HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS BLK 2 LT 10
- MUNICIPALITY OF ANCHORAGE
~' DEPARTMENT OF HEALTH AND HUMAN SERVICES
Envlronmenlal Health Divl~on
825 "L" Street, Anchorage, Alaska gg502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
TANKS
SEPTIC [] HOLDING
TYPE OF SYSTEM
WELL
LOT LINE
FOUNDATION
DISTANCES
SEPTIC ABSORPTION
N~,~K FIELD
WELL
[] TRENCH [] BED [] W. DRAIN
4'40 7' .
3c, l" ~ 4!-4
,~) FT
REMARKS:
5TA, LJH IT~
~OF.A~-r--12 pvc ?lPb~
$:~2LIP PVO ~'lP'~
ABANDON EXISTING
BEDROOM
--RESIDENCE
GAL SEPTIC TAI,,IK
-SEE NOTE 6
% 20"
SANDPIPER
.... :..~..-_. l~r.qO
HPCE ,..o~- IO BLOCK 2 THUNDERBIRD HEIGHTS BY RWW CK DH -OF-
SUB'JECT.
NEW SEPTIC SYSTEM i OATEd, J4I'fo. DATEg, I.4.J~E) '2
I
PACE
'""~--OF--
~ ,~',"
,.ql~ 7' . '
]"~:1
'Fro~ : IRLHAJt ELECTRIC (( ' 694-9993
POi
ALMAR ELECTRIC
PHONE & FAX (607) 864-9993
For FAX wall for beep &nd ~l'~ si, * butto~
FACSIMILE MESSAGE
TO:
CCC Conetructton
........ EaZle ~lver, Ak,
99577
REFEREHCE:
Thunderbird HelEhto
LOT-~0BLOCK._2~$UB.
Tested and inspected on site sewer ll£t station:
3ystem checked ok., no code ln£~actlons observed.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744
HAND WRITTEN PERMIT
Permit Number: SW90D~/
Date
Design Engineer: ~,R f~,
Owner Name:~£;~NZF
Permit Type: ~'~;~
Expiration Date:
Day
Owner Address :~ ~O ~,
Parcel ID:OF/- 72/
Lot Legal: Subdivision:
Sectx?n:~ Townshi~F Range:
Lot Sxze:~6~ (~. or acres)
Max Bedrooms: 'This Permlt:~ Total Capacity:~
SEPTIC TANK: Minimum septic tank capacity: /~ gallons. Each
septic tank must have
required if depth ~o top of septic tank(s) is less than 4.0'.
Lift stations require an appropriate electrical inspection.
WELL LOG: A copy of the well log must be sent to DHHS within 30
days of the well's completion.
CERTIFY THAT:
1. I will install the on-site sewer system and/or well in
accordance with all codes and regulations of the
Municipality of Anchorage (MOA) and State of Alaska , and
in compliance wi~h the design criteria of this permit.
2. I will adhere to all MOA and State of Alaska requirements
for separation distances from any existing well, septic
system, or surface water on this or any adjacent or
nearby lot.
3. I understand that this permit is valid for a single
family dwelling with a maximum of ~ bedrooms. I also
understand that any enlargement will require an
additional permit.
· ~. I understand this permit is issued for the calendar year
and expires on December 31 of the year issued.
5. I will notify DHHS prior to all inspections by the
engineer or well driller.
DATE:~---2/'~)
db/ll5
\ ~ I0' UTILITY EASEMENT
VENT .PIPES (TYP, PVC}
15°
PERF PIPE (PVC)
"SOLID PIPE :~VC)
BLOCK 2
.3 BEDROOM
RESIDENCE
GAL SEPTIC TANK
'4" MONITORING TUBE
EXTEND TO BOTTOM
SAND FILTER
SANDPIPER COURT
ABANDON EXISTING
;YSTEM-SEE NOTE 6
PROJECT JOB NO. H90282.02
,~U PCE LOT lO BLOCK 2 THUNDERBIRD HEIGHTS By RWW CK DH I-OF-
SUBJECT
NEW SEPTIC SYSTEM ' DATE5/16/90 DATE 5/16/90 2.
" '' MONITORING TUBE 6" NATIVE SOIL TO
.... (4"PVC W/CAP) ~ FOR FUTURE
~"NATIVE
. SOIL
NOT COMPACTED
'. .GEOTEXTILE SEPARATION
· ~ //FABRIC- SEE NOTE 5
~-. , ° o ° ° £0 . o o. e "P~RFORAT~O_~O ''~ ~''
, ~ PIPE G ,
. .. .... ... '..' '"',
.GRAVEL .'. · · - ,' . .~ ...... .
