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HomeMy WebLinkAboutSLEEPY HOLLOW #1 BLK 2 LT 11Hollow #! Block 2 Lot 11 #051-501-06 Municipality of Anchorage Page i of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990140 PID Number.' 051--501--06 Name: JOHN BUGGENHAGEN Wastewater System: [] New · Upgrade Address: P.O. BOX 670031, CHUGIAK 99567 [,ORT~/SOUm] ABSORPTION FIELD* No. of Bedrooms: · Deep Trench · Shallow Trench [] Bed [] Mound nether Ph°ne:(907) 263--4857 4 (.0~.) CSOU~0 11 2 SLEEPY HOLLOW 4.6-5./1.2-1.6 F~ 7~6/0.5 -- -- -- 0.5 -- 2.0 ~ 32/62+ WELL: [] New [] Up R. Ft. F~ (487/310) 797 TOTAL S~.F~ ASTM D-3034/F-610 ~. EAGLE MOUNTAIN EXC. 99 - 9/3/99 .. TANK SEPARATION DISTANCES · SopUe [] .o,dl.~ [] ~.T.~.P. From Tank Field Station Tank Sewer Unes ANCHORAGE TANK 1250 Well 100'+ 100'+ -- -- 25'+ STEEL 2 SurfaCewater 100% 100'+ - - - LIFT S~ Line I Remarks: * SEE ATrAOHED I.ET'I~ER. BENCH MARK · , 2.06 FEET OF M.O.A. APPROVED SAND FILTER ADDED. BO'I-FOM OF SIDING AT POINT "A". 100.00 Ft Inspections performed by:. AWWC, INC. Dates: 1st 8/9/99 ~*'"[' ~l~,'~ ~ ....... 2nd 9/3/99 Department of Health and Human Services approval "D~,.'". ........... ,"~.o~ PERMIT NUMBER: sw99o, 4o AS-BUILT DRAWING P, CE, ~- ~ A B C CD5 ,..\ ~.q,.~ ~ /H.H. WlmON, P.E. . So~ - - ~ ~ -'~--~ -~ X / ~ C01 12.8 83.3 - ~ co2 15.3 ~4.s / ~ ~ ....... ~ ~ - - ~E~ ~o,~ ~05 25.2 65.2 = - ~ COS 80.2 1~- ~'~ . / x k ~ ~ ~-~ ~.~ ~.5 / ~ A~ In~ TH~I~ ~ ~ ~ ~-' }9.8 s1.4 - ~ ~ U~P~ED x ~ r/~ [ EXISTING BED TO BE ~ , ~) ~ E~ENDED ABOVE GRADE) 6901 DEBAR ROAD, SO~ 2B. ~CHO~GE, ~, 99504 ~ 0 · SL[[PY HOLLOW ~UB~I?ISIO~; LOT 11, ~LOO~ 2 AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ~:F~t ....... :....~ BUGGENHAGEN (907) JOHN K.D.W. 1 = 30' 2 OF 3 PERMIT NUMBER: sw99o,,o AS-BUILT DRAWING P.~cEL ,.OS, -50,"u""ER=-06 NORTH TRENCH r~ /. ~,2- ~,4 SOUTH TRENCH ~ . 96~7 - ~',~ (AV~,) ~ ~'4,52 (AV~,) ....................................... ~ ..~PTIC TAJ',IK Al' IKIt~l' ,- ~7,71 U ~j Afar- ~.~o ALASKA WATER & WASTEWATER CONSULTANTS, INC. PHONE: (907) BBT-B179/FAX: (907) ~-,~24B SLEEPY HOLLOW SUBDIVISION; LOT 11, BLOCK 2 1YPE OF WORK: PREPARED FOR: PHONE NUMBER: -- BU~£NH^~£N (907) JOHN DAT£: 10/25/99 ID~'wN ~: SC,~Z: P^~[: K.D.W. N.T.S. ,5 OF 5, ess Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B N Anchorage ~ Alaska 99504 (907) 33%6179 ~ Fax (907) 338-3246 Consulting Engineers September 20, 1999 Municipality of Anchorage Department of Health & Human Services Division of Enviromnental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: As-built of Septic System Upgrade for Lot 11, Block 2, Sleepy Hollow Subdivision #1 To whom it may concern: As can be seen on the attached as-built drawing and inspection report, two different types of trenches were installed due to installation complications and different soil conditions. A deep trench was installed next to the test hole performed by Hank Wilson, P.E. and a confirmation percolation test wa~ performed by AWWC, Inc. The percolation test performed by Mr. Wilson was found to have a percolation rate of 20 minutes/inch but was not performed in accordance with AMC 15.65. Our percolation rate was found to be 2 minutes/inch (data previously submitted to DHHS) and was in accordance to AMC 15.65. Given the variation in percolation test results, it is our opinion that a 0.8 application rate should apply. The second trench is a shallow drainfield type trench with a sand filter. At the south end of the shallow trench, the drainfield was curved to avoid removing a tree that the homeowner did not want damaged. This resulted in the trench encroaching within 8 feet of the foundation. The house has a crawl space with a footer elevation that is probably close to the elevation of the drainpipe in the field. Given the porosity of the soil (sand filter required), it is certain that wastewater will move downward rather rapidly and not migrate laterally towards the foundation. Even if it did migrate laterally, the effluent would be below the footer depth by the time it reached the foundation. In short, there appears to be minimal risk in granting the requested waiver. 1 If at you have any qu~estt{ vns, please contact us 337-6179. Thank you for your assistance. Pr ~ ~.,M.S. MUNICIPALITY OF ANCHORAGE Department of Heaith and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~g-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 15, 1999 Expiration Date: Jun 14, 2000 Permit Number: SW990140 Legal Description: SLEEPY HOLLOW#1 BLK 2 LT 11~ Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: John Buggenhagen Owner Address: PO BOX 771956 EAGLE RIVER , AK 99577-1956 Parcel ID: 051-501-06 Site Address: 018895 MOUNTAIN RD Lot Size: 34098 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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 provisions. PRIOR TO CONSTRUCTING THE PROPOSED ABSORPTION TRENCHES, THE ENGINEER SHALL PERFORM A PERCOLATION TEST IN ACCORDANCE WITH AMC 15.65. Received By: Issued By: Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers June 1, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic Upgrade Design for Lot 11, Block 2, Sleepy Hollow Subdivision #1 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic system consists of a 1250 gallon septic tm~k and a bed type drainfield. The existing bed is in a state of failure and must be upgraded. Comments regarding the proposed design are summarized as follows: 1. SOILS: A test hole was excavated and a percolation test was performed by another engineer north of the existing septic system. Attached is his soils log. A percolation test was performed between 9 feet to 10 feet, and found the rate was 20 minute/inch. As can be seen on the log, the percolation test was not performed according to EPA specification. We propose to do a confirmation percolation test. 2. TRENCH DESIGN: a. Percolation Rates: 20 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/fi2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. Maximum Total Depth: 13.5 feet g. Effective Depth: 7.5 feet h. Width: 2.5 feet i. Reduction Factor = N/A j. Minimum Length: 2 ~ 35 feet lon~ each (70 feet total length) k. Effective absorption area = 1050 ft~ 3. SURFACE WATERS: There are no surface waters wittfin 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The proposed septic upgrade area is generally flat; in short, there are no slope concerns We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerel~ l~ Pre~s e M.S· Note: Attached is a site plan drawing, a design drawing, a soils log, and a 4page specification letter which are all part of this design package. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers August 25, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Revision to Septic Upgrade Design for Lot 11, Block 2, Sleepy Hollow Subdivision #1 To whom it may concern: A permit was issued by your department on June 15, 1999, to upgrade the septic system (permit number: SW990140). Utilities locates were performed prior to construction and layout of the trenches were based on the fact that utility marks were shown off the property. Verbal approval for a 1 foot lot line from one of the proposed trenches to the north and east property line was obtained on 8/9/99 per Donna Meats. Excavation of the trenches began on 8/9/99 and a conftrmation percolation test was also performed. The south trench was installed first. The trench was 35 feet long by 3 feet wide by 13.5 feet deep and 7.6 feet of clean, washed sewer drainrock was added. The total square footage of this trench is 525 SQ.FT. On 8/10/99, excavation of the north trench was started but was stopped due to digging up utilities. Utilities locates were not marked correctly and were off by 5 to 6 feet. After a detailed research, it was discovered that there was a recorded easement that was not on the recorded plat. Given the limited area, there is not enough room to install the second trench in the 30 foot radius of the test hole. A second test hole was excavated to the south of the existing septic system which is the back of the house. See attached soil log for soils classification and p~rcolation test data. Groundwater was encountered at 8 feet during excavation of the test hole and six days later, groundwater was found to be at 6.5 feet. The monitoring tube will be checked prior to construction of the second trench to insure proper separation distance to groundwater. The following is the design criteria for the second trench: DESIGN CRITERIA: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/sq.ft. c. Number of Bedroom: 4 d. Design Flow: 600 gallons per day Note: the trench already installed meets the requirement for 300 gallons per day (525 sq.ft.). The proposed 5 foot wide drainfield will meet the additional 300 gallons per day. e. Minimum absorption Area for second trench only: 300 SQ.FT. f. Maximum Total Depth: 4 feet - base total depth off of groundwater elevation. g. M.O.A. Approved Sand Filter: 2+ feet h. Effective Depth: 0.5 feet i. Width: 5 feet j. Minimum Length: 60 feet long k. Effective Absorption Area = 1050 SQ.FT. SURFACE WATER: There is no surface water within 100 feet of the proposed septic system. TOPOGRAPHY: The area where the proposed second trench will be installed is generally flat. We are unaware of any adverse impacts this installation would have on adjacent wells or septic sys!ems. If you h~e any questions, please contact us at 337-6179. Thank you for your assxstance, j J/ sie~en~Gam e~,~2E., M.S. ..~ / ~ /~ PROPOSED DRAINFIE!.D, ALREADY ..,-~--~-----~ -- INSTALLED. TRENCH IS 35 FEET >.~. '-. FEET WIDE. 7,5 FEET OF CLEAN, , // ~ ~~ ~-- EXISTING .BED (APPROX. \ SEP~C TANK \ ' 0 \ \ --~7'~ ,//?~]' t~ TRENCH THAT IS 60 FEET LONG BY \ t ,-/ ~ I ~ ~J-- ~ ~ 5 FEET WIDE BY 4 FEET DEEP. ADD \ \ '~- ~ \ ./ I uu ~ ~' 2 FEET OF M.O.A. APPROVED SAND ALASKA WATER AND WASTEWATER CONSULTANTS, INC. J ' orn ss; JOHN BUGGENHAGEN (907) 265-4857 (/~}~/~'.~.._~:'-79'5~..."L~,~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 5 7 I~j 9 lo- ~'" 11- ~ ~2- LEGAL DESCRIPTION: (FEET) (~- 1- 2- 13- 14- 15- 16- 17- 18' 19 20 DATE ~ PERFORMED: ~5*~.~"~:rP~' /~o~CO~nship, Range, Section: COMMENTS SLOPE SITE PLAN ~.~'~--~, 66~~L WAS GROUND WATER ENCOUNTERED? IF YES, ATWHAT O DEPTH? P E ~epth to Wator Reading Date Gross Net Depth to Net Time Time Water Drop Zo~ ZO~ ~. I , PERCOLATION RATE Z~ (m~nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND / 0 FT PERFORMED BY: ~ ~' ~.~//G~'O~ ~ ~. ¢~IIL~'O~( I CERTIFY THAT THIS TEST WAS PERFORMED IN WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Z~'. ~. , ~ ACCORDANCE 72-008 (Rev. 4/851 ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DE,APR ROAD, SURE 25 * ANCHORAGE, AK, 99504 "~ h PHONE (907) 337-6179 * FAX (907) 335-3246 LEGAL DESCRIPTION: S~EPY HOLLOW SUBDIVISION; LOT 11, BLOCK 2, /JZ/~-~-- --" ' DATE PERFORMED: 8/9/99 GM CL ~ / 4-- ~ GC :~ OL ~ SW MH ' ' , tn ~ SP CH 7-- ~C~ DEPTH TO GROUNDWATER DATE ,. \~ \\ / 9-- 'J CLOCK NET TIME WATER LEVEL NET DROP 11-- ~ DATE READING TIME (MINUTES) READING (INCHES) 12 -- 8/9/99 1 5:50 -- 6- __ -J 6 6:00 10 MIN. 161 ~ 8 6:10 10 MIN. 1" 5' 9 6:10 I Ld 11 6:20 6' __ 191 PERCOLATION RATE 2 (HIN./INCH) PERC. HOLE DIA. 6' (INCHES) 20 1 1 TEST RUN BETWEEN 7.0 FT. AND 8.0 FT. COMMENTS: PERC CATTY WAS PRESOAKED FOR 4+ HOURS PRIOR TO TEST. PERFORMED BY ALASKA WATER · WASTEWATER I, , CER~FY THAT THIS WAS PERFOR~EDJN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. DATE: E/~3 DEPTH TO GROUNDWATER DATE PHONE (907) 337-8179 * FAX (907) 338-3246 J SOIL LOG PERCOLATION TEST] ~m~ TEST HOLE ~2 I ~- -: ORGANICS 4 ~f GM CL .-.~e~,.,~-: GC OL ~.,,..~ .... ~ V~ ~~~ ~li ~,kc.. ,.~. 7 ';:%;<~':'* IDEPTH TO DATE k  3ROUNDWATER 9 t[i SM/ML 6.5' 8/16/99 10 11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP TINE (HINUTES) READING (INCHES) 12 ~. 14 ~1~I~ 18 19 PERCOLATION rate <1 (HIN./INCH) PERC. HOLE Dia. 6 (INCHES) 20 TEST RUN BETWEEN 3.0 ft. AND 4.0 ft. CO~ENTS: M.O~ ~PR~D ~D ~L~ IS N~DED. PERFORMED ~ A~ WATER ~ WA~A~R. I, UE~R~ A. GARNESS, CE~ ~AT THIS W~ PE~M~DJN ACCORDANCE WI~ ~ STATe ~D MUNICiP~ GUIDEMNES IN EF~CT ON DEPTH TO DATE 3ROUNDWATER 8.0' 8/10/99 6.5' 8/16/99 \� WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys (9c` LOCATION OF WELL (Please c''mR1e_te_"sr Drilling Permit No. A.D.L. No. 1 Borough (�Subdivisionnn// Lot Block Ib. 'A gtrs. Section No. TownshipNO Range E� Meridian & l—of_of—of S❑ W ❑ ITncANCE Ic. DISAND 154ECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: /J /� C - Street Address and Area of Well Location 2. WELL LOG Feet Below Surface Motorial Type Top Bottom 4. WELL DEPTH: (final) ft.— 5. DATE OF COMPLETION 6• C3 Cable tool Q'Rotary Ej Driven E3Dug Auger Q Jetted [:] Bored Other: �f1 Cid z `C 7. USE: Domestic Public Supply 0 Industry Irrigation Recharge El Commerical Test Well Other: 8. CASING: Ej Threaded Ey Welded diam. in. to ft. Depth Weight Ibs./ft. diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: 'ice/l.-��-2.:r .f�.:-r�i � Diameter: rn ri - ObBi0g0LIV 40 41nci fi:jQ , Slot 'Mesh /Size: Length: � Set between S ft. and J ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: - v, ft. .i = f `" i Above or Below land surface Date Equipment used: / I I . PUMPING LEVEL below land surface and YIELD k�"f- ft. after hrs. pumping r� g.p.m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: Yes ❑ No Material: ❑ Neat Cement Other: �^ 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. E) Subm. Jet ❑ Centrifical Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature a F C This well was drill e der y.)urisdiction and this report is true to thhee, est of my knowledge and belief; `j Registered Bursipess Nan) A _ Contract Licens /Nu b nn [r� Address: - {�• l..! c�S���.