HomeMy WebLinkAboutCHICKADEE SLOPES TR A LT 5Chickad
Slope
Tr'oct A
Lot 5
#015-231-40
82/27/2887 14:81 90~2~30742
AWPS PAGE 02/82
ANCHORAGE WELL & PUMP SERVICE,
330 EAST 76TH AVE. ANCHORAGE, ALASKA 99518
(907)243..0740 - FAX:(907)243-0742
E-MAIL: pumpmanjim(~att,~iet
WELL CASING dUT OFF AND REMOVED
PLATE WE/,DED WATER TIGHT ,~,~"
-~PORTLAND CEMENT WITH 5#/I00# BENTONITE
'~PORTLAND CEMENT PLUG WITH BENTONITE
BENTONITE CHIPS-1 CUBIC FT. BAG
SULLIVAN WATER WELLS
o
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343.7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Apr 18, 2005
Expiration Date: Apr 18, 2006
Permit Number: SW050088
Legal Description[CHiCKADEE S[~OPES TR ;;A LT~5
Design Engineer: 0000 None Required
Owner Name: STEPHEN & MONICA RIEDEL
Owner Address: 12300 ROCKRIDGE DRIVE
ANCHORAGE, AK 99516-2433
Parcel ID: 016-231-40
Site Address: 012300 ROCK RIDGE DR
Lot Size: 85120 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4, From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special previsions.
-THE EXISTING WELL NEEDS TO BE PERMANENTLY ABANDONED PER ANCHORAGE MUNICIPAL CODE
15.55.060J
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET 'PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF
THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER
PROGRAM AT 907-343-7904.
Received B.~ ~*'~ ' ? ~'"~
!
Issued By:.~
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
(9O7) 343-79O4
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR ,~, SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number SW
Property owner(s) ,~'~"~'~/') ~/~'/L~ ~ ~ ~, q
Mailingaddress I~ ~nt,~ ~/6~
Site address ~ ~ ~ (
Day phone '~ ~/-{~ ~'~'~
ZipCode
Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size ,~5-/~ Acr/e~.Ft.~
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only
[] Water Storage
[] Jacuzzi []
[] Water Softening Unit []
I certify that the above information is correct. I further certify that this application is being made for a
Sin~y Dwelling and is in accordance}~vith applicable Municipal Codes.
/~gnatu~re ~;;I/property owner ;r authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:.
(Rev. 09/04)
Waiver Fees:
Date of Payment:
Receipt Number:
I~-r ~ I'~.''.',,' ~.-, ..
,~. ~.,.~_. V:.'~.' .
~. '~-'~:' ~ I
O' ,.,.trc,~ ~,L,'~..e. . · ~.
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~:.)~ ............ ~l~O~h*~c~m%"C',H~T -,4o ~'T- O,c Al %
"-- ...... · ' ~-l. ~ . '-/t --"Z4-?_ m.l~o:
5,funicipality of Anchorage
Development Services Depzr*m~ent
On-Site Water e~5 Wastewat~r Program
4700 Sou~ Bmg~w St
P.O. Box 196650 ~=homge, ~ 99519-6550
(907) 343-79~
PERMIT REQUIREMENTS FOR A Dor¢,F_.STIC WATER SYSTEM
Permi~t. An application to dr/il a new or replacement well shall be submi~ed to this department by the
property owner or their agent prior to commencement of drilling operations for a single family water
well. A permit for domestic water source shall not be issued if there is no existing or pe,,-mitted on-site
wastewater disposal system or connection to public sewer service for the property available,
scheduled and approved. A permit for a domestic water system shall be valid for one year from the
d~2te of issue.
