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Home My WebLink AboutTHUNDERBIRD HEIGHTS #3 BLK 6 LT 12Thunderbird H ights Block 6 Lot 12 #051-582-30 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221372 PID Number: 051-582-30 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JACQUELINE & ALAN CLEMENS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 24518 TEAL LOOP, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot THUNDERBIRD HEIGHTS #3 6 12 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 Ft2 Ft. Well 200'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- GREER 1500 Gal. Material Number of compartments Lot Line 10'+ _- NA HDPE 2 Foundation 10'+ ILIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. 4BR SYSTEM. Alarm location Electrical installed by Installer DENALI PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1s' 11/1/22 dates: 2 d 11/2/22 Location and description 31d 4tn TOP OF RISER ON -SITE WATER AND WASTEWATER SECTION APPROVAL, Conditional Approval: Date Awl�.'�v' 1►' — ••,•• •••• •••••••;••,/ Septic System Approved /I Curtis Huffman f -�•%•• •� #Q`, CE 12899t Date ) Z 1 f ? _ - •, _ �R�/ AW ��`�pPR ��c.�AW fiESS10� Note: this approval does not include well permit requirements. ��,,,t,,�.�,,."► ,1\GV VJIVL/ IVi PID: 051-582-23 PERMIT: OSP221372 MT 4 A—C=39.2' B—C=20.4' A—D=40.4' B—D=22.4' A—E=43.5' B—E=27V A—F=44,7' B—F=28.5' 0 1 11 1 S B9 56 00 99.96 5'—NO FIELD INSTALLED DISTURBANCE 1500—GAL HDPE AT CONST. SEPTIC TANK W/ DCOs. APPROX. WA CO M 0 �H B D\C�O �DCO FCO F c 2.1 v rn 4 BED HOUSE F� ASPHALT I BLOCK WALKWAY I ASPHALT I DRIVEWA - 271.8 WOOD RET. WALL N. B9 5B 3 E") 11 E. 1 99.96 FCO DG0 H c � M DOD MT 99.50 FINAL GRADE L&A'n 116-08 95.50 500—GALLON HDPE STEP \�95 33 TANK E EXISTING FIELD SEPTIC SECTION SCALEi NTS THUNDERBIRD HEIGHTS #3 BLK 6 LT 12 PREPARED FOR: ALAN & JACQUELINE CLEMENS 24518 TEAL LOOP RD CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmoil.com bUFFUK btNVIL;L5: .4, ®� OF AZI, is', It I 4c 9 TIF1 * 0 DATE: 12/13/22 rtis Huffman SURVEY: HOLT CE 128991 DRAWN: FWCS 12/13/2022,ip SCALE: 1" = 30' %.WSSIOIA�" 0 0 ------- --------- REdd ydd\ }V-72 - --- Q * / w co % ƒ n 5 $8'M�OE&O.OS 4,4 1 7\ o : >i _,:- a\}\ 0} §may 9 \z«j 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://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221372 Work Type: SepticTank Upgrade Tax Code Number: 05158230000 Site Legal Address: THUNDERBIRD HEIGHTS #3 BLK 6 LT 12 G:1865 Effective Date: Expiration Date 1,Zcnr TAS .-- �-, N s r. Y Department y/2;1`/Zo ZZ 2LI&� 9/2 �-/20z j Site Mailing Address: 24518 TEAL LOOP, Chugiak Owner: CLEMENS JACQUELINE K OR Lot Size in Sq Ft: 20000 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: -- 1 . ith: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 (24/7). 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 Received By: Date: 9/27/22 Issued By: Date: MUHMP L UT Y OF ° HC COR , OC "-s Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section -1- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION 30 Parcel I.D. 051-582-y Property owner(s) JACQUELINE & ALAN CLEMENS Day phone Mailing address 24518 TEAL LOOP, CHUGIAK, AK 99567 Site address 24518 TEAL LOPP, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) THUNDERBIRD HEIGHTS #3 B6, L12 Legal description (Township, Range & Section) Lot Size 20,000 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade El Duplex (D) El Holding Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 1'�II[R1171RIEYfA1ERI SOPPRRI d PfANN IX�uu if I gnature of property owner or authorized agent) ermi Rush Fees: do�� Waiver Fees: ate of Payment: Ci ll(otad (' _ Date of Payment: Receipt Number: 61(4 2D Receipt Number: Permit No. 65 P?iZ 1-3-1 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com September 21, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: THUNDERBIRD HEIGHTS #3 BLOCK 6, LOT 12 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. No groundwater was noted