L
GROUND
.SEWER
~RAVEL
=
III
A .T~sYPICAL SHALLOW BED SECTION
NOTES
ALL CONSTRUCTION BBALL BE IN ACCORDANCE WITH ClIAPTER 115.65
OF THE MUNICIPALITY OF ANCBORAGE CODE AS CURRENTLY ANNENDED~
WASTEWATER DISPOSAL R~GULATIONS.
2. CONTRACTOR SHALL PROVIDE VERIFICATION OF ABSORPTION RATING
OF FILTER SAND PROVIDED PRIOR TO PLACEMEt~T.
3. CONTRACTORS BID SHALL INCLUDE COST OF REROUTING BUILDING
DRAIN BY CERTIFIED PLt~4BER TO ACCESS NEW SI~TIC S¥STEN.
4. CONTRACTOR SHALL COORDINATE WITH'PLUNBER TO PROVIDE STRAIGHT RUN OF DUILDING DRAIN PIPE FRO~4 LOWEST FIXTURE INTERCEPT- TO
NEW SEPTIC TANK.
5. GEOTEXTILE FABRIC SHALL BE PLACED O~ER ENTIRE BED ABOVE'
S~%TER GRAVEL. L~P FABRIC UP SIDES OF RED 2 FT. MINIKUM.
ANY LAPS REQUIRED IN FABRIC ON BED SHALL DE 1.5 FT. MINIMUM.
FABRIC SHALL BE AMOCO 2090 OR APPROVED EQUAL.
6®
CONTRACTOR TO ABANDON EXISTING SYSTEM TO SOOTH OF SOUSE BY
FILLING WITS SAND OR EXPOSING, CRUSHING AND BACKFILLING.
~ P.o~[c~ ~uB.o..9O~B~.O~ ~
HPCE ~°~ ,o B~OC~ T.UN~E.B,R~ .E,G.TS .~ RWW~ O. ~
SUBJECT -OF-
NEW SEPTIC SYSTEM DATE 5/16/90 DATE 5/16/90 2
Munlcipalily ol Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Slreet. Anchora,ge. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:'~::~'Cq..AI~.. P-._~-._L'I'¥
I,,O T I 0 ~I,,OC.K. Z:
LEGAt~ DESCfllP'TION:~~) ~ S ~j~ownship, Range. Section:
C:)L...
4-
6-
?-
8-
11
13-
20-
WAS GROUND WATER
ENCOUNTERED;~ ~
17...5 PT
PERCOLATION flAIE ~. ~ld ."~ [m,~mles..,ncr, j PERC HOLE
1ESTRUNeETWEEN ~FTAND, ~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,~"/~ ' ~O
72-~a IRev. ~85)
"'
~,- · .... ,, .... ~,, ;,/~, ,,~ ;.
RECEIVED..
O~SeBIPTION:~~ ~Town~Bip. Range. Section:
1
2
3
4
5
6
?-
8-
9-
i0-
11
12
13
14
16-
17-
18'
19
20
SLOPE SITE PLAN
WASDROUND WATER
ENCOUtITERED?
IF YES. AT WHAT
DEPTH?
PEflCOLATIONRA'TE(:~' ~"~ Im,nuI(;~,'mCI~IPERCItOLEDIAMETEfl ~//
TEST RUN eETWE£H ~ FT ^NO . 7 FT
· ACCgI~DAHCE'~II'T~ ~J'L $'~AT/ANcO MUNiCIP,~g. ~,b~OELINES_J~I Ef..[EC..,T,_ON THIS D^TE. DA'JE:L/"O~""'~ r' ~7
TO
HIGH, PHUKAN & SORENSEN
CONSULTING ENGINEERS, INC.
(907) 272-7111
FAX (907) 277-3177
(9~7) 745-7774
fAX (907) 74~-2435
WE ARE SENDING YOU ~."'Attached CI Under separate cover via
n Shop drawings r"l Prints ~
[] Copy of letter [] Change order []
[] Samples
the following items:
[] Specifications
COPIESDATE NO. DESCRIPTION
I ~'//~o ~ /T/'~.//~/~,~"/c ~
~i. ~F HE~TH &
~I~ONMENT~
THESE ARE TRANSMITTED as checked below:
[] For approval
[3 For your use
As requested
[] For review and comment
[] FOR BIDS DUE
REMARKS
[] Approved as submitted
[] Approved as noted
[] Returned for corrections
[]
19
[] Resubmit
[] Submit
[] Return
RECEIVED
copies for approval
copies for distribution
corrected prints
__ [] PRINTS RETURNED AFTER LOAN TO US
COPY TO.
