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Home My WebLink AboutCHICKADEE SLOPES TR A LT 5 (2)Chicka Slop Block A Lot 5 #015-231-40 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTifiCATE Of HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.231-40 HAA # Expiration Date: 1. GENERAL INFORMATION Complete legal description ~'Chlckadee Slopes, Block A, Lot 5 ' Location (site address or directions) 12300 Rockrtd§e Drive, Anchorage, AK 99516 Current Property owner(s) Roger Bolton Dayphone Mailing address (SAME AS ABOVE) Lending agency Day phone Mailing address Real Esta~Agent Charles Blalock - pRUDENTIAL VISTA Day phone 273.7288 Mailing Address 4241 B Street. Anchorage, AK 99503 Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WAS I ~-WATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer [] [] [] [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served 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.) Certificates are valid for one year for properties served 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. 4. 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, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND Enqineerinq Address 20441 Ptarmiqan Blvd. Eaqle River, AK. 99577 Engineer's Printed Name Kenneth M, Duffus 5. DSD SIGNATURE L./ Approved for L)L Disapproved. Conditional approval for bedrooms. Phone 696-611t Date 12/2710f bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Legal Description: A. WELL DATA Well type odvate Data completed 6115//2 Total depth 142 ft. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastawatar Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Chickadee 81ooee Block A. Lot 5 If ~ B, or C provide PWSID # Sanita~/seal ~/N)y Casedto 4~ ft. Parcel ID: 015.231.40 FROM WELL LOG 6115~72 Date of tast Static watar level IQ Well p~duction ~ WATER SAMPLE RESULTS: Coliform {) colonles/100 mi. Data of sample: 12/2tl01 B. SEPTIC/HOLDING TANK DATA Tank Type/Matartal Anchoraoe Tank I Steel Date installed t0/26/93 Tank size 1250 g.p.m Well Log (Y/N) y wins propedy protected (Y/N) y Casing height (above ground) 1' AT INSPECTION 12;2t/01 ft. 2.45 g.p.m. Nllmta 0.2 mg./t. Collected by: KND E~olmeflm Other bectaria_~_ colonies/10Oml gal. Number of Compa~ments 2. Cleanouts y.. Foundation cleanout y__Deprasaion over tank LHIgh water alarm NA Date of pumping 12Jt2J01 Pumper A+ Home Services C. ABSORPTION FIELD DATA Data installed t0r26/93Soll raUng (g.p.d./f~ or ~/bdrm) t,Q Length 82 ft. Width ~ ft. Gravel below pipe 3.5 Total depth L ft. Eft. absorption ama 759 · Monitoring tube Y Depression over field N Data of adequacy tast t2/2tl01 Results (Pass/Fall) Pass For ~_ bedrooms Fluid depth In absorption field before tast L in. Elapsed Time: 1415 min. Final fluid depth L in. Any rejuvenation treatment (past 12 mo.) (YiN & type) System type ~haflowTmnch fl. Water added il00 gal. Now depth 12 in. Absorption rate >= 600 g.p.d. N~ If yes, give date Do UFT STATION Date installed NA 'Pump on' level at __ in. Datum SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot tQD'+ Absorption field on lot Public sewer main Sewer/septic service line Building foundaUon ~'+ Water main Wells on adjacent lots 1QQ'+ Size in gallons Manhole/Access (Y/N). "Pump off' level at __ in. High water alarm level at. Cycles tested Meets