HomeMy WebLinkAboutSLEEPY HOLLOW #2 BLK 2 LT 18Onsite File
Sleepy Hollow
#2
Block 2
Lot 18
#051-511-21
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Municipality of Anchorage
On -Site Water and Wastewater Section ° (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP191352
PID Number: 051-511-21
Dwelling: ❑ Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New FOR Upgrade
Name
Robert & Sharla Thomson
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
23851 Mountain Cir. Chugiak, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
529-7371
3
Existing GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Sleepy Hollow #2
2 18
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
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
>100'
N/A
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Greer 1000 Gal.
Surface Water
>100'
N/A
N/A
N/A
Material
Number of compartments
Lot Line
>5'
N/A
N/A
N/A
NA
Plastic
2
Foundation
>1 0'
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks Tank only permit.
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Red Dog Masonry
Drainfield D3034 CO/MTD3034
Inspector J. Mlllette
BENCH MARK (Assumed elevation) 100 ft
Inspection151 9/28/19
Location and description
Lower level door threshold.
3`d
4`"
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
0, q ��
Conditional Approval:
Date
ffi49th
.. ...... $
�.,L ........... ......�. 0
�.�...............mun................C....
®fin MICHAEL E. ANDERSON e
�0
Septic System
Approved Date 1,1)�2 11,�OD
f` No. CE -4381
�VIP1%.., 1/13/20 ••°'����
Note: this approval does not include well permit requirements.
AP
®®fRffiE®- � 1011 411P
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SLEEPY HOLLOW #2, BLOCK 2, LOT 18
PERMIT # OSP191352 PID # 051-511-21
i
i O
Ol
LOT 18 LOT 17
J� P�
�O
NEW 1,000 GALLON SEPTIC TANK w/20"
^o MANWAY (EXISTING TANK REMOVED
ND DISPOSED OF PER MOA CODE)
EXISTING ABSORPTION TRENCH
/ TO REMAIN IN SERVICE
GARAGE
100 'WELL RADIUS /
EXISTING WELLS /
LOT 19
POWER POLE
GE
ENGINEERING / /
�a!��n� ��l�►_ A B LEGEND
PLAN AS -BUILT
0 50 100
FEET
1 "=50'
2C01 17.2 34.3
MH
21.7
31.4
SV
23.4
28.5
2CO2
24.6
27.1
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
SLEEPY HOLLOW #2, BLOCK 2, LOT 18
PERMIT # OSP191352
PID # 051-511-21
PROFILE AS -BUILT
(NO SCALE)
OPS
Na
f
O\ \wA�y
J
O p
�h Lot 18
Bk 2
OF A4 l
ill
�i
%* 49T—"
i
AW, P. Bonet'
�i LS -10393
t l t
Septic
Pipes ® Conc
Fran
Nouse
i
4'
0
.-Cow
W.* em� 13
Frame
1� Retain ng GarageWal/ i
tom\
.ei 0
ol/ Vell O
Elect ®` / 8'x12'
Meter \ Shed
%
9-.
I hereby certify that I have surveyed the following described property:
Lot 18, Block 2, Sleepy Hollow Sub'd No. 2, Plat No. 73-86,
Anchorage Recording District, and that no encroachments exist
except as indicated hereon. This As -built will only show the
easements that appear on the recorded subdivision Plat No. 73-86,
Anchorage Recording District; under no circumstances should this data
hereon be used for the construction or establishing of boundary or fence lines.
0 25 50
SCALE IN FEET
1"= 50'
I Surveyed: August. 4, 2020
Sleepy Hollow Sub'd No. 2
Lot 18 Block 2
As Depicted on: Plat No. 73-86
Anchorage Recording District
GRID: NW1060
II
ASBUILT SURVEY
Robert & Sharia Thomson
23851 Mountain Circle
Chugiak, Alaska 99567
DRWW&.aw CEM&.
