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HomeMy WebLinkAboutCHICKADEE SLOPES TR A LT 1AChickadee Slopes Tract A Lot 1 A #015-231-83 Municipality of Anchorage Page r of Z 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 Permit Number: :�,w PID Number: Name: Wastewater System: ❑ New Upgrade Address l�C. fF�11��l.� 72J.� �5' ✓ ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trenc hallow Trench ❑Bed El Mound Ll Other LEGAL DESCRIPTION Soil Rating: ZGPD/S Total Depth from original grade: . Ft. Lot: / Block: Subdivision 1 � ,q- � (Q / S Depth to pipe bottom from original grpde: 2 Ft. Gravel depth beneath pipe / 2 Ft. Township: Range: Section: Fill added above original grade: / Gravel length: �{ / Ft. �c / Ft. WELL: El New El Upgrade Gravel width: Number of lines: Distancebetween lines: '7Q Ft. . Ft. Cl flcatioAn (Private. ,B,C): I r Jr 2 Total Depth: Ft. Cased To: FL Total absorption area: G vV SQ. Ft. Pipe material: raA5 T S t1`1 �O !�V Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft 1 Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft Ft. SEPARATION DISTANCES Septic �AJC4v ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: / Capacity in gallons: From Tank Field Station Tank Sewer Lines N v0 Well 3P- /14--!�+ Material Number of compartments: L-- Surface f� _ -- LIFT STATI Water Lot ��y .� Size in gallons: Manufacturer: Line 10 Foundation �6 �- � _ "Pump on" level at: ump off' level at: High water alarm at: Curtainr ?J � 914 --Pump Make & Electrical Inspections performed by: Drain Remarks: +- '�/ u �-�- BENCH MARK Gt��►�-' '���12T Location and Description: O� Gtr �L L CAS / ti i tA11_49� _t� 1�1' 6L ---U) S� ArI Assumed Elevation: ldZI-Ft ENGINEER'S SEAL .,�f4k . S S ENGINEERING a 17034 Eagle River Loo Road, ®e#Inspections performed by: 1st �� .� ky.� ��•_�: Eagle River, Alaska 99577 2nd /� -�� •--r,.- • • • 1' *ol6e�t R, a":a�far Department of Healt an Uma ices a pro al&57-ea p P �3 + No. I ' . •.,,- F Reviewed and approved by: ate: 72-013 (Rev. 9/91) MOA 25 Permit No. SW92041 1 Municipality of Anchorage Page 2 of 2 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 CHICKADEE SLOPES SUBDIVISION, 01523183 1 anal noccrintinn• TRACT A- I nT 1 PID No.: 1 co co FINAL GRADE 97.5' SULA710K NEW 95' 1500 GAL S.T. N.T.S. = Q. MT CO NEW 1500 GAL SEPTIC TANK !c0 p co 72-013 A (Rev. 9/91) MOA 25 o C01 FCO A 5 BDRM HOUSE 9 FINAL GRADE 86.9' WATER FOUND ENGINEER'S SEAL s / 0 Ko rt A. 81:q f: x 4 o. 1457 -f - 'z' A A B FCO 7.8' 23.5 C01 18.0 28.3 CO2 28.0 35.7 CO3 24.0 50.3 TRENCH C04 103.7 115.0 MT 56.4 72.0 ENGINEER'S SEAL s / 0 Ko rt A. 81:q f: x 4 o. 1457 -f - 'z' A 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 PERMIT NUMBER:SW920411 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:LESSLER JAMES E & OWNER ADDRESS:7135 HUFFMAN ROAD ANCHORAGE, AK 99516 PARCEL ID:01523183 LEGAL DESCRIPTION: CHICKADEE SLOPES TR A LOT SIZE: 37208 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 A LT 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:12/09/92 EXPIRATION DATE:12/09/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE TOTAL LENGTH OF THE DRAINFIELD MUST NOT BE LESS THAN 88 FEET. IF THE INTEGRITY OF THE EXISTING SEPTIC TANK IS ACCEPTABLE, IT WILL BE RELOCATED AS PROPOSED BY THE ENGINEER RECEIVED BY: �'�^ �. " DATE:- ISSUED ATE: ISSUED BY: DATE: Z Epson Co. Realtors P.O. Box 112342 Anchorage, Alaska 99511 December 8, 1992 To Whom It May Concern: 907-345-6644 Becki Powell, Associate Broker of The Simpson Co., Realtors, is the authorized agent of James & Elaine Lessler and is hereby granted permission to pick-up the MOA Conditional Approval for the septic system at 7135 Huffman Road or Chickadee Slopes Lot 1A Tr A. Dated/9 © q� Dated J �/ U 1q'Z_ �o .municipality of Anchorage t � i j Department of Health and Human Services 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 9, 1992 Roger Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot lA Tract A Chickadee Slopes S/D Waiver Request #WR920079, PID #015-231-83, HA920810 SW920411 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 2 feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sin rely, / Robert W. Robinson Civil Engineer On-site Services RWR/ljm i MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section WR#4K PIN Waiver Review Worksheet 015-231-83 HA# HA920810 Permit # c ot-n Date Received: Dec 1, 1992 Legal Description: Lot lA Tract A Chickadee Slopes Subdivision Engineer: Roger Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: James & Elaine Lessler Waiver Requested: Lot line waiver - 2 feet Criteria: 1. Geology: A. Water Table S. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: i List Conditions for Reasons for above; �J r /it* �i7C�(i1���71oi1 Date: Rec #: 24278 `L By: Amount: $ 70.00 Name of Reviewer Date Paid: 12-1-92 .i HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN m November 30, 1992 Mun.icipatity of Anchorage DEPARTMENT UE HEALTH AND HUMAN SERVICES 825 L Street P.U. Box 196650 Anchorage, Ataska 99519-6650 REFERENCE: Tract A, Lot 1A; Chickadee Stoped Subdivision ROBERT SHAFER, P E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 We request you .issue a condi.tionae. Heatth Authority Approvat and a pewit to upgrade the septic system serving the re6e&enced property. An adequacy teat was per6ormed on the existing system and the absorption capacity o6 the system was bound to be inadequate 6or a Give bedroom house. The system currently absorbs 300 to 400 gattons per day. There .is no e�6tuent daytighting onto the ground sur6ace. Two test hates were excavated and percotat.ion tests performed. The approximate toca.tion o4 the test hotel are shown on the attached ,site pian. We request a two boot property tine waiver .in ander 6or the proposed dra.in6ietd to be constructed in undisturbed soils. The property served as a graven pit at one time. It was excavated and back.6.cUed .in the batt o6 1978 (see attached soit4 togs). We do not anticipate any adverse e66ects on neighboting properti" by the .instattation ob the proposed septic system. 