A¢~lication. The application shall be on a form provided by the department. It shall be signed by the
property owner or authorized agent attesting that the well will be sited, drilled and completed in
accordance with standards and provisions in AMC Chapters 15.55 and 15.65. The applicant shall
submit an accurate site plan signed by the property owne¢ or property owner's agent drawn on an 8-
1/2 by 11 inch sheet (or larger if necessary) to a scale not smaller then 1 inch to 50 feet. The site
plan shall show:
1. Legal description of the lot or parcel.
2. Location of th9 proposed well.
3. Lot lines, roads, rights-of-way and easements on or adjacent to the lot.
4. Location of all proposed or existing structures on the lot.
5. Measured distance to ail existing water supply wells within 50 feet of the proposed we!l see.
6. 100 foot prote~ive well radius.
7. The location must be shown of all components of wastewater disposal systems. This shall
include sewer trunk and service lines; sewer clean-outs and manholes; fuel tanks; curtain drains
and out-falls; and any known areas confining hazardous waste or other potential pollutants. Also
included are existing (or proposed) paddocks, kennels, animal enclosures or containment areas
within 200 feet of the proposed well.
The minimum separation requi?ements between wells and specified facilities or areas shall be:
S --pA,~,TION
FROM WELL TO:
Sewage holding tank 75
Septic tank 100
Septic absorption field 100
Private sewer service line 25
Public sewer trunk line 75
Public sewer manhole or clean-out 100
Hydrocarbon storage tank 25
Curtain drain 25
Animal feed lots, shelters, containment areas 100
Any source of potential contamination 75
MIN. SEPARATION
DISTANCE IN FE~--'r
A~ention: The well driller
shall provide a well Icg to the
property owner within 30
days of completion and the
property owner or the well
driller ~;hall provide a well log
to the Dept. of Health. &
Human Services within 60
days of comoletion.
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
CERTIFICATE
FOR A
· · Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastew.ater Program ?' 4 /'
P.O. Box 196650
Anchorage, AK 99519-6650
vcww.muni.org/onsite
(907) 343-7904
OF ON-SITE SYSTEIVIS APPROVAL
SINGLE FAMILY DWELLING
Parcel I.D. 015-251-40
1. GENERAL INFORMATION
Expiration Date: i-i/'~ /i'
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CHICKADEE SLOPES; TRACT A, LOT 5
12300 ROCKRIDGE DRIVE *ANCHORAGE, AK 99516
STEPHEN & MONICA RIEDEL Day phone 344-0300
12300 ROCKRIDGE DRIVE *ANCHORAGE, AK 99516
Day phone
VALESA LINNEAN W/ KELLER WILLIAMS Day phone 865-6440
101 WEST BENSON BLVD. SUITE 503 *ANCHORAGE, AK 99503
Unless otherwise' requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
· Individual On-site ·
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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 samples. (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 seM ~mxed he, eLo ~,d ~ u, ~he w,lu~,,u,, da~ shown be/ow, ' .... ;~" '~*°* ~"'
investigation, based on procedures oUtlined in the Certificate of On-Site Systems 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 verify that based on the
information obtained from the Municipafity of Anchorage files and from my investigation andinspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFBEY A. GARNESS, P.E.
Phone 337-6179
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
'~'/ Approved for 5
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
'
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11/05)
Arsenic Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: "~'//~ ~//~ ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4~700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS' APPROVAL
CHECKLIST
Legal Description:
CHICKADEE SLOPES; TRACT A, LOT 5
Parcel ID: 015-231-40
WELL DATA
Well type PRIVATE
Date completed 4/20/05
Total depth 200, ft. ·
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 63 ft.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
YES
YES
18+ in.
Date of test
FROM WELL LOG
4/20/05
AT INSPECTION
5/20/2010
Static water level 33 ft.
39 fi,
Well production 5 g.p.m.
4.58 g.p.m.
WATER SAMPLE RESULTS:
)nies/100 mi. ~g./L.
: Arsenic:i .IL. Date of sample: 1/3/2011
B, SEPTIC/HOI.:DING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation clean0, ut (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 5/20/2010 Pumper
Other t100 mi.
Collected by: GE(3 Ltd.