alarm & circuit requirements? in. On adjacent lots t00'+ On adjacent lots 1Q~'+ Public sewer manhole/cleanout Holding tank t00'+ 1QQ'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line ~'+ Absorption field [;'+ Water service line, lQ'+ Surface water IQQ'+ Property line 10'+ Water Service line Curtain drain ~1)'+ F. COMMENTS SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 1[1'+ Water main lQ'+ tQ'+ Surface water 1QQ'+ Driveway, parring/vehicle storage Wells on adjacent lots 1110'+ 25'+ G. ENGINEER'S CERTTIFICATION ~_~'r.~:..' ' I ~ ~at I ha~ dete~in~ ~mugh field inspe~ons and ~%,~,~,~,..~., ~ m~ew of Munidpe/ m~Ms that ~e a~ s~ems am in ~ ~ EngineeFs HAA Fee $900 Date of Payment 1 ~2/~/01 Receipt Number t~/' Waiver Fee $ Data of Payment Receipt Number DEC-2T-OI 11:$ZA~ FRO~F-CT&E ENVIRON~NTAL SRV .~_.. CT&E Environmental Services Inc. 9~75615301 T-258 P.01/02 F-341 CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 1018610001 KND £n§ineering Chickadee Slopes Blk A Lot $ Chickadee Slopes BIk A Lot 5 Drink~ng Water PQL Units Method Client PO# Printed Dote/Time 12/'27/2001 11:50 Collected Date/Time 12/21/2001 14:30 I~ceived Date/Time · 12/21/2001 16:00 Technical Director Stephen C. F. de AIIoweblc Prop Analysis Limits Date Date Init 0.200U 0~00 mg~ £PA 300.0 (<10) 12/21~1 Total Coliform col/lOOmL SMI8 9222B (<1) 12/21/01 KAP 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 Permit Number: ~k\ J.'!,°~_"~["¢--\ ~'~ PID Number: Name:Wastewater System: ~ew ~ Upgrade Address: ABSORPTION FIELD No. of Bedrooms: ~ep Trench ~hallow Trench ~ Bed ~ Mound ~ Other Soil Rating: Total Dept~rom original grade: LEGAL DESCRIPTION o.~ GPD/Sq. Ft, Subdivision: Depth to pipe~t~m from original grade: Gravel depth beneath pipe Township: [Range: [Section: Fill added above original grade: Gravel leng~ / ~ Ft. Ft. WELL: ~ New ~ Upgrade Grave, widths, Number of,ines: IDist,,~weenlines: Ft. ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~i[le~ ~ Dale Dnlled~ Static ~a~e~ Leveh I~s[alle~: ~a~e ims~alled~ SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacture~,_~_ ~ Capacity in gallons: From Tank Field Station Tank S .... Lines~: ,~ ¢ ¢ : Material:~ Number of Compartments: Surface , , LIFT STATIO~ Water I~O ~ fO0 ~ ~ ~ Lot 7~,~ ~l~ -- -- -- Size in gallons: [ Manufacturer: Line f * "Pump on" level at: '/f" level at: ~ High water alarm at: Foundation ¢0 ~ ~ + ~ ~ CurtainDrain ~ ~- ~ ~ -- __ Pump Make~ Electrical Inspections performed bY: Remarks: BENCH MARK ~~ (~ ~~ ~ ~ Location a~d Description: _ ~Assumed Elevation: Inspections performed by:l,:~w~ [ . Dates: 1st to/~/ '"'" """ .... Department of Health Huma~ ~rvices appr~a~ ~".. .te: 72-013 (Rev. 9/91) MOA 25 Permit .No. Page Municipality of Anchorage 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 72-013 A (1/93) Permit. No. Page ~ of '~ Municipality of Anchorage 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 Legal Description: L.0~L ~- ~c ~ ~A2~.