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HomeMy WebLinkAboutSLEEPY HOLLOW #2 BLK 2 LT 27Sleepy Holl #2 Block 2 Lot 27 #051-511-14 !� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I =• ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME (JJ & in vv PHONEEW UPGRADE MAILING ADDRESS LEGAL DESCRIPTION •C LOCATION NO. OF BEDROO IS O DISTANCE TO: Well 1 Q Absorption area � Dwelling PERMIT NO. Y Q. 2 W Q Manufacturer Mate ri No. of compartments A L N ~ Li �oacity in gallons IF HOMEMADE: Inside length Width Liquid depth I 6 v J0Z DISTANCE TO: Well a Dwelling PERMIT NO. S? F Manufacturer Material Liquid capacity in gallons p DISTANCE TO: Wel- I O O Foundation I Nearest lot line f to PERMIT NO. p�f y� o 'QJ Lux J W Z Z W No. of lines / Length of each line / Total length of line / Tranch wid inches Distance between lines I F is= 0 Top of tile to finish gradeMaterial 3 f beneath tile Q 4a Inches Total effective absorption area W Length Width Depth PERMIT NO. 6 F L Type of crib Crib diameter Crib depth Total effective absorption area I W W � DISTANCE TO: Well Building foundation Nearest lot line Classf Up IF Depth Driller Distance to lot line PERMIT NO. W DISTANCE T0: Building foundation Sewer line Septic tank Absorption arealsl OTHER I \ PIPE MATERIALS r SOIL TEST RATING I INSTALLER I REMARKS f U? ID I I I I I I I I APPHO ED DATE LEGAL V �A 72-013 (Rev. 3/78) rlUN I C I F^Fri L I TY C -IF Fih1CHUsFRRGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION p ' 825 'L' STREET, ANCHORAGE, AK 99501 264-4720 ANCHORAGE E94-21331 : EAGLE RIVER. CAtJ-S I TE SELJEFZ F?EFZII I T i PERMIT NO. AM= (a 36197141 APPLICANT: WAYNE CLARK PHONE: 265-6032 ADDRESS: BOX 4-1121 ANC, AK 99509 LEGAL DESCRIPTION - SUBDIVISION: SLEEPY HOLLOW 2 BLOCK: 2 LOT: 27 TOWNSHIP: Q RANGE: XX SECTION: XX j MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING = 125 (SQ.FT./BR) I LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR. SEPTIi SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. IFF<E:"ICH D>ES I C3it4 WIDTH = 2.5 FT. LENGTH = 42.0 FT. TOTAL DEPTH = 9. 0 FT. GRAVEL DEPTH = 4.5 FT. GRAVEL VOLUME = 19.4 CU. YDS. TANK SIZE = 1,000.0 GALLONS (TWO COMPARTMENT TANK) E:EG [7E5 I Gt-F WIDTH = 14.0 FT. LENGTH = 28.0 FT. TOTAL DEPTH = 5.0 FT. GRAVEL DEPTH = 0.5 FT. GRAVEL VOLUME = 14.5 CU. YDS. TANK SIZE = 0000.0 GALLONS (TWO COMPARTMENT TANK) F4 I E> EZ 6FZFi I tJ F= I EFLD> DES I Ci t-4 WIDTH = 5.0 FT. LENGTH = Q0 FT. TOTAL DEPTH = 7.0 FT. GRAVEL DEPTH = 2.5 FT. GRAVEL VOLUME = 2c6 CU. YDS. TANK SIZE = 1,000.0 GALLONS (TWO COMPARTMENT TANK) I CERTIFY THAT: 1. 1 AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS ANDWELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED A COPY OF THE CODE SUMMARY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS PERMIT. 3. i UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF P.ESIDEPCE THAT THE WELL WILL SERVE. SIGNED: � U 1 APPLICANT: WAYN2" CLAP.K��,� ISSUED BY: / --��K�`-' - - ---- DATE: 06/17/83 • 61UNICIPALITY OF ANCHORAGE t?'( DEFART6"ENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2G4-4)20 I .Si 825 L_ Street, Anthorape, ALska 99501 SOILS LOG — PERCOLATION TEST EX b3 -07y i':..7"ORFI.cO FOR •./ fn 'c•!?:L� '/�/1:Q� r P,1/1_y (.rfi!/ DATE PERFCRVED. •�_5/c?�.i PLT_ _. _ / —Lr- �-- Ifry [ /• •; . c� i_/I i,., - LVrALOEEC-i'Pi1CN�:_ji ��--� 0. V/1 r CH G -.:7n SLC,'E `,�sSIrE PLAN rI � r ? I . i I!/J. "'•) (L.. j•�.i il%r ("'J lj�f/I,:LN('/ , �z•-Frs.,_,�I•_�7'''-(,S1li d• �- 1 � tr ' 6 a "•O• �.Znti� �i: :�il,/r'../.L -IT -_'--L T to .i..,y��,r..�'.t,.�i..cr�f...l� �.,,.v- Jr;,� _ r�'�•' i P 11 V E ,C -� . srj ri I. . ;�✓I. : r�.� — - rf�,.,�—� _. Yd �._�I-l�—��'�—'1. v II � �.�:a. S�1! f•r:: •K.i 1 lf�; � s - - - � L�tih_ r4 - WAS O RMr4n C Q OA N /0D ENCOUNTERED) �l �O O �I I�� I I _ r P 12 r• " �oT' �` 'irON 1'; E � IFYES, AT HAT _?•- _f1 II II JI • -�• DEPTH?13 „1. ••7r_ =•�^te_. 