HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS BLK 1 LT 3Thunderbird
Heights
Block 1
Lot 3
#051 -721 -OS
n
MUNICIPALITY OF ANCHORAGE
1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 2644720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME Sr&&S CQNSTRU�,lom
PHONE0'
�Q�2
�OW Z831
NEW
UPGRADE
MAILING ADDRESS
P.o. BOX, vVoi,l0. 6W&t4k. AjASZA q15 0-7
LEGAL DESCRIPTION
Lo -r 3, &4 1, TNvN0Fe01j?,LD 14E[6,N-T5 , SZ5, Till Ql v1
LOCATION
7Av7v�eBli2D fAl,�s
NO. OF BEDROOMS
3
Q
DISTANCE TO:
Well
un,.j�/
Absorption area r
5
Dwelling 7
5
PERMIT NO.
3
++--���'
EQ
Manufacturer
Material
No. of compartments
to
01—
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
d le
DISTANCE T0:
Well
Dwelling
PERMIT NO.
JD2
_ F
Mani lacturer A
Material
Liquid capacity in gallons
W =
DISTANCE TO:
Well
Foundation.
ll]
Nearest lot Ime ,
PERMIT NO.
Z Z
1=. G
No. of lines
I
Length of each Ime r
Z (.S
Total length of lines I
2
Trench width
inches
Distance between lines
NJA
2 f
Top of tile to finish grade ,
Material beneath the
Total efiective absorption area
7
0
3
Z inches
a
Length
Width
Depth
PERMIT NO.
W
<I..
Type of crib
Crib diameter
Crib depth
Total effective absorption area
rn
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot fine
PERMIT NO.
J
DISTANCE T0:
Building foundatioh 11
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
NG AsTa-2Zu '+
SOIL TEST RATING
°7 D
INSTALLER �•l�-(h�.[��fr^�f n,�,,�.
REMARKS
GSC 85-15
0
SRal E D- CAl1 5E�
o>�
as
OF Aow
0 d
.Ll psi ..
—
p f�... ..........:�•�
e
Ice J. Corwin
r
No. CE -5293 �'/
•fir
2'• 0 V 3
�..
8 �OPRticrcri(,,
A F DATE LEGAL
//D
<Ui � -'ZJ-,�'f LOT 3, BUGI, %�IUA/DC,e8he0 flElC� cJ
{,
72-0A IRev. S/�81
n
,
~ 1-1UT11 a C a F�- AL a -:-`l O1,,s FCr�ZF jCC
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
025L STREET, ANCHORAGE, AK 99501
264-47.-^_0
PERMIT NO: 8502y3
DATE ISSUED: 05/29/85
APPLICANT: SKAGGS CONSTRUCTION
ADDRESS: P 0 BOX 670690
CHUGIAK, AK 99567
CONTACT PHONE: 600-2031
LEGAL DESCRIP: SUBDIVISION:
THUNDERBIRD
HEIGHTS LOT: 3 FLOCK: 1
SECTION: 25
TOWNSHIP:
16N RANGE: 1W
LOT SIZE: 25043 (GO.FT.
OR ACRES)
MAX BEDROOMS: 3
Listed below are the options
available to
ycu in designing your septic
system. Choose the option that best fits
your site.
�F�•EhFCF -0
4v' _ LT F-; �1 a hn- - -- - - - - - - -- -
DEPTH TO PIPE BOTTOM (FT.)
�.0
4.0
GRAVEL DEPTH (FT.)
*;0
3.5
TOTAL DEPTH (FT.)
9.0
7.5
GRAVEL WIDTH (FT.)
2.5
5.0
GRAVEL LENGTH (FT.)
20.0
GRAVEL VOLUME (CU.YDS.)
20.0
TANK SIZE (GALS)
1,000.0 *
1,000.0
SOIL RATING (S,C.FT./DR)
65
05
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
Z. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid fob a maximum of 3 bedrooms and
any enlargement will require an additional permit..