~[~e- ~1~-$ PID No.: 1las T. Kenle¥ CE-8176 72-013 A (1/93) * 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:SW930439 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:BOLTON ROGER W & OWNER ADDRESS:12300 ROCK RIDGE DR ANCHORAGE, ALASKA 99516 DATE ISSUED:10/20/93 EXPIRATION DATE:10/20/94 PARCEL ID:01523140 LEGAL DESCRIPTION: CHICKADEE SLOPES TR A LT 5 LOT SIZE: 85120 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 343-4744 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: ~ ~ DATE: 'Mr. & Mrs. Roger Bolton Residence Lot 5, Chickadee Subdivision Anchorage, Alaska PERCOLATION TEST RESULTS and GENERAL SITE INVESTIGATION REPORT MUNICIPALITY OF ANCHORAGE I~NVIRONMENTAL SERVICES DIVISION OCT 1 2 1993 RECEIVED On September 28, 1993 the above reference 2.5 acre site was inspected in conjunction with soil perk tests being performed for application and approval for the replacement of an on-site waste water disposal system.. The site is located at the intersection of Huffman Road and Rothridge in Anchorage, Alaska. The system is being replaced in conjunction with an upgrade from a 3 bedroom system to a four bedroom system. The existing tank is being replaced with a 1,250 gallon tank and the leach field is being moved south of the existing location approximately 75 feet. The site is on the West side of Huffman Road with a gradual slope ranging from approximately 1% to 2% in the east-west direction and 3%-5% in the north-south direction. The immediate area that has been selected for the waste water disposal system has an average slope of 1%. The site is moderately treed with birch, spruce, and alders. It appears that there are no obstructions that would prevent surface water runoff. On-site observation and physical survey shows that there are no water wells nor private waste water disposal systems within a 100' radius of the proposed system. Consultation with owners of neighboring properties revealed that all adjacent waste water disposal systems are performing adequately. No surface water was observed at the time of the inspection and it appears that there is no potential for contamination of adjacent water wells or streams. The structure that will be served by the replacement system is a four bedroom, roughly private residence. One percolation test was taken at the site to assess the adequacy of subsurface soils to accommodate the replacement on-site waster water disposal system. The results of this tests is attached to this report. The test site had adequate percolation rate to support the proposed 4 bedroom residence. Subsurface soils were found to be dense silty sands overlain by 36" of loose silty sands, overlain by 48" of loose silty gravel overlain by 12" of surface organics. The percolation rate for the replacement site was found to be 8 min/inch. If there should be any questions concerning the percolation rates or characteristics of the site please call me at 561-1011 Sincerely, , Douglas T. Kenley, P.E. C.E. #8176 ~) DRWN: CHKD: DATE: ~-~-~-9~ SCALE: I"-~ ~o' AbASk"A HC 34 BOX 2057 GRID: PR. NO: I! ROGER BOLTON RESIDENCE LOT 5, CHICKADEE SLOPES SUBDIVISION Anohoraga, Alaska DOUGLAS T. KENLEY, P.E. I ,,lin ROGER BOLTON RESIDENCE LOT 5, CHICKADEE SLOPES SUBDIVISION Anchorage, Alaska DOUGLAS T. KENLEY, P.E. I PERFORMED FOR: LEGAL DESCRIPTION: 2 al ? 8 10 12 13 14 15 16 17 20 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST t SLOPE SITE PLAN WAS GROU.DWATE" E.COU.TE.ED? O S L IF YES, AT WHAT O DEPTH? p E Depth t° Walar Afler ! ~/~'/~3 Gross Net Depth to Net Reading Date Time Time L/1~ ? Water Droo ,o1,./ · ~ rD I'/~ ~ ~o t 'fY 3OMMENTS PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85l PERCOLATION RATE ~ (m,nutes/,nch) PERC HOLE DIAMETER ~'~ TEST RUN BETWEEN ~--//2-FT AND ,~-'"'/7-'"FT CERTIFY THAT THIS TEST WAS PERFORMED IN GRF .... =.R ANCHORAGE AREA BO~-'~IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 't~- E,E /~ ~-"'~' ?