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Home My WebLink AboutSLEEPY HOLLOW #2 BLK 1 LT 19 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOIRT LEGAL/DESCRIPTION _ ~/~ //=~ ~ DISTANCE TO: I Inside length DISTANCE TO: DISTANCE TO: IF HOMEMADE; Well We,, 13 ¢ ' Length o.t~a~ lin~ Width Crib diameter Well Building foundation Dwelling a ri I bef t ] Depth B~-/~u ndation Sewer line PHONE E~ UPGRADE NO, OF BEDROOMS No. of compar~e, nts Nearest lot line / Liquid depth PERMIT NO. Liquid capacity in gallons inches · ¢~ ./~ ~ ~.~ PERMIT NO. Total effective ab~i)rption are8 Total effective '~sorption area Nearest lot line Distance to lot line ~E~ea(s) Septic tank OTHER PIPE MATERIALS SOiL TEST R~NiNG~/ ~' INSTALLER REMARKS APPROVED ~," ~'Z~I ~- I)IEF:'I::IRTHEi]",IT Ui;' HEI:::IL. TII FIND EI",I'v'IROI",tMEIxlTI:::IL. PI';::OI"EC:TIOI",I ,- 0;.~5 L. 2:T[;]'.EET., I:::II',IC:I-IOI'('F](]i~'.., I:::l~::: FIPF:'I_ I CFII",IT: I]:ON]"Iq(]T I:::'HI]ti',IE; t.. F_"(;ii f:~t.. E:,ESCI:~: I P: L.OT ::J!;IZIE: MFlY, :1.9 BLOCI<: i. ~LI.,.I L.I:!;!:,TED EJELOI4 I::IF;~:I]!; 'TI'IE OF:"TZ[OI',IS I::I'v'i'::IiI..I'::IEI[..E ]-O "r'OL.I I1",1 [:,ESIGI",IING "r'OLIl~: :~;EF:'TIC : ~.:il.ll. L. IIL.nJ:.E. THE 'I"I-.II::I"F M:.::,'f '1, (8 I..~ :1.. O '~,~ 5. 0 ~. ~ :l.S. 3 :1.., OEIO. 0 :~.::.i.: :1.25 :+::+: GRF:IVEI... I_ENGTH :::' 75 F'T. I:;.'.'IEQU i I;.:.'IES MIJI_'T' I F'L,E RUI",I:~; (i",IOT E',:.:',CEE[;, I I",IG 75 F"T. IEFIC:H ) :.:.::.1.: Tl:::li",fl'::: i'II...I:~;T HI::I'v'IZ F:IT L.EI:::IST THO COHI:::'F:IF;'.TI'IENT:E; C:IEI';;:T I I="r' 1"111::l'I": FIH F;'F:IHIL..IFIR I.'.IITH TI'IE FORTII t3"r' 'TI'lIE MLII",I;[C];I::'FIL. iT"r' OF FINCHOI:;~'.FIGE (I"IOR) f::llqB' THE STFITE OF' FII_I::ISI<I:::I. NIL.L. I I",ISTFIM... I::11",1[:' I I",1 COMI::'!.. I I::II'.,IE:E 1.,.I :i; T'H THE!; [:,ES I GI',I CIR Z TEl:;,'. ]: I::1 (;;ii:' TH I L:;; PERM I T. t.,.IZL..[... F'ff)F.IEF;:E '1'0 FI1...I.... MOFI FIN[) STFITE OF: FII.J:::ISI<FI I~:EQUIF~;~EI"IENTS FOR THE SET 13FICI< D]:STI::INE:ES i::'RCII'I FIl",l'-r' E:',:':',ZST]:I",I(:fi !4Ei:LL., I.,IFI'.ii;TIEI-qI:::ITE]q: [:,ISF'O'_:J;FIL E;'.r'2':;'i'Ei"l OR IZ't..IE&.IC :SEI.,.if!!:f;]:I:::IGE :!i;"/:.'3TEIt Obi ]'H:[S OR F1N"r' FIDJ'FIC.E':NT OR I",IEFIRB"r' LOT. UI",I[)IEB'.:~;TfqI",tl;> T'HFIT '1't'11 Iii!; PEI';;:M I T I S 'v'FIL. I I) FOR I:::1 I'"lFI;q I MLII"I OF 3: EIE[';,I:;i:OOMS I:::Ii",ID I:::ll",l"r' EI',IL.I:::IRGE:HI~ii:blT HIL.I... RE[;!I...III;;'.E FIIq FI[)I)ITIOhlI:::IL F:'ERH:[T. NOT BE FIF>F'I';;'X)VE;[:' i4ITHOUT I::'IN E[...ECTP. ZCFIL INSF'ECT:[OI",I I';'.EI::'ORT.~ I I",IS'TIqI..I_E[;, -IN FIN I:::IB:EiFI COVE;F;:EI) E:'¢ I"IOR BL.III....I;:C[NG CODES, ':; ;;;i: ::' IZlN[:' '.':L~:) 'THE SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L, Street, Anchorage, Alaska 99601 264-4720 SOILS LOG -- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 ? 8 9- 10- 11 13- ./4I, SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? ,zOo y-...'--Ot/l 0, ~ Gross Net Depth to Net Reading Date Time 'rime Water Drop 14- 15- 16- 17- 18- 19- 20 /:/Cz--/- PERCOLATION RATE [/l l/~ (minutes/inch) TEST RUN BETWEEN T~ND -- FT COMMENTS ".,,: ~ 8FiB 'i~6;C .... 72-008 (6/79) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURE$ OivlE[on of Geological ~ Geophysical Surveys leepy DI~TANC F, AND PROM ROAD INTERgECTIONE WELL LO0 ' fl.*pso LL ~[~gvel a~d silt s.VUf, G.ravel arid silt ~3ZUgy ano ~rey gravel ~zVUk-~m r o o K · ].'[-~ck a~d w~[~-~--~-6c'k Top Bottom 90 ~ 63 i6~ 380 ~85 420 565 OWNER OF WELL: Mr, Bruce Swanson Ap~.,,: P.O. Box 285 EaRle [liver, Ak. 99¸ 4, WELL D[PTH: (finD1) 5, OATE OF COMPLETION ~, [] Cabl. ,col ×~[]~.o,a,y [] C.l.. E] [3 A.p.. E]-,f.p O.a,. (::~Threaded ta~.