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Home My WebLink AboutSLEEPY HOLLOW #2 BLK 2 LT 19LoC I Mur.icipality of Anchorage — �— On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171142 PID Number: 051-511-22 Dwelling: ® Single Family (SF) ❑ Duplex (D) El Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: ABSORPTION FIELD - EXISTING Charles W. Monnett Address ® Deep Trench El Shallow Trench El Bed ❑ Mound 23833 Mountain Cir., Chugiak, AK 99567 ❑ 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 Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. SLEEPY HOLLOW#2 2 19 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. -- -- Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Ft2 Number of trenches Dist. between trenches From Tank Field Tank Line -- -- Ft. Well 100+ 100'+ 100'+ NA 25'+ TANK ® Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100'+ 100'+ 100'+ NA Anchorage Tank 1000 Gal. Material Number of compartments Lot Line 5'+ 10'+ 5'+ NA Steel 2 NA LIFT STATION Foundation 5'+ 104 5'+ NA Manufacturer Capacity Curtain Drain NA *501+ NA NA Gal. Pump on level at Pump off level at High water alarm at *None None known. S.T decommissioned and new 1000-Gal S.T. installed per code. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer JRs - Flintstone drainfield Drainfield CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspdates: 1"6/19/17 2nd 6/19/17 Location and description 3rd 4th Concrete porch landing COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL -.0Engin ~ OF AI ‘ Conditional Approval: Date ��5�' -4 Of ;,ni9TII 4 . '►1.11. . KENNETH . � iy Ai 4 `i 711• , , I sT�k`lJ (_ �S / ,� Approved ( —' Date 7'1(9 �7 * �'hrr r.," t�:�� eer's Stamp Inspection Report_9-1-12.doc AS-BUILT SYSTEM DETAILS/SITE PLAN Permit OSP171142 SLEEPY HOLLOW#2 B2, L19 PID#051-511-22 Lot 19 '.7� NEW 1000-GALif .. r%.:":. SEPTIC TANK sump -97 GM D.N 1.7 Chimney 0 COI •bl co •eck D N 2 Story Frame Hous- deo B •, 10 NI ho ` 0.1 / �' 0 •O `► CY 4, r 1i ., rr Q\ O'41 , V W 0.70 �� ^p`�, 2/3� (11 .e)0 0 ,41 n ��`OD T U, o tt 0 Chain ink fenc- 44. a� )0v W I SCALE: 1"=30' {4 N O 098.15 (J9O N a A-C=24.0' P_ B-C=17.0' in H 1oA-D=28.0FINAL GRADE 1 B-D=20.5' 2 I RIES 2 te wIs ,INUULAT ION 1000-GAL , T31 co TANK o F EXISTING FIELD o 93.21 92.95 _ E e 9 `�\ I 2a I SCALE: NTS Er / (S. 1' -1.6. PREPARED FOR: vk_CTER E' '//��^�� CHARLES MONNETT / "-� 23833 MOUNTAIN CIRCLE 8," /��.1111%-,� ott, ; * 4 • TH * CHUGIAK,AK 99567 / � r d K E4 $ I FIELD BOOKS COMPUTED: a II is 16 �� 9OUNDMY:BOUNDARY DRAMN: BMW 1 111 ' „, 1 $4' srNaNa STAKING ` KMD 1 `gyp " S� / "s�uLT' WAL DATE: 6/27/17 '�1y b�( u \ SS10 DM nLE: anD: 6-! [� C 0Th o ``_�f NW1060 �6'4i-ONSULTING , �e L ACAD FILE Joe N°.: • 17165 E KIK. 9g577��3 _t"`"`"yo MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Program PO Box 196650 4700 Elmore Road 4 ' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite `" • el,artmen t 44CHOR Pc' On-Site Wastewater Disposal System Permit i'O _I -11TH Permit Number: OSP171142 Effective Date: 6/15/2017 Work Type: SepticTank Upgrade Expiration Date: 6/15/2018 Tax Code Number: 05151122000 Site Legal Address: SLEEPY HOLLOW#2 BLK 2 LT 19 G:1060 Site Mailing Address: 23833 MOUNTAIN CIR, Chugiak Owner: MONNETT CHARLES W Lot Size in Sq Ft: 54337 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Special Provisions: A foundation cleanout shall be provided if there is none currently present. Received By: Date: Issued By: ette/e. Caltar Date: V/5 /7 #1. MUNICIPALITY OF ANCHORAGE ROS .,. ghi. Community Development Departmentlir Phone: 907-343-7904 Development Services Division Fax: 907-: Is. 70 On-Site Water& Wastewater Program , u ) '7, N