16 you have any questions, or require additional .information 6or your review, please contact us. Sin erety, 7j""' P V `j y'-6 ' JAMES P. WILLIAMS, C.ivit Engineer ER J. SHAFER, P.E. %tv chment 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 97-4 Pq b..yRese.aa• Ne.+.aa • d ROG R SHAPER yr No. 215 / C;g� PERFORMED FOR: ;��� FL40J& Lj.— TJE�'Z _ DATE PERFORMED: � 714ACT A I LOT 1 A ( � LEGAL DESCRIPTION: 77IL Kee cSUpg_g 'S1D Township, Range, Section: DEPTH T L4 ` —1 /1 N,�/l�- SLOPE SITE PLAN (FEET) l — '-L—uF - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ALL FILL — 026A-NIcS WOOD C-WPSf 12007 -St Slum?-( Cc.ay�y oaGArr[cs , r E7 /V / L7 �orAvkC MVCL 3.0• H WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After i Monitoring? W Date: Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS 1l VI QSUI7A:&S FCA 61U—S171C CAE' 7 G PERFORMED BY: S & S ENGINEERING I — CERTIFY THAT THIS TEST WAS PERFORMED IN 77034 Eagle River Loop Road No. 2 ` — ACCORDANCE WITH *j;�N��C�$�1�r jeUIDELINE I EFFECT ON THIS DATE. DATE: , \� o - 9Z- 72-008 (Rev. 4/85) e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST C t �y�iD1GIN • O ei —.7 'tt 1+•• c.•e••sssase s asi•• • ISO;* .e • e• •' 'e FER • rn ; ROGER J. HA 1 rrSss No. B 1$�4 PERFORMED FOR:–A�/VE �l�SSLtCit• DATE PERFORMED: "TjL LA's? i+ Gu? / A LEGAL DESCRIPTION: -CID Township, Range, Section: SLOPE SITE PLAN 2 0 3 Q O 4 - 5 6- 7 7 8 9 JI -J sl=-�— 10 12 13 14 15 16 17 18 19 sW/GW 7 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Yes O tom+ 10' P E Depth to Water After f Monitoring? 1— Date: Reading Date Gross Time Net Time Depth to Water Net Drop 0 SPA' :t0 S Will ADD 4 — a�. (</ .� 20 L� " PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER V C TEST RUN BETWEEN 2'5 FT AND �`� / FT COMMENTS SE:i ;< Crw16A^, Lyg& 11t�?4FieS �t+�iytEraalu7y PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle) River Loop Road No. 204 V ACCORDANCE WlL%41"J#IEfift"I")AL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Ap AW a N W ••o ,/ �1 /cy• I • • • ' W • • O • ss � �, e cc f ,� a a • 09 A •Q G • s ^' IaC Q � O N J n w cr p ;2:C) W�k10 Q � J z Q �� � O invNO sz Q � D CC f.' W Q- U Q O c h U)��N WOo Q(L) --Cr- ^� _ " N N II y j � h -6j (3 v J Lu to C) J Z Q WCC J 0 J W 3 N 3avysdn GVOY WN -4-404 v cc W m 3lV�S 1" = 40' SCALE HUFFMAN ROAD - 100'WELL UPGRADE am o \ � N V r i 0r ml D m G) •% 14%�� �.C�• C • •°m' ° o� � C" � . ° • ZD ��• �' y: n •'� d � NO .a � y cTTi ` W � a N � „ u (A r o I (3) O ` :•.'. C) �Z m 1 y � a \o C y � C\ � �10 n 2 v,rng 0 z UPGRADE am o \ � N V r i 0r ml D m G) •% 14%�� �.C�• C • •°m' ° o� � C" � . ° • ZD ��• �' y: n •'� d � O � � y cTTi ` Oyu N � „ u (A r o I (3) O ` rn� C) oco tJbo O C C\ N N •A \n �10 n v,rng z r"D rfl Z D y v ` X� 1 4= t � n S i �01o's• o •% 14%�� �.C�• C • •°m' ° o� � C" � . ° • ��• �' y: n •'� d dopow 0 Parcel I.D. 01.5-231-83 Municipality of Anchor " e On -Site Water and Wastewater Prog ' SIEP ? d 2016 (907)343-7904 . Certificate of On -Site Systems 1. GENERAL_ INFORMATION Expiration Date: _1 Z-2— 1� Complete legal description Chickadee Slopes, Tract A, Lot 1A Location (site address) 7135 Huffman Rd. Current Property owner(s) Charles & Janet Brower Day phone Mailing address PO Box 1009 Nome, AK 99762 Real Estate Agent Day phone (11 2. TYPE OF DWELLING: (] Single Family (w/wo ADLI) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: `5 nT 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual E Individual Water Storage ❑ Holding Tank ❑ Community Class , - Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for., COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ % o Waiver Fee $ Date of Payment C) �l 1 Date of Payment Receipt Number 61'i- 5 � Receipt Number COSA # MCI 610 (a I Waiver # 5. STATEMENT OF INSPECTION 13Y 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-SkeSystemApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) sale; fundfiortl 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 flies 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water levels 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE _ K System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 9/26/2016 bedrooms, with the following stipulations: 7 vow Original Certificate Date The Municipality of Anchorage Development 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory ,Arsenic Advisory Well Flow Advisory Other COSAblueeheet E :., 0 If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 ' Certificate of -On -Site Systems Approval Checklist Legal Description: Chickadee Slopes, -Tract A, Lot 1A Parcel ID: 015-231-83 A. WELL DATA Well type Private If A, B, -or C provide PWSID # Well Log (Y/N) Y Date completed 10/2611980 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 240 ft. Cased to 240 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/26/1980 9/19/2016 Static water level 30 ft 37 ft. Well production 2.0+ s.p.m. 6.0 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate. d l mg/L Arsenic ) ug/L Date of sample: 9/21/20L16 Collected by: PES. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/16/1993 Tank size 1,500 gal. Number of Compartments 22— Cleanouts (YIN) Y Foundation cleanout (Y /N) Y Depression Iover tank (Y/N) N High water alarm (YIN) N Date of pumping 9/16/2016 Pumper A+ Homes Services . C: ABSORPTION FIELD DATA 6/16/1993 2 2 1.2 GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ft or ft /bdrm) System type Length 88 ft. Width 5 ft. Gravel below pipe 2 ft Total depth: 4'4 •8, .: Eff. absorption area 628. ft? Monitoring tube Y Depression over field N Date of�ade4^py jest 9/'1'9/2016 Results (Pass/Fail) PASS For bedrooms Fluid depth in absorption field before test 7- Water 756 New depth 13 in. in. -- added gal. Elapsed Time: 120 min. Final fluid depth 7 in. Absorption rate >= 750+ g.p.d: Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOTTO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 2* I Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ _- Wells on adjacent lots 100+ F. COMMENTS *Waiver on File #WR920079 G. ENGINEER'S CERTIFICATION�j�.