HomeMy WebLinkAboutSLEEPY HOLLOW #1 BLK 2 LT 5Sleepy Hollow
#1
Block 2
Lot 5
#051-501-12
Municipality of Anchorage
Development Services Department s
BuIldi Cattily DNWon
g
On-Site Water and Wastewater program, 4700 Elmore Road
P.O. Box 190850 Anchora0s, AK 99507 Page of
www d anchorage alc s (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 6WI00010 PID Number: 051-601-12
N.ay:
MARY 8 BILL INORAM
Wastewater System: ❑ New ® upgrade
MNMa
PO BOX 6671116CHUGIAK,AK92567
ABSORPTION FIELD
oimr N"mbertl e..mon.;
4
Uh PT—.h pcn.iwwTl..s pa.e 13W..d Oan..
LEGAL DESCRIPTION
0.6
old�p
12
12 r♦
at>a:2 La.5 MO"NaWi:
SLEEPY HOLLOW #2
O.pMbpq btllam.p.a�Nlp.da
QMda p1A0eYn Ppn:
a.6.2
8,8 pl
A
To,wal,P iGryr. i.a.n:
fa .ad...no.. bgbM p,M.
OrovN tapir.
1.3 n,
100
Ft.
Well: ❑ Now ❑ Upgrad0
omwwbn:
N"mbaaw.. tx,Ianap.N..e1 «:
To.I O.VN� G.rd a:
EXISTING
EXISTING PRIVATE
3 Fl,
ru1.Iab roa�au.
1 WA n
Ape M.Ipy.
ct n
loco 4 P,�
ASTM 30341ADS/F810
�+^'
er, Dune:
6u11, Wra t...i.
b.l.i.r
ONe M.a.a
n,
TWEED EXCAVATING
6/1812010
rrl:
� we:
cr.p N.Ipm reore aa".o
aPM
n.
pt
TANK
SEPARATION DISTANCES
Q1 Septio ❑ 1-lolding ❑ S T E.P. ❑ Other.
To
Septic
Absorption
UR
Holoi gPmta
,P.cn:
From
Tank
Fleld
6tation
Tank
Sawa Lire
ANCHORAGE TANK
1450
on
VUa
1014
100•+
27t
STEEL
STS
NVMeI eywbwee
2
awrwaWoar
100''
100''
LIFT STATION
ILAUi.$'
gat.
10'+Cb
VWV or Ywl".
wan"&"...a5•
Orb
NONE
KNOWN
Mamshl ,
!=TOP
fflew de.+ .",.p",la,.,mbp.
BENCH MARK
r CONCRETE AT POINT A
Aq.n. elpn:
100 M.
US En ne C
YInmp
Inspections performed by: 15861 S. Birchwood LP. Rdoatcs: 1" 61172010 C� �" �n... .
Clwrtplok,Alaska 99561 w�
nit 8/192010
J 2
Development Services Department Approval
Conditional Approval Data
1
a
a «viei ed and approved by:
PERMIT NO.SW100010
PAGE 2 OF 4
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.0
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL LOT 5; BLOCK 2; SLEEPY HOLLOW #2 P.I.D. NO. 051-501-12
100•
' WfLL RADIUS APPROXIMATE LOCATION
SHED OF EXISTING KEYBOX
(NOT IN USE)
EXISTING 4 BEDROOM
HOUSE
EXISTING SHOP
' FCO (w/BATHROOM)
DECKS FLAT \ \�.� /TSM
APPROXIMATE LOCATION-
! OF EXISTING SEPTIC LINES - Y ' 02
\ T7
NEW DEEP'':•• -
.:� TRENCH TH//4I
NEW 1250
GAL. STEEL DBL"
SEPTIC TANK ' 1
WIN
l
EXISTING ABANDONED 1250
STEEL TANK TO
EXISTING
ABANDONED TRENCH_E__
MT1-
1w
31.2
THlI
i
==-TT- n
xi!
FENCE LINE
/ x/x'' i•' .• 1' . 40
�x SI`N EaSEMENt CINEER STAMP
4-4
-',�' � ,XPi. •'-meq:
CI
Ny
J
s
M•
PERMIT N0. SW100010
PACE 3 OF 4
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.u-
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL LOT 5; BLOCK 2; SLEEPY HOLLOW #2 P.I.D. NO. 051-501-12
11K" � l�
C
i
" S
LOT 11 BLOCK 2
SLEEPY HOLLOW #2
\ \ (SERVICED BY CUSS 'A- WELL) rSEPTI1z EA
i- - e0'
I I
LOT 4 BLOCK 2
SLEEPY HOLLOW #1
1 I
I I
(UNDEVELOPED)
I I
I
II ➢NG T00'
WELL RADIUS
I
APPROXIMATE LOCATION
I
SHED NLYBO%
IN
O(NOi
I
(NOTIN VSE)
US
O
I
EXISTING A BEDROOM
HOUSE
I
I
CO EXISTING aSHOP
1'
I
leu
DECKS FLAT /.:
N'y I
_-
\ .i x t
API TING E LOCATION v:_ OI
OF EIISTIND SCPTIO UN[$
11
1T1
2
I,,
NEW DEEP l • /
I
I
I
i
I
7
TRCNCN
TN I
NEW
(LI
(WILI
E-4 [
1
GL S[CL
TEEL
�C
SEPTIC EAMNDBLIJ DBL3
�
ItI
I
sr, XTz
L(
O 1
I
EXISTING ANDON[° 12M TI �'
SLE
�L
STEEL TANK TO .'OI��Y�
(SE
I
EXISTING .•
ABANDONED TREK — _A- — —ASI
—
10
I
FENCE UNE
xJ..'