~.2__ ff. CIpth Weleht ~7 , Ihl./fh FINISH OF WELLI fi, STATIC WATER LEVE[.:__3C}O ft. II.PUMPINg LEVEL below land lurfaoe and YIELD IS, PUMP: (If available) HP __ft. oapoolly -- g.,p.m, [] Centrlfloal [] Olhlr 14.REMARKe: Production of 30 GI)H []F []c 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. # ~:)~'~ ,~t/ ~,~ HAA# 1. GENERAL INFORMATION Complete legal description L19/Bl Sleepy Hollow Location (site address or directions) 18524 Mountain Drive Property owner Mailing address Lending agency Mailing address [~,-\ Agent Add ress David Johnson & Judy Johnson Day phone 272-1825(Judy) S ~ ~ Day phone % ~-~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 3 (three)~ Individual well x× Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system, TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) F¢ont MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater 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 Erdman & Associates . Phone 376-6909 Address 151 E. Herning Ave Wasilla, AK 99654 Engineer's signature DHHS SIGNATURE -/Approved for Disapproved. GenOitional approval for bedrooms. Date 8/20/93 Arch~e Giddings .' bedrooms, with the following stipulations: Additional Comments By; (~~/~ ~J Date 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. 724)25 (Rev. ~/gl) Back MOA#21 --~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~./~/~,/ 5/ ?y ¢.')._ Parcel I.D. O~'[ ~"1,1 A. WELL DATA Well type private Log present (Y/N) If A, B, or C, attach ADEC letter, ¥ Date completed ADEC water system number PlA 5/1.4/8/+ Driller Morguso. Total depth 565, .Cased to Sanitary seal (Y/N) ¥ FROM WELL LOG 5/t/+/84 Date of test Static water level 390~ Well flow 0.5 unknown Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot [/_3 ' 382' Casing height Wires properly protected (Y/N) Y g.p.m. AT INSPECTION 8/18/93 100+ unable to probe 3.0 w/storage g.p.m. ; On adjacent lots 100'+ Absorption field on lot 129 ' Public sewer main none ; On adjacent lots 10~'+ Public sewer manhole/cleanout none Sewer service line 40'+ Petroleum tank none apparent WATER SAMPLE RESULTS: Coliform Satisfactory Date of sample: 8/18/93 B. SFPTIC/HOLDING TANK DATA Date installed 5/13/84 Nitrate_ Collected by: Other bacteria none Archie Giddings Tank size 1000 gal Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) ¥ Depression (Y/N) High water alarm (Y/N) N^ _ Alarm tested (Y/N) NA Date of pumping '~/~-_~ Pumper ~, ~-~,~ POMA__~¢i~}~ SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: N Well(s) on lot To property line lO'+ Surface water/drainage On adjacent lots !00 ~-- Foundation 33 ' _Absorption field tO' Water main/service line 40'+ 1 O0 ' + 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at NONE Manufacturer Manhole/Access (Y/N) "Pump off" level at _ Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed 5/13/84 Soil rating Length 38' Width 60" Total absorption area 380 sqft Depression over field (Y/N) N Results (pass/fail) Pass Peroxide treatment (past 12 months) (Y/N) none SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 129 ' On adjacent lots 1OO '.~ To building foundation 49' On adjacent lots 1OO ' + Cutbank Surface water 125 sqft/bedr~C?s~em type Gravel thickness 48" Cleanouts present (Y/N) Date of adequacy test for Three If yes, give date Deep Trench Surface water 100' + Curtain drain none E. ENGINEER'S CERTIFICATION Total depth 14' Y bedrooms NA Property line 10~ To existing or abandoned system on lot none 75'*(none) Water main/service line 50'+ 100'+ Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~ .