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Home My WebLink AboutTHUNDERBRUSH LT 7 ~ Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal'System and/or Well Inspection Report Name: Wastewater Systom: ~ New ~pgrade Address: I1~ ~~~ ~¢ ~q~ ABSORPTION FIELD Phone: INo. ofB~oms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: ~' ~ GPD/Sq. Ft. ~ Lot~.l ~ ~ ~ Block:~~ ~ ,Subdivisi°n: Depth to pipe bottom from original, grade:/~ ~ravel depth beneath pipe ~ / Ft. Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: I Number f lines: Distance betweenlines: WELL: D New ~ Upgrade Gravel width: ~ / ~ :~ Classification (Private, A,B,~): Total Depth: Cased To: Total absorption area: ~ipe material: ~[~ Driller: / Date Drilled: StaEcWaterLevel:Ft. =~'~lnstaller: ~ Datei~stalled: ..~,~. SEPARATION DISTANCES ~Septic~ m Holding U S.T.E.P. TO Septic Absorption Lift Holding Public/PrNate Manufacturer:__¢ ~ Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~~ Well I~[ ~ / ~- ~ ~ Materia~ NumberofCompartments: Surface [~'~ ~,+ -- ~ ~ LIFT STATION Water Foundation [~ ~¢ -- ¢¢ ~ "Pump o~p off" level at: I Hie~ wa,~r a'~rm ~t: CurtainDrain ~~ ~[~ )~{ Pur~ke&Model I Electrical lnspections performed by: Remarks: BENCH MARK Location and Description: I Assumed ElevaDon: /~ FI, ENGI~E~EAL Dopartmont of Hoalth d Hu vices apprgval ..... Reviewed and approved by ~- . Datey~ 3~ 72-013 (Rev. 9/91) MOA 25 Permit No. SW950022 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box .196650 · Anchorage, Alaska 995'19-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegaIDescription: THUNDERBRUSH SUBDIVISION, LOTS 7 & 8 PIDNo.: 01514264 CO1 88X~I NEW lO00 GAL SEPTIC TANK C02 /, FINAL GRADE ;80.4~ MT C04 5,4. · 74,4'; NO WATER FOUND 3 BDRM DECK C04 A E CO~ I sT.s 116.81 cog 133.1 1 ~5.41 d03]36. ]43.5I C04 7Z.9195.61 MT 70.2 92.0 THUNDERBRUSH CIRCLE 72 013 A (Rev. 9/91) MOA 25 ' INSPECTION REPORT MUNICIPALITY OF ANCHORAGES, BUILDING SAFETY DIVISION TL/OOR ROAD .... 3500 EAST " ' INFORMATION (907) 786-8211 INSPECTIONS (907) 663-3464 / PERMIT NO. ' ' /PHONE ' ~ ~; / ~ /DATE FOOTING PLBG. UNDGR.- FOUNDATION __ PLRG. ROUGH -- BOND BEAM -- GAS TEMP. -- FRAMING [] GAS . INSULATION- [] MECHANICAL SHEETROCK -- [] MECH. FINAL STRUCT. FINAL -- [] PLBG. FINAL -- OTHER [] OTHER LOT / ~ BLOCK / ~ SUBDIV. ~ [] ELEC. TEMP, ~ [] [] [] ELEC, SEnVlO£ -- [] [] [] ELEC. ROUGtt ~-- [] [] ELEC. ELNA[:/ - ~[] [] OTHER ~. ~' ~ _ [] [] FIRE FINAL .---~-- [] [] ZONING --~.-~-- [] [] [~1 ~:ORRECTIONS ESSENTIAL AS ~XPLAINED BELOW ~ ..WILL REEXAMINE AT NEXT INSPECTION ['l ,OO NOT CONCEAL UNTIL REINSPECTED COMMENTS - ~T ? '/' LL WHEN '~'~ORRECTIONS ARE MADE, PLEA~I~ ~,A FOR INSPECTION- ,~ · ' I~O NOT REMOVE 1.HIS NOTICE PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT ,q PERMIT NUMBER:SW930022 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:APPLEGATE RICHARD L & OWNER ADDRESS:il400 THUNDERBRUSH CIR ANCHORAGE, ALASKA 99516 DATE ISSUED: 3/01/93 EXPIRATION DATE: 3/01/94 PARCEL ID:01514264 LEGAL DESCRIPTION: THUNDERBRUSH LT 7 LOT SIZE: 15471 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~ ISSUED BY:~ DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECT~ON ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOtL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ~'eDruary 1~, 1993 ~unicipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.Oo Box 196650 Anchorage, Alaska 99519-6650 ROBERT SHAFER, P.E ROGER SHAFER. P E CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 RECEIVED FEB 2 3 1993 Municipality of Anchorage D~pt, Health & Human Services REFERENCE: Thunderbrush Subdivision, Lots 7 & 8 Request you issue a permit to upgrade the septic system serving the referenceQ property anQ issue a Con4itional Health Authority Approval. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. No health hazards exist or are anticipated by the issuance of a Conditional Health Authority Approval. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. We do not anticipate any adverse ef~eclrs---on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. jSi~cerely~ , II ~am__~uam~s P. Williams, C.E. Roger J. Sh~fer, P.E. JPW/RJS/LSU/lsu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I"= $0" SCALE UPGRADE ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lots 7 & 8 Thunderbrush Subdivision 11400 Thunderbrush Circle GENERAL: The scope of this project includes the installation of a leachfield trench ugrade to serve the 3 bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify integrity. If the integrity is found to be poor, the tank is to be replaced. The existing seepage pit is to be excavated, crushed, filled with soil, and abandoned in place. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be resposible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. page 2 Construction practices 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DR~INFIELD INSTALLATION: Excavate the proposed trench to the diminsions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. page 3 Construction practices MINIMUM MATERIAL SPECIFICATIONS~ Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank The following septic system Anchorage: pipe materials are approved for use in installations in the Municipality of Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). e Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. INSPECTIONS~ Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. page 4 Construction practices 2 o The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL OESCR,FT,ON:/ . 8 1 3 5 7 8 14 17 19 20 OATE PERFORMED: ~-"~/~(]..~ownship, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES. AT WHAT O DEPTH? P E Data: ?'~- 17-~ SITE PLAN Depth t0 Water Alters_ Moniloring? Gross Net Depth to Net Reading Date Time Time Water Drop Illq6 ~- ~'&" -- I;R:IO ~3 ~,~ ~" ~'tfftt /~o ~o' ~ ~ ~/~" ~/~" 1~:~ I0 . ~ ~lg~' V~~ PERCOLATION RATE ~-'~ (minutes/inch) PERC HOLE DIAMETER ~ ~'~ TEST RUN BETWEEN ~'~ FTAND COMMENTS S & S ENGINEERING ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ~/~.:'"~ ~*~l~ ~,.,v~,, ~..,,~1~ ~,.,a,~ ~. ~ V ACCORDANCE WITH A[~N~UIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GREA 2 ANCHORAGE AREA BOR' ~.~1~/ Department of Environmental Quality '~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~Z~7~ ~)~J_~zT~-~ MAILING ADDRESS ~¢X /~0 ,~A PHONE LOCATION ~/~X/~/}~7('~. ~ I/~q~ LEGAL DESCRIPTION -...~t-~3'~3/~'~'1 ~-~-. SEPTIC TANK: ~)//~ ~'~- /0{0~/ NUMBER OF DISTANCE '~ FROM WELL MANUFACTURER ~.~A~ MATERIAL/)~- COMPARTMENTS INSIDE LENGTH INSIDE WIDTH ~ LIQUID DEPTH -- LIQUID CAPACITY /~'O GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER ~ OR WIDTH v/~ , LENGTH I~, DEPTH q LINING MATERIAL~I~m ~, CRIB SIZE: DIAMETER ~tDEPTH ~ / DISTANCE FROM: ~ TOTAL EFFECTIVE BUILDING FOUNDATION ~ r NEAREST LOT LINE~'Oz~- . WELL ABSORPTION AREA (WALL AREA) (~ ,~::' SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: ~-,$ ,5/'lol~l'q[ INSTALLED BY: ~ PIPE MATERIAL: (~ AJ],3T- IA,nfl DIAGRAM OF SYSTEM LOT SLOPE: REMA R Ks:Ora~U~ Form No, EQ-031 DATE ?/~/7¥ APBROVED N G.A.A.B. ,j GreaTEr ANCHORAGE Area BOROUGh SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION OF: SEPTIC TANK ~/ SEEPAGE PIT ~ DRAIN FIELD TYPE AND SIZE Of FACILITY TO BE SERVED . / / COMPLETION DATE ANTICIPATED OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL OUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYSTEM ~.5~///~ /7'/ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK O ]FOUNDATION TO SEEPAGE PiT ~ , DRAIN FIELD / WELL TO sePtiC TANK (/(:~%~9 / , DRAIN FIELD /' SEEPAGE PIT ALSO CONSIDER AREA WELLS, SEEPAGE PiT /~-~ .,~'D RA I N P']ELD CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET iNTO UND]STLIRBeD SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT ~ITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRiBeD SYSTEM IS IN ACCORDANCE WITH SAID CODE. 