HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS BLK 2 LT 2Thunderbird
He's
ights
Block 2
Lot 2
#051-721-06
SET 2" BRAS", CAP
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—
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WHEN STREET IS EXTENDED
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1�
MUNICIPALITY OF ANCHORAGE
f�.lth and Environmental Pr,l ction
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
-- ..- -
IJJS?ECTlON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
:ll.6a }i - - .,InILIi:G nCDRCf.S 3ao_L. C
•� _ L[Gnt. 1`[ �,.RIPTIO�I _L Z-- � Z 1""—�" ��-'
NUMBER OF
Gal :'•.:: C L.
TUjr R _ �_-_M"\TriiIAL-_.-- CO'.iPARTtAENTS
� GALLONS.
IN>LJi. LCfI(.1ili_. 1-aIDC �:�UT11 LI�J •J if) DL'PTH---_—LIO'JID CAPACITY�-4
TILL DRAIN FIELD: TOTAL LENGTH a�I
1 OF LINE
Ce KI'.n RC$T LGT LILAC...
UP I.•.':Ct i I<\':1 \:'. L1. _.... ___FOV:)UnTION_ _.--
_ UISIANCC ULT �iLCLA LILACS _—TRCplC11 Pn DT11r3G. IN. -TOTAL EFFECTIVE
Jfof Linc:, ----. _.--------
SQ 1 T. LCN GM OF EAC11 LINE
D[FTII OF 1 ILTCII ,
;-1•I:i 7GI-nf IILL TO 1 I':1 _II GRA:)C-+_ MATERInL ftCNCATH TILE � ^•�� ABOVE TILE �IN.
0I1%IUGR __011 \•IIDT11--. LENGTH_, DEPTH
Log Crib _Rings_ Crib Size: DIA:dLTEll ____ULPTII_OISTANCC 1711.0".1: WELL
TOTPL EFFECTIVE
li!)I L!r.i:•] !'.'J: Y):.'r1U'I._._—. NCARLST L0T LMC nl1:;ORPTION ARCA (MALL AREA) 50. FT
clas —I
lass: Depth:
•.Jell Distance To: Lot Linc
3ldg; Sewer Line: 1
ripe 47tcrials: -- I
of: Bedrooms /� 4' !
installer: �iLQL, t_!
Rcr)a r!a
s
APPROVED
1 1 I I
14
APPROVED
January 4, 1978
Harvelle Harrison Dev
3201 C Street
Calais Office Center
Anchorage, Alaska 99503
Subject: Lot 2 Block 2 Thunderbird Heights Subdivision
Permit #771027
A permit issued by this department for well and/or sewer
system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Health and Environmental Protection
Sewer and Water Section
. MIJtJ I �G Ir""�il_ I TY OF 1�t+ltJf-j^�FiGE
DEPARTMENT HEALTH AND ENVIRONMENTAL JTECTION
' 825 'L' STREET, ANCHORAGE, AK. 99501
264-472.0
Ip m
ORJ—SITE SEWEFZ F"EFZM I T
PERMIT NO. C 771027 )
APPLICANT HRRVELLF HARRISOU DFV 3201 C ST (CALAIS OFFICE CENTS 276 5551
LOCATION T UNDERBIRD DR
LEGAL L2 B2 THUNDERBIRD HTS SUB LOT SIZE 21091 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
dEPTH= 12 LEtJGTH= 2S) GRA'„•EL dEI-TH= oS
THE LENGTH DIMENSION IS THE LENGTH CIN 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 &N 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 CIN FEET).
V,:EQU I FZEF6 SEF}T I 'Tnr-JK S I 2:E= 125 GRFLLOtJS
F='F=lCKF=FGE F'LAtJT OF T I OtJ
R PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED.
2. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION.
----------------------------------------
-r W 01
---------------------------------------
TWO C 2 ] I hJSF=`ECT I OFJS nFZE FZE 1� I 2Ed ---
CKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
:PARTMENT WILL BE SUBJECT TO PROSECUTION.
NIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
10 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
THER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
JAILABLE TO INSURE PROPER INSTALLATION.
F'EFZM I T EXF} I FZES dEGEMF EFZ 31r 15�1 :r r
CERTIFY THAT
I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND !JELLS AS SET
ORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
ESIDENCE IS REMODELED
TOINCLUDEMORE THAN 4 BEDROOMS.
