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Home My WebLink AboutSLEEPY HOLLOW #2 BLK 2 LT 26Onsite File Sleepy Hollow #2 Block 2 Lot 26 #051-511-15 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201067 PID Number: 051-511-15 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name KRISTI SORENSEN ABSORPTION FIELD ❑ Deep Trench El Wide Trench El Bed ❑and Site Address 18433 Mountain Road Chugiak AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth froriginal grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. ravel depth beneath pipe Ft. Subdivision Block Lot SLEEPY HOLLOW #2 2 26 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 Tol Septic Absorption Lift Station Holding Sewer Total absorp ion area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well >100'I NA NA NA TANK ❑® Septic ❑ S.T.E.P.,❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >100' NA NA Material Number of compartments Lot Line >10' NA NA NA plastic 2 Foundation >101 NA NA LIFT STATION Manufacturer Capacity Remarks _/ Gal. Alarm location ,/'� Electrical installed by Installer PIPE MATERIAL House to tank D2661 drainfield Tank to D3034 CMM General Contractors Drainfield CO/MTD2661 Inspector Curtis Townsend, PE BENCH MARK (Assumed elevation) 100 ft Inspdection 1'` 4/21/2020 2�a 4/23/2020 Location and description 3'd 4/28/206 4111 garage slab ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date —ONQ't .... ........... �� Oa C 11� �4srF�F � , AW Septic System Approved � iiGC0t' Date J� 0 6 Note: this approval does not include well permit requirements. \ NEIGHBORING WELL 1S > 10' FROM PROPERT LINE NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE/ �3 0 Lot 24 IGHBORING SEPTIC IS>10'FROM PROPERTY LINE Lot 2 6 / THERE ARE NO STEEP SLOPES WITHIN 50' OF THE PROPOSED TANK. NEIGHBORING WELL IS > 100' NEW 1250 GAL SEPTIC TANK BM A 4 BR OUBLE HOME CLEANOUTS FCO UNDER DECK \SUMP FLAT SLOPE \ M \ EXISTING 65' x 6' x 48" EFFECTIVE DEPTH TRENCH, TRENCHES HAVE LENGTHS OF 20' + 45' 2� \ '0\ \ NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE SWING TIES ON PAGE 2 :�N—E�IGHBOR�INGWE�LLIS > 10' FROM PROPERTY LINE --'CHUGACH STATE / PARK N 0' I / 100' 1 I \I SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,250 GALLON SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH A 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Septic As Built Drawings Prepared for KRISTI SORENSEN 18433 Mountain Road Chugiak, Alaska 99567 SLEEPY HOLLOW #2 BLOCK 2 LOT 26 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 355-9820 DATE: DRAWN: SCALE: PID: 051-511-15 OSP201067 4/29/2020 CLT 1"=40' SHEET 1 OF 2 MARK A z B SV1 24'-9" 29'-5" Q0 SV2 26'-0" 31'-9" U SUMP 69'-4" ZZ 63'-4" MT 80'-0" 61'-8" Z' Z z Q0 Z U U w 0 ZZ m Z 0 H Z ¢ S O innn .......00U O 1,250 G PLASTIC TANK EXISTING 65' x 6• x 48" EFFECTIVE DEPTH TRENCH Septic As Built Drawings Prepared for ...