ant ON-SITE SEWER/WELL PERMIT APPLICATION Q JUN 13 201? Parcel I,D. 051-511-22 A BARBARA F. VREELAND 94 ` ' Property owner(s) Day phone o Mailing address PO BOX 671623. CHUGIAK, AK 99567 Site address 23833 MOUNTAIN CIRCLE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) SLEEPY HOLLOW #2, BLOCK 2, LOT 19 Legal description (Township, Range & Section) Lot Size 54337 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) L] (w/wo ADU) Septic Tank jJ Upgrade r3/1 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. /~ (Signatures py serty owner or authorized agent) Pe it/Rush Fees: 215— Waiver Fees: 4 /2-I Date of Payment: 6-14-t1 Date of Payment: IiftTi ' Receipt Number: ob42.\ D Receipt Number: G51ti elD Permit No. (7)91-1 l V-4- Waiver No. Permit App_9-1-12.doc �EtCTERRq ^ ¢� ARC 1 m ERRA • CONSULTING, INC 212 E. 51st Ave,Anchorage,AK. 99503 Office(907)868-3791,Fax(907)868-3793 9ryfgY LETT NG_�°�� June 8, 2017 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit—Sleepy Hollow#2, Lot 19 The owner has requested we proceed forward to obtain a septic permit to upgrade the failed septic tank. We propose to decommission the existing 1000-gallon septic tank per code and install a new 1000-gallon tank in the same location to serve the existing 3- bedroom house. The adjacent lots are served by private water. There is no surface water within 100' of the proposed tank. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. B ,. ► M. Western ,4 ner's Representative Attachments: On-Site Sewer Application 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 ,.. , `��: s 7 I X10�': i4� t • �,. t 1 ,co _ T 1-frfjo•:: . d-�.T • S 1 3; ,a'j .. IGP • ...rjd?:.-... • 0 \ 'xtit' \ Iit +O \q; ; N c"%:-T;" • 3 f yy �l `S --- '� F•t% rte, v ' ‘ 2017 SEPTIC TANK UPGRADE: ,i, \ `r1;: N Decommission existing septic tank per f +, '` code &install new 1000-gallon septic '4`t.,`.,li;• \ • \ 70 17 tank and two post tank cleanouts per �� '''. ,N ��`• " code, maintaining 5'+ from foundation & 51t � • \ z9 ,�� tc.�.: existing field, and 10' + from water line. Tr Tr 'ski,;" - 4'1'r 1 A \_ p O 0 _' ip p 2 rl _.., -ti.r1117' `-"' \1::> P- -i:-:; t NOTES O U. • ,!:�a ter, rr c\ "1 'F6It:;��•�� E' 1. No wells on adjoining lots are a ', '" within 100' of proposed tank Tom–C 4+ ''•', — Arm placement. �'(� % C� 2. No surface water noted within 0 � 1. ► , �'7 T 100' of proposed tankt � Kra placement. S O .4‘,14.4‘.„ V na V.� � 7.4st iff, rP .i . .m.GNIC1.i�4LT7'Y OP ANCHORAGE ,- Hez and Environmental Protc . m Fourth Floor West 825 L Street Anchorage, Alaska 99501 , 279-2511, x 224, 225 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME._ _-....._.._.__.. _...-... .._.--- ._ MAILING AI�I)RCSS . _l v.�Ql._._/t ,Q �._ '! _._. PNONlEI /1/I±� �'3. LOCATION...11 62-66)dep.....,,t,?.. _ LEGAL [ _SCRIPT ION I. r�.. (J.. _..51A''� y J"iQ •`c�- i/V) SEPTIC TANK: DISTANCE /? �-Q- - ....f.-C4-'e.. 1 NUMBER OF FROM WELLZdQte_._.__ MANUFACIUral`R _. 4�., rvtnTr lllnl. - -_f- �- _ � ._ ...COMPARTMENTS- f. _. . INSIDE LENGTH__ _ — INSIDE WIDTH.7-7-7..---- LIQUID DEPTH . .__ l IQUID CAPACITY"""GALLONS. rrtrur=.4. .11 T TAL DISTANCE FROM WELL. ._. .... .-._FOUNDATION..._t'. _. .NEAREST t_nf LINE._77..�J. ... ._...._OF LINE LENGTH (- -�� DISTANCE BETWEEN LINES _._.-.41/4/4 _I RENCI4 VII1JT1.1IN. TOTAL EFFECT Pit- ABSORPTION AREA . .2T>__-. ..__ SO. I T. t ENGTII OF EACH LINE ..___.. _.._.C>2V / -----.___�..---'--.--- DEP1II OT I It.TLR DEPTH: TOP OF TILL TO FINISII GRADE 4_ . _MATERIA_ IIINEATII TILE ._.7. (......:-H÷AtiOVE TILT: __•=i____.. .1:1. SEEPAGE PIT: DIAMETER _—._OR WIDTI I_--_-, LENGTH--, DEPTI'I ,-_—.__ -....____--,____._.- k. Log Crib Rings/;RIB SIZE: DIAMETER__.