~'~ ' .... Engineer's Name Arch[e ¢.id4inss Date 8/18/93 HAA Fee $ '-~)~ ' ~ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 7¢A' · ~ ~% Archie Oidclings ,* ~ Waiver Fee: $ Date of Payment Receipt Number 08/20/93 11:50 CT&E ENVIRONMENTAL LAB SERVICES ~ 90? 2?2 822J N0.376 Q02 COMMERCIAL TESTING 8; ENGINEERING CO. ~,~ENVIRONMENTAL LAE~ORATORY BERVICE~; Allowable Ext. Anal Parameter Result~ gual Units Method 51mits Date Date Init Nltr~te-N 1,~7 mg/L gPA 353.2/300,0 10 08/18 ~ * Bee Special Instructions Above UA = Unavailable ** See 8ample Rem~r~ Above NA = Not Ar~lyzed U = Undetected, Repol~ced value is the practical quantification limit, ~T - t,e~s Than D = Secondary dilution, GT = Greater ~91an ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, ~JTAH, ILLINOI~i OHIO, MARYLAND, WEST VIRGINIA, NEW JEFISEY, SOUTH cAROLINA ENVIROLAB Environmental Assessment Laboratories of AK,Inc. P.O.Box 872988, Wasilla, AK 99687-2988 Ph. (907)373-4143 FAX 376-8016 REPORT ON DRINKING WATER ANALYSIS SATISFACTORY Erdman and Associates 151E.Herning Ave. Wasllla, AK 99687 Sample collected: 8/18/93 1300 AG Sample received: 8/18/93 1630 DH Sample type:Routine Water Treatment: None TEST NAME: Presence/Absence of Total Coliforms Resulte~O/lO0 mls No other bacteria growth noted, nun%bet of positives w/lO0 mls inoculated. Normalsl 0 positives per 100 mls 0 Reported: 8/19/93 1630 DH Report sent to AKDEC: N/A Comments: L19 B1 Sleepy Nollow'~ Thank you, Richard Hope, Envirolab ERDMAN & ASSOCIATES CONSULTING ENGINEERS Static Water Level: (measured from top of casing) Casing Above Ground: ~--~ WELL FLOW TEST ' ! (ft.) (ft.) Project # Meter Cum. Water Time Reading Volume Volume Level Flow Comments TOTAL VOLUME OF FLOW:. ~tz~ (gal.) TOTAL TIME OF FLOW: ~---~O (min.) AVERAGE FLOW RATE: ~-0 (§pm) Reviewed by; Underground conditions are subject to change over the u of time. 15t East Hernln~ Avenue Wasllla, Alaska 99687 907-376B989 ERDMAN & ASSOCIATES CONSULTING ENGINEERS SEPTIC SYSTEM ADEQUACY TEST Number of Bedrooms: Septic Tank Size: lo'PO (gal.) Soil Absorption System: Required Flow: f~~ (absorption) -- ~)~ ' ' latJ In~pecto~ _ ~/~l Project Cum. Tank Change SAS Change Time Flow Vol, Vol. Level Tank Level SAS Comments (gpm) (gal.) (gal.) (ft.) (ft.) (ft.) (ft.) _~o ~ I~o __ ~ ~.o -o, I .- ~ ~o -- '-- -- '~~ ~too R~COVg.~ ~lo~ y~ ~.1 TEST RESULTS ~assed Failed Reviewed By:~, Underground conditions are subject to change over the co~rd~e of time. 151 East Hernina Avenue . Wasil!a, Alaska 99687 907-376-69~9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HFALTH AND ENVIRONMENTAt. PROTECTION DIVISION OF ENVlRONt~ENTAL NEALTH CERTIFICATE OF INSPECTION FOR HEALTN AUTHORITY APPROVAL 1. GENERAL INFORMA'rlON (a) OF ON-SITE ,SEWER AND WATER PACILITY 264-4720 Application Date Legal Description (include lot, block, subdivision, section, township, range) ___~-. ~'i'"-,L5¢ ...... ~,'4~"' "~ ..... ~-- [ocation (address or directions) (b) Applicant Name ??,-~'q,~,~..- ~,~_,,.~.;Telephone: Home d~_0P .3 ~)~?..¢ Business Applicant Address (c) Applicant ~s (check one): Lending Institution (d) Lending Institution .~.. ZI~._..~ 'z:']c" ~'~ .f.~.~', ._ Telephone Address ..... ~- rx~ .... ' ' Beal Estate Company and Agent Address Telephone ............................. ........ 