SIGNED:~
LOT I0 BLOCK 2
\ \~---I0' UTILITY EASEMENT'
VENT PIPES (TYP, PVC)
15o
PERF PIPE (PVC)
SOLID PIPE (PVC)
3 BEDROOM
RESIDENCE
)0 GAL SEPTIC TANK
MONITORING TUBE
EXTEND TO BOTTOM
SAND FILTER
SANDPIPER COURT
\
ABANDON EXISTING
NOTE 6
PRoJ~c'~ ~,o. ,9o282.oH ~
HPCE ~u,J~'°T ~o BLOCK H T,UNDERB~RD H~,G,TS ~ RWW C~ DH '-O~-
NEW SEPTIC SYSTEM DATE5/16/90 DA'E: 5/16/90 2
MONITORING TUBE~ 6" NATIVE SOIL TO
(4"PVC W/CAP) FOR FUTURE
'/ _.., SLOPE .TO DRAINJ si:. I I L~r~r~ I~" fGROUND
Jill . TIVE SOIL -
~ NOT COMPACTED ~ (l~
_ . GEO~XTILE SE~RATION
~ ~/ FABRIC- SEE NOTE 5 ~1
~..~ , ~ ~ o= ~0"~ _ '~ o~ ". ~~" P ~RFORAT~g~() . '= "~, .~ ~-SEWER
~-.,? .. ..... .... .... .~...~> ~,; ~ .....~'...-"..
~UIMIT'OF.. ~. . '.. I ·
_
=.NFS SANDY-.- " .'-' .' . '. · ' ." '. .
- -..'GRAVEL. ,... ,.. : .;'.'~., ... ... . . . . '.' :'..' ',iii
_
A .T~sYPICAL SHALLOW BED SECTION
NOTES
ALL '~ONSTRUCTION SIIALL BE IN ACCORDANCE i~ITtl CItAPTER 15.65
OF TIlE MUNICIPALITY OF ANCUORAGE CODE ~S CURRENTLY AMMENDEDt
WASTEWATER DISPOSAL .RDGULATIONS.
CONTEACTOR SI{ALL PROVIDE VERIFICATION OF ABSORPTION RATING ·
OF FILTER SARD PROVIDED PRIOR TO PLACEMENT.
3. CONTRACTORS ElD SIIALL INCLUDE COST OF REROUTING BUILDING
DRAIN BY CERTIFIED PLt~SER TO ACCESS NEW SEPTIC SYSTEM.
4. coNTRAcTOR SHALL COORDINATE WITH'PLUMBER TO PROVIDE STRAIGtIT
RUN OF B[JILDING DRAIN PIPE FROM LOWEST FIXTURE INTERCEPT TO
NEW SEPTIC TANK.
CEOTEXTILE FABRIC SHALL BE PLACED OVER ENTIRE BED ABOVE
SEWER GRAVEL. I~P FABRIC UP SIDES OF BED 2 FT. MINIMUM.
ANY LAPS REQOIRED IN FABRIC ON BED SHALL BE 1.5 FT. MINIMUM.
FABRIC SHALL BE AMOCO 2090 OR APPROVED EQUAL.
CONTRACTOR TO ABANDON EXISTING SYSTEM TO SOOTH OF
PROJECT. dO, NO. H90282.02 '~
HPCE LOT I0 BLOCK 2 THUNDERBIRD HEIGHTS
RWW
DH
SUBJECT
NEW SEPTIC SYSTEM DATE 5/16/90 DATE 5/16/90
· DEPA~I~MENT OF HEALTH & HUMAN SERVICES '¢~t ,.,]'.'~' '~';*;;-----~.~-i,:fD~,,.,~,~,,,~t ~k"'"~"'"~
825 L" Street. Anchorage. Alasl(a 99502-0650 ~'.,,~"4~'.. CE 25'807
SOILS LOG -- PERCOLATION TEST ~ifi'~,,,._,.. ....... · ~,~-',_,~
LEGAL nESCnlPTION:77//,/,4,~,~'Z~,/4D/::~ ,&/'/",_k",_~'Township. Range. Section:
1
2
3-
4-
5-
6-
7
8
10
11
12
13.