� I certify that I 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 Steven Pannone • .Mew* .*Pa mane 9/26/2016 -8149 .Date COSA canary sheet 2-6-15.doc I Lot 1-8 iD co O 00 N N In 0 0 0 M fJ LO N89054'35"W 114.90 Lot 2 �10' x 10' Utility Easement Chain link 8084M Lot 1-A �0 30.0 N89058'00"W 134.66 HUFFMAN ROAD _ — — EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. oWell O IUD Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying — adjacent thereto, that no improvements on the property tying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska _ this 17th day of March , 1989 FRED WALATKA & ASSOCIATES BE(907-248-1666) Engineers and Surveyors I I SCALE: 1 "= 40' N J OfU I N U o 00 p oW w `,.N\\\i` 4F . G Aq�� m .. ���F `'' o I 49th s l ,; � % I00 ((ff 00 /,moo .Fred Walatko s'F 3255 - S� " r I ����``�FfSSI0NA4 �`'►_ 30 Recertified 3-21-90 124.92 9.21-16vI/% AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT TRACT A. GHICKADFF SI_r)PFS RUBONSION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying — adjacent thereto, that no improvements on the property tying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska _ this 17th day of March , 1989 FRED WALATKA & ASSOCIATES BE(907-248-1666) Engineers and Surveyors 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. # 015 -231 - CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # HA920810 1. GENERAL INFORMATION Complete legal description Lot lA Tract A Chickadee Slopes Subdivision Location (site address or directions) 7135 Huffman Road, Anchorage, Alaska 99516 Property owner • James/Elaine Lessler Day phone 345-8566 Mailing address 7135 Huffman Road, Anchorage, Alaska 99516 Lending agency Mailing address Ari.mnf ZY A AA rocs Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Five (5) 3. TYPE OF WATER SUPPLY: Individual well ------- Community well Public water Day phone Day phone 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 xxxxxxxx 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 (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 S & S Engineering Phone 694-2979 Address 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Engineer's signature 6. D S SIGNATURE Approved for bedrooms. By: Disapproved. Conditional approval for /\/6A/� Additional Comments Date bedrooms, with the following stipulations: 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 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. 72-025 (Rev. 1/91) Back MOA #21 June 22, 1993 HEALTH AUTHORITY Municipality of Anchorage APPROVALS epartment of Health and Human Services .0. Box 196650 nchorage, Alaska 99519 SEWER & WATER MAIN EXTENSIONS ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 RECEIVED JUN 2 2 1993 Municipality of Anchorage Dept. Health & Human Services FERENCE: Chickadee Slopes Subdivision, Tract A, Lot 1A SEWER & WATER INSPECTION Conditional Health Authority Approval (HAA) was issued on December 8, 1992, for the referenced property. All work ENGINEERING STUDIES required for the conditional HAA has been completed. AND REPORTS Attached is the On-site Wastewater Disposal System and/or Well Inspection Report for your approval. We request you issue a final Health Authority Approval for the referenced WELL INSPECTION & FLOW TEST property. If you have any questions or require any additional information, please contact us. SITE PLANS _/__ / ROAD DESIGN A. Shafer, P.E. SOIL TEST S/LSU/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE 0 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 NA -QillJ d PHONE NEW UPGRADE MAILING ADDRE! LEGAL DESCRIPTION L0717 —A T—V'—r- h LOCATION NO. OF BEDROOMS UY DISTANCE TO: Well �O Absorption are Dwelling /O PERMIT N �` QQ s a Q Manufacturer Materi No. of compartmep2& gallons Liq. cy p i CJ IF HOMEMADE: Inside length Width Liquid depth Y Jaz DISTANCE TO: Well Dwelling PERMIT NO. 2 Z < Manufacturer Material Liquid capacity in gallons 0 i DISTANCE TO:LU Well / Foundation Nearest lot line PERMIT NO. J LL Z Z w No. of lines Lef each line Total Ie g o li es Trench id inches Distance betwee lire F p Top of tile to finish grade f Material beneath tile inchesnd Total effecti a absorption area w r, Length Width Depth PERMIT NO. H CL wa Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS O � _ y f"If' SOIL TEST RATING A Is INSTALLER � N REMARKS L APPR D DATE LEGAL 72-013 (Wv. 3/78) (/ PERMIT NO. M U 1 I I L. I -r ke r F" F4"I= F -r F=1 C3 E l� DEPARTMENT U, HEALTH AND ENVIRONMENTAL r-mOTECTION c 825 ' L ° STREET, ANCHORAGE, AK. 99501 - d� 264-x}720 � L 0rJ t)LU S WELL, F4NE> C -3"—:E5 I TE -EWE1- F= EFZM I T C 800253 ? APPLICANT DENNIS BOYD LOCATION UPPER HUFFMAN LEGAL TRT. A SLOPES TYPE OF SOIL ABSORPTION SYSTEM IS: MAXIMUM NUMBER OF BEDROOMS = 5 c 1,927S. R. A. 1622-K ANCH J \j. LOT SIZE 100000 SQUARET- TRENCH S�Q l0 SOIL RATING (SQ FT/BR 7 = THE REQUIRED SIZE OF THE SOIL ABSOR lIO SYSTEM IS: L>EF='TH= 1rTH= C3FRf=1 V E: L_ E>EF"TH= 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 CIN 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). FZE(;4U I FZE:E> :SEF='T I r TF4t`-.IK !S I ;Z_E= 3 1510C3 (3f:4L_L_C:l":S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWCDI <;2 > I I C:,"n-> FiRE FZEQU I FZEL> --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 156 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"EFRM I T aXf=' I FZE� E>a0aME3aFR X11 1.soE3:l3 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS R"ODELED TO INCLUDE MORE THAN 5 BEDROOMS. SIGNED: ISSUED BY-- . .r (I, -----------DATE-- --�� Ci _I " LvLw!7 . f I f_E t•4 I f I c_-: F -i L_ I -T "-e RZI F= t=i t -a I:z: t--70 E a 9.a f= DEF°NFRT h1ENT HEALTH AND ENVIRONMENTAL :OTEGTION 825 K' STREET, ANCHORAGE, AK. 99501 264-472► L •i E i_._ l.._ 1=i t'-� E? R..a f �.l — � I T E : =1 E !