�"`ILS,I,, KRISTI SORENSEN 18433 Mountain Road Chugiak, Alaska 99567�.�' •''!�� SLEEPY HOLLOW #2 BLOCK 2 LOT 26 ; 49TH • OSP201067 �.....::.......r................,......:......0 0 ............ ........................ EKLUTNA ENGINEERING, LLC DATE: 5/1/2020 , :.CURTIS TOWNSEND:6j 19162 MOUNTAIN ROAD No. C 11904 DRAWN: CLT �j s CHUGIAK, ALASKA 99567 • SCALE: 1 " = 1 ��1♦��. � •% ��,��• (907) 355-9820 ��t��;;- PID: 051-511-15 SHEET 2 OF 2 Y Q W v � � 10' UTILITY EASEMENT PLOT PLAN ___ AS BUILT _X_ SCALE _1=_= 60__ GRID _ NW 1060__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000��O (907) 522-4625 Fax oo F A C p04 Professional Land Surveyors kenOlongsurvey.com o 9 Q lonathanOlanasurvev.com I hereby certify that I have surveyed the following described property: LOT 26, BLOCK 2, SLEEPY HOLLOW SUBDIVISION — No. 2 (PLAT No. 73-86) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the __Z81j _ Day of _ h'+'_'_ -__I Z_�_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. : 49TH* z� KEAp...4NC ... s ••�. 4�28`2�.• �t ..LS -5202..• 5`S4 4�n "ESSIONN �o AECC963 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201067, Rebecca Carroll, 04/17/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201067, Rebecca Carroll, 04/17/20 MUNICIPALITY OF ANCHOP, A~I= MUN,O PAL,T¥ OE ANCHORAGE EPT. DEPARTMENT OF H~AL.TH & ENVIRONMENTAL PROTECTIO~NVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ( 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 DEO 2 6 1984 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DEDO~IPTIO~ LOCATION ~. OF BEDROO~S Well / I Absorption area Dwelling PEFIMIT NO. I- ~ Manufacturer ~ < ~ t~~ C~ /~ MaterieJ NO. of compartmm,~ Liq. capacity in g,llons ~ ,. Inside length Width Liquid depth ~ /., ~ IF HOMEMADE: ~OZ~ ~ DISTANCE TO: Well ~/~ Dwelling / PERMIT NO. O ~ ~ Manufacturer ~--~ Materiel Liquid capacity in gallons PERMIT O. ~Z NO, of lines Length of .ach line Total length - ~ w ~- ~a [ ~,~.,~ ~f lines Trench.~. '/wMth Distance between lines ~ ~ ~ - '= inches 'Tota~ti~e~bsorption are Top of tile to finish grade ~/ Mater'albeneathtHep~l~.~" ,~ 2 /l~c-~ inches ~'Z~ ~,~ Length ~ Width De PERMIT NO. ~"~ Type of crib--S/ Crib diameter Crib depth Total effective absorption ar0a m ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class ~/~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS iNSTALl_ER - l ~,, ~,,, APPROV~ ~ ~ DATE LEGAL /78) i}EF'FIR]'HEI",IT 01:::' HEFILTH I:'ll",lE:, I:Zi",I',,,'IRONM[EhlTFIL. F'RCFFEC:'f'IEd,,i 825 '"1..'" ~];TR[Z[!~'i'., f'INCIIOi~:I::IGE., FIK ;;2:~;,$.-.47:'2E~ ; Fll',lCIlOl:;'.lq(!i[; (!;[~]:,-~..--.2:.1...~::L : C, ['..4i --... ::~:5; ]ET' I[Z:: :'.:.!!; lEE IL,,.I~ EE: IF,.:.:: .,.C,-"~, If.