HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS BLK 2 LT 1AThunderbird Heights Block 2 Lot 1 A #051-721-45 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211365 PID Number: 051-721-45 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Michael Zwalve ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 27220 Falcon Dr., Chugiak, Ak 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-854-0007 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Thunderbird Heights 2 1A Fill added above original grade Ft_ Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 51+ NA Poly 2 Foundation 10'+ 7' LIFT STATION Manufacturer Capacity Remarks * new construction only, existing pipes unknown Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034* Tank to drainfield 3034* Richard Person Construction Drainfield CO/MT3034* Inspector Crewdson Engineering BENCH MARK (Assumed elevation) 100 ft Inspection 15` 9-27-2021 9-28-2021 da:3`" Location and description 2�d 9-29-202 411 Bottom of siding at BM" on drawing. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Fnninaar'c Stmmn Conditional Approval: Date100, �. .. .. d ., James A. Crewdson ; / / C1 j527 i Septic System `— Approv �h Date o'iF` .•.c�� 'FESSIONP�'" Note: \\��\\�.'�►� this approval does not include well permit requirements. k 61i VJ/VL/ 10) EDGE -OF ROAD IAIATPP SEPTIC TANK Greer Poly 1250 BENCH MARK 100' ELEV FG 99.7' INSULATION FC S1 DC SEPTIC TANK ELEV: TOT 97.4' INLET INV 96.8' OUTLET INV 96.6' PROFILE ELEV BOS MH NOT TO SCALE Cree�rc son Engineering,_ LLC "— CM1 & ng Box 671389 Chugiak AK 99567 • ce11c.1@ou0c Celirrext:907-280-9493 • Fax: 907-688-2295 S1 UL; � CO E DRAINFIELD / ��Q 2 ' Thunderbird Heights, Block 2, Lot 1A Septic Tank Upgrade Record Drawing Prepared for: Michael Zwalve Date: 10-4-2021 Permit: OSP211365 Page: 1 of 1 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWOSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING LLC LEGEND BM - bench mark BOS - bottom of siding BR - bedroom C# - cleanout DC - double cleanout ELEV - elevation FC - foundation cleanout INV - invert M# - monitor tube MH - 24" manhole S# - septic tank riser SFH - single family home TOT - top of tank SWING TIES (feet) A B C FC 1.8 18.2 MH 14.2 16.3 S1 19.1 17.6 DC 24.0 20.4 M1 11.6 16.6 C1 26.4 9.7 Thunderbird Heights, Block 2, Lot 1A Septic Tank Upgrade Record Drawing Prepared for: Michael Zwalve Date: 10-4-2021 Permit: OSP211365 Page: 1 of 1 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWOSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING LLC LEGEND BM - bench mark BOS - bottom of siding BR - bedroom C# - cleanout DC - double cleanout ELEV - elevation FC - foundation cleanout INV - invert M# - monitor tube MH - 24" manhole S# - septic tank riser SFH - single family home TOT - top of tank ALLC #112279 —... ..... - a • i Jam A rewdson .' C11527 ��►��PROFESSIO �®~ ALLC #112279 Docusign Envelope ID: A5B2E6D0-88B9-4E43-A659-9FC0A1 C545CB �riicnt MUNICIPALITY OF ANCHORAGE a o� Development Services Department r Right of Way Section„ Department THIS AGREEMENT, made this 13th day of October, 2021, by and between MICHAEL M. ZWALVE and his heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: THUNDERBIRD HEIGHTS, BLOCK 2, LOT IA, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The SIXTY FOOT RIGHT OF WAY OF FALCON DRIVE & THE TEN FOOT UTILITY EASEMENT, immediately on the north and east sides of PERMITTEES property as shown on Plat No. 1977-220, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a 6' height wooden fence for a length of 94.8 feet upon the referenced real property which encroaches 10.8 feet upon the PERMITTER'S 60.0 -foot Right of Way, a deck and fence upon the referenced real property which encroaches 5.5 feet and a septic pipe upon the referenced real property which encroaches 7.5 feet upon the PERMITTER'S 10.0 -foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing wooden fence to encroach 10.8 feet upon the PERMITTER'S 60.0 -foot Right of Way, a deck upon the referenced real property which encroaches 5.5 feet and a septic pipe upon the referenced real property which encroaches 7.5 feet upon the PERMITTER'S 10.0 -foot Utility as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching wooden fence, as placed upon the PERMITTER'S 60.0 -foot Right of Way, a deck and septic pipe, as placed upon the PERMITTER'S 10-0-foor Utility Easement. DocuSign Envelope ID: A5B2E6DO-8889-4E43-A659-9FCOA1C545CB 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 60.0 -foot Right of Way and/or from the 10.0 -foot Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: DocuSigned by: 10/14/2021 dUl" . Zwalve Owner GRANTOR: MUNICIPALITY OF ANCHORAGE October 14, 2021 (1 Jack L. Frost, Jr. Right of Way Supervisor - FA L co/V EDGE OF ROAD N 89'53'03"E 106.90' L 1G 12.3'x16.2' SHED z + C o q + y 00 o 50' RADIUS Lot 1 A TEMPORARY Q- TURNAROUND 21,089 S.F. 0 x Q W N CHAIN-LINK FENCE x �_ x S 89'51'11' FENCE 00, 5.0'x6.7' DECK- N1 / 2.0' 232.62' �FCk 90,2, 2 RFS/0F�0F P5* \ Qa 43. S 55'05'37"E \ 38.09' -���-SEPTIC W / PIPES MANHOLE /I WOODEN FENCE Lot 2 / 10' UTILITY EASEMENT NOTES: 1) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 2) THE SHED ENCROACHES INTO THE UTILITY EASEMENT AND R.O.W. FOR FALCON DRIVE. 3) THE FRONT DECK ENCROACHES INTO THE UTILITY EASEMENT. 4) THE WOODEN FENCE ALONG FALCON DRIVE ENCROACHES INTO THE R.O.W. �bb /o PLOT PLAN __— AS BUILT _X_ SCALE 1 " = 40' GRID NW 1865 Project No 21-556fA2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax O F Professional Land Surveyors ken®langsurvey.com < ......... jonathan0longsurvey.com '9S�Q I hereby certify that 1 have surveyed the following described property: LOT 1A, BLOCK 2, THUNDERBIRD HEIGHTS SUDIVISION (PLAT No. 93-114) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _' Day ofLam___, _ 1__, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. ?* : 49TH y* KENNETH NG o ��csILL J�o p Fo [5-202..' S p 0?"ieSSIONA- AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http-J/www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211365 Work Type: SepticTank Upgrade Tax Code Number: 05172145000 Site Legal Address: THUNDERBIRD HEIGHTS BILK 2 LT 1A G:1865 Site Mailing Address: 27220 FALCON DR, Chugiak Owner: ZWALVE MICHAEL M Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Pt: Total Bedrooms: 8/27/2021 8/27/2022 21089 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 (2417). 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 I. Special Provisions: A Right -of -Way Encroachment permit is required for the existing absorption field partially located in the right-of-way. Please submit a copy of the encroachment permit to close out this permit. Received By: LI -1 Issued By: _wm/�L' Date: Date: 4 Municipality of Anchorage] P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services DeLiartment On -Site Water and Wastewater Section Waiver#: OSV211062 COSA#: Permit#:OSP211365 PID#: 051-721-45 Legal Description: Thunderbird Heights Block 2 Lot 1A Engineer: Crewdson Engineering Applicant: Michael Zwalve Ncnt s Dcparrmenr Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 0.0 feet. In addition, your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 5.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. avvvvaaaaaaaaasvvvvavvvavavvaa■avvavvavvv■av■mm■vaavaaaMavvaaaaaavmamvvaa02a0UI Waiver is Granted: X Waiver is not Granted: Date: 0 �b!