SIGNE072 0 � a! _- ----�
APPLICANT
ISSUED
HARRISON DEV
v -z>.. //--a/- 7r
V3. 0
•0 & E GEC'�%ECHNI CAL & DEVEnPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 6682280
Russell Oyster Earl F/lis
694-2774 SOIL LOG 688-2280
Soils 8 Foundations -
Land Development
��VE�a.� J i�\t124L�SO.i
Performed for: Name: _�\tom. (�-..1 x•c Tel. No. 27t.-551
Mailing Address:aL Rini 3
Legal Description:- \—,%T 2 sxvp^'
Depth (feet) Soil Characteristics
0
\4/ RSmtA L�t�GAw1.cS, 275`Y8�
2
3
4
5
6 GW �c\.loY I�iLAYtl. W��CaA �5�9�ib
7 X1'4
%?., \ a CAN u . f RY
LV:C-L1 �
8 n\J b
Lno6.1-- C�4-9-SN" .
9
10
11
12
13
14
15
16
Ground Water Encountered: Yes No v If yes* what depth
Proposed Installation: Seepage Pit_Drain Field ✓ \^]
Comments: qC tl\SA/lMCr4,� \it .� \�.�� ��lA .
Performed by: � ..v.�..>o Date: \JoJ \A. \fM
'B:5
f
r
V ao
/o•
u•
Sp/i/-fn/�r fi
hConc. Fnd, mo
ti
2
M
TOP OF FOUNDATION WALL ELEVATION • IT SHALL BE THE RESPONSIBILITY OF THE BUILDER
ELEVATIONS BASED ON DATUM OR OWNER TO VERIFY THAT BUILDING LOCATION
SHOWN MEETS ALL SUBDIVISION COVENANTS PVD
PREPAPED FORS
//aive/% • Ha.iisen LOCAL ZONING CODER AND ORDINANCES.
PLOT PLAN TRYCK LOT 2
)ES. LATE BLOCK 2
io Z6 " I�IYMAN
cRID , , �� ,�^ THU/VDERB/RD Hf/GHTS
J
ti OF .4
-N I
SCALE
JACK W. CA3BISOt1 :;!g,
i'• ND. 949-S
Q;/�S;'Nh
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-721-06 Expiration Date:
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
THUNDERBIRD HEIGHTS S/D; BLOCK 2, LOT
25034 THUNDERBIRD DRIVE, CHUGIAK, AK, 99567
LESTER & MARLISE JAMES Day phone 360-8656
25034 THUNDERBIRD DRIVE, CHUGIAK, AK, 99567
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
n
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
®
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
COSA to be released to the engineer, unless
COSA Fee $ 5%
Date of Payment (N�(' 7 C O1
Receipt Number �O p 7
)S'
COSA ft
the engineer.
Waiver Fee $ 02 S
Date of Payment /;L
Receipt Number M12_ u
Waiver # (YWIW5
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. t 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, Lto attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system a/ continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefif of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will if confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for —1 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
337-6179
Date
bedrooms, with the following stipulations:
`OF A16 ((,
`J= ON-SITE m�
WATER AND
0 WASTEWATER ozl
SM PROGRAM
Original Certificate Date:
-L— I
The "ic7p)fty oFAnchorage Develop,emt 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
raav inilm9i
Nitrate Advisory
Arsenic Advisory
Other
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:
I_A59:11No17_\r_1
Well type
Date completed _
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
THUNDERBIRD HEIGHTS SID: BLOCK 2, LOT 2
If A, B, or C provide PWSID#
Sanitary seal (Y/N)—
Cased to ft.
FROM WELL LOG
I•l2=1
Parcel ID: 051-721-06
AWWU
Well Log (Y/N)-
Wires properly protected
Casing height (abo rc
AT
ft.
g.p.m.
in.
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
epic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA NOTE: SEPTIC TANK 1536 YEARS OLD AND LIKELY
APPROACHING THE END OF ITS USEFUL LIFE
Tank Type/Material SEPTIC/STEEL Date installed 1978
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 9/10/2014 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 1978 Soil rating (g.p.d _/ft 2 orlj2jqrm 85 System type TRENCH
Length 29 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth '9.0 ft. Eff. absorption area 348 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 12/16/2014 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 445 in. Water added 600 gal. New depth 44.5 in.