-.Jl IEE If._ If PEI';;:I,11T IqO. F:lF'l:::'l.. I CFII",IT: RI])N '" '.'S GIZi",I[EI:;;~I::II... :']',f:~]:~:",,' PHONE: 694-q.C'"17;I. I::I[:'E:'I:;:E¢{:]';'!i;: oFr:' OLD L]iL.E}.IN Hi.,.I'¢ EI:':]GI._I!i: RIVEI:;L, I::11< 995E;7' LIZGF:IL. E:,E:;;C:R ]: F"F I Obi 51.JBI} I ',,,' ]: S :[ Cd'-,I: 'Z, LEEF"T' HOLL.OI.,! 13LOC:I'.::: L. OT :~,IZIE 8,,:,q3E~O SI]:k F'T. TOHNSH]:F': ::I. LSN RI::II'.,IGE: :IF.W. SECTION: :Lb] HFlY, IHIJM f,IUHBE]';?. OF:' 13[Z[)ROOMS = 4 :5011....F..'FI]'II'a3 = J.;-]5 ::L;?.5 ::L25 ('Z, 6~. FI'. ,.."BR) I...Z~E;TED [3ELOkl FIRE ::HE OF'TION':3 FI',,,'FIII...I:':I[.:','LE 'TO '/OU IN [:,EL-];ZEiNZNG '.fOUR LxEPTIC :'3'./STE]'I. CIIO0'J:;E TILE: OF']'ION TI.IFIT E',ESIFF FITS './OUR SITE. 'T If;;: EEC Ihq C]:: If-~ IIZ:, E!E "2E; ]{: C::'4 If'...[ 141D"I"II = LtZNGTI I = TOTF!IL. C,l~l::']i'l.I = (!iRRVEL [)EF'Tll = I._Ei]qGTI '1 = 40. ]"O]"FIL.. DEPTH = 5. GRFI'v'I!B... I]:,IZPTI.I = 0. GRFI',,,'I~:]L.. ',,,'OLUME ~-~ iF;2]. TI:::INK SIZE = %, 2!50. t1...1t ]: I]Z:, tE ~3:111]:;~: F::l~ ][ If'-,~ I1:=' I,.IZI}TH = 5. 8 L.E]'qGTI'I = 59. 0 TOTf:IL. [)[~F'Ttl = 7. O GF;'.F'I',/IZL I::'IZPTH = 3:. 0 GI';~:I:I',,,'EI~, ',,,'O[.,.I..JI'"IE]: a 38, ;2 Et Fl". E1 F"T'. 8 F'if'. 5 F'l". E; CU. ','1]:':']. 0 GFI[..LOI",ILc, (]'].qO COMF'I::'II';;FFHENT "FlaNI<) ]: If2-.: IL_ l[]::,E:::, E: :E:]; X o:F_4 FT. F'T. FT. I::"T. CU. ]"Ri",II( 2;IZE = % ;~:50. 0 (!iI::II..LCIhE~; '::T1.¢3 E:OI'IF'I:::FF:;Fr'MENT TRI',II:::) I CERTIF"¢ THFiT: :if. I FIM f::'FIMILIFIR I.,.I:[TH THE I;:Er.;!UIRE;I',E~]'.,IT.S FOR ON-:BITE :SEI.,.IERZ, F'~N[:, I.,.IEI_LS R'.2:'; ~,ET FOt;'.'r'H B'.¢ THE MLII'.,IiCIf-"FILI'T".¢ OF F:Ii',ICHOI':~:FIC. iE FIN[:, TH[:] ':7,1'RTr£ OF FILir:I2~,I-(f:i. ;:ii:. I I-,.IILL Iiq:STI::ILJ... THE S'.R~];'IF'EI,I II'.,I FICCOR[:,FII',[CE P.IITH TFIE COl}E:5 FIND I..IFIVE F:l COP'./ OF. THE CO[:,E ::.;UMl,lFIr;'.'.r' r:lN[:, I}IFIGRFII,1 F:IT]"FICHHEI',!TS .LIHICH I:E; F'FIRT OF THI:F:; F'IE F?.M I 1.. ]:. I UN[:'E']~';:STFIN[:' THFI'r' THE ON-SI'f'L.Z.. !:SEI,.IE.]R S'.r'STI]M I"IW¢ I:;~!r~)]:!UIRL:: I~I'.,II.,I::If~',Ei[.:]','IENT ~F :'HE I:~:EZ, I[;:,[]]',ICIE IrE; r;?.IZMO[:,EL.E:I} 'FO If4CI....IJE:,E I"IORI:~ THFIN 4 t:~EE:,ROOMS. F'EF;.'H I T i:::IF'I::'L. ;i: Ct:'Ii'.!T Ill':r."!; THE'; RE:::;F'Ot'-,I'S Z [3 ]: L Z 'F'r' TO Z Nf:'ORH I':'Ef;.:'..E;ONNEi.. [:,1..11;?. Z [",lEi :"HE I N'."/TFIL. LF:IT ]]OI'IF I i",I'.E;I::'EC]' I ON:F.; O1:': F'IN'T' I,.IEL. L:E; f][)JlaCENT TO TH I :.:.:; F'r~:o;:'ERT'¢ FIND 'THE NI...IME~tER OF F..'ESII].:,ENCE.,2; 'TIIFIT THE !-,]EI..L. HILL IF FI LIFT S'TI:iTION Z:._'.; ZNE;TFIL. L. EI}., FIN IZLECTF;::[E. FiL F'ERI, I:[T FIN[:, ZI'.,I:E;I::,ECTION MU'.:!;T .BE OEFI"FIII',IED. rifS.