14.
15-
16-
18-
19-
20-
T
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
PERCOLATION RATE I~/ ~.~ Im,nule~,ncnJ PERC ItOLE DIAMETER
TEST RUN BETWEEN ~ FTAND '~ FT
:.%~:.ii:~'i!l~N-~-~, SUBJECT BY,~.//~'~',/~' CK ~F--
IT ~ ~ ~~
~PT. OF HEAL~
MAY ~0.~
RECEIVED
LOT 10 BLOCK 2.
w& // P~'~p~-,~t ~-~ '
Pt'~ PI~
3 BEDROOM
RESIDENCE
)0 GAL SEPTIC TANK
SCALE: 1% 20~' '
SANDPI PER COURT
ABANDON EXISTING
-SEE NOTE 6
'
\
\
\
.\
HPCE LOT IO BLOCK 2 THUNDERBIRD HEIGHTS
RWW
CK
DH
Su 'jECT.
NEW SEPTIC SYSTEM DATF-5/~/90 DATE 5/~/90 2
May 31, 1990
B90282.03
LOT 10 BLOCK 2 THUNDERBIRD HEIGHTS SUBDIVISION
NOTES FOR MOUND SYSTEM
ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65
OF THE MUNICIPALITY OF ANCHORAGE CODE AS CURRENTLY AMMENDED,
WASTEWATER DISPOSAL REGULATIONS.
me
CONTRACTOR SHALL PROVIDE VERIFICATION OF ABSORPTION RATING
OF FILTER SAND PROVIDED PRIOR TO PLACEMENT.
CONTRACTORS BID SHALL INCLUDE COST OF REROUTING BUILDING
DRAIN BY CERTIFIED PLUMBER TO ACCESS NEW SEPTIC SYSTEM.
CONTRACTOR SHALL COORDINATE WITH PLUMBER TO PROVIDE STRAIGHT
RUN OF BUILDING DRAIN PIPE FROM LOWEST FIXTURE INTERCEPT TO
NEW SEPTIC TANK.
GEOTEXTILE FABRIC SHALL BE PLACED OVER ENTIRE MOUND ABOVE
SEWER GRAVEL. LAP FABRIC DOWN SIDES OF MOUND 2 FT. MINIMUM.
ANY LAPS REQUIRED IN FABRIC ON BED SHALL BE 1.5 FT. MINIMUM.
FABRIC SHALL BE AMOCO 2090 OR APPROVED EQUAL.
CONTRACTOR TO ABANDON EXISTING SYSTEM TO SOUTH OF HOUSE BY
FILLING WITH SAND OR EXPOSING, CRUSHING AND BACKFILLING.
SUBJECT
~ MUNICIPALITY OF ANCHORAGE /'~
0° DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTECTIoN
,. ENVIRONMENTAL ENGINEERING DIVISION
825 LStreet-Anchorage, Alaska 99501 Telephone264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
LOCATION
NAME
DISTANCE TO: · _O
DISTANCE TO:
Manufacturer
IF HOMEMADE:Dwelling Inside length
Well
DISTANCE TO:
No. of lin~
Top of tile to f,in~J) grade
Length Width
Type of crib
Well
DISTANCE TO:
DISTANCE TO:
length of~ach~ne
Foun~t,~ S
Total lan(lib o~.~ine$
[~epth
Crib depth
Building foundation
Depth Driller
Building foundation
Sewerline
OTHER
PIPE MATERIAL~
4 " O_T P ,¢ 4"
SOl L T EST RATING
INSTALLER
~11~ _r'5..~.2 4oc .Serui~¢,
REMARKS
PHONE I [1~ NEW
Dwelling
Material
Near'"i "
Trench width
I ,""~ --(:~ inches
inches
NO. O~
P E . , zz' o a 4/
No. of compartm,~t$
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PEHMIT NO. 7g01¢/__~ /
Total elfec~e~b~tion area
PERMIT NO.
Total ef recline absorption area
Nearest lot line
D~$tance to lot line
Septic tank
72-013 {Rev. 3~78)
LEGAL
PERHIT NO.