-�J f= f� f=' E fes' tai I �i" PERMIT NO. C 8002.33 i APPLICANT DENNIS BOYD S.R.A. 1622-K ANCH 344-9277 LOCATION UPPER HUFFMAN LEGAL TRT. A CH1CAREE SLOPES LOT SIZE 10©#a0 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM NUMBER OF PEDROOMS = 5 SOIL RATING CSO t= T/BR i = 250 THE PEOUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: -E;R t_ E t R�� T H == :J_ i�j: 1 #7a fR n'-.- E L G" E F —r"— IS THE LENGTH DIMENSION I S THE LENGTH ( I N FEET) OF THE TRENCH OR GRAINFIELD. THE DEPTH OF R TRENCH 2FR PI IS THE DIS HFA ; EEN THE SURFACE OF THE GROUND AND THE E OTTOM E EXCAVATION IN FEET}. THERE IS NO SET WIDTH F TRENCHES. THE GRAVEL DEPTH IS T MINIMUM DEPTH OF RAVEL BE WEEN THE OUTFALL PIPE AND THE BOTTOM OF T EXCAVAT I Ot CIN FEET. f� E C:. . Ert!E5;ON5IGILI T H •thy -.= = - cry C3Fl L_ L_ C3 r i � PERMIT APDL_ I t� AF HHS IGILI Y TO INFORM THI- DEPARTMENT DURING THE iP;STNLLRTI►�N IPJSF'ECTI +tJELLS -DJrfC:ENT TO T S FF:GFEP.TY ANQ THE P�J�.�HBER OF RESIDENC-ES LL WIL SERVE.c ��E RD T I Q t'^•I '� 1=� E=� f= �: � r_7! i1 I f� F+ C>BACKFILLING O1aNY SY T FINAL INSPE ION AND APPEt'OVAL BY THIS DEPART?'LENT WI L BE SU OSECUT I ON. MINIMUM DISTANCE BETH EN A EJVLt� AND ANY N -SITE SEWAGE DISPOSAL SYSTEM IS 10►3 FEET FOR A FR AT WELL/F' TO �►3 FEET FF?►�E4 A PUBLIC WELL DEPENDING UPON THE T'r'F'E OF F'�_ L I EdE MINIMUM D I S T ANS= E FROP PR WETO A PRIVATE SEWER LINE I 25 FEET AND TO A t-Gf-1H N I TY EWER LINE .WELL LOGS ORE REOUIRED ANDETURNED TO THE DEFT=iRTMENT WITHIN 30 DAYS +F THE WELL G��NPLETION. OTHEED REQUIF:EMENTS MAY AF'FI F I CATIONS AMD +�+_NSTRUCTION DIAGRAMS ARE tVAILABLE TCS INSURE PROPERTION. F=' Fes. it: f.,1 I -1- C: �: F-= I F=� [= •=, G,. E: (--1 _7 1-i E= r=- F< _l _ _ e3 I CERTIFY THAT V: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 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 REOU I PE ENLARGEMENT IF THE I DENCE I EMODELED TO INCLUDE MORE THAN 5 EEDROOMS. I RPPL I CANT DE14N I S GO`r`D 61, ____ V4. 0 3779 A67 J2--� ZN ...... ....... SOILS LOG Zh LITY OF ANCHORAGE p PERCOLA710N H AND ENVIRONMENTAL PROTECTION TEST / ` chorage, Alaska 99602 276-2221 40- SOILS ons' -PERCOLATION TEST ry. ` PERFOR�dEO'FOR: DATE PERFORMED: _e , t.EGAL DESCRIPTION; TrQeT f4d, SLOPE SITE PLAN DEPT" t ) r IFEE ) ML 66 ML' , a. i 2 brrncvi7 4t Z) - - - - - ( F , ' h - 4M .0 6r'ow silly sandy T -12 1M' soy +1. t i ' J Q, /glosx t E �9rswe//y sood (W 2) 7PSit/_ (J l • �y fo brDwr► �` r- 5� SP c/os� 6�dded cogrsc _ l _ _ sand w"d S 4Ady yMf•t /. n ! I ! "Z t# �: 1~. .r,ed. f 4� #/�_�p ` 1 -- k.. �,on- J^ayrave/ _ tom+ r�bO -A'6 _ wise s%/ a zj wi J S < _. 'n Rae clean-ry�,�v_ ax 1 WAS GROUND WATER S yp x ENCOUNTERED? LOtO%' - y''�� ;.�%CVE j �` `, t r- r, Pik floor E _ -�sf y \ • 2 - wet.__ _.L� "'��:. IF T AT - / YES, A WH � DEPTH? i t � t3 be siMy Y v w/ tt 5 fr x i t - Gross Net Depth to Reading Date , Time Time Water. ri �• ..i tet: PERCOLATION RATE (minuteslinch) i -4 ` TES RUN BETWEEN FT AND FT >'z ;' +Connwi IVTs; coni �7ir o /qo Ae 6vdmO? A17 &,Odi -4ek gre4,S .�/pue.-; i 01qq 1�O /n c0 011.' C q r r rprovi G o •► o s /2 PEIFOIaMED S CERTIFIED BY: y�Or 4>< �e4s7� /8 117�OS 16' O/fOUJ �•! S 4rlO� COI7Sm i 4 s7.�;� �z=ooe(7176) /f DL Q4a/. /l/o. /942 r - x I � �f� ZIJ�C��- ���� �° � i ��Z� /�v CIA-, SOILS LOG LEGAL OUSCHWOLW , L iff IOTECT?Oft 31 sm&Aw�rw s =A -Z silt, ff#7 11 I:? I- - - I -v �, '40je 13 -14 - AwIrl _14ellc 4::7/60 M,SGfMm>wATER i,m",.mumrcRco? W VF$, Ar WHAT IWPIW Read" Date t An/lAso - FT A /0011 CERn"Co s7.- 44 17 4UM IY17Q 49 D"h low Com±Iftlow r L Read" Date t An/lAso - FT A /0011 CERn"Co s7.- 44 17 4UM IY17Q 49 D"h low Com±Iftlow r .W SOILS LOG vIUNICIPALITY OF ANCHORAGE ' \\ 1/a DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 665:x Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: '0&/2n1_? '50 yd DATE PERFORMED: C�%� ! o /780 LEGAL DESCRIPTION: ZO/ SLOP SITE PLAN t FDEPTH�u AIL loam --' I ' - brown c'ldwr7 00rvd i 1 - � G'' minty x s 47 W- }--} 4 seepsr 1 �— t -----+-}-- -on .si/l c�nd vr°/ 6 y s y yrs i *i//e� tuiii j - -- - - �yrrw�//y calarse s4nd. `-- - + - + ------- _4 -� -- /�ii��ar� 10 - - - - WAS GROUND WATER S_ 11 ENCOUNTERED? I �I Y �j�,,� D P 12 ---- �- �jOT7JDVl1 T /oAr IF YES, AT WHAT E }. ._ DEPTH? 13- 14- 15- 16- 14-, 3 145 ,6 l¢, 17 eOLfJI'Yae7 18 /4. 19 20 PERCOLATION RATE ¢ 20 (minutes/inch) TEST�RUN BETWEE ^ FT AND _�_ FT Reading Date Gross Time AA I Net Time' m,A Depth to Water A. Net Drop /oN&O S cw 7�/Z b.4Z //.' ? J/ 3S S. / /o S to / ss 6, 00. COMMENTS PERFORMED 72 008 (7/76) CERTIFIED BY: C �a bf w 4S! mamp Al lilEwZ l SIX INCH a opt s } * C►i/'!' TO THK CVTH OF 240 ace t. DRILLED A7 IM Orl p0m• PROPERTY 01AiliER�"` x T LOCATION OF WRt.I. S SeLC�R S� IO 12 s, DRILLER Blot& ALO lt70t�.I. Ro S#A ua Go cNt a WELL LOG: QM-MSp� ��� J�,� Dt Q �� p,.,. ' : a &W&(JdW*#A4 OF ANCHORAGE yQ vY '^"„ice CDT ■ ENVIRONME ON v 0--••--121 T" 12----19' Cowve t and ctay:. CJ Oil 17 '1980 �9----37• roc. RECEIVED 37---401 BotvLm .nock. 40----58' Bedrock. 1/2 goat. pst &&u&tU p derc.