APB Land Surveying
12204 East Prince of Peace Drive
Eagle River, Alaska 99577
(907) 227-1361
HwPA{,„. MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program �o:, s„
.,,�\ Pd Box 196650 4700 Elmore Road s�
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 `' r
i`;4 http://www.muni.orgionsite �. ' -,, ;";.: .c,),
< epartment
On-Site Wastewater Disposal System Permit
Permit Number: OSP191352 Effective Date: 8/10/2019
Work Type: SepticTank Upgrade Expiration Date: 8/9/2020
Tax Code Number: 05151121000
Site Legal Address: SLEEPY HOLLOW#2 BLK 2 LT 18 G:1060
Site Mailing Address: 23851 MOUNTAIN CIR, Chugiak
Owner: THOMSON ROBERT J & SHARLA W Lot Size in Sq Ft: 50891
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field E1 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: Lku}'J/(.wl t' tpoilP) Date: J f l9-//'7
Issued By: i), ,' / - � - Date: g-a/9
RUSH
MUNICIPALITY OF ANCHORAGE '=
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-511-21
Property owner(s) Robert & Sharla Thomson Day phone 529-7371
Mailing address P.O. Box 1303 Chugiak, AK 99567
Site address 23851 Mountain Circle Chugiak, AK
Legal description (Sub'd., Block & Lot) S�r �1 HolloL,: Z glk 2 Li I $
Legal description (Township, Range & Section)
Lot Size 50,891 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field [ Initial ❑ Single Family (SF)
(w/wo ADU)
Septic Tank [ Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage E
RUS
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
14/1"--.—LS.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 3600
0 Waiver Fees:
Date of Payment: g/21,161 Date of Payment:
Receipt Number: OWdbq //.) Receipt Number:
Permit No. OSPlq 1 36aZ Waiver No.
Permit App__-. ::....c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPUAN(
OSP 191352,Deb Wockenfuss.08/1(
,r.4 ' GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
August 9, 2019
M OA Development Services Department •
On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Sleepy Hollow#2,Block 2, Lot 18 -23851 Mountain Circle
Dear On-Site Services Engineer:
The existing septic tank on the subject lot has outlived its useful life and must be replaced prior to
the issuance of a COSA. We are submitting this permit application for the replacement of the
septic tank. The attached site plan identifies the location of the home and the existing well along
with the existing and proposed septic tank site.No conflicts exist between this proposed system
and any other well or septic system on this or adjacent lots.
The new septic tank will be a minimum of 100' from the wells in the area and 100' from surface
water. The tank will be 10' from the house foundation and 5' from deck and stair supports.
Please ref erto the attached plan sheet forthe septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
•
L-r.9-1
Michael E. Anderson,P.E. ••• oF /441.6.
•
i�
f 49th �
�.....�. w al.:ftp
To VII MICHAEL E. ANDERSON l� ,
�v f4 No. CE-4381 ••_/
8-9-19
!!! PROFESS\ i'•
•!ia•11•"••
Munia:10:::::OMPag°
Cn-site ewater
SLEEPY HOLLOW #2, BLOCK 2, LOT LIMN
OSP191352 Deb IWxkenfuss,08/1
/
/ / / / //'
� o
/ O /
/ ,ce/
/,...
LOT 18 LOT 17
OJT ���P/
J /
/ ^/
/ / CONNECT TO EXISTING
SERVICE LINE NEW 1,000 GALLON SEPTIC __ _ - __TANK w/20"MANWAY —
/ DECO 4 S&tOPd- — 7•`
E S-TIIN EPTIC/ '
My?Cp / /TANK PER OAdODE.
/ EXISTING ABSORPTION TRENCH ?St,
/ N
/ TO REMAIN IN SERVICE co / THREE BEDROOM \
'fp
/ HOME / \
/ GARAGE \\
I \
(// .
I11 ®1` / V f
1 • EXISTING WELL I/
LOT 19 \\ Gam' i /
_ _ \�j /
\
►)'GE \ Z
CNOIN[l AINO NOTE:
ogssltriaii� NO SLOPES>25%WITHIN 50'OR SURFACE WATERWITHIN 100' OF THE LEGEND
40° --:? '!4.14,7%. PROPOSED SEPTIC SYSTEM
•.•-P,..•• ..•.• . CO-CLEANOUT
• �r'•� 4—\s .1 2C0-DOUBLE CLEANOUT
•/A �� *• ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
49th _ FCO-FOUNDATION CLEANOUT
:71 .•� . .--i PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FS FLOW SPLITTER VALVE
�.... ....»...•..•..•.-••..w•- • SYSTEMS.
