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HomeMy WebLinkAboutSLEEPY HOLLOW #2 BLK 1 LT 9Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221474 PID Number: 0515110100 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New *Upgrade Name Roy & Amber Levi ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 188464 Mountain Road, Chugiak ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Sleepy Hollow #2 Blk 1, Lot 9 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank I Field Lift Station Tank Line Ft2 Ft. Well see below TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water > 1 00 Material H D P E Number of compartments 2 Lot Line > 10 NA Foundation >rj LIFT STATION Manufacturer Capacity Gal. Remarks 96' Waiver to onsite well see attached narrative Alarm location Electrical installed by PIPE MATERIAL House to tank /CBS drainfield Tank to 3034 Installer Guaranteed Services Drainfield CO/MT PVC :?a Inspector C. Leet BENCH MARK (Assumed elevation)100 ft Inspection Is' June 1, 2023 �a June 1, 2023 dates: 2 Location and description � Top cleanout noted on drawing 3rd July 1, 4'h ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp F. Conditional Approval: Date C ���(� A A s gyp°• e9 � li hk) c�°, Charles A. Lect �i,�q�9� ° celoaao Septic System ' Date 'Z� Z Approved . I Prequirements.90�®�®®® Note: this a roust does not include well permit PP (Rev 05/02/18) HERMIT NUMBER: OSP221474 I PID NUMBER: 05151101000 Lot l t Q Deck Sh�i& 10 Lot 1 � 100' P �Q4 iv �d_ j Shed 3-..EDRC70M �EDR e } p tsa; i o rL T Covered { = Porch x x ' SLE Y C K 2 HOLLO'":%2 'c o \Lot 12 ov i <Cj ,o ' E ` / Y -, Lot 4\ 1t 7- VINIMJM SEPARATION DISTANCES VERT CAL: o' SEPARATION TO IMPERMEABLE STRATA 4" SEaARATON TO SEASONAL HIGH 'WATER h.OWONTA� `.' mMUM 100' SEPARATION FROM PRIVATE WELLS .' %iV.UM 100' SEPARATION FROM SURFACE WATER OR STREAMS %WUM 10' SEPARATION 'A'ATER SERVICE LINE m 49TH d� Charles A. Leet QQQ c CE 10480Pprn L o t 1' J ALASKA RIM ENGINEERING xeri Palrr,er, Aicska 99645 '1 PH_ (907)775-2347 : PH: {008;617-40 _ !' aas er menyineerirg.11c grnoil.corn AREPAGE: 1 OF 3 Consulting Engineers: Planners SCALE: 1 " = 60' WO: 2022102 1000 GALLON SEPTIC TANK REPI;ACEMEN T SLEEPY HOLLOW #2, BLOCK 1, LOT 9 OVERALL SITE AREA ;a ©MAY 12, 2022 �ERMIJT NuMBER: 105='221474 P i D M L R-. 05151,i SWIN' -:C-S DFSCRIPTION CORNER R CORNE0 R N L R (A' CORNER (A) -19.5c j 20.00 ST CO 50.35 7-78 24" ACC-ESS S V`1 /M H SV2/CO 1 76.18 80.21 455.83 49,84 1 84. 9C 55.33 DECO 2 31 9.50 58.30 WELL 73.98 58.10 Deck Shed 8x 1 Lot 9) 01� 'shed, D C F1 �0. 3 500, 10 CRN B FXIST. CIRN A I- -5—BEDROOM HOME CRNIC Clovered ol ch ,,`fi X., <0 -7- —Ar- - =30' NOTES: EXISTING FIELD :S BASED ON mQA RECORD DRAwiNGS Q EXzSPNr, CLFANOUT TOP ASSUMED ELEVATION AND IS NOT BASED ON FIELD 100.00' HDPE 1000 GALLON S-_—:- -A*,-, INSET A svi / M'i °Do°°<�4aD x V % 4 ............. Charles A. Leet CE 10480 03 DOUBLE OPPOS:NC CLEAN 0,7 10-FEr.. 0,THE OUTLET FND OT THE, TANK ALASKA RIM ENGINEERING PalmerAicska 9964-5 , PH: '907'775-2347 -. PH: (6M617-4-070 ----ARE P/ A, G F: 2 OF 31 Consulting Engineers: Planners SCALE: 1 " — 401 WO: 2022102 1000 GALLON SEPTIC TANK REPLACEMENril' SLEEPY HOLLOW #2, BLOCK 1, LOT 9 SIT E PLAN DETAILS Oc MAY 12,2022 DERivii NUMBER: OSP221474 I PID NUMBER: 05151101000 FG INV IN 89.62 BENCH MARK: TOP OF FOUNDATION CLEANOUT AS NOTED ON THE DRAWING ELEV. 100.00 NV OUT 89.41 ' gq�oo�oDp�t1 ALASKA RIM ENGINEERING jcky L' ° Qa �� 9 D� Palmer A aska y9ii4- p � �',, ='F?: i;3G7}77B-�347 PH: {608}617-407 9TH ° VV }5� v a'ask.ar:rnen ineerin. .IIcC ma:l.cam p e 4— d PARCEL ID 051 -51 1-0 ° °°°°°°°°°°° ° ° ° °°° A E PAGE: 2 OF 3 °°Q Consulting Engineers: Planners SCALE: 1 = 40' WO: 2022102 Q� Chorles A. Leei °°a� ry CE 10480 . `��� "1000 GALLON SEPTIC, TANK REPLACEMENT SLEEPY HOLLOW #2, BLOCK 1, LOT 9 QQ PROF `-' 4�ddd�Oddd� TANK PROF'—-E n?019 M� i 100.1 ti a � O U 0 o X o j Y X U Q (n 00'ss9 X � � Q jj Mryc�j J v! 0 o a 23.9' N 0 t a c v v > U cxc U ti a to O c O U— X c LL � Vn a a� v� F- I-T ww a U J s v O U 3 ( N a i \J E �_ O t= Q �o�� a � " ° W J @ •v1 O U J c� Lo �u c -° O 3 a n o d in u v N v OU O oL (� z � NL n fl n N N C V >:E ° c Z oL o 0)(� c-u Y= v L atTC7 > J O �NvNO2CL zYC) zQ��? U a 7 � I_ 0sE a ° �:J 5:3 '76 0. 