in MOA On-Site file documents and we propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. For functionality and flexibility, the owner has decided to install a 1500- gallon septic tank. The lot and area are served by a public or class A water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221372, Curtis Townsend, 09/27/22 N 0°01'10''E 100.10'S 89°56'00" W. 199.96 N. 89 58' 35" E. 199.96S 0°01' 10" W. 99.95TWO STO R Y FRA M E HOU S E DECKDECK ASPHALT ASPHALT DRIVEWAYDECKCONCRETE15' UTILITY EASEMENTWOOD RET. WA LL S X X X X X X X 27.820.227.88.82.1 13.038.612.24.014.34.0 13.038.3 2.426.0 28.8FIRST WATER CONSULTING THUNDERBIRD HEIGHTS #3 BLK 6 LT 12 DESIGN DETAILS: NO WELLS WITHIN 200' OF PROPOSED SEPTIC TANK. SITE AND AREA SERVED BY PUBLIC WATER. VERIFY & STAKE IF NECESSARY ANY WELL W/IN 200' OF PROPOSED SEPTIC TANK. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221372, Curtis Townsend, 09/27/22 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 / ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT / NAME /'1 I NEW NO, OF BEDROOMS ----.~ DISTANCE TO: ~.~F-Z Manufacturer ~ f~- ~ [~ Material ~__~iof compartments ~ ~- Liq. ca aclty in gallons Inside length Width Liquid depth /~,~O IF HOMEMADE: , ~ Well Dwellin~ PERMIT NO. 0,(~ DISTANCE TO: O z "~ Manufacturer ~ Material Liquid capacity in gallons _~, ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~ inches ~ DISTANCE TO: OTHER PIPE MATERIA L~/~_~ ~ - ~~~//~ ~__~/ LEGAL PERMIT NO. FIPPL. IC~NT~.~ O. El. K. C:ONST. SRFI LOCOTION RRVENS LEORL LOT '..t. 2 8LK 6 I'HUNDEREJlRD HTS. 6~05 8-~ POLMER LOT SIZE 20000 S~LIRRE FEET T',tPE OF SOIL. RBSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4, mgIL RRI'IN~] (Se FT,"'BR)":' 90 THE REQUIRED SIZE OF' THE =.ELL RBSLIRPTION THE LEN~]TH DIMENSION IS THE LENC~'¥H (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE OROUND ¢~N[.:, THE BOTTOM OF THE EXOBVFtTION (IN FEET), THERE IS NO SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILITV TO INFORM THIS DEPRRTNENT DURINO THE INSTRLL, OTION INSPECTIONS OF ~NY HELLS 8DJ~CENT TO THIS PROPERTV RND THE NUMBER OF RESIDENCES THRT THE HELL HILL SERVE. BRCKF'ILLING OF RNY SYSTEM HITHOUT FINRL IN~$PECTION RND RPPROVRL. BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETHEEN 8 HELL RND 8NV ON--SI'YE SENRI2E DiSPOSRL SVSTEM I~ i88 FEET FOR R PRIVRTE HELL OR &58 TO 288 FEET FROM R PUBLIC HELL BEF'ENDING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTRNCE FROM 8 PRIVRTE HELL TO 8 PRIVRTE SEWER LINE I)5 25 FEET RND TO R COMMUNITV SEHER LINE IS 7~ FEET. OTHER RE~2UIREMENTS MRV RPPL~, SPECIFICRTIONS RND CONSTRUCTION DIRGRRNS RRE FIVRILRBLE TO iNSURE PROPER INSTRLLRTION. I CERTIF"," THFt]' i: I RN FRMILIRR HITH THE REQUIREMENTS FOR ON-'SITE SEWERS RND HELLOS RS SET FORI'H B't' THE HUNICIPRLITV OF RNCHORRGE. 2: I HZLL INSTRLL THE ~N.'~TEH ZN RCCORDRNCE HITH THE IDODB%. ;$: i UNDERSTRND THRT THE ON-SITE ~ENER S'¢~TEM NRV RB6~UIRE ENLRRGENENT ~F THE RESIDENCE IS REHODELED TO ~NCLUDE HORE THRN 4 BEDROOMS. RPPLIC' '~,/8. S.K. CONST. Russell Oyster 694-2774 O & E ENC~NEERING & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Performed for: Name: --~Z~i'/'~ ~)~'~-~ ~ Tel. No Mailing Address: Legal Description: Z~7"' /-~?, Depth (feet) Soil Characteristics 4 10__ 11__ PLOT PLAN 12__ 13__ PERC. TEST 14__ 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No/-",/ If yes, what depth Drain Field__ 15:59 '~'9(~72785941 Et(LUTNA lNG ~.002 ANCHORAGE DISTRICT 800 E. DIMOND BLVD., FOR: Jaylene OFFICE ;UiTE 3-470 May 12, 1992 WALTER J. HICKEL, (907) 349-7755 PWSiD ¢/' 211156 My review of the records 'n file in this office reveals that the Ek utna Thunderb rd Heights Subdivision Class "A" PUI~Iic Water System, is in compliance with the routine coliform bacteria 8ampllng requlr~ments ~.$.ed in Table C, and with the inorganic samphng requirements listed in Ta~ le B of 18 AAC 80.200, Sincerely, / A ,4 Rachel Clark Colieg'e intern JOB # IOO, 0 ~-/,~/:::, ~/r',~.. SEPTIC TANK CLEAHOUT #1 CL£ANOUT #2 SEPTIC UEHT ~EPTIC UENT #2, TOTAL DEPTH ~,~,~, ~ ~,.