1 .l� 1 r/•� O,oss Net D.; Ih to! .• t / ! Time Time Yla!er I D•r•, 15 //t7c�Y�' !/J� u�E�/G F':(�tSr Volie: h Y-�G/ 14 (�,; rf�h [O`'y—t° �<i�f9F�r^ _...'..,e.��•�i� , ��/��GT PERCOLATION RATE / 1 TEST �RUN - EETY:EEN FT AND eE7:T5 /' J. •J11L:_t h_ /_:�Ji—.o'L/ .'. G�.��i�/ �,-• Ci. HTIF IED BY: PERFOR,.ED EY. r i— —__�f - - - n Ml JM I ClI F7jlL I TY OF= FirvCH l^F C3E ' DEPARTMENT OF ZALTH AND ENVIRONMENTAL PF SECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 44ELL FyEF<M I T PERMIT NO. ( 780007 ) APPLICANT LEE SULLIVAN PO BOX 197 EAGLE RIVER. 694 2588 LOCATION LEGAL LOT 27 SLEEPY HOLLOW SUB #2 LOT SIZE 70000 SQiARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. I WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. I OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F>EFZM I T EXP' I FZE9 I7ECEMBEFZ 31r BL97u I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. E ISSUED BY CANT LEE SULLIVAN I WELLS AS SET V3. 0 by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 6942598 OWNER OF LAND DEPTH OF WELL 0 I I ADDRESS STATIC LEVEL OF WATER FT. -t LEGAL DESCRIPTIO otco.c) SJ�'0 RAW DOWN FT. / 10 y � % DATF. -Started / /D S Ended GALS. PER IIR 660 PERMIT NUMBER _] g A 0 0 -7 KIND OF CASING � � 0,0 KIND OF FORMATION: , From D Ft. to3—Ft. D`�EQ�y20Ey From Ft. to Ft From Ft. to -L44 --Ft. -iX wg it CreL G From Ft. to Ft From-j$_Ft. to!2—Ft. From—Ft. 134,- ,- nJ CC 64e From Ft. to—Ft.- o Ft._From From1 :2 Ft. to3jL-Ft. C/9 N0 s'- to Utz c From o Ft. to—Ft— Ft`From3OF From 3 OFFt. to -E.3 --Ft. c' / R Y ! ' L< 6C From Ft. to Ft— From�_?_Ft. to ')DO Ft. 'EQ Q ° c /L From Ft. to—Ft.- o Ft._From Ci Fromr;?00 Ft. to aor Ft. 8Co/Cc„! RoctC 3- From Ft. to FL_ 0-5-From�Ft. to 32.0 Ft. L L"foe Sb410 From Ft. to Ft._ 3 0 From ZFt. to n? Ft aloKEnl From Ft. to—Ft.- o FL_From FromFt. to 34rFt. gEAqQ6CC Salitl• From Ft. to—Ft.- o Ft._From From5- Ft. to IlOo Ft. 16/le• cK KKK .(<L_ kj From' Ft. to Ft. - !P✓A'C7 Z LF'JSgronl' o Ft. to—Ft. Ft. - - From Ft. to Ft. -C°0" 12-' From 'c' Ft. toL—Ft. From I1E10Q0 05, Sa" O From Ft. to—Ft.- o Ft._From Ft. to Ft. From—Ft. From " o Ft. to—Ft.- Ft._From Ft. to Ft. From—Ft. From oFt._ Ft. to—Ft.- FromFt. to Ft. From Ft. to Ft. MISCL. INFORMATION: / // 707N4L Gr4Si� / 6 From Ft.'to Ft. From Ft. to Ft n I� DRILLER'S NAME 1 L_.0 0-A .41 /- A n p V /1,' T r Iv t J 11� APPLII' NT FILLS OUT UPPER HAI'`10NLY j l r� IrC: Ni aJ[P.L(r' �. /vC'K Phone G�j�'NGo3 Time (' G Zip Code / G% j / Date Mailing Address J Date Data ; /?r I J Q J2 Inspector Inspector Inspector Buyer Field Notes: Q_ C C),MUNICIPALITY OF ANCHORAGE , �Jf"ICC' Address Zip Code Z� Lending Institution F.'.;:-7 fv n7 ram P l_ o b h5C CPhone ,6 &y �V 3 Address ( ) DISAPPROVED Zip Code ( ) CONDITIONAL APPROVAL - DATE Phone Realty Co. d Agent Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received i Address Zip Code Legal Description /,0-7a ') ..Z/. S L �� O� O L,D eZ n� 7'f'Te re'E' k `e!r e rl u';, Street Location I $ ` Type of Residence F g e Family ❑ Multiple Family 1 No. of Bedrooms ❑ Other Water Supply P-T.'dividual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community For wells trilled prior to that date. give well depth (attach log If available). ❑ Public Utility Sewer Disposal ndividual ' �O S 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. L_.0 0-A .41 /- A n p V /1,' T r Iv t J 11� Time Time Time Time Date Date Date Data ; /?r I J Q J2 Inspector Inspector Inspector Inspector Field Notes: Q_ C C),MUNICIPALITY OF ANCHORAGE , �Jf"ICC' 'r_OF HAt. ENVIRO-'.'A`NTAL PROTECTION TION Z� SEP 814:3 RECEIVED. , ( ZAPPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ' ( ) CONDITIONAL APPROVAL - DATE BY:'�!'J Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank SIZe t 7 v r 72 023 IMP "D 1s 47 Municipality of Anchorage Development Services Department Building Safety Division \ _ / On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # 016Z 23 Expiration Date: l - S- l 0 1. GENERAL INFORMATION Complete legal description Lot 27; Block 2; Sleepy Hollow #2 Location (site address) 16411 Mountain Rd. Chugiak AIL 99567 Current Property owner(s) Homestep Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Tennille Knorz W/ Prudential Jack White Vista RE Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well./❑ 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 273-7377 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 sample results. (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 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 Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliancewith all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S IS Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Rd., Chugiak Ak. 99567 Engineer's Printed Name Robert A -Shafer 5. DSD SIGNATURE Approved for �� bedrooms. Disapproved. Conditional approval for Date &24-09 bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: " (Rn IIMS( / Municipality of Anchorage (• Development Services Department \ ! / Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST a7 Legal Description: Lo♦ � (y Z S lee Dw go l to Gi 47- Parcel ID: OSI . A. WELL DATA Well type _Dj::% 2 If A, B, or C provide PWSID # _ Date completed + / /78 Sanitary seal (YIN) Total depth _qqo ft. Cased to Ty ft. FROM WELL LOG Date of test i 2 1`�' Static water level Well production I U 9 p•m- WATER SAMPLE RESULTS: Coliform —0_colonies/100mL Nitrate 2.- mg/L Arsenic: 00 ug/L date of sample:if� B. SEPTICIHOLDING TANK DATA j TankType/Material Tank size /0610 gal. Number of Compartments Z Well Log (YIN) 4 Wires properly protected (YIN) V 4 n Casing height (above ground) I L (in. AT INSPECTION 9iso`� ft. tp.m. Other bacteria © colonies/100 mL Collectedby: Date installed s 'e 3 Cleanouts (YIN) V Foundation cleanout (YIN) Depression over tank (YIN) /J High water alarm (YIN) Al Date of pumping d7bo 09 Pumper SZ�S D1 MA %f C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.e o Ibdr 1Z5 System type 'I �► Length T -D ft. Width - ft. Gravel below pipe 2 •� ft. Total depth 8 -ft. Elf. absorption area 3l�iz. Monitoring tube Depression over field Ili Date of adequacy test of I 6 a9 Results (Pass/Fail)�C�S For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth I in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >=�y" �_ g p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N I IA- if yes, give date "i[Yf1Jh pMsooJe_ed y -LI ho�S tin"oC +esEir�'. D. LIFT STATION Date installed N/rT 'Pump on' level at _ In. E. SEPARATION DISTANCES F Size in gallons 'Pump Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /vor f Absorption field on lot /W,f Public sewer main Sewer/septic service line *25"f Animal containment areas 45-0 #1 High water alarm level at in. Meets alarm B circuit requirements? On adjacent lots 1-6U f On adjacent lots /00'f Public sewer manhole/cleanout► Holding tank _ �A Manure/animal excrete storage areas /00 rf SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �/t Property line f4 Absorption field it Water main /0 r{ Water service line /O Surface water 100 r� Wells on adjacent lots 00it- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /y F4 Building foundationUj rf Water main O r* Water Service line /� r f Surface water Joc) If Driveway, parking/vehicle storage f0 IF Curtain drain 4611e known Wells on adjacent lots IL -0 t G. ENGINEER'S CERTIFICATION I certify that I have determined ro field review of Municipal records t at the -be conformance with MOA COSA ui sin e Engineer's Printe NaI Lm%� /� Date _ _ eV� r7 4 COSA Fee $ 49 O Date of Payment Receipt Number (Rev. 11/05) . So in Waiver Fee $ Date of Payment Receipt Number Jen+ Jat��11 FA A. SCS ReLN 1094832001 Client Name S & S Engineering Printed Date/time 09/23/2009 10:21 