� Approved by: " ��s Name of Reviewer v a v m m v v v a v a v a a m a a v v a m v v v v m a v v a m a v v v v e m v e v m a v a v v v v v a v a v a v m a v a v v a m v v a a a v v m v a v v a m MUNICIPALITY N H Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-721-45 Property owner(s) Michael Zwalve Mailing address Site address 27220 Falcon Dr, Chugiak, AK 99567 Day phone Legal description (Sub'd., Block & Lot) Thunderbird Heights, Block 2, Lot 1A Legal description (Township, Range & Section) Lot Size 21,089 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank Upgrade ED (w/wo ADU) (D) ❑ Holding Tank F-1Renewal EJDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Drainfield to Foundation / Drainfield to Lot Line Distance: 5'/ 0' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: _PZZS Waiver Fees: 4� 2Z� Date of Payment: $I2 (o �oZ6� 1 Date of Payment: c• 4 ►vi Receipt Number:0 (0 6906 Receipt Number: Permit No. (2 PZ 11-365 Waiver No. 0)U2 I)062 G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc James “Jay” Crewdson, P.E. Email: CELLC.1@outlook.com Cell/Text: (907) 280‐9493 Fax: (907) 688‐2295 PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567 August 25, 2021 Onsite Reviewer Municipality of Anchorage On‐site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519‐6650 Reference: Thunderbird Heights, Block 2, Lot 1A Septic Tank Upgrade and Drainfield Waiver Requests Design Narrative Septic Tank Upgrade: The existing 38‐year‐old 1250‐gallon steel septic tank serving the subject property needs to be upgraded. The proposed design is detailed on the design drawing. The proposed septic tank upgrade, if constructed as designed;  Will satisfy all code required separation distances,  Will not cause any probable adverse impacts to adjacent properties,  Will not negatively impact existing wells and septic systems on adjacent properties,  Will not be adversely affected by potential drainage that could flow onto and off of the subject property. Drainfield Waiver Requests: Drainfield to Foundation: A recent asbuilt survey shows a drainfield monitor tube that is approximately 9.6‐feet from the garage foundation.  The edge of the drainfield is likely closer to the foundation than the monitor tube and will be located while rebuilding the damaged aforementioned monitor tube.  The current separation distance has been in place for 38 years and does not appear to be impacting the structural integrity of the garage’s slab‐on‐grade foundation.  In an effort to ensure the waiver will cover the actual distance found, we are requesting a waiver for the drainfield to be at least two times the drainfield invert depth, 2 x 2.5’ effective depth = 5‐feet, from the garage’s slab‐on‐grade foundation.  The actual distance determined during construction will be shown on the septic tank upgrade inspection report. Drainfield to Property Line: While designing the septic tank upgrade, the drainfield was found to be extending north through the 10‐foot utility easement and across the property line to approximately 5‐ feet or more into the right‐of‐way (ROW).  A ROW encroachment permit request has been submitted and is anticipated, per verbal with the ROW department, to be approved without any required changes to the Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211365, Rebecca Carroll, 08/27/21 Page 2 of 2  Date: August 25, 2021 Subject: Thunderbird Heights, Block 2, Lot 1A drainfield.  The current drainfield location has been in place for 38 years and does not appear to be impacting utilities and/or improvements in the ROW.  As such, we are requesting a 0‐feet drainfield to lot line waiver, which will allow the current location of the drainfield to remain as‐is. Please feel free to contact me if you have any questions. James “Jay” Crewdson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211365, Rebecca Carroll, 08/27/21 o S� - TI ZU.- ��1�� MUNICIPALITY OF ANCHORAGE ACCT. NO. _ w 1 A LC�� WATER CONNECTION — Location Record ADDRESS NAME 2 ADDITION REPLACEMENT CONN. BLOCK �- 97 NEWCONN. LOT 7 DATE MADE )SHOW SKETCH ON REVERSE SIPERM NQ. SIZE�. a"r I] TYPE OF MAIN I THAW PLATE W. CORP STOP CURB STOP C TO C CURB STOP C TO 1 CORP CONNECTOR COUPLING C TO I S BUSHING X BRAS X GALVANIZED BUSHING 2 pART UNION 3 PART UNION X SERVICE CLAMP COPPER PIPE 1 114„ KEY BOX 2" KEY BOX THAW WIRE 6 ON n&� CONNECTION MADE BY 31.058 (12177) KEARNY WIRE CONNECTOR CONN. OTHER: INSP. PERMIT TOTAL EXTRA PIPE BROKEN MAIN, EXT. CONNECTION, FT (2-3COMMENTS: CASING. DELAYS, ETC. 6' ` � pILA (] PAID PREY. ❑ W.M. -- 13 (3 PAID CASH [l SUB AGREEMENT ALT. n DISCONNECTS Q IMP. DIST. EXCAVATOR E Q EXT. AGREEMENT APPOINTMENT TIME: TIME READY: ( # INSPECTED BY C A3 -11V 14180N 3.Lvo NI S IT n T�N��RF3rr�p V Q .� AvM H313NS A8 No'-LV003 3N1 -I 301A83S ONy X08 A3X 7 �J _L33a1S E'o.r EDGE OF F A L CON �F L = 703 \ WOODEN FENCE 9 7' 12.3'x16.2' SHED+ / . t .001 S 89'51'11"W 23: Lot 2 Cb Z . h S 55'0\ 38.09' 50' RADIUS Lot 1 A TEMPORARY SEPTIC 21,089 S.F. p PIPES TURNAROUND L CHAIN-LINK FENCE 5.0'x6.7' .62, WOODEN FENCE x � 10' UTILITY EASEMENT/ x � x � S 89'51'11"W 23: Lot 2 Cb Z . h S 55'0\ 38.09' NOTES: 1) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 2) THE SHED ENCROACHES INTO THE UTILITY EASEMENT AND R.O.W. FOR FALCON DRIVE. 3) THE FRONT DECK ENCROACHES INTO THE UTILITY EASEMENT. 4) THE WOODEN FENCE ALONG FALCON DRIVE ENCROACHES INTO THE R.O.W. PLOT PLAN ___ AS BUILT _X SCALE 1___40__ GRID --Lt—L8—K-- Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000O�p4� (907) 522-4625 Fax o Professional Land Surveyors kenOlangsurvey.comc( �F ..�q�44 jonathanOlangsurvey.com �v'\ .. ..S Q I hereby certify that I have surveyed the following described property: LOT 1A, BLOCK 2, THUNDERBIRD HEIGHTS SUDIVISION (PLAT No. 93-114) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property tying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the =`-XPi _ Day of ` r 4 i___—_—_, _ �_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49LH �* KENNETH ....... ...: .o 04 �Fo ''..LS— 202. 0 4�� OFESSIONA� �o AECC963 SEPTIC 2.0' CANT p PIPES W � n .62, WOODEN FENCE 10' UTILITY EASEMENT/ NOTES: 1) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 2) THE SHED ENCROACHES INTO THE UTILITY EASEMENT AND R.O.W. FOR FALCON DRIVE. 3) THE FRONT DECK ENCROACHES INTO THE UTILITY EASEMENT. 4) THE WOODEN FENCE ALONG FALCON DRIVE ENCROACHES INTO THE R.O.W. PLOT PLAN ___ AS BUILT _X SCALE 1___40__ GRID --Lt—L8—K-- Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000O�p4� (907) 522-4625 Fax o Professional Land Surveyors kenOlangsurvey.comc( �F ..�q�44 jonathanOlangsurvey.com �v'\ .. ..S Q I hereby certify that I have surveyed the following described property: LOT 1A, BLOCK 2, THUNDERBIRD HEIGHTS SUDIVISION (PLAT No. 93-114) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property tying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the =`-XPi _ Day of ` r 4 i___—_—_, _ �_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49LH �* KENNETH ....... ...: .o 04 �Fo ''..LS— 202. 