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HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 4 LT 31 Municipality of Anchorage Page ? of 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 Name: Wastewater System: [] New [] Upgrade Phone: I NO. of B~;~ooms: ~,~,~,_ .~,,~.,.~_ [] Deep Trench n Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: I Range: I Ssction: Fill added above original grade: Gravel length: Gravel width: Number of lines: tOistance between lines: WELL: New U Pg Fade Cisssification (Private. A,B,C); Total Depth: Cased To: Total absorption area: Pipe material: Driller'. ~ S~aticWater Level; installer: Date installed: Yield:--'~'~GPM IPump set at:Ft. Icasing Height Ab°va Gr°und:Ft. TANK SEPARATION DISTANCES Aseptic [] Holding [] S.T.E.P. TO Septic Absorption Lift Holding Publlc/Prlvale Manufacturer: Capacity in gatlons: Material; Number of Compartments: Surface Weter */,¢' LIFT STATION LineL°t /~ i Size in gallons,'~Manufacturer;i.,~ ;"Pump on" level at: ~'-~mp off" tevel at: High water alarm at: Foundation ).~. / I% Curtain ~.~ ~ump Make & Model I Electrical Ins'~ctions performed by: Drain I Location and Description: Assumed Elevation: ENGINEER'S SEAL ~ -A~% Louis A, Department of Health and Human Services approval '~,.~2,~ ..,,'~?' 73-0t3 (Rev. 9191) MOA 25 Permit No. SW990128 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 19665~ Anchorage, Alaska 99519-665~ Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descrip[ion: LOT 31~ BLOCK 4, THUNDERBIRD HTS .1 PlO No.: 051-582-22 RAVEN COURT 60' R.O.W. ~%~ L=77.53 LOT 52 I LOT 5 1 ASPHALT DRIVE 10' UTILITY EASEMENT LOT 50 SEPTIC +30' SCALE 1" = 40' SWING TIES A-C = 30.4' B-C = 22.7' A-D = 58.4' B-D = 24.0' A-E = 40.8' B-E = 25.5' A-F = 41.7' 8-F 25.9' N89'59 [[,EVATION (NTS) VACANT XISTING LEACH FIELO NEW SEPTIC TANK - 200.32' VACANT TEST HOLE MONITOR TUBE SEWER CLEANOUT WELL LEACHFIELO EASEMENT 6/15/99 EN~II~8 8EAL '~.." ~9TH~ "..~ :" t ::.: : ;~u:~.~' ..... :"' '~ .~.::~.~.~....~ ~". LOUIS A. BUTERA ."~ '0~%'.. c~-~ ."L~ ............. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Bo× '196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 08, 1999 Expiration Date: Jun 07, 2000 Permit Number: SW990126 Legal Description: THUNDERBIRD HEIGHTS #1 BLK 4 LT 31 Design Engineer: 0024 Eagle River Engineering Services Owner Name: Fred Powlowski Owner Address: 27928 Raven Court CHUGIAK, AK 99567-0412 Parcel ID: 051-582-22 Site Address: 027928 RAVEN CT Lot Size: 20045 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [~ 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 Wasteweter 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. Received By: Issued By: Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694~3297 fax June 8, 1999 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re~ Lot 31, Block 4, Thunderbird Heights #1 Narrative & Permit Application Dear Mr. Cross: The proposed septic tank upgrade will have very limited impact on adjacent properties for the following reasons: The sun'ounding lots are have public water connections, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. Reserve space is adequate, due to absorption capacity of the soil in this area. We have completed an adequacy test with passing results. 4. Drainage will not be affected and is not a major consideration in out' design. This is a septic tank replacement in the same area as the old tank which has structurally failed, no special considerations. If you have any questions please call our office at 694-5 t 95. Sincerely, Louis Butera, P.E. \1997\99-017-NAR Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR SEPTIC TANK REPLACEMENT LEGAL: Lot 31, Block 4, Thunderbird Heights #1 6/8/99 A. GENERAL 1. The site plan drawing shall be a part of this specification. 