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST DE OOTAINED; (3) AO-EUILTS
WILL NOT DE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
- ----- - --- ---------
APPLICANT: SF;AGGS C.'! ;TRUCTION
ISSUED BY AWWW"- DATE:
• MUN I C I FALL I TY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
2264-4720
C7N—SITE SEWER Fes'[=RMI T
PERMIT NO: 840879
DATE ISSUED: 10/15/84
APPLICANT: SKAGGS CONST.
• ADDRESS: P.O. BOX 670690
CHUGIAK, AK 99567
• CONTACT PHONE: 688-28931
LEGAL DESCRIP: SUBDIVISION: THUNDERBIRD
HTS.
LOT: 3
BLOCK: 1
SECTION: 25TOWNSHIP:
16N
RANGE: 1W
LOT SIZE: 25043 (SO.FT. OR ACRES)
MAX BEDROOMS: 3
' Listed below are the options available to
you
in designing
your septic
system. Choose the option that best fits
your
site.
-- TRENCH
I3E]D
W _ IDRA I M
DEPTH TO PIPE BOTTOM (FT.) 4.0
4.0
4.0
GRAVEL DEPTH (FT.) 5.0
0.5
-3.5
TOTAL DEPTH (FT.) 9.0
4.5
.
7.5
GRAVEL WIDTH (FT.) 2.5
14.0
5.0
GRAVEL LENGTH (FT.) 26.0
28.0
28.0
GRAVEL VOLUME (CU.YDS.) 13.3
14.6
20.8
TANK SIZE (GALS) 1,000.0 **
1,000.0
1,000.0 **
SOIL RATING (SO.FT./BR) 05
85
85
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or.public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF'A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE: _
-0-4s i.Q�"lv
-- --- . -- '-�------- ----i---
APPLICANT: SKA CO
ISSUED B DATE: j
Municipa i�ty
O�
Anchorage
SS2 7-3)
PO .4 6-650
ANCHORAGE. ALASKA 99502-0650
(907) 264-4111
TONY KNO WLES.
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #: 840879
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 3 Block 1 Thunderbird Iieights Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Keith E. Bandt, Supe visor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
ET SOILS LOG
MUNICIPALITY OF ANCHORAGE
❑
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG /-�nPERCOLATION TEST ry U^
PERFORMED FOR: SIiJVC�� L. S�cI/�(L%Sy—( 1,/�S�iC�l.-I I�JY� DATE PERFORMED:
LEGAL DESCRIPTION:�n! •3 R�Oi�F I��III'%'lC'r fill (1 �It���I����'
mITTlp , SLOPE SITE PLAN
14
Date
15
ccbl;
•
• f4�7;a B` .
•v
Municipality of Anchorage aP :r.l'Y:1:••. f
°°°�2-'•=_`
;";,��.. 2�:tee<�._
On-Site Water and Wastewater Program J"
(907)343-7904 S. r C T T
Certificate of On-Site Systems Approval
Parcel I.D. 051-721-01 Expiration Date: yt F
1. GENERAL INFORMATION
Complete legal description Lot 3, Bk 1 , Thunderbird Heights Subdivision
. . _ 25144
Lpc. i ;'� = ) Thunderbird Drive, Chugiak, AK 99567
e,erty-o ) Patrick & Jennifer Brown Day phone (808) 228-2667
r�s ter;►, :..
....tit PSC Box 111 APO AP 96531
'Illiinraryr Raney Hardman RE/Max of ERDay phone (907) 440-7257
-;'%, t.
2. TYPSOF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System Public Sewer ❑
WaiverNariance request for: Distance:
IP
Received by: Pl Date: I Ji /
7
COSA to be released 1,e engineer,unless otherwise requested by the engineer.
COSA Fee $ 594 Waiver Fee $
Date of Paymenti ,1 '.l Date of Payment
Receipt Number O 02/1169-4 Receipt Number
COSA# 05C a-6103 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.