0 4�� OFESSIONA� �o AECC963 MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264A720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Sk19GG S CIONS fRuGf:pA) PHONE XNEW UPGRADE MAILING ADDRESS P, C h ,s LEGAL DESCRIPTION LOCATION -Munder _ Bird y,l +s.. NO. OF BEDROOMS y LiY DISTANCE T0: Well e M Absorption area / Dwelling A• PERMIT NO. • 30 :ir1 iQ W f Manufacturer Material eL No. of comparjtnents oC Liq.capacity in gallons" I a SO IF HOMEMADE: Inside length Width Liquid depth d he JZZ DISTANCE TO: Well Dwelling PERMIT NO. _ _ H Manufacturer Material Liquid capacity in gallons D W = DISTANCE TO: ell Foundation Nearest lot line / PERMIT NO. Onnet tJr: tfQrJ 3 a i ti Z FZw No. of lines Length of each lin ,, , Total length of lines Trench width Iris Distance between lines cc ham- o Top of tile to finish grade M terial ben ath the a• S Inches Total effective absorWn area W Length Width�rlD h S /� I� PERMIT NO. d H W d Type of crib r Crib diamet r th Total effective absorption area US DISTANCE TO: Well 8uildi 1 ndation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE T0: IBuilding foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS STM 3 SOIL TEST RATING g late INSTALLER E - .h AL REMARKS // ten O 0 0 W APPROVED 9Dc� LEGAL ///J/ 72-013 (Rev. 3178) MUNICIPALITY OF ANCHORAGE Departmentr'1 Health and Environmentar"Arotection- A)C) fir - .825 i%.825 Street, Anchorage, AK. 1501 264-4720 Permit #. 60-369g 7 * * * HANDWRITTEN PERMIT W62. 1MAR ON-SITE 'SEWER PERMIT Applicant: o�c 1�j"cf Mailing Address: _P0. &0 h n4uoi.ary AKI"47 Location:T/!Al k I W •Cr,.2f Phone -Number:, /R$-2p-lf Legal Description: L.tls/1 Lot.Size: �). pBS�FY' Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed:... I/ Holding Tank: Maximum Number of Bedrooms: _� Soil Rating(sq.ft/br)_ 2s-�S The Required * e,of the Soil Absorption System Is: �oI . DEPTH •�� LENGTH `J GRAVEL 'DEPTH . . S�' WIDTH Ak The length dimension is the length(in feet) of the trench or.drainfield. The .depth of a trench or pit is the distance between the -surface of the ground and the bottom of`the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between.the outfall pipe and .the bottom of the excavation(in feet). ,* * REQUIRED.SEPTIC(HOLDING) TANK SIZE'=. 2s- n GALLONS Permit applicant has the -responsibility to inform this department during the . installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *,* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection.and approval by this departmen will be subiect to prosecution. . . Minimum distance between a well.and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well.. Minimum distance:from.a private well.to a private sewer line is 25 feet and to a community sewer line.is 75 feet. Well logs are required . and must be.returned.to this department within 30 days of the well completion. Other requirements may apply.- Specifications and.construction diagrams are available to.insure proper installation. * * * PERMIT EXPIRES DECEMBER 3L.1 9 3 3 I certify that: (1) I am familiar with .the requirements for on-site sewers and wells as- set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that.the on-site sewer system may require enlargement if the residence is. -remodeled to include more that 3 bedrooms. Signed: Issued bye_oe— 1. Applicant Date: "In the event that hIN staElon.19Insiailed M 'SWP/024 (1/81) electrical permit and Inspection must be obtained. As-builts cannot be approved un- til the electrical Inspection is received In this office. The electrical work must be per. formed by a Viceiscd olect•ician.^ Uf TCIYACITTT)F 'AKrHURAGE--_`t,�-•-- �-�+ Department of Health and Environmental protection 825 1 treet. Anchorage, AK. 1 a 269-4720 HANDWRITTEN PERMIT m1t i� ,f,3A5,t7 "CL P*W�Oft ON-SITE'SEWER PERMIT Iicant8. S �_ Mailing Address :.Pp,3rih)w�A�9 t1.1s I. inion t .(pj t4)_ ,Q_r. 2-s- Phone Number i / Rk •2 h' 3/ Al Descriptions le J P/k-27hu.iAdicsLfML Lot Sire: w2lti2b TY1 e_of-Soil Absorption System Is: Trench: Drainfieldt Seepage Sea:. t/ Nolding•,Tankt 12 imum Number of Bedrooms t--�_ Soil Rating(sq.ft/br).rC it . .. . . - The Required3 Fe of the Soil Absorption System Isr �bt .�� LENGTH JIQ GRAVEL DEPTH.___.s,§. WIDTH 4 length dimension is the length(in•feet) of the trench or drainfield. The ^pth of a trench or pit -is the distance between the surface of the ground and * bottom of the exca'vation(in feet). There is no set width for trenches. e gravel -depth -is the zainimtmt depth of gravel between the outfall -pipe and - i bottom of the-excavation(in feet). !, § * * REQUIRED SEPTIC(HOLDINGY TANK S17E-=:.12S:O__ GALLONS a '� Iit applicant has the•responsibil3ty to inform this department during the IAllation inspections of any wells adjacent -to this property and the number, residences that the well will serve. ' ` « " 'Two(2) INSPECTIONS ARE REQUIRED Ifiliing of any system -without final inspection.and approval by this departmen ;the sub�ect--to prosecution. mum distance between a well and any on-site sewage disposal system is 100 f ec- +i private well or 150 to 200 feet from a public.well depending upon the type �iblie well. Minimum distance from a private well to a private sewer line 15 feet and to a community sewer line is 75'feet. Well logs are required � must be returned to this department within 30 days. of the well completion. iC requirements may apply. Specifications and construction diagrams are. ilable to insure proper installation. * * ` PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * " certify that: _ �(1) I am familiar with the requirements for on-site sewers and wells as - set forth by the Munieipality'of Anchorage. (2) 1 will install the system in accordance with codes. I(3) I understand that the on-site sewer system may require enlargement if i the r sidence .is remodeled to include more that 3.. bedrooms. Issued byl. i cd0 't Applic nt Date'.. 1n the mml that t,lift'stetion is Inslsj" M electrlcet petmit and Inapeotion twat t* obtained. Asdauilts cannot tie epproved un- til the dectriesl Insj)milon Is fecelvs6 In this office. The electrical work must be per- tormcc' by a c!cct•ician ^ SOILS LOG i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ TESTOLATION 825 L. Street, Anchorage, Alaska 89501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: GSK 1pevl S'Cmc:1 % by -1 '/ DATE PERFORMED: LEGAL DESCRIPTION: Gor /, 642f ///<rdCC,QRi,ed /YGr<y'Nrs c/Bn.. S!G? ,' T/[ d, .P_ /k// S5H " SLOPE ' SITE PLAN DkvT iFEE�, 1017A7 - f' 2 f O �F1 � �'mL:-S< S'.QACc A Q.F,Oc'CGS geovecY 6A4/4S < i 4 r — /asp sE / acaecbH (cope Ar (/TE 5-s .i 6-. • • f16 i��eL, 7 OF: Noce. I 8 9 10 11 WAS GROUND WATER ENCOUNTERED? .L,,_ i• 12 IF YES, AT WHAT DEPTH? % '}E• 13 14 *4'e') ' W,4re. G a/� 15 yct//roce0 ion seV4CIV d4YJ o✓<rH At 16 Cr'/Aa/S'r /yd Levet. 17 18 19 e 11 1i Reading Date Gross Net Depth to Time jQntp�T� Water Net Drop �ur •• (�_'+ p - Vr.. •��r 1 1 b i 1 •,. iVim`✓ No. CL -;325 • •- J �4 VT [• wry J✓' • Fp 'a•.„...•• y ;; 20 1 I PERCOLATION RATE (minutes/inch) L.J TEST RUN BETWEEN FT AND FT i COMMENTSA-6LFJ1 ^ferO ,cr /Il- 54 f1f XPLdPnoN CJ<ra en7-re5H ACE/C A/o c'�PCATEe f+'c'lc�t•)nSr/ 6i('r•F , PERFORMED BY: awF ,e'r C ul57 dGr/A/f/ 1/P CERTIFIED BY: .G e, rcAGKs'F,R- OATE:,q/7 EX 8s-ool Sr 8S-oo2, ' 72-008 (6/79) � .r MUNICIPALITY OF ANCHORAGE 1 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. 