2. All materials and worlonanship shall meet the requirements of Anchorage Department of Health and Environmental Protection Permit. B. THE SEPTIC TANK 1. Septic tank construction shall be a 1250 gallon steel two compartment tank approved by the Municipality of Anchorage. 2. Septic tank is to be installed level on original base material. 3. All connections are to be made with caulder couplings. 4. The existing tank is to be pumped, removed and disposed of by burial onsite. 5. New tank to he provided with 2 cleanouts after tank. \1997\99-017-spc RAVEN COURT 6o' R.o.w. ~ % / / --'-L"o ~ ~o' ur,uT~ ~SEMENT o' % L=7~ /% ~ LOT 50 / ~ X ~ X~ / ~ ~ ~. ~ ~ +30' , ~Or 32 ' X ~ ~ ~ . ~ ~ REP~CE EXISTING  SEPTIC TANK N80'5~0'~ - 200.32'  ~ - TEST HOLE · - MONITOR TUBE o - SEWER CL~N OUT PUBLIC WATER + - NO SURFACE WATER ~SE~ENT PROPOSED L~CH FIELD NO KNOWN CURTAIN 0RAINS i- EXISTING L~CH FIELD S E P T I C T A N K U P O R A D E LEGAL: LOT 31, BLOCK 4, THUNDERBIRD HEIGHTS ~1 ~.......F..~¢~O~ OWNER: RICK PAWLOWSKI ,, ~-- .~.~ .......... JOB~ 99-017 I DATE: 06/07/991 SCALE 1 = 40' ~.0. Bo~ 773294 %% ... .... q~h~ss~o~ (907) 694-~195 ¢j%: (907) ~94-3297 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL, INSPECTION REPORT v.-- ,<NEW NAME OZ<~ ~i!~~tg~ DISTANCE TO: Well Leo th(of ea h I' e. Type of crib OTHER NO. OF BEDROOMS PERM ,T NO~ ~, No, o compartments PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS 7g01/~ (Rev. 3/78) /// Inside length Liquid depth Dwelling PERMIT NO, Dwelling Foundation ,~ ~,,/~ Material Nearest lot line Liquid capacity in gallons sD~%le~r ii ne DATE LEGAL PERi~I,TNO. -~,.¢, ,.~ Total eff~./?~vf~orption area PERMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot line Distance to lot line Septic tank PERtlI T' NO. [:,EPFtRTMENT r' HERLT['I RND EN'¢IROhlMENTRL ' "OTECTION 825 '"L STREET, I=INCHORFIGE., 264-4720 0003:08 ) RPP[..ICRNT WILBUR DI]"TBI;;'.Ei'.,IDER S.R. BO'X 4:22 ERt3LE RIVER LOCFI'T' I 0 I'.,I RFP/EN 'TYPE OFr SOIl.. RBSORP]"ION S'¢STEM IS: TRENCH 68833::29 20090 SL.]URRE FEET MRi,',:IMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT/BR)= i20 THE REG:!UIRED SIZE OF:' THE SOIL RBSORF'TION SYSTEM IS: THE LEI'.,~GTH DIMENSION IS TFIE LENGTH (IN FEET) OF TFIE TRENCH OR DRRINFIELD. ]'FIE; f)EPTH OF R TRENCH OR PIT IS "[HE DISTRNCE BE'f'P,IEEN THE SURFBCE OF ]'HE GRGLII'.~[:, RND THE BOTTOM OF THE EXC[tVRTION (IN FEET). THERE IS NO SET WIDTN FOR TRENCNES. THE GRRVEL. DEPTH IS TNE MINIMUN DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIF'E RN[:, THE BOTTON OF' TNE E',,.,',CRVR]"ION (IN FEE]'). PERMIT RPF'LIE:RNT HRS THE RESPONSIBILIT~'r' TO INFORM THIS DEF:'BRTPIENT DURING TNE INSTI::ILLFITION INSPECTIONS OF RN~¢ WELLS tgD..TRCENT TO TNIS PROPERTY FIND TNE I',IUMBER OF RESIDENCES THFI'F TFIE !.,1ELL HILL SERVE. .............. 'l"'l-...~ ~.~ ( ;~-"~ ::, Z I'-.~'_-'~;F)E C ]''' I 0 ~-,t'._~.; RF']:E I':;:E,2 LI :l:: l~E[:, ................. E:FiCI,:;FILLING OF FIN'¢ S'~'S'TEM NITHOUT FINRI. INSF'EC'I'ION RN[:, RPPRGVRL E:'¢ THIE; DEPRRTMENT klILL BE SUBJECT TO PROSECUTION. NINIMtJiq [)ISTF:INCE BETWEEN R WELL RND FINY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVBTE 14ELL OR :256.4 TO 200 FEET FROM R PUBLIC WELL DEPENDING LIPON THE T'¢PE OF PUBLIC .t4ELL MiNIMLIM DISTRNCE FROM R PRIVFITE .WEI_L TO R PRIVBTE SEWER LINE I.S 25 FEET RND ]"0 FI C'OMMLINIT'¢ SEWER LINE IS 75 FEET. OTHER RE~]:!UIREMENTS I"1F?