~ DZSTANCE ~0~ top to ~OU~D ~ ~ /, g = & = 100° ADEQUACY TEST LOCATION: L INSPECTOR: TYPE OF DWELLING: 7'"',...;,o NO. OF BEDROOMS: 2./ CALCULATE PEAK LOAD REPORT JOB NUMBER: Flow Vol. Cumul. /~ S.T. S.A.S.MT ~1 S.A.S. MT#2 Rate Igal) Vol. Liquid A Liquid /~ Liquid CCOM~ENTs Time (gpn9 (gal) S.T. Level Level level REVIEWED BY: _ ~-- DATE: SEPTIC TANK SIZE: TYPE OF S. ~- S.: q./~.¢ (MEASURED IN FEET.) Municipality of Anchorage Development Services Department · Building Safer7 Divlslon' .. On-Site Water & Wastewater Program". ' . :. ' .'~' ~ ' .......... 4700 South Bragaw SL · r '" ' y;P.?.Box196650A~chorag ,AK99519--6650 '' ': CERTIFICATE OF HEALTH .b, UTH'ORI'i'Y ,b, PI~ROVAL'''- i ' . i . FORA SINGLE FAHILY DWELLING" Parcel I.D. 051-582-30 1. GENERAL INFORMATION Complete legal description Location (site address or directions) THUNDERBIRD HEIGHTS SUBDIVISION ~3; LOT 12, BLOCK 6, 24518 TEAL LOOP * CHUGIAK, AK 99567 Current Property owner(s) ANNE JI[FFERY Day phone 688-7775 Mailing address Lending agency ' Mailing addres~ Real Estate Agent 24518 TEAL LOOP * CHUCIAK~ AK 99567 Day phone DOUG VANE'rTEN w/ PRUDENTIAL VISTA Day phone 562-6464 Mailing address 4242 'B" S'rREE'r * ANCHOEACE, AK Un/ess otherwise requested, HAA w~ll be held by DSD for plckup. 2. NUMBEROF BEDROOMS: 4 gg503 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class "A' Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Servlces Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the mpmsentet~ons given In paragraph 5 by an independent professional civil englneer registered In the State of Alaska. Certificates of Health Authority Approval are requlred for the transfer of t~tie (except between spouses) for prope~es sewed by a single family on-site wastewater disposal and/or watersupplysystem. DSD also lssues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties sewed by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Ce~ficates are valid for one year for prepe~es sewed by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. · to closing for the englneedng ean, fce$ provlded. .....J .. 4. STATEMENT OF INSPECTION BY ENGINEER "'~ As ce ~fied by my sea~ a~xed heret~ an~ as ~f the va~idati(~n ~ata sh~m be~w~ ~ ~rify~ ~atmy ~ ; . invesb'gation, based on ~cedures outlined in the Health Authority Approval Gu..Idelk~. .' fox,Is app/ica#on, shows that the on~slta ~/atar sUpp~, and/or wastewatar disposal system Is(are) safe; functto~el and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Informafion obtained from the Municipality of Anchorage files and from my Investigation"~n~l In~pec~Z~n, the on-site water supp~,' ~-nd/o'r wastawatar disposal system Is(are) in compliance wfth 'all a. ~licable Municipal and State codes, ordinances, and regulations In effect at the b'me of Installation.... .. . ', ' : Name of Firm. ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In cenduc~ng this evaluation, AIMWC, Inc. attempted to pro~de a thorough, consden#ous engfneadng analysis of the system in accen~ance with ADEC and MOA DSD Guidelines & Rugulatfons. The refx~ed results desctfbed the pett~rnance of the s~,stem under the conditions encountered at the t~me of the test, and soparatlon distances measured to readi¥ Identifiable features. The operational life of all wells and septic systems depend on the Iocal so~s cendYJon, groundwater levels that may · fluctuate during the yaar, and the water usage of the famliy being esn/~d by the system. These conditions are ou~Jde the conb~l of the maluat~ of the system. Satisfactory test results do not guarantee future pedon~ance of the system, nor do they guarantee that there are no hidden defects er ~creachmeats. AWWC, Inc-. can therefore not pmvlde any warranty or future estimate of how long the system will continue to meet the operational requlrements of the ADEC or MOA DSD. The content of this report Is the sole benefit of the ovmer listed abew. Any reliance upon ~' use of this report by any other person or l~arfy ls not authorized, n~ wlll lt confer any lugal dght whatsonver. 