0 .MICHAEL E. ANDERSON r a MH-MANHOLE
•��-3,,� No. CE-4381 .,:�� 0 50 100
���p o,,h• eisns �•,.••'F '•• FEET _SLOPES>25% MT MONITORING TUBE
SLOPES>46% SV-SEPTIC VENT
-0�.7OFESS��Pi• 111=50' TH-TEST HOLE
•
I
/ ;
• i• •
°' �� :
. • '10 i / • • :1
• CV.
S> h° / �Q
• / -off - ..'�74.)-
.g4� . N • i �. .
.? 17 4
• LOT 18 .. Ar•...
ts
yo •
ti*
f
SEPTIC 2,..n9`g`, S> .''')r3 • V/Ol
/. .011! �h SCALE 1 in. - 50 ft.
5
•
�(, �J� .y •q-41 NOTE: THIS IS Ai
Y
- 11; HOUSE • ` , �� .,.,b) 4C' ..z �ivt;
� (g
�9 i , •/ o , �� . I HEREBY CERTIFY THAT.I HA
• O� ell' \ , / WELL. 51 O/ DESCRIBED PROPERTY: LOT
• ' 4: \ / 1•1. a5' # 2, ANCHORAGE RECORDI
?:C31./LP \\ r)1°
. /• THAT NO ENCROACHMENTS EZIS
• �8> ilk . • `.y5j.oi/ HEREON. THIS PLAT WILL ON
•i- \ \ •'• - COVENANTS; Ca'RESTRICTIONS
• . r' CORDED SUBDIVISION. PUT • i
•
\ �` V' :i)' . s' CTRCUM.STANCES SHOULD.ANY D
�' . 00 ��; CONSTRUCTION OR.FCR ESTABL
, f / • LINES; UNLESS NOTED.
• ,. . . c ) \- `,' P DATED: `` X2'3-85�
/ 907-688-2594
MUNICIPALITY OF ANCEtORAGE
DE RT~ENT OF HEALTH AND HUMAN SER ,ES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Yelephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/C)R WELl.. INSPECTION
Address
' N~ Bedrooms
Township, Ran§e, SeCllon
TANKS
~ SEPTIC [] HOLDING
~'~ ~/ ~
TYPE OF SYSTEM
TRENCH L~ BED ~
W.
DRAIN
OTHER
ongmaigrade ~ ~ /
F~
Gravel lenglh
.~'z2 SDF'r
~ FT
~ FT
WELLS
[] PRIVATE [] OTHEFI fldentifv)
FlJ FT
REMARKS:
DISTANCES
FRO~M .~T~ SEPTIC ABSORPTION
TANK FIELD WELL
WELL
LOT LaNE
FOUNDA'rlON
ID :F
iD. $--
Eagle River [!ngiJleerJllg Services
-- -P707~ 773294
Dale: Eagle River, AK 99577
Municipal en~Lli~.?i~s in effect en this
~1~' ~/'~ /~'~' ~ ~x~
He~ Department Approval:
72-m3 (3/85) vt
__ cerlily Ihal this insl]ection was performed according Io 811
Date
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologi¢ol 8~ Geophysicol Surveys
LOCATION OF WELL. (Please complete either Io, lb or lc,)
~'i .'~:.c-/~L~..>A:L:,~.- I,
Orilling Permll NO,
A. D.L. NO,
16 WATER WElL CON+~RACTOD'S
This I~e(~ ,',os d~iH~"~ under
/t-<~ '., ';;' '-':~ 6
,t Block ib~J- I/4qfr.. Section No. fowr~shiPN[~ Range ED Merldl.n
Feet Below 4. WELL DEPTH: (final ~' 5. DATE OF COMPLETION
3' '(~ ,/ · 8. CAnINe:, ~ Threaded ~ Welded
p~ "'
I)IEF:'ARTHFZNT OF:' HEAI..TH AI',ID [ii:iq',,):l!l::(l::)lql"lli~:l'.]"l"~l_. I='I::'~01"IiEI3'I"]:OI'q ' '""'
EI2]~:; L STREET, Al
,:~:61.' 47,~:
I::'IiERM ]: T NO:
DATEi: IS!3LIEi:D:
8, , 77
A F:'F::'L, I CAN'1" ~
ADDREE~S:
CL]N'I"ACT F='I"I[~NE:
DEI',I,q[)I',I & DENS[;IIq E;ONk3
I!~,,l:j,, BOX 966 E.R.