Elapsed Time: min. Final fluid depth44-5 in. Absorption rate >= 600+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
'BELOW EXISTING GRADE TO BOTTOM OF MT. MT ONLY EXTENDS 68" INTO 72" EFFECTIVE. 40" SOIL COVER OVER INVERT.
NOTE: HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE-SOAKED WITH 2320 GALLONS OF WATER
IMMEDIATELY PRIOR TO STARTING ADEQUACY TEST. PRE-SOAK AND TESTING METHOD WAS DISCUSSED WITH JEFF
POET & JAY CREWDSON W/ M.O.A. DURING PRE-SOAK. LAST 1950 GALLONS CAUSED NO RISE IN LIQUID LEVEL.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level atwa er alarm level at in.
Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: AWWU WATER
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main ntZ -sewer
Sewer /septic service line Holding tank
containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field
Water main 10'+ Water service line 19+ Surface water
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '.01+
Water service line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
.5.+
100'+
Building foundation 10'+ Water main 10'+
Surface water 100'+ Driveway, parking/vehicle storage 10'+
Wells on adjacent lots 200'+
'PER INSPECTION REPORT. "WAIVER REQUESTED.
G. ENGINEER'S CERTIFICATION
I certify that t 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.
Engineer's Printed Name JEFFREY A. GARNESS
Date (-zJ Zci I14
(Rev. 10112/12)
GARNESS ENGINEERING GROUP, Ltd,
- - CIVIL & ENVIRONMENTAL ENGINEERS
December 29, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
Anchorage, Ak 99519-6650
REFERENCE: Thunderbird Heights S/D; Block 2, Lot 2. Lot Line Waiver.
To whom it may concern,
During our inspection of the subject property, it was discovered that the drainfield may be as close
as 0 feet to the north property line. The drainfield cleanout is approximately 2 feet from the
property line (see attached as -built survey). Without excavation, we cannot confirm the exact
distance from the drainfield to lot line. We are requesting that you waive the distance from
drainfield to lot line to 0 feet. The septic system on the adjacent lot is on the north side of the lot
and is well over 25 feet from the system on the subject property. In short, there is minimal risk
associated with granting this waiver.
please contact us at 337-6179.
n.S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://Www.mun i.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
went S,
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**** VARIANCE/WAIVER REVIEW ****
Waiver#: 141537
PID#: 051-721-06
COSA#:141667 Permit#:
Legal Description: Thunderbird Heights B-2 L-2
Engineer: Garness Enclineering Group
Applicant: Lester & Marlise James
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.
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.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: Cl Approved by:
o viewer
...................................................................
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Aitr'.
DEPARTMENT OF HEALTT H & 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.# Clsl-1�l-Cyn
1. GENERAL INFORMATION
HAA # Q Qq S r!(_ -'6L1
Complete legal description Lot 2 Hock 2: Thunde4bi4d He iahta
Location (site address or directions) 25034 ThundeAb.Lad D2ive
Chug.Lak, AK
Property owner Donald and Hope HetpeA Day phone 688-2559
Mailingaddress •0
- Ray 379 CLLgZ'FA_ 4Aa,0ir 995
Lending agency
Mailing address
Day phone
Agent V1ag.in,i.a. KohKield - REMAX Eagte R.i.veh Day phone 694-4200
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 V
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 XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (A". "I) Front MOA $21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & 5 ENGINEERING Phone
17034 Eagle River Loop Road No. 204,
Address E"It River AhsL, 09577
Engineer's signature
6. DHHS SIGNATURE
X,c Approved for bedrooms.
Disapproved.
r.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to pu rchasers 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.
72-025 (Rw.1191) Baca MOA Y!1
�..0 ... - .. .. :.t-. .Y.rwW+.:-•. rC � fir.-+ +. .awn .a tv 1 _ _
1 1
' i • • ���� � O � � � ��� � � WALTER J H/CKEL, GOVERNOR
a
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE (9 07) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
January 19, 1993
Mr. Ray Shafer
S & S Engineering
SUBJECT: Thunderbird Heights
Class'A" Public Water System, PWSID 211156.
Dear Mr. Shafer.
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class 'A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on January 4, 1993. This does meet the provisions of
18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on September 14, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on December 1, 1992. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations.