�- Signed: (/. "J -2� ,�%'<..--'1:,• Date: Authorized Representative v Form 02-WWR (II/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer C N v, r 0 z a PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P,O. BOX 196650. 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT 'ERMIT NUMBER:SW910027 )ESIGN ENGINEER:S & S ENGINEERS IWNER NAME:TOMLINSON ROBERT A & IWNER ADDRESStP. O. BOX 672121m CHUGIAKo ALASKA 99567 ARCEL ID:05150106 EGAL DESCRIPTION: SLEEPY HOLLOW #1 BLK OT SIZE: 35098 (SO, FT.I UMBER OF BEDROOMS: 3 THIS PERMIT: 3 2 LT DATE ISSUED: 3/05/91 EXPIRATION DATE: 3/05/92 HIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM LL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REOUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS ~IBAACBO). THE FOLLOWING SPECIAL PROVISIONS. ECIAL PROVISIONS: 1%- ~' SCALE t,:~'.!/~ K (9C.?) 688-3-1 POST OFFICE BOX 874747 - WA$1LLA, At. ASKA 99687 S & S Engineering Lot~l Blk 2 Sleepy Hollow # 1 There is 48 ft. of 10 inc. casing in the well. Reduced hole to 8 inc. at 60 ft. to 350ft.Dec 16 1990 we pulled off well and at that time. it was producing 8 g.p.m. We checked well on 17 of Jan 1991; Well had some sluffing ~n, was not making as much water as before. We moved back on well 1-31-91 and starded c]aning out well. We cleaned the well out to original depth then took it down to 350ft. We placed pump in well on 2-6-91,On 2-7-91pumped 210 gal of water outof the well.the well was dry.%r~ed then one hr. later there still was no water in well. we designated t~ie we].], dry. The 8 g.p~m, of water that was there, could have changed by the ea~'th Quakes 2 of them abo~th this t~m~ Or ~t could have bee~; a large pocket of water and we pumped it o~t. -Jo. tm_ LLI_.U .~.~,:a }page 2 ef 2 pages WE S[~RVE Al. t. ALASK~ Per. mi'L lqL.xnl::~eP: Date :[-~;:~ued~ Del::)aPt. m6)nt c~ HeaZ'Lh .~ Human g~Pv:~.c:es 0 lq-... S Z T E W E L, L.. F' E R M ]: T 900:3::~:3 ........ : ~ , :!0/:t J, 1¢0 BOX 672 12 ]. [:;I.tUbIAK, AK 9956 Day Phc~ne: Lot l_..[~.,gal." Subdiv'i. sic~n." SLEEPYHOLLOW ¢~]. [..ot.~ It B].ock~ 2 'Sec: t i on: ]. 5 -[ o~,~l'i ~h i p: 15N F;.'.an ge: J. W Let Size :3509B Max bedrc, ems~ ]his Pepmi'L: 5 Total Capacity: 3 Wi:H..I...,: l_c)g must. be sub, mitt. ed to) Municipaiit. y of Anchorage Depart. ment of Healtl'~ and Human Ser. vzces witnzn 750 aavs ~')I well comple'L~.c,n,, l'l\l.t:il 'I'AI.. I PER ,qT]'(~CHED S i TE PLAI',I BY S&S EI',IG i NE:ER [NG ~ q£] CFROSS CONIx!EC::TtON ALLOWEI) BETW[~.EN WELLS. k~[-ITIF'¥ DHHS IF' .dlELL. (S) P~RE A~:IANDONED. CERT :[ F'Y 'I-HA'I ,: am lalm]. 3. ai'~ w:~.tl' the "eou~.rement.=4 for on--ez~.e sewers and w~ells as se~. i~)p'ih [:~v the Mun~c:~pal:~ty oF Ancherage (MOA> an(') Lhe Btat. e cW Alaska. 2. I w:li :i. nstall 'Lhe s/stem zn accordance with ali MOA codes anti re~lu].at, ic~ns and ~.n cc)mplzance with the design criteria of this permit., :.,. i w adhere t~"~ ~.I]. MOA an~ State :if Alasl<a requzremer'i'ts for. the set back an~ en].ar'oB, m(an~ w~I1 ['eqt~.~.~ an additional permit, . .................... .... ~ i..~,,.,,r ~.-- r , ,.L,I. ,~ ,-... , iii ...., ~ ,,I,.,(.,, ,I by DOC Co. dba SULLIVAN WATER WELLS ' P.O. BOX 6/'0272, CHUGIAK, ALASKA99567 * TELEPHONE688*2759 OWNER OF LAND ADDREss LEGAL DESCRIPTION DATE-Started PERMIT NUMBER DEPTH OF WELL .~' ~' p~ I STATIC LI:VEL OF WAT£R FT. ~ t~ Ended DRAW DOWN GALS. PER HR K,N,, OF CAS,NG KIND OF FORMATION: From ~ Et. to ~ Ft C,¢l.£ leo ¢ ~le~ ~ ~/~O From From ~ Ft. to ~ Ft. OO~ ~4E~ From From Ft. to__ Ft. ~ I ~ ~ ~ From From. Ft. to Ft. ~0 -~ ~ . From ~om~q vt. to~/ vt. ~C ~Y a/ ~rom From Ft. to Ft. ~ ~dO~ & / From~ From {~ [ Ft. to~Ft. 1~ ~ < ~ ~3Tl ~ From~ From ~Ft. to Ft. ~< ~ From From~ ~ Ft. to ~O~ Ft. ~d~0~ ~C/~ From From Ft. rooFtree) l O '--C o ~ ¢ ~A r~ From From 20 Ft. to~Ft.~o~* <~znC< From From ~Ft~/~;. ~0~ From From~Ft.~ Ft. ' From Ft. to Ft. to __Ft. to Ft. to Ft. to Ft. to Fl. to Ft. to.__ Ft. lo .Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to __Ft. to Ft. to__ Ft.¸ Ft. Ft. Fl. Fl, Ft. Ft. Ft. Ft. Ft. Ft. Ft. FRECEIVFD rt. APR '~ 6 i~91 Ft. Municipality of Ancl~orag. e 13~,r{.tH~.~lth & Human Services Ft. 70 .g'¢ ?T' ~ U N I C ]' P A L I 'F ¥ 0 F A N C H 0 R A G E Depa~"tmen{ o~'~ Wealth & Human Services $25 L St. reet~ ~nchopage, Alaska 99501 0 N .... S I T E W E L L P E R R I T 'ermit ~4umber: 890008 Date Issued: 01/26/89 Upgrade Gwner Name: AHFC wnet- Address: PO BOX ~.0:1.020 ANCHORAGE ~ AK 99510 Day Phone: 694-2979 RaPE:el Id: 051-50~-06 Lot Legal: Subdivision: SLEEPY'HOLLOW ~] Lot: 11 Block: Section: 15 Townsh~.p: 15N Range: 1W Lot Size 35098 tsq. ~'t. or acres) Max Bedpooms: This Perm¢:t: 0 Total Capacity: 4 ELL: Log must be submitted t.o Municipality o~ Anchorage Department o~ Health nd b~luman Sepvzces within 50 days o¢ well cempletion. NS'FALL PER LOCATIGN ON ENGINEERS AT"] ACHED PLAN. THIS PERMIT ~,S ISSUED F'OR TNE EXISTING 4 BEDROOM RESIDENCE ONLY AND EXPIRES N 12/31/89. CERTIFY THAT: ~,,. I a~ ¢amiliar, with the peqL~iremen~2s t'op on-sit~ sewer's and wells as set forth by {he Municipality of Anchorage (MOA) and the ~ta't.e of Alaska. 2. I will install the system in accordance with all MOA codes anci Regulations, and Sn complzance with the design cpitePza oF this pePm&t. 3. I ~J. ll adhere to all MO~ and State of Alaska requirements ~'or' the set bacl< distances fr. ol~ any exist:lng we].]., wastewatep disposal system o~ public sewepa?e system ~n {his on any ad.]aE,:ent on neaPby lot. 4. I understand that ~pepm~t ~s valid ~or a maximum ot 0 bedrooms. I also undel stand~ at,~e ~apacity ~¢ the t.~tal system is 4 bedrooms and any enlargemel~w ~ui~e an addit, ional permit,. SCALE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nam? DISTANCES ^dd,eas'~"~'~' ~1 ~ ~ ~ ~' ~ SEPTIC ABSORPTION WELL Phone(s) J Perm,t NO. No. ol B s WELL Lot ~ Block ~ ~/ ~~[ FOUNDATION ~' Township, Range, Secbon / Material No. o~ Compa~ments TYPE OF SYSTEM ~ TRENCH ~ED ~ W. DRAIN ~ OTHER or,g,nalg,adeDep'ht°p'peb°tt°mlr°m ~, ~ FT Tomldepthiromong,n. gmde ~FT Zo~al a~socptlon area Dlslan~ ~lwee. h.es ~OOSQFT ' ~ FT Number o, knes Soil rahng Pipe matenal - PRIVATE [ THER {Identify) . . ~, .. ~ ~ Date installed: I M U N I C I P ~ t [ '1' Y 0 F A N C H O B A G E Dep~-t~me~L ~,¢ !'~:.:,-:~].t.h & Human Services 8~75 L. Street~ Anchorages. Alaska 9950~ 0 N S I T E S E W E R I:)' E R M I T F',.:,~mtt Wumber~ 880255 ;.a~ ........ ued: I 1/17/88 Eli 1 ar' gement Enqineer Designed Uwner' Name: ALASKA HOUSING FINANCE CORP. -'.~w,~,:~' q,'ph-.~ .... ]~,'~) i-. ~:.;4 AVE. ANCHORAGE. AK 99504 Day Phone: 694-5500 ~ection: 15 fo~nship: 15N Range: 2W ~!