EAI,')I..,li!: IR :[ VER, Al":: 99¥F77
LIEGAL. DESCR:[ P,
I..:OT Si ZI?.'::
MAX BIEDRI30MS:
ERJBD.1;VISIOhh~ k]I.,.EEF'Y HOLLON LOT." 1El E,L,,I]L,I...
:].A (Sf; ~::'r' (..)IR AL,RE~)
L:i. stt::~d I:)elc~ ape 'Ll"le::, ch~H',.ic)ns a'.2a J, ]. a[:) ]. e '~',c:~ you :i.n ch:.~s:i, grlirig yE)LU-
¢,y~,'[.~;)fih, [;[lC)(;)SM:.:~ 'l'.1'1(¢~ OI:]'[.J.C~I'I 'L ]'I ~'l:. bef;'l:, f':i.'[..'-.~ yc:n..u'
'qr'- IF;~'. E: lt'*,tl C:] Ih,il
· )~-'~' TANI< MUST I'IAVE': AT I..EAS'I" TWO COMF'AIRTMIEN"I'S
I (::: (~:1' '1:, i F y t, h a'l:, ~
F(:)I"LI') by 'Lhe Mum'l:ic::&pat:Lty c~t' An(:::l'~c)f'ag(:¢ (MOA) arid the [;kkate of A].asl.::a,,
:-~,, I ~J,].l :i,n!k3'k.&~].]. '~IIE,) !~JB'LBill ;il'/ ~lc:c:c:H'dal'lE:l.~ w:i.'l:.h al:t. MOA (:c)(::lt;~s and
and J.n cc~mp].iance ~itl'l the des:i, grl cr.i'l:,ep:i,a ciF t,h:Ls pel'm:Lt.
::$,, Z w:i,].l aclh~;,p(:,~ 'l:.o a].l I"IO~ arid State i:~t: A].aska r'6H:JL~J.p[)meR't.s J'C]l- the s;~t back
distances fr'om any t~)x:Ls'Ling well, wastewatep disposal sys'Lem t::ir, pubZ~(:::
Sl~[ql"a:ll.]f:~ Syti[l'[.E.)fll (;ltl 'LhJ.!~i I::lp any ;;Id.j&~c::(gf'l'['. (]P Fl~/P[:)y ].1:1'~.,,
4,, :1: urldt;~r's'Lar'ld t, hak 'Lhis per'mit :ts val;kd fop a maximum of 3 bedpooms and
IF: A I..tI:::'T S'I"A'TIC]I',I IS INS'r'AL.,LED IN AN AREA COVE, I:,d=D BY MOA BIJILDING
'I']IEIxI:, (:1.) AN EI...I;EI]'I'IRtCAL. PEF;d"I:I:'f' AND IIISFI:.i..,I].I.IN MUS'I BE (:)B'FAII',Ilii:D; (2';~:) AEh"',EUIL.'I"S
WIL. L NO]' BE ,AF'F-?~OVED WI]'HOUT AN IE.L. LCIF,.II.,AI., II',I[,~I::'ECTZ[)N I',I=,F[.I.',I., AND (.:,) THE
EI.,EC',"FF;:ICAI,,. WOR DC)l',il.*.'i: )Y A L. 1I...EI I,:;II::.D [:L[!.L, I R.I.[,I(,:~[ I.
!ill I GI"IIE D D (¥ f'L:: ,~
~ql f L, IE,AII f ,, DEIqS(:: [,,(JI IS
~ , . .~. .
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 g Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
%~'~- SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR: ~")1' /~'(~'
LEGAL DESCRIPTION:
2!
3
4
5-
6-
7-
8-
10-
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
O
P
E
14
...... ~15
11
12
13 l'.
