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Home My WebLink AboutTHUNDERBIRD HEIGHTS #1 BLK 6 LT 21 MUNICIPALITY OF ANCHORAGE ~,~"E'~'"--~.~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAl ENGINEERING DIVISION ON~ITE SEWAGE DISPOSAL SY~EM AND/OR WELL IN~ECTION REPORT DISTANCE TO: PERMIT NO. DISTANCE TO: OTHER DATE LEGAL F PERMIT NO. APPLICANT FORESTEOGE HOMES LO~TION MRL~RD COURT EKLUTNR- LEGAL '¥:~'~8~THUNOERBIR~,.HT~ LOT SIZE 22B00 ~QURRE FEET TYPE Of SOIL ABSORPTION SYSTEM IS: TRE~H MRXIMUM NUMBER OF BEDROOMS SOIL ~TI~ (SQ FT~R)= 85 THE ~IRED SIZE OF THE SOIL RBSORPTI~ SYSTEM IS: DEPTH= ~-O LENGTH= 22 GI=IRVEL DEPTH= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH ORDRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE ~ISTRNCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCAVATION ¢7N FEET>. THERE IS NO SET WIDTH FOR TRE~S, THE GRAVEL DEPTH IS THE MINI~ DEPTH OF GRAVEL BET~EN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXC~TION (IN FEET>. RE(~U I RED SEPT ! C TI=INK S I ZE= '1 OOO (~i=il/ONS PERMIT BPPLICR~4T HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT ~WJRING THE INSTALLATION INSPECTIONS OF BN~ WE'LL~ RDJRCENT TO THIS ~OP~TY ~ T~ NUMBER OF RESIDENCES THAT T~ ~LL HILL ~E~ T~O (2) I NSPECl'IONS I=iRE I=IEQUIRED BACKFILLING Of ANY SYSTEM WITHOUT FINAL IEF~CTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION, MINI~ DISTR~E BETWEEN R WELL AND R~' ON-SITE SE~GE DIS~ SYSTEM IS t00 FEET FOR R PRIVATE WELL OR t58 TO 280 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM fl PRIVATE WELL TO fl PRIVATE SEWER LINE I~ ~ FEET flHD TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY APPLY. SPECIFICATIONS R~ ~NST~CTION DI~RR~ RRE RVRILRBLE TO INSURE PROPER INST~LRTIO~ PERPI I T E~P ! RES DECEMBER I CERTIFY THRT · : I RM FAMILIAR WITH THE RE~IRE~NTS FOR ~-$ITE SE~ fl~ ~LLS ~ SET FORTH BY THE MUNICIPALITY OF RNCHO~G[ 2: I WILL INSTALL THE SYSTEM IN ~COR~E WITH ~ 3: I UNDERSTR~O TIiflT THE ON-SITE SEWER ~¥STEM MR~ REQUIRE ENLARGEMENT IF THE V4. B / 2_1 MUNICIPALITY OF ANCHORAGE SOl LS LOG - PERCOLATION TEST $ ? lO- 11 13- 15- 19- 20- WAS GROUND WATER ENCO~JNTERED? IF YES, AT WHAT DEPTH? Municipality of Anchorage. Development Services Department . . Building Safety Division : - On-Site Water and Wastewater Pr6gram 4700 South Bragaw St. . .. '. P.O. Box 1966~0 Anchorage, AK 99519-6650. wWW.ci.anchorage.ak.us (907) 343-7904 ... CERTIFICATE OF HEALTH AUTHORITY APPROVAL' FOR A SINGLE FAM!LY DWELLING ,: Parcel I.D. 0 5"1-..~ ~ 2. 1. i GENERAL 'INFORMATION ." Complete legal description Expiration Date: ~ -~. 0 - O / .Lot 21, Block 6, Thunderbird Heights 27628 Mallard Court - Location (site address or directions) Current'Property o,~ner(s) "-'.: Mailing address Lending agency Mailing address Kent & Joyce Logan Dayphone . 688-3037 27628 Mallard Court,-Chu~iak,~AK.99567 . Da ,on 2. NUMBER OF BEDROOMS: Real Estate Agent Mai!ing Address Unless otherwise requested, HAA will be held by DSD for pickup. 3 Day phone 3. TYPE OF WATER SUPPLY: Individual 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 [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of AJaska. 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 well and may be reissued with new water sample results less than 30 days aid. (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. · 4. STATEMENT OF INSPECTION BY ENGINEER = As Certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for 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 ebtalned from the Municipality of Anchorage flies 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, Phone (o' q ~- ,~- ~1 '7 ? -Date (.:'/Iq/°! ~; ~,~,,~- ~--.-=-.,,,~ '~ ~o~tc.~ ' cow~ i~ CE.,sm 'J ~. ..~,~' ~ -~ ,.~, ............... ; ~ ~ . bedrooms, with the following stipulations: and regulations in effect at the time of installation. Name of Firm .~ & K FNGINE~RING Address 17034 Eagte River Loop Roac[ No. 2~ ' Engineer's Printed Name ,Robert C, Cowan, 'P. E. bedrooms. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for .... ON-SITE ~' WATERANn Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:, L/",,.) - ,~, 0 - 0 / Municipality of Anchorage Development Services Department Building Safety Division " · On-Site Water & Wastawater Program 4700 South Bragaw St. " P.O. Box 196650 Anchorage, AK 99519-6650 www.ct anchorage.ak.us (~7) 343-7904 HEALTH AUTHORITY APPROVAl.. CHECKLIST __ ' · ' l ~,~, 4, H'r-s A. WELL OATA ~f~.d~..- Well type ~ I~A, B, or C provide PWSID # Well Log (Y/N) Sanitary seal (Y~ Wires properly pmtacted (Y/N) Date completed Total depth ft. Cased to ,/" ft. Casing height (above ground), in. - FROM AT INSPECTION Date of test J ' Static water level / ft. ' ft. / Well production/// g.p.m, g.p.m. WATER SABLE'/RESULTS: ' ' Col~o~ ~. colonies/100 mi. Nitrate ' mg./I. Other bacteria colonies/100 mi. Da('& of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ Tanks[ze I~OC) gal. Number of Compartments ~ Foundation cleanou; (YIN)C~ Depression over tank (Y/N) /~./O High water ataml (Y/N) Date of pumping ~, / I ~ / O t Pumper ~---'1:~. 1.~ Length ft. W dth ft. Fluid depth in absorption field before test :~- in. Water addedS'~.:~laL Elapsed Time:'~_ min. Final fluid depth .~..~- in. Absorption rata >= Any rejuvenation treatment (past 12 mo.) (Y/N & type)/~ ONe' ~-~J~v~,~ If yes, give date Date installed ~,~~ Cleanouts (y/N) ~ System type ~~=~- H Gravel below pipe ~ fl. Depression over field t",J 0 For '~ bedrooms New depth ~,'in. '~"~"~ g,p.d. UFT STATION Date installed 'Pump on' level at Datum Manhole/Access 'Pump off' level at in. High water alarm level at Cycles tested. E. sEpARATIoN DISTANCES DISTANCES FROM WELL O.O.O.O.O.O.O.O.O~T TO: SEPARATION Septic tank/lift station on lot . ./. , ~. · ~ Absorption field on lot J' ' * ' Public sewer main / Sewer/septic ,*r~ilil~e Meets alarm & cimuit requirements? On edJacent lots On adjacent lots Public sewer manhole/cleanout Holding tank · SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~' ~- Property line Z~ ~ Absorption field / (~ ~'~ Water sewice line. ,/(~/.~A Surface water /~ /'+' Water main Wells on adjacent lots ~.__~,R~ SEP,~d~TION DISTANCE FROM ~J~ISORPTION FIELD ON LOT TO: Property line /0 '~ Building foundation /(~ ~ Water main Water Service line ~/0 ~- , Surface water //~ Curtain drain ~J/Wells on adjacent lots COMMENTS F$ G. ENGINEER's CERTIFICATION I certify that I have determined through field in~pecUons and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on (his date. Engineer's Printed Name ~0~'~''z/*' ~'- ("O~"a~v Oato . ' / /0 [Mveway, paddr, g/vahtcle storage HAAFee $ 300." Date of Payment (,, / / 'i~ / ¢~ I ,-. Receipt Number O 0 .~' ¢~ cl c~.. (Rev. 12/00) Waiver Fee $ Date of Pay~ ent 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 LO, # F'Y~I - .Z,,~,~ _ [~.~ HAA# ~ ~ ~ 1. GENERAL INFORMATION Complete legal description Lo~ ~I; ~ock &; T~E ~g~ Location (site address or directions) 106 ~,6~d Corot,t, Clmg,L~z~, A~4~[ Property owner .... Mailing address Lending agency. Mailing address Agent ___ Address K(,,;,~E, ~d .1ouc¢ E. Loq,.t,,,t. Day phone_6,~,~-$~19 106 ,~.~a.Z~d Cou,,'~, Chu, g,~!z, A.l, msl~ 99567 Day phone__ Day phone_ 3. TYPE OF WATER SUPPLY: Individua! well Community well Public water Unless otherwise requested. HA 4 will be held for pickup. NUMBER OF BEDROOMS: NOTE: !f community well system, provide written confirmation from State ADEC attest- mg to the legality and status of system, 4. TYPE OF WASTEWATER DISPOSAL: individual on-site X~X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality ano status of system. t 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affix(,d hereto and as of the validation date shown below, I verffy that my investigation of this Health Authority ^pproval application shows that the on-site water supply and/or wastewater dlsposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated heruin. I furtherverify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in complian~.e with all Municipal and State codes, ordinances, and regulation.