0 z Z U o m 1 ate+ a -c.� j v d = X O E" -� O O O i LO I-,v�i v=i w Y '00 'v O O u Q a -O J `ic�—•" Q 1 U` LU p 2 lD O N O C� m o w u�NQo� aL N �a)u z moo a s c pi jtDz� 1 al c0 M, V 1 — L cz O (�, ..-t u N cc U' 1 fS OA L ca — IL C) .Mn 3a y M O wJ = O '� c0 �q92 GF ? j CN U u Q) U C!1 CLS 0 U z 6 � Q -' F O Q m U u 0 0 �' t o O (Cj ¢ y o �/� co i fV M ^C�II r C31 0.4 d!J 0 CO j` w 0 � ❑1 43 0 a � c� � c� AW c, ate • c ,P V' �• C,. _�• 6 "gip '•'! O� , O LL. • _' O `- Municipality of Anchorage '` s Ihp:ntment P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV241006 COSA#: Permit#:OSP221474 P I D#: 051-511-01 Legal Description: SLEEPY HOLLOW #2 B1 L9 Engineer: Alaska Rim Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 96.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on -site wastewater disposal system will require all separation distances be met or another approval from this department. .................................... 0 K 0 E E 0 ..... ■ 0 N 2 0 0 N .................. 0 0 M E X■ 1 Waiver is Granted: X Waiver is not Granted: Date: �� L% Approved by: Name of Reviewer **** VARIAN C EIWAIVE R REVIEW **** ARE, LLC dba ALASKA RIM ENGINEERING CIVIL ENGINEERS— PLANNERS 1920 Kentucky Derby Dr. Palmer, Alaska 99645 Telephone (907) 775-2347 Email:alaskarinmengiueering.licLa?gmaiLcom October 12, 2023 Municipality of Anchorage Onsite Water and Wastewater P.O. Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 RE: Sleepy Hollow #2, Block 1, Lot 9 Subject: Onsite Well to New Septic Tank Waiver Request This letter is to provide you with the information for a request for waiver for the separation distance between a well and a septic tank for the above referenced property. The septic tank was installed on this property on June 1, 2023, to replace the old septic tank for this single family dwelling. The construction was documented by our firm. In July 2023, Farpoint Land Services, LLC, provided ARE, LLC with an as built survey of the referenced property. The measured distance from the well to the center of the tank's manhole lid was 100.1-feet. Adjusting for the tank size, the calculated horizontal distance from the tank to the well is 97.04-feet. This is the only portion of the onsite wastewater disposal system that is inside the well protection radius. The tank installation was challenged by the depth of the tank and the location of the tank between the building(shed) to the north and the well to the south. A true horizontal measurement was hindered by the ground slope and excavation spoil piles. On July 26, 2023, water samples were collected and submitted to Mat -Su Test Lab for analysis. Two water quality tests were performed: Total Coliform Bacteria and Total Nitrogen. Total Coliform Bacteria -The results were satisfactory for the absence of all three components of Total Coliform Bactera, E. Coli Bacteria, and Fecal Coliform Bacteria. (see attached Mat -Su Test Lab Drinking Water Analysis Report). Total Nitrogen — The combined Nitrate/Nitrite value of were 1.53 which is below the 10mg/1 recommended practice set by EPA (see attached Mat -Su Test Lab Drinking Water Analysis Report).. In fact, the Nitrate/Nitrite sample indicated values consistent to the neighboring wells and lower than what was previously reported (see MOA COSA 2013). Based on the information provided in this report, it is my opinion that the lesser separation distance will not have an adverse effect on the groundwater, nor will the public health welfare and safety be at risk. Professional Consulting --- Practical Solutions Page I of 2 ON -SITE WASTEWATER SEPTIC TANK REPLACEMENT SLEEPY HOLLOW #2, BLOCK 1, LOT 9 Page 2 of 2 We are requesting a waiver of 96-feet between the onsite well and new HDPE septic tank to be granted with this submittal. We believe the waiver is justified will not affect the onsite well for the following reasons: - The newly installed HDPE tank is less prone to leaking than the previous vintage 1988 steel septic tank. Soil logs from the well driller and previous leach field indicate free draining soils. The well is upgradient of both the tank and