Date installed 10/26/93
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
DENALI PUMPING
Date installed
Length
Total depth
ABSORPTION FI.ELD DATA
10/2i6/93
82 .ft.
*8.5 ft. Eft. absorption area 759 ft2 Monitoring tube YES
Date of adequacy test 5/20/2010 Results (Pass/Fail) PASS
Fluid' depth in absorption field before test 35 in.
Elapsed Time: 230 min. Final fluid depth 38 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
I'BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2o~ 0.8
Width 5 ft.
Water added 455 gal.
System type TRENCH
Gravel below pipe 3.5 ft.
Depression over field. NO
For 3. bedrooms
New depth 40 in.
Absorption rate >= 450+ g.p.dl
NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at __
Size in gallons
Manhole/Access
,in. "Pump off" lev~igh water alarm level at.
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot, 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
in.
100'+
Meets alarm & circuit requirements2
On adjacent lots 100%
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+
Water main N/A Water service line, 10'+
Wells on adjacent lots 100%
Absorption field 5'+
Surface water, 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
Water main N/A
Driveway, parking/vehicle storage
10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
! 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 JEFFREY A. GARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Reft# 1110003001
Client Name Garness Engineering Group, Ltd Printed Date/Time 01/11/2011 8:09
Project Name/# Chickadee Slopes TRA,LS Collected Date/Time 01/03/2011 12:00
Client Sample ID Chickadee Slopes TRA,LS Received Date/Time 01/04/2011 9:05
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 01/05/11 01/07/11 NRB
Waters Department
TotaINitrate/Nitrite-N 4.60 0.I00 mg/L SM20 4500NO3-F B (<10) 01/05/11 AYC
Microbiology Laboratory
E. Coli Ne~oative 1 100mL SM20 9223B A 01/04/11 DLC
TotalColiform Negative 1 100mL SM20 9223B A 01/04/11 DLC
Municipality of Anchorage
Development Services Department
Building' Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street .
P.O. Box 196650 /
Anchorage, AK 99519-6650 /~,/~
www.muni.org/onsite "
(907) 343-7904 / / ~'./
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE%AMILY DWELLING
Parcel I.D. 015-231-40
1. GENERAL INFORMATION
Expiration Date: //---
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CHICKADEE SLOPES; TRACT Ap LOT 5
12500 ROCKRIDGE DRIVE *ANCHORAGE, AK 99516
STEPHEN &: MONICA RIEDEL Day phone
12500 ROCKRIDGE DRIVE *ANCHORAGE, AK 99516
344-0300
Day phone
VALESA LINNEAN W/ KELLER WILLIAMS Day phone 865-6440
101 WEST BENSON BLVD. SUITE 505 *ANCHORAGE, AK 99505
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · ~ Individual On-site ·
Individual Water Storage [] . i Individual Holding tank []
Community Class Well ['--]. Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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 samples. (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 s~¢xed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate Of Qn-Site Systems 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 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(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 537-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE., AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
.Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater levels that may
fluctuate dudng the year, and the water usage of the family being served by the system.
These conditions are outside the COntrol of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
~/' Approved for ~
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations: ---9 -u S~'-' 3'
. .. ~;yyjjj))
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
mLra~e Advisory
(Rev. 11/05)
,-',i se~ .u Advisory
Maintenance Agreements
Supplemental Engineer's Report'
Other
Original Certificate Date: '~ ~ ,/ (E) ~ / c~~
M:unicipality of Anchorage
Development Services Department
CERTIFICATE OF
Legal Description:
WELL DATA
Well type PRIVATE
Date completed 4/20/05
Total depth 200 .ft.
Date of test
Static water level
Well production 5
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi.
Arsenic:/~.~O ug./L
SEPTIC/HOLDING TANK DATA
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
0N-SITE SYSTEIVlS APPROVAL
CHICKADEE SLOPES; TRACT A, LOT5
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 63 ft.
FROM WELL LOG
4/20/05
55
.ft.
.g.p.m.