051-721-45-000 Expiration Date: Legal description THUNDERBIRD HEIGHTS BLK 2 LT 1A Site address 27220 FALCON DR Chugiak AK 99567 10/14/2025 Current property owner(s) WUTZKE PATRICK JOHN &SARAH DANIELL X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: LIM bedrooms, with the following stipulations: Original Certificate Date: 10/30/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 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 Application 1. GENERAL INFORMATION Parcel I.D. 051-721-45 Complete legal description THUNDERBIRD HEIGHTS BLOCK 2 LOT 1A Location (site address) 27220 FALCON DRIVE, CHUGIAK, ALASKA 99567 Current property owner(s) WUTZKE PATRICK JOHN & SARAH DANIELL Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee Waiver Fee $ Date of Payment _ U �(� y Date of Payment COSA # VE;C 2'`"I IN 27 Waiver # COSA Applicalion.doc COSA Checklist.docx COSA Checklist Legal Description: THUNDERBIRD HEIGHTS BLOCK 2 LOT 1A Parcel ID: 051-721-45 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 10/14/24 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/20/83 ALL standpipes present per record drawing Total measured depth from grade 3.8 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 10/14/24 Results Pass Fluid depth prior to test 6 in Water added 600 gal New fluid depth 6 in Elapsed time 1440 min Final fluid depth 6 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 6” ED) Effective depth used 6 in (Final Fluid Depth) Effective depth remaining 0 in (1” Fluid levels - rechecked on 10/24/24) Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately that there is 6.6” ED. No fluid levels rose in the MT, there was no fluid ever in CO invert or backed into the septic tank – levels were constant. Fluid levels were rechecked on 10/24/24 and there was only 1” of standing fluid & assume there was heavy use at time of testing. The system seems to be absorbing at the top of the field, and one may consider future treatment of the absorption field. Satisfactory 2021 adequacy test per MOA docs and MT was rebuilt with septic tank upgrade install at that time. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *5 ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *0 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MOA WAIVER #OSV211062 – 5’+ FIELD TO FOUNDATION & 0’ TO PROPERTY LINE TO FIELD. IR SHOWS 10’ TANK TO FOUNDATION. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/16/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/16/24 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite t Septic System Absorption Field Advisory Certificate of On -Site Systems Approval # OSC241427 Subdivision: Thunderbird Heights, Block: 2, Lot: 1A 907-343-7904 Fax: 907-343-7997 Prior to the absorption field adequacy test, 6 inches of standing water was observed in the absorption field. This indicates approximately 90+% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNICIPALITY CIS Development Services Department, D�;Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-721-45 1. GENERAL INFORMATION Expiration Date: 9-119-2-02--T Complete legal description Thunderbird Heights, Block 2, Lot 1A Location (site address) 27220 Falcon Dr, Chugiak, Ak 99567 Current property owner(s) Mailing address Real estate agent Michael Zwalve Diane Shearer 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 907-854-0007 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .5-60 Date of Payment Receipt Number 6 COSA # OSG Z 1 151 g Waiver Fee $ Date of Payment Receipt Number 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 Crewdson Engineering LLC Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 8-25-2021 6. DSD SIGNATURE T WX System #1 Approved for L Jam s A. Crewdson S i) y pp bedrooms 011527 i System #2 Approved for bedrooms (�9 ' •.,,,� Disapproved ill\XROFESS`NP�� Conditional approval for bedrooms, with the following stipulations: c OF,q�C/i�% _ -SITE WATER AND m� SIV2 PROGRAM 6 J By- Original Certificate Date: /©--i'. 9-2 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 Legal Description: Thunderbird Heights, Block 2, Lot 1A If more than 1 septic system on lot: COSA Checklist # of PUBLIC WATER ❑ is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material Septic/poly Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping not required for new tank D. ABSORPTION FIELD DATA Which system tested (date installed) 9-20-1983 ® ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) [:1 N/A — pressurized field IN Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-721-45 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) is ug/L ❑ Arsenic less than MRL (ND) Collected Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: new tank has not filled to operating level Adequacy test date 8-18-2021 Results E] Pass For 4 bedrooms Fluid depth prior to test 0* in Water added 600+ gal New depth 0* in Elapsed time 120 min [Z Code -required soil cover over field Final fluid depth 0* in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *Monitor tube was only 2" into the drainrock at the time of testing. It was rebuilt wh( the septic tank was upgraded. COSA Checklist yellow sheet E. SEPARATION DISTANCES PUBLIC WATER Septic Tank/Li non Lot > 100' ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes���ft Absorption Field on Lot > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ❑ Yes if No ft Community Sewer Main > 75' ❑ Yes if No ft Community Sewer Manhole/Cleanout > 100' Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft olding Tank > 100' ❑ Yes if No ft Animal Co t > 50' ❑Yes if No ft Manure/Animal Excreta Sto From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' p Yes if No ft Surface Water > 100' Property Line > 5'✓❑ Water Main > 10' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Water Main > 10'✓❑ F. ENGINEER'S COMMENTS Yes if No ft Community Wells > 200' ❑ Yes � � o ft R Yes if No ft ❑✓ Yes if No ft Q Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' it Yes if No 7* 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' _ ❑Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS *determined while rebuilding the monitor tube G. ENGINEER'S CERTIFICATION ®qtr, • S 't I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with . • • • . • .. MOA COSAguidelines in effect on this date. . • , , • , James A. Crewdson ; ,r • C11527 .•��/� fi�F'' ....•••',.law . COSA Checklist yellow sheet ft ft �\ Municipality of Anchorage • -- Development Services Department ; Building Safety Division /.. .h. -_ �- On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.' O s! -;-7 — H S— COSA # Expiration Date: 6-21-68 1. GENERAL INFORMATION Complete legal description Lot IA: Bleak 2: Thunderbird Heights Subdivision Location (site address) 27220 Falcon Dr. Chugiak, AK 99567 Current Property ownei(s) Earston Hewitt Day phone 240-0686 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Bennie 4-"g Day phone 244-7176 Mailing Address Unless otherwise requested, COSA will behold by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 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 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 engineers 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. 1 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 Engineeimg Phone 694"2978 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineers Printed Name l�d B�E-1 ` C.-vwA.✓ Date S F 407 y ROBERT C. COWAN 'moo CE -8801 5. DSD SIGNATURE �� Approved for _JL bedrooms. fi`OPw "EwSs� F, r Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; ' Original Certificate Date: `2, 1 O% (Rw. I IM) Municipality of Anchorage Development Services Department Building Safety Division Qn-Sits Wates & Wastewater Program 4710 Bragaw, Street P.O. Box 196850 Anchorage, AK 99519.8850 www.muni.orglonsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST f t hl6�Fi� �1 Legal Description: M Jig t�11�1Go2 } I eFUt1D6QB! 12 D Parcel 10: o .c i - 7 3 r -N S' A. WELL DATA �nYt!