absorption field. Bacterial analysis indicates the current well is free of bacteria. The Nitrate/Nitrite were below the 1 Omg/l recommended practice set by EPA. In fact, the Nitrate/Nitrite sample indicated values consistent to the neighboring wells based on the MOA Nitrate Model. If there are any questions, please contact me. Sincerely, ARE, LLC. a: 49rH Chories A. Leet . CE 10480 , Charles A. Leet, PE Principle CC: ARE File No. 2022 025 ENCL: As -built MOA Inspection Form MOA Wavier fee form water and wastewater fees(to be paid by Guaranteed Services) Mat -Su Test Labs, Bacteria Nitrate Nitrite Record Drawings July 25, 2023 Over Existing Site Plan Site Plan Profile Professional Consulting --- Practical Solutions Page 2 of 2 Test atmSu I Name: Levi Roy Lab ID#: M230725 ;flailing Addi ess: P.O. Box 672450 Date Sampled.- 07/26/2023 Chugiak, AK 99567 Time Sampled.- 1142 Legal Description: Sleepy Hollow #2 Blk 1 Lot 9 Sampled By: L. Roy Sample Site Location: Kitchen Sink Date ReceitJed: 07/26/2023 Time Received- 1339 Parameter Method Result. Unit MRL MCL Date Nitrite—N TNTplus 835/836 (Hach 10206) <MRL mg/L 0.200 10.0 07/26/2023 Method Repotting Littut (AIRL): the lowest concentration that can be reported reliably Afaxittuun Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA mg/L: milligrams per liter: li 10001h of a gram Results Reported By: t"G�.Q.1LC.,.2 (,/l�Q/L�yLCt.J'fl1i Patience Obermann Laboratory Analyst Reviewed By: Signature: -'Au- tf�lG .`!.'101 i0S2 AKDT, Email: office@matsutesttab.com P ,a trmsu Test Lab, I Name: Levi Roy Lab ID4. M230724� :YlailingAddress: P.O. Box 672450 Date Sampled: 07/26/2023 Chugiak, AK 99567 Time Sampled: 1142 Legal Description: Sleepy Hollow #2 Blk i Lot 9 Sampled By: L. Roy Sample Site Location: Kitchen Sink Date Received: 07/26/2023 Time Receive& 1339 Kitte Parameter Method Result Unit MRL ` IV1CL Date, Nitrate —N TNTphus 835/836 (Hach 10206) 1.53 mJL 0.200 1.0.0 07/26/2023 Method Reporting Limlt (MRL): the lowest concentration that can be reported reliably Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA nag/L: milligrams per liter; I/ 1000` I of a gram Results Reported By: Patience Obermann Laboratory Analyst Reviewed By: Signature: L'1yis I*U Email: office@matsutestiab.com 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: OSP221474 Work Type: SepticTank Renewal Tax Code Number: 05151101000 Site Legal Address: SLEEPY HOLLOW #2 BLK 1 LT 9 G:1060 Site Mailing Address: 18864 MOUNTAIN RD, Chugiak Owner: ROY LEVI C & AMBER S Design Engineer: ALASKA RIM ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 4/17/2023 4/16/2024 51844 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 By: IS S✓ JJ 7--a 14 G/a-S /c/}._ rz- I Issued By: Date: Date: 20� 3 MUNICIPALITY Development Services Department Phone: 907-343-7904 ` On -Site Water &Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel l . D. # 051-511-01 Property owner(s) Levi & Amber Roy Day phone 907.7079837 Mailing address PO Box 672450; Chugiak, AK 99567-2450 Site address Legal description (Sub'd,, Block & Lot) Sleepy Hollow #2, Block 1. Lot 9 Legal description (Township, Range & Section) Lot Size 51,844 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: {® all that apply} Absorption Field 17 Initial ❑ Single Family (SF} El (w/wo ADU) Septic Tank 0 Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ll Multiple 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 an9cable MuniciDal Codes". 4 ig 'ture of pll6perty owner or authorized agent) Permit/Rush Fees: 0 aa -Sr Waiver Fees: Date of Payment: 111oZ 2.1A Receipt Number: (a1 11 Permit No. 0S p;Z; I ql Date of Payment: Receipt Number: Waiver No. '',': ?': �: "zz G ;Development Services\Building Safetylon Site water and wastewateAl'ormstClient ForrsTermit Application.doc Professional Consulting --- Practical Solutions Page 1 of 1 ARE, LLC dba ALASKA RIM ENGINEERING CIVIL ENGINEERS – PLANNERS 1920 Kentucky Derby Dr. Palmer, Alaska 99645 Telephone (907) 775-2347 Email: alaskarinmengineering.llc@gmail.com November 17, 2022 Deb Wockenfuss Onsite Water and Wastewater Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 RE: Sleepy Hallow #2, Block 1, Lot 9 Subject: Tank