Name of Firm Pinard Engineering Phone (907) 232-1347
Address PO Box 871347 Wasilla, AK 99687
Engineer's Printed Name Paul E. Pinard Date 12/5/17
Aor..7ANA it
6. DSD SIGNATURE 3 * 4910 r � * r
X
System#1 Approved for bedrooms " !MIR ..___,..70
s
System#2 Approved for bedrooms �It*..
* � •�.r
Disapproved tt. • E-4791,07fi
•4.•
Alno1•�i t
• •
Conditional approval for bedrooms, with the following stipulations:
ris S �c_., .c 'cs 3. ..-veour, QLD
A male ( lc. -20 eat' le L S,
_``4:R. .- ZYOF,q , ,
tib,,,
ON-SITE 00'-
WATER AND ti`
7-2_11 WASTEWATER Z?
TPROGRAM o=
SERdtc
By: I w\- V--CJIC_ Original Certificate Date: ( Z-- I ( — ( 7
t
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 blue sheet j '- _. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On .Site Systems Approval Checklist
Legal Description: Lot 3, Bk 1 , Thunderbird Heights Parcel ID:051-721-01
A. WELL DATA
Well type A (Public) If A, B, or C provide PWSID# 211156 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test.
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA '
, Tank Type/Material Septic/Steel Date installed 6/21 /85
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 11 /28/1 7 Pumper One Stop Pumping
C. ABSORPTION FIELD DATA
Date installed 6/21 /85 Soil rating (P /If ft2/bdrm) 85 . System type Deep Trench
Length 1 .5. :f,, Width 3 ft. Gravel below pipe 6 ft.
V .Q
... N
Tot ,>''.� bsorption area 258 ft2 Monitoring tube Y Depression over field
D :deq w : .,i.•: 17 Results (Pass/Fail) Pass For 3 bedrooms
l't .4-• . 'n absor. . J _ 4.re test 0 in. Water added 500 gal. New depth 14.5 in.
E .6'"-•(-012..i- r...---.' fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejutr ,�a�,ii�tr-- • ' '-st 12 mo.) (Y/N &type) None Known If yes, give date
D. LIFT STATION NA
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO: NA
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 + Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1 00'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 5' * Building foundation 10'+ Water main 10'+
Water Service line 1 0'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+
Curtain drain None Known Wells on adjacent lots 200'+
F. COMMENTS
* A waiver was issued for the 5' separation to the prpperty line by
MOA letter, dated 9/5/03.
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and , '11
review of Municipal records that the above systems are in , x,
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Paul E. Pinard ter- ,
Date 12/5/17
a, •�� ��
MoevSS`°
COSA yellow sheet_2-6-15.doc
Municipality of Anchorage
1
Development Services Department
Building Safety Division
/ On -Site Water and Wastewater Program „ ...
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. !75 f-' 31 01 COSA
Expiration Date:
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Lot I Block 1: Thunderbird Heights Subdivision
7514d Thunderbird Dr. Chueiak• AK 99567
Current Property owner(s)
Joy Vickery Day phone 229-0796
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Kevin Taylor
Day phone
Day phone 273-7223
Prudential 3801 Centerpoint Dr. Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
0
`fiv,_ 6 // c/o Y
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. (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 Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm s a S engineering
Address 15861 S. Birchwood Loop Rd.6 ugi (, AK 956
Engineer's Printed Name
5. DSD SIGNATURE
✓Approved for bedrooms.
Disapproved.
Phone 694-2979
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: �Original Certificate Date: t10
.. �91
rre« nasr
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
v
Vt"LCEr P
ID:
Legal Description: L J�IH
A. WELL DATA
Well type �LBU (. - If A, B, or C provide PWSID # a� �tn Well Log (YIN)
Date completed _ Sanitary seal (Y/N) _ Wires properly prote /N)
Total depth ft. Cased to ft. Casing h (above ground)
In.
FROM WELL LOG NSPECTION
Date of test
ft.
Static water level
Well production P.M.g.g.p.m.