4. The last Volatile Organic Chemical (VOC) were submitted to this Department
on June 4, 1992. This does meet the provisions of 18 AAC 80.200(a), State
Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class 'A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
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.1`Michael
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MUNICIPALITY OF ANCHORAGE
\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENGINEERING DIVISION
1ENVIRONMENTAL
825 L S
• treet • Anchorage, Alaska 99501 Telephone 2644720
CERTIFICATE OF INSPECTION
SEWER AND WATER FACILITIES
1. PROPERTY OWNER
h/
MAILING ADDRESS
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2. LEGAL DESCRIPTION ,
c'� ?ci.✓ Su��
3. TYPE DWELLING
SINGLE FAMILY RESIDENCE O OTHER (Describe)
O MULTIPLE FAMILY RESIDENCE
4. WATER SUPPLY
P
O INDIVIDUAL
X COMMUNITY/PUBLIC
5. SEWAGE DISPOSAL
INDIVIDUAL/ON-SITE
a PUBLIC UTILITY
O HOLDING TANK (Maintenance Required)
APPROVED FOR BEDROOMS
`O
J CONDITIONAL APPROVAL (See Attached)SEAL
O DISAPPROVED
DATE
BY (TITLE)
7
�N
72-014 (3n8)
Municipality of Anchorage Aga
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I—<,,t Z f5 k .2TJ> - Parcel 1.1),
A. WELL DATA
Well type ^ /�
If A. B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
r
Pump level
SEPARATION DISTANCES FROM WELL TO:
Wires properly protected (Y/N)
AT INSPECTION
i
Septic/holding tank on lot On adjacent lots
I
Absorption field on lot 4' ; On adjacent lots _
Public sewer main
Sewer service line
Public sewer manhole/cleanout
tank
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Other bacteria
Date installed 1 E5 -7 0 Tank size 12-5-0 Compartments 2' `'
Cleanouts&#,VN) _ Foundation cleanoullM) T Depression (Y/Np4;4
High water alarm (Y/N) /A Alarm tested (Y/N) `—
N
Date of pumping Pumper I.'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
r �
Well on lot �` On adjacent lots %a Foundation l
To property line Ib"f Absorptionfield dol. Wat6;rmain/serviceiine tom
Surface water/drainage t't"
72-026 (Rev. 7191) From CONTINUED ON BACK PAGE
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4� .,
Date installed 1 E5 -7 0 Tank size 12-5-0 Compartments 2' `'
Cleanouts&#,VN) _ Foundation cleanoullM) T Depression (Y/Np4;4
High water alarm (Y/N) /A Alarm tested (Y/N) `—
N
Date of pumping Pumper I.'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
r �
Well on lot �` On adjacent lots %a Foundation l
To property line Ib"f Absorptionfield dol. Wat6;rmain/serviceiine tom
Surface water/drainage t't"
72-026 (Rev. 7191) From CONTINUED ON BACK PAGE
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N
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0
C. LIFT STATION
Date installed
Size In gallons
Vent(Y/N)
High water alarm level
."Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at _
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO: 1
Well on lot
On adjacent lots
"
Surface water
D. ABSORPTION FIELD DATA 'art, 1A CPU IV 1
Date Installed �`��%B Soil rating �¢AYt- System type �2� 544
eel ngth '` �q Width 2> Gravel thickness �1 Total depth 14 -
Total absorption area "g I LL)Cleanouts present<7N) �1
Depression over field (YWry tl Date of adquacy test
1Z 12.Z.
Resuitsfail)for bedrooms
Peroxide treatment (past 12 months) (Y,41 44 0"A If yes, give date
3 6K.. f''P?Re✓v.�..'r��s'T�'a
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots Property line ) o +
To building foundation To existing or abandoned system on lot
1
Onadjacentlots 4- Cutbank A Water main/service line
-f-
Surface water 1 cpt;, I a' Driveway, parking/vehicle storage area
Curtaindrain Nr�)�Se (Z-rA0W9
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection;
S'& 5 ENGINEERING
17034 Eagle River Loop Road No. 204
Signature Eagle River. Alaska 9osn Aw
!'A.
Engineer's Name
Date
HAA Fee $ -1 76 c 02)
Date of Payment " 913
Receipt Number
72-M JR". 3/91)8. k MOA 21
Waiver Fee: $ —
Date of Payment
Receipt Number
i3Ul INHAFER
d0.": '.3
