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Home My WebLink AboutTHUNDERBIRD HEIGHTS BLK 2 LT 8 , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IP"°NE I mEW LEGAL DESCRIPTION [~ Manuf~turer Material No. of comp~ts Liq. ~p~ gaUons IF HOME.DE: Inside length Width Liquid depth ~O ~ Well Dwelling PERMIT NO, DISTANCE TO: O Z < Manufacturer Material Liquid capacity in ~llofls Well Foundation Nearer lot bna PERMIT ~ ~ ~ No, of lin~ Length al each line Total length of Il es ~ & ~ inches Distance lines ~ ~ T~ of tile to finish grade Material beneath tile Total eff~tive absorption area ~ DISTANC~ TO: Well Building foundation Nearest lot line ~ Building foundation Se~r line Septic tank Absorption area(si ~ DISTANCE TO: OTHER SOIL TEST RATING INSTALLER -- 72-013 (Rev. 3/7~) . . ~. DEPARTME,,, OF HEALTH AND ENYIRONMEN~r~L,PROTECTION~ ~.~'. ' , ' ' ' --4 ~ , ' , , - ~ '1 ~ · . . , ' ,_ LEGAL ~ ~ g~ ~~. ~ LOT'~IZEA~ F~b, SQUARE FEE~ TYPE OF 50IL ABSORBTION ~Y~TEM IS: ~ , ,' ' ' HAXIHUM NUMBER OF BEDROOM5 = ~ . SOIL RATING THE REQUIRED SIZE OF TH~, SOIL ABSORPTION SYSTEM IS:. __J'., , .77 , . . DEPTH= gEt~GTH= ~ GRA"~'EL , DEPTH= /. THE LENGTH DIHENSION IS THE LENGTH (IN FEET) OF .THE TRENCH OR ~RAINFIEED. THE DEPTH OF A TRENCH, OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOH~OF THE EXCAVATION <IN FEET). THERE I5 NO SET WIDTH~ FOR TRENCHE~. ' ' THE GRAVEL DEPTH IS THE HINIHUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOH OF THE, EXCAVaTION (IN FEET). , ~Et~UI~ED --~EPTI~ TANK _~.I-~'~E= {000 ~L_LON_~ PERHIT RPPLICRNT HRS THE RESF'ON~IBILIT~ TO INFORM THI~ DEPARTMENT DURING THE INST~LL~TIO~I INSPECTIONS,OF 8N~ WELLS 8DJACENT TO THIS PROPERT~ 8ND THE NUMBER OF RESIDENCES THaT THE WELL WILL ~ERVE. ------ TWO (~) .I N~PEOT IONS ~RE REOU I RED BACKFILLING OF ~NY 5YSTEH WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEP~RTHENT WIL~ BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN'A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR ~ PRIVRTE WELL~ OR i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS 8RE REQUIRED ~ND NU5T BE RETURNED TO THE DEPARTMENT WITHIN OF THE WELL COMPLETION. OTHER REQUIREMENTS M~Y 8PPL~. SPECIFICATIONS ~ND CONSTRUCTION ~I~GRAMS ~VAILABLE TO INSURE PROPER INSTALLATION. PERId I T EXP I RE'~ DECErdE:EF~ ~1.. I CERTIFY THRT i: I RM FRMILIRR WITH THE REQUIREMENT~ FOR ON-SITE SEWERS RND WILLS RS 5ET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEH IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTRND THRT THE'ON-~ITE 5EHER SYSTEM MRY REQUIRE ENLRR~EMENT IF THE RESIDENCE I5 RE.ODELED TO INCLUDE~ORE THnN 8 E:EDRO0,5, __ GINNED ~pplic~t ~.=. lOS ~ WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAl, CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 March 26, 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 submitte~t to this Department on March 1, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 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. The last Radioactive Contaminants Sample results were submitted t° the Department on December 1, 1992..This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 4, 1992. Based on analysis of the previous VOC samples results have been satisfactory. Thls does meet the provisions of 18 AAC 80,200(a), State Drinking Water Regulations... Issuance of this letter does not irhply 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, Sincerely, Michael Lu Environmental Eng. Asst. II 6D4-2774 Soils ~ Foundations , O ~- E GEO.'~',:CHNICAL ~'- DEVEL,_,PMENT ~:'O. Box 90. Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Perfomed - foK: -Hame: ...... · ':'- '~ Hatllng Address: '-'Lig;~l'b~scrtpMon: ~.~77- ~ I)e~th (feet) 5 7 lO 12 13 16 Ea# E/lis SOIL LOG ~.2~o Land Development Ground Water Encountered: Yes Proposed Installatton:'.$eepage Pit Coelments: " , ' ' Performed by: No /~ If yes, whmt depth Drmin Field /~ Oate: &-Zx- 7~' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. if 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - "'~ ~ ~ - ~.~ , HAA if ~ Location (site address or directions) Property owner ~,~,y ?ad~'_~ ¢~ SanJ Mailing address AK 99567 Day phone &RR-9fS~ Chu. glak, aK 99567 Lending agency Mailing address Agent Address Day phone Day phone. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 ",4 TYPE OF WATER SUPPLY: Individual well Community well ~ Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOS.~L: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 waste~'ater 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 Engineer's signature Se DHHS SIGNATURE ,Approved for ..~ Disapproved. Conditional approval for Phone bedrooms. 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 o! Alaska. The DHHS does this as a courtesy to purchasers ol homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~ ~..l~- ~-~'~'~.~,,,3~q)~..l~,-~,l--~ Parcel I.D. A. WELL DATA Well type ~ IfA, B, orC, attach ADEC letter. ADEC water system number '~-I I [,~'-(,~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG Date of test Static water level Well flow Pu mFl'~ Driller Casing height Wires properly protected (Y/N) J~' _ . ~-~ ~'~ AT INSPECTION g.p.m. g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS:~~ Coliform J Nitrate D eo~fsample: ; On adjacent lots ; On adjacent lots Public sewer manhole/cI~'r;~3ut ~Petroleum tank Collected by: Other bacteria Date installed \ ~ ~ ~ Cleanouts ~"~N) High water alarm (Y~ ' B. SEPTIC/HOLDING TANK DATA Tank size \ o ~ (:3 Compartments Foundation cleanout (~N) ~ Alarhl tes~ed '(Y/N~ Date of pumping ~ ~ 2.~) -~'.~ Pumper ~'-_~, ~£.r$~'~ t_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~0 To property line /~ ~ Absorption field Surface water/drainage Foundation Water main/service line 72-026 (Rev. 7/<Jr)Front CONTINUED ON BACK PAGE C. LIFT STATION '~; * Date Installed Manufacturer Size In gallons Manhole/Access (Y/N) ' Vent {Y/N) "Pump on" level at ' ' High water alarm level ~ _ ,~'""Cycles tested .... Meets MOA electrical codes (Y/N) ~ " , · SE~FT STATION TO: ~q~ on lot ' On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed I~ Length ~ ~ Width Total absorption area Depression over field (Y~) Results~J'ail) Peroxide treatment (past 12 months) Soil rating ~'(3 '1~1t~--~ System type ~;~ ~-,cc~O Gravel thickness / / Total depth -~ · C!eanouts present ~/N) k/ Date of adequacy test ~' -'3 _c~ ~ for -'~'"'~ J"' ~'-'~'- ( '~'~ bedrooms ~. c,~ ~ If yes, give date ~'/I~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: . . . Wellonlot To building foundation ~ ~ T~.[~xisting or abandoned system on On adjacent lots Surface water \, Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to atI~T~A and HAA guidelines in effect on the date. of this inspection. Date ,--> HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTO~,..~ w~ INSPECTOR INSPECT OR ~NlClPA[.ITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DE~. ~ HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~j~NT~ P~TE~ION {~ ENVIRONMENTALTelephoneSANITATION~47~ DIVISION OCT 1 2 1979 REQUEST FOR APPROVAL OF INDIvIDuAL WATER AND SEWE~I~~ DIRECTIONS: Complete all pans on page 1. Incomplete ~u~ will not ~ p~. Please allow ten (10) days fo~ pr~ess[ng. 1. PROPERTY ~NER PHONE PROPERTY RE~ENT (If d~f ferent from abo~) ' PHONE 2. RUYER / PHONE MA1LING~DDRESS ' '' 4. REALTORIAGENT / j PHONE 5. LEGAL DESCRIPTION STREET LOC~ON ' 6. TYPE OF RESIDENCE [~' SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~EDROOMS [] One I--I Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL' * ATTACH WELL LOG. A well Icg is required for all wells drilled ' ,[~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach Icg if available.) 8. SEtN~IS~AL SYSTEM ~ INDIVIDUAL/ON-SITE** /~;77~? YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/'/9) - THIS SlOE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I"q SINGLE FAMILY [] ONE [] THREE [] FIVE I--1 OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL - DEPTH OF WELL [] '~ COMMUNITY" ' DATE DRILLED [] PUBLIC UTI MTY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSALSY~TEM , PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED . []PUBLIC UTILITY Connection Verified INSTALLER I'-]Septic Tank or []Holding Tank . · Size:. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS ' [~'APPROVEDFOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) I--I DISAPPROVED DATE BY 72-010 (Rev. 6/79)