/yt Uw Well type CAMn If A, , or C provide PWSID #-a fru(j Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly /N) Total depth ft. Cased to ft. Casing hg' (above ground) in. FROM WELL LOG Date of test Static water level ft. Well production G.P.M. g.p.m. jWATER SAMPLE RE S: orm colonies/100 mL Nitrate mg1L Other bactene colonkW100 mL c: mg/1 Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material—tin-1c Z'STIML. Date installed 411W1,95 Tank size _1260 gal. Number of Compartments .42, Cleanout ( I) '4e� Foundation deanou(IVN) Depression overtank(Y®-a High water alarm (Y& A26 Date of pumping Pumper c1 F-1`� �ymPt)t?G C. ABSORPTION FI LD DATA Data installed D 3 . Soil rating (g.p.d /ft= ftzJbdnn System type n Length g_ft. Width ft. Gravel below pipe O. 61 ft. r9 Total depth 31 ft. Eff. absorption area Monitoring tube ES Depression over field �La Date of adequacy test _ Results Pas ail --�� For 4bedrooms n �r�� � Fluid depth in absorption fleld before test .� in. Water added o-cagal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth _�in. Absorption rate >= 6,00*_ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) ".) — If yes, give date = D. LIFT STATION �{ Date installed "Pump on" level at_ in. E. SEPARATION DISTANCES Sine.in gallons Pu eve! at _ in. Cycles tested High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: CLA4,S /q Septic tankAdt station on lot Absorption field on lot Public sewer main On adjacent lots Public sewer manhole/cleanout Sewer /septic service line / Holding tank areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: t 1 s, Building foundation /D •f- Property line S Absorption field Water main 10 l Water service line /D Surface water fn0 -t- Wells Wells on adjacent lots aft SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r I I Property line of Building foundation D + Water main /O --f- Water fWater Service line ID Surface water /d4 /I Driveway, parking/vehicle storage !D 4 Curtain drain AV" KAAftVWells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION r I certify that I have determined through field inspections and / *° review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date."' p ktlltlR'F G eow�w wt Engineer's Printed Name OQ &A --r Cd../d.r q Ce -`48801 Date $ 105-/07 �I` .•.4 COSA Fee $ ' 30. 040 Date of Payment S' /4/9-7 Receipt Number 9 P C (Rev. 11!05) Waiver Fee $ Date of Payment Receipt Number ' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services zTYCFA�Io On - Services Secon te P.O. Box 196650SIAnchorage. Alaska 99519-6650 �s V t � vu ON 343-4744 OCT 70 1997 CERTIFICATE OF HEALTH AUTHORITY RECE, APPROVAL FOR A SINGLE FAMILY DWELLING C ED Parcel I.D. It OSI — d) — r'� �lj HAA # V (QS lnil-1'_l 1. GENERAL INFORMATION Complete legal description Lot 1; Block 2; Thunderbird Heights Location,(site address or directions) 27220 Falcon Drive Chugiak. AK ;Property owner, Darrell & Diane Ferguson Day phone 688-7084 Mailing address 9�27Q' Falrnn nr;v- Chug+ak, AK 99567 ,Lending agency `' Day phone Mailing address Agent Kevin vakalis-Cornerstone Bldrs Day phone 244-8205 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: .4 3. TYPE OF WATER SUPPLY: Individual well Community well xxx 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 7ocx - 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. n.025 JP v. t/9i) Front MOA F=1 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 S b S ENGINEERING Phone 6 g Ll -'1 g 79 17034 Ea£le River Loop Road No.204 Address 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date 10 110 /17 SOF CE -8801 bedrooms,. with the following stipulations: Date A% 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. 72-MM..1191) 6. MOA m CAUTION 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. 72-MM..1191) 6. MOA m Municipality of Anchorage MUNjkjNALjTy of DEPARTMENT OF HEALTH & HUMAN SERV10E6Nv1mNwNrALsW Environmental Services Division ��r�TT 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-Q 10 19 0 Health Authority Approval Checklist RECEIVED Legal Description: Idi' 1 RLa r ,2. nuammitf1 an Parcel I.D.: O $'/ — 7 a) - o S A. wElrD@TA Well Log present (YM) Total depth anitary seal (YM) r Date of test Static waterlevel Well production 5 4 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform Nitrate Data of sample: Collected by: B. SEPTICfHOLDING TANK DATA aifls6 Casing height (above ground) AT INSPECTION (YM) Data installed 9$3_ Tank size 1Z-50 Number of Compartments Cieanouts (9N)LIM Foundation deanout I&W) jj e, Depression(Y© Mn High water alarm (YM) �f Date of Pumping Pumper Ta15 17-17 C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.djV or ft=lbdrm) i z 5 47- System we RE D Length. !— Width 1 Gravel thickness below pipe Total depth_ Effective absorption area Z Monitoring Tube present&) Depression over field (Y® Atn Data of adequacy test10 1 �T— Results `J I) PASS For I'oct2. bedrooms Fluid depth In absorption field before test (in.); Tk3.M Immediately after gal. water added (in.): D2`I Fluid depth -- (ins) Minutes later: Absorption rate = + g.p.d. Perkadde treatment (past 12 months) (YM) 0o,jE t=.nww*I If yes, give date 72-026 (Rev. 3196)' D. LIFT s�+� Date installed Manhole/Access (Y/N) High water alarm level at' _ Cycles tested E. 9EPAfIATION DISTANCE; SEPARATION OMMQ.ES Septic/holding tank on tot Absorption field on lot Public sewer main Sewer /septic service line _ Size in gallons level at' 'Datum FROM WELL ON LOT TO: On adjacent lots On adjacent lots Public Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: Pump oft" level at" Foundation t0; 4- Property line to Absorption field S / Water main/service line(O' f Surface water/drainage t00' } Wells on adjacent lots .�IC� r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property } lineBuilding foundation 16 � } Water maiNservice line I0 r Surface water i0 o ' i JJ Driveway, paridng/vehicle storage area t roe Curtain drain b1mic KNe �n1 Wells on adjacent lots Zoo' + F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municlpal record sr are in conformance gellnes in effect on arils date. Signature Engineer's Name 06 CRY C. Co wq,J Y •. / to C. eaw�we Data /0 l I 0 ct �j �. •. CE - 8801 r` HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. W96)' Waiver Fee $ Data of Payment Receipt Number •Y {t A r rr 6 ,Ire F•� A , g n r ,.. eF, } I .IV s, a ',A INN Al may' c w rl' F tii S ASetfiLT-NO COftNEF#S SE,THIS ATE• SMA5D A` SQGTA �S LAND I HEREBY 6E=RTIrY THAT I'HAVE SURVEYED THE SCAI.c' r • ' �,,►'ww'ti r 1=0LL6W1 G DESCRIBED PE O'PltR7Y; �!�arr,�ur:•� D'� � •. � �'� • '•- Ri�y,a4 AND MAT NO ENCRClACHMENTS'I&IST EXCEPT AS �w ,•' ' c j %+• INDICATED.. iTIS';THE REMNSIBILITY OF THE OWNER TO DET'ERMIN'E THE EXISTENCE OF ANY {a};iD:' r •'••• •• + WiriAEN�'S,'COVENANTS, 4R RESTRICTIONS iyyfrr �d3' �y WHICH DO NOT APPEAR ON THE RECORSZ. 