16
17
19: [':-6736 :~
2O
Reading Date Gross Net Depth to Net
Time Time Water Drop
RATE (minutes/inch)
TEST RUN BETWEEN
COMMENTS ~'~"~ ~'~ ~/ ~ //~/~/ ~-~,/~/~
.. .
PERFORMED BY; ~ ~ ~ ~. .
72-008 (6/79)
FT AND FT
_CERTIFIED BY: .~_~'.~.-~
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~,~/ - ~/\ ~'~ \ HAA # _ L\
1. GENERAL INFORMATION
Complete legal description
L18/~2
Location (site address or directions) Mountain Rd
T15N R1W Sec.15
Property owner
Lending agency ~ , t IG.'~/~c'&
Mailing
Agent ·
Day phone
d
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: three ~
TYPE OF WATER SUPPLY:
individual well x
Community well
Public water
NOTE: If community well system, provide written confirmation from State AD£C attest-
ing to the legality and status of system.
'rYP£ OF WASTEWATER DISPOSAL:
Individual on-site ,~--
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater 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 376-6989
Address 151 E. Herning Wasilla, AK 99654
Engineer's signature ,/~__ ~.~__~'~ Date /o./, /97_
SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev 1191) Back MOA¢I21
Legal Description:
A, WELL DATA
Well type pri,,~-,~
Log present (Y/N)_
Total depth 218
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
L18/B2 Sleepy Hollow #2
If A, B, or C, attach ADEC letter.
Y
ParcelI.D.
Y
ADEC water system number
Date completed 7/28/85 Driller
Cased to 2t 8 Casing height
Wires properly protected (Y/N) y
Handly DrillinL
2'
FROM WELL LOG
Date of test 7/28/85
Static water level 207 '
Well flow 4 g.p.m.
Pump level unknown
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot approx. 115'
Absorption field on lot appro×. 12o'
Public sewer main NA
Sewer service line 50' +
WATER SAMPLE RESULTS:
Coliform __~a~4~f~c.~o~y Nitrate
Date of sample: 9/29/92
B. SEPTIC/HOLDING TANK DATA
Date installed 9/27/85 Tank size
Cleanouts (Y/N) ¥
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO;
Well(s) on lot ~ppr~w. 115 ' On adjacent lots
To property line lO ' + Absorption field
Surface water/drainage Inn ' 4-
AT INSPECTIO~JNiCiPALffY OF ANCHORAGE
9/29/92 I!NVIRONMENTAL S~RVICES DWiSION
OC'[' 0 '1 1992
a..rox. ,,7,
; On adjacent lots 100' +
; On adjacent lots 1 O0 ' +
Public sewer manhole/cleanout NA
Petroleum tank none ap_p~arent
Other bacteria
A. Giddings-engineer
Collected by:
lO00 §al Compartments 2
Foundation cleanout (Y/N) ¥ Depression (Y/N)
N _ Alarm tested (Y/N) N
~:[~__"'_l~'rd-~j__-~-~''°- V.-'I -~" '5
Pumper_ 5' ¢, ¢~¢ ,4,¥o wLc,~
I r~o, 4- Foundation
5ft..'- Water main/service line
N
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
NONE
"Pump on" level at
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 9/27/85 Soil rating
Length 30~ Width .5'
278ft2
Total absorption area
Depression over field (Y/N) N
Results (pass/fail) PASS
Peroxide treatment (past 12 months) (Y/N) N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot ~,~,,,-,~,,19,q~
To building foundation 46'
On adjacent lots .50 ' +
Surface water 100' +
Curtain drain none
E. ENGINEER'S CERTIFICATION
HAA Fee $ / ~'~l
Date of Payment
Receipt Number
72 026 (Rev 3/91) Back MOA
Surface water
85 sqft/bedroomSystem type-Deup Trench'
Gravel thickness 3.5'ED
Cleanouts present (Y/N)
Date of adequacy test
for three
If yes, give date
Total depth 8'
Y
9/29/92
bedrooms
On adjacent lots lOOLa Property line !0 ' 4
To existing or abandoned system on lot ~rrotre
Cutbank 100'+ Water main/service line 50'+
Driveway, parking/vehicle storage area_appro_-:__ 70'
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
~,-2" o" A '°...",f' ",,
Engineer's Name ~,¢~A¢~ ¢, ¢~A~¢ ~. ~"" *" · ·
Date ~o~ /~ ~" I~ ~h I -..;5'_~g
(¥/p
Waiver Fee: $
Date of Payment
Receipt Number
ERDMAN & ASSOCIATES
CONSULTING ENGINEiiRS
SEPTIC SYSTEM ADEQUACY TEST
Number of Bedrooms:
Septic Tank Size: ~0~ . ~- ~(gal')~'~
(absorption)
Date
Inspector
Project #
Cum. Tank Change SAS Change
Time Flow Vol. Vol. Level Tank Level SAS Comments
(gpm) (gal.) (gal.) (ft.) (ft.) (ft.) (ft.)
