air < ,v _1 _76' 6. DSD SIGNATURE * 49TH X„aim System #1 Approved for / bedrooms / _ " wassitk ✓ nv KENNffir . System #2 Approved for bedrooms / Disapproved P �OFESSIO�� ./ Conditional approval for bedrooms, with the following stipulations: ON_S1TE syr` WATER AN W ASTEW AM 0,6 T SER By: Original Certificate Date: / Cr —� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: THUNDERBIRD HEIGHTS#3A BLOCK 4, LOT 16 _ Parcel ID: 051-582-44 If more than 1 septic system on lot: COSA Checklist#_ of_ Structure served by this system __ A. WELL DATA–COMMUNITY WATER CLASS A PWSID #211151 ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to—_ ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments B. TANK DATA– NEW TANK 1/17/2019 C. LIFT STATION - NA Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material STEEL Age of lift station years Measured operating fluid level in septic tank Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 12/4/1981 Adequacy test date 1/14/2019 ® ALL standpipes present per record drawing Results El Pass For 4 bedrooms Total measured depth from grade 11.5 ft (max) Fluid depth prior to test 79 in Measured depth to pipe invert from grade 4.4 ft (min) Water added 670 gal ❑ N/A–pressurized field New depth 92 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1320 midepth into effective 7.1 ® Code-required soil cover over field Final fluid depth 75 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to date of test) Any rejuvenation treatment (past 12 months) N Gallons introduced gallons If yes, enter date Comments/Deficiencies: Per ST Upgrade observations, it appears MT extends 7.1'into the 8' ED –missing 0.9' included in MT fluid depth measurements. COSA Checklist yellow sheet copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line >25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No _ ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' [' Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main >75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No _ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® 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 Surface Water > 100' Z Yes if No _ ft 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' Z Yes if No ft Water Service Line > 10' Z Yes if No _ ft Community Wells >200' Z Yes if No _ ft •Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATIONi•i+ O��R�S `x'010 4 t., p I certify that I have determined through field inspections and review „,'�` •°`��,r�"'.,o ,¢, I� of Municipal records that the above systems are in conformance �rIgt ;; ��"' V ®, with MOA COSA guidelines in effect on this date. go COSA Checklist yellow sheet copy.docx 6t�;;gt ' • ,�i ria-6,,t) •<• / ;' d ��P80FESS,'%j �`� 8203D Lot 15 k \ °55110„W 203'5° p \ N78 \ eL:ill . 3 \ N shed r. Greenhous cr CD \ IIIll 2.00 N '4.2 1 LC MO 1 58.0 I 0 \ %— O 1o 2 Story Frame House I M v.) L. WJ I Asphalt (Ni II > a I CI 39.0 i 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-582 44 . HAA# Thunde~ird~eiqhts S/~'#3A; Lot 16, Block 4 Location [site address or directions) 24723 Teal Loop · .;Property owner Mailing address Lending agency Mailin. g address Agent Shari Boyd Address ' 3201 "C" Bill & Connie Flanders 205 Palace Circle Fairbanks, Dayphone (907)688-5839 AK 99701 Day phone with Prudential J.W. Dayphone 762-5863/229-0132 Street, Suite 200 Anchorage, ~K 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well X× Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of syste.m. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ×X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA~21 5. 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 da/t~/f this inspection. Name of Firm" AI'A~KA WA'IrE R & W,A~,~WVAI'E~ Phone Address ' (3H ...... Engineer's signature ~_~_ I~ .?~../~..