>GLon. 58---960' Buttock.. A 4ediawitorty. •cock. lncae"e 4A wztec V.UU to 3/4 SrPRo 960--200' Scd4wLta ty tock W h tA4A o"" 4 fA&w t m &Ock- Pkoduc t rL t.o 1�PRl. 200--240' Wet Ipkan&t" and po•UW s ,teck *k6V4A¢ WL UCAteaac Oft yd,& d tto be tt" .than TWO BAR to to t wZ#A 210 ;e" of. oat" ataAd Af 4A ca otn#- 1.6 gat4 pe4 {.t. 3/4 ko e S hap 4MU be 4natatAed 10 to 15 {mat W bottom - 3000 gaoU o.. int -cot opt betU4 p" U Ao" 4U& ,Amu .f. Z } Coat o j� A%-LU4mqs 120.00 p X 240 meet.: 14800.00 COST INCLUDES ALL. LABOR AND [YtATZRIAL !OR COMPL IMON OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRIL UNG WORKS FOR THE SUM OF 54800.00 _ THANK YOU VERY MUCH. OERNIE,,CLAUS OF RAMPART DRIL G WORKS DATE 1980 with ORWICP CMAIME O W ?Vt% PEI MONTH WALL K tD ON rAST DUE ACCOUNTS: " 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. # HAA # O E�9 2 (CJII C) 1. GENERAL INFORMATION Complete legal description Tanot A.I nt 1 Chickadee Kfn.poA cl,hdi ,,iAin Location (site address or directions) 7135 Hu66man Road, Anchonaae, Atasiza .995)6 Property owner James and Etaine Lazte'r' Day phone 345-8566 Mailing address 7135 Hujman, Anchorage Ata,6ka `9516 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 5 XXX Day phone Day phone 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 (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 furtherverify 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 0 7034 Eagle River Loop Road No. 20.4 Address Eagle River, Alaska 99577 Engineer's signature Date — �-�►2 Requut Heatth Authoni..ty Appnovat under the condition that the eepti.c .6y6tem iz to be upgraded in the 6p&i.ng ob 1993. 6. DHHS SIGNATURE Approved for bedrooms. s,,•' 741 Disapproved. \ Conditional approval for `� bedrooms, with the following stipulations: Additional Comments' Cti"1lf— fir, CHCS" 'L�i%� ��T i Bye'- 1IITIC 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 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. 72-025(Fev.1/91) Back MOA#21 Municipality of Anchorage ArML Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST '772Ac-r A Legal Description: ` ffKK4p Q-,�)Pa �y- L -o7 I A Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 104 Log present ION) Date completed �� 22):k -8d DrillerDk"qqa-? UZ![.cl mrs Total depth yy Cased to -I o Casing height Sanitary seal&N) P- c Wires properly protected 6)N) Date of test Static water level Well flow Pump level FROM WELL LOG r P, s7• g.p.m. (A Jr— SEPARATION SEPARATION DISTANCES FROM WELL TO: �S AT INSPECTION I-6-�2 g'I G t Septic/holding tank on lot ) 86 'f ; On adjacent lots 00"/ i Absorption field on lot ��, ; On adjacent lots Public sewer main Public sewer manhole/cleanout i y Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform — Nitrate C) - ),?, Other bacteria Date of sample: - _ Z Collected by: J� S FNGtNeEata B. SEPTIC/HOLDING TANK DATA Date installed 10 - Xz - eO Tank size /S60 GAL Compartments —1 w6 Cleanouts (9N) High water alarm (Y,4 Date of pumping d�Tr S,PE Foundation cleanout WN) DwEc-(-1w� Depression (Y/ ) Alarm tested (Y/6 Pumper A -i - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot )96' On adjacent lots 100 Foundation G�?o To property line (r,,>( + Absorption field dab Y Water main/service line- Surface ineyU '� NSW O�.iG 'T�o Surface water/drainage �� t 5� J)P412,aor- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access I at "Pump off" level at SEPARATION DISTANeE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Cycles tested Surface water Date installed �z-pd Soil rating System type 745�/V 150';y5'+10 i © t Length = 139' Width 3 Gravel thickness y Total depth U Total absorption area Jja� -SF Cleanouts present (Y/6 / ��� Depression over field (Y/to % LI Date of adequacy test il Results (pass/f ) ���G //// for bedrooms Peroxide treatment (past 12 months) (Y/O 10T k1AkvN If yes, give date MIX SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots IQ(JProperty line— To I To building foundation i�d r To existing or abandoned system on lot Z✓/� On adjacent lots a2 s _Cutbank Water main/service line ZS f Surface water ! Q� �� Driveway, parking/vehicle storage area Curtain drain l/ FL !•�/� E. ENGINEER'S CERTIFICATION '- A LMOR M /�VRom kO - Z/00 G PP. AFP�0-✓1-L JzeaUesr6b. /certify that I have checked, verified, or conformed to all MDA and HAA guidelines in ef+=�qV�*e&e of this inspection. wNil S & S ENGINEERING �r rsj�.• •• ��.,,�1, Signature '®34 Eagle River Loop Road No. 304 i ,* r4�� q Eagle River, Alaska 99577 e • Q.*•4404•».04. M.»lrr�s. Engineer's Name i 0.0.00 , A . 1I Date ROG NoJBAFER� 215 ;1111% '*J90FESSi'0* F •••»00.0 P� � HAA Fee $ t L 0 - Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ ')u,CK> Date of Payment i a - \ - C) Z Receipt Number`�� CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. �wsow�roRr 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 60397 Chemlab Ref.# 92.6168 Sample # 5 Matrix: WATER Client Sample ID TRACT A LIA CHICKADEE SLOPES Client Name :S & S ENGINEERING PWSID UA Client Acct :SNSENGP Collected NOV 4 92 ! 15:35 hrs. BPO# PO# :NONE RECEIVED Received NOV 5 92 ! 13:48 hrs. Req# : Preserved with : AS REQUIRED Ordered By :R. SHAPER Analysis Completed NOV 6 92 Send Reports to: Laboratory Supervisor STEPHEN C. EDE 1)S & S ENGINEERING Released By 2) .................. Parameter Parameter Results Units Method Allowable Limits ---- ------------------------------------------------------------------------------------------------------------------------------- NITRkT1-N 0.28 mg/l EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BT: J.W. Remarks: ------------------------------•-------------------------------- 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than OWNSGS Member of the SGS Group (Socidte Gdnerale de Surveillance) J COMM) C, Drinki LL TESTING & ENGINEERING CO. AK DIV CAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 9018. Analysis Report for Total Coliform Bacteria TO BE COMPLETED WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be: ��± Satisfactory Name S & S E�I P �TO3,q Earle Rive 4.oeP R°:dT�Idr ❑Unsatisfactory Mew AAWOU EWe RIWWw,❑ Sample too long in transit; sample should not be over 30 hours old at examination car sup. zoowe to indicate reliable results. Please send new sample