Replacement Dear Ms. Wockenfuss; This narrative is to request approval to replace the existing tank. Tank Replacement The proposed plan is to pump and crush the existing failed tank in-place. Septic Tank Proposed is to replace the existing 1000-gallon tank with a new 1000-gallon tank meeting MOA requirements. The tank will be installed and backfilled according to the manufacture’s recommendation and the current municipal code. If insulation is required or used it will be document on the inspection form and record drawings. We are proposing a tank manufactured by Greer Tank or its subsidiary Anchorage Tank and Welding. If steel is used it will have the required advance coating applied at the factory. We will verify the tank manufacture and material and that the appropriate cover is placed over the tank. Upon completion, we will provide record drawings of the installation. If there are any questions, please contact me. Sincerely, ARE, LLC. Charles A. Leet, PE Principle CC: ARE File No. 2022- 025 ENCL: On-site water and wastewater fees On-site septic /well permit application November 17, 2022 Site Plan Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221474, Curtis Townsend, 04/17/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221474, Curtis Townsend, 04/17/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221474, Curtis Townsend, 04/17/23 MUNICIPALITY OF ANCHORAGE DEPARTMENI' 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 ~ SEPTIC ABSORPTION Address TANK FIELD Phone(s) PermdNo. No.o~Be~ s ' WELL ~ . r driveway, water bodies, etc ~ TANKS ~ SEPTIC ~ HOLDING __ TYPE OF SYSTEM ~TRENCH ~ BED ~ W, DRAIN [~ OTHER Depth iD pipe bottom from Total depth I ...... igina, grade Gravel width Total absorption area Distance betwee~ Number OJ I~nes Soil rating / Pipe malerJal ~ PRIVATE ~ OTHER (Identllv) Installer Date Inslalled; ~EMA~KS: t / Municipal and State guidelines Iff effect on Ibis ~- 72-013 (3/85) c:)~f ,';~:? 7/'::?0 fi:ll~l J ~t(:.:x;~ r I.)l::!!i~ i cjIl~!d l'¢ll:J5i'iF'Fi'[iV OF:: ......)1 I ¢ 1, I I II 11 I~.li'll'l f.'JF:~ :I: 'I f'EN ..l::.r' il' ,t[.~ .~..)t.l t,g!Z] I I:,II:.:I!iL I:::'t:;'(3F:'t~ I:~1 '/ ¢'~ :!:l~:~l,,I DONEi:O. 'H I: F:I:]:;;I'It I I /,,. b, I2/:~I/'V0 ¢~hti) VAt ID F'I.¢:!i::IE l.'Jl~].!,. I.'J!E~]:~!:: !:~I'Id!..',U*I t::)l'.I I:!d'JE¢IhtlEi:]:;:U Sill: 0 C c._> 0 C) 0 ,=; ~9 ;':~ © ¢) C) (P MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmenlal Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT LEGAL DESCRIPTION TANKS SEPTIC ~ Hal. DING TYPE OF SYSTEM TRENCH ~ BED ~ W. DRAIN E3 OTHER SQ FT DISTANCES WELL WELL LOT LINE FOUNDATION SEPTIC ABSORPTION TANK FIELD FT Fl WFLLS [] PRIVATE A OTHE[I (Identify) FI1 FT REMARKS: Meeicipal and Slate ~mdelines ie ellect 011 this dale: Health Department Approval: 72-013 (3/85) ' L, CE 5034 Up c:] r' ac:lc I:: NMA / .I. 09~() W]:I.:i~;HIRE BI..VI:). ~i:lLJ.l: lie 1800 Day F:'hcn'lc..,: ,?.'/4 '-TA 1 :l. i'o:~!~!t, l'C:,c:Jl.kil'l/.!!:~ :[I]!iiJL~]./::Lt:j,(:)I] (::)V(::~I' tialil:: (~i~) . Id:.:A!. !lxll:ii: :1.4,, 0 ' OI::: II::IEI',ICH I0 I::d:i]~li.)Vl~:]i FROM R,I:GI'I'I'"OF:'"WA¥~ l'l~ l l,i ;× :I:S'I':I:Ixlt:) II:;~I:J~:IxlCH DIZI~IEN!iilIOIg!!!i~, D[I NOI t~£×CI!:]::i:D 10' i If I i~i I:::'IERM I I .L S i !!!i~':'~l.lED F OR '1 HE l!:X i[ SI' :1; NG ;]!; BE,01::/[)[)M I;IES l, DIi:IxlCI:::.' ONI_¥ THAI: f'o~th by 't.h~? Muni~;ipalit. y ol' Ancl"~or. age (MOA) and the State ol' A'laska. w:i]ll ~i~u~t.a].~. t. he syst. c.u~ :i.n ac;c:o~u;lanc:~.:~ with all MOA c'.c:lde~ and Pegu].aticu~s, irt comp].:i, ance u~i'l:,h 'l:.he dc~s:i, gn c,::vit, er.:i.a oi this w:l.:l.], acll"ll.:;~l.~;.~ I.,o all MOA ar'icl St.a'l:.e clt' F~Zl.,~il.::a~ i'C~clUil'l.~)m~:.~nt, s t'cn" the set. back ENGINEERING EVALUATION & INVESTIGATION SERVICES, INC. September 22, 1988 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services 825 L Street Anchorage, Alaska 99502-0550 The objective of 'this proposed reconstruction of the existing drainfield is to realign the ~ast 14 feet of the absorption trench to get the system out of t~'~"~a~ right-of-way and the lO foot setback. This is required instead of a lot line waiver because of the type of mortgage financing the buyer is using, The realigned trench will be constructed identical to the existing system which appears to be constructed in compliance with the attached permit, No wells are within 100 feet of the realignment nor are there any streams. The existing system was adequacy tested in August and passed easily. 