I'.IL~r-.! I C Z r' 'il_ .T T%-' C,F
[,EF'~:TMEHT OF HEALTH Fit. ID EW./!RO~FiEHTF=L F'.-.,2TECT!Of~
825 'L' STREET, RNCHOF:RGE, AK. 99501
264-4?20
or.,i--_~; T TE 5EI..IEF: PERI'-1 ][ T
RPF'LICANT M. ROBERT ANDERSON BO::< 19:1.,5 AHCH
LOCATION SAHDPIPER CT/THUNDERBIRD RD
LEGAL Lt0 B2 THUHDERBIRD HTS
TYPE OF SOIL FIBSORBTIOf. I SYSTEN IS: TRENCH
LOT SIZE
~E: 1265
28500 SOURRE FEET
MFI>:IMUM I'.IUMEER OF BEDROOMS
SOIL RFITII'I6 (SQ FT/BR)= 125
'THE REQUIRED SI2E OF THE SOIL FIBSORPTION SYSTEM
[-'-, E F' T FI --- E: L EI"-ILaTH = -:i-? G R FI'-,-' E L D EP T t-t-'-= ~1-
THE LEHGTH DlblENSION I$ THE LENGTH (IH FEET> OF THE TF:ENCH OR DRRIHFIELD.
THE DEPTH OF Ft TREHCH OR PIT IS THE DISTFIHCE BETI,IEEH THE SUF'.FRCE OF THE
GROUND ~ND THE BOTTOM OF THE E×CFIVATIOH (IN FEET>.
THERE IS t. IO SET I,IIDTH FOR TREHCHES.
THE GRAVEL DEPTH IS THE IIII,IIHUM DEPTH OF OF:AVEL E~ETHEEN THE OUTF~LL PIPE
FINL") THE BOTTOH OF THE EXCSVATIOH (ltl FEET.".
F:EC-!IJ I AEC' '-'-;EPT I C TRI'-IK $ I ZE= 1F_-~ g---'lE~ 13RLL,31'-IS
PERMIT RPPLICRHT HAS THE RESPONSIBILITY TO INFORM THIS DEPRF:TMEHT DURING THE
INSTALLATION IHSPECTIOtlS OF Fitly HELL-C; RDJFIOEHT TO THIS PROPERTY RN[> THE
NUME'.ER OF RESIDENCES THAT THE HELL IqlLL SERVE.
TI-ID ( 2 > I I'-.ISPECT I 0I'-.15 RF-'E R E~_--!.LI I F-.'EC,
,E.'RCKFILLING OF FlHY SYSTEM I. IITHOUT FINAL IHSPECTIOH RN[~ RPPROVRL BY THIS
DEPARTMEtlT WILL BE SUB.TECT TO PROSECUTION.
MINIMUM DISTANCE BETHEEN R I.IELL Fli'ID ANY ON-SITE SENRGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE I.IELL.~ OR
150 TO 200 FEET FROH Fl PUBLIC WELL DEPEtI[)IHG UPOtl THE TYPE OF PUBLIC HELL
:OTHER F.'.EQUIREHENTS MAY FlPPLY. SPECIFICATIONS AND CONSTRUCTION DIe, GRAMS ARE
AVAILABLE TO INSURE PROPER. INSTALLATION.
F'EF:I',I I T E,%::P I F,'ES DECEI"IE:EF-: ZI., 197E:
:I CERTIFY THAT
:~L: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS RS SET
FORTH BY THE MUHIClF'RLITY OF RNCHORFIGE.
~': I I, IILL IHSTRLL THE SYSTEI'I IH RCCORDRHCE HITH THE CODES.
~: I UNDERSTRN[> THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE
~L2CRNT M. ~E',ER.T RNDERSON
...... .....
MUNICIP. ALITY OF ANCHORAGE
DEPARTMENT OF H EAI,TH AND ENVl RONMENTAI. PROTECTION
825 L. Street. Anchorage. Alaska 99501 264-4720
SOILS LOG - PERCOLATION TES'~
SOILS LOG
I-I PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5-'
6-
7-
8-
9-
GP
SLOPE
DATE PERFORMED: ~'~""~' '~'
SITE PLAN
10-
11
12
13
WAS GROUND WATER .~o [
ENCOUNTERED? O
P
E
IF YES. AT WHAT
DEPTH?
~P
COMMENTS A V E' ~."..A G ~
//~Z/ANO /'7/
PERFORMED BY:/['%A~ ~A~(J~
72-008 (6/79)
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE * ~ '%\~'. · ~ ' ', ' f,, '(mtr~eslinch)
.' ,~.~;* -., ......