4'¢fa~i~the HAA to the following address: TYPE OF RESIDENCE Single-Family/l~ Multi-Family E,.1 Other Number of Bedrooms WATER SUPPLY Individual We[I,~ Community I~J Public D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsito ~ Public [3 Community L-J Holding Tank ~] Note: If community well system, must have written confirmatioa from tile State Departrnont of Envifonmerltal Conservation attesting to the legality and status, Page 1 of 2 72 025tn,8~) EhI(;INEERING FIR~/I PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORIViATION , A~ cgdi~ied by my ~eal affixed hereto and as of the validation date shown below, I vedfy that my investigation of this Health Au~horjly Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate fo~ fi38 number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from lhe Murdcipafity of Anchorage rites and from my investigation and inspectioe, the omsite water supply and/or w~st~/ator disposal system is in compliance with all Municipal ~nd State codes, ordinances, and regulations in effect on ......... ~=~ _ ~ Telephone bt:~ ~.-,, /~;r~zecl for .~;~;,¢~ bedrooms b~,~-~-~/7 /E_ ?:.~ ........ '-" .Y~ Date /~$proved ~%=_ ........ Disappro~U Conditional %errcs o~ ~nd~t~onai Approval CAUTION The Mur~cipaJ~/ of Anchorage Dopadmont of Health and Environmenta~ Protection (DHEP) issues Health Authority Ap;,ro~a[ cerhhc~e~ basod ~olely upon the representations given in paragraph 5 above hy an independent professional ,.,c.r~,.rre~?~redir~theGtatoofAlaska Tho DHEP does this as a cour[esy to purchasers of homes and their lending ~rE' '~; or 5 r~ order tO 5ahCy cortmn federat and state requirements. Employees of DHEP do not conduct inspections or ~r~ /z¢~ d~ b¢ore a cerhlJcate is ~Esued The Municipality of Anchorage ~s not ~osponsible for errors or om~ssions in the A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Lega Descripnon: Well Classification ~ ~ ~, Well Log Present~2'N) Date Completed ~=~ ~ I,L~ ,,- ~ ~.~ Yield Total Depth ~ L,~> Cased to '"~L~Z.-, Depth of Grouting Static Water Level '~ ~2_' Pump Set At U ,. Casing Height Above Ground ~Y~ Sanitary Seal on Casing ) Electrical Wiring r~ Condui (~N) Depression Around Wellhead ('~ Separation Distances from Well: To Septic/~Tank on Lot __ ~ \ '-~'' : On Adjo~mng Lots \ To Nearest Edge of Absorot~on Field on L.ot _ 'Y"~c~¢~ _: On Adjoining Lots \ ~ ~' To Nearest Public Sewer Line ~"~ fA, To Nearest Public Sewer Cleanout/Manhole. To Nearest Sewer Service Line on Lot ~ ~ IJ~" Water Sample Test Results _ ,~,,~ "Z'./.5-~,c/c)d' Z"'o~- ~ / Comments / If A B. C D.E.C. Approved (Y/N) lA B. SEPTIC/.HeL-f~ TANK DATA Date Installed ~ -'¢'b-¢cL Size Standpipes~N)£,,, Air-tight Caps(~ N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alar~ [Y/N) , Separation Distances from Septic/N~ Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course. Oomm.n,s t ~::;~--~ No. of Compartments "'Z_. Foundation Clean out {~'~'q~ Date Last PumPed ;for _ Temporary Holding Tank Permil (Y/N) To Building Foundation _ To Disposal Fielc _ To Stream Pond. Lake. or Major Drainage Page 1 of 2 72-026t11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field ('~'/N)) Results of Last Adequacy Test Length of Field ?~;;~); Depth of Field Gravel Bed Thickness "~ '~_~/..O "~ Standpipes Presen~'N) Date 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 Type of System Design To Property Line t To Existing or Abandoned System on ; On Adjoining Lots ,~) To Cutbank (if present) Dm LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at 'k~! . Vent (Y/N [~ i:" "Pumping cyc.le.s during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Requ~s't ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. .......... ~ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 ( t 1/84)