~ Date //~,/~.oo --- _ DHHS SIGNATURE A?proved for Disapproved· Conditional approval for bedrooms. · '~'. bedrooms, with the following stipulations: Additional Comments 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 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 professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501 · (907)~ Health Authority Approval Checklist Legal Description: THUNDERBIRD HEIGH'rS S/D ~3A; LOT 16, BLOCK 4 Parcel I.D.: 051-582-44 A. WELL DATA Well type CLASS "A" Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number 211151 Date completed Cased to ~ove ground) FROM WELL LOG Date of test Static water level Well production ._/ WATER SAMPLE RESULTS: Wires properly protected (Y/N) g.p.m. AT INSPECTION / g.p.m. Coliform - Nitrate - Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA * INSIDE FOUNDATION, PER INSPECTION REPORT Date installed 19/~-/R1 Tank size 1750 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression (Y/N) NO High water alarm (Y/N) NO Date of Pumping 8./2.~/~9~9 Pumper SANITARY PUMPERS C, ABSORPTION FIELD DATA Date installed 1 ?/4/R1 Length 76' Width ** 5.5" BELOW INVERT OF DISTRIBUTION LINE Soil rating (g.p.d./fF or fF/bdrm) 125 System type TRENCH Gravel thickness below pipe 8' Total depth 11.5'+/- Effective absorption area ~ Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test R/?7/g9 Results (Pass/Fail) PASS For bedrooms Fluid depth in absorption field before test (in,); 75.5" Immediately afterjB, R8 gal. water added (in.): *'100" Fluid depth 74-.5" (ins) Minutes later: 870 Absorption rate = 600+ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION ~ Date installed Size in g Manhole/Access (Y/N) "Pu~el at* "Pump off" level at* High water alarm level at* ~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: COMMUNITY On adjacent Iots..&.~ ~ Public sewer manhole/cleanout Foundation 5'+ Property line 5'+ Absorption field Water main/service line '10'+ Surface water/drainage 100'+ Wells on adjacent lots 5'+ 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: F. Property line Surface water Curtain drain ENGINEER'S C~RTIFICATI~ Engineer's Nan~ Date HAA Fee $ Date of Payment Receipt Number 10'+ Building foundation 1 O' Water main/service line '10'+ 100'+ Driveway, parking/vehicle storage area 10'+ NONE KNOWN Wells on adjacent lots 200'+ l'~ PER PREVIOUS HM'S. UNABLE TO FIELD VERIFY. fioldinspectionsandroviowofMonicipalrocor~_~t~.(.~~nsaro :1,1¢n,. in effect on this date. ~?..~.-i~..'~ / ,1.~ ,IFFFR~ A. OARNESS -7955 . ...'~¢ ........... Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchoragel Alaska 99519-6650 · ' :' 343-4744 CERTIFI'oATE OF HEALTH AUTHORITY.` APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ~'~°i GENERAL INFORMATION Complete legal description ?ht.~qderb±~d He±qhts, Lot 16 T16N R1W Sec. 25 Location (site address or directions) 24723 Teal Loop Property owner Mailing address Lending agency Mailing address Agent Loretta ~ong 8225 Race Circle, Anchorage, AK Jackie Kooistra Day phone JZ7R-4~11 (~au~er) 99504 N/A Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 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. - 4. 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 ~tatus of system. 72~025 (Rev, 1/91) F¢ont MOA #21 '~{,IOM speeu!Sue IBUO!SSejoJd eqi u! SUO!BB!LUO JO SJOJJe JoJ elqlsuods@J iou s! e~Joqouv ~o ,q!l~d!o!unlM eq.L 'penss! s! e]~og!~Jeo ~ eJo~eq ~l~P eZXleU~ Jo suo!]oedsu! lonpuoo iou op SHHQ lo seeXoldLUa 's3UeLUej!nbeJ em]s pub I~Jepe~ u!mJeo/gs!ms oi JepJo u! suo!Inl!mu! Bu!puel J!eql pub SBLuoq ~O sJes~qoJnd ol Xsepnoo e s~ s!ql seop SHHQ eqJ. '~lS~lV ~o e1~IS eq~, u! p~Je~s!l~@J Jeeu!§ue I~UO!SS@~oJd luepuedepu! u~ Xq eAOq~ g qd~Jl~Jed u! Ua^l§ suo!]