~'~'/ MAILING ADDRESS LOCATION (/~'/'.~7~ /-~f~/.Af~'/~///-~/,Z.~/z~/~ LEGAL DESCRIPTION PHONE .~M 4/._ FROM WELL R //,,/' N INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PI : NUMBER Of TS DIAMETER O~;¥~IDTH., ~LENGTH , DEPTH __ LINING MATE, ,AL __CRIBSIZ/ DIAMETER' ~PTH DISTANCE F~M:'~'~ELL~ / T~TAL EFFeCTIVe ~ ~ BUILDING FOL ~IDATION , NE~'EST LOT LINE . ABSORPTION ARE~ALL AREA) ~. ADDITIONAL AB~/ ~ / " FT. WELL: TYPE ~-~,/O, ~] CONSTRUCTION ~ ~//.~/~/~ BUILDING NEAREST NEAREST FOUNDATION , LOT LINE , SEWER LINE CESSPOOL , OTHER SOURCES APPROVED / DISAPPROVED REMARKS DEPTH /~/2 ! DISTANCE FROM: SEPTIC SEEPAGE , TANK , SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: ~--~*E ~t: PIPE MATERIAL: ! LOT SLOPe: REMARKS: Form No. EQ-031 DATE G.A.A.B. SRE'-'"-'. ANCHORAGE AREA BO" *mH ~ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /'~P ~-~'/~- gZ"L '7",~LJ MAILING ADDRESS '~'/'~,~ '~'""/ '~ SEPTIC TANK: DISTANCE .~'~'~ ~/- ('~/L~-' I '7._C.~?.~ - NUMBER OF FROM WELL~--~ MANUFACTURER ,~7'~,,R-C~/_._ ..~'~ MATERIAL ~7-~?~--L COMPARTMENTS ~' INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~Z'--~ GALLONS. SEEPAGE PIT: NUMBER OF Pits / DIAMETER __OR WIDTH , LENGTH , DEPTH LINING MATERIAL~-~$ CRIB SIZE: DIAMETER DEPTH ~ /DISTANCE FROM: WELL BUILDING FOUNDATION , NEAREST LOT LINE ~O/f' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) """'--- SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE '~'"-/~"0/0, CONSTRUCTION ~''~/-- O~/ee_6__O DEPTH /z/'Z/ DISTANCE FROM: BUILDING NEAREST I-f NEAREST SEPTIC .~'/" SEEPAGE FOUNDATION , LOT LINE ~¢ , SEWER LINE , TANK , SYSTEM //~ ~ / CESSPOOL , OTHER SOURCES APPROVED ~ DISAPPROVED REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: Form No. EQ-031 DIAGRAM OF SYSTEM DATE G.A.A.B. SEWAGE DISPOSAL SYSTEM GREA, ~::R ANCHORAGE AREA BOR,..,.,u,...,H DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. APPLICATION AND PERMIT SOIL TEST RESULTS / A-/l~'O/4f(-L COMPLETION DATE ANTICIPATED OTHER TO BE INSTALLED BY NOTE; THIS PERMIT IS NOT VALID WITHOUT ~4:)IL TEST / ? 7'.z. PFDMTT VAI TD ONE YFAR FINAL INSPECTIONt 24 HOUR NOTIC~ REOUlRED. BACKFILLING OF ANY s¥~rrEM WITHOUT FINAL INSPECTION BY THe. HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZe_~''~C~ ~' / TYPE~tP.~l Olr cnnc~'RteSEEPAGE AREA SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS 5 ft. FOUNDATION TO SEPTIC TANK 20 ft. DRAIN FIELD :[0 FOUNDATION TO SEEPAGE PIT 15 ft, SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK 5 fie , SEEPAGE PIT ?-~--~. DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK "~'~'~ e DRAIN FIELD /L~)/~ WATER MAIN TO SEPTIC TANK DRAIN FIELD 10 fie . lO ft. SEPTIC TANK. SEEPAGE PiT i (~ ~.~ /, ALSO CONSIDER AREA WELLS. 25 ft., SEEPAGE PIT 100 ft., DRA,N FIELD 50 ft., TO RIVER. LAKE, STREAM. DIAGRAM OF SYSTEM 4" CR.~ IR0~ SIPUON S~PT1C PiPE K'ITtI AiRTiGHT CRIB ·] A::I:/./CAPS .... '": ii,':":":- -- cxs~ l,o~ I.'=.~ :'.'.E .... I.;::.;-1 <. .,,' N] N] ,:ll~ ' I Il If4U~ t-'-'. '-; C ~ r~qu~red wh~ncver lin~ crosses (CRIB 4' ~I~I~UN AB0(E HATER undcr driveway. 