Nitrate'~O (o ~ mg./L.
Date of sample: 5/20/2010
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Corn partments 2
Foundation cleanout (Y/N) YES
Date of pumping 5/20/2010
ABSORPTION FI,ELD DATA
Date installed 10/2r6/93
Length 82 ff.
Depression over tank (Y/N) NO
Pumper
[*BELOW EXISTING GRADEJ.
Soil rating (g.p.d./ft2o~ 0.8
Width 5 ft.
Total depth *8.5 ft. Eft. absorption area 759 f¢ Monitoring tube.. YES
Date of adequacy test. 5/20/2010 Results (Pass/Fail) PASS
Fluid depth in absorption field' before test 35 in.
Elapsed Time: 230 min. Final fluid depth 38
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
CHECKLIST
Parcel ID: 015-2.31-40
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/20/2010
39 .ft.
4.58 g.p.m.
YES
YES
18+ in.
Other bacteria ('~
Collected by:
~ colonies/100 mi.
GEG Ltd.
Date installed 10/26/93
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
Denoli Pumpinq
Water added 4~5,5 g, al.
:.
in. Absorption rate >=
NONE KNOWN
System type TRENCH
Gravel below pipe 3.5 .ft.
Depression over field NO
For 3 bedrooms
New depth 40 in.
450+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at.
Datum -----.--
E.
in.
Size in ~gallons Manhole/Access ~
"Pump off" lev~gh water alarm level at
Cycles tested.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas. 50'+
¸in.
100'+'
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent .lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
Absorption field 5'+
Surface water. 100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
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 JEFFREY A. GARNESS
Date ~/3-7 Jl~
COSAFee $ ~ ?O'~-
Date of Payment ~//'/~ 0
Receipt Number al ~' ~ ~-~
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
S Bc2°5B' 00" E :gSO.00
o
coo o
o
GARAGE
28.3
26.0 it
GRAVEL DRIVEWAY
5~ .9
HU FFMAN ROAD
AS-BUILT SURVEY
SCALE: 1" = 40'
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
STRUCTURES OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.
NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINE
OR LOCATE STRUCTURES.
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
'
I HEREBY GERT[FY THAT I HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 5, TRACT A, CHICKADEE SLOPES SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND THAT NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE, ALASKA THIS _20TH
DAY OF MAY__ 2010__.
HOLT LAND SURVEYING 8464, FB95-56,139-50,141-10
TEL. 345-5513
SGS Reft# 1102260001
Client Name Garness Engineering Group, Ltd Printed Date/Time 05/27/2010 9:58
Project Name/# Chickadee Slope Tract A Lot 5 Collected Date/Time 05/20/2010 11:00
Client Sample ID Chickadee Slope Tract A Lot 5 Received Date/Time 05/20/2010 11:20
Matrix Drinking Water Technical Director Stel}hen C. Ede
Sam!ole Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container 1D Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/21/10 05/26/10 NRB
Waters Department
TotalNitrate/Nitrite-N 3.62 0.100 mg/L SM204500NO3-F B (<10) 05/24/10 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 05/20/10 DLC
Total Coliform Negative 1 100mL SM20 9223B A 05/20/10 DLC
05/02/2008 00:12 FAX ~002
Denali Pumping & WaterWorks LLC
p o Box n333: 346-PUMP (7867)
Anchorage, Alaska 99511-3332 Fax 334-3991
~ck Ticket
Technician
Customer
~ k/c/~ O~ o ~
Description
Quantity Price Total
:ucl Surcharge
.~is. cellaneous Comments
OPEN ACCOUNTS ONLY
By signing this truck ticket you have agreed to pay the amount listed above. Payment ia due
upon receipt of an invoice that will be trailed to you withi~ I~, days. Any invoices unpaid 30
days after the invoice date will accrue interest charges of' 1.5% per month. All collection and
attorney fees plus court costs will be borne by you should it be necessary to initiate legal pro-
ceedings to recover any unpaid balance.
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