___UEPTH DISTANCE FROM: WELL_.__. TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE______ . ABSORPTION AREA (WALL AREA) SQ. ET. Well --I-� /� I E I ' ; i I I..., Class: cX r.._ea Depth: • i . !.. I I ? w»-- '-- --J.- ..d.. Well Distance To: Lot Line ;. i '. Bldg: Sewer I I _ ` Lane• !• I ! Pipe Materials: 47-vt 303 I .. ;- i - • - I ! I �.'-1•-_ .._ _ .._. I-. I # of Bedrooms: •' - - ; i , I '[b - I 0 - ---,- -Installer: r I _ �. I rI �.. _i ,•Remarks « ............ .l• ,6 � . . . _ t?' �� 'I . - - I:. I ! _ l —1 . . .. 1 i ! ,. ;5tiri .....1_ , 1 1 _. ._ . _ I r i ~- 2017 SEPTIC TANK UPGRADE: NOTES __- Decommission existing septic tank per 1. No wells on adjoining lots are code&install new 1000-gallon septic within 100'of proposed tank tank and two post-tank cleanouts per placement. code, maintaining 5'+ from foundation& 2. No surface water noted within existing field,and 10' + from water line. 100' of proposed tank placement. MUNICIPALITY OF ANCHOtLAGE and Envirenmental Prot6 Fourth Floor West 825 L Street Anchorage, Alaska 995011 279-2511, x 224, 225 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYS'fE~ SEPTIC TANK: DISIANCE ~ NUMBER OF INSIDE I_ENGr 4__ ~__ INSIDE WlOJ'l '~ . LiQUII)DEPTH _~ _. L IQLJ'() CAPAEFrY_~GALLOh~q 1'O [AL LE NGTI~ DISTANCE f. ROM WE I:OUNDATION/~ _ .NJ.ARESf t Of LIN~~-~2 F _ ._OF LINE SEEPAGE PIT: DIAMETER .... OR WIBTII .__, LENGIH .... DEPTiI W Log____ Crib Rings/CRIB SIZE: DIAMETER ..... DEPTH_____ DISTANCE FROM: ELi '10TAL EFFECTIVE BUILI)ING FOUNDATION .... NEAREST LOT LINE ....... ABSORP'flON AREA WALL AREA) SQ. FI. Well Class: ~ Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ 30~ I~ of Bedr?oms: '~ ' -- Installer. ~--~ ---~' -- Rem a :~_~~ T i (:ll::'[::' ()J,.[) I:iil_[i]t"d",l ][ l",[ I':l tl,_ll]]i ][ t::I < ..... ::, IJ I:, L. iZISi~ I]i:2 .:::,L.I I .I Hl::li..I,l:;IN ...... , Iqf:ll:.::ZiZt"ll..IN t'.,lll~"ll]i:t-[l;i: (jif Ii!:lii:E:,f(:l::ll::ll'l'_:ii; :::: ::ii: :[ :5;:i:i;I.ll_!T:, I' I' MUNICIPALITY OF ANCHORAGE Department of Health and Enviromnental Protection SOILS LOG Performed for Mike Bailey Date Performed 8/12/76 Legal Description Lot 19, Block 2, Sleepy IIollow Subdivision 14 Red-brown, silty sand (SM) Perc rate = 250 ft.2'/bdrm Gray-brown, sandy g~avel (GW) Perc rate = 85 ft.2/bdrm Gray-brown, silty sandy ~ravel (GW) Perc rate - 225 ft.~/bdrm. Gray-brown, sandy gravel (GW) Perc rate = 85 ft.2/bdrm. Total Depth = 15 feet No water table encou]~tered AVERAGE PERC RATE FROM SOILS LOG = 105 ft.2/bdrm. Date Percolation Rate Performed BV ~[ Net Time Depth Net Drop minute ~_--- NORTHWEST EXPLORA~ lO SERVICES r INC. A & I., DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 # TELEPHONE 694-2588 OWNEI~ OF LAND ADDRESS LEGAL DESCRIPTION ~:./ J /~/c .... /~3d/ K." DATE- Started : '~ Ended PERMIT NUMBER '7 ~' <: :~ if DEPTll OF WELL ___ STATIC LEVEL OF WAIEP, IrT. · DRAW DOWN FT. GALS. PER HR cii d50 KIND OF CASING KIND OF FORMATION: From () Ft. to. c), __Ft. · ' Ft. to--Ft. -~/~,'~/~Y From .~ ~Ft to Ft._ l From_~ From /,~); Ft. to. ~/.~-* Ft. Ft. to Y~-~Ft. Ft. to. Ft. to 115'}f Ft. Ft. to. / ~&} Ft. From /,~;;,/ Ft. to_ /~1~? Ft. From //(~_Ft. to I Froln From From From From From '~)1S' Ft. to (),¥-~LFt. (JrL&,-,.'"'.' ~ -/~ t From From ~'I o Ft. to- 5~ J Ft. ~42-~a9 ~ d~/~,y%¢:'4.. From From ~ ~0. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to _Ft Ft. to Ft~ Ft. to_ Ft Ft. to Ft. Ft. to_ Ft. __ Ft. to __Ft. Ft. to Ft. Ft. to_i : ~ Ft. Ft. to____Ft Ft. to Ft Ft. to_ Ft Ft: to Ft _____/Ft. to Ft. Ft. to____Ft. Ft. to__ Ft MISCL. INFORMATION //~'*';i/) T'o 4;: /'6/) o DRILLER'S NAME ' ' ; , '~ ' MUNICIPALITY OF ANCHORAGE o�We Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-511-22 1. GENERAL INFORMATION Complete legal description SLEEPY HOLLOW #2 132, L19 Expiration Date: ( ^2 q -2-2 Location (site address) 23833 MOUNTAIN CIRCLE, CHUGIAK, AK 99567 Current property owner(s) BRIAN DEMERS Day phone Mailing address Real estate agent PO BOX 671543, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment Receipt Number 705/- y COSA# 03caa1 � g 3 Date: Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 06/14/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the or— well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: • • • . ;1 for current or future occupants or guarantee that no unseen encroachments, deficiencies or j g•' '._� ��J discrepancies exist can be given by First Water Consulting & Fks *' TH .. { 6. DSD SIGNATURE '. Curtis Huffman System #1 Approved for bedrooms�+0�29, •• CE 128991nn •. �� System #2 Approved for bedrooms �iliF0pR0F SSONP' "r Disapproved Conditional approval for bedrooms, with the following stipulations: ��ll�llY tOFt((((/��/i ON- m �A/ATER AND _ o WASTEvk'ATER o PRO M FNT SFRNNG��` Original Certificate Date: ( -,z 2.q "2 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other DON Legal Description: SLEEPY HOLLOW #2 BLOCK 2 LOT 19 Parcel ID: 051-511-22 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 6/11/1977 Total depth 463 ft Cased to UNKNOWN ft (ASSUMED 40'+) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6110/22 Static water level at beginning of test 414 ft. Comments B. TANK DATA Age of tank(s) 5 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/9/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/1977 ® ALL standpipes present per record drawing Total measured depth from grade 6.3 ft (max) Structure served by this system _ Well production at time of test 5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.63 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW'{S Date of Sample 6/10/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 6/10/22 Results ® Pass For 3 bedrooms Fluid depth prior to test 3 in (W/ SLUDGE) Measured depth to pipe invert from grade 2.5 ft (min) Water added 450 gal ❑ N/A — pressurized field New depth 38 in (3" INTO LATTERAL) Monitor tubes go to bottom of effective. If not, state Elapsed time <1440 min depth into effective MOA IR IS TED — APPDX. 4'ED ❑ Code -required soil cover over field Final fluid depth 3 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: AT MG GRADE/INVERT. DROPPED 22" IN 15 MINUTES AFTER TEST TO W/IN 1' OF START. NEVER BACKED INTO SEPTIC TANK. MAY CONSIDER CLEANING OUT SUMP. NO KNOWN FROST ISSUES PROVIDED. FW"'H E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. AUW .. .... ..........�/ '. • Curtis Huffman A �� 'FG,/•,• CE 128991 •.•� �� }� d1��. • 5(17/2 .. *�R APROFESSOW - ft ft ft ft ft ft ft ft • Municipality of Anchorage 'ra On-Site Water and Wastewater Program N: ' .`- (907) 343-7904 s. C T, CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-511-22 Expiration Date: 1 10 "1 1. GENERAL INFORMATION Complete legal description SLEEPY HOLLOW#2 BLOCK 2, LOT 19 Location (site address) 23833 MOUNTAIN CIRCLE, CHUGIAK,AK 99567 Current Property owner(s) CHARLES W. MONNETT Day phone Mailing address PO BOX 671623 CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: 49:0 /9 - Date: 7 - COSA to be released to the engineer,unless of -�^`�f re uested bythe` � q engineer. COSA Fee $ Waiver Fee $ Date of Payment (p13011 1 Date of Payment Receipt Number QOt-(t -1 t Receipt Number COSA# O`�C1 }2(A 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/22/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��\ encroachments,deficiencies or discrepancies