'R&M Civil Engineers ENGINEERING & GEOLOGIC^L CONSULTANTS 229 EAST 51st. AVE, -- P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090--35419 Geologists Land Surveyors JAMES W. ROONEY, P. E. MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. June 19, 1974 Mr. Richard Applegate Star Rt. A Box 1650 Anchorage, Alaska 99507 R & M No. 462043 RALPH R. MIGLIACClO Engineering GeologlsL Re: Test Hole and Soil Log Report for Sanitary System Dear Mr. Applegate: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your zequest of June 18, 1974 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lots 7 and 8 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 14.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. During excavation and the logging of test hole, there was no indicatiom of ground water below the immediate base of the test hole which was terminated at a depth of 14.0 feet. Since the soil was relatively dry, we do not feel that the water table is located within the upper few feet below the test hole base or to a depth of 17.0 feet. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do~ no~ hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. JWR:kd xc: GAAB ANCHORAGE FAIRgANKS JUNEAU TH-I 6-17-74 ORGANICS SILT, TRACE SAND (ML) 0.0~ 0-5' 1.0' SILT, SOME SAND & GRAVEL (ML) 2-5' GRAVELLY SAND, SOME SILT (SP) 8.OI SILT, TRACE SAND (ML) 10.0' GRAVELLY SAND TRACE SILT (SP) NO WATER TABLE 14.0' T.D. NOTE: Test hole excavated with tractor-mounted backhoe. RICHARD APPLEGATE PROPERTY LOG OF TEST HOLE Engineering ~ Geological Consultants Inc. ANCHORAGE, ALASKA AN~HORAG~ ~A~R~A"KS ALASKA JU.EAU '"~"~' '''~""~ . '~' -- ~ .'P'O'B°;4'1224 · 1310C InternationalAirport Road ·. Well Owher (907l 274-461 \ DRILLING LOG Use of Well f Location (address of: Township, Range, Section, if known; or distance main road L7:ES, m .... , .hu-d_.bru.n £u!:div, !l~th o££ Birch Size of casing · 'Static water level Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at 24 gallons per (~if) of drawdown from static level. .-- Date of completion -1_1 Cc% 7~ ' ~ ~,pth of Hole. ~ Z0~ feet Cased to ~ 202 feet "' ,/ll~i0 :ft. 0ibdV&) (below) land surface. Finish of well (check one) open end ( .X ); (minute) for ! - hours with WELL LOG Depth in feet from · ground surface Give details of formations penetrated, size of material, c~p~. ~u}ak~r~_c~n~ss, · · - 0 TO '": ('~' ~ .TO 12 ~ .TO, '~ .TO ' Ciltv Or, vsl _~L~K--TO 14~ ~ ~'~ TO )ff':f TO ~o~ TO .TO --STATE WILLIAM'A. ~GAtl, GOVEPJ{OR soUTHCENTRA£ REGIOIIAL OFFICE AJACKAY BLDG. 338 DENALI ~TR[ET ANCHORAGE 99501 interprefation of contained in Section I Conservation Waste e you had ownership at you intend to use, that this particular pplicable in your case. existing Borough ~all cases except . Cherry Envircnmental Engineer 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 ParceiI.D.# 015-142-64 HAA# HA930093 1. GENERAL INFORMATION Complete legaldescription Lots 7/8 Thunderbrush Subdivision Location (site address or directions) 11400 Thunderbrush Circle Property owner Richard Applegate Day phone 346-3101 Mailing address 11400 Thunderbrush Circle Anchorage, Alaska 99516 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Three (3) XXXXXXXX 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: XXXXXXX 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. 72-025 (Rev. 1/91) Front MOA ~21 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 & S Engineering Phone 694-2979 Address 17034 Eaqle River Loop Road, Suite 204, Eagle River 99577 Engineer's signature Date o DHHS SIGNATURE Approved for Disappr6ved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Additional Comments been completed and approy~. The upgrade of the on-site wastewater system has This property has a full approval. 