5. DSD SIGNATURE I,'"'"' Approved for IJf' bedrooms. Disapproved. Conditional approval for Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manltenance Agreements Supplemental Engineer's Reort Ot~er Original CerUficate Date: Municipality of Anchorage Development Services Department Building Safety Dlvt~n On-61te Water & W~s'tewater Pm~am 4700 ~h 9ragaw SL P.O. Box 196650 Anchorage, AK 09519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: THUNDERBIRD HEIGHTS S/D ~5i LOT 12~ BLOCK 6~ Parcel ID: WELL DATA COMMUNITY Well ~13e(~MMUNITY If A, 6, Or C provide PWSID~ 211156 WeD Lo~ Date completed ~ltary~?_~.._~.~ , FROM WELL LOG 051-582-30 WELL Casing height (above ground) AT INSPECTION ~ g.p.m. .~ g.p.m. WATER ,~AMPLE RE~UL'r~: B. SEPTIC/HOLDING TANK DATA Tank Type/Mateltal STEEL Tank size 1250 gal Nund~er of Compertmenta Fouedafien cleanout (Y/N) YES Date of pumping 4/9/01 C. ABSORPTION FIELD DATA Lengm 46 Total depth ge Dateinstalled 5/8/81 2 Cleanouta (Y/N) YES Depresalon over tank (Y/N) NO High water alarm (Y/N) N//A Pumper JR'S PUMPINO *PER OLD HAA **NEW 2' STEEL MONITORING ~JBE INST.~IIFn 4/5/01 VERIFIED SEW~-R ROCK DEPTH raling (g.p.dJft~L~-~'~ 90 ~'~/stam type .' TRENCH It. Wldlh *2 lt. Grovel below pipe *4 ft. ft. Eff. abso~ption area *568 ftI Mon~odnotube**YES Depresslonoverfielc[ NO FOr 4 bedrooms Newdepth 26 in. 600+ g.p.d. ffyes, give date - Date of adeduacy test 3/9/01 Results(Pass/Fan). PASS Ruld deplh in absoq~Uon field before test 0 in. Water added 777 gal. Bapsed'llme: 10 min. Finalflulddepth 5 in. Absorpllonreta>- Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNO~Rfl UFT 8'rATION Oate Inste~ed SIz~ In g~on~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: High water alarm level at in. Meete atenn & drcult requlremente? COMMUNITY WELL Sep~c tank/I]~ ~teflon on lot .~on field on lot Public eewer main On adjacent lots Holdlng tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorp~on field. Water main 10'+ Water service line 10'+ Sudace water 1 oo'+ Wells on adjacent lots. 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10"+ Water ~ewlce line 10'+ Curteln drain NONE KNOWN Bulldtng foundaUon 10'+ Surface water 100'+ Wells on adjacent lots 200'+ Water main 10"+ Driveway, peddng/vehlclestomge 10'+ F. COMMEHTS O. ENGINEER'S CERTIFICATION /~..~t,7~..,~.~.~__~' I ~ ~at I h~ de~ ~h ~eld ~s e~ ~a~ ~ M~ ~ g~ellnes ~ e~ ~ ~s da~. Waiver Fee $ Date of Payment Receipt Number 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 HAA# 1. GENERAL INFORMATION Complete legal description Lot 12, Blk 6 Thunderbird Heights #3 Location (site address or directions) 24518 Teal Loop (Formerly Raven Loop) Eklutna, Alaska Property owner Mailing addCess Lending agency Mailing address David G. Thompson PO Box 671892 Chugiak, Ak 99567 Day phone 688-3294 GMAC Day phone 562-2181 460 w. Tudor Road Anchorage, AK 99503 Agent Address Fortune Properties 3000 A Street Suite 101 Anchorage, AK Day phone 99503 .562%76'53 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: X Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025(Rev. 1/91) 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 LCM~ Limited Engineer's sig natur6~,~TA ~i bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone 562-1830 Anchorage, AE 99503 Date 5/11/92 i.,~ .. ...... · %%~ bedrooms, with the following stipulations: Additional Comments By: . Date 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 12, B 6 Thunderbird HtS #3 Parcel I.D. A. WELL DATA Well type A Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller 211156 Total depth Sanitary seal (Y/N) Casedto FROM WELL LOG · .. Casing height Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot > 500' Absorption field on lot > 500' Public sewer main N/A Sewer service line N/A Wires properly protected (Y/N) g.p.m. AT INSPECTION ; On adjacent