TEST RUN BETWEEN ' , FT AND F'r',
~:~,T'~N(; o~ /,/~...,~./I'~,~.~..,/~.,.CT'~,~,,,
: ~.__,. ;;.,,,~';...:
,-~o.,p,=~a<,: -? ..... -* · ...... /-~--"-
BOMHOFF & ASSOCIATES, INC.
Engineering- Planning- Surveying
102o Wcst lnternationa! Airport Road
Anchomgo. Alaska 99502
Tclcphon¢(g07) 279-5522
BORING NO.
STATION
ELEVATION
0
BORING NO.
STATION
ELEVATION,
0
6
?
8-
9.
I0.
I0,
II.
13'
14,
I?'
18.
2:1'
2~'
Il'
12.
14
15.
16,
17:
18
19
20.
2:2'
23'
2:4
MUNICIPALIT"~'~) F AN'CHORAGE · . ~ __
DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECT~ICIPALITY OF ANO-IOI~GE
825 L Street · Anchorage, A¼ske 99501 DEPT. OF I:2ALTH & :
ENVIRONMENTAL F~OTECTIoN
ENVIRONMENTAL ENGINEERING DIVISION ,4- ..-
· - JUN 61980.. ,,-.
Telephone 264-4720 . -
DIRECTIONS: Complete all parts on page 1. Incomplete request~ will not be processed. Please allow ten (10) days for processing. } '
t. PROPERTY OWNER
Alaska Pacific Bank -. ·
MAILING ADDRESS
P:O. ~ 420 A~ChOrage, Ak. 99510
PROPERTY RESIDENT (if different from
· -. ;:~ John Chris ~olst~uL,
· ' P.O. BOX 1331, Wasilla, Ak.
Work ~279-9671
JPHONE
274-9661 :": ";
· J. PHONE
~ LENDING INSTITUTION ,, I PHONE
Alaska Pacific Bank J 274-9661
P.O. BOX 420 Anch, Ak. 99510 .
4. REALTOR/AGENT ~ , , · . PHONE ....
Terry Lousignont - ~ntury 21 metropolitan Realty 274-1631·
'L';,, ]: [] MULTIPLE FAMILY
..... ' 7. WATER SUPPLY
i~'~'- .... .. . r--I-.iNDIViDUAL'
....... :" J~]/' COMMUNITY
· '" ' [] PUBLIC UTILITY
MAtt. lNG ADDRESS- . ~
523 'W. 8th Ave., Anch, Ak. 99501
';" · 72-010{3178)
:.,:? *~,'.
2.1.
~. LEGAL DESCRIPTION
Lot 10, Block 2r Thunderbird Height~' ' '
STREET LOCATION . ..: :, -.-
NHN Sandpiper Court Eklutna, Ak. 99567
6. TYPEOF RESIDENCE ·
'~'; ~i "~:~[] :"., SINGLE FAMILY ' ' '
NUMBER OF SEDHOOMS
Other
8. SI~WAGE DISPOSAL SYSTEM * 4 .
If system is over two (2) yeers old en adequacy test is required "'
r--I PUBLIC UTILITY by this Department.
· NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
I'-I One I--I Four
'" [] Two ' [] Five ~,'
~] Three [] Six ....
o ATTACH WELL LOG. A well log.is requlred for all wells drilled ~ ~
since June 1975. For wells drilled prior to that date, give well ' ",' '* ' -
depth (attach log if available.)
. SiDE FOR O :FICIAL USE ONLY
· INSPECTION APPOINTMENTS
FIME TIME TIME ..-
DAT~ DATE DATE ·
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS '
:',~ ~ SINGLE FAMILY ~ ONE ~.' THREE "~ FIVE ' ~* '~ '..OTHER','?
~ WATER SUPPLY PERMIT NUMBER . ' ..
,~ :' COMMUNITY DATE DRILLED ...... ..
~' ~ ' PUBLIC UTILITY~
3. SEWAGE DISPOSAL SYSTEM PERMITNUMB~ ~~I' ' ' ' ': '=':'"
~INDIVlDUA~ON -SITE · DATE INSTALLED :
Connection Verified INSTALLER ~ ., . .-
~Septlc Tank or
~ Holding Tank
Size: ~ IfTankishomemade SOl. RATING.
give d~mensions: t ~
TOTALABSORPTION AREA , MATERIAL. ' '
I
' · : ~PPROVEDFOR ~ BEDROOMS ': ' '~ '
' ' . ~ CONDITIONAL APPROVAL (letter must accompany certificate) ~ : ':'...