1ABLE) CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 PEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. H 'ALTH ^ THORITY 'h SEEPACE P)I EXCAVATION BASED ON SOil. TE~T. i Grade: ~'.per IC3' or 1/4" p r foot except lO' pre¢~udin HOUSE tank & tha. should not exceed 6' pe~ 100 on flat CAST 1~011~.~/SEPTIC terrains. 1KTO [!~:= I I'~:-'------~l 4 IlltH 0IST~'~E~---~T' L C~ST IRO, SlP.O, SOIL . / IiEAP[~T LOT [111£ I CERTIFY THAT I AM PAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE ~REA BOROUGH ORDINANCE NO. 28-65 AND THAT THE ABOVE GREATER ANCHORAGE AREA BOROUGH · DEPARTMENT OF ENVIRONMENTAL QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 ~ Dated Performed ~~ Performed For e~ ~m[~-~'~ Legal Description: Lot ~- ~ock~&~ Subdivision ~,-o~z,~ This Form Reports Soils Log ~ Percolation - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 3~ 4~ 5~ 6~ 7~ 9~ 10-- 11~ 12~ 13~ 14~ tl Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop I Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit or Trench COMMENTS: .-~.,~.._ ~.Z-~'--¢-~oZ~ .:~~<,/ ~-"~.~--~ -~-~ ~F~ ~ Test Performed BY .~- Date Certified BY: Date: July 3, 1973 Hr. Roger ~. Bolton Star Route A. Gox 7 Anchorage, Alaska 99507 SUBJECT: Lot 5, Block A, Chickadee Slopes l)ear Mr. P_olton: Your request ~or a sixty (60) day extension of the previous waiver is hereby granted. This work must now he acc~}pltshed by Senter.~her l, 1973. :(o extension beyond this date will he granted. We ~,~ould recommend that ¢ollowtnq a new soil test, you contact this office Cot exact information on the required pit size. Sincerely, .qusan E. [)ickerson Sanitarian lb ,tt~: Mr. $tr!ck!~nd ..... ~0 C Street Ancbor~e, Al~,ska D~sr Sir: I would ]!k~ to ~sk for ~ sixty ~y ~wten~.on to th~ waiver your office Issue~ me Ir, st ~,Jint.~r involvin~ my-on sit~ ~ewer system ani soil test Drob]~ms. · b~?i]t t~,~ system myself ~:~itk borrow~.~ eo~iptmrnt an~ !nta~ to ~]~n ss~a f~w weeks. Ao~ "'. Bclton Anchorage,, A~ Block A Lo+, 5 T'og~r w. Bolton Star 5o ute A Box 7 , Anchorage, Alsska 99507 Greater ~lchora~e ~;rea Atten~io~ o~e Diek~rso~ ~ ~ Street ,J anuar~Z ,~, 1 i)73 Omsr Sue; i~m to m~.mundarstanding on my part and to fr,azin~~ weather, z bare b~mn unabl= to comply to tbm Morou~b ~wer sy~tm~. As p~r o~r pbo~ convors~tlo~ on o~u~ary ~, !g73, i am ~sking for a waiver ~mt!]. July ], to bava a soil tost ru~ and maka correction if any is r~q~!r.~d, as soon ss th~ ground tkaws t~is RECEIVED -_ 1973 ,~;-~EATER ANCHOI~AGE AREA BOROUGH DEPT. OF ENVIRONMENTAL QUALITY FOR Gi[RTJFIi[D MAJL--30 (pJus postale) Dece~ber 6, 1972 Mr. Roger Bolton St. Rt. A, Box 7 Anchorage, Alaska 99507 SENT T9,~ ~ P.O., STATE AND ZIP CODE OPTIONAL SERVICES FOR ADDITIONAL FEES RETURN k, ~.. ~h~- ~ ~h~ -a~ ~ ~v~ ............ 15~ P With deUvery to addressee onJy ............ 65~ RECEIPT 2. Shows to whom, date and where delivered ** 35~ SERVICES With delivery to addressee only ............ 85g DELrVER TO ADDRESSEE ONLY ...................................................... 