'tUShl . ' oue^e 7Aer} Sews d � VISION,'PLAT. UNDER N0, CIRO MSTANG1rS SHOUI..'O F$ w , 1 �; . I5 d91 � ,te d ANY DATA HEREON SE USED FoR CONSTRUCTI^!J '�'-�� i �' ,' r ARY LINCE ES LINES, OR FOR ESTASLIMI3G E. lo'd EcOMKOB 'ON Kd-1 Allv3C QNdl lvt N, Sh;t. M,3 f6-II-Nnr oeofAneh6rageDZunicipali� Department of Health and Human Services ` / 825 "L" Street Rick Mystrom, MayorP.O. Box 196650 Anchorage, Alaska 99519-6650 October 21, 1997 Robert C. Cowan, P.E. S b S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 1A Block 2 Thunderbird Heights Subdivision Waiver Request 9WR970067, PID 9051-721-45, RA970473 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on—site wastewater disposal system and a lot line has been approved. The waived distance is 2 feet from the leachfield to the north property line. This approval applies to the existing on—site wastewater disposal system lot line separation only. Any future upgrade to the 'AM'—site wastewater disposal system will require all separations be met or' another approval from this department. If there any further questions or concerns regardieg this waiver, + please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On—site Services ljw 97 n MUNICIPALITY OF ANCHORAGL Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#j,�OglMl `1 PIN 051-721-45 HA# RA970473 Permit # Date Received: October 10, 1997 Legal Description: Lot 1A Block 2 Thunderbird Heights Engineer: Robert C Cowan Y E.. S & S Enaineerine 17034 Eagle River Loon Road Suite 204. Eagle River. A7acka 99577 Applicant: Darrell/Diane Ferguson Waiver Requested: Lot line waiver of 2 foot from the absorption field to the north property line. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: xxxxxxx Waiver is NOT Granted: List Conditions or Reasons for above: SEF Fy6/aEERl A7rgegED Tyt T.,Ci[A7Wy L E7TE R Date: October 21, 1997 Rec #: Fee Waived per DJR Amount: $ By: Pew Name of Reviewer Date Paid: W.&THAUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER ►SPEcnON ENGINEERINGSTUDIES ANOREPORTS WEUHSPECTION & ROW TEST SORTEST PERCOLATION TEST STRUCTURAL& MECHANICAL eSPECTICNs ONSITE WASTEWATER DSPOSALSYSTEM DESIGN October 10,1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Attn: Dan Roth P.O.Bor 196650 Anchorage, AK 99519 REFERENCE: Lot 1; Block 2; Thunderbird Heights Dear Mr. Roth, ROBERT C. COWAN, P.E. CML ENGINEERS (907) 6942979 FAX (907) 6941211 RECEIVED OCT 10 1997 Municipality of Anchorage DepL Health & Human Services The original inspection report completed on 9/20/83 on the referenced property shows the separation between the north lot line and the leachficid to be 8 feet. An approved HAA completed by Eagle River Engineering on May 25, 1993 records a separation distance of 2 feet bchrcen the north lot line and the leachfield. We are requesting that all waiver and encroachment fees be waived since this system was documented and approved in 1993. If you require additional information, please contact us. Sincerely, Robert C.Cowin, RCC/gk MUNICIPALITY Of ANCHORAGt: ENVIRONMENTAL SERVICES DIVISION OCT 101997 RECEIVED 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY ANCHORAGE • ^• DEPARTMENT OF HEALTH i£ 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 Parcell.D.# 091-771-05 HAA# tQtJ�l',f���L 1. GENERAL INFORMATION Complete legal description Thunderbird Heights Location (site address or directions) Lot 1, Block 2 27220 Falcon Drive, Chuqiak Property owner Craig & Kathleen Albee Day phone 688-0960 Mailingaddress ur 79 ach,igink AK g9S,67 Lending agency N/A Day phone Mailing address ; Agent Rae Hall/Great Land Realty Day phone OF at's swel rowel .. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 694-9125 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 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. 72ms1n...1n1) F, t w0A121 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply arid/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 roginpPring Sprvineg Phone F94 -SIBS Address P.O.' box 773294, Eagle River, AK 99577 Engineer's signature ��� Date �6. 'DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M 1uTtnN Date .S— ZS— 03 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. 72IM I WA/91) Back MOA R21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:rNUNXA,6/,CD i/EIbNTS Parcel I.D. 77,1 -40S Lv/ / '6"ek Z A. WELL DATA Well type PUQL /L If A, B, or C, attach, ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER RESULTS: Wires properly INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout tank ry Nitrate sample: Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria Date installed 09/ 17,45DTank size L- ZCompartments Cleanouts (Y/N) %�E 5 Foundation cleanout (Y/N) YES Depression (Y/N) NG High water alarm (Y/N) N�q Alarm tested (Y/N) NIA Date of pumping _05//�t��9 Pumper J /Z SEPARATION DISTANCES FROM SEPTIC/HAL=G TANK TO: Well(s)onlot &14 Onadjacentlots Foundation )U i AS oC[ Topropertyline IZ 14-590JET AbsorptionfieldSire.,..cLWaterrazia/serviceline -No Surface water/drainage 72-026(Aw. 7191( Ftwl CONTINUED ON BACK PAGE rn rn N 9 P m< ao rn w C CV) Z Z Date installed 09/ 17,45DTank size L- ZCompartments Cleanouts (Y/N) %�E 5 Foundation cleanout (Y/N) YES Depression (Y/N) NG High water alarm (Y/N) N�q Alarm tested (Y/N) NIA Date of pumping _05//�t��9 Pumper J /Z SEPARATION DISTANCES FROM SEPTIC/HAL=G TANK TO: Well(s)onlot &14 Onadjacentlots Foundation )U i AS oC[ Topropertyline IZ 14-590JET AbsorptionfieldSire.,..cLWaterrazia/serviceline -No Surface water/drainage 72-026(Aw. 7191( Ftwl CONTINUED ON BACK PAGE C.. LIFT STATION Date Installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes SEPARATION DISMICE FROM LIFT STATION TO: Well D. ABSORPTION FIELD DATA On adjacent lots Manufacturer chole cess (YIN) "Pump off" level at _ Cycles tested Surface water _ fate installed e4o -9 3 Soil rating System type - 45E4 Length 4O Width /9 r Gravel thickness a Total depth 3 :Total absorption area %Li Cieanouts present (Y/N) Y ..Depression over field (Y/N) Nb Date of adequacy test OS/ZO/93 Results (pass/fail) _— P/1 SS for �1 / bedrooms 'Peroxide treatment (past 12 months) (Y/N) M�� If yes, give date N14 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N1,4' Onadjacentlots f ZDa Propertyline-Z & rWAl /1;TYd7) i0% To building foundation / To existing or abandoned system on lot /VIA On adjacent lots f 30 r Cutbank MIA Watermaln/service line t /D Surface water /V/14 Driveway, parking/vehicle storage area Curtain drain -MING AOPMP.04T E. ENGINEER'S CERTIFICATION t certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ./-/0, date of this Inspection. Signature — /* e�5t,4 o : 49�tt lr l Engineer's Name_ �% �� �'+-► '�•••• �. "t;3. Date .i/a//s J o, G' : luoi. A. Pvyr, s e '....a. n\. ROpFESSYOt',11, HAA Fee $ f 7d Waiver Fee:; Date of Payment _2/—%/3 _72Date of Payment Receipt Number — %/ / C Receipt Number 22-M ma'. X1)8. k MOA 21 ENVIRONMENTAL OFANgiORAGE ,;VICES DIVISION MUNICIPALITY OF ANCHORAGE ���� 2 j 7 SE DEPARTMENT OF HEALTH & HUMAN SERVICES 198 DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPRO1 D OF ON-SITE SEWER AND WATER FACILITY ILlg'�_ 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) 1_ / ?x./L lei-n��.iA^,2RiR�\ ;4TS. Location (address or directions) (b) Property Owner 4LAa ,4 1'%x Aa, Telephone: Home Business Mailing Address (c) Lending Institution h�cani� 5vS Mxrb�sd Telephone Mailing Address L.ALxg Z",etr ArT�' kAzZI/ (d) Real Estate Company and Agent Cm. / t-+NOA i�AMu+YL Address - �• �3yY "� -/l.99 r ,L. A'L 95!;' Telephone (e) Mail the HAA to the following address: or. Check here Mriffold for pick up. List contact person and day phone number below. S 8 S ENGINEERING 17034 Eagle River Loop Road No. 204 2. TYPE OF RESIDENCE Single -Family 0­� Number of Bedrooms / 3. WATER SUPPLY Individual Well ❑ Community ❑ „ Public ®__*� Note: It community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGEDISPOSAL Onsite M_ 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 77075 ffl v 81851 From n 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, 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 S & S ENGINEERING Date Telephone - �'Sc/-25115 to-,. 