o:~
~ ~o %04
'
I,{. ~' ~o 4'~ _~ _-- ~ --
~,~ ::~' I - _
'- I00 %
- I
~COVERY
TEST RESULTS
X/" Passed Failed
Underground conditions are subject to change over the course of time,
~5~ East Homing Avenue Wasllla, Alaska 99687 907-376-6989
ERDMAN & ASSOCIATES
CONSULTING FNGINEERS
Well Depth: ~]~) (ft.)
Static ~acer Level:
(measured from top of casing)
Casing Above Ground:
WELL FLOW TEST
(ft.) Inspector
(ft.) Project #
Meter Cum. Water /
Time Reading Volume Volume Level Flow Colments
~_~ ~/_~ ¢ ,~. (gal.) (ga]..) (ft.) (gpm)
TOTAL VOLUME OF FLOW; ~-~ (gal.)
TOTAL TIME OF PLOW; ~-'- (min.)
AVERAGE fLOW RATE: ~.~ (gpm)
Underground conditions are subject to change over the course of time.
_ _15_'I_Eo_st Hernlng Avenue Wc~siila, Alosko 09687 907-376-F,980
Environmental Assessm~nt La~bora~ori~ of'
F'h. (90'7)373-4143 FAX 376-8016
REPOR'[' ON DRINKING WATER ANALYSIS
Erdman and Associates
151 E. Herning Ave.
Wasilla, AK 99687
SATISFACTORY
Sample collected: 9/29/92
Sample received: 9/29/92
Sample type:Routine
Water Treatment: None
1400 by AG
1630
TEST NAME: Presence/Absence of Total Coliforms
Results:O/100 mis, number of positives w/lO0 mis
Normals: 0 positives per 100 mis.
Reported: 9/30/92 1630 ~4 hr Colilert.
Report sent to AKDEC: N/A
Comments: Li8 B2 Sleepy Hollow ~2
inoculat ed.
Thank you,
Richard Hope, Envirolab
LAB INSTRUCTIONS {or I,lORKerden ~ 58963
[late - '~
R,_-pov~ F'rinted: SEP 30 92 ~ lr :06
ChemLab"
Client Acct
I]oll~,cted :E:EF .... z~ 92 ~, 11:00 bps,
x~eiwu :b~.r' 29 92 (~ 12:10 hrs.
Fpo~r, ised ,.>~:P 30 ~2
Anal,/sis Completed :
Laboratory = .... ~---
Ci~ent Sa~pie ID: LI8 ~E SLEEPY HOLLO'4 1~2
Client Name :ERDMAN & ASSOC
Ordered Dy :kliKE ERDMAN
F'nesepved ~ith :AS REQUIRED
F'~!SID :UA
u~q I t ! ;( !'JAI'ER
Sample ROUTI~iE SA?iF'LE COLLECTED BY: UA.
MUNICIPALITY OF ANCHORAGE ~
DEPARI'IVIENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITy
264-4720 ! ~
Application Date '//('7 /~, ~.