¢ RF'PL'¢. SPECIFICBTIONS RND CONSTRUCTION DIRGRRMS RRE RVFIILRBLE TO INSURE PROPER INS]"BLLRTION. I E:E[Yf'If:"./ TFIRT d.: I RI"1 FRI'"IILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND 1.4ELLS RS SET FO[;'.'f'H E:'¢ T'HE MUNICIF'I~LIT'¢ OF' RNCHORRGE. 2: I WILL INSTRLL THE S'¢STEM IN RCCORDRNCE WITH THE COf~ES. ]~: I UN[:,ERSTF-iN[:, THRT TNE ON-SITE SE!.,.IER S'¢STEM r,lR'¢ RE(.:!UIRE ENLBRGEMENT IF' THE RESIDENCE IS REIgO[)ELED T'O INCLUDE MORE TNRN 4 BEDROOF'IS. .::, I _~f,lE[.: ............. F:tF F I... I CI--INT/.-~I I L.E, UR D I TI'E, RENDEF-, is ,_,ED ......................... ............ 0 PERFORMED FOR: Z~! ~_. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'[ SOILS LOG - PERCOLATION TEST SLOPE DATE PERFORMED: /~ SOILS LOG [] PERCOLATION TEST SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND , FT COMMENTS 72-O08 (7/76) 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 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE Of HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. OS1-SS~-~2 HAA# /~/~ Oe-z-O I ~'1 Expiration Date: ~" - ~ - 0 GENERAL INFORMATION ' Complete legal description Thunderblrd Helghta No'.1 Lot 31: Block 4 · Location (site address or directions) ~7928 Raven Ct~ Peters Creek: AK 99567 Current Property o. wner(s) fredrick Powlowsl(I Dayphone Mailing~ddress (Moorpark: CA 93021-3~31) Lending a~nc~ Day phone Mailing address Real Estate Agent Mailing Address Joe Perrn~l 16600 Centerfield RelMa~ Day phone ~ Rd. Eagle Rlver~ AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: IndMdual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer r-~ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) 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 served by a private or Class C '~ell and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Westewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,cl.snchomge, ak.ua (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Thunderbird Hel_ehts No.1. Lot 31. Block 4 Parcel ID:~ A. WELL DATA wen type UaMC Date completed __ If A, B, or C provide PWSID # Sanitary seal (Y/N).__ fl. 'Cased to ft. FROM WELL LOG Total depth Well Log (Y/N) Wires prope~y protected (Y/N) Casing height (above ground), AT INSPECTION mg.ll. Other bacteria Collected by: _ Date of test Stetlc water level fl. Weft production g.p.m WATER SAMPLE RESULTS: Coliform (~lonles/100 mI.Nltrete colonies/100 mi, Amenin: rog JI. Date of sample: O. SEPTIC/HOLDING TANK DATA Tank Type/Matedal_.~ Date installed ~ Tank size 1250 gal. Number of Compartments.2._ Cteanouts (Y/N) Y Foundation c~eanout (Y/N) ¥ Depression over tank (Y/N) N, High water alarm (Y/N) N Date of pumpln~ Pumper JR'8 C. ABSORPTION F~ELD DATA Date installed_.l.9.~.0.__.~ll rating (g.p.dJf~ or ~/bdrm) 120 System type trench Length 80 fl. Width ;~ ff, Grovel below pipe ~ ft. Total depth 7 ft. Eft. absorption area 480 · Monitoring tube Y Depression over field N Date of adequacy test 5~/02 _ Results (Pass/Fall) Pass For 4 bedrooms Fluid depth in absorption field before test Dry in. Water added 600 gal. New depttt~, in. Elapsed Time: 30 min. Final fluid depth.l~r.~ in. AbsorpUon rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date Sent By: REII~/~× OF EAGLE RIVER: [NC.; 9076960214; May-7-02 & g:18AU; Page 1/1 _..NO. 037__.P. 9 IIt.~[tlill'~. I~'q!q;~.~%; -~ ...... ~:b~'.o '"" 04/19/Z002 ~l 11:21 [ 50291 ~002 Parcel I.D. # 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 /-~-~/, c~.~c,~ ~. 