200 West 34th, Box 267 o Anchorage, Alaska 99503 · (907) 274-7611 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: FANNIE ~kA_E DATE PERFORMED: LEGAL DESCRIPTION: ~ 9 BL~ 1 SLEEPY HOLLOI~T Township, Range, Section: 1988 1 2 3 4 5 6- 7 8 9 10- 11 13- 14- 15- 16 17- 18- 19- 20- COMMEN.fS SILT AND ORGANICS SANDY GRAVEL WITH SCME SILT SILTY SAND OR SANDY SILT SANDY GRAVEL WI~] SC%~E SILT SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? SANDY SILT OR SILTY SAND SANDY GRAVEL WITH SC~E SILT IF YES. AT WHAT DEPTH? Depth to Walet A[ler/ ~onilorifl§? Reading Date NOT t - l D- P E Gross Time ~RCED Net Time Depth to Water SOILS Net Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BE.f WEEN _ F.f AND F.f PERFORMED BY: EElS CONSULTZNG ..~qG. I BRUCE D. PAT'~ I~ONCER]IFY 'fHA'f 'fidis 'fEST WAS PERFORMED IN SEPT 22, 1988 ACCORDANCEW~IRALLSTAIEANDMUNICIPALGU~DELINESIN EFFECT ONIH~SDA'fE~ OAIE: ~, 72-008 (,qev. 4/85) LOT8 10?' Utility Ease~nent~. ~ LOT 9 ~CALE 0 40 80 LOT 10 10' Electric ease_m~n-~-> ~-'~ E~W,~ i~Td~ ~a~fi~ld ~f x~t~dpzpe beptic '"' d' 70~ / Depress~ % / water se~ce ~ er Se~ce 7 s op / NOTES: 1. Septic Drainfield extends acrossed the lot line approximately 2 feet into Mountain Road ~ Right -of-way. 2. Property line bearings and distances not shown for clarity. The platted bearings and distances were used in conjtmction with the monunents shown as "found" above to determine encroachments. i hereby certify that I have surveyed the property described on this plat and the improvements situated thereon are located as LEGEND Lot Corners Found Rebar Foundatio. Drainage Arro~s NOTES 1. It shall be the responsibility et the builder or owner to verify that building location shoun meets all subdivision covenants and zoning ordinances, 2. It is tho responsibility of the builder to verify all' elevations uith respect ta all utilities g drainage, 3, This plat represents the parcel oF property described below taken From the recorded plat describing that parcel, Instruments recorded prior tu or after the Filing oF the recarded plat are not shoun on this plat, 4, The information on this plat is For tbe use oF lending institutions specifically to shoo any conflicts betoeen existing structures and platted lot lines or easements, the plat is not to be used For positioning additional structures or ?encee, ASBUILT LOT 9 BLOCK 1 SLEEPY HOLLOW #2 EEIS CONSULTING ENGINEERS~ INC. 200 West 34th, Box 26~ Anchorage, Alaska 99503 (907) 274-7611 Project It 8138 I Date August 18,1988 ~80,00 76-~68 .......... ~49.64 353.10 ~54,59 oo 89.13 ~,¢%o'o.~ o~ ~,7~.~o M( r\., Tom Fink, Mayor / unicipality Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 F.N.M.A. 3201 C Street Anchorage, Alaska 99510 Subject: Lot 9 Block 1 Sleepy Hollow Subdivision Permit #880176, PID .~051-511-01 A permit issued'by.thi~ Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report (three-part'form) must be sent to this office for review and approval, and for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit H LI N :[ E: ]: P (:~ L. ]: T Y D I::: (:i N C: I'1 0 1:5 tq (:':) Ii: D I',1 S i1: I" I!!i: N I: L L.. F:' Iii: I::~ I"1 :1: "r' PF",'[3V:I:DIEi: C',(::)IqI:::E:I:?I~'I(.YTZ[:)N I::)F:' I:::'I:;;tDF'I!!EF';~ (~E(F~fl\IDDIxlf'Ili!!:IxlT E)I::: I::X:I:~i!FI"]'.I',I(~) !^lEi:l,.[ \MUNICIPALI1Y OF ANOtORAG E~VIRONMENTA/SERVICES DIVI$ ~, / /~UG 2 6,1~88 10' Electric easement j · / ~ ,~ [ I¢~ ~_F%%,' ,,~a~field 10" Utility ~s~ /C~+ ~ Septic T~¢ ~e~ay/ / rI ¢CALE % 0 40 80 LOT 10 NOTES: 1. Septic Drainfield extends acrossed the lot line approxin~tely 2 feet into Mountcin Road ~ Right-of-way. Depresszon grgOnd marks % / water se~ce l~e / ~'~'~at"~  er Se~ce o %/ s op 2. Property line bearings and dj. stances not shown for clarity. The platted bearings and distances MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Al~chorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE J [~NEW ~ ~'/&'~ "~,~ b ~ ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Liq. capacity in gallons IF HOMEMADE Inside tength DISTANCE TO: Well Dwe-Iling Manufacturer Well t Material DISTANCE TO: Ij~?