1a57•1 , 6. DHHS APPROVAL Approved for "' bedrooms by '�' �� Date Approved « Disapproved Conditional Terms of Conditional Approval � 0W CAUTION „ 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. Page 2 of 2 72.025 ram 8186) BACk MUNICIPALITY OF ANCHORAGE (MOA) LTH AUTHORITY APPROVAL (HAA) 11CtPAL p "I ALW & CHECKLIST - FEBRUARY 1984 DEPT• EtJTAL PROTECTION 264-4744 �11RONN' 319R� Legal Description: L.ci—c L ►,�uN 2 �H���a„ems /ice. A. WELL DATA RECE�V Ep Well Classification If A, B, C, D.E.C. Approve (Y)/ ) �� S Well Log Present (Y/N) - Date Completed Total Depth Static Water Level — Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depth of Grouting — Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/He#ding-Tank on Lot e- r_� I- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 250/./ ; On Adjoining Lots _ To Nearest Public Sewer Line Cleanout/Manhole — Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HALBMIG TANK DATA — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date InstalledI-L� Size ,L SO No. of Compartments > Standpipes &N) Air -tight Caps ON) Foundation Cleanout ON) Depression over Tank (Ye Date Last Pumped -Y Cfl- r Pumping/Maintenance Contract on File (Y/N)Ael.Dr; for Holding Tank High -Water Alarm (Y/N) N1_4 Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/Holding Tank: To Water -Supply Well ��� 'E To Building Foundation To Property Line To Disposal Field 'I' To Water Main/Service Line. To Stream, Pond, Lake, or Major Drainage Course — Comments Page 1 of 2 72 -OM IR” 8'661 RoW r C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / S� Type of System Design' S r-�➢Ayc 2 c` Date Installed 5 ' Z.>- 873 Length of Field yon Width of Field S r Depth of Field r Gravel Bed Thickness i C, Square Feet of Absorption Area 7��o d' Standpipes Present (6) Depression over Field (Y/Date of Last Adequacy Test Results of Last Adequacy Test -S A� s �sa�`'/V E12An Separation Distance from Absorption Field: To Water -Supply Well Z V To Property Line k2 To Building Foundation (cr ± To Existing or Abandoned System on Lot YJ/10� ; On Adjoining Lots -30 '7e To Water Main/Service Line rf To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course X/�a To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons x Manhole/Access (Y/N) "Pump On" Level at j t "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments n' Check Permitted Bedroom Rating Against HAA Request •• Pumping Cycles during Adequacy Test. Meets MOA 1 certify that I have checked, verified, orconformed to all MOA and HAA guidelines in effect on the date of this inspection. SignedS d S ENGINEERING pate 17034 Eagle R oop o. 204 Comp"NRkwCS, 0 (o 99577 MOA No. � �— 3 Receipt No. (o V 61 (0© d3 ��/� /j Date of Payment 'L2 1 . 6/ J Amount:$ d Page 2 of 2 72-0261R" 8'861 BMF T _ 6 a STEVE C0%WR. GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (9071 Addnu: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 r DATE: June 18. 1987 PWS I.n.o 211156 274-2533 To Whom it May Concern: According to records on file in this office the EKLUTNA THUNDER- BIRD HEIGHTS Water System is in compliance with the State Drinking Water Regulations• Sincerely, even W. g, PE Distri' ngineer n W t MUNICIPALITY OF JWCHORAGE DIVISION OF ENVIMZ4ENTAL HEALTH DEPA lc7'MC OF HEALTH AND ENVIRCNME.U'I'AL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legg} Des=!pti n (irclude�gt, block, "ivis�gff ssegicn, tcwrship, range) Locati (ad ss irect rs) �' S a v`---7-16 /1/ �- c.n e& to, �2 I Fog c o o ,y (b) Applicants Applicants Address (c) Applicant is (check one) Lending Irstituticn ; Owner/builder'} ; Buyer r=f ; Other Q (explain); (d) Lending Institution Telephone Address (e) Pnal.Estate Co. & Agent Address Telephone 696 //94!27 2. Tvoe of Pesiderce Sirgle-Family Multi -Family Other (describe) Number of Bedrocrts `T' 3. Fbter Suooly Individual Wall Ccz=nity� Public Note: If cormnity well system, must have written. confirmation Fran the State Department of Envircrrrental Conservation attesting to the legality andAatus. Is the cell adequate for the amber of bedroans specified in this HAA) 4. Sewage Disposal Orsite1 7V Public Ccrrunity Folding Tank Is the wastewater disposal system adequate••fcr the number of bedreav Y. .1) (Page 1 of 21 2-15-84 5.-Engireerinq Firm Providing Inspections, Tests, Data and Infcrmsticr. I certify tha ave checked, verified, or cenfczmed to all NDA MA Guidelines in effect on t� thi-sAnsoecticn. Date_ ZZ -def Nara of Firm Teleohore $ 8 £ E:101wr Rm'.1 Address Mrs 196X Signed by Pt!'6J4? li e��.r")�: CA���t . Date (ENGINEER SEAL) t`� 6.DHEP Approval Approved for bedrooms By Date ApprcwedOFT Disapproved Conditional Terns of Conditional Approval _ The Municipality of Anchorage Department of Health and Envirolmmental Protection does rot guarantee the continued satisfactory perfcrmanoe cf the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and furs ticral for the rumber of bedrooms and type of structure indicated. (DIEP SEAL) 7. Nail the the lowing address; KS2/d5/s (Page 2 of 21 2-15-84 n ,1 L /.BZ f114Vy e41,w MA4ANOMAW MUNICIPALITY OF ANCHORAGE (MCA) pfP OFOHEA HEALTH AUTHORITY APPROVAL ( HAA) ENVIRp�ENTAL PROTEC "4 CHECKLIST - FEBRUARY 1984 tgy 4'1984 A. WELL DATA R E C EIV E D Well Classification If A, B, cc C. D.E.C. Appy ( ) Well Log Present (YIN) Date Cmpleted Yield Total Depth Cased to Depth of Grouting Static Water Tavel Pump Set At Casing Height Above Ground _ Sanitary Seal on Casing (Y/1N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (YM) Separation Distances frau Wall: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By Date Water Sample Test Results Caments B. SEPTIC/HOLDING TANK DATA Date Instal d %'3 Size /Z J — No. of Caipartaents Z Standpipe ( Air -tight Caps Foundation Cleanou ( ) Depression over Tank ePuzapsdft_Ze_L1J ) Date Las Pumping/Maintenance Contract on File Y �✓l for Holding Tank High -Water Alarm (Y ) % Temporary Holding Tank Permit (YINrlig Separation Distances fran Septic/H/o�l►dirg Tank: To Water -Supply Well c�/;f! /T To Building Foundation 1'7 / To Property Line p To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major -Drainage Course Camerts &/� / .S'C�/r/LC �- ti q5eO,J [Page 1 of 21 2-15-84 1 C. ABSORPTION FIELD DATA Soils Rating in Abs rption Strata �2 ��jL Type of System Design _ Date Installed / L� 3 o Length of Field d-1 0 Width of Field f q Depth of Field Z Gravel Bed Thickness Square Feet of Absorption Area r%E r Standpipes Present resen ( i) Depression over Field Date of Last Adequacy Hast Results of Last Adequacy Test /J /ra.