I, GENERAL INFORMATION '
,. (a) Legal Description (include lot, block, subdivision, sect/oR, township, range) ~'~/,-¢'
2-.a't- IS' r2,
Location (address or directions)
(b) Applicant Name ~~~_ Telephone: Home ~'~-- ~ o=G Business _¢~'¢
Applicant Address ~ ~w ~ ~¢.~'(' ~
(c) Applicant is IcnecK one~: Lending'Institution ~ ;'Owner/builder~ Buyer ~: Other ~ (explain);
la) Lenalng nstitution
Address
Real Estate Company and Agent ,/'L./..~
Address
Telephone
Telephone
:2 TYPE OF RESIDENCE
, Sirl,gle-Family"'~ Multi-FamilyCI "Other
Number of Bedrooms ~ ~'i ;,.',:
'?3. WATER S,,UPpLY
Indiv, idu~l,.Wel!~.,' Community I-]' Public[]
; Note; If community well system, must have written confirmation from the State Department of Environmental Conservation
~; attesting to the legality and status,
4: SEWAGE DISPOSAL
Onsite/[~ )~ Public: [] Community [] '. Holding Tank []
Note; If community well system, F~ust have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11/84)
ENGINEERING FIRM PROVIDIN~ ~NSPECTIO~,~S, TESTS, FILE~ SEARCH, DA~,~ AND INFORMATION
As certified by ray.seal affixed hereto and as of the validation (!ate 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 ail Municipal and State codes, ordinan.ces, and regulations in effect on
the date of this inspection.
Name of Firm _ Telephone
Address EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, AK 99577
PTOTBOX~73'294
694-§195
D H E P APPR(~V¢,I.-,/
Approved for badroomsb
Approved_ /~ Disapprog~ed
Terms of Conditional Approval
:Condition la~_-¢//
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Flealth 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 es 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
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~,.,
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAO~.
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Well Classification ~,~z ¢"4
Well Log Present (Y/N)
Total Depth '~- / ~' t _ Cased to
Static Water Level 0...~ ,7 ,/
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
Cleanout/Manhole _
If A, B, C, D.E.C. Approved (Y/N)
Date Completed 7~¢2'~/~ '''5'''' Yield
Depth of Grouting _
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Water Sample Collected by ~_'/.&; ,~¢~¢.~t ¢~.,~£/~e~',-.,,~ -: Date
Sample Test Results ..?e.¢ ,/?~/¢,~r- ,~-.-~-~ ~, /-~- ~
Water
Comments
; On Adjoining Lots ¢'~/¢~'~ /
/...2 3' / ; On Adjoining Lots' ~/¢~ z
To Nearest Public Sewer
_ To Nearest Sewer Service Line on Lot .¢~ 5'- /
B. SEP'rlC/HOLDING TANK DATA
Date Installed ~'~¢_ ¢'/~
Standpipes (Y/N) ,/v
Depression over Tank (Y/N)
Pumping, Maintenance Contract on File [Y/N)
Holding Tank High-Water Alarm (Y/N) _ /~.//'.,4
Separation Distances from Septic/Holding Tank
To Water-Supply Well ,'/,,'?-_-P /
To Property Line 70
To Water Main/Service Line
Course ,,/['/',z¢''~ ,~.-,
Size /¢~¢~ No. of Compartments
Air-tight Caps (Y/N) __ ~ Foundation Cleanout (Y/N)
Date Last Pumpea
: for
Temporary Holding Tank Permit (Y/N) "-'-~
-o Building Foundation Z¢, d' /
To Disposa Field ~ /
'Fo 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
Width 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 Z./'¢'
Lot
To Water Main/Service Line ¢/o /
To Stream/Pond/Lake/or Major Drainage Course '
To Driveway, Parking Area, or Vehicle St'orage Area
Type of System Design
Length of Field ~ /
Depth of Field ~¢' /
Gravel Bed Thickness '~ /x/~ /
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots '/--~¢ /
To Cutbank (if present)
Comments
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
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Receipt No.
Date of Payment
Amount: $
I certify that I h_.cve~-~?~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~--'""~.//~'-~~ Date ,/~//
Company ~'~ MOA No. ~ '~ ~ ~
~ OF
¢ ,,&49~ ~ ~neer's Seal
~ ~ Louis A. ~u~ora
Page 2 of 2 ~¢~"~ '
72~026 (11/84)