~.r ~'~¢~ y¢~'- IFOundatiOn__~L ~ .... ~- ~o, line ~ ~ _ ~_ · Totatlength of inos/¢ Trench wi:lth Top of tile to finish grade ~ /~_ [Material beneath tile L~n.,h 'Width " -- / ~Z inch., Type of cr]b Depth Crib diameter ~_R Well NO, OF BEDROOMS PERM,T N0.92~I[11~3 Liquid depth PERMIT NO. Liguid capacity in gallons PER~,,T Distance between Crib depth Total effective absorption area Building foundation Nearest lot line DISTANCE TO: ~/,~.~ Depth Driller Distance to lot line IPERMIT NO. BISTANCE--T(): f~uildhlg four~dation Sewer line Septic tarlk [Absorption a~ea(s} OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS PERMIT NO. DEPRRTMENT OF HERLTH RND EN'v'IRONMENTRL PROTECTION 825 "L" STREET, RNCHORFIGE, BK. 99501 264-472.0 O[-,l---~---; ][ TEE SE[,~Ii-___R F'E~:f,'l ][ -r ( 821017_< ) RPPLICRNT LOCRTION LEGRL HRROLD D GROSS SLEEPY HOLLOW 2:44~ BOBBIE CIR LO'[ SIZE }44-55E;4 DD$~D SQURRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD MRXIMUM NUMBER OF BEDROOMS SOIL RRTING (SQ FT?BR)= ±25 THE REQUIRED _,I~E uF THL ..,OIL RB__RF¥ION =,Y=,TEM I=,: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS TME DISTRNCE BETWEEN THE SURFRCE OF THE GROUND FiND THE BOTTOM OF THE EXCRVRTION (IN FEET). THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRYEL BETWEEN THE OUTFRLL F'IPE RNB THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT FIPPLICRNT HAS THEE RESPONSIBILITY TO INFORM TNIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELL'.---; RDJRCENT TO THIS PROPERTY FiND TFIE NUMBER OF RESIDENCES THRT ]'HE WELL WILL SERVE. ...... TI.,~O ":: 2 ::' 1' Iq_'B. PEC:T I 0 f-~--'5, F:~RE RIEQU 1. RE[:, BRCKFILLING OF' RNY SYSTEM WITHOUT FINRL INSPECTION RND FIPPROVRL B"r' THIS [:,EPRRTME'NT WILL BE SUBJFCT TO PROSECUTION. MINIMUM DIS';TRNCE BETWEEN R WELL RND RNY ON-SITE SEI,4RGE DISPOSRL SYSTEM IS :1.00 FEE']' FOR FI PRI'¢RTE WEI_I... OR :1.50 TO -2.00 FEET FROM ~ PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R F'RI'¢RTE SEWER LINE IS 25 FEEl' RN[:' TO R COMMUNITY SEWER LINE IS 75 FEET. OTMER REQUIREMENTS MRY FippI.y. SPECIFICRTIONS RND CONSTRUCTION DIRGRFIMS RRE R'v'BILRBLE TO INSURE PROPER IWSTRLLRTION. I CERTII=Y THRT t: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY TFIE MUNICIPRLITY OF- I-]NCFIORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNI}ERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS/REMODELED~ TO INCLLIDE MORE THRN ~ BEDROOMS. _--]~/" -./~x RPPLICRNT HFIROLD D GROSS ~) ~]~r-,,Jnr lOc.t) ~ ' lc-: ~'e ' / CONST ,IJCTION TEST LAB ~ERFORMED FOR, LEGAL DESCRIPTION: THIS FORM REPORTS: Harold Gross Lo1 cj Block BVisuol Soils Exominolion 48TH AVE STE 'C' A~,CHORAGE, ALASKA 99503 248-1333 Subdivision DATE PERFORMED: 1N-3N=81 ~leepy Hollow D Percololion %e$I 81-1625 DEPTH SOIL =EET DESCRIPTION NOTES Sandy Silt - ML 2' Fn Sand - SP 5' __ Sandy Gravel with trace of Silt - GP BOTTOM OF HOLE ,','AS GROUND WATER ENCOUNTERED -~ YES, WHAT DEPTH _EGEND = -- Perc zone :, S - Somple loken : -- Frozen zone , No GENERAl_ S,TS S,OPE ~' -- Woter loble , . ,, , :-EADING DATE GROSS TIME NET Ti'~E~',;i~:;~:¢: ,[:,":';;:DEPTH TO H20 NET DRAINAGE ~-ERCOLATION RATE: DRAINAGE REOUIREMENTS'. 5 SF/bedroon~&~.:.' , ~' ......~...~ ...... ~ .... -ES~ PERFORMED BY: Kevin Brau~ DATA CERTIFIED BY: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA c~9501 SHEFFIELD, GOVERNOR ~74-2533 .M DATE. ay 22, 1986 PWS [.D.~ 213522 To Whom it May Concern: According to records on file in this office the Water Regulations Sleepy Hollow Water System is in compliance with th(: State Drinking Sincerely, Michael P. LewJ.s ]Environme~1tal Engineer 0 E Ste- w...