< in effect on the date of this inspection. Name of Firm ___ ~_ = £ c~..~.=; .,~c Address 17034 Eagle River L~p ReadNo. ~ _ Phone Engineer's signature Date __ DHHS SIGNATURE Approved for bedrooms. Disapp[oved. - Conditional approval for bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) tSSues Health Authortty Approva! Cer~iti,.'~tes based only upon the representations given In paragraph 5 above by an independent professional engineer registered in th e State of Alaska. The OHHS does this as a courtesy to purchasers of homes an d their lan di ng institutions in Or,er to sa fisfy certain federal and state requirements, Emptoyeee of DHHS do not condu;f 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 Departmen~ of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type -- Log present (Y/N) Total depth Sanitary seal (Y/N) If .~, B, or C, attach ADEC letter. ADEC water system number '~'\\ Date completed ~' Dr[liar Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer serwce line __ ~ c, ~ ¥ ; On adjacent lots ~.o c~ ~ ¥ ; On adjacent lots AT INSPECTION Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS; Coliform Date el sample: · Nitrate Other bacteria Cotlected by: B. SEPTIC/HOLDING TANK DATA Date installed \ c~ ~>'~ [/- 3 ''~ ~ Tank size \ C~.C)&::::, Compartments '~ Cleanouta ,~N) ~ _ Foundation cleenout (~N) "/ Depression (~) High water alarm (Y~/ ~ Alarm tested (Y/N) /"~)A Oate of pumping _ "~- ~7..- Pumper_ ~'- ~-,~;~,Po.~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN~'~O: Well(s) on lot ~' On adjacent lots · To property line_ ~ c,' t~ .Absorption field Surface water/drainage _ ~ c~ C) Foundation Water main/service line C. LIFT STATION Date installed Size m gallons Vent (Y/N) High water al~,rm level -- Meets MOA electrical ~ "Pump on" level at ~off' 'level at J_ Cycles tested SuHace water D. AB$OI:~PTION FIELD DATA Date installed \ Length Total absorption area Depression over field (Y~ · Results ~,~,~,~,~,~,~ail) __ Peroxide treatment (Past Soil rating ~' ~' ~/~l~- System type ~"~"~[~ 4'~'1/ Gravel thickne~ ~ Total depth ~ ~ ~ ~ Cleanouts present ~) ~ Date of adequacy test ~ ' ~ '~ ~ for ~ ~ bedrooms ~ ~ ~ If yes, give date. ~ ~ To building foundation On adjacent lots Surface water \ Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well onlot '~C>'~ ~" . On adjacent lots ~'1~ . Propertyline \==?. ~, C) ?' To existing or abandoned system on lot ~..~1.~ Cutbank ~ //~. .. Water main/service fine \~ ~' ~' ._ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the data o! this inspection. S,gnature ~egle RivIr, Alaska ~5~ ,, HAA Fee $ ~ Waiver F~: $ Date of Payment 7 -~ ~ -~ ~ ~ Data of Payment Receipt Number ~ ~ ~ 7 ,. ~ Receipt Numar DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKE~., GOVERNOR Mr. Ray Shafer S & S Engineering 17034 Eagle River Loop Eagle River, Alaska 99577 August 13, 1992 (907) 349-7755 SUBJECT: Thunderbird Heights Subdivision Class "A" Public Water System, PWSlD 211156 Dear Mr, Shafer: I hav~ completed a review of this office's flies concerning the status on the above- referenced C~ass "A" Public Water System end found following: Inorganic Chemical Contaminants: Date of last samples on record: Organic Chemical Contaminan,s: Date of lest samples on record: 18 AAC 80.200 09/13/89 Volatile Organic Chemicals (VOC's): Date of test sample on record: 18 AAC 80.200 06/04/92 Radioactive Contaminants: Date of last sample on record: 18 AAC 80.400 06/04/92 Total Coliform Bacteria: Date of last sample on record: 18 AAC 80,200 Under current composite sampling program Final Operation Certificate: Date Issued: 18 AAC 80.200 07/06/92 Present in 11/12/81 Outstanding Violations: No August 13, 1992 Page 2 A. Based on the sbove information, this Public Water System is in compliance with Stats Drinking Water Regutations (18 AAC 80). If you have any questions on the above comments, please do not hesitate to contaCt this oh3ce at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. ML/pf Jaylene Peterson, Eklutna Utilities, h,c. David Dayton