50d SPECIAL DELIVERY (extro f~ requireH) .................................... POSTMARK OR DATE PS Form NO INSURANCE COVERAGE PROVIDED-- (See other side) Apr. 1971 3800 NOT FOR INTERNATIONAL MAIL ,o,o: ,J?oo.,g,-,,, Subject; Lot 5, Chickadee Slopes Subdivision. Dear Mr. $olton: At the time of the final inspection on your on-site sewer syster~, a determination on pit size could not be ~.l'Jade due to the absence of a soil test. l'he syste~:, was apparently backfilled, even after the disapproval by this Department. The area sot1 test reflects soil of 225 square feet per bedroo~'~. Using ti~is soil test, we still can~oC approve the system. the date of receipt of this letter, you will have thirty {30) days to dig up and! enlarge the existing pit, or to escrow money for the operation (work to be done by July l, 19?J). Failure to co~,~ply with ti}is notice will result in legal action against yOU. Until the above is accomplished this office will not approve the system for V.A. loan ourposes. The water sa~*)ple taken Dece~}ber 5, 1972 was satisfactory. If you have any questions on the above, please contact ~,e at 274-4561, extension 136. Sincerely, Susan E. Dtckerson Sanitarian CC; Denise Bashaw, Environmental Control Officer John R. Lee, Environmental Services Supervisor 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner '~o'~-~,," Mailing address k~~,~ Lending agency -~ Mailing address lb-bO Agent Day phone Day phone ~5-7 - 5~ 3 ur 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: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 [~:~u,~l~ T" ~ [~"T' Phone Il. Address ~_0~ ~(~)~.~ Engineer's signature DHHS .SIGNATURE ,/'/' Approved for bedrooms. Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) y' Total depth Sanitary seal (Y/N) ~" Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number t,J/A Date completed G- /S- '72.. Driller Cased to U r~ t.~o~ ,O Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test ~) - /5 - ? ;~- Static water level Well flow ~' Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I oo Absorption field on lot Public sewer main Sewer service line '7¢' ~r AT INSPECTION ¥- 7-q3 (:D :53-5 g.p.m. ¢q~ MUNICIPALI I ~ ur/~l~ J"*~) ,~'.~c ENVIRONMENTAL. SERx, ICFS DIVISION g.p.mtlov 0 4. 1993 RECEIVED I' ; On adjacent lots jO o ; On adjacent lots / Public sewer manhole/cleanout Petroleum tank kJ WATER SAMPLE RESULTS: Coliform (:~ Date of sample: ~' - ~'o- ~.~ Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping ~<x,,.~ Tank size I/5- Foundation cleanout (Y/N) Compartments y Depression (Y/N) Alarm tested (Y/N) rq Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Sudace water/drainage 72-026 (3/g~)* Front On adjacent lots Absorption field Foundation '7%- Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons / Vent (Y/N) ~Pump on" level at water alarm level/// High Meets MOA elec~d~l codes (Y/N) ~ ~_ / SEPARATI.~DISTANCE FROM LIFT STATION TO: Well o/~t On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested D. ABSORPTION FIELD DATA Surface water Date installed Length ~7~~ Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) O. Gravel thickness present (Y/N) "¢ Cleanout Results (pass/fail) System type ~j. S' Total depth Depression over field (Y/N) for After test /,J//A If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I o o/Jr To building foundation On adjacent lots Surface water Curtain drain H~'~ E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area On adjacent lots I o o' ~r Property line To existing or abandoned system on lot Cutbank {d/A Water main/service line I certify that I have checked, verified, or conformed to all MOA and HAA guidelines~h~o&:~t~f~.