� r �'� • Al IM DOC K �tXsrJ� t4 g "X F .5-W z7 - I hereby certify that I have surveyed the following described property: Lo 61 oek Anchorage Recording Precinct, Alaska, and that the improve- " ments situated thereon are within the property lines and do not overlap or encroach on the property h 1 in adjacent thereto, that no improvements on lying adjacent thereto encroach property on the in and that there are no roadways, � premises question transmission lines or other visible easements on said property ®aaoa���®tea except as indicated hereon. F $H Y9� ,yrNr'9 Dated at Eagle River, Alaska J_V this day of � ' ROBERT C. JOHNSON �— SCALE: Registered Land Surveyor No. 880 -LS Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAl,. SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 ^pp,,oat,on Date GENERAL INFORMATION (~UST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) ,.] Location (address or directions) (b) Property Owner~l~/2¢~''t'j /L~,zcz,"~"J' Telephone: Home '~¢~¢r'5-¢/'Z Business Mailing Address /AC'O'/~2( ¢ ;7~, ~ ~,¢/¢¢'~2~/~,,¢, ,//~h~,~>> ~'~'-~ 7 (c) Lending Institution ~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followino address: or: Check here I~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family '~' Number of Bedrooms WATER SUPPLY Individual Well,Eli Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~I Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 trey 8/861 From ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. ~ further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~"~,,¢~,/z¢ /'~. ~),¢ '~.7Z:)/u' ~ /~.~. Telephone ~ ~- ~/~ Engineer's Seal DHHS APPROVAL Approved for ,,'~ bedrooms by Approved ,Z/~¢~ - Disapproved Terms of Conditional Approval Conditional CAUTION 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 e courtesy to purchasers of homes aod their ]ending 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. Page 2 of 2 72-025 trey 8/861 Back WELL DATA iC~gALI~ OP ANCHORAGE iCUN . o~.~,,VtCLJ~I[~'I~ALI"I'Y OF ANCHORAGE (MOA) ~NvttON HEALTH AU'rHORITY APPROVAL (HAA) 5 990 CHECKLIST-264.4744FEBRUARY 1984 Well Classification P£/-' / t//'~ ;q~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed (",~,~ ~.~//¢LO Yield Total Depth Y~ 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 Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ; On Adjoining Lots ,//-5'-' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~,~ Water Sample Test Results Comments To Nearest Sewer Service Line on Lot SEPTIC/HOLDING TANK DATA //,A/;~", ~ Date Installed No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~Y' Foundation Cleanout (Y/N) Depression over Tank (Y/N) ,A~ Date Last Pumped ? Pumping/Maintenance Contract on File (Y/N) /Z~ ; for Holding Tank High-Water Alarm (Y/N) ..... /'~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line '~- ~_ To Water Main/Service Line /~ ~)''/'- Course To Building Foundation To Disposal Field ¢ // To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026fRcv 8/861Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /Z.~..~ Date Installed '¢/:' ~,J~;' ,/~,,~//~, ~ Width of Field .~ Type of System Design Length of Field '~ ~-~ .¢ Depth of Field ~ ¢'~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: 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 Gravel Bed Thickness ,5¢'~ Standpipes Present (Y/N)y]m Date of Last Adequacy Test To Property Line ~ ,// To Existing or Abandoned System on ; On Adjoining Lots /'~o ¢" To Cutbank (if present) /~c;, 'cz` /~ '~ ~d~Z~ o Z o? D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ba~e checked, var, iliad, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date of Payment ~, % ~ ~ O Amount: $ /~ (~ Engineer's Seal Page 2 of 2 72-026 trey 81861 Back D. R. DAYTON, P.E., R.L.S. HC788ox 1026 Chugiak, Alaska 99567 (907) ~8-2417 July 3, 1990 Municipality of Anchorage Dept of Health and Human Services 825 'L' Street Anchorage, Alaska 99502 Re: Lot 9, Block 1, Sleepy Hollow Subd., Sec 15, T15N, R1W Permit No. 90084 This is to verify that the two dry wells on the subject lot were abandoned by pulling the casing, filling theholes with gravel to 15' below ground. Concrete fill was used from 15' to 5 below ground. The top 5' was filled with gravel. ADEQUACY TEST LOCATION DATE ~ _ TANK SIZE= NO. of BEDROOMS, ~ TESTED BY' ~,/~,/./~,'"',"o ~ LOAD, 15OGALLONS X..,~__BEDROOMS RESULTS PASS ,~ FAIL__ SEPTIC TANK LIQUID LEVEL METER CUMULATIVE FLOW SEPTIC TANK /~ S.A.S. /~ COMMENTS TI ME READING VOLUME RATE LIQUID LEVEL SEPTIC'rANK LEVEL S.A,S. EPT. OF H~A[[ ~ ~NV~ )F~,',I~T,*,L PR4 TECFfON MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND I--NVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (e) Application Date May 20, 1986 Legal Description (include lot, block, subdivision, section, township, range) I.o~_9_~_Blo_e~ 1 ... S£~6~ Hollow Subdivision #2 Location (address or directions) (b) Applicant Name MoEt~20 Telephone: Home 688-4038 Business Applicant Address P~. Bo;( 671044, Chokg~.