-~,¢ Oedrooms: f'hJs Pe~-mit: 1 Total Uapm~' J(.y: 4 !.d::.l,i IL I¢,~I~]!-:: "l*nt'fdjm total septic tank capacity: 1,250 gallons. Each septic i.,_~]d., must t~ave at lea~'f. 2 compartments., DepLh Lo top el sept zc t~nk (s) <: 4. n Ceet t'equzpes insulation over Lank (FJ). INSTALL PER ENGINEERS AF~ACHED DESION,. NDI'IFY DHH8 PRIOR 'TO EACH 1NSF'E.t;i ION BY ]HE ENGINEER. f'HIS PERMIT IS ISSUED FOR THE EXID'I iN~J 4 BEDROOM RESIDENCE ONLY AND EXPIRES ON 12/31/88. t ;I-,1( I ~l I HAl": 1 am [amiliar with the requirements {op onrsite sewel, s and wells as set ¢~u' Lh by t. he Municipality of Rnchopage (MOA) and t, he State o¢ Alaska. i w~],l install t. he system in accordance wit. h all MOA codes and regulat, ion~. . ..... ~ :i compliance with the design criteria o~ this permit. .I w~l.] adhere t,o all MOA and State o~ Alaska requirements ~or the set back :~:v,L~.~ces ~rom any existing well~ wastewater disposal system o~- public )n this or any adjacent or nearby lot. this permit :~s valid ~or a maximum of 1 bedrooms. I th~ capacity el Lhe {oral system is /4 bedrooms and will require an additic)nal perm.iL~ ~ ~ (Owner) HOUSING EINANCE SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~ [~ ~'~'~-~ 1 2 3 4- 5 8- 9 10 11 12 13 14 15 16- 17~ 18- 19- 20- COMMENTS DATE PERF OR~ Township, Range, Section: -'~'~ ~"i,~ t ~..~ L.j i _~'.~.-~ ii ~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 ,¥ I t /,. S IF YES, AT WHAT ~ DEPTH7 p Reading Date Dross Net Depth to Net Time Time Water Drop ~ I\-~ t~-', ~' ~ "5' ( ~..- -~ .,- PERCOLATION RATE 14 {minutes/inchl PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND [o FT PERFORMED I~Y: I CERTIFY THAT THIS TEST WAS PEREORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THtS DATE. DATE: 72-008 (Rev. 4/85) DEPARTI~T~NT O'F HEALTH & ENVIRONMENTAL PRO~ ~CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~ DISTANCE TO: Well ~Z Dwollin~ PERMIT NO. ~_~O < Manufacturer ~ '/~ Material Liquid capacity in gallons ~ DISTANCE TO: Tren ~ No. oflines ~ ~ Lengthof~]i. Total leng~l~es ' ~ Total effecti absor n N~] Top of tile to 'i~ish .fade ~ Length Width .~/ Depth PERMIT NO, ~ ~ Type of crib Crib diame er ~ _ Crib depth Total effective absorption area ~ Well Building foundation Nearest lot Bne ~ DISTANCE TO: . . Class~/~W ~,Dep~ ~T/ ~& Distance to lot line PERMITNO. ~ DISTANCE TO; Building foundation Sewer line Septic tank Absorption area(s) PiPE MATERIALS SOl L TE~T ~ATI NG 'NsTALLER/~ REMARKS / , ' ~ ' PH, 694-2979 Permit ~ Applicant: Location: Department MUNICIPALITY 0F ANCHORAGE Health and Environmentalrotection 825 Street, Anchorage, AK. ~501 264-4720 * * * HANDWRITTEN PERMIT * * * ~ ON-SITE SEWER PERMIT Mailing Address: R3 ~ I/~ ~c/~- Phone Number: Legal Description: Type of Soil Absor~ System Is: Trench: ~/ Drai~field: Maximum Number of Bedrooms: ~ Seepage Bed: not size: Holding Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH /O t LENGTH c~-~f GRAVEL DEPTH ! .. WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall ~ipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /0Q CD GALLONS * * Permi~ applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * ~ Backfilling of any system without final inspection and approval by this departmen- will be subject to prosecution. Minimum distance between a well and any on-site s~wage disposal system is 100 fee' for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if  ~modeled to include more that 3 bedrooms. Applicant f Date: SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: Lo-,- ~. t "~.-K, 1 2 4 /0o 5 6 7 8 9 10 11 12- 13- 14. 15- 16- 17- 18- SLOPE WAS GROUND WATER ~,~/~'rpSENcou NTER ED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water , Drop 20- ~. ~/~ PBRCOLATION RATE {minutes/inch) COMMENTS TEST RUN BETWEEN ~ ~ FT ;~ ~ ~ ~ CERTIFIE PERFORME~ ~: ...... ~ ~A ~ DATE: ~'"F~:'~~ ~ - / / 72-008 (6/79) Mumc pality o.f Anchorage Developr ent Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING Pamel I.D. 051-501-06 GENERAL INFORMATION Complete legal description SLEE~¥ HOLLOW #1, L°T 11, BLOCK 2 Location (site address) 3.8895 MOUNTAIN ROAD, CHUGIAK, AK F)567 Current Property owner(s) STEVEN & TARA HAAS Mailing address Lending agency" Mailing address * Real Estate Agent Mailing Address Day phone__ POBOX230283, ANCHORAGE, AK 99523 Day phone__ LES BAILEY & ASSOC. - KW Day phone__ Unless otherwise requested, COSA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE ,OF WATER SUPPLY: Individual Well Individual Water Sto'rege Community Class__ Well Public Water System 4 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 tiUe (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 pdvate 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. = FILE COPy As certified by my seal a~xed hereto and as of the va~fda~on date shown below, [ ve~ that ~ invesfi~aUon, based on procedures ou~in~ in the Ce~ficate of On-$ite Syste~ Approval Guidelines for ~is appficafion, sho~ that the on-site water supp~ and/or wastewater dis~sal system is (ere) safe, ~nctionai and adequate for the number of bedrooms end ~pe of stru~ure indicted herein. I ~Aher veri~ that based on the informa~on o~ined from the Municipali~ of Anchorage files and from ~ inves~gation and inspe~on, the on-site water supply and/or ~ewater disp~a[ system is(are) in compliance ~th all appU~b/e Munidpal and State codes, o~inan~, and re~ula~ons in effect etthe ~me ofins~llafion. Name of Fi~ ~~ CONSUlTiNG, ~NC. Phone Address 20~I PT~IGAN BL~v EAGLE ~ER, ~ 99577 Engineers Pdnted Name .. KENNE~ M. D~S Date ~ Engineers Commen~: This inves~gaUon was complet~ in compliance ~th ADEC and MOA mguaUons. ~e a~e~ment of the condi~on offfie well and se~c applies on~ to the condi~ons as offfie day tes~d. ~e flow and a~o~t on rotes ~y Change due to su~U~ace condi~ons ~at may not ~ o~ew~ from ~e suEa~, ~anges inland use, Io~1 soil chara~ed~, groundwater levels that ~y flU~uate during ~e year a~d the w~er Usage of the ~mi~ being ~wed by the s~tem. ~e operational life of all well and septic systems am subject to these va~ous and dynamic cham~e~s~ and are o~ide the ~ntrol of the evaluator of the well and se~c system. Therefore, · ArcTerra can not give any estimate of how long a system will function satisfactory for current or futura occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory x 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 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni~org/onstte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SLEEI~ HOI:LOW #1, LO~ 11, BLOC/<: 2 Parcel ID: 051-501-1~ A. WELL DATA (*Propert7 also served by c~ass 'C' well---see MOA records) ' WeltypeJ~V'A~lfA B orC~idepWSlD#,21 iZ2 . Date completed 2~6//989 Sanite~/seal (Y/N) Y I/~res properlY protected (Y/N) ¥ Total del~h ~42 ff. OaSedto 70 ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 2,/6~998 3/28//1 Static water level . 52 ft. . 53 ft. Well production I.S: g.p;m. *'1.5+ g.p.m~ 2~ in. WATER SAMPLE RESULTS: Coliform NI~G .colonias/100mL Nitrate .. 3.7 rng/L Arsenic: :ND rng/] Date of sample: 3/28//1 Collected by: Arc'I'ezza B. SEPTIC/HOLDING TA'NK-DATA - PUBMC SEWER Tank Type/Material Septic/Steel Date installed. 9/3//999 Tank size :1250 gal. Number of Compertmenls 2 Clean°uts (Y/N) ¥ Foundation cleanout (Y/N) Y__Depression Over tank (Y/N) __N High water alarm (Y/N) :N Date of pumping --,~ZZSZ?,J~_L Pumper JRS C. ABSORPTION FIELD DATA - PUBLIC SEWER Date installed . 8//999.' Sollmting' (,q.p.d./ff20rfl=/bdrm) 0.8/:1.0 System type ~ Width 2.5/3.0ft. Gravel be ow pipe 7.6/0.5 ff. Totaldepth~14.!/3.3 ft. (measured 3/28/11) Length _3Z/_6~ ff..:. Eft, absorption area 487/3:10 ~ Monitoring tube _ y Depression Over field _ N Date of adequacy tast~ Results (Pass/Fail) ~ For_4 bedrooms Fluid dep{h in absorption field before test 0/0 in, Water added 6O~/3SO gal. New depth _26/0 _in. Elapsed Time: ~ min. Final fluid depth :10,8/0,o in. Absmpfion rate >= 600+ Any rejuvenation treatment (past 12 mo.) (Y/N & type) N.~_lf yes, give date __ D, UFT STATION Date installed "Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons. "Pump off" level at.. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot. 1.00'+ Absorption field onlot 10o'+ Public' sewer main' ~+ Building foundation ,5'+ Water main 10'+ Wells on adjacent'lots in. Manhole/Access (Y/N) High water alarm level at... in. Meets alarm & circuit requirements? Animal containment areas SlY+ . : Manure/ammal excrete storage areas _loG+ SEPARATION DISTANCES FROM SEPTIc/HoLDiNG TANK ON LOT TO: Property line 5'+ Absorption field $% Water service line_L0.'+ Surface weter~oo,+ On adjacent lots.. 1.00'+ On adjacent lots 100'+ Public sewer ~ola/cleanGot 1.80+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: - PUBLIc SEWER Property line 10'+ Building foundation ~l+ Water main 10% Water Sewice line. 10'+ Surtacewater 1o0% Driveway, parking/vehiciestorage 10'+ Curtain drain~wella on adjacent Iots~o0, Prvt. ;& 1 SO' Camm F. COMMENTS oral constant flow t~on of 5,5+ ~ from. water s ~ fCca~m. G. ENGINEER'S CERTIFICATION .~ __ 'pal records that the above systems are in '~*'~" comonnanco with MOA COSA guidelines in effec~ on this date Engineer's Printed Name.. ~NNET~ M. Dt~'T, TS · . ..~ COSA Fee $490.00 Waiver Fee $ '~TA:[~p' ' Pete o .a mant )Il o , me.t Receipt Number 01 5 ~ ) C Receipt Number (R~v. 1~/05) MuniciPality ServiceS of Anchorage Development Department Building Safety Division On-Site Water & Wastewater Program ' ~ ~ 4700 Bragaw Street , ~ , P.O. Box 196650 ~ .~¢ Anchorage, AK 99519-6650 ii?o' ¢ ~ , ~,~,.: ~' www.muni.org/onsite · ~ ~ F'~': (907) 343-7904 ~ ~! TM CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 0~::~1', ~) i'"' C.~ 1. GENERAL INFORMATION COSA# Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SLEEPY HOLLOW #1; LOT 11~ BLOCK 2 18895 MOUNTAIN ROAD * CHUOIAK AK 99567 WESLEY &: MARIA KERLIN Day phone 688-8910 18895 MOUNTAIN ROAD * CHUGIAK AK 99567 Day phone BROOKE STILTNER w/ REMAX Dayphone 244-6742 16600 CENTERFIELD DR. * EAGLE RIVER, AK 99577 Unlesso~erwisemqueste~ COSA willbeheldbyDSD ~rpick~. 2. NUMBER OFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DS[:)) 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 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 bedreoms 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 3701 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 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. Safisfactoq/ test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encreachments. GEG, LTD. can therefore not provide any warranty or future estimate dhow 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. owing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: ;z. 3- o'7 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 CHECKLIST Date of test Static water level Well production WATER SAMPLE RESULTS: A. WELL DATA Well type PRIVATE Date completed 2/6/89 Total depth ,342 ft. Coriform 0 Arsenic: ND B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1250 gar. Number of Compartments__ Foundation cleanout (Y/N) YES Date of pumping 5/29/2007 C. ABSORPTION FIELD DATA Date installed 8/1999 Length 32/62 ft. 467/+ Total depth 14.6/7.1 ft. Elf. absorption area 510 ft= Monitoring tube YES Date of adequacy test **,3/29/2007 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 1592gal. Elapsed Time: 1010 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) 2 Depression over tank (Y/N) NO Pumper. L*DEEP~ Soil rating ~or ft21bdrm) 0.8/1.0 Width 2.5/5.0 ft. IfA, B, orC provide PWSID# N/A Sanitary seal (Y/N). YES Cased to 70 ft. FROM WELL LOG 2/6/1998 52 ft. 1.5 .g.p.m. *CLASS "C" WELL. **PRIVATE WELL *,3.05/ colonies/lO0 mi. ug./L. AT INSPECTION 5/29/2007 5,3 1.5+ Nitrate **5.88 mg./L. Other bacteria 0 colonies/100 mi. Date of sample: ,3/29/2007 Collected by: GEG Ltd. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. g.p.m. Date installed 8/9-9/,3/1999 Cleanouts (Y/N) YES High water alarm (Y/N) N/A JR's PUMPING in. Absorption rate >= NONE KNOWN System type *DEEP TRENCH/ 5 WIDE Gravel below pipe 7.6/0.5 ft. Depression over field NO For 4 bedrooms New depth 27 in. 600+ g.p.d. If yes, give date - *THERE IS ALSO A BED THAT WAS INSTALLED IN 1989. BED IS 12' WIDE X 25' LONG, WITH 0.5' EFFECTIVE **TESTED DEEP TRENCH OF 1999 SYSTEM Legal Description: SLEEPY HOLLOW SUBDIVISION #1, LOT 11, BLOCK 2 Parcel ID: D. LIFT STATION Date installed Size in gallons ~ ~ ,,Pump on" i~ 'igh water alarm level at__ in. ~ ~ C~ts alarm & circuit requirements.'?. E. 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'+ 100'+ 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'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ Pv'r &: 150'+ CLASS C SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'-F Curtain drain NONE KNOWN F. COMMENTS *WAIVER PREVIOUSLY GRANTED" Absorption field Surface water_ 5'+ 100'+ Building foundation. '8'+ Water main Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots.lO0'+ PVT &: 150'+ CLASS C 10'+ 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 COSA Fee $ ~/"'~© '~' 1 73 ~ ',J,<~ [-'1 Date of Payment Z/,'%~ ~:~ _ (D '7 Receipt Number '7 '9 ~ CO C~ (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Mumcipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewatcr Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsit¢ (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 070112 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 11 of Sleepy Hollow #1 subdivision. This inspection revealed a nitrate concentration of 5.88 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. · 9~'~SF_Z: ol Municipality of Anchorage Development Services DePartment Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D, 051-501-06 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING HAA C)qb© Expiration Date: ~"- Complete legal description SLEEPY HOLLOW SUBDIVISION #1; LOT 11, BLOCK 2 Location (site address or directions) 18895 MOUNTIAN ROAD *CHUGIAK , AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN AND KlM BUGOENHAGEN Day phone c/o ROGER MORRIS w/ PRUDENTIAL VISTA, EAGLE RIVER Day phone ROGER MORRIS w/ PRUDENTIAL VISTA Dayphone 689-1812 16635 CENTERFIELD DRIVE *EAGLE RIVER AK. 