WATER SAMPLE RE S:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Ars u9/L date of sample: _ Collected by:
B. SEPTICIHOLDING TANK DATA
Tank TypelMaterial�J��'1 1G tLs Date installed
Tank size 16CO gal. Number of Compartments Cleanout&4)
Depression over tank High water alarm (YS) A)d
Foundation cleanou�(�N) P (�
Date of pumping % a� , 0� Pumper
C. ABSORPTIOIFILD ATA
( S Soil rating (g.p.d./ftZ r ftZ/bdrm System type 1 tKr
Dale installed 9 r
r ft. Gravel below pipe �_ ft.
Length a � • s ft. Width
r
Total depth _Is ft. Eff. absorption area.266ft2 Monitoring tube JivAepression over field
Date of adequacy test 6 I 05 Result (Pass) IN ail) IIWS.> For 3 bedrooms
n
Fluid depth in absorption field before test U .$$ in. r� Water addedgal. New depth_1_1 in.
Elapsed Time: min. Final fluid depth in. Absorption rate >_ t,l SO 9'P•d
�
Any rejuvenation treatment (past 12 mo.) (0 type)
&)�o If yes, give date '
D. LIFT STATION /l)// 1
Date installed Size in gallons
Man
"Pump on" level at_ in. "P evel at —in.
High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO.r�$LtL
Septic tank/lift station on lot
On adjacent lots��
Absorption field on lot
On adjace
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal c ent areas
Manure/animal excrete storage areas
PARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
f r
Building foundation $ t" Property line $
/
Absorption field S
Water main + Water service line
f
�U r '� Surface water
Wells on adjacent lots 0 A
SEPARATION DISTANCE FROM ABSQRPTION FIELD ON LOT TO:
Property line $ f Cw�.V�6Buildn foundation _ ID Water main 1014-
Water
t7t4-Water Service line Surface water /GZ'7 f -i Driveway, parking/vehicle storage 54 -
Curtain
4 -Curtain drain t=&- KI( Y00 Wells on adjacent lots i19 A
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined
review of Municipal records tht
conformance with MOA COSA ou
Engineer's Printed Name
Date
n
2;f FEcrIVE
-OCO MT
h field inspections and
above systems are in
A. •a d.
urns
COSA Fee $ Q
Date of Payment D OS
Waiver Fee $
Date of Payment
Receipt Number Receipt Number
(Rev. 11105)
c..
t-; 'tet•. e.��>
a—
AS -BUILT
N I hereby certify that 1 have surve ed the following described
hepropertyL—! i r [s
tgA
ni'Ll IL
Anchorage Recording Precinct, Alaska, and that the Improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on promperty Iv • adjacent thereto encroach
on the premises in question and tat there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
21v
Uris day of G L
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No. t4l-S
V Box 77-0456, Eagle River, Alaska 99577
Phone (907) 69425.13
a—
AS -BUILT
N I hereby certify that 1 have surve ed the following described
hepropertyL—! i r [s
tgA
ni'Ll IL
Anchorage Recording Precinct, Alaska, and that the Improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on promperty Iv • adjacent thereto encroach
on the premises in question and tat there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
21v
Uris day of G L
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No. t4l-S
V Box 77-0456, Eagle River, Alaska 99577
Phone (907) 69425.13
Municipality of Anchorage O
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program t
4700 South Bragaw SL - "`
P.O. Box 196650 Anchorage, AK 99519-6650
www.ct.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH ALITiIORiTY APPROVAL
FO H SINGLE FAMILY DWELLING
Parcell.D. 051-721-01 HAA# n2,tT����
Expiration Date: q — C1 — O q-
1. GENERAL INFORMATION
Comtilete legal description Lot 3; Block 1: Thunderbird Heights Subdivision
Location (site address or directions) •25144 Thunderbird Dr.
Current Property owner(s)`*6Liori tiekjtj h Day phone 561-1856
s; S
Mailing address ;' 2600 Cottonwood Lp: tilasilla, AK 99564
Lending agency
Mailing address
Day phone
Real Estate Agent Jeanine Smith — PrudentiaDayphone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup..
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:.
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑ .'
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class . Well
❑
Community On-site
❑
Public Water System
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 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 well and may be reissued with
new water sample results. (Certificates may be reissued for a period or 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.