- Separation Distance from Absorption F d: To Water -Supply Well CL 11SsF- To Property Line � To Building Foundation 2 Z To Existing or Abandoned System on Lot /J ! ,.I' ; On Adjoining Lots A/ ! /'f To Water Y&kV oervice Line 7^-' To Cutbank(if present) X /P - To Stream/Pond/take/cr Major Drainage Course /V 1 -1 - To Driveway, Parking Area, or Vehicle Storage Area AvL Oq Cawents D. LIFT STATICN Date Installed Dimensions Size in Gallons Manhole/Access (Y "PwV On" level at M "Aad Off" Level at High Water Alarm Level at Vent (Y/N) Tested for ing Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) Caments ** Check Permitted Bedroom Rating Against HAA Request ** I certify �ve check9d, verified, or confcru d to all MDA HAA Guidelines in effect on the da of a'iameotiopo'— S KBl/d5/ ov..giiE'196X -,'C.1377 ....."t g [r+-= proE�T. AIASYA.. pH. GC42-7, "T (Page 2 of 21 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION April 27, 1984 PWS I.D. X0211156 To Whom It May Concern: BILL SHEFFIELD, GOVERNOR Telephone: 19071 274-2533 Addreu: 437 E Street Suite 200 Anchorage, AK "l�gay99501 OF ANO PROTEMON APR 2'1 M- 4 RECEIVED According to records on file in this office the Thunderbird Heights Subdivision Water System is in compliance With the State Drinking Water Regulations. Sincerely, A4 mes F. Hayden Environmental F ld Officer JFH/msm cc: Mr. Robert Shafer C. Please check or fill in the following: 1. Comprehensive Plan — Land Use Classification Residential Marginal Land Commercial 4.1 'I'Commercial/Industrial ,­ , , Parks/Open Space Public Lands/Institutions Transportation Related 2. Comprehensive Plan — Land Use Intensity Special Study _ 3. Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Dwelling Units per Acre Alpine/Slope Affected b. Avalanche Alpine/Slope Affected Industrial Special Study c. Floodplain �— d. Seismic Zone (Harding/Lawson) D. Please indicate below if any of these events have occurred in the last three years on the property. Rezoning Case Number Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building/Land Use Permit For Army Corp of Engineers Permit E. Legal description for advertising. - - 's r I✓m00%, Co -r &e6z F. Checklist 30 Copies of Plat Reduced Copy of Plat (81h x 11) — Certificate to Plat X Fee Topo Map 3 Copies Soils Report 4 Copies x Aerial Photo Housing Stock Map X _ Zoning Map Water:_ Private Wells Sewer: Private Septic 20-00]13 c IR" $/MMOA-24 Waiver a' Community Well Public Utility Community Sys. Public Utility MUNICIPALITY OF ANCHORAGE ECONOMIC DEVELOPMENT AND PLANNING P.O. Box 196650 OFFICE USE Anchorage. Alaska 99519-6650 PRELIMINARY PLAT APPLICATION RECD BY. — S 9 4 3 5 AUG 2 1993 VERIFY OWN: A. Please fill in the Information requested below. Print one letter or number per block. Do not write in the shaded blocks. 1. Vacation Code C 2. Tax Identification No. 3. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). �9��GO���DO�G7G669�000Z� va�o�ov��e�mmum� 4. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page. 5. Petitioners Name (Last - First) 6. Petitioners Representative city 'evoe State city 64 e ger state 7. Petition Area 8. Proposed 9. Existing 10. Grid Number 11. Zone Acreage Number Number Lots Lots ® ® FM/ 9L 12. Fee S B. 13. Community Council 1 hereby certify that p am) p have been authorized to act for) the owner of the property described above and that I desire to subdivide It in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances.) understand that payment of the basic subdivision fee Is nonrefundable and is to cover the costs associated with processing this application, that It does not assure approval of the subdivision. l also understand that additional fees maybe assessed if the Municipality's costs to process this application exceed the basic fee. 1 fuller understand that assigned hearing dates are tentative and may have to be postponed by Plannina Staff. Plamno Board, Planning Commission, or the Assembly due Date:. ,6 /t /3 zo-aw ttwerenuWt. bignature *Agents must provide written proof or authorization. C. Please check or fill in the following: 1. Comprehensive Plan - Land Use Classification :; Residential O Commercial 7 Parks/Open Space :; Transportation Related 2. Comprehensive Plan - Land Use Intensity: 3 Special Study 3. Environmental Factors (if any): a. Wetland 1. Developable O 2. Conservation 7 3. Preservation Marginal Land 7 CommercialAndustrial 0 Public Lands/institutions Dwelling Units per Acre: O Alpine/Slope Affected b. Avalanche c. Floodplain 0 d. Seismic Zone (Harding/Lawson) 7 Alpine/Slope Affected • Industrial 7 Special Study D. Please indicate below if any of these events have occurred in the last five years on the property, 7 Rezoning Case Number. 7 Subdivision Case Number. 7 Conditional Use Case Number. 7 Zoning Variance Case Number. :1 Enforcement Action For 7 Building/Land Use Permit For E. Legal Description for Advertising. F. Attached written statement in accordance with AMC 21.15.130.B. stating reasons in support of the vacation. G. Checklist 0 30 Copies of the Vacation Request p Reduced Copy of Vacation (8 1/2 x 11) El Certificate of Plat 7 Fee 0 Topo Map 4 Copies 0 Soils Report 4 Copies 0 Aerial Photo 0 Housing Stock Map B Zoning Map 0 Water: 91 Private Wells 7 Sewer: P Private Septic 20-019d1w 992' Buk Waiver 0 Community Well 0 Public Utility 7 Community Systems 7 Public Utility VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING & DEVELOPMENT P.O. Box 196650 Anchorage, Alaska 99519-6650 A. Please fill in the information requested below. Print one letter or number per block. M iiiiii ilii iiiiii ■ . BY: OWN: Tax I.D. Number . •- - 1 • oee�see■e�i�eeee��E�■i■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 3. Existing Abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT Al IR R1 Ica I nT ant 6ve�oeose�■oeero�o■oeoo�os�■o�re��� MENEM Monson 5. Petitioner's Representative. Address: SIL fo/Ca.t. City: e1..Q� Stater Zip Code: 67 Phone No. SBP 0Q6Q Address: City: C``y1o9 ce State: Zip Code: f9s(7 Phone No. X98-Y-✓rS� 6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification. ® ® r 10. Grid Number. 11. Zone. 12. Fee S 13. Community Council B. I hereby certify that (I am) (I have been authorized to act for) the owner of the propiII described above and that 1 desire to vacate 1t in conformance with Chapter 21 OI the Anchorage Municipal Code Of Ordinances. l understand that payment Of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval OI the vacati, n. I also understand that additignal fees may be assessed if the Municipality's cost to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff. Platting Board. Planning Commission, ort sembty��iri ahvL�.al reasons. Date: //7� fl 20.019.8.,.. 9921- Fm t 'Agents must provide written proof or authorization. MENEM Monson 5. Petitioner's Representative. Address: SIL fo/Ca.t. City: e1..Q� Stater Zip Code: 67 Phone No. SBP 0Q6Q Address: City: C``y1o9 ce State: Zip Code: f9s(7 Phone No. X98-Y-✓rS� 6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification. ® ® r 10. Grid Number. 11. Zone. 12. Fee S 13. Community Council B. I hereby certify that (I am) (I have been authorized to act for) the owner of the propiII described above and that 1 desire to vacate 1t in conformance with Chapter 21 OI the Anchorage Municipal Code Of Ordinances. l understand that payment Of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval OI the vacati, n. I also understand that additignal fees may be assessed if the Municipality's cost to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff. Platting Board. Planning Commission, ort sembty��iri ahvL�.al reasons. Date: //7� fl 20.019.8.,.. 9921- Fm t 'Agents must provide written proof or authorization. U5,Clj, - -x 176.8' 7rees Ix , 0 Tree e0o 206.0 220-j Za��—� I,."- 22/.4 I Im x '300 263.2 x tl -V 26S 7J.0 \" 25&0 lf58-3 1261.2 262.2 I x