"
"
wm uuMCNi
11K" � l�
C
i
" S
LOT 11 BLOCK 2
SLEEPY HOLLOW #2
\ \ (SERVICED BY CUSS 'A- WELL) rSEPTI1z EA
i- - e0'
PERMIT NO.SW100010
PAGE 4 OF 4
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www. ci.anchorage.ak.u<_
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL LOT 5; BLOCK 2; SLEEPY HOLLOW #2 P.I.O. No. 051-501-12
ST1
S12
GRADE = 100.0
FINAL GRADE
T. T,
qq;b
0
125GALLON
INLET = 93.8'_/NEW
OUTLET = 93.6'
SEPTIC TANK
A
B
ST1
68.8'
98.5'
ST2
65.5'
92.8'
DBL1
64.9'
91.2'
DBL2
64.6'
90.3'
C01
95.8'
118.2'
FINAL
CO1
MT1
95.5'
118.0'
GRADE = 101.4'
CO2
CO2
55.3'
34.1'
56.2'
35.3'
---------
ORIGINAL
GRADE = 100.1'
CO1=93.3'
SR
CO2=93.3'
N. T. S.
NEER NIP
MT1=88.1'
��. lb
Z cif,...»• . :rt
MT2=88.1
• #r�
9%.'.
NO WATER FOUND
� � �•�••• ' •"
81.1' B.O.H.
"?�:
��
MT2
Municipality of Anchorage
Development Services Department
Building Safety Division
y,r On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www ci ancflCraCe.ak.u5
(907)343-7904
Soils Log - Percolation Test
r';r`crme�:'r: 1 IF32�AA J(i� C 14Iy+�-3 CcS,P��
Legal Description: Int— TownDshfp nge. Section:
Slope
Depth
1-1-7-
2-
Cr
9 c%je%/$an3
(,W/ 5w
Sc- 1%4 /
SdvN<
fbdc-s
,a- o- • Bay{
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
5
IF YES, AT WHAT DEPTH? L
O
Depth to Water After P
6tonitoring? =� E
Date: la
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
I
1 n
(m
s"
1- e,
►OsM
2a h
-1•s'r
iV n
30i,-
't�tt
su
y
I1.�J
a..;tl.0
1 r1C�
PERCOLATION RATE PERC HCLE D:A.•.IETER
TEST RL'N EET':lET
FT AND 5.S FT
PERFORLIED BY: t CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage 6 I
Development Services Department
Building Safely DMslon
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196850 Anchorage, AK 995196650
www.munl orglonsito
/
L
(907)713-790
Soils Log - Percol tion Test
Performed For: jarti�
Data Perk
CC ��/Z
Legal Desalptlon: 5' T.e�tK!C' JcCFP &'Un ) Township, Range, Section:
7-
8-
9-
t0-
t t-
12-
13-
Sto
Wlgcvnb
M
.� a aae*
l01► Ural
WAS GROUND WATER
ENCOUNTERED? O _
a —
tF YES. AT WHAT DEPTH? L _
DaPth to W tlar Aft"
P
Monitoring? E
Date'
Reading I Dale I Gross Time Nel Tlme Depth to Water Net Drop
PERCOLATION RATE fe+ ~) PERC HME DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFrECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW100010
Legal Description: SLEEPY HOLLOW #1 BLK 2 LT 5
Design Engineer: 0003 S & S ENGINEERING
Owner Name: MARY & BILL INGRAM
Date Issued: Feb 09, 2010
Expiration Date: Feb 09, 2011
Parcel ID: 051-501-12
Site Address: 023737 SLEEPY CIR
Lot Size: SO. FT.
Owner Address: PO BOX S671116 Total Bedrooms: 5 Permit Bedrooms: 5
CHUGIAK , AK 99567 -
This permit is for the construction of:
❑✓ Disposal Field [?] Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
The Engineer shall do a soils and percolation test for the replacement drainfield and a percolation test for the main
drainfield prior to construction. Please submit stamped and signed results with the As -built Inspection Report. If the
results require a design change, construction of the system shall stop pending On -Site review and approval.
Received
Issued
Date: �2 A
:By" d G'i/j iC Date: �d
\ Municipality of Anchorage
-� Development Services Department
a
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99507
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. QS l — '�_o I — /
Property owner(s) MARY & BILL INGRAM
Day phone 688-0140
Mailing address PO BOX 671116, CHLIGIAK, AK.
Zip Code 99567
3
Site address 21737 SLEEPY CIRCLE, CHLIGIAK, AK.
Zip Code 99567
Legal description (Sub'd., Block & Lot) SLEEPY HOLLOW #1 S/D, BLOCK 2, LOT 5
Legal description (Township, Range & Section)
Lot Size Sq. Ft.
Number of Bedrooms 5
THIS APPLICATION IS FOR (® all that apply):
THIS APPLICATION IS AN:
Absorption Field 0
Initial
0
Septic Tank El
Upgrade
❑
Holding Tank ❑
Renewal
❑
Privy ❑
Private Well ❑
Water Storage ❑
I certify that the above infor
Single Family Dwelling and
(Signature of property owp(€r or autlpdzed agent)
/ I further certify that this application is being made for a
with applicable Municipal Codes.
Permit/Rush Fees: S 3U Waiver Fees:
Date of Payment: a 3 Date of Payment:
Receipt Number. 6-7267 C Receipt Number.
(Rev. 11/05)
S&
NEAI.TNNITNC"rf
APPROVALS
SEWER& WATER
LV.N E TENSOPHS
SEWER & WATER
INSPECTION
ENGNEERNGST"S
ANOREPORTS
NELLNSPECfION
& FLOW TEST
SITE PLA S
SOILTESt
PERCOLATION
TEST
$TRVCTURAL&
IAECI N CAL
INSPECTIONS
ONSITE
WASTEWATER
XPOSALSYSTEIA
DESIGN
ROBERT C. COWAN .
CIVIL ENGINEERING
PH: 907-694.2979
FAX: 907.694.1211
February 2, 2010
MUNICIPALITY OF ANCI IORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 5; Block 2; Sleepy Hollow # I S/D
It is requested that you issue a permit to install a new 1500 gallon IIDPE septic tank
and a 5 bedroom septic system to serve the existing four bedroom dwelling and
shop(with bathroom)on the referenced property.
Test hole #1 was excavated on 9-14-88 and a percolation test was performed. At the time
of excavation no water was encountered to sixteen feet. After the seven days of ground
water monitoring no water was found. We are also proposing to dig a new test hole,
completing the percolation test, seven day ground water monitoring and submitting to the
MOA prior to construction of the new system. The proposed test hole will be used to
confirm soil conditions for the alternate site.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you requir6-addit)onal information, please contact us.
A. Shafer, P.E.
Enclosure
15861 S. Birchwood Loop Road - Chuglak, Alaska 99567
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MunlClpality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 `L" Street, Anchorage, Alaska 99502-0650
T SOILS LOG — PERCOLATION TEST
PERFORMED FOR: l7f-/��/ I DATE
LEGAL DESCRIPTION: L-7 Pj2 Ste/ - Tgwnship, Range, Section:
5
6
7~
110
17-
18-
19-
20-
COMMENTS
7181920
COMMENTS
m
0-11'1 - 2zJ5--1%41
'br1 C•r
VkOL'ei
WASGROUND WAT
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE
Depth to Wrier r
Monitoring? Date..
PERCOLATION RATE qll> (minutevmcn) PERC MOLE DIAMETER
b ~
TEST RUN BETWEEN la FT AND FT
PERFORMED ig; S ENGINEERINGv
17034 Fag a O, CERTIFY THAT T MS TES AS PERFORMED IN -
ACCORDANCt45 iib$*Vi SkI ;QQMICIPAL GUIDELIN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
e v Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
�\J(
PERFORMED FOR: �!1� id�,/'1��1� l i-3 I G,�--- DATE
\'
LEGAL DESCRIPTION: 1f�J V [� � 1 V�C DL Sownship, Range, Section:
2
6, o
3 0`
4 p+
f 6
6-_ ^v
o.
7-
8-
9-
to-
it -
12
8 9 10 11 12
13 oa
o
14 �5 K
d
15 �.�
16 0
17
18
19
20
WAS GROUND WAT
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE
SITE
Depth W Water Aher
Monitoring? IX Date:
=N
PERCOLATION
„.
PERCOLATION RATE 14 (minutes/inch) PERC HOLE DIAMETER Le
? TEST RUN BETWEEN e) FTAND FT ,
PERFORMED BY; S d, S ENGINEERING
17034 Eagle River Loop Road No. 204
ACCORDANCE W%Nk9}T keg677AL GUIDELINES
72-008 (Rev. 4/86)
il
CERTIFY THAT T IS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
PERCOLATION
„.
PERCOLATION RATE 14 (minutes/inch) PERC HOLE DIAMETER Le
? TEST RUN BETWEEN e) FTAND FT ,
PERFORMED BY; S d, S ENGINEERING
17034 Eagle River Loop Road No. 204
ACCORDANCE W%Nk9}T keg677AL GUIDELINES
72-008 (Rev. 4/86)
il
CERTIFY THAT T IS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
S&S
ROBERT C. COWAN .
CIVIL ENGINEERING
PH: 907694.2979
FAX: 907-994.1211
ONSITE
WASTEWATER
DGPCMSKTEN
DESIGN
15861 S. Birchwood Loop Road - Chugiak, Alaska 99567
ON-SITE NVASTENVATER DISPOSAL SYSTEM
TEALTNAUTNORRY
CONSTRUCTION PRACTICES
AMRaILs
and
MATERIAL SPECIFICATIONS
SEWER& WATER
"N EXTENSIONS
REFERENCE: Lot 5; Block 2; Sleepy Hollow 41 S/D
February 2, 2010
sEA<_R&WATER
GENERAL:
KSPECTION
1. The scope of this project includes the installation of a new 1500 gallon IIDPE
septic tank and a 5 bedroom septic system to serve the existing four bedroom
ENGNEEANGSTLDES
residence and existing shop(with bathroom) located on the referenced
ANOREPORTS
property.
2. Construction shall be in accordance with the approved site plan and design
ATU&SPECTION
FLOW
an permit drawings, Municipal l� y pwith s ecial rovisions or conditions and all
p p
A TEST
,
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground
"""A"&
utility locates.
4. Unless specifically agreed otherwise, the property owner shall be responsible
ROADOESICN
for final grading areas subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for
SOIL TEST
system installations. Owners installing their own systems must also receive
prior approval from the respective agency.
PERCOLATION
TEST
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
w�&
Construction shall include two 4" cleanouts for pumping access. All IIDPE
ME�MPECTION&
septic tanks are required to have a 4" monitoring pipe installed next to the
tank extending to the bottom of the tank.
ONSITE
WASTEWATER
DGPCMSKTEN
DESIGN
15861 S. Birchwood Loop Road - Chugiak, Alaska 99567
Page 2
Lot S; Block 2; Sleepy Hollow 01 SID
February 2, 2010
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All IIDPE septic
tanks are required to be covered with a minimum of 2" direct burial insulation, and a
maximum of 4 feet of cover.
5. A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCIUDRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot 5; Block 2; Sleepy Hollow 01 S!D
February 2, 2010
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pine Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (}1DPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam I-II or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final Ieachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot 3; Block 2; Sleepy Hollow #1 SID
February 2, 2010
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S R: S Engineering. S R S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S R. S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S R S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
r— —
H
CVs% r ���. �1 � N��OY� � �I•ffe
J7 /
1 � ~.�" sss�� t•Iv�o
- -....•..mss ZLT.TH?"ATtr—.
..
I HEREBY CE7tTiFT.
FOLLOWING THA7 1 HAVF THE
OEJCRI0, PROP•
�E'
SAID 6' +IIiC,sa� Arrwr�zr-
a
.mss..
VATV
OOICAT>a IT IS TM U�,�
OWNER TO pETSR►dRL T
s/ri�r
OF ANY
00
RID
NOT APPEAR on TM pe=R= MEEN
VISION PLAT. L� NO
CIRglY�Q SiQLO
0 ED nROmMJND-
R
OF FZMANY
M LJI Ng OR WIDE IAW OII
r y��7
ANY LIKES.
DRAWN,
a+ -t
- SO I
5�y
0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name---- '
Li2 Lf��� L
DISTANCES
—»
TO
FROM �
SEPTIC
TANK
ASOAPTION
FIELD_
---
WELL
Access �(v
C7•0'�—C�L��� �L
a• '
phoncog portion No. No. of BelJocends
WELL
f /^i7 )
1 ^ rj,� 1
LOT LINE
LEGAL OESCIiIVT10N
Lot / Block
z�Subdlvrsloo
Z" !/j_I�l�
Township, Range, Sechani
FOUNDATION
AS•B UILT DIAGRAM ]Show locatron of well, septic system. property Imes. loundahon.
dnvaway, water bodies, etc.)
TANKS-
N
T
-
SEPTIC ❑ HOLDING
Manalaawer /
Capacity ill gallons
M,ional
No. of Compadments
�__
-
-
TYPE OF SYSTEM
FRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom Irmo
original grade 10 FT
l otal depth floor orrgmal grade
-
---
—
FII added above mlgrnal grade
Gravel depth beneath pipe
(� FT
FT
-
-
lj
1
--
_
—
Gravel Icnger _
FT
_
Gravel wldih may,
J FT
Dlsl ance between Imes ,
-- --G��
Tolal absorption area
1
FT
-
-
11
Number Whites
—.I
SO raring
SO FT
pipe material
nstall`\er Date Instal etl//
WELLS
_
v
M
—
--
PRIVATE ❑ OTHER (Identity)
Qass'lLcii6on IA, B,C)
'I otal Depth Cased to
IT
------F --- FT
InsI011er
—
-
-
Dato Installotl:
REMARKS:_
Inspections Perlo metl by:
ENGINEER'S SEAL
,:+5•!Y'�M�
— __ —
����
Dale.
fg ��`1.`4 •••�• •arJ�yj
----
insp lion was d accu ling to
F
�1
"•'^'-
5 & S ENGINEERING ---
I fil leyThal this
__-17034-mqlvitiver-Lo,P4Zatdl4u—A4_—_
perenr all
, .•• ,�' t.{
•• Vial Rd
Munici aF I®lafll II��Nb eQ�i� �llale: ---
rn
1
Pill 14N, ,'�1y ••.w
/�f%�
Health Department Approval:— ` •! "�_
Date:
12-013 (3/85)
u Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PXjE�R FORM
ED FOR:
�1/,iQ'Li� DATE
PERF
Net
Drop
LEGAL
DESCRIPTION:
LTJ � ownship, Range, Section:
NI Ir -3,
DEPT�-I�
I SLOPE
2 -
�_
�'- Jar
o •-'I Int .
�—
1 /K�
O
3
4
9j
r
O
A.
o�
7
c'
N
8
/ rt
_
Qu.o
9 -
-�
10 -
WAS GROUND WATER
ENCOUNTERED? O
11
p L-
_
p �'r
IF YES, AT WHAT
12-
n
DEPTH? __ p
_
,.p,
E
13 -
`-
Ileplh to Water Alter-J�X -
o �-
Monitoring? _ Data:
14 o
- o`r�
b m
15-
1-6 1
/ - `� I F
1 / - i61 -F/
wj
19
20
SITE P
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
NI Ir -3,
�_
�'- Jar
o •-'I Int .
�—
1 /K�
PERCOLATION RATE W
TEST RUN BETWEEN
PERFORMED BY: 5 & S ENGINEERING I/
17034 Eagle River Loop Road No. 204
ACCORDANCE W#jt*gWj9"fi19W PAL GUIDELINES
72-008 (Rev. 4/85)
1(
(minutes/inch) PERC HOLE DIAMETER
I —
FT AND + FT
CERI IFY THAT TIJIS TEST PERFORMED IN
f ON THIS DATE DATE:
HUN1ClPALI1Y OF ANCHORAGE
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-472O
ON-SI|E SEWER it WELL PERMIT
Permit Number: 890201
Date Issued: 09/23/d8 Engineer Designed
Owner Name: GERALD MENTOR
nwnci Address: P.O. BOX 670745
:HUGIAK, AK 99567
Day Phone:
694-2979
Parcel 1d: 051-501-12
Lot Legal: Subdivision: SLEEPY HOLLOW 41 Lot: 5 Block: 2
Section: 15 Township: 15N Range: 1W
Lot Size 1.83A (sq.ft. o, acres)
Ma^ Dedrooms: This Permitx 4 Tota] Capacity: 4
SB'|lC TANKv Minimum total sepLic Lank capacity: 1,250 gallons. Each septLic
!^/.k must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
|',L .e�/vi'es insulation over tank(s)"
WhLL: tog must be submitted to Municipality of Anchorage Department of Health
anJ Human Services within 3v days of well completion,.
lNFURM O.H^H^8" PRIOR TD ISI & 2ND INSPECTIONS BY ENGINEER, If --
At 11 N
�AF|[K L/|| 1 U HOURS, CALL z43-4681 AND LEAVE A MESSAGE.,
CO1\1Sl|0CT PER ENGINEERS A/1[ACHED APPROVED DESIGN.,
|HlS i'H<MTT EXPIRES 12/31/98 AND VALID FOR A SINGLE FAMILY HOME.
I'Me||/LN PRnOF MUST BE SUBMITTED WITH AS -BUILT FOR THE CLASS C
NELL HUANQnNMENT"
I CER11FY [HAT:
1, l am /amiliar with the requirements for on-site sewers and wells as set
;'wLh by the Municipality of Anchorage (MOA) and the State of Alaska"
�l will install the system in accordance with all MOA codes and regulations,,
und in comp11ance with the design criteria of this permit.
3 l will in all MOA and State o{ Alaska requirements for the set back
distances vrom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot,.
4, l understand that this permit is valid for a maximum of 4 bedrooms. I
also understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an additional permit..
S1gned: DATE: �j-'�,�-«z`6�
(Owncr) `I'l KP R
,
IC�r.pJ By:
DATF:
o Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
Yt
rpr�, 146Y -C' .°.
PERFORMED—DATE PERFORMED:
LEGAL DESCRIPTION: L -S T>Z SVS/ ,,T&nsh 1p, Range, Section:�tiJ
SLOPE SITE PLAN �—
(�EL.+✓' F -1-1-1—F--1 F—T—TT—T--F—T—T--F—r--T—I
7
8-
9
10 - �-
11-�'
`- 0
12-
113-A,
2-13- --
G--trl --
14-
15
16
17-
18-
19-
20-
COMMENTS
8-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED? _TL_
s
IF YES, AT WHAT L.
o —t
DEPTH? P
E
Ileplh to Watr re
Monitoring? (late:
Reading Date Gross
Time
Net Depth to
Time Water
Net
Drop
WC�✓V �', �%
��� A
`T t 7
FT AND FT
IFE
PERCOLATION RATE
[N
_ (minutes/inch) Pf_RC HOLE DIAMETER
_
TEST RUN BETWEEN
FT AND FT
PERFORMED t& S ENGINEERING
1703_3 Efag a ver M"ad No. 2u4—
ACCORDANCR)JWR%ijbCq`DAM1iW2%WICI PAL GUIDELINE;
72-008 (Hev. 4/85)
/V CER1IFY THAT T S� TES /WARS PERFORMED IN
ON THIS DATE. DATE:
S
un cip HtYow
Anchorage
P.O. B' 196650
ANCH.ORAGE, ALASKA 99519-6650
(907) 343-4200
TONY KNOWLES
MA YOR
September 2, 1987
DEPARTMENT OF HEALTH & HUMAN SERVICES
Mr. Bob Martin
Coldwell Banker
4105 Tudor Centre Drive
Anchorage, Alaska 99508
Subject: Lots 1, 2, and 5 Sleepy Hollow Subdivision
Dear Mr. Martin:
I have annotated our files to reflect the installation of a
well on each of the subject lots, as noted in my previous
letter.
For your information, the department will require that a
well permit be purchased at the time a sewer permit is
obtained. Again, as stated previously, the issuance of
a sewer permit for any of 'these lots is subject to the
technical criteria being met.
If you have further questions, pi. ease call me at 343-4744.
Sincerely,
Susan E. Oswalt
On-site Services
SEO/ljw
/tAunicipa itYot
Anct orage
P,O1B . 196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
August 12, 1987
Mr. Jay Williams
Jay Williams Drilling Company
PO Box 670042
Chugiak, Alaska 99567
Subject: Well Permits: Lots 1, 2, 5 Block 2 Sleepy Hollow
Subdivision
Dear Mr. Williams:
This department is in receipt of three well logs for new
wells drilled in Sleepy Hollow Subdivision. Our files show
that neither sewer nor well permits have been issued for
any of these properties. According to the listing realtor,
the wells were developed to increase the marketability of the
vacant lots.
Regardless of the reason, AMC 15.55.040 clearly prohibits "any
person" from constructing a ground water well unless a valid
permit has been issued. In addition to that, the wastewater
ordinance in Section 15.65.020.B. requires either public sewer
or an approved on-site sewage disposal system be present when
a lot has a well.
You are hereby notified of three separate violations under the
above code sections. Future violations of the above will result
in legal action against you. In addition, this department
reserves the right to deny sewer permits for these lots should
technical criteria not be met, or may require abandonment of the
wells at a later date.
It is my sincere hope that you choose to comply with Chis order.
If you have any questions, please call me at 343-4718.
Sincerely,
Susan E. Oswalt
On-site Services
SEO/ljw ~5
CC:
Bob Martin, Associate Broker
Coldwell Banker
PO Box 770249
Eagl& River, Alaska 99577
Robert W. Robinson, Manager
On-site Services Program
Environmental Services
PERFORMED FOR:
LEGAL DESCRIPTION:
3-
4~
7
8
12
~4 -
17
18
19
2O
COMMENTS
SOILS
LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST ~,O~/-' ~] -" 1o0, ·
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
, .1Z~34 Eagle River [ oep Road No 204
PERFORMED BY . , '
72-008 (6/79)
TEST RUN BETWEEN "'-"~"--~FT ~ FT
4040 "B" Street
Anchorage, Alaska 99503 Phone (907) 562-2000
MECHANICAL gRAIN SIZE ANALYSIS
SHEET 9 OF 11
FOR SA~dPLE: 187i ..........................................
WORKURDER NO. A21716 JOB NO. A2171&
PROJECT: JOHN ~}ROSS SITE DEVELOPMENT
- ~ ~!
LOCATION: _~.~CL~YEY gd~' 6/~,c_l 90~ /~b(/~ ~ ¢~
DATE RECE~Vr.D/:' 17 OCT 1983 DATE TESTED: 17 OCT
1983
FROST CLASSXF'ICATiON:
UNIFIED CLASSIFICATION:
TEXTURAL CLASSIFICATION:
COEFFICIENT OF UNIFORMITY = 8.4
PERCENT
NFS
QW
SANDY gRAVEL
COEFFICIENT OF CONCAVITY =
SIEVE PASSINC~
3 INCH !00
2 )iNCH 100
1 1/2 iNCH 100
1 INCH 86
3/4 INCH 77
1/2 INCH 60
3/8 INCH 49
NO 4 29
NO 10 14
NO 20 6
NO 40 3
NO 60 2
NO 100 2
NO &200 1. 0
1.4
/
/
o~
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. _C7 5 / - 50 / - / 2 COSA # / D O D -'7-
1. GENERAL INFORMATION 9
Expiration Date: Cl - A — / O
Complete legal description X015; Block 2; sleepy Holllow subdivision #1
Location (site address) 25737 Sleepy Cir. Chugiak, AK 99587
Current Property owner(s) Mary& Bill Ingram
Day phone 888-0140
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent Craig Llghtle
Day phone 929-7806
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 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 (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
A
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 S s s engineering
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name Roberta Shafer
%c%,a4t -,t I �t 1 "01 t-"-4 CO SA
Ail vrrJt ,La p tune tr� `} g CCIK � 0,14 Ct)3 r
Tteeuv a.de. T4 dg -a to
DSD SIGNATURE
Approved for
Disapproved.
bedrooms.
Phone 694-2979
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: `& • 'z�cOriginal Certificate Date: &
or Irl
(a.. 11M)
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.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. �S I -So I- Ic,� COSA# IOW401
Expiration Date: jr--- l I d
1. GENERAL INFORMATION
Complete legal description Lot 5; Block 2; Sloepy Hollow Subdivision #1
Location (site address) 25737 Sleepy Cir. Chugiak, AK 99567
Current Property owner(s) Mary a Bin Ingram Day phone 688-0140
Mailing address PO Box 671116 Chugiak, AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent Crag ughne Day phone 929.7606
Mailing Address
Unless otherwise requested, COSH 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 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 compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm S 6 S Engineering
Address 15861 S. Birchwood Loop Chugiak, AK 99567
Engineers Printed Name Roberta Shafer
Rubvzd} Condi-i-ioe'CA Com. _kepc io .be
q ralfeA 6 Z _v.2 ISi a01o, Fkef-e is
nc P"hiner ��+ � WyarA CreetW L
-'11 ris o perv\4 rxCW;o�s "e. ViO�'0n,
me 4cWbrt e4cl as a reSu-1}- o -C, rTu�4rr. -n( ;s Tro
5. DSD SIGNATURE V
Approved for
Disapproved.
Conditional approval for
I..• e• it
Phone 6942979
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: e Original Certificate Date:
IRw IM)
4
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
Legal Description: _ke"C S./Ztvc,tC a.; �-= d u.,010 '114I Parcel ID: U.S_/- 6-0 1- /)
A. WELL DATA
NV e
Well type 7E fV IY if A, B, or C provide PWSID # = Well Log01) t `�
Date completed T /0/ Sanitary seal (f IN) Ira Wires properly protected09N)gL7S
I I if
Total depth �ft. Cased to �O ft. Casing height (above ground) % + in.
FROM WELL LOG
Date of test 3
I
Static water level -112 ft.