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 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 vafidation date shown below, I verify that my investigation, based on procedures outlined in the Health Authofity 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 structuro indicated herein. I further verify that based on the information obtained from the Municipality of Anchoi'age files arid from rhy 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 ALASKA WA]:ER & WAsTEWATER CON~ULsANTS, INC. Phone Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREW A. OARNESS, P.E. Date 557-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a ti~o/ab-gh, conscientious engineering analysis of the system in accordance with ADEC and ~OA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the teat, and separation distances measured to readily identifiable features. The operational life dali welts 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. AKWWC, Inc. 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. 5. DSD SIGNATURE Approved for ~-- bedrooms. Di~pDi'oved: · Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: ~-. ON-SITE : ~. ~-~=: WAT.~R AND == :. WASTEWATER ~ ; PROGRAM ." Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 12/01) Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SLEEPY HOLLOW SUBDIVISION #1; LOT 11, BLOCK 2 Parcel ID: 051-501-06 *THIS PROPERTY IS ALSO CONNECTED TO A COMMUNITY WELL LOCATED A. WELLDATA ON LOT 15, BLOCK 1; SLEEPY HOLLOW SUBDIVISION #2 in. Well type PRIVATE IfA, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 2/6/89 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 342 ft. Cased to 70 ff. Casing height (above ground) 18+ FROM WELL LOG AT INSPECTION Date of test 2/6/98 1/2,3/2004 Static water level 52 ft. 53 .ft. Well production 1.5 g.p.m. 2.2+ .g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N/A mg./L. B. SEPTIC/HOLDING TANK DATA Nitrate 4.36 mg./L. Other bacteria 0 colonies/100 mi. Date of sample: 1/16/2004 Collected by: AKWWC, INC. Tank Type/Material STEEL Tank size 1250 gal. Number of Compartments 2 Depression over tank (Y/N) NO Pumper JR'S PUMPING [*DEEP TRENCH/ 5 WIDE] Soil rating ~rft2/bdrm) 0.8/1,0 Width 2.5/5.0 ft. Date installed 8/9-9/3/99 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Foundation cleanout (Y/N) YES Date of pumping 1/50/04. C. ABSORPTION FIELD DATA Date installed 9/5/99 Length 52/62 ft. System type *DRAINFIELDS Gravel below pipe 7.6/0.5 fl. Depression over field NO For 4 bedrooms 27.5/ New depth 0 in. 135-_164/ (487/.310) Total depth _ft. Eft. absorption area 797 ft2 Monitoring tube YES Date of adequacy test 1/25/2004 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0/0 in. Water added 1352gal. Elapsed Time: 560 min. Final fluid depth2.5/0in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN 600+ g.p.d. If yes, give date - D. LIFT STATION Date installed Size in gallons M~ "Pump on" level at~' ' ' High Water alarm level at .in. Da.~tum. ~ Cycles tested Meets alarm & circuit requirements? E, SEPAF~ATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100% Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhoie/cleanout Holding tank N/A SEPARATION DISTANCES FROM SEP'i'i(~/HOLDiNG ~ANK ON LOT TO: Building foundatiori 5'+ ProPerty line 5'+ Absorption field Water main 10'+ Wa'[er service line 10'+ Surface water. N/A 5'+ 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIEL© ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN BuilcJing fGundati0n 18'+ SurfaCe water 1 dS'+ Wells on adjacent lots 100'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ F. COMMENTS *WAIVER GRANTED WITH SIGN OFF ON AS-BUILT PACKAGE G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections bnd review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date, Engineer's Printed N~.me JEFFREY A. GARNESS Date Date of Payment ~-/~/04 .ece ,t Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number =eb-20-04 02:45P Permit Counter 907 343 8250 VISTA REAL ESTATE ER P.O1 I HEREBY o-ERTIFy ,THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNE~ TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED 5UBDI~ V/SION PLAT. UNDER NO CtRCUMSTAN6ES SHOULD ANT DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY L~NES. SCAt. E>,.:_ ,.o,~ / DRAWN; SEWARD & ASSOCIATES LAND SURVEYING 694-082q ','/4~ "~ % - 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. # 051 -50t -06 1. GENERAL INFORMATION Complete'legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 11; Block 2; Sleepy Hollow #1 Location (site address or directions) 18895 Mountain Road chugiak, AK Property owner Mailing address John Buggenhagen Dayphone 263-4857 P.O. Box 670031 Chugiak, AK 99567 Lending agency Mailin. g address Day phone Agent Add ress. Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: Individual well Community well Public water xX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Xx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 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 dis ordinances, and Name of Firm Address Engineer's Signature ;posC~~.~pliance with all Municipal and State codes, rig u lati°~a~qtl~a~rot~t~h ~.s pection-  ~L Date ~ q ~ DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. performed to insure the wells continued suitability. Current nitrate More information on nitrates is available from the On-site Services Program, D1{tiS, 343-4744. Additional Comments 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 pu mhasem 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, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES~~ Environmental Services Division OCT 7 ]999 825 L Street, Room 502 · Anchorage, Alaska 99501 · ENVIRON~EN~AL SERVICES DIVISION Health Authority Approval Checklist Legal Description: A. WELL DATA Well type PRIVATE Log present (Y/N) Total depth Sanitary seal (Y/N) 342' SLEEPY HOLLOW ~1; LT 11, BK 2 ParcelI.D.: 051-501-06 If A, B, or C, attach ADEC letter. ADEC water system number YES Date compleled Cased to 70' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform r~ Date of sample: .