lots N/A ; On adjacent lots N/A Public sewer manhole/cleanout N/A Unknown Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ,:,.,~/8/8i Tank size 1250 Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) N/A Date of pumping 4/8/92 J Compartments Unknown Y i Depressi0r! (Y/N) U/A Alarm tested (Y/N) Pumper J.R. ' S Pumping N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot none On adjacent lots none To property line 25 ' ~' Absorption field 5 '- Surface water/drainage N/A 18' ~ Foundation Water main/service line 60 '/~ 72-026 (Rev. 7/91)Front CONTINUED ON BACK pAGE C. LIFT STATION Date installed None Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 'u~/8/81 Length 46' Width 2' Total absorption area 368 S.P. Depression over field (Y/N) Results (pass/fail) Pass Peroxide treatment (past 12 months) (Y/N) 9o Soil rating Gravel thickness N Cleanouts present (Y/N) Date of adequacy test 4 for Deep Trench System type 8' Total depth Y If yes, give date 5/7/92 bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot None To building foundation On adjacent lots N/A None Surface water Curtain drain N/A 29 None 25' On adjacent lots Property line To existing or abandoned system on lot N/A Cutbank None Water main/service line 71' 50' Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect.~~ ,~t~is inspection. Engineer's Name Scott L Hattenburg, P.E. HAA Fee $ / ? 0 ~ ~ Date of Payment~'-/~ -~¢ ~ '~ Rscsipt Number b 0 Waiver Fee: $ Date of Payment Receipt Number DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF 825 L Street - Anchorage, Alaska 99501 ENVIRONMENYAL p;:O'[ECTION ENVIRONMENTAL SANITATION DIVISION 0C'~' 2, 0 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL wATER AND SEwER~bVE~ D DIRECTIONS: Complete all parts cfi page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROP tRTYOWNER MAI LI NE AD DR ESS PR'(~Ti~ERTY RESIDE~I~T (If different from above'~- PHONE PHONE 3, LENDING INSTITUTION ] PHONE MA~L~G/ADDRESS 4. REALTOR/AGENT PHONE 272- 0.5'7/ MAI LI N~ AD DR ESS 5. LEGAL DESCRIPTION STREET LOCATION S. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY [] One [] Four~F"~ [] Other [] Two [] Five Three [] Six ,~2__ * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL US.'~ ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~ INDIVIDUAL/ON -SITE CATE INSTALLEC []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO; Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS []~;~-%z~isP R OV E D FOR 4 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ 72-010 ( Rev. 6/'/9) INSPECTION APPOINTMENTS T~ME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR p¥ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEDTJ~;~iRONMENTAL ?F:OTECTION ( ~ 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ,~,UG 'J. $ 'tg81 .~ Telephone 264-4-720 FCF/VF 0 DIRECTIONS~ Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten {10) days for processing, 1. PROPERTY OWNER J PHONE G. S. K. Construction,745-2553 MAILING ADDRESS SAR 6105 A-3, Palmer, Ak 99645 PROPERTY RESIDENT (If different from above} PHONE 2. BUYER Danny E. & Kathleen B. Kraft 428-3227 MAILING ADDRESS 458E DYea, Fort Richardson, AK 99505 3. LENDING INSTITUTION J PHONE United Bank of AlaskaJ 2761911 MAILING ADDRESS 645 g Street, Anchorage, AK 4, REALTOR/AGENT PHONE Totem Realty/William J,- _Sc~legel 272,0571 MA~LING ADDRESS 724 E. 15th Avenue, Anchorage, AK 99501 5. LEGAL DESCRIPTION Lot 12, Blk 6, Thunderbird Heights Subdivision STREET LOCATION Raven Loop Rd. 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] 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 UTi LITY depth (attach log if availabl'e.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [~] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDI VI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY 5 - g'g I. Connection ~/erif[ed INSTALLER []Septic Tank or [~] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~"/APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED