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SLEEPY HOLLOW #1 BLK 2 LT 10
Onsite File Sleepy Hollow #1 Block 2 Lot 10 #051-501-07 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211148 PID Number: 051-501-07 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name ROBERT & COLLEEN JOHNSON AORPTION FIELD ElDe Trench El Wide Trench El Bed ound Site Address 23740 SLEEPY CIRCLE, CHUGIAK, AK 99567 Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 208-267-8644 4 isF Ft. LEGAL DESCRIPTION Depth to pipe invert from origins EXISTING avel depth beneath pipe Ft. Subdivision Block Lot SLEEPY HOLLOW #1 2 10 Fill added above original gr Ft. JG?I length Ft. Township Range Section - - - Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between ches From Tank Field Tank Line Ftz Well *N/A EXIST. - - 125+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER TANK 1250 Gal. Surface Water 100'+ EXIST. - - Material HDPE PLASTIC Number of compartments 2 Lot Line 5�+ EXIST.I - - NA Foundation 10 1+ EXIST. - _ LIFT STATION Man r Capacity Gal. Remarks *PROPERTY SERVED BY A PRIVATE COMMUNITY WATER SYSTEM (OLD CLASS "C") Alarm location installed by PIPE MATERIAL House to tankD3034 dTank to rainfield D3034 Installer ARM SEPTIC SERVICES, LLC Drainfield EXIST. COiMTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspection im 6/7/2021 Location and description ection 2 nd BACK DOOR THRESHOLD 3b 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional A roval: DateO 0006 �O o�4 AC OQ 4-:7 � ..... ...a . ��.... .... ......*. 0, .. ..... v. ......................� (/ e e A. G mess;• 0� 9 Septic System Appr , Date Z ki 2 CE_ �� �o o�fP •�•.�I�� Note: this approval does not include well permit requirements.AEccaa° �Op000� (rcev ub/uui d) PERMIT NUMBER: ' p C p /� , ry, ! n PARCEL ID NUMBER: OSP211148 RECORD DRAWING 051-501-07 Ep�l G1RG�� DN OF WATER SERVICE LINE FROM PRIVATE COMMUNITY WATER SYSTEM. LOCATION PER 1984 INSPECTION REPORT. INSTALLED FOUNDATION CLEANOUT (FCO) NEW 1250 GALLON GREER PLASTIC SEPTIC TANK— INSTALLED DOUBLE CLEANOUTS (DBL7 & DBL2) / / / A B ;�•�3 / FCO 25.7 20.5 / MH 21.6 34.6 STI 24.6 37.3 DBL1 26.4 38.2 DBL2 27.4 37.9 SUMP1 28.0 54.5 35.5 '9 �A 0 W \\ \ 000E \\ G30PC'CNG15ssl5 \ 000 NO�p�p,. ,.rf(Itlll SLEEPY HOLLOW #1; BLOCK 2, LOT 9 EXISTING WELL. BELIEVED TO BE BELOW GRADE— 1N � 1 EXISTING DRAINFIELD. 1 PASSED SEPTIC ADEQUACY TEST ON 4/23/2021. N NOTE: OLD STEEL SEPTICT �A�NPK WAS DECOMMISSIONED PEC SCALE: CODE PER THE CONTRACTOR 1' = 30' 0 m 0 O c m OF too �s w • 7 1 ; :: 4A SS , td........ . r.. CIVIL & ENVIRONMENTAL ENGINEERS - •• ••••••••••••••••••® . - � ...... 1.. . ANCHORAGE, ALASKA' PHONE (907) 337.6179 • WE9SITE: www,gamossonginoodng.com .iur.r... ............... .m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: e y A. arness (v ROBERT AND COLLEEN JOHNSON 208-267-8644 2 OF 3 ��6'i�• 79 • : �W® PROJECT/LEGAL DESCRIPTION: DRAWN BY: �� ••'•� •••..'•,; ' �� SLEEPY HOLLOW #1; BLOCK 2, LOT 10 J.L.M. A FQ1 Y......... TYPE OF WORK: DATE: LICENSE 44 RECORD DRAWING FOR SEPTIC TANK UPGRADE 6/21/2021 #AECC884 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS ;,_��•.,;,. ••n ; � TAKEN WITH LEICA DISTO �..,;,; S910 LASER DISTANCE r`d t• ( METER. SWING -TIES TO I HOUSE CORNERS WERE GENERATED IN AUTOCAD. '9 �A 0 W \\ \ 000E \\ G30PC'CNG15ssl5 \ 000 NO�p�p,. ,.rf(Itlll SLEEPY HOLLOW #1; BLOCK 2, LOT 9 EXISTING WELL. BELIEVED TO BE BELOW GRADE— 1N � 1 EXISTING DRAINFIELD. 1 PASSED SEPTIC ADEQUACY TEST ON 4/23/2021. N NOTE: OLD STEEL SEPTICT �A�NPK WAS DECOMMISSIONED PEC SCALE: CODE PER THE CONTRACTOR 1' = 30' 0 m 0 O c m OF too �s w • 7 1 ; :: 4A SS , td........ . r.. CIVIL & ENVIRONMENTAL ENGINEERS - •• ••••••••••••••••••® . - � ...... 1.. . ANCHORAGE, ALASKA' PHONE (907) 337.6179 • WE9SITE: www,gamossonginoodng.com .iur.r... ............... .m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: e y A. arness (v ROBERT AND COLLEEN JOHNSON 208-267-8644 2 OF 3 ��6'i�• 79 • : �W® PROJECT/LEGAL DESCRIPTION: DRAWN BY: �� ••'•� •••..'•,; ' �� SLEEPY HOLLOW #1; BLOCK 2, LOT 10 J.L.M. A FQ1 Y......... TYPE OF WORK: DATE: LICENSE 44 RECORD DRAWING FOR SEPTIC TANK UPGRADE 6/21/2021 #AECC884 IPERMIT NUMBER: PARCEL ID NUMBER: I OSP211148 RECORD DRAWING 051-501-07 1 FINAL GRADE ATION %CTOR) INS INS- GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS ANCHORAGE, ALASKA - PHONE (907) 337-6179 WEBSITE: a .gamessengineedngxom PREPARED FOR: ROBERT AND COLLEEN JOHNSON PHONE NUMBER: 208-267-8644 PAGE NUMBER: 30F3 o' % PROJECT/LEGAL DESCRIPTION: SLEEPY HOLLOW #1; BLOCK 2, LOT 10 DRAWN BY: J.L.M. f VIP, ## TYPE OF WORK: RECORD DRAWING FOR SEPTIC TANK UPGRADE DATE: 6/21/2021 LICENSE #AECC884 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211148 Effective Date: 5/17/2021 -Work Type:-SepticTank Upgrade _ . Expiration Date: 5/17/2022 Tax Code Number: 05150107000 Site Legal Address: SLEEPY HOLLOW #1 BLK 2 LT 10 G:1160 Site Mailing Address: 23740 SLEEPY CIR, Chugiak Owner: JOHNSON ROBERT K & COLLEEN E Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy Lot Size in Sq Ft: 33928 Total Bedrooms: 4 ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received Issued By: Date: s h -4- Z- I Date: 5 1-7 a o a 1 Development Services Department \ On -Site Water S. Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION - Parcel I.D. 051-501-07 Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) ROBERT AND COLLEN JOHNSON Day phone 208-267-8644 Mailing address 23740 SLEEPY CIRCLE, CHUGIAK, AK 99567 Site address 23740 SLEEPY CIRCLE, CHUGIAK, AK 99567 Legal description (Sub's., Block & Lot) SLEEPY HOLLOW #1; BLOCK 2, LOT 10 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms HOUSE IS 3 / SEPTIC SIZED FOR 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade Q Duplex (D) ElHolding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 12.2 !S�: Date of Payment: 3�Z 1 Receipt Number: 0-69 77 G Permit No. 05 P2 11 I q 8 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211148, Rebecca Carroll, 05/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211148, Rebecca Carroll, 05/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211148, Rebecca Carroll, 05/17/21 SGS Ref.# 1211916001 LOQ Units Client Name Garness Engineering Group, Ltd (GEG) Printed Date/Time 04/29/2021 13:31 Project Name/# Sleepy Hollow #1; B2, L10 Collected Date/Time 04/26/2021 15:05 Client Sample ID Sleepy Hollow #1; B2, L10 Received Date/Time 04/26/2021 16:09 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 04/27/21 04/28/21 DMM Waters Department Total Nitrate/Nitrite-N 5.25 0.200 mg/L SM21 450ONO3-F C (<10) 04/27/21 EBH Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 04/26/21 AI Total Coliform Negative 1 100mL SM21 9223B A 04/26/21 A.L 2 of 5 8495E R=341.8 .92 cNr V47 5 Lot 11 RA LO Lot 12 SCALE: V= 40' 13 o\-\ S06 ON se -0- WO Lot 13 Lot 9 Note: Asphalt location is approximate due to snow and ice. )F At •149th 00 JOO .7... 0 00 00 ... .... . zi & Owl 4 0 lizabeth L. 3latka : ff 11 -k. AOW 0" 8M - LS • AW *0 4 SSI0t4g� A)0W "► 14 - 'Z,02- I AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 10, BLOCK 2, SLEEPY HOLLOW SUBDIVISION No. I Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other Visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 12th day of APRIL. 2021. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON BE Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 21-1, pg 52-53 907-248-1666 This drawing Is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any Inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shalt not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services In preparation of this product. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMI:NTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE r)ISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE (~NEW ~-77c'~'5-- []UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BE~OOMS I~~/~ ~A~ - Dwelling/~, ~ / PERMITNO~o/ ~ J Well ] Absorption area / Width DISTANCE TO'. ~0~ -{- //, 5' Manufacturer ~.-.*/~ ~ ~.,~ Material Liq, capacity in gallons Well Inside length DISTANCE TO: ~/~- ~/~ Manufacturer DISTANCE TO: _ Well ~2_~)~e~ ! Leneth of e ch line No, of lines Top of tile to finish grade Length /~//A Width Type of crib Crib diameter Well DISTANCE TO: BuiJding foundation DISTANCE TO: I:oundation ~'0, Total lehgth of lines NO. of compartments Material beneath tile Material / Nearest lot lin.~, Trench wi~:~l~ inches inches Liquid depth PERMIT NO, -/~Y///A Liquid capacity in gallons PERMIT NO. ~'~0 / ~¢--~-- Depth PERMIT NO. /V/A Total effective absorption area Nearest lot line _.PERMIT NO. Septictank ~4~o~.¢_ Absorptionarea(s) 2%~')¢~ Building fou ndatio/~/,~ Driller ~r~ Sewerline ~o I ./_ Oistance to lot line OTHER / SOiL TEST RATING INSTALLER REMARKS LEGAL I..]....,IEI. L~.I..._.I..I FIRE TI-IE .......... qL.II. 'H"'"'FF TI-IE ~P'T'I(]N TI-.IFF'F L, IL_~ FI] [..l~....[_fll,[tl. "r'" F' r:,EF [ TE. E~' E:.:Z J[]::~ B.JI .. IE:" IFqL' ~::::~ :E Ih.il [.'E':F'TH TO PZI::'E EJO"I"'I"OH (F'T.) ,::1.. IZI 4. El (}I:']:I::I',,/EL [:,FZI::"TI'~ ':.'Fl'. ::, 0, 5 ;2. TOTFIL. [:,[!:F"'TI'I ,:: F;"Iq ', , ~ ~j~... 4. !5 6. El GRFI',,,'EI... l,J I [:,'T'I..i < F:'T. ', 5 '~' :1.6. El 5. El I]i F:: FI ',,/ E] L LENL':f'FI'I ,::F'['." :4.::4~ q~;-]' 0 -J-,..,. [~RFI',,/EL ',,,h:}L, UME (: E:U. '~.'[):~J;, ) iL'.:,L 'Z'~ ;~:SP., 2. TI:II,II:::. '_.i.: il ZE ,:i GFII..E; ) t., :+: :1.., ;~i:SEL ~) :+::+: :1,., ;:?5~D. E~ :!~;OII._ RFFTiI'.,I(~i ,::E;Q. F'T. ,.."131~'.) 85 85 8'.5 :.m.~.: GRI::I',,,'EI.. L. ENGTI.I ]::. 75 F:T. Iq:Eg~LI]:RE'.~5 HUL. TIFi..E RUNS <NOT E',:.:X]EE[:,II",IG 75 FT. E~CH) :+m.: TFINK h'IIJST HF:I',,,'E FIT L.EFIS;T ]'HO COHF'FIRTMENTS; OPn o ~ ~.0 '"'~. 0 ~o. o / m~_'~'~ d) I C:EF,~:]' I F:'"~~ ]"IIFFr: - i. I F'IH FFII'qlLIIt::iF.'. I.,.IITH ]'HE F..'E{(i:!IJII',~tE:HENT:5 I::OR ON-SITE: S;EHERS ~':II'.,IE:, I::'ORTH E:'.r' THE HI._INICIPFiL. IT'f OF FII.,!CHORFIEiiE <HOFi) FIN[:, THE S;TFII"E OF' FIL. FISKF~. 2. Z I.,.IIL.I.. II'.,liS, TF&.L. TIIli£ E;'~.'~i;TEH II,,i I':ICCO;';i:E:,FINC[ii: HITH FILL MOI:::I CO[:,E'E; FINE:, REGLIL_FIT~ON:5., FIN[:, I N COMPL I FiNCI'~: 14:1: TI-I "lTht~: DES ]: GN CR I TER I FI C)F 'I"H I S; F'ERH I T. 3:. :l: HIL. I... FI[::,I.IEZRL]: TO I'::II.L: I,I(]FI FIND S'FFITE OF i':II..I::IE;KI::I REg!LKt:I:~:EI"IEI'.,FI':~; FOR THE ~:E"I" E',FICK [:, I '.~!;'TFII'.,ICI!%:E; FROI',I Fli'.,l'~.' E::.:: I S;T I NG I-,.llZi:LI. .... klFr.5'r'I~-!].,.IF:ITEI'R [:, I Sq::'OS;Ffl... SYf'.:.i]"E:I'I Oi:R F'L.IE:L I C :~EI.,.IE:RFIGE ?.,."J!!;TEH Oi'.,I 'FHIS}; OR FIN'.? I::I[:,JI::'ICE]qT OR NI.!ZF:IREJ"r' I....(]T. 4. I LIN[:,E:R~];TFli",I[:, TIIFTF 'I"I-IIE; PEI'Ri'I]:T IE; VI::IL.I[.':' FOR I::I HFI::'::IHL.IH OF' 4 E',E[)ROOMS FIN[:' F:IN"r' E]",IL..FIRGEI'II!!]",H' HILL RI!!)]:!LIIRE. ]hl",~ FIB'[:'ITIOI",II:::IL. F:'ERHtT. IF F:I I..IF'T ...I II.l....I,~ :1:~; .I.l,l.:,l L1h.~.~[. IN FIN I::IREFI CO","EI::::E[:' E:"r' I'IOF:I EUILL).I. 14..* C:O[:'EE;., .... L L I]IE:T~:I I ~qE: [:'.; (. ;::'. 2 b ... L.,I..I .[ L r _ THEN ,:: ::1.. ', 1::IN ELE:C'I"F~: I CFIL I::'E:Rhi I T FIN[:,' l' NE;PECT ~ ON 1,11..IST' ' ...... ':' - :' ' ' ":' F.E.~ uB. I., FINE) (":~ ', THE I,.IZl..L NeT :' :' ' ':: :: :: L,L FII:'F'RO',,,'[:~:E:, klI'I"H(]LIT I:::lJ'.,l EL.ECTRICFII.. ll l...I.l::._.[.(..ll . .. [{I..ECTR'I CFIL. I.,.IOi;]:K i,'II...IE;T 13E [:,Cll'.,l~ EJ"r' F:I I... :1: CENSEB' E:L.E CTIR I C I I::lb,l. FIF:'Fi... I CFINT: [.:,FI',,~:~3 I. ,.:,I..IE:,[ ~ ~ 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 LEGAL DESCRIPTION: 1 2 3- 4- 5- 6- 7- 8- 9- 10- 11 13 14 15 16 17 18 19 2O COMMENTS O t=' SLOPE SITE PLAN ENCOUNTERED? IF YES, AT WRAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ATION RATE (minutes/inch) TEST RUN BETWEEN , FT AND FT 72-008 (6/79] 1 -2 3- 4- 5- 7 8 9 10 11 12 13- 14- 15- 16- 17 18 19- 20- MUNICIPALITY OF ANCHORAGE D£PARTMENT OF H,:ALTH AND ENVIRONMENTAL PROTECTION 825 L. Street,. Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST COMMENTS SOILS LOG [] PERCOLATION TEST PERFORMED BY:_/- ~ SLOPE SITE PLAN-- WASGRO 'N':,WATE. A/0 ENCOUNTERED? o P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /~//j~ (minutes/inch) /. TEST RUN BETWEEN FT AND ~ FT LOBAL EN~INEF. R~NO P. OMI:~ANY SRA Box 2327 7221 F. Ifluffman Road Anchorage., Alaska 99516 U.S.A. Phone: (907) 345-6446 O r~4 ,,4- .'OLOBAL EN(~IN .F. EFIIN~ COi~PANY SRA Box 2327 7221 E. Huffman Road Anchorage, Alaska 99516 U.S.A. Phone: (907) 345-6446 STA]'E OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS NO~lDaLO~d IVIN:Z/'a"~O'8 ~ANa A. APPROVAL TO CONSTRUCT P{ans for the construction or modification of ~]~j~O/[~ ~_[~ '~ ~'~1 ~F~ ~ ~~ '-~ ¢~ ~f~/ public water system located in --~ a;'~~ ~ ~' , Alaska, submitted in accordance with 18 AAC 80,100 by__ t lk have been reviewed and are ~ approved. //~ conditionally approved (see attached conditions). 8Y~' ' TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction, B. APPROVED CHANGE ORDERS Approved by Date The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made avaiisble to the public. The construct!on of the ~ ~' '~/" w~ter ~ystem was completed on granted interim approval to operate for,90 days following the completion date. As-built plans submitted during the interim approval period, or an inspeciion by the Department, has confirmed the systern was constructed according to the approved plans. The system is hereby granted final a2proval operate. (- !~')a ) F~l public (date). The system is hereby 8Y TITLE DAT~ G $U Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 5 Y' Certificate of On -Site Systems Approval Parcel I.D. 051-501-07 1. GENERAL INFORMATION: Expiration Date: q-�3^23 Complete legal description SLEEPY HOLLOW #1; BLOCK 2, LOT 10 Location (site address) 23740 SLEEPY CIRCLE, CHUGIAK, AK 99567 Current Property owner(s) ROBERT & COLLEEN JOHNSON Day phone 208-267-8644 Mailing address 73526 HWY 2, MOYIE SPRINGS, ID 83845 Real Estate Agent BROOKE STILTNER Day phone 244-6742 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class PRIVATE Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $__5 0 Waiver Fee $ _ Date of Payment (P/3/aDa 1 Date of Payment Receipt Number 096116- Receipt Number, COSA # S C 21 I L1:7 Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: _7/ v In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE `l`�tlll((((rrrrrr�� System #1 Approved for bedrooms G�Qp,IITY OF ���i��� System #2 Approved for bedrooms ` �� ON,S/ E y0 Disapproved o WA ATFR qND Conditional approval for bedrooms, with the following stt do 5,,;AT m^ 000F1. ER = AM �!3 JJJ/JJJL SF VI��SOI��\\,\ ' JJJ1)f)i111 By: Original Certificate Date: C, The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-1G-12.doc COSA Checklist Legal Description: SLEEPY HOLOW #1; BLOCK 2, LOT 10 Parcel ID: 051-501-07 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 ROPERTY SERVED BY A PRIVATE WATER SYSTEM (OLD CLASS "C) . - v I,✓t,- WELL DATA I ❑ II log is filed with Onsite (or attached) Date dr d Total depth ft Cased to ❑ Sanitary seal is functi Ing correctly ❑ Wires are proper protect Casing height ove ground) in. Date of fl test for COSA Stati ater level at beginning of test mments WeT('�Todrag�timn.� ,�#-e'tgpmbe tank volume '� Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 5.25 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 4/26/21 B. TANK DATA >Requiraintenance N Age of tank(s) NEW years tenance complete Tank type/material PLASTIC yeMeasured operating fluid level in septic tank NEW ial❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 4/2811984 Adequacy test date 4/23/21 ❑ ALL standpipes present per record drawing Results 2✓ Pass For 4 bedrooms Total measured depth from grade 10.2 ft (max) Fluid depth prior to test **0/0 in Measured depth to pipe invert from grade 6.4 ft (min) Water added 788 gal ❑ N/A — pressurized field New depth *34/0 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 23 min depth into effective •32.5.130.5 ❑ Code -required soil cover over field Final fluid depth **0/0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: *EFFECTIVE DEPTH MEASURED ON 4/23/21. **SUMP1 / SUMP2 -ADDED WATER TO SUMP1 COSA Checklist yellow sheet NONE E. SEPARATION DISTANCES From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' SERVED BY PRIVATE WATER SYSTEM (OLD CLASS "C") Yes Private Well on Lot to: (Please enter distances if less than required or if community well) ft Septic Tank/Lift ia#i on Lot > 100' Yes if No ft Community Sewer Manhole/ ut > 100' .�Yes if No ft ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if ft Pr' ewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No I ing Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 0 Animal Contain 50' ❑ Yes if No ft ❑ Yes if No ft Fv7I Yes if No ft Water Service Line > 10' 21 Yes Manure/Animal Excreta Storage > �YeI Co Sewer Main > 75' F-1 Yes if No ft s Ye l �^ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' P� Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: C] Absorption Field > 5' Fv� Yes if No ft Private Wells > 100' (Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Fv7I Yes if No ft Water Service Line > 10' 21 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' [D Yes if No ft If absorption field is under driveway comment below Property Line > 10' Fv7I Yes if No ft Wells on Adjacent Lots: Water Main > 10' C] Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS THERE IS BELIEVED TO BE AN QMiYWELL BURIED ON LOT 9, BLOCK 2, SLEEPY HOLLOW #1. MEASURED 103'+ FROM SUMP2 TO WELL WIRES FOR THIS • ` WELL. .S ji %�"��C' d-�--•-•� ��"•4"�u'�i��t:Jf� L r� Lr'�! ��t...� . :�r�l G. ENGINEER'S CERTIFICATION a 0F ^ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with R 4 ;' j*I MOA COSA guidelines in effect on this date., ... , • .. _ . • , • • , , ... ................ QO .J ffre A. Go ness.. QO 9 `l•. CE— �G COSA Checklist yellow sheetP, nod o ofessio 0 #AECC884 INtitrate Advisory Certificate of On -Site Systems Approval # OSC 211347 Subdivision: Sleepy Hollow #1 Block 2 Lot 10 A water sample revealed a nitrate concentration of 5.25 milligrams per liter (mg/Q. 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. Ma�l�ng Address P� O Box 196650 *�" Anctiorage3 AL k' 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. has's a ,e i Ma�hng Address P� O Box 196650 *Anchorage, Alaska 99519 6650 *www muni or � { N cr Lot 11 G1?G�"� S��q _�. - -- - 8495E N Cal R�341.80 1_:z67.92 Lot 12 SCALE: 1 "= 40' R. co .- Ma�ro\e i°� o sept�c`jercl�pl� tyP� i� Lot 13 Imw .• . 49th •�7 �10 00 "A 00 lizabeth�tka : o 1P • • 8036 - LS • • �� �� ��� pROFfSSiONAt•��'�.� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FB 21-4, pg 31 PLAT ARE NOT SHOWN HEREON BE UNLESS OTHERWISE NOTED. FB 21-1, pg 52-53 Z uo Lot 9 RECERTIFIED 6-15-21 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 10 BLOCK 2 SLEEPY HOLLOW SUBDIVISION No. 1 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 12th day of Y APRIL 2021. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 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 Parcel I.D. # °SI- .~ol- 07 1. GENERALINFORNIATION Complete regal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Day phone Mailing address Agent -~--- P/~- ;//~ ~ I'~C~ ~t~4. ¢ / Address ~-~1.~. ~ ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ Dayphone_ f,, ~/V'- 5z2.0'~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Flolding 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) Fror~l MOA/121 STATEMENT OF INSPECTION BY ENGINEER . As certified by my seal affixed hereto and as of the validation date shown below, I verify tl~at 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, 1 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. Narne of Firm J~¢~ ~'/~O~L4L~..~ '~- Phone Address ~:~ ~ ~ /¢/--¢t H ,,~.o :5 Engineeds signature ~ ~~. [)ate ! / DHHS SIGNATURE .~i App roved for /~r/¢~_ ¢,/ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~-~' ~¢'~'~¢¢~-¢~ [::)ate 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: IE)K'4,L ¢ I~.~_~ i~o ~¢~ ¢ Parcel I.D. A. Well Data Well type _ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to FROM WELL LOG Casing height Wires properly protected (Y/N) .g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate , '"/ Other bacteria Collected by: ~.- B. SEPTIC/HOLDING TANK DATA Date installed ii/- Z.~, c~ ~/ Tank size J,,~ ~'o Compartments ,,~ Cleanouts (Y/N) ,~ Foundation cleanout (Y/N) _ ~' Depression (Y/N) High water alarm (Y/N) h¢~/._\ Alarm tested (Y/N) Date of pumping . J~ t~ I~ I 't '¢~¢. Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line __~ Sur[ace water/drainage On adjacent lots '7 l ~ Foundation Absorption field I I Water main/service line ~tlC) 72-026 (3193)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N) Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /-'//'~¢' 8 F Soil rating (GPD/Ft2) 85 System type '~.t.~4 ~ Length ~6;> Width zT'<~ Gravel thickness 3. ~ Total depth ~ Total absorption area ~ ~ Cleanout present (Y/N) y Depression over field (Y/N) ~1 Date of adequacy test t[o~ Results (pass/fail) ~ for ~ Bedrooms Water level in absorption field before test ~ ~ y After test ~ y Peroxide treatment (past 12 months) (Y/N) ~ .If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~ Surface water ~ Curtain drain ¢"1 On adjacent lots ~ ! ~ Property line To existing or abandoned system on lot Cutbank /"¢~'~ ¢-~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, ........... venfied, or conformed to all MOA and HAA guidelines tn effe~¢4 On t~.~:datc.~Qf thts inspection. Signature Engineer's Name Date HA,& Fee $ ~c"~E) ¢ ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back ENVIRONMENTAL LABORATORY SERVICES RF',PORT of AI4P, LY',41S 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Cl.:i. enl; Nai~o :TOBB),iN GPURI~LAN[), ILk:, WORK Ordox O~_',gorer} By :TOBBI~N SPURKr,AN)~ Repoxk ConR:)lo'[:i~d ; ) J./1.0/93 P~"O } E'C i: Name : Co3.].cc'LcO t"xojcct:t~ : Receiw~d ~1.1.10~/')3 PV}SII) : 2].3522 TechBica [ D.i ~:e c ['o~: f;TliiPHI,'.FJ ....... NJ. kl:ako .-N ].. '/ mq/l, EPA 353.2/300.0 l 0 J ]/09 Ci.1R e?~ Sea fiomp]e RetoRt'ks tlbove NA ,: No[: hn,~].yze(i l} : llrldelsect:od, Repo)c'hed vail.tie is 'khe pl:ackJ, ca:L quanki(:JcakJol~ }.i.mik. [,T ,: [,ess Tha~ l) ;: Secondary d].J,tl/Jol~. GT -: g}?u~/k~)! Than Member of the SCS Group (Soc,~,~ Gbn~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, ORIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTF':CTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTFI AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Jun6 26, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10; Block 2; S16epy Hollow Subdivision Location (address or directions) Chugiak off Mou~ain Road Applicant Na~r~e David Behrcns Telephone: Home 688-3240 Business 333-5561 SR I, Box 1173, Chugiak, Alaska 99567 Applicant Address (b) (c) Applicant is (check one): Lending Institution []; Owner/builder P~; Buyer []; Other [] (explain); Alaska USA Fed Cr Un (d) Lending hrstitution Address Anchorage, Alaska (e) Real Estate Company and Agent Telephone Address Teleehone Ho~d (f) ~the HAAtothefollowing address: S & S dngin6~rin& SRB 196X Ea~(e Rive% Alaska 99577 TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well ¢1 Community [] Public [] Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [Y~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environrnental Conservation ettestieg to the legality end status. Page 1 of 2 72-025 nl/84) ENGINEERING FIRM PROVIDu,~G INSPECTIONS, TESTS, FILE SEARCH, b,,rA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Healt~ 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 obteined 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 code~ ordinances, and regulations in effect on the date of this inspection. Name of Firm --EAGLE--RIVER-ENGtNEERIN~-RVICE$ Telephone Address EAGLE RIVER, AK 99577 Date ~'/~//'~ P. O. BOX 773294 094=5~95 DHEP APPROVAL Approved for '~-~'~'~-~"~,)_ bedrooms by Approved /~' Disapproved Terms of Conditional Approval (/"~'?~ ~ ,c¢¢. Date ~¢'~- ~"~' Conditional _ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-o25 (11/84} WELL DATA MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) t=NVIRONMENTAI. PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKUST - F=E.RUAR¥ 964 264-4720 Legal Descripuon: I~ Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Water Sample Test Results Comments _~:~ ~ [~5> ''~'- · Date Completed B, C, D.E.C. Approvedd~/N) Yield Depth of Grouting ~//~ Pump Set At /~--~ Sanitary Seal on Casing (Y/N) / Depression Around Wellhead ',Y/N) ; On Adjoining Lots ?..,..~."¢~ ~.4 : On Adjoining Lots To Nearest Public Sewer To Nearest Sewer ServiceDate._Line on Lot~/,~.~. B. SEPTICF~LC~..~4NG TANK DATA Size· Date Installed Standpipes ~N) Air-tight Caps~}'N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticCHofdif~j' Tank: To Water-Supply Well _ To Property Line _ To Water Main/Service Line _ /~ /¢.... Course ~/A No. of Comoartments Foundation Cleanout ~'~f'4) ~. Date ..~'~ '~.~. - Last Pumped for _ Temporary Holding Tank Permit (Y/N) _ To Building Foundation ~/¢, ~ To Disposal Field //..~ To Stream Pond. Lake. or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption S ~;~ Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field Depth of Field _ ,c~ Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot ~/'~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments TO Property Line / 0 ~ To Existing or Abandoned System on ; On Adjoining Lots ~ /"/' TO CutbEtnk (if present) D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Manhole/Access (Y/N) "Pump Off"Vent Level(y/N)at Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha¢l ~ ¢:~1~11 ~l~il J~o r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed SlUR 19~X Date JUL I 1986 Company EAGLE RIVER, AK995~/MOA No. ¢2~'-'S'-'~ c.5o .~ Receipt No. 3¢¢ '¢-/~ ~ ~ Date of Payment G"~' ~ Amount: $ ~ ~e~ Page 2 of 2 72-026 (11/84) ANCHORAGE/WESTERN DISTRICI' OFFICE 437 "E" STREEI', SuI'rE 303 ANCHORAGE, ALASKA 99501 BILl- SHEFFIELD, GOVERNOR Tbl~phone: (907) 274-7533 DATE: July 1, 1986 PWS I.D.~ To Whom it May Concerl.' ~ · According to records on fil,e in this oCfice the Water Regulations SLEEPY HOLLOW Water System is in compliance with the State Drinking Sincerely, Michael P. Lewis Euvironmental Engineer MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Description (include lot, block, ,/ // Application Date _/////~ ~ subdivision, sectiqn, township, range) Location (address or directions) _ (b) Applicants Name~/~(~/~ ~_~~hone- Home Business Applicants Address ~¢~2~) (c).Applicant is (check one) Lending Institution ~_~ ; Owner/huilderJ~ ; Buyer ~ ; Other ~ (explain); (d) Lending Institution ,,~ dR) A_7/'~ Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone M~-i& the }LtA to the following address: T_~e of__R_esidence $ingle-Family~ Number of Bedrooms Multi-Family ~-~ Other (describe) w_a3~ Individual Well ~ Community ~] Public~2 Note: If community well system, must have written confiz~ation from the State Department of Enviromnental Conservation attesting to the legality and status. S~ewa~ Dispos~a~ 0nsit~ Public ~-~__] Community ~ llolding Tank ~ Note: If community well system, must have written confirmation from the State Department of Enviromnental Conservation atte.sting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providin~ Inspections~ Tests~ File Sear__~ 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 regula- tions in effect on the date of this inspection. Name of Firm Date Telephone DHEP Aj!pr oval Approved for ~-l bedrooms (ENGINEER SEAL) Approved -- Disapproved __-- Condition~. X Da ] THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIOMS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFES%IONAL ENGINEER REGISTERED IN THE STATE OF AIASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 'EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN T[~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 A® ~UNTCIPALIT~ OF ANCHORAGE (~OA) ~0V 6 1984 Well Classification __' Well Log l%tesent (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in (~nduit .{Y/N) Separation Distances from Well: Cased to Date Completed Pump Set At Yield Depth of Grouting Sanita~.y Seal on Casing (Y/N) DeP~essionA~ound Wellhead (Y/N) To Septic/[~ Tank on Lot .~OO t~. ; On Adjoining Lots ':--/ - TO Nearest Edge of Absorption Field on ~) ' ; On Adjoining Lots To Nearest Public Sewer Line Cleanont/Manhole Wate~ Sample Collected By Water Sample Test Results Comments To Nearest Public Sewer To Nea~e.s~. SeweF Service Li~e on Lot B. SEPTIC~r~AW~ TANK DATA Standpipes (~.~ . ~Alr-tight C-~pJ(Y~ Foundation Clea~out .~ __ Depression ove~ Ta~ .(~ ~te ~st P~d P~ing/Maintenan~ ~nt~a~ on Fil~ (Y~ ; fo~ '~a~y Holdi~ Tank ~rmit ~p~ation Distan~s ~ ~ptic~ Tank: To Wate=-Supply ~11 ~ O I_~ To ~ilding F~ndmtion. // To ~o~rhy Li~ /D t~- To Disposal. Field // To ~ter ~i.-/~ Li~ _~O f~ To S~e~, ~nd, ~e, ~ ~jor D~aina~ Co~ ~ ~ ~ Com~,nts L Jo [Page 1 of 2] 2-15~84 C. ABSORPTION FIELD DATA Soils 1~ating in Absorption Strata Date Installed z~. ,/~ ~/ Width of Field .~" Square Feet of Absorption~ea Depression ove~ Field gf~ Results of Last Adequacy Test Length of Field ~-cD i Depth of Field .~ ! Gravel Bed Thickness .~.~ I/ Standpipes Present Y~ Date of Last Adequacy Test ~ ~ Separation Distance from Absorption Field: To Water-SupPly Well ~D / ~ To Property Line /O TO Building Foundation ~)~' ~ '! To Existing Or Abandoned System cn Lot /(_3~ ~f~-~_ ; On Adjoining Lots ~) ! ~ TO Water Main/Service Line /~) g~ To Cutbank(if present) To Stream/Pond/Lake/or Majo~ Drainage Course A_) O ~ ~ To D~iveway, Pa~king Area, or Vehicle Sto~age Area ~ ! ~ Counts ~ D ~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pum~ Off" Level at Pumping ~ycles d~i~g%Adequacy Test. Msets ~OA Comments ** Check P~mitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA onthe date of this inspection. Signed , ~ ~ £~ 8R~ ~98~¢ . Date Compan~ ~"";~ ~ PM, 6~4-29~0 MOA NO KB1/d5/s [Page 2 of 2] 2-15-84 November 3, 1984 Alaska Department of Environmental Conservation ATTN: Steve Eng Sir: This is a request for a 90 day extention of approval for the Class A water system in Sleepy tlollow Subdivision #1. I need this additional time for the Engineers Asbuilt of the water line. The Coliform Bacteria water test will be done monthly by Chem Lab, the samples will be taken monthly by David Behrens, from his lot at the end of the water line at Lot 10 Block 2 Sleepy Hollo~, Subd. He will be responsible for the final test and results, in ob}aining your departments approval. ~// ~ 7 ,~,/~,~/~ ~//~ o~ Thank you, C John L Gross I David Behrens, above. Ilar ed this do hereby, agree to tbe terms listed in the letter Day of November 1984. l)avid Behrens 5633 B Slreel Drinking Water Analysis Report for Inorganic, Organic, and Radiochemical Contaminants PUBLIC WATER SYSTEM: Eagle ~v~, ~as~ 99577 OHy Sm~e Z~p God6 TO BE COMPLETED BY PUBLIC WATER SUPPLIER SAMPLE DESCRIPTION: No!e: Check box to lefl of conlsminanls listed below lot the ~n~ly~ ~s desired. ANLhO*;/AGc///cS :r,N DISIR'.CT OFFICE Collected By. J.L. L9 B1 Sleepy Hollc~ Sample Location Source Type [] Surtace Water [] Routine Sample [] Special Purpose Sample ~ G¢ound Water Day Year [] Untreated Water [] Treated Water TO BE COMPLETED BY CERTIFIED LABORATORY C!IEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 "B" STREET ANCHORAGE, ALASKA 99502 CHy Slale Zip Code Sample No. 5323 Station No. Labooalory Analysis NO GY 5-23-84 Received by Date INORGANICS [] Arsenic ~i Barium [3 Cadmium F3 Chromium [] Fluoride E] Lead ~ IAercury F~ Nitrate - Nitrogen [] Selenium L~ Silver [] 'rurbldily Limit Mg/I (0.05) < (1.)< (0.010) < (0.05)< (2.4)< (0.05) < (O.002) < (lO3 (o.o~)< (o.o5) < (1 NTU) _:i0 0 1 t_ 05 10 .;0 0 2 zl o. ].!o -- o. o~I O. O0102 O. 001_ o Oll - o .~_o_ _ I ORGANICS Limit Mg/I [] Endrin (0.0002) LLJ I~ [] Lindane (0.004) [] Methoxychlor (0.1) E) Toxaphpne (0.005) [] 2, 4-D (0.1) [] 2,4,5 - TP Silvex (0.01) D RADIOACTIVITY Limit pCi/I [] Radium 226 & 228 (5) [] Gross Beta (50) E) Strontium - 90 (8) © Tritium (20,000) 5-29-84 DEI~F. OF I~NVIRONMIE~TAL CONSEIIYATION Bltl~ SH£FFIELO,- GO'~ERHOR ~077 274-2533 437 E. Street Suite .200 Anchorage, AK 99501 December 23, 1983 To Whom it May Concern: According to records in this office the Sleepy tiollow Subdivision Water System serving Lots 9 and 13 of Block I and Lots 11, 12, and 13 of Block 2 is in compliance with the State Drinkiug Water Regulation. t. lM/msm iM.S itx c e rely,