exist. OF L,4 tS "re - - '' k 6. DSD SIGNATURE 41 k49,j,�_I-I System #1 Approved for ` __ •-•- 71, rf% _ y pp S bedrooms. r� KENNETH M. CULT 116 System #2 Approved for bedrooms. � rF 4/7 Disapproved. Pi6P ssio`ati \`_"f Conditional approval for bedrooms, with the following stipulations: OF ANcx, s - • UUATCR AN c WAONSTEWASITETED R PROGRANI _ �JC1r—�ry�llt'f� By: wt.. Original Certificate Date: 1 10 —/7' 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheer_10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: SLEEPY HOLLOW#2 BLOCK 2, LOT 19 Parcel ID: 051-511-22 A. WELL DATA Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/11/1977 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 463 ft. Cased to 40+ ft. Casing height(above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 6111/77 6/712017 Static water level 415 ft. 433 ft. Well production 15 g.p.m. 4+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.47 mg/L Arsenic: ND ug/L Date of sample: 6/7/2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 6/19/2017 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NA-NEW TANK Pumper C. ABSORPTION FIELD DATA Date installed 8/1977 Soil rating (g.p.d./ft2 orcft2/bdr�85 System type DEEP TRENCH Length 20 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth 9.1 ft. *(Measured 6/7/17) Eff. absorption area 255 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/7/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 5 in. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450+g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _in. "Pump off' level at in High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ - On adjacent lots 100'+ _ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 501+ Manure/animal excrete storage areas 100'+ _ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS 'Monitoring tube extends 5.1'below invert w/4'of cover above invert. Water showed in monitoring tube around 100 gallons during lest rising to only 5"and was dry again in less than 10 minutes. G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF Ai Ar Engineer's Printed Name KENNETH M.DUFFUSAsw k Date 6122/17 9TH COSA canary sheet_2-6-15.doc KENNETH M. Derr 7116• .mow if ',qb 6, dS Air 'OFFs510`• -- ___ ----- - -- _--- —7------------- — —_ _.. .- --------- — 0 / 3 8459C 0) O to / / co / �O // � O // /1/ Lot 18 O �, - 'S. • • • • • • 4 I, 4.1 Q ' • 49th %� • •� , / 000 ;..c.\ Lot 19 * • • t‘) 6,/ / septic - •, ID ••4406: • •W • Os ••• • •• F 11 • • • / "�YY / �, • Brett A. Wilmot . p s / i ^;2:4\i-co 0�A• 112392 - LS •• JQ- _ / / 1.7 Chimney 0 t• �. ,� y — •0. 1 !!O • • • • • • • • •1V r // -, ® eCk 1 �0SS I pN►,� t�0 / 2 Story Frame Hou : deo* 0 - p. . ` ' 1,`\�`` / 01 * o / / 0.7 0A t ^gypt_. 4,7tiO,• \ \ �� ,,c) , / ... , \ , e.„(,•: ‘, 4/6 Chain Ink f • \ \ 1 ` oQ �� .! \ 0 Lot 20 ^'' cb� ? y O(0. AS-BUILT NO CORNERS SET THIS DATE / ' -'7 \.. �i I hereby certify that I have performed a Mortgagee's inspection / of the following described property: LOT 19. BOCK 2. Weft O, SLEEPY HOLLOW SUBDIVISION No. 2 o (j. Lot 21 ,'((// Anchorage Recording District, 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 I 25 that there are no roadways,transmission lines or other visible easements on said property except as indicated hereon. SCALE: 1"= 40' / Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 26th day of JUNE ,2017. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON. AES, FB 17-7, pg 3 BE (907-2413-1666) Engineers and Surveyors MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL NEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE BEWER AND WATER FACILITY 264-4720 1. GENERA[. INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (c) Applicant is (check one): I_on~in~ InstRution ~: Owner/builder ~Buyer ~; Othor ~ (oxplam); ....... (d) Lending Institution ../'~'~_~f/z~'~f (e) Real Estate Company and Agent _ ////4 Address Telephone (t) Mail the HAA to the following address: / ............... TYPI= OF RESIDENCE Single-Family [["]~ulti-Family [] Other Number of Bedrooms ~¢'~..'_ WATER SUPPLY Individual Well ([~"'-Comrnunity [] Public [] Note: If community well system, must have written confirmation from the State Department of Fnviron mental Conservation attesting to the legality and status. SEWAGE DISPOSAl. Onsite ~';]"'""Public [] Community [] Holding Tank F.'] 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 (11/841 ENGINEERING FIRM f)ROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As codified 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 wastowater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furti~er 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 __ J-JA_GLE RIVER ENGINEERING SERVICES _ Telephone FABLE RIVER, Al( 99577 Address Date /~,~//~ A~_ Engineer's Seal Approved __V~ ........ Disapprove'"'d~t '~. Terms of Conditional Approval ~ _ Conditional _ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based eolely 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 reqoirements. 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 ornissions in the professional engineer's work. Page 2 of 2 727025 (~ ~/84) MUNICIPALITY OF ANCHORAO~ DEPT. OF HEALTF' & .NWRON NT^L MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) '1~ CHECKLIST - FEBRUARY 1984 RECEIVED Legal Description WELL DATA Well Classification ,"°f4~I~1 ?- ~'''~¢ If A. B. C, D.E.C Approved (Y/N) Well Log Present I Y/NI _ /V Date Con' 01eted ~"//~ /./ ?.2 Yield Total Depth /'/¢ $ ~ Cased to Static Water Level /'¢'/,.~' '" Casing Height Above Grouno /" Electrical Wiring In Conduit [Y/N/ · Separation Distances from Well: To Septic/Holding Tank on Lot ~'/D¢ To Nearest Edge of Absorption Field Dn Lot To Nearest Public Sewer L ne Cleanout/Manhole Water Sample Collected by _,~'~,:~ ~ Water Sample Test Results '~ ¢- z ~' ,'~b 0"/-¢-~-'~ ,~. DePth of Grouting _ /~"/~) Pump Set Al __~/5-,2 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots "/,cD '¢- On Adjoining Lots ~o ' To Nearest Public Sewer To Nearest Sewer Service Line on LOt '~ -'~ '¢-" : Date __ Commeats B. SEPTIC/HOLDING TANK DATA Date Installed __/¢ 7 2~- Standpipes (Y/N) _/Y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) //'///'¢~- ; for Holding Tank High-Water Alarm (Y/N) /t,//.¢~ _ Temporary Holding Tank Permit (Y/N) Size /¢90~-~ No. of Compartments Air-tight Caps (Y/N) ,,Y_ __ Foundation Cleanout (Y/N) Date Last Pumped 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 ~ z 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 /¢' ? ? Width of Field '3 z Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test .~ ~,'~ ~-~ Separation Distance from~Absor, ption Field: To Water-Supply Well /~ To Building Foundation ,~ ~ Lot /N) ~ ~ ~ To Water Main/Service Line ~/o ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ,::~o / Depth of Field // / G~¥el Bed Thickness 7 / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /o ~ To Existing or Abandoned System on ; On Adjoining Lots '¢' ?¢ ~ To Cutbank (if present) /t~¢,~,~ LIFT STATIC N/J'/~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensiofrs 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 ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~ Date //,/,~ Company .~7',/~,/~., ~; MOA No. Receipt No .... ~_~, ~ Date of Payment Amount: $ ~.~C,, E)(~) Engineer's Seal Page 2 of 2 72-026 (11/84)