S.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation dale shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guideliges for this application, shows that the on-''':' 1 c;
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 "•f ;�
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances:
and regulations in effect at the time of installation. ; • ; ; '
•,+J. .. ,l:i r Y: try 1: , se::... . ..,,
,. _ ,. ,.•r: •'•<.• )"694-2-979 • ' — • -• .. ,.
Name of -Firm S.-& S. Bngineer:ing__ ' Pi1�Dir
17034 N. Eagle River Iio.op Steffi `; 0,?it;Eag'1'.e:~River, :AK 99577-
Address >;
Engineer's Printed Name Robe*-* G Cowan- Date % ��/03
DSD SIGNATURE C. COWANcE
. �e
be !?� ' , . •.• :,;,'`�`+" .
Approved for., 3
. .. _ ''•:. - . meq',;;,•:-,y..,,..,;...r.:'. �.� �RGiE'aSM. '
Disapproved.
Conditional approval for - - -bedrooms; with the following stipulations: "1: • ',': ;
Additional Comments
PAD
PROGRAM
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory: Supplemental Engineer's Report
Well Flow Advisory .Other
1111
By: Original Certificate Date: I — f — d 3
(Rev. 01102)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AU T HOM I T APPROVAL CHECKLIST
Legal Description: LO I- �_ L✓ �, �lH'L1a1 �f-t&-M I ►?.A Parcel ID: e!!5-1'
A. WELL DATA Q TT�1(rl�fTS ' /O
(,� r3rLl L
Well type _ If A, B, or C provide PWSID #1 /S-6 Well Log (Y/N) _
Date completed _ Sani ry seal (YIN)_ Wires properly protecte (Y/N)
Total depth ft. ased to ft. Casing height (ab a ground) in.
FR WELL LOG AT INSPECTI
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMP E RESULTS:
Coliform colonies/100 ml. Nitrate mg./I. ther bacteria colonies/100 ml.
Arsenic: mg./I. Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 1 Date installed
Tank size . al. Number of Compartments Cleanouts (YIN) T "7—
Foundation"cleanout (Y/N) y Depression over tannk((('Y/N) High water alarm (Y/N)
Date of pumping I I 11 OZ Pumper
C. ABSORPTION FIELD DTAT,
Date installed rating (g.p.d.lftZ 2 bdrm e45 System type 2�AIG44
Length 21 • ft. Width 3 ft Gravel below pipe (e.> ft.
Total depth Eff. aborption area �ftZ Monitoring tube �' Depression over field
.7Date of adequacy test Results (PasslFail) PASS For bedrooms
Fluid depth in absorption field before test 0 in. Water added g9gal. New depth, in.
Elapsed Time: 10 min. Final fluid depth %d in. , Absorption rate >= � g.p.d.
/
Any rejuvenation treatment (past 12 mo.) (YIN & type) W+ If yes, give date �'
D. LIFT STATION
Date installedtatin.
"Pump on" lev
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N) _
"Pump off"level at_ in. High water alarm level at
Cycles tested
Pd6t1c.
SEPARATION DISTANCES FROM WELL
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
LOT TO:
Meets alarm & circuit requirements?
On adjacent I
On adjacent I
Public sewer
Holding tank
in.
SEPARATION DISTANCES FROM SEPTICfHQetr1NG TANK ON LOT TO:
r / /
Building foundation + Property line -* Absorption field S
Water main 'r Water service line 10 Surface water 100 1r
Wells on adjacent lots N
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line S Cl�ArdQt Building fou dation t C) Water main 0 t'
t 1
Water Service line (Q 1 f' Surface water 100 � Driveway, parking/vehicle storage
Curtain drain iUDNEKti)Or%11-J Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name F r% otx —1-C • ca wAw.