~3ueseJdeJ eql uodn ,quo p~sBq se1~o!J!PeO l~^oJdd¥ XipoqinV q31~@H s~nss! (SHHC]) seolAJeS U9LUnH pub q~l~eH lo ]ueLu~J~dec] e~gJoqouv ~o Xl!l~d!0!unJAI eqJ. sluewwoo leUOpJppv / LLg66 g6IG-~69 euoqd I:I=I~NIDN=1 AG NOIJ. O=IdSNI 40 /N:IIN:I/¥/S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,Z,,:~/~ ,~'/,,¢ ~, ~'~'~"'~','&,'~ ~//'/ Parcel I.D. A. WELL DATA Well type /~ 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 te§t Static water level Well flow Pump level' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot g.p.m. AT INSPECTION ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Public sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ! ¢ 2'/ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /.. ~5/__) ~,,~Z~/J£ Compartments ~ Foundation cleanout (Y/N) /~ Depression (Y/N) A//~ Alarm tested (Y/N) -- (:,',~ ',) /V SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /' ~-~ To property line .-~ ' Absorption field Surface water/drainage Foundation ~2 ~ Watermain/service line ~'/~ · 72-0~6 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "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 Length ~'~' Total absorption area Depression over field (Y/N) . Results (pass/fail) Peroxide treatment (past 12 months) (Y~) L/ ///¢~'/ Width PAS5 Soil rating Gravel thickness ~ / Cleanouts present (Y/N) Date of adequacy test for ,~'~(~/~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot~./~ ~' ~00 '~ 6,~t~ On adlacent lots ~../,~ To building foundation c) I On adjacent lots /'..~0 Surface water Curtain drain /'V//~ .Cutbank System type Total depth /~' Y Property line To existing or abandoned system on lot h,///¢ Water main/service line Driveway, parking/vehicle storage area bedrooms $0' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name ~'~-, Date HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-O26 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIB. ONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 May 23, 1991 WALTER J, HICKEL, GOVERNOR 563-6775 FOR: E/R Engineering Loria PWSID ¢f211151. My review of the records on file in this office reveals that the Eklutna Thunderbird Heights Subdivision Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Keven K. Kleweno Lead Engineer Sprinted on recycled pape~ b y C..O Test Hole 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TABLE I PERCOLATION TEST RESULTS Soil Type SM GM GM GM GM GM GM GP SM SM SP SM GM SM GM GM SM' GM ML SM GM SM Depth to Bedrock or Water (Feet) None Observed None Observed None Observed 7.5 (Rock) 1Q'~0 (Rock) 4.0 (Rock) 8.0 (Rock) 7.0 (Water) None Observed None Observed None Observed None Observed None Observed None Observed 4.0 (Rock) 8.0 (Water) 9.0 (Water) 10.0 (Water) 11.0 (Water) None Observed 10.0 (Water) None Observed None Observed None Observed 3.5 (Rock) 10.0 (Rock) None Observed None Observed None Observed 2.5 (Rock) Percolation Rate (Minutes/Inch) 10.0 8.0 4.0 1.5 10.0 2.9 6.7 1.0 6.7 5.0 1.0 4.0 3.3 8.0 3.3 6.7 8.3 5.0 40.0 3.3 5.0 10.0 ALASKA TESTLAB TABLE I PERCOLATION TEST RESULTS Depth to Bedrock or Water (Feet) Percolation Rate (Minutes/Inch) None Observed None Observed None Observed 7.5 (Rock)--~ lQ'J0 (Rock) t~Ot~O (Rock) 7.0 ( Wa t e~/ None Observed 10.0 8.0 4.0 1.5 None Observed None Observed None Observed None Observed None Observed 4.0 (Rock) 8.0 (Water) 9.0 (Water) 10.0 (Water) 11.0 (Water) None Observed 10.0 (Water) None Observed None Observed None Observed 3.5 (Rock) 10.0 (Rock) None Observed None Observed ~ None Observed 2.5 (Rock) 10.0 2.9 6.7 1.0 6.7 5.0 1.0 4.0 3.3 8.0 3.3 6.7 8.3 5.0 40.0 3.3 5.0 10.0 ALASKA TESTLAB Eagle River Engineering Services A ' 11940 Business alvd, Suite #205 P.O. Box 773294 694-5195 Eagle River, Ak. 99577 Fax 694-3297 Legal: LoT re, ~uo~ 4, %~,tJ~t~am~z_~ ReqqT'~ ~ ~ V~P, ~., ~-~ Ow ner: LO~ Date: 2~~ ~ 2~. 6qu ~ ~ Type of test: D Well Flow Test ~Septic Test Only D Well & Septic Test D Other: Meter ~onitor Well ~ank GPM PSI Remarks Time Reading Level Level Level ~,fl~.