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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. 79-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Sox 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~) ~_/-~' \ L~.~ - LOdl HAA# 1. GENERAL INFORMATION Complete legal description Lots #7 and #8 Thund~rbr~sh Subdivision Location (site address or directions) 11400 Thund~rbru~h Anchorag~, Alaska 99516 Property owner Mailing address Lending agency Mailing address Agent Address Richard Appl~gat~ Day phone 346-3101 11400 Thund~¢br~sh ¢ircl~ Anchorag~, AK 99516 Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: XXX · 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: 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. 72-025 (Rev. 1/91) Front MOA ~21 '>pOM s,~eeu!6ue leuo!ssejoJd eq~, u! suo!ss!tuo Jo sJoJJG Joj elq!suodseJ ].ou s! ebeJoqou¥ ~.o X~.!led!o!unl/4 eqJ. 'pGnss! S! eleoU!peo e eJoJeq ei. ep eZ~leUe Jo suo!l, oadsu! ~.onpuoo ].ou op SHHQ jo SGe~OldUU=I 's~.uemeJ!nbeJ Gi.e:lS pus teJepe,t u!epao/IJS!:leS o]. 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'uo!:!.oedsu! pus uo!:l, e6!lse^u! ~LU LUOJJ pus selU e6eJoqouv ,to ~].!led!o!unl/4 t.uo4 peu!e:~.qo uo!:~.eu~Jo:!.u! eq~. uo peseq :Is q:!. X,t!Je^ Jeq:pn~ I 'u!eJeq pm. eo!pu! eJn].on.qs Jo adX1 pus stuoo.,peq ,to Jequ~nu sql Jo~. e~enbape pus leUO!,toun~. 'e~.es s! LUe:IS,~S lesode!p .,e:leMe),se~ Jo/pus Xlddns Je),eM e],!s-uo sql ~.eqi. sMoqs uo!].eO!ldde le^oJddV ~.poq:l. nv qi. leeH s!q~. ~.o .~u ].eq:l X,tpe^ I 'Moleq UMOqS elep uoR. ep!le^ eq~, ,to se pus oleJeq pex!;4e leas 4~u Xq peuFPeo s¥ I:I::I::INIIDN::I ),8 NOI.LO:adSNI dO .LN::IIN:a/Y.LS 'g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /~T~ "~-~8 %/-~AJ~J'/,.i~,.~d Parcel I.D. A. WELL DAT~ Well type 'Ft/_tL)~¥'7~--'- Log present (~N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Wires properly protected ~_~N) AT INSPECTION ADEC water system number (~¢.T I1~ 1~l'7¢f Driller /~~~/~)/Z,//,Z,//U~- Casing height g.p.m. /od ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: (~/~) J}~-'r4EcT'E/¢ Other bacteria Collected by: ,~J;' ~ ~ ~f't-i~J]~=~l B. SEPTIC/HOLDING TANK DATA Date installed '-'¢__ (~_ "~L~ Tank size ~0(~ (~/~C Compartments Cleanouts ON) (~/~E Foundation cleanout (Y/~ fl'J'O Depression (Y/~ High water alarm (Y/(~ ~/~ Alarm tested (Y/~ /"')//~ Date of pumping ~,- ~-o -~'~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: Well(s) on lot /Od ~ on adjacent lots TO property line J~ Absorption field Surface water/drainage /(~) ~ Foundation ]~ Water main/service line 4~ ¢''/- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer J ~~ Manhole/AcCe~/(~ Vent (Y/N) "P~ J "Pump off" level at High water alarm level ~ ..-//Cycles tested Meets MOA electrical codes (Y/N) ~ Well on lot ~...J On adjacent lots Surface wa"~r.~..~ D. ABSORPTION FIELD DATA Date installed ~7--~- ~ff Soil rating Length )~, ' Width /~' ~ Gravel thickness c/ ~ Total absorption area ~0 Cleanouts present ~,J) Depression over field (Y/~__~ /~dO Date of adequacy test Results (pass/fail) g/~ ~:2/¢~IL for ~ Peroxide treatment (past 12 months) (Y~-~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot /(')(~ To building foundation On adjacent lots / '~'c~ ,,~ ?//3~System type Total depth bedrooms ~k.~O i f yes, g i ve ~,~,e .~:~4¢z~ On adjacent lots /~ ~ Property line ~0 ~ To existing or abandoned system on lot Cutbank ~/~ Water main/service Pine Surface water /00 '¢ Curtain drain ,J/J!d/"J E_ ~rgo~tg Driveway, parking/vehicle storage area ~-~¢ '/ E. ENGINEER'S CERTIFICATION ~ '~=(~U.~"T//~(r ~--16~0¢¢1°/'[4~-- /¢,,~.4o I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect~n. Signature Engineer's Name Date 5 & $ ENGINEERING 17034 Eaale River Loop Road Eagle River~ Alaska 99577 HAA Fee $ Date of Payment Receipt Number 72-026 {Rev 3/91) aack MOA 21 Waiver Fee: $ Date of Payment Receipt Number