Project Name/0 L27;B2;Slccpy Hollow 92 Collated DateMme 09/11/2009 10:30 Client Sample ID L27;B2;Sleepy Hollow 82 Received Date/time 09/11/2009 13:35 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks, Allowable Prep Analysis Parameter Results POL Unnt Method CanteincrlD Limns Date Date Inn Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/15/09 09/21/09 NRB Waters Department Total NitreteMirrite-N 2.04 Microbiology Laboratory Colony Count 0 Total Colirorm 0 Fecal Cohlonn 0 E 0.100 mg/L SM20 4300NO3-F 11 (<10) coUl00mL SM2092229 coUl00mL SM209222D coU100mL SM209222B 0921109 LCE 09/11109 DLC 09/11/09 DLC 09/11/09 DLC jY of 1 AS •BUILT I hereby certify that I have surveyed the following property: �,E_/i. "__74-P.ioC_h(-ZL_— Anchorage Recording Precinct, Alaska, and that the ments situated thereon are within the property lin not overlap or encroach on the property lying adjac to, that no improvements on properly lying adjace encroach on the premises in question and that thi roadways, transmission lines or other visible eass said property except as Indicated hereon. Dated at Eagle River, Alaska } this 17- day ot._�T-t 4 19 ft ROBERT C. JOHNSON awl SCALE: Regnstered 1 -and Surveyor Nc Box 456, Eagle River, Alaska Phone (907) 694-2343 Municipality of Anchorage ., ' Development Services Department / Building Safety Division „ - On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 (ZQ —I $S�o✓t� Anchorage, AK 99519-6650 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �I��v FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-511— / y COSA# CIPO390 1. GENERAL INFORMATION Expiration Date: 3 —a a-- 2-7 Complete legal description SLEEPY HOLLOW SUBDIVISION #2: LOT 27, BLOCK 2. Location (site address) 18411 MOUNTAIN ROAD • CHUGIAK. AK 99567 Current Property owner(s) VERNON do SHIRLEY WILKIE Day phone 417-924-3326 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 4320 LONGHORN LANE • MANSFIELD. MO 65704 Day phone ROLF MILTON w/ PARTNERS REAL ESTATE Day phone 694-4994 11940 BUSINESS BLVD • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ SEPTIC SYSTEM SIZED FOR 3 BEDROOMS TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 Onsite 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 affixed hereto and as of the validation date shown below, I verify that my 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 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 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 " ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date 1Z ZZ 06 Engineers 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 d 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 ownerfisted 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. 5. DSD SIGNATURE Approved for _'; bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory L Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other l�'OFrrd .rrri ON-SITE WATER AND WASTEWATER ; PROGRAM ' 1)1 By: �/„/ �. Original Certificate Date: (nav llm) Municipality of Anchorage ' Development Services Department Building Safety Division On-site Water & Wastewater Program 4700 Bragaw Street P.O. Bos 196650 Anchorage, AK 99519.6650 www.muni.org/onsdo (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _SLEEPY HOLLOW SUBDIVISION: LOT 27, BLOCK 2. Parcel ID: A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Date completed 1/12/1978 Sanitary seal (Y/N) YES Total depth 440 ft. Cased to 55 ft. FROM WELL LOG Date of test 1/12/1978 Static water level 140 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform _6 colonies/100 ml. Nitrate 2. tB mg./L. Well Log (Y/N) YES Wires properiy protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 8/1/2006 134 ft, 3.89 g.p.m. Other bacteria 6 colonies/100 ml. Arsenic: __t!D_ ugA. Date of sample: 12/7/2006 Collected by: GEG. LtD. B. SEPTICIHOLDINO TANK DATA Tank Type/Material STEEL Date installed 