~.~z, Alcska 99567 (c) Applicant is (check one): Lending Institution []; Owner/builder i~; Buyer []; Other [] (explain); (d) Lending Institution FJ,'f~,,f: I~¢rs~c~t~ Ba~L~ Telephone Address ___¢~_.e,.z~L&6a~,~.~tO~.~.~ A~ (e) Real Estate Company and Agent ~in~n~Bg. Address Telephone (f) i~'~e HAA to the following address: --~S-& S Engin¢64.~J .... SgB--l~ 6X Eag&e~Riv¢~,,__Ala&~'z 9 9 5 7 7 TYPE OF RESIDENCE Single-Family [2{ Multi-Family [] Other Number of Bedrooms 3 _ WATER SUPPLY Individual Well [] Community [] Public ~ Sleepy Hollow Water System Note: If community well system, must have written confirnration from the State Department of Environmenlal Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 [1u84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 & $ EN_GI N_B RING Telephone Address $R B 'il96X Date EAGLE RIVER, AK 99577 JvJ,b,¥ 2 2 1986 DHEP APPROVAL Approved for ~7'~J'~z~'~ '3~_/Ioedrooms by ~ ,~ Disapproved ] erms of Conditional Approval Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon tile 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 arralyze 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ~ UN~C. ~ PA L ~ T'rf~ClE II~i;¢f~l~'J'^-~F.E B R IJ A R y 1984 UEPT. OF HEAl. TH & ~-~4720 'ENVIRONMENTAL PROTECTIohl Lega Description: L-~'F~ ~ ~-_2~-, ) Well Classification If A B, O. D,E.G. Approved ~N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To septic/l~2"di~-g Tank on Lot ¢,~.~,~/ To Nearest Edge of Absorption Field on Lot _ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Watbr Sample 'rest Results Comments ~[::~ ~-~ I~epth of Grouting Pumn Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) : On Adjoining LO~S On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot : Date $. SEPTIC/HO~ TANK DATA Date Installed \r2 -'1.* - Standpipes (~/N) Depression over Tank (Y/l~? Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (YIN) Separation Distances from Septic/~gCTank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size ~. ¢=,,~:::~.r., No. of Comoar,mems ~ / Air-tight CapsUle)N) Foundation Cleanout (Y~' (~/~ ' Date Last Pumpeo . ~'-'7~\ ; 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 Strata Date Installed t Width of Field Square Feet of Absorption Area '~ Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field Depth of Field /~' Gravel Bed Thickness Standpipes Present CN) Date of Last Adequacy Test (~,O/ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~'O / To Existing or Abandoned System on ; On Adjoining Lots '~ ~ To Cutbank (if present) ~,~ lc__ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & $ ENGINEERING _ t4~Y 2 _2 !98R Signed SR6 196X Date companyE~E~,k.~..~V~_~ ~ MOA No. Rece pt No ~ ~' ¢~ ~' ~ ~' Date of Payment Amount: $ ~ Page 2 of 2 72-026(11/84) Property Owner Mailing Address Buyer Address Lending Institution Address NT FILLS OUT UPPER HAl ONLY Zip Code Zip Code Zip Code Type of Residence [] Multiple Family [] Other No. of Bedrooms _ Phone Phone Phone Water Supply [] ]ndMdual ,) .~ ~ Community [] Public Utility ~,~ AI~'ACH WELL LOG. A well tog is required for all wells drilled since June 1975. For wells drgled prior to that date, give well depth (attach Icg if available). Sewer Disposal [] Public Utlgty [] Holding Tank Year Individual Installed:__ When Connected to Public Utlgty: NOTE: TRE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Date Inspector Field Notes: Date Insp6ctor Time Date Inspector Time Date Inspector M~ ,IIC:IF/'[[f'W OF ANCHORAGE DEPT. OF HSALTH & ENVIRONMENTAL PROTECTION RECEIVED (~'~) APPROVED BEDROOMS i ) DISAPPROVED 'CONDITIONS OF APPROVAL Well To Absorption Area Well to Tank Well Log Received Soils Rating Date Sewer Installed I *~.~ :2"1~ ~.~ ~/ Septic Tank Size