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 X 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 ~ 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-o25(Re¥.1/91) Front MOAe21 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. Name of Firm Address ,"~.. ~, ,':~?x Engineer's signature Phone DHHS SIGNATURE L'/" Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval 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 pumhssers 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. t4ECEIVED Municipality of Anchorage ~j,[~ DEPARTMENT OF HEALTH & HUMAN SERVICES dUL 00 1999 Environmental Services Division MUNiCIPALiTY OF ANCHO 825 L Street, Room 502 ·Anohorage, Alaska gg501 · (91~,~I~IitI~?.~4ERVlCES DIVISION Health Authority Approval Checklist . '* ' ~' -?.'-/,~,.,.?~,.~-~-~tl~/J~',s / Parcel I.D.: Legal Description: ~.¢7- c¢/, Z~L~( ~" "5 ~ ' ¢' A. WELL DATA Well type Log present(Y/N) Total depth Sanitary seal (Y/N) Cased to Date of test FRO'M W,~G~ Static water level / Well production / WATER SAM~k~ULTS: Coliform ~ Nitrate Da o/f sample: If A, B. or C. attach ADEC letter. AD~/W/ater system number Date completed Casing height (above ground) Wires properly protected (WN) AT INSPECTION g.p.m, g.p.m. Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~///~ Tanksize /25.c:~ d¢/~__ Number of Compartments ?~ Cleanouts(Y/N) 4~?~ Foundation cleanout (Y/N). /I/ Depression (Y/N) /u/ High water alarm (Y/N) Date of Pumping ,,~/.'~ ~'/~/~'~-) Pumper C. ABSORPTION FIELD DATA Date installed /~'~"~ Soil rating (g.~prd~/fF or fF/bdrm) Length ?/_P ~ Width. ~ / Gravel thickness below pipe Effective absorption area z~/~ ,~ z~'Monitoring Tube present (WN). Date of adequacy test g../~/x~ ~ Results (Pass/Fail). Fluid depth in absorption field before test (in.); Fluid depth / -2 (ins) Minutes later: P~roxide treatment (past 12 months) (Y/N) System type ~ / Total depth '? __ Depression over field (Y/N) ,42 For /-¢' bedrooms immediately after.C/¢ gal. wateradded (in.): ';~'/'~,~" Absorption rate = ~ ~'~// g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) ~ ~ Size in gallons "Pump on" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot -/- -Pod Absorption field on lot A-'/,~ On adjacent lots On adjacent lots Public sewer main Sewer/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /Z Water main/service line Property line /3 / Absorption field ,~- ' Surface water/drainage ~'~/~.x~>/ Wells on adjacent lots -,~,:;~.~z) / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ,J~ ~ / Water main/service line ~'/,~" Driveway, parking/vehicle storage area .P ~ ~ Wells on adjacent lots 7' ~-z- ~ ¢)" F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Municipal record~jh~d~,~s are 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 Parcel I.D. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ¢~'c0~¢¢~/ ~.. ~O~- :~ ..¢~.ce ,4. ~ ~,','¢r Day phone Mailing address ~?q~-~ ~%'-'¢,', ~,¢~'-./ C~t~:i~' / /~-/-( ~/¢5f,?*£ll/ Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SEP 11 1996 RECEIVED 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~)25(Rev 1/91) F,onl MOA,21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below,'l 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 c6des, ordinances, and regulations in effect on the date of this inspection. NameofFirm P~%'II,", "~. /¢~..~(~.~ Phone(?c'~7'.-/r.-/,;,?: Address IL~E(.,I ~o,-(~eT.-/ ~ ~U. ~ Engineer's signature '~,~;,-. ?. (~2ZW Date ~/~/~6" DHHS SIGNATURE Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the followin~ 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 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: /~ ~/~¢'/~' ,~/7"~<."'~,~"~"~"'::~ ~.