~ DISAPPROVED
'/2'010 {Rev. 3/78)
· ~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# . 051 -'/21-i 5"
GENERAL INFORMATION
Complete legal description
LOt 10;'~I~bk 2; Thunderbird Heights
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address
27232
Sandpiper Street
Chuqiak,
AK 99567
Day pbone 688-6126
~h,,g~; A~ 99567
Day phone
Agent Virqinia Kohfield/Remax of E.R.
Address,
Day phone 694-4200
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
e
NOTE:
Individual well
Community well XX '
Public water
If community well system, provide written ~onfirmation from State ADEC attest-
ing to the legality and status of system.
T{'PE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
xx
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 Apl~roval. 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 Ancho~'age 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 f this inspection. ·
Name of Firm Alaska
Address wast a/' '
Engineer's signature
vater
Wastewater Consultants,
$
or prior to, closing for the
Engineering Services Provided.
DHHS SIGNATURE
~ Ap. proved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
Additional Comments
Date ~ - 2~ "~'
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 abova by an independent
professional engineer registered in the State of Alaska. The DH HS does this es 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 o~' omissions in the professional engineer's work.
RECEIVED
Municipality of Anchorage APR 1 2 t999
DEPARTMENT OF HEALTH & HUMAN SERVI~KFT~,ujry o~~
Environmental Services Division aw~saw~so~
825 L Street, Room 502 * Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: "~'14u~tr=~..l~4¢.~ ~r=l&H-z'~: ' Pa~l I.D.:' . O~l --W ZI - I~--
A. ~ DATA ~
Well~ ~ ~' ~B,~C,a~ECl~~mnumber ~/)l~
T~ dep~ ~~d to ~M (~ ground)
~~ Wires pmpe~
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG
AT INSPECTION
g.p.m.
Coliform Nitrate -- ~ Other bacteria
Date of sample:
B. SEFTIJTANK DATA
Date installed ~,/~f,/~o Tank size / Oo O
Collected by:
;~. Cle~outs (~N).
High water alarm (Y~)
Number of Compartments
Foundation cleanout i~l~l) ~ Depression (Yin)
Date of Pumping ~/og-5 /~ Pumper ~- ~:) ·
,' J
ABSORPTION RELD DATA
Date installed ~,/H/=lo Soil rating (g.p.dJfF
Length Scl Width ~ ~+ Gravel thickness below pipe Total depth ~.-7t- ~. O I
Effective absorption area ~"/~, ]~' Monitoring Tube present {~¥N)
Date of adequacy test ~Z_/~I ~ -Z.O/4~ Results (~lllt) {)~, 5.s For --~ bedrooms
Fluid depth in absorption field before test (in.); J * -~' Immediately after'7~3 gal. water added (in.):
Fluid depth 7..-.~' (ins) Minutes later:.. J~l'? Absorption rate = ~'o4- g.p.d.
Peroxide treatment (past 12 months) (Y~I~ j~u4~ Jf~.d~J If yes, give date ·
72-o26 (Rev. 3/g6)'
D. UFT STATION
Date installed
Manhole/Access {~)
High water alarm level
Cyctes tested
Size in gallons ~'O~
'Pump on" level at'
*Datum
'Pump off level at* v,-.~ z ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding t~nk on lot On adjacent lots ...-.-..-
Absorption field on lot ~..---"O'~"~d~an adjacent lots
Lift station ~
SEPARATION DISTANCES FROM SEPTIC~I~ TANK ON LOTTO:
Foundation __.~_~__ Property line I O I't" Absorption field
Water rnain/sewice line fO/+' Surface water/drainage IOO1'1' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~Ot''~' Building foundation
iot.p
Surface water i0o
Water main/sen, ice line
Curtain drain
Driveway, pmtdng/vehicle storage area
Wells on adjacent lots .7_c~ I t'
/ox..;-
F. ENGINEER'S CERTIRCATION '
I certify that I have~te~in~l~b fle~d insPectlon. I and review of Municip~~ms are
in confommnce/~ ~ ~u~ effecf on this date.
Signature !
//
72-o2e (Rev.
Waiver Fee $
Dat, e.of Payment
Receipt Number