Date 9/S103
HAA Fee $ 3 7 S-
Date of Payment �1 / X -la 3
Receipt Number `f /1 `t 3
(Rev. 12101)
Waiver Fee S
tem
U
VOW C COWAN `Q
�Ii41CfE5;;01`�-
ISo , vo
Date of Payment 9 ( S` (0 3
Receipt Number
so
kii
AS -BUILT
NI hereby certify that I have surve ed the following described
property: 3 sr.
64—If e
:S. Lk !14r 14, N, R I U---: sr f ,
Anchorage. Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach an the property lying adjacent thereto, that
no improvements on property lying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this—M6 �i day of C er 7'-. 19 4f:!!;-
ROBERT
SROBERT C. JOHNSON
SCALE: Registered Land Surveyor No. IWLS
&+x 77.0456, Eagle River, Alaska 99577
Phone (907) 694-2543
NEALTHAITHORITY
APPROVALS
SEWER d WATER
AWN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANOREPORTS
WELL WSPECTION
a FLOW TEST
SITE PIANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTUiALa
NAECHANTICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTENA
DESIGN
TIG ROBERT C. COWAN, P,E.
CIVIL ENGINEERS
(907)694-2979
September 4, 2003 FAX(907)694-1211
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, Alaska 99519
REFERENCE: Lot 3, Block 1, Thunderbird Heights Subdivision
Request you grant the following waiver for the existing three bedroom house on
the referenced property: a waiver for the separation distance from the existing
leachfield and the south lot line of the above referenced property at five feet.
The mitigating factors involved which support the issuance of the waiver is as follows:
1. The existing leachfield is functioning properly.
2. It would be an unnecessary expense to the homeowner to have the leachfield
moved at this time.
We, therefore recommend a waiver for the separation distance between the existing
leachfield and the south lot line at five feet.
We do not anticipate any adverse effects on the neighboring properties by the granting
of this waiver.
If you have any questions, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/jhm
17034 NORTH EAGLE RIVER LOOP 0 SURE 204 • EAGLE RIVER, ALASKA 99577
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:30 0079 PID#: 051.721-01 HA#:030458 Permit#:
Date Received: 2M
Legal Description: Thunderbird Heights Block 1 Lot 3
Engineer: S & S Engineering
17034 N. Eanle River L000
Applicant: Lori Klein
Waiver Requested: 5 foot waiver from the Leachfleld to the South Lot Line
Criteria:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
Waiver is Granted: ice' Waiver is not Granted.
List Conditions or Reasons for above:
Date: -I — 0 3 By: 4E�
of Reviewer
Rec#: 41193 Amount: $150.00 Date Paid:159 _ /2003
1�Iumeipali y of Anchorage
Mark Begich, Mayor
Building Stifety Di-visioll
I3.0. Dn 196650 • 4700 Dragaw Street
Anchorage, Alaska W519.6650 • (907) 343-£3301 • rets (907) 343-8200
L t 1p://�wtie.mun i.org
9/5/2003
Robert C. Cowan
S & S Engineering
17034 N. Eagle River Loop
Suite 204
Eagle River, AK 99577
Subject: Waiver Request for Thunderbird Heights Block 1 Lot 3
Waiver Request #WR030079
Parcel ID #051-721-01
HA030458
Dear Robert Cowan:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
5 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
e r y W. Poet
Engineering Technician
On -Site Water & Wastewater Program
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
2644720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) -
/,oT 3 tatoc/< ! 7'110VD 2 6/2b NE/GHTS
Location (address or directions)
' _jOS TNUNDE2R/ILO D2/VE ._ ..
Applicant Name ST(/ r>usrAPsou Telephone: Home 6� 304- Business "4'¢ '571
Applicant Address 52 2 /03 Tis't1A1DC*t&P-."A -2/VE CVVe,.//9 ft9rf5 7'
°. (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer 13; Other ❑ (explain);
;.
j
(d)
ie,
Lending Institution
Address
Real Estate Company and Agent
Address
Telephone _
�S
_(f) _,Mail the HAA
Telephone
the following add ss:
I±Y .