-' '~'/ Parcel I.D.: ~-~'~/'~ A. WELL DATA Well type If A, B, or C, attach ADEC letter, ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production cW~;~?mSAM P L~ ~of sample: Date completed Cased to FROM WELL LOG ~ g.p.m. Casing height (above ground) re sp roped Y~~~_ Wi AT I~J.,,,~,-P~CTI~ICIPALITY OF ANCHOP, AG~ ENVIRONMENTAL SERVICES DIVISION 8EP 11 1998 RECEIVEDg.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'/'/~//,¢o Tank size '"~' 5'"~ &~"Number of COmpartments ,Z, Cleanouts (Y/N)__ Foundation cteanout (Y/N) / Depression (Y/N) /~ High water alarm (Y/N) Date of Pumping ~/?/~'~; Pumper ..~,.~','J,'z",--~-x' C. ABSORPTION FIELD DATA ?/'~g/',~'42 Soil rating (g.p.d./ft~ or fF/bdrm) Date installed Length ~' ~ ''~''/' Width z./~) ;..t J, Gravel thickness below pipe. Effective absorption area /y'~z) ~-z¢ ~'Monitoring Tube present (Y/N) Date of adequacy test ~/b~'~ ~; Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth /,~.-~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) __ For /z/z/''x~ Immediately after¢'~ gal. water added (in.): System type ,~..~-...z Total depth .~' bedrooms Absorption rate = ~/~ g.p.d, If yes, give date ~ 72-026 (Rev. 3/96)* D. LIFT STATION Dateinstalled Size in gallons Manhole/Access (Y/N) High water alarm level at* "Pump on" ~/el at* u E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent P~/~ic sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: Foundation /,~ ,~',z- Property line "?' ~ '~'~ Absorption field Water main/service line -~'~ '~"/'/Surface wateddrainage ,f~o,u'~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line / ~"~'/' Building foundation Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent rots F. ENGINEER'S CERTIFICATION I certify that I have determined thru in conformance with MOA HAA guidelines in effect on this date. Signature HAA Fee $ 3f/?")' ~ Date of Payment ~'/'/~/'/~/~' Receipt Number 4::~,=~/.(",¢ ~//~':~4:~2~..,~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# ~k ~;i"~/ _ ~c( .~.~ _ ...,.,.,~, .,~ HAA# ~u1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 31; Block 4~ Thunderbird Heights Subdivision Location (address or directions) 412 Raven Court (b) PropertyownerWa~ne and Janet Kuikenda~ Telephone: (home) 688-9777 Business Mailing Address (c) Lending Institution Kerf Bank of~ Alas~ Mailing Address ATTENTION: Kathy Telephone (d) RealEstate Company and Agent RE/MAX OF EAGLE RIVER - Darlene Nicola~sen Address 16600 Centerfield Drive, Suite 201, Ea~le River, Alaska Telephone 694-4200 (e) Mailthe HAA tothefollowing address:(orcheck here,~;;~ifholdforpick up.) Listcontactperson and day phone number below: S & S ENGINEERING/694-2979 17034 Ea~l~ River Loop Road, S~.t~ 204 Eagl~ Rivage Alaska 99577 2, TYPE OF RESIDENCE Single-Family E] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public EX Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 I~uoR!puoo le^o~dd,¢ leUO!l!puo0 jo ewes/ pe^oJddes!a ~/-.~ , p@^oldd¥ Xq SuflooJpoq ~ JOJ. peAoldd'~' lVAOBcIclV sNNa '9 elec] euoqdele~ ssoJppv ~uJ!:J Jo eLu~N 'uoRoedsu! s!ql ~o el~p aql uo ~oejlo u! suo!leln6eJ pus 'seoueu!pJo 'sepoo OleOS pu~ led!o!unlAI I1~ q~,!M eoUe!ldLuoo u! si ~e~s~s I~sods!p ~el~e~s~ Jo/pu~ ~lddne Jel~ el!s-uo sql 'uoRoadeul pu~ uo!l~!lse~ul ~ ~oJ~ pub sel!~ e~BJo~ouv ~o ~!l~d!o!un~ eq] ~oJ~ peu!Blqo UO!lB~Jo~u! e~l uo peeBq l~ql XI!JOA Joq~nj I 'u!oJoq POI~O!pul eJnlonJls ~o adX1 pus s~ooJpaq ~o jeq~nu oq~ Joj el~nbop~ pu~' leUOROUnj 'e~s si mels~s I~ods!p JO~MOlSBM Jo/pu~ ~lddns JOI~M el!s-uo e~l 1~1 ~MO~S I~AoJddv ~lpo~lnv ~IlBOH s!ql Jo uo!le~!lseAu! X~ leq~ X~!JOA I 'MOleq UMOHS olep uo~l~PlleA eq~ jo se pus oleJoq pox!J~e lees X~ 4q pe!j!~Jeo sv NOIZY~BOdNI aNY v&va 'HOMYHS iqld 'S~St$ 'SNOI~O]dSNI 9NIOIAOMd ~BIJ DNlaHHNIgNB 'g ~lclpA~J¢~kl:~bl~'~EOF ANCHORAGE (MOA) f~.