Well production %oD g.p.m
WATER SAMPLE RESULTS:
Coliform [ colonies/100 mL Nitrate / �iaZ mg/L
Arsenic: 5_0 ug/L date of sample: Z7//O
AT INSPEITION
v
g.p.m.
kezvelpy Tc --r
Other bacteria O colonies/100 mL
Collected by: .54-'s &x war4x' 6
B. SEPTICIHOLDING TANK DATA SEYfI� 5pr"2 Ing RrWaE, _�r& SfPT7e _pj:en1IT-
Tank Type/Material
Tank size
gal. Number of Compartments _
Foundation cleanout (Y/N) _
Date of pum ' Pumper
ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d.lft2 or ft2/bdrm)
Date Installed
High water alarm (Y/N)
System type
/M6/0
Length ft. Width ft. Gravel below '�_ ft.
Total depth _ ft. Eff. absorption area _ft 2 Monitoring tub _ Depression over field
Date of adequacy test Results P all) For _bedrooms
Fluid depth in absorption field before t _ in. Water added_ gal. New depth_ in.
ElapsedTime: Final fluid depth _ in. Absorption rate >= g.p.d.
Any r ' ation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION NIF%
Date Installed Size in gallons
'Pump on' level at _ in. 'P evi
Datum Cycles tested.
ole/Access (YIN)
at _ in. High water alarm level
Meets alar li circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: SL+~ erne- tent IT 5olooblo
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer ma a/cleanout
Sewer /septic service line
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SE /HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water service line Surface water
W 1nadjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD O�LOT :
Property line Building foundationWater main
Water Service line ce water Driveway, parking/vehicle storage
in.
Curtain Welts on adjacent lots
F. COMMENTS* 9OLnE •_',Hc* cc>,c vV6<-T1eiS To C�rtss R tv�7�'� SysTr 01 . AksT 1A) t1^,,F
�Tvwa .C6 oFPC2. IhyPOK. �'/�
,A 01rZ. FrorJ OU FUCL,-CSwlcrt/ -&/ 7'01,7,0 `'�lzC r 760176IV4. , �TouJ Krait kyt)7-rWUQE'.
-MErb -e-VL. A!W00TT VAOn-TiOVS c�,L, vr�vle, r•'^�%
G. ENGINEER'S CERTIFICATION rye(: ,.-� •..��
I certify', that I have determine gh held inspections and r
review of Municipal records at
t e above sysl s are '
conformance with MOA COS gu' Ines i eft t o th da i m
Engineer's Printed Name
„4 a U"w
w. uema
Date 2• /a 4t. �'�•. �
COSA Fee i $ T % `{" Z t Ci c• r_i:
Date of Payment
Receipt Number (rn 3 / �j
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
02/10/2010 11:46
FEB -09-2010 16,26
9076941211
FLYC" TITLE
,
z�
Title Gu/�
smntyrjency
sersi,y/ Kegn•at 4nrf
February 9, 2010
S & S Engineering
15861 S. Birchwood Loop Road
Chugiak, AK 99567
Re: Escrow 2868D AIS
Ing am— Vanderloove0ohnson
Lot 5 Block 2 Sleepy Hollow
To Whom It May Concern:
SNSENGINEERING PAGE 02/02
907 622 2843 P.01i01
ALYESKA TITLE GUARA1" FY AGENCY
11823 Old Glenn Hwy, Suits 118
Eagle River, AK 99577
Phone: (907)622-2842
Fax: (907) 622.2843
I have been authorized to do an Escrow Holdback at closing and bold one and a half times the highest excavation bid.1 am
holding 518,000.00 (1 % times the bid of $12,000.00) 1 am also in receipt on your figures of fund$ to be acrowed for the
excavationhoils tcsting/Final Strlvey/septic install inspections and COSA release far final Gr the atnouot of S $2.175.00 to be
paid upon completion.
If you have any questions, please do not hesitate to contact me at 907-622-2851.
Sincerely,
0
the le Sc eevel
Escrow Officer
TOTAL P.01
�7 Greyrs Construction, LLC
fr* 2320 North River Circle
00 Eagle River, AK 99577
0.0 Cell: 727-1233 or 727-9843
Fax # 907 696 0485
Name f Address
S and S engineering
fan: 694-1211
p: 694-2979
Proposal
INM
Project Name
hem
Description
Qty
Cost
Total
Scope of Work
install 1230 gal standard septic
included in bid, a trucking, ro tank,11.000.OU
g all materials to complex
11,000.00
no eloariclan, no surveying
Scope of Work
install 1300 gal standard septic
included in bid, trucking, rock, tank, all materials to compleatjob
12,435.00
12,48i.W
no electrician, no surveying
-- --- — - +r»• •M•• .+•. euro w m comPteted in a workman like manner according to standard
on job site will result in a change order, when verbably specified. All agreements contingent praeias Any alteration upon delays fully covered by Worktr='s Compensation Insurance. Pa beyond our control. Our workers am
Permits and Suneying will be done by customer, unless wherwisc be made in PoII upon completion.
specified.