~./~R./~ B. SEPTIC/HOLDING TANK DATA Date installed 8/9/99--9/3/99 Foundation cleanout (Y/N) Date of Pumping NEW C. ABSORPTION FIELD DATA Date installed 8/9/gg-9/3/gg YES 2/6/89 Casing height (above ground) 2'+ Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION 2/6/98 3/8/99 52' ,54' g,p.m. ?.~ g.p.m. Nitrate 664 ,~g,/~ Other bacteria Collected by: A.W.W.C., INC, Tank size 13,~n Number of Compartments ;Z Cleanouts (y/N)YES YES Depression (Y/N) NO High water alarm (Y/N) NO Pumper - ,:: SEE AFl'ACHED L.~, ,~.R. I *[NORTH/SOUTH] 2.08 FEET OF M.O.A. APROVED SAND FILTER BELO~ SEWER DRAINROaK. *DEEP/SHALLOW Soil rating (g.p.d./fF or fF/bdrm) **..~_QJ~ System type TRENCHES Length *__~3.2.,~/_~?.~Width ~ Gravel thickness below pipe* *_7_.a~ Total deptl~l 3-14'/5-6' Effective absorption area 797 SO FT Monitoring Tube present (Y/N) YFS Depression over field (Y/N) NO (4B7/310) Date of adequacy test N~/ Results (Pass/Fail) For ...~---~--'~edrooms Fluid depth in absorPtion field before test~dded (in,): · FI~ Absorption rate = ,cl.p.d. · reatment (past 1,2 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION ~ Date installed Size in Manhole/Access (Y/N) "~at'''~* "Pump off" level at* High water alarm ~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 1 N/A Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout 100'+ 100'+ 25'+ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundalion ~'+ Property line ,5'+ Absorption field 5'+ Water main/service line 113'+ Sudace water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10'.4- Building foundation '8'+ * SEE ATrACHED LETTER Water main/service line 10'+ Surface water 1 ~3n'+ Driveway, parking/vehicle storage area 10'+ Curtain drain Nt3NF KNC)WN Wells on adjacent lots 100'+ ield inspections and review Yelines in effect on this date. F. ENGINEER'S CERTIFICATION · I certify that I ha. yeT/ in conformanlwith/ Signature Engineer's Name Date /a/-Z ./~/ HAA Fee $ Date of Payment Receipt Number ' A. GARNESS Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-50].-06 HAA# GENERAL INFORMATION Completelegaldescription Sleepy Hollow #1, Lot 11, Block 2 T15N R1W Sectionl5 Location(siteaddressordirections) 18895 Mountain Road, Chugiak Property owner Mailing address Lending agency Mailing address Agent Address Robert A & Christi C. TomlinsODayphone P.O. Box 672121, Chuqiak, AK 99567 N/A Day phone 786-5180 N/A Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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) Fronl MOA #21 '){JOM s,Jeou!l~ua 18uo!ssejoJd eqJ u! suo!ss!~uo Jo sJoJJa JOj elq!suodsm 1OU S! e§'eJoqouv J~o /,4!led!o!unI,N eqJ. 'panss! s! e~.~ojjj~Jeo e e.~ojeq e~.~p ezXleUe JO suo!loedsu[ lonpuoo :rou op SHHQ jo seaXoldLu'; 'sluawa.qnbeJ e~.e~.s pue leJepej u!e~Jeo,~s!~.es o~, Jap Jo u! suo!~n:!.!lsu! 6uipuel .qaql pue sewoq jo sJeseqo.~nd ol Xsepnoo e se s!q~, seop SHHQ aqJ. 'mlSel¥,to a~.eiS aq:; u! pa~e:~s!6aJ Jaau!6ue leUO!SseJ, oJd ~uepuedepu! ue ,~q e^oq~ cj qde~aeJed u! ua^j6 suoRe~.uese.~deJ eq~. uodn ,~luo pes~q se~.eo!j!Meo le^oJdd¥ X~.poq~.nv qlreeH sanss! ($HHQ) seovua$ uemnH pue q~.l~eH J.o lueuJ.pedeQ e6eJoqouv jo ,~.!led!o!unlAI eqJ. S~UeWLUO0 IgUO!I!PPV :suo!~elndR. s I~U!MOIIO,t eql ql!M 'SUJOOJpeq Jo,t Ig^oJddg IgUO!~!puoo 'pe^oJddes!Q 'SLUOOJpeq ~, Jo~ pa^ruddy ~- 31:1¢1/'¢N OIS SHHQ //.,966 ~ '.zeAT~ eT. bg2 "~6E£££ xo~ 'O'~ sseJppv "9 ~bL~-~69 aUObld ~;¢U~.A..].~¢-~ buT-zeeu~..6u2 ,ZeAT~ eTbe3 LUJ!.-IJOaUJeN 'uo!!.oadsu! s!q:~ ,to e~.gp eq:~ uo :!.oej,ta u! suo!~,glnbaJ pug 'saoueu!p.~o 'sepo::) e3g:lS pue led!o!unl~ llg q~,!,v, eougildLUo3 u! s! LUe~SXS lesodslp Ja:!.g,~al.se~ Jo/pug Xlddns J@~e,'~ e~.!s-uo eq~. 'uop,::)edsu! pue uo!~.eaR, se^u! ~u~ t.uoJ,t pue Sel!,t e6e.~oqouv j.o &!led!o!unlAI aLI~ t.uoJ,t peure3qo uo!;,guJJolu! eq:l. uo peseq 3gq~. X,t pe^.~aq~J n,t I 'u!aJeq pa:!.go!pu! a]n~.onJls.,to edX1 pug sLuooJpaq ,to JaqLunu aq:!. Jo,t e!.enbepg pue leuo!~.oun,t 'e,tes s! uJa~.sXs Igsods!p Je~.e,v,e:!.sg~ ~o/pug Xlddns Je:i.e,'v, el!s-uo eql :f. gq:!. s~oqs uol].g::)!ldde Ig^oJddv X~,poqlnv qlleeH siql ,to uo!~.e6Flse^u! ,~.,,.u ),eql ,~,tpe^ I '/~olaq u,~oqs e~.ep uop, gP!le^ eql ,to se pug o~.e~eq pexij,tg IgaS XLU Xq pe!,t!:!Jao s¥ t~=I=INI!DN=1 Ag NOIJ.O=IdSNI dO .LN'=IIR=IJ.V.LS '~ C. LIFT STATION ~ Date installed Manufacturer Size in gallons Manho. gJe/-A~ss (Y/N) Vent (Y/N) "Pump on~ ,.-~ "Pump off" level at High water alarm level ~,--'~ ~ I '__ Cycles tested Meets MOA electrical cod. es~/N) SEPAR~E FROM LIFT STATION TO: ,,,.~e~.~r~ lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed /?J"~ Length /~£/~;/t~,~.,/~' ~Nidth /~q///Z ' Total absorption area {~Z Depression over field (Y/N) /~/O Results (pass/fail) /~ Peroxide treatment (past 12 months) (Y/N) Soil rating ~ System type Gravel thickness ~ /' Total depth Cleanouts present (Y/N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / To building foundation On adjacent lots Surface water ~//'~ Curtain drain On adjacent lots / / ~ Property line ~C~,~-b To existing or abandoned system on lot Cutbank ~///¢ Watermain/serviceline Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Engineer's Name Date HAA Fee $ . . Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91 ) Sack MOA 21 Municipality of Anchorage ~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ (--~¢t~Y #O'lX~b~ ~ I A. WELL DATA ~5~ ~/~ ~/~/~ Well type ~/~ If A, B, or C, attach ADEC letter. Log present (Y/N) Y~5 Date completed Parcel I.D. 0~/- ~BI -OL~ Total depth Sanitary seal (Y/N) ADEC water system number ~-~/~//~/ Driller Cased to ~' z~-/b,~O~. Casing heigh¢?~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow .~-'-~- ~ g.p.m, 3~ ~' g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Pebl~ sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~//~ ~/~ /'~ ~/Z- Other bacteria Collected by: B. SEPTIC/H~L~Nt~ TANK DATA Date installed /]~ /,27,-~/4,/b4._, Tank size / ~0 Compartments Cleanouts (Y/N) )/¢ .5 Foundation cleanout (Y/N) YC ~ Depression (Y/N) High water alarm (Y/N) /V/~ Alarm tested (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t~¢ / On adjacent lots To propertyline --~0 / Absorption field Surface water/drainage /-i/~ Foundation Water mai n/service line 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 11: Block 2: Sleepy Hollow Location (address or directions) (b) Property owner Mailing Address AHFC #51822 Telephone: (home) 520 E. 34th, Anchorage, Alaska _Business (c) Lending Institution Mailing Address Telephone Jack White Co.- Lori Crowder (d) Real Estate Company and Agent 10928 Eagle River Road, Eagle Rive£, Ak. 99577 Address Telephone 694-5500 (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms 4 3. WATER SUPPLY Individual Weil~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E~ Public E3 Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Name of Firm __ Address _ Date 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. · Telephone ~'*¢,z/Z~ ~...