8/5/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 8/7/2006 Pumper JR -S PUMPING C. ABSORPTION FIELD DATA Date installed a/5/1983 Soil rating (g.p.d./ft'or� 125 System type TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 2.5 ft. Total depth 06A ft. Eft. absorption area 375 fe Monitoring tube YES Depression over field NO Date of adequacy test 8/1/2006 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test DRY in, Water added 906 gal. New depth 21n. Elapsed Time: 5 min. Final fluid depth DRY in, Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — SEPTIC SYSTEM SIZED FOR 3 BEDROOMS D. LIFT STATION Date Installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons "Pump ofr Manhole/Access (Y/N) water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank(lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent Iota 100'+ 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 tx../zzlof, COSA Fee Date of Payment Receipt Number (Rev. 11/05) Waiver Fee E Date of Payment Receipt Number SGS Ref.N 1067178001 Client Name Garness Engineering Group, Ltd. Project Name/N Sleepy flollow SD No 2 L27 B2 Client Sample ID Sleepy Hollow SD No 2 L27 I)2 %latria Drinking Water PN'SID 0 All Dales/Times an Alaska Standard Time PrintedDate/lime 12/212006 13:21 Collected Date/Time 12/072006 13:00 Recetred DatelTime 12/082006 14:04 Technical Director Stephen C. Ede Sample Remarks: ' Allossable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/M3 Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/12/061220/06 TK Waters Department Nitratc-N 2.18 0.100 mg/L EPA 300.0 D (<10) 12/08/06 12/08/06 JDS Microbiology Laboratory TotalColirorm 0 coV100mL Sh1209222D A (<I) 12/08/06 DPT Municipality of Anchorage Development Services Department Building Safety Division -_� On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 lr% CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1)!91- 511' ( y 1. GENERAL INFORMATION COSA# Expiration Date: 3- O C Complete legal description SLEEPY HOLLOW SUBDIVISION N2• LOT 27 BLOCK 2. Location (site address) 18411 MOUNTAIN ROAD * CHUGIAK AK 99567 Current Property owners) VERNON do SHIRLEY WILKIE Day phone 417-924-3326 Mailing address Lending agency Mailing address Real Estate Agent Day phone ROLF MILTON w/ PARTNERS REAL ESTATE Day phone 694-4994 Mailing address 1JW4U DUJINrJJ DLVU - ,"•�, Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 SEPTIC SYSTEM SIZED FOR 3 BEDROOMSI 1 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ 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 seat atrixed hereto and as of the validation date shown below, I verify that my 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 Municipality of Anchorage riles 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 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date (3 10'f 4 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the fest, and separation distances measured to readily Idonlifiable 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 orthis report by any other person orparty is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for a_ bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the fllowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other vwvn �. WtTGa Amn WASTEWATER PROGRAM By: or. QaA/4 Original Certificate Date: — —0co M_ ,,.K, Municipality of Anchorage ` Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 1966W Anchorage, AK 99519.WW www.muni.orglonsie (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST *!- Legal Description: SLEEPY HOLLOW SUBDIVISION: LOT 27, BLOCK 2, A. WELL DATA Well type PIRMAR H A, S, or C provide PWSIDfx N A Date completed 1/12/1978 Sanitary seal (YM) YES Total depth 440 ft. Cased to 55 ft. FROM WELL LOG Date of test 1/12/1978 Static water level 140 ft. Well production 10 — 9 -p.m -WATER SAMPLE RESULTS: Coliform Q_ oolonies/100 ml. Arsenic: ND ug./L. B. SEPTICIHOLDING TANK DATA Parcel ID: OSI -i'll +1.1f' Well Log (YM) ' YES Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 8/1/2006 134 ft. Nitrate n AVA mgJL Other bacteria I Date of sample: 8/2/2006 Collected by: GEG. LtD. ml. Tank Type/Material STEEL Date installed I Tank size 10002 Cleanouts (YIN) YES gal. Number of Compartments _ Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) I N/A I Date of pumping 8/7/2006 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA i -en -ow NOW 501 Date installed a/5/19e3 Son rating (g.p.d.Nt'tx1� 125 System type TRENCH Length 50 ft. Width 5 R. Gravel below pipe 2.5 ft. Total depth 0664 ft. Efl. absorption area 375 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/1 /2006 Results (Pass/Fail) PASS For 12 bedrooms Fluid depth In absorption field before test DRY in. Water added 906 gel. New depth 2 in. I Elapsed Time: 5 min. Final fluid depth DRY in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YM &type) NONE KNOWN If yes, give date — SEPTIC SYSTEM SIZED FOR 3 BEDROOMS D. UFT STATION Date installed Sizze in gallons Manhole/Acoess (Y/N) _ "Pump on' level at _in. "Pump ofr leve igh wateralarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service Ane 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinghrehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent loll 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I ceftfy that I have determined through Held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guideNnes in effect on Mm date. Engineer's Printed Name JEFFREY A. GARNESS Date G/1-4/&& COSA Fee ©— Waiver Fee $ Date of Payment S' d b Date of Payment Receipt Number ARRV Receipt Number (Rev. 11105) .......... a J _-79)53 jk� 08/07/2006 11:15 9076944995 A :I_ PARTNERS REAL ESTATE PAGE 02 t.. , . • 1 hereby eeriiiY that I ho.e "'u.eyed the t'ollewlna described • ' 1•-0 f z--7 g • � Z , - .. property: ' '• � � e'' '1 S' T � r A! s 13�w � S.k!� 't �.� �.. t ' .Sr Anchorage Recording Precinct, Alaska. srtd that the imptove- menti situated thereon are withlh the Pro ppeerty lines and do , �' ' -..:, ••.,".� net overlap, or encroach an the properV tying odleoent there- ;� .' •'+r to, that no ImOro'tenhente on Property lying ad3went thereto encroach on The pramises In Question and that these area* i r roadwkm tranfmission ltnes or other visible easemeota on add property except as imucated hereon. ' .S:.p-G-�•(J.G-�; _ Dated at 8ag1a River, Alaska • . ROBERT C. JOHNSON %SGpai •�•' Registered LandSveyorNo. _ nrAZ., SCALE r � '` '' 1• a *4V Hou 456, Hagle RNTs, Alaska �. .' Phone (w) epi -3541 I SGS RcLN 1064403001 Client Name Garness Engineering Group, Ltd. Project Name/p Sleepy I lolloty SD Lot27 Bk 2 Client Sample ID Sleepy I lollow SD 1ot2713k 2 Matrix Drinking Water SamDlc Remarks: All DatesfFImes are Alaska Standard Time Printed Dateffime 08/1120061 8:30 Collected Datefrime 08/022006 10:13 Received Datefrime 08/022006 11:20 Technical Director Stephen C. Ede Parameter Results PQL Units Method Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 Waters Department Nitrate -N 0.833 0.100 m8/L EPA 353.2 Allowable Prep I Analysis Container ID Limits Date Date Init C (<10) 08/03/06 08/07/06 6111 D (<10) 08/02/06 ALR Microbiology Laboratory Total Coliform 0 col/100ml- SN1209222B A (<I) 08/02/06 TLF 08/17/2006 16:19 9076944995 4--� Jim Sullivan 698-2510 or 258-2510 745-2510 Fax 688-2543 PARTNERS REAL ESTATE NR 9750 , matin! wNn-R sv;cr,.ts skiys .� SlxtuT 5p- CTI & WELNC. NWWA CERTIFIED PUMP INSTALLER Alaska Distributor P.O. Box 770197 Eagle River, Alaska 99577 Payment due on receipt of Invoice unless other arraneomor,te m,,in Customer order No. Phone D etion Nam Addreis ^ Ory• Description Pricy Amount e' %r*ivcd in Satislac'tory Condition TOTAL - rrvasc pay ay invoice. All aeeount Past Due will be charged 1117.%. $25 second billinq charge THANKYOU m