~MENfAL SI~l~[tLl~ ~b~Y Approval (HAA) ~' CHECKLIST- FEBRUARY 1984 JUN 1 5 1989 343-4744 Legal Description: ~ RECEIVED A. 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 DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ,-~ ~.c~ ¢0t 'fL~p, C.. ~ C. ~ Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set 'At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date SEPTIC/HOLDING TANK DATA Date ,nata,,ed S,ze ¢ SOO Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /~ Pumping/Maintenance Contact on File (Y/N) ~ Holding Tank High-Water Alarm (Y/N) ~) ~'~ No. of Compartments ~ ~" Foundation Cleanout (Y/N) Date Last Pumped ;for /~j a Temporary Holding Tank Permit (WN) SEPARATION DISTANCES FROM SEPTIC/H(~-[~4NG TANK: To Water-Supply Well ~ To Property Line ( To Water Main/Service Line To Building Foundation To Disposal Field TO Stream, Pond, Lake or Major Drainage Course Comments (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / ~ (~ c~/~:~ Type of System Design Datelnstalled _.:~_ ~ , ¢,~uIl~ ~O Length of Field Width of Field Z.~ ~ Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Z-TL ~:~ O ¢ Statndpipes Present (Y/N) Depression over Field (Y/N) /'J Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ¢--~ OO To Building Foundation To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line l ,~- To Existing or Abandoned System on ', On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump O~ High Water Alarm Level a~t~---------. Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & S ENGINEERING Signed Company Date of Payment Amount: $ 72-026 (Rev, 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DATE RECEIVED INSPECTION APPOINTMENTS INSPECTOR INSPECTOR INSPECTOR ~(~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. ©: ) 825 L Street - Anchorage, Alaska 99501 ENVi~ON,~,,~E~U,,L , , ENVIRONMENTAL SANITATION DIVISIO~ u).~'[~ Tolophona 204-4720 PROPERTY~ID~T (If~ifferent frem above) PHONE 4, R~A~T~/AG~NT ~ ~ ¢ PHONE MAILING ADDRESS ~ ~ ' ~ ST R E E T L OCAT ' O N~,~_~.~, L"~?-'Cr -z' .~_ J /~ B. TYPE O ERES, DE.DE NUMBER OF~BEDROOMS ,~ [] One [] Four [] Other SINGLE FAMILY [] Two [] Fiv, e [i] MULTIPLE FAMILY ~. Three [] Six 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all walls drilled  , COMMUNITY since June 1975. For wells drilled prior to that date, give well PUBLIC UTILITY depth (attach ]o§ if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** ) ~ ~/~_ 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 [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified NSTALLER []Septic Tank or [] Holding Tank Size: "If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Ar~a to nearest Lot Line 5. COMMENTS I~/~'A~P ROV ED FOR .__~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~(~.,~ DATE BY 72-010 (Rev. 6/79) Douglas T. Kenley Civil Engineer State of Alaska C.E. 8'176 Legal Description SEPTIC SYSTEM ADEQUACY TEST Applicant Date of Test System Data Tank Volume Number of Bedrooms /~-,,~'~0 ~ ,~'z.. ¢' Absorption System ~'.~ Absorption required (1.5 dally flow) TEST DATA TIME VOL, DIFF. FLOW TANK TUBE LEVEL DIFF, COMMENTS (gals,) (gpm) LEVEL System Passed ~ System Failed Comments ~'~,~ ~.~, -,-,-,-,-,-,-,-,-,-~-,~-'..~. /~..~-' l/..~;,--'z~ 2225 ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, AK 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: May 11, 1989 PWSID: 211156 To Whom It May Concern: According to the records on file in t~is office, the Eklutna T~under~ird. HeiGh__ts S~D Water System is in compliance with the State of Alaska Drinking Water ReGulations. Sincerely, Vera E. Craig Environmental Field officer VEC:kk