¢~ ~' S & SENGIN~'r'I<ii4G 17034 Eagle Rifler Loop Road No. 204 Eagle River, Alaska ;~"577 ~ .-.- ~ ~ DHHS APPROVAL Approved for _ Z~ Approved ~ bedrooms by. . ~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Emp oyees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption.Strata'~c~r? ."' "~.~c~ ~ Type of System Design~,~,~t~G~-o Date Installed '¢¢'-~,/~"z2 '- I¢'"/4~;~ Length of Field '~¢~\'~2 --- Width of Field '~ 1 "z.-~ --U~-' Depth of Field .¢4. ~ ~.~~ Gravel Bed Thickness ~ ,'~¢' Square Feet of Absortion Area t-0¢'O .?~:--~ Statndpipes Present~C~/N) "7' Depression over Field (YC~j) ~ Date of Last Adequacy Test I Results of Last Adequacy Test ~:::¢~ccd~l~ ~ ~ ~,-'1~t(-~~ ~-' ~ / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ 1.~ To Property Line tc~ I To Building Foundation \'7 To Existing or Abandoned System on Lot ~//~ ; On Adjoining Lots To Water Main/Service Line ~.~4r- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~ ~ To Driveway, Parking Area, or Vehicle Storage Area '¢~ ~ Comments ~ ~ c:~¢~,zT:'''%-- ~('2-",~=~.~C~ D. LIFT STATION I~I~ Date Installed i~llons Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signed ......... ;.--, -~,- ~^-,~ ~,- -.,. Company Eagle River, Alaska 995~7 Date ~"' ~ '- '~' ~' MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) (,~1~'~1 Health Authority Approval (HAA) MUNICI~IJ~;~^NCHO~A~HECKLIST- FEBRUARY 1984 ENVi~,ONME'~I~ E RVICES DIVISION 343-4744 MAR ~ ]989 Legal Description: ~ t~. "~-,~ A. WEL'DA A RECEIVED ' Well Classification ~--~C;~, DO,/~'t.~ If A, B, C, D.E.C. Approved (Y/N) WerlLogPresent~'l~) V // Date C~mpleted '2.-/~,~ ~../~,:~ Yied '~,'~ Total Depth'-"~'J-, Cased to '~ O Depth of Grouting - Static Water Level ~-Z.-' Casing Height Above Ground Electrical Wiring in Conduit~l) \/ SEPARATION DISTANCES FROM WELL; To Sept c/Ho d ng Tank on Lot To Nearest Edge of Absorption Fiel[..~ oP Lot To Nearest Public Sewer Line To Nearest Sewer'Service Line on Lot Water Sample Collected by ~, S Water Sample Test Results ¢¥'~"~'"/[~:~ ~ ~',~> ~_~, Comments Pump Set At Sanitary Seal on Casingd,~YN) / Depression Around Wellhead (Y~) ; On Ad oining Lots \ v~ ~,. ~1~. ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK D.a~TA Date Installed I~--?,---'~l-'~Size Standpipesd~/N) '-f Depression over Tank (Y~) Pumping/Maintenance Contact on File (Y/N,) Holding Tank High-Water Alarm (Y/N) t'~/~ ~ \'~_.'~"-o No. of Compartments Air-tight Caps~YN) y ~ Foundation Cleanout~[~N) ~ ~ Date Last Pumped " ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HO/LDING TANK: To Water-Supply Well ~ 4:~:~--~ v/' To Building Foundation × To Property Line '~ ~ A.-- To Disposal Field To Water Main/Service Line ~ ~-k- To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 Parcel I.D. # MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 0~-/ ,¢'~/ 0~ HAA# ~\~- ~"~'C'~LI 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (inClude 10t, block, subdivision, section, township, range) (b) Property owner Mailing A~dress (c) Lending Institution Location (address or directions) ~.'~,~", ~---~. Telephone: (home) Telephone Business Mailing Address (d) Real Estate Company and Agent ~ ¢¢¢1'~''~' ~---~;~. -- ~ Address l ~'~i ?_~[~, '~::~._.[~¢-~ ~kJ,,~.~ ~. Telephone ~O~'~ ~'~' Co (e),.~he HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: $ & $ ENGINEERING 17034 Ea~lle RiYer Leap Road Eagle River, Alaska 99577 2~ TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Comm un ity,/~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. sEWAGE DISPOSAL On-site.,~"' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ~ ,to ~ ~ed ')~JOM s,Jaeu!6ua leUO!SSe,LoJd eq~, u! suo!ss!wo Jo sJoJJa JOj elqisuodsaJ lou s! a6eJoqouv,to X]!led!o!unlAI aql 'panss! s! aleoi,tBJeO e aJo,Leq e]ep aZXleUe Jo suoBoadsu! ~,on p uoo ),ou op SHHQ jo saaXoldLU3 's~ueLuaJ !nbaJ m,e~s pue leJape,L u!eiJeo X,tsBes oh Jap Jo u! suop, n]Bsu! 6u!pual J!eq);-pue sewoq ,Lo sJeseqoJnd oh Xse~Jnoo e se s!ql seop SHHQ eql 'mlSelV ,to elelS aql u! Jaeu!6ue leUOiSS@,LoJd ~uepuad@pu! ue Xq a^oqe S qde,15eJed u! UaA!6 suo!~ejuasaJdeJ eq~ uodn/~lUO peseq pe]eo!,Lpeo le^oJddv/qpoq~,nv q~leaH sanss! (SH HQ) sao!^JaS UeLUnH pue q~leaH jo ~UeLUiJedea eaeJoqouv,Lo Xl!led!o!UnlAI eqJ. le^oJddv leUOB!puoo ,LO SLUJe/ leUO!l!puoo pa^oJddes!a ~- pa^oJddv ~ S/,/~2~ Aq suJ°°JPeq~-FJ°,t Pa^°Jddv 'lYAOl:tdd'¢ SHHa '9 ~%~; '~N p~o~ doo'i Ja,~!B elbe~ t,$OZt, sseJpp¥ auoqdeleI w J!.4 ,Lo aLUeN C. ABSORPTION FIELD DATA Square Feet of Absortion Area I, ,oc:~,~-~ 'l-'~=,~,-t-- Statndpipes Presentd~[;ZN) Depression over Field (Y/i~E~ ~ Date of Last Adequacy Test I I ~ I - ~' SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well '~-~ To Property Line To Building Foundation /.~ [,~ To Existing or Abandoned System on Lot ~ ; On Adjoining Lots To Water Main/Service Line \ ,=~ i~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~ ~ ~-~ To Driveway, Parking Area, or Vehicle Storage Area ~ D. LIFT STATION Date Installed Dimensions  Manhole/Access (Y/N) High Water Alarm Level at ~ Vent (Y/N) Tested for ~during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ & $ F~N;ERING ~ Company 17034 Eagle River Loop Road No. 204 ~ Eagle R~,ver, A~aska ~'~ Date of Payment /~ [~' ~ Amount: $ ~ ~ ~ .O~ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) ~ (~-~1 , Health Authority Approval (HAA) l~ui,!;~:~" ~' ~ ':-' ~ECKLIST ' FEBRUARY 1984 /~',,",: L~'~;V'~'/,L :,',.' ._i.. [:',Vi~IC;;~ 343-4744 Legal Description: g~,:~,~ II ~--. A. WELL DATA ~ ?''' r-' -"~ ~ ~- ' ~' ~\ Well Classification f'~ If A, B, C, D.E.C. Approved ~N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot '~,¢::~'"'Y- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot "~ I-o' ; On Adjoining Lots To Nearest Public SeWer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 1_'~.-'7~-~, Size Standpipes (~ZN) Depression over Tank Pumping/Maintenance Contact on File (Y/N), / Holding Tank High-Water Alarm (Y/N)/~/' Air-tight Caps (~N) No. of Compartments Foundation Cleanout ~N) Date Last Pumped 1'~,~--~ V ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line ~. ,,~ IA" To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: · ~.¢;~-p/Jr' To Building Foundation To Disposal Field Comments 72-026 (Rev 7/88) Fron~ Page 1 of 2 Property Owner ,,/'~,~/~/~/ D~/'? 1,t' Phone Buyer~ Address Zip Code / Lending Institution . =t~z ~ .~ ~ ~.'" tx..~ ~ ~ ~ ~ ~.' ~. 't m' ~ Phone Address '~¢ ¢ -2 .~ ,~' r ~ ~* ~ ~ ~j ~ Zip Code .~¢¢ ~ ~ Sewer Disposal / ~ ~ Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector , ~ MUNICIPALITY OF ANCHORAGE RECEIVED !~...~ ) APPROVED BEDROOMS ZCONDITIONS OF APPROVAL ( ) DISAPPROVED DATE 8 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size