2. TYPE OF RESIDENCE
Iv
! ' Single -Family Multi -Family ❑ Other
Number of Bedrooms
t 3. WATER SUPPLY
s " 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 DJSPOSAL
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 72.025111,e/)
I 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 shows that the on-site water supply and/or wastewater disposal system is safe, functionaland 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 COaWlAt '4s- MIC . Telephone SfO / p / $
Address 47 %0 BUISAIJF AA2 L LD Sur GdvC
ni c � e s3csls rr� . 9 950 9'//7 � S
"Date
�.OF.g4 e1
so C2
r • J. Corvine, J =yB Engineers Seal -
u•'' r� • CE -5283 '✓
6. DHEP APPROVAL—Z--
.Approved
PPROVA /
•Approved for bedrooms by t
Approved_ Disapproved
Terms of Conditional Approval
Conditional
avep'�5—
r
' 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 stale 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.
s[ Page 2 of 2
4,-' - 72-025(11/84)
BILL SHEFFIELD, GOVERNOR
DEPT. (O�f FJENVIRONMENTALL CONSERVATION Telephone: (907)
Addrrn:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE:
PWS I.D.A S6
To Whom it May Concern:
274-2533
According to records on file in this office the FY/u4 T1unclt11>,,W
Yee A fJ Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
f^1
A. WELL DATA
N
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORAG,
DEPT. OF HEALTH 3
ENVIRONMENTAL PROTEQION
Well Classification C01aj11Ut4I T -1 It A, B, C, D.E.C. Approved (Y/N) YDS
Well Log Present (Y/N) Date Completed
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Depth of Grouting _
Pump Set At
Yield
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
Water Sample Test Results
Comments * commuNlry Or_ Li- 15 19PP/'0X1Av1h}7LY ONE
m8 -LZ AW/4-Y F" Al iN15 Pee PEaTy
B. SEPTIC/HOLDING TANK DATA
Date Installed 42425
2 o Size X00 0 /SAL, No. of Compartments 7—
Standpipes
Standpipes (Y/N) %E✓r Air -tight Caps (Y/N) YC75 Foundation Cleanout (Y/N) YES
Depression over Tank (Y/N) Aic> Date Last Pumped AJZA
Pumping/Maintenance Contract on File (Y/N) _ /4 ; for
Holding Tank High -Water Alarm (Y/N) IV,& Temporary Holding Tank Permit (Y/N)N/4
Separation Distances from Septic/Holding Tank:
To Water -Supply Well
To Building Foundation 6
To Property Line To Disposal Field
To Water Main/Service Line 4 Z, 5 1 To Stream, Pond, Lake, or Major Drainage
Course
Comments -k AJQ E -
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorptjon Strata B5 Bb211/1 Type of System Design 7-11MWCH
Date Installed /��BS Length of Field 2/. FT•
Width of Field 3fo lAic/fE5 Depth of Field 7Z /nJcyES
Gravel Bed Thickness 7 Z l tjcl1E'S
Square Feet of Absorption Area 2:59 SO . FT. Standpipes Present (Y/N) Yr S
Depression over Field (Y/N) N O Date of Last Adequacy Test
Results of Last Adequacy Test N41A
Separation Distance from Absorption Field:
To Water -Supply Well zoo 'f To Property Line /� f
To Building Foundation To Existing or Abandoned System on
Lot Ai.m ; On Adjoining Lots 30 f
f
To Water Main/Service Line To Cutbank (it present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comment0^1r—
D. LIFT STATION &10 j GIS Cb)
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
'Pump Off' Level at
•• Check Petted Bedrq& Rating Against HAA Request ••
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Icertifyth hec4;4erified,orconformed toall MOA and HAA guidelines ineffect onthe date ofthis inspection.
Signed Date
Company - � AZ. MOA No. -ST565-215
Receipt No. R t-�
9-
OF
Date of Payment PC,
= �� �%111
Amount: $ Giti
..• n .�
Page 2 of 2
I 'm : a J. Cor.;n 1
Et ��•, Ja. CE -5233 1�1
72-026(11,84)
rdo
�e CA.�.�••.•.•.+•'...i.��
Engineer's Seal