Signature of Acceptance
Total
TWEED EXCAVATING AND CONSTRUCTION
17034 EAGLE RIVER LOOP RD., SUITE 202 • EAGLE RIVER, ALASKA 99577
PHONE (907) 6941373 • FAX 6941250 Page No. of
PHO E DATE
STREET J09 NAME/
Q--iJ /-C S f'le U -t
CITY, STATE AND ZIP CODE JO LO ATIp /! Q/��
_s2 ,� L
ARGyITECT DATE OF PIANS
Vie hereby submit qpecifiCStiOnS and estimates for:
h sfa /l r>ew -kf Ss 7'9/ S d2��ls
/ve r c%sl� /7 920L' / s
Trlsrsys� 4
8iL�S q10 4,171 lNel`lf1Q Top Svc/ O/- SC-diKfV
11iIC� al,,"' 7�Rr ,5410'111e/ Gvo(GC
We propose hereby to furnish material and labor --Complete in accordance with above specifications.
for thee um of:
on
dollars ($ " '" `r"' -ZA-7 1-7
Payment to be made as follows:
Pages
Feb 08 10 11:52a Lonnie 907.688.4988 p.1
j
Garage floors ofa Alas"Zoaa�T�.as
...___a_L ef..4soo467
INVOICE "7-69"246
/� • r p f o
,WWAX a Mi�
1
MMA
. . •
• • -
r
.+ 5a.o �r
M
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services it
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# CA_ �-:J)\-\n
HAA # — 1A ('Y 3C Yr )`Ll
1. GENERAL INFORMATION
Complete legal description Lot 5; Btoch 2; SKeepy Hollow Subdivizion tom_
Location (site address or directions)
Sleepy cikete and Mountain Road
Property owner —JeA)ty Mint.P_x _ Day phone 688-4572 (h)
Mailing address _ Y.U. Box 745 Chugiah, AK 99567
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF 13EDIIOOMS: 4-
3.
3. TYPE OF WATER SUPPLY:
Individual well XXX
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 _XXX_
Holding tank
Community on-site
Public sewer --_
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025)Rev.1/91) Front MOAM21
5.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
S 1'- 5 Lt�U'i'tJl-L•titt
Address 17034 Eagle River
Eagle River, !Alas o
Engineer's signature --
6. DHHS SIGNATURE '
�\ Approved for bedrooms.
'—��L bedrooms.
M
Disapproved.
Conditional approval for
Additional Comments
oa' U�>r
T�I
Phone
Date �— 7
bedrooms, with the following stipulations:
Date �- / A "9.3
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (flee. 1/81) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "-r Q ,r_Parcel I.D.
A. Well Data
Well type R t,,I If A, B, or C
Log present Y&N)
Total depth
Sanitary seal Y�N)
0S/ - Ski- /v -
attach ADEC letter. ADEC water system number �1 A
Date completed -3 \ ,"oI Driller _-S]M4 mAAs
Cased to `b a —_Casing height 12i1�
Wires properly protected ()Y N)
FROM WELL LOG AT INSPECTION
Date of test
���--
On
; On adjacent lots
Absorption field on lot _—
1'r
Static water level
Public sewer main
��
_Public sewer manhole/cleanout
c
tk
_Petroleum tank —
Well flow
, b
g.p.m.
Pump levell
J
I l a
M
fd1
G`¢
C�
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
���--
On
; On adjacent lots
Absorption field on lot _—
] 1
; On adjacent lots
Public sewer main
��
_Public sewer manhole/cleanout
Sewer service line
tk
_Petroleum tank —
WATER SAMPLE RESULTS:
Coliform__ D __Nitrate _ 0, \-a o _Other bacteria _
Date of sample: 2° - 3 Collected by: _ s 8, 5 FNGINEERING
17034 Eagle River Loop Road No, 904
B. SEPTIC/HOLDING TANK DATA Facile River, Alaska 99577
Date installed CA $ _Tank size �_�`�c' Compartments 2
Cleanouts; ON) _� — Foundation cleanout (2)N) _— .Depression (YQ _ N
High water alarm (Y NQ /J ,Alarm tested (Y/N) —_ � L
Date of pumping __ 2) —'3 � 9 3 Pumper _ T( (Ess P O D t,
SEPARATION DISTANCES I -ROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \—SZ )__On adjacent lots �o o \>- Foundation I a 1�
To property line 2�1 Absorption field 51 _Water main/service line
Surface water/drainage I a 6 11 d-
72.026(8/93)• Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION D
LIFT STATION TO:
lot On adjacent lots
D. ABSORPTION FIELD DATA
'Pump off'
rface water
Date installed �I Z� �Soil rating (GPD/Ftz) k -22S 4 ge System type 16;_A(A
Length' Width 2) Gravel thickness Total depth 11
Total absorption area 0 $ Cleanout present ((DN) __Depression over field (Y,NU J
Date of adequacy test g ' 2 —'13 Results ail) PAA -s for 4 Bedrooms
N u
Water level in absorption field before test After testa
Peroxide treatment (past 12 months) (Y& Idonj 9 /L�-t ° iJ If yes, give date h
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I On adjacent lots loo ' Property line f /S
To building foundation
On adjacent lots_
Surface water
Curtain drain
30 14-
rl
0o r4-
E. ENGINEER'S CERTIFICATION
To existing or abandoned system on lot k
Cutbank .-! /p- Water main/service line /o r
Driveway, parking/vehicle storage area D5 o a UrroF_, - �Rn«
l certify that 1 have checked, verified, or
Signature
Engineer's'N&W=.agtc,
F..Igln REW?pr
Date
110ad No. 204
HAA Fee $ f 0 e62D
DateofPayment 7 2�_?J
Receipt Number 2��y� C
72-026(3/93)* Back
3
to all MOA and HAA guidelines in effect on
the date of this -inspection.
Waiver Fee $
Date of Payment
Receipt Number
s