via special delivery mail. i SAMPLE DATE: LwT ® Mo. Day Year Date Received I ( 1,5192-, 3. SAMPLE TYPE: Time Received -134 Routine Analytical Method: Membrane Filter ❑ Check Sample (for routine sample with lab ref. no. l ❑ Treated Water ❑ Spial Purpose ❑Untreated Water • No. of colonies/100 mi. SAMPLE - Time Collected No. LOCATION Collected By Lab Ref. No. Result* Analyst rT cLST , / Am �P r 92.6168 2 [� KA-'c�F �YJ�P �n` 'f U• m 3 t I m 4 5� m A , C .E . C . (� BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count O Coilform/100 ml BEFORE verification: LSB BGB Fecal Collform Confirmation COLLECTING SAMPLE Final Membrane Filter R Its c Colifornd100 ml Reported By Date �( "� _ / TNTC = Too Numerous To Count Time: /,53 C� X.M. p.m. OB = Other Bacteria PART ONE OF Two ����5 Member of the REMAINDER TO FOLLOW G07wf O7^ hloAr See 4/60 Aryl dal -dal /¢, 19781 BOk/h'acii'! i ,.'.'AS GROUND WATER I NCOUNTr RFD' ,F VFS, AT WHAT UCP1H7 • QUNICIPALITY OF ANCHORAGE X11 SOILS LOG . •;.,>L • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION "• Pa.uh f.45"• Andsor.grt• Akita 49502 276?7i1 TEST --T•- SOILS LOG — PERCOLATION TEST •,�;•, ;;.. PERFORMED run. _-J_..-�{/4✓ DATE PERFORME.D:�T. LEGAL DCSCRIPTION __4 LQ/'�iG�T f� �%J/�Qd�C ��Q aS ' , • 0. ►1u ` or - org4nic S and brclwn ; SITE PLAN 1 - - O /otarrJ--�-- own / tSro�.vri 3r•7 M/ 917srC� i G ~ iniify3 I 4. pow - i �o a 4 s 7 off' sendf, 9ns�//fir :. .. ; .. �---i - •—�---�-- i --�. � i ' e erA1r + A aid. ' • r • - -� . { _ t____l-_ G07wf O7^ hloAr See 4/60 Aryl dal -dal /¢, 19781 BOk/h'acii'! i ,.'.'AS GROUND WATER I NCOUNTr RFD' ,F VFS, AT WHAT UCP1H7 --- Date G'Oss T,•rn Net itme Depth to W,:ter • Not Drop --T•- O own / O• s O �o a --- Date G'Oss T,•rn Net itme Depth to W,:ter • Not Drop own / O• s O �o a L_.J V1 PCOI ATIO'1 ITATE � a 1-- utes "chl n J TC^Ts ly I' TY/EFN 1 AND FT coa•►�F'i-�_ �G.CGO/!!I'r?t':'I'��J . /'>�fl!!� _D M Z,ZO it1%rl� �i�ts_ • PERFc,r Mr. D _ -- . C.M.TIf It 1) AV ( ------ "T �UNIC LITY OF ANCHORAGE O R ENT OF ALTH AIJO ENVIRONMENTAL PROTECTION P 64% Anckwa". Alak. 119M 27&2121 SOILS LOG - PERCOLATION TEST ►Ef1ipRMEO FOR:, LEGAL DESCRIPTION: Tim • .' ocPTM � {* ,�� M �. fiEE Tkkm t ML ! AfL "• ' •• 1 ' � 3 At V SM 'e. '.•r� AIL, . 4P '.,•,.,3,yT•jiy w� '� r 4w bw Jr — DATE FEW SLOPE aPO �rvvs/i~��i f... ti/�j► (I/): Sn.y fb Opwwn 4ose 64rddsd co4rse ; '_y11,. s..,d ...rd A.r.dr $010' sl. M (e2) ' �ifn y c/wws .wed. /) • si> : oafs ise ONC C�Zi • �nwy so.�dr si/�; � ; T- -'roy t/awpv r WAS GROUND WATER ENCOUNTERED) // IF VES. AT WHAT CS A6 DEPTH? r. io COMMENTS .CY IVA W4, Aioj on do'd PEA OR ED M . • >: f>DA 17/761'0 • 14 pit MEM ems* i I I ; -' R.adlrq Dots Tim DIP* Is. � {* ,�� M , . Tkkm watem •M ++O�j�j1«� j w w '.,•,.,3,yT•jiy w� '� r PERCOLATION RATE TEST RUN BETWEEN .0v/P;Fo Or _/Gb y % � e� - ERTIFIfer: �t�1) -E FT AND i.. 4oe loose opt_ .:: ,..-. - r •n�H�riwe1R'y'•MrM'IfMw'!�, .l rt r.• 441 i 'S ! ' _ .... _ _ . -� �.. .- -+�w� r vr� rr�ra r r ry t AS.�7p{�� '-_",�►.._. , MUNICIPALITY OF ANCHORAGE • '� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # iA Q21Q � 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) k Location (ad,44s's oC 'rectlgnS? IL ,a....�,K, .sem- •a;"�•r (b) Property ovvneiE, -�4 ."t�" '� Telephone: (home) Mailing Addresmssh. . (c) Lending Institution ''�Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: 1ecs .2 ?:Z ss :rte. 2. TYPE OF RESIDENCE Single -Family Number of bedrooms sa Business 3. WATER SUPPLY Individual Wellr1 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 , C`` -s -f"''�- ff Telephone 02-2�2_1 �_jjf Address Date �z 17_�Y yo Ir.1% vi % AV ;•4 /. ••• •.•• •.�••� �Ey f• 0•••• •..•..•.•.0• at • RECD, M. . I •G F : Is �i DHHS APPROVAL Approved for bedrooms by -"�Date Approved X Disapproved Conditional Terms of Conditional Approval The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 "NOVPG� MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval J ..• �r��P�S�Rv,��s • CHECKLIST - FEBRUARY 19) 84 343-4744 Legal Description: /fzG-1117 = of/A C'h ii6_We_'S/oX! A. WELL Well Classification r, V.2 rC If A, B, C, D.E.C. Approved (Y/N) Well Log Present &4) Date Completed Yield 1 J1�4,ti Total Depths Cased to Depth of Grouting -Al I/A Static Water Level 33 Pump Set At Casing Height Above Ground 17' Sanitary Seal on Casing %) — Electrical Wiring in Conduit yqN) Depression Around Wellhead (YO SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /OOf ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /8.0 * i ;On Adjoining Lots 160-t / To Nearest Public Sewer Line —'J/� To Nearest Public Sewer Cleanout/Manhole /4,V-4 To Nearest Sewer Service Line on Lot 2!'t Water Sample Collected by / •fie id ; Date efV- Z Water Sample Test Results &t f - 0 IV, A -?Yr`• /,�`�(2 Comments B. SEPTIC/HOLDING TANK DATA Date Installed o 22 Size /SSV No. of Compartments Standpipes 6?N) Air -tight Caps t%) Z- Foundation Cleanout (Y, I�j Depression over Tank (Y/ Date Last Pumped b3 �3//R�i _1e 5-220 Pumping/Maigteriance Contact on File (Y/N) for 6 /A Holding l'arik Wiglas �7Alarm (Y/N) A/,Z,4 Temporary Holding Tank Permit.(Y/N) �✓/ /.� SEPARATI4N'09AN _CE*MSEPTIC/HOLDING TANK: To Water-Supply-WeM•- - Ape so, To Building Foundation iV Y' / To Property Lime, 00,/o It, / To Disposal Field 16 �e To Atet;,Nlairl/BAivi k L � ,�� 02-!'�` To Streat, �an�i,:l,ke or Major Drainage Course/oo Comments Am,.re ��`f/`i.7.�s�� j� 6� s�ii"&,e ooi..J.4, 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ZZo Type of System Design 1�7 4 Date Installed rO�Z Z,%8� Length of Field " f q�'DlY-? = /3g � Width of Field Depth of Field g` Gravel Bed Thickness Y Square Feet of Absortion Area //0 C) Statndpipes Present (5N) Depression over Field (Y19 Date of Last Adequacy Test Results of Last Adequacy Test ���•�� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line To Building Foundation fD f To Existing or Abandoned System on Lot tiZa ; On Adjoining Lots !fit f To Water Main/Service Line z��` To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ?/o To Driveway, Parking Area, or Vehicle Storage Area e:! Comments Zh RAZE Wa /O rSC As 20d, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Cod Comments Dimensions nManhole/Ae6�ss (Y/N)mD Off" Level at **Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, ver inspection. Signed — Company Date S y 1ZS -15;;�o Vent(Y/N) Pumping Cycles during Adequacy Test. or conformed to all MOA and HAA guideli afre; ate of this se • • � f ".4 " "• �in s Seal MOA No. Receipt No. Receipt No. _ Date of Payment Waiver Fee: $ Amount: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 �, •. GE - 2251 0, 'el CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 LABORATORIES FEDERAL TAX ID # 92-0040"0 k l i L 1� �4. f t' 31 ek a " .4 LL J �l 7N -i;: 0) -1 d p 1 4, AN 9c ,T -OKFcAlp ILI ""4 tq A 2 QU f, h D Oidecel i,y llt 2-� 9c 1) to ILI, ..,,.....:<...: . . . . . . . . . . «n«.>.....,.,.......... . . . . . la t uc t met hcw i,, al t F ---------- '�h" e of flip. U, 4 DO `:D- CHEMICAL & GEOLOGICAL LARORA TORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 5633 B Street _ Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# Anal sis shows this Water SAMPLE to be: /<PRIVATE ER SYSTEM Y i' Name Phone No. ��'� ��' 43'3 MaTing Addres city State SAMPLE DATE: Mo. Day Year Zip Code SAMPLE TYPE: Routine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 X1,9 i1A _ 0L 2 3� Y Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /- 12 *- i0 Time Received I � i'�s Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst 9300EU ryt R- 4 m m BACTERIOLOGICAL WATER ANALYSIS RECORD 1 READ INSTRUCTIONS Membrane Filter. Direct County Collform/100mt BEFORE COLLECTING SAMPLE Verification: LTB BGB Final Membrane Filter Results ` Collform/100ml Reported Byyr�--Lir--- Date Time: 1500 a.m. p.m. TNTC = Too Numberous To Count PART ONE OF TWO OB = Other Bacteria REMAINDER TO FOLLOW Tom Fink, Mayor Municipality of Anchorage Department of Health and Human Services1rt5 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 December 22, 1989 Bobbie Wirth Alaska Housing Finance Corporation 235 West 8th Avenue Anchorage, Alaska 99501 Re: Health Authority Number HA890131, Tract A Lot lA Chickadee Slopes Subdivision, Parcel Identification Number 01523183 Dear Ms. Wirth: It has recently come to our attention that a seven (7) bedroom home occupies the referenced property. The Health Authority Approval application received April 11, 1989 by this office stated the home contained four (4) bedrooms and the subsequent approval was for the same. As a result of this finding, the referenced Health Authority Approval is rescinded. If you have any que tions, Sin erely, L� J n Smith, P.E., Manager -Site Services Program please contact me at 343-4744. cc: Linda Smith, Vista Real Estate Company Leroy C. Reid, Phd., P.E., Alaska Environmental Control Services Daniel J. Roth, Civil Engineer, M.O.A. MUNICIPALITY OF ANCHORAGE • ..� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES r' 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # , � � - � - HAA # t- '�' C' 1 1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) t4j Gl�����ao%� Slues �,21V Q 3 Lt/ 23 Loc tieti'ie'ddress or.8* ctions) i o S4 777 ................ fir.- /_ 1 (b) Property,9\% .g. y LC , Telephone : (home) Businessa 7 -7 Mailing Address2 3 w �K (c) Lending Institution Mailing Address (d) Real Estate Company and Agent V,'S4t Address ?000 C f f T- Jk ITE" MQ/ Telephone YTT- ?6zo j'± 2 -d 4(o Telephone (e) Mail the HAA to the following address: (or check here fP1, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE f f Single -Family [X Number of bedrooms _( 3. WATER SUPPLY Individual Well t Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public O Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7188) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 . G C • S Telephone Address /4ia bo% 33 ¢ 411 Date L < `IURWIW � ..- 1IL w.-+ 6. DHHS APPROVAL Approved for bedrooms by Date 4 Approved— Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) &OFTYLL'' AN�1� t Authority Approval (HAA) ALSE6cvEC Sib 343-4744 - FEBRUARY 1984 343-4744 I APS? I 1 1989 Legal Description: A. WELL DATA RECEIVED Well Classification( If A, B, C, D.E.C. Approved (Y/N) Well Log Present OI) Date Completed Yield Total Depth -'2 L10- Cased to Depth of Grouting Static Water Level 1?2 f Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) '4' Sanitary Seal on Casing ON) SEPARATION DISTANCES FROM WELL: Depression Around Wellhead (Yo To Septic/Holding Tank on Lot %00''� ; On Adjoining Lots &V "74 - To Nearest Edge of Absorption Field on Lot 1690 ; On Adjoining Lots l -'W To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole XAX To Nearest Sewer Service L' Lot Water Sample Collected by &,(--_ '5., I?ALhV Date `3 - Water Sample Test Results Be T J/r6 O Comments Aka-, JimJ 7Z!57 J._Z� ' B. SEPTIC/HOLDING TANK DATA Date Installed Size 406) G,U.No. of Compartments Standpipes (DN) Air -tight CapsONN) Foundation Cleanout (Y& Depression over Tank (Y/6 Date Last Pumped '-*'-. ✓( 2' " -k-MM-2 Pumping/Maintenance Contact on File (Y/N) ; for Holding Ti %4rarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPAFJA. tSl TM SEPTIC/HOLDING TANK: PP To tQr�u I ft To Building Foundation �y 40. -0904.90 To P#operty Line To Disposal Field To Water Main/S6tvite-Eine. / f To Stream, Frond, Lake,or !09'j'0�Drainage Course f Comments 72-026 (Rev. 7/88) Front Page 1 of 2 L i A dA44e.4 ew 5ccpg5 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Designe/'1 _ r Date Installed W _X2_�.o Length of Field 62�) f Width of Field 36 " Depth of Field ie",of Gravel Bed Thickness Square Feet of Absortion Area 11M Statndpipes Present ON) J Depression over Field (Y& Date of Last Adequacy Test 03'-3/- TY Results of Last Adequacy Test 6maje. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 4-1 To Property Line To Building Foundation 14- To Existing or Abandoned System on Lot i[( Q ; On Adjoining Lots i To Water Main/Service Line �S~ "`" To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments LIFT STATION Date tailed Dimensions Size in Gallo Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ""Check Permitted Bedroom Rating Against HAA Request*" I certify that I have checked, verified, or conformed to all MOA and HAA g inspection. „ / A Signed — Company Date / MOA No. Receipt No. OS �Dc�% g � 0 % Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 ". 06"eiiii:f9so iC. REM, JR.; % CE .2251 ►, f this Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC \�"' . FV 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LABORATORIES ANAL;SiS RE?01t1 by SAMPLE for Work Order # 12478 Date Report Printed: APR. 5 89 @ 10.19 c . r: "RACE A 114, .r Ii:HP.uG E JFe Ciiant Name A E _ S client Acct AKEC3RP Cc1_ecte3 AYB 39 @ 11:41 P.O.# NONE REC D ved APR ; B39 @ -13:00 Req # ese,.-ver W—t kS RE',i'RED Ordered By R.P i:omple'ed :APR 5 89 Send Reports to: a or tcry $u.aervrsor :3:'EPHEN C. EDE 1)A E C S R:? e. as e4 By 1 eC_ai hemlau Ref #. 473+ Lab SmpL TD: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits ',TITRATE -N i.06 mg/l EPA 353.2 lc ;,p1e ROUTINE SAMPLE. remarks: SAMP:,E :OLLEC"ED yf R.i'. Tests Pexzormedee SpeCiai Tnstructions Ahcve UA -Unavailable Ncne Detected. "` See Sample Remarks Above '+A= Not wralvzed LI -Less 1', -,an, GT -'wester Than CHEMICAL & i LABORATORIES OF ALASKA, IN Drinking Water Analysis Report TO BE COMPLETED 0 PUBLIC WATER SYSTEM I.D.0 +►c I I I i ' ' I] PRIVATE WATER SYSTEM Phone No. Name Mallin Cily stale SAMPLE DATE: Fa --TS] -3`. § tMo Day ' Year SAMPLE TYPE: �p Routine Check Sample (for routlne sample with lab rel. no. ❑ Special Purpose SAMPLE NO. 3 4 5 StiJ:S is auee Anchorage, Alasic, 99518 r Total Coliform Bacteria Zip Code LJ Treated Water 14 Untreated Water I Time cpIlected Collected LBY READ INSTRUCTIONS Membrane Filter. Direct Count BEFORE I Verification: LTB 11 Final Membrane Filter Results COLLECTING SAMPLE Reported B TNTC = Too Numberousl D Count 4: OB = Other Bacteria shows this Water SAMPLE to be: XSatii factory ❑ Unsatisfactory ❑ Sapie too long in transit; sample should not le over 30 hours old at examination to i idicate reliable results. Please send n*ev sample via special delivery mail. Date R ceived 1 D Time F. eceived , C,> o Analyt al Method: Membrane Filter N2. f colonies/100 ml. t,� Lab jef. No. Result*, Analyst !' m - -- - M.t m i m i CIl [CAL WATER ANALYSIS RECOR O �{ Coliform/100ml `/ - -- t Coliform/100ml �r x Time:a.m. P.M. Time APPLI AT FILLS OUT UPPER HA 'ONLY - {operty Owner' ?' i } i I l j til 'j `�a tom' lJl �Y L\ vLc Cg h 3 LC I 5 3 �j�, Phone .Mailing Address is {; !! 1� ,' i l J Zip Code ,'--- Inspector Buyer Inspector Address %, '/ ; x l �� /,/ /� i i , �, ! Zi Code / '• p Lending Institution ,!� i-�-� I�=�t7! � Phone Address Zip Code Realty Co. & Agent Phone Address ( ) APPROVED BEDROOMS Zip Code Legal Description d, < -2A c, - Street Location Type of Residence 5 Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Date Sewer Installed Well To Absorption Area °y Water Supply `011 Individual Septic Tank Size ✓K`� v ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal ! Z Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ^; Date Date Date Date --3 Y\ 6',\ Inspector Inspector Inspector Inspector Field Notes: ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( CONDITIONAL APPROVAL* — —93 DATE BY: �fi�f--d/J^-�^-Y e Soils Rating Date Sewer Installed Well To Absorption Area °y Well Log Received Septic Tank Size ✓K`� v Well to Tank w' . 72-023 (3182) CHEMICAL & GE .OGICAL LABORATORIES, ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: LTJ Mo. Day Year SAMPLE TYPE: O Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. no. ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 L 3 I J 4 l 5 I I Analysis shows this Water SAMPLE to be: . Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No., Result' Analyst k' j m j m *No. of colonies/ 100 ml or N0. of Positive portions. 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected READ INSTRUCTIONS Date Recelved Presumptive 24 Hours 48 Hours BEFORE Confirmatory 24 Hours _Time Received loml 1 10m EMB Broth 24 hours: COLLECTING SAMPLE Multiple Tube Report: Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By Source A.M. p.m. Lab. No. — 10m1 I 10m1 I 20m; l.oml I 0.1ml Broth 48 hours: _10ml Tubes Positive/Total 10ml Portions Collform/loom) 8GB -- Collform/100ml Date Time- a.m. p.m. 111A r n 1=100711. DATE RECEIVED INSPECTION APPOINTMENTS � _ TIME TIME TIME 6. TYPE OF RESIDENCE G YVt DATE DATE DATE ! Q — O Sd — - —(?n tam ff4 INSPECTV INSPECTOR&,t INDIVIDUAL* INSPECTO C�>l since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTEC P4ICIPALITY OF ANCHORAGE DEPT. OF i- =.i.l i /0.4 825 L Street - Anchorage, Alaska 99501 ENVIROivMENIA'L :.;i--CTION ENVIRONMENTAL SANITATION DIVISION _ _ _ _ Telephone 264-4720 U f -'- 1 I REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWV�V'IM DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ' 'i— v' �0 PHONE MAI NG ADDRESS TL1lViG 7 K_ PROPERTY RESIDENT (I different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE r1 MAILING A DRESS „, 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL FiDESCRIPTION 1' — — � _ STREET LOCATION v 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS Other EJ Four❑ 171 -SINGLE FAMILY � Two Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM �< INDIVIDUAL/ON-SITE** /frb 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) a