~.of this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (3,~J3)* Back Waiver Fee $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICE9 :~ Chemlab Ref.# :93.3988-1 Client Sample ID :WATER SAMPLE Matrix :WATER REPORT of ANALYSIS 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :D H i CONSULTING ENGINEERS Ordered By : Project Name Project# PWSID :UA WORK Order :69372 Report Completed :08/12/93 Collected :08/10/93 @ 16:30 Received :08/10/93 @ 17:00 Technical Director:ST~-~.~. EDE Released By : / r')/ hfs. hfs. Sample Remarks: Parameter ROUTINE SAMf~E COLLECTED BY: UA. QC Results Oual Units Allowable Ext. Anal Method Limits Date Date, Init Nitrate-N 0.17 mg/L EPA 353.2/300.0 10 08/11 LLH .......... * See Special Instructions Above ** See Sample Remarks Above U = Otldetected~ Reported value is the practical quantification limit. D = Secondary dilution. Member of ihs $G$ Group (9OCi6'6 O&n6ra,e de Survei,,snCe) UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than ENVIRONMENTAL SERVICES IN ALASKA. COLORADO, UTAH, ILLINOIS. OHIO. MARYLAND. WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA COMMEIt~'IAL TESTING & ENGIiF~EERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER r-i PUBLIC WATER SYSTEM I.D. # [-1 PRIVATE WATER SYSTEM I~ailmg Address City State Zio ~e Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ) [] Trealed Water [] Special Purpose [] Untreated Water TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,.l~_Satisfaclory 1:3 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. Dale Received ~'~" / ~-"~ Time Received [ ':~'""~ Analytical Method: Membrane Filter * No. of colonies/100 mi. SAMPLE Time Colle¢led Lab Ref. Ne. Resull* Analyst No. LOCATION Collected By ' F).l~.C. ¢--/_-~.~,'~ :~'~.__.,BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membr.,e Filter: Direct Count ~ Coliform/100 mi BEFORE COLLECTING SAMPLE TNTC = Verification: I_SB BGB Fec. I Coliform Confirmation Final Membrane Filler Results ,~ /~ ?, TOO Numerous To Count ~me: Coliform/lO0 mi tr~<d. .... OB = Other Bacteria t SGS Member of the SGS Group (So~ PART ONE OF TWO REMAINDER TO FOLLOW Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.-t ~ 6. /~, ~'~IC~AOt~I~-~ Parcel I.D. A. WELL DATA Well type I~t)~JID U^L.-~If A, B, or C, attach ADEC letter. Log present (Y/N) I~ (~ Total depth t'~ (-~ Sanitary seal (Y/N) ~(~ ADEC water system number Date completed UNV-4JO~.~,,J (~ Driller Cased to 147-~ iD Casing height Wires properly protected (Y/N) Date of test d//y/O Static water level Well flow Pump level FROM WELL LOG (~) AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 54~ ~ ~ ~ ~ Absorption field on lot { O~ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RES(~TS: Coliform C) Nitrate Date of sample: ~"" lO'" ct~ Collected by: Other bacteria c',~"~.~ ,,~wt 5 B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size lO(bE) 0_9 ~ Compartments Foundation cleanout (Y/N) ~/ t~ Depression (Y/N) Alarm tested (Y/N) ~/~, ~ q '~ Pumper (2~'O- SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot c~O ~ ~ ~ ,,On adjacent lots To propertyline ~00' 4- (~ Absorption field Surface water/drainage _/~c~¢--.- Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed 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 ~ .