~/~ ~:~q:zo [~'~ ~Z ~Z~ ~e~ 4:~ - 7o ' '" ~/~ 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 28 ~ 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 16, Block 4, Thunderbird Heights T16N, R1W Sec.25 Location (address or directions) 125 Teal Loop (b) Applicant NameRay & Lorie Long Telephone:Home 688-9480 Business 694-4200 Applicant Address SR2 Box 125 Teal loop~ Chugiak, AK 99567 (c) Applicant is (check one): Lending institution []; Owner/builder[]; Buyer []; Other [] (explain); (d) Lending Institution City Mortgage Address Centerfield Drive (e) Real Estate Company aed Agent N/A Address Telephone 694-3503 Eagle River, AK 99577 Telephone (f) MailtheHAAtothefollowingaddress: oickup ~y engineer 2. TYPE OF RESIDENCE Single-Family E~ 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. Page 1 of 2 72-025(11,84) ENGINEERING FIRM PROVIDI INSPECTIONS, TESTS, FILE SEARCH, D :[ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, [ verify that my investigation of this Health Authority Approvai 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. Name of Firm EAGLE RIVER ENGINEERING SER~/J_CES Telephone EAGLE RIVER, AK 99577 Address PTOTBOX-773294 Date 694-5195 Engineer's Seal DHEP APPROVAL Approved for "~,~// bedrooms by ~ Approved ¢;'i-~", ~ .... Disapproved Terms of Conditional Approval Conditional 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 (11184) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA/ HEALTH AUTHORITY APPROVAL {HAA) AHCHORA~IECKLIST - FEBRUARY 1984 h~UNtCIpALtTY OF 264-4720 DEPT. OE HEALTH 8, ENVI~,oNMENTAL pI~O'~ECrION Legal Description: ~ 7- Well Classification ~J~'~-~"~E'~/~L ...... .~ If~B,C,D.E.C. Approved~__.,0N) Well Log Present (Y/N) Date Completed Yield 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 Pubiic Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample-Test Results Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ,Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~' ¢~ ' To Property Line ~ / To Water Main/Service Line /0 z Course ~'~o ~ Size ,~5-~ ~:-~4 No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ~ ~or Temporary Holding Yan~ Permit ~Y/NI ¥o ~ui~ding Foendation Xo Disposal ~ia~d ~- ~ /V To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~..'/J'~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ o~, To Building Foundation -~' / Lot To Water Main/Service Line '/g~ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ¢~ ~/ / Depth of Field /'¢~ / Gravel Bed Thickness ~;~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line '~'~ To Existing or Abandoned System on On Adjoining Lots /'.?~ / To Cutbank (il present) Comments LIFT STA'rlON Date Installed Size in Gallons "Pump On" I_evel 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 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '..-~'~ ~-~'~- Date Company ~'-'~"/~ ~ £ MOA No. Receipt No._ ~' ~::~,'~ 7~' Date of Payment Amount: $ ~.~,' (_.) ~2 Page 2 of 2 72-026 (ll/84) Eagle River Engineering Services P. 0. Box 773294 Eagle Bive~ AK 99577 694~95 I TIme ' Time ue Date Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner G. S. K. Construction Phone Mailing Address SRA Box 6105-A3, Palmer, AK 99645 745-2553 Buyer Ray B. & Loretta L. Long Address 166 Whtrlaway Road, Eagle River, AK Lendlnglnstitution Alaska Pacific Bank Phone Address 101 W. Benson Blvd., Anchorage, Al( 99503 276-3110 Realty Co. & Agent Totem Realty, Inc./[~illiam J. Schlegel '. Phone Address 724 E. 15th Avenue, Anchorage, AK 99501 272-0571 LegalDescriptlon LOt 16, Block 4, Thunderbird Heights Street Location Teal Loop Road Type of Residence ~] Single Family [] Multiple Family No. of Bedrooms 3 [] Other Water Supply [] individual ATTACH WELL LOG. A well log is required for all we~ls drilled since June ~ Community 1975. For wells drilled prior to that date, give well depth (attach log if C) Public Utility available.) Sewage Disposal ~ Individual Year Individual Installed: 1982 [] Public Utility When Connected to Public Utility:_ [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.