- '1'~ Length L~t ~'~ Width [~t (~) Total absorption area Depression over field (Y/N) Results (pass/fail) ~N~ Peroxide treatment (past 12 months) (Y/N) Soil rating ~-IO° Gravel thickness Cleanouts present (Y/N) System type Total depth Date of adequacy test for '~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~O~ ~ (~ On adjacent lots tZ-O~ (~) Property line To building foundation ~ ~ ~ (~) To existing or abandoned system on lot On adjacent lots [~3C ~ ~ (~ Cutbank ~o/~, Water main/service line Surface water klc~¢_ ~ Driveway, parking/vehicle storage area ~ Curtain drain I,~/~. E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on~?~e~! this inspection. · ~ / ~f . ~,~ Engineer's ame~_~ ~K/Gh{ %[~~_~~__~~"~"'"~"~'"~ ~ L~ · .....: HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3,91) Back MOA21 Waiver Fee: $ Date of Payment Receipt Number 15:57 CT&E Et~J[ROHHENTRL LAB SERUICES ~ ?87 345 1.J~6. .- _ N0.246 D03 -~ ~t~ ~e,.~,\L-~. -to COMMERCIAL TESTING & ENGINEERING CO. AK DIV Drinking Water Analysis Report for Total Coliform Bacteda TO 9E COMPLETED BY WATER SUPPLIER D PUBLIC WATEI:I S~TEM LO-# ~-"~~d E) PRIVATE WATER IIYIFTEM Ma. Dray SAMPLE TYPE: Routine Cheek 9ample (for mutlna ~ample with lab roi. no.... ---) ,~peelel PUlT)ole Treated Water UntTeated Water I~. ~L LO~ATION TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be; 0 Unsa~islacioty [3 Sample too ~ng ~ transit; samde ~ ~ o~r 30 ~ oM M gxam~bn ~ ~d~e rel~b~ msu~e.. ~aee n~ sample via ~ ~e~ ~. ._ ~te Re~lv~ Time Rem ~,d Aflal~l~l ~thod: M~bra~ * No, et colonles/100 mi. Time Coil~Aed Lab Fief. Ne. Result* Anal'/M ~':~° ~ ~'.~. -.~ -~ - READ INSTRUCTION_.._~ BEFORe_ COLLECTING SAMPLE THTC = Too Numerous To Count OB = Other Be~erla ACTERIOLOGICAL WATER ANALYSIg RECORD C~) _ Cellfemuleo'at Mand~er et 1he ,~O$ Group PART ONE OF TWO REttAINDER TO FOLLO~ J [5:~ CI&E EI~UIk'Lit. IHENIFL LHt~ b~_KUI~Et~ ~ ~J~J/ ~4m ±~_~b __ COMMI~RCIALTEIBTINQ & ENSINIEERIN~ CO. BHVlI~ONMIEN?AI- LABOFIATORY Chemlab Re£.t :93.3988~t Hair tx z#All~ o~ 19 S'TReET ~m~ple RelletrksJ [~Yl'ft~E ~ CT~.t~i.~-z..O 9T: UA, h~s. Nitrate-t~ Allo~able Ext. l~r~l ~c Init Resul[s Onal Units ~ettxxt Limits Date D~te 0.17 mcj/L I~A 353.2/300,0 10 08/1[ bLH ~.=~=~- .... ====~=~=~"'==~ ...... U~ ~ unavailable ** see ~ple Re~cks ~ve LT - U = ~te~. Ee~rted v~ue ts ~he pra~[cel ~%tftcatt~ ltatt. Lees ~ D = 6e~ diluti~. ~~NTAL ~R~8 ~ ~ ~~' UTAH. ILLIn9. OHD. MARYLA~, ~ ~lN~, N~ ~EY, ~H ~A GREATSR ANCHORAGE AR£A BOR~JGH Department of £nvfronmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received Time of Insoection Date of Insoectton e Aoproval Requested Address: RCC~=qT FOg AP~ROUAL OF INDIVIDUAL SE~ER & ',;~ATER FACILITIES FOR Prooertv Owner :_____~(:' Legal Description: Phone: Location: Type of Facility to be Inspected: Number of' Bedrooms: .o , C,r Well Data A. Type C. Constructi Deoth I,?/2 / Sewage Disoosal System: "~z J-~//~W~"<.'( ~ B. Installer A. Installed .... ~ ..... - C. Septic Tank:/,/~. Size~~j2. ~anufscturer D. ~ge Pit~/~.. Size 2. ~aterial c Disposal ?~eld: Total Length of Lines Distances: A. Well To: Septic Tank , Absorption Area //[~/Z~-' , oewer Lines Nearest Lot line ~' //' Other Contamination'-~ · Foundation to S~ot~c Tank ~----- ~ Absorotion Area '~-- Absorption Area to Nearest Lot Line ~!'r ~'~ . peuB!S :s~uemmoo '6