-.BUII..TS cr~li'.,IhlOT BE: I::Fl:'PI:;~!O',?EI} I.,JI'FI.IOUT AN ELECTRICAL. ZI'.,ISF'L~C':]"ION RIEF'ORT. THE E:LEC]'RIcr:IL.. I.,.IORK HU:!;T E~[]; DONE E','./ I'::1 L:[CEN"!;E[:, EL. ECTI;?.ZC.T. RN. F?.Oi'4'":]; I]iENE]::I::II.. SEF?.'v' I}I':FTE: MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 ~ Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ '~ WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~ j~NN~O ~ Mailing Address: Location: 0~t ~,O ~ ~g~V~N~_I Phone Number: Legal Description: LAG ',~ ~i. [~ _ ,"~ Lot Size: - , Type of Soil ~sorption System Is: ~ Trench: ~ Drainfield: Seepage Bedl Holding Tank: Maximum Number of Bedrooms: ~ _ Soil Rating(sq.ft/br) I~-~ The Required Size of the Soil ~sorption System Is: DEPTH ~1 LENGTH ~' GRAVEL DEPTH _ ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDiNG) TANK SIZE = __/~'~-.~'~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications a~d construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will ~1 the ( 3 ) I un/~-s~at ~eStem in accordance with codes, i on-site sewer system may require enlargement if to i~clude more that 3 b~rooms. SWP/024 (1/81) ~9-~' MUNICIPALITY OF ANCHORAGE ,/4 .~,~'~' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION TEST ) 825 L. Street, Anchorage, Alaska 99501 264-472.0 SOILS LOG - PERCOI_ATION TEST ~o~t~ ~-~/ SLOPE ENCOUNTERED? O 12, P IF YES, AT WHAT DEPTH? ,, ~, unea~;n~ Date Gross Net Depth to Net Time Time Water Drop 14- 15- 17 - 18- 19 - JONN E. SWANSON 1834-E 20- PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN -- FT AND FT Pi~FO~M~DBY: ~&~e:~"~(~. __CERTIFIED DATE: _ 72-008 (6/79) by A & L DRILLING COMPANY , ' i .~. ~ .~'?', BOX ~7, EAGLE,RIVER, ALASKA 99577 ' OWNEROFLAN Z£5 ADDRESS :~' DATE - Started t~', Ended_ TELEPHONE 694-2588 / DEPTH OF WELL 6~? D O STATIC LEVEL OF WATER FT. ! O ~ ! DRAW DOWN F'r. 3fi_ GALS. PER HR /07o O ' KIND OF CASING _ d ~O~ KIND OF FORMATION: From__O Ft, to--/ Et. 00 ~,~O,~,O,,'g ~-.,.~ From Ft. to-- z-Ft.~ :. From , __Ft. From , ~..Ft. -". From_ Ft. ~ From __Ft. '!; From __Ft. '~:: From_ Ft. ,!, From .... Ft. · From __Ft. to~ .Ft._ ~oO ~ Fl'on] to~.Vt._ ~Aa~ * ~4~C:~ From to , .Ft, ~ From_~_ to~ .Ft From to .... Ft.. From to~Ft,, , From to~.Ft From From 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.____Ft. __ _Ft. to Ft, Ft. to__ Ft, .Ft. to__ Ft. ___ Ft. Ft~ to__ Ft._ From __Ft. to to_ .Ft From _Ft. to M1SCL. INFOI~VlATION: / /~o I--'ERf'II 'r NO. DEI::'FIRTb'IENT OF ERI...TI'~ FIN[::' EN',/IRONi"tENTRL F'I 'ECTION 825 "L" x;TREE'f'., FINCHOF..'RGE., FII'.'.:. 264.-4'720 FIF'F'L I E:Ri'4T LOCRT I ON LEGFIL LEE SUL. L I VFIN L2E; ~iLEEEPY I-IOLLOI4 ~2 F'O BOX ::L97 ERGLE F::'.Z',/ER LOT E;;I ZE 6E~OEuZl 5QLJF:IRE FEET H]:NIHUH DISTANCE BETHEEN A HELL RND RNY ON--SITE SEI,.IRGE DISF'OSRL S"r'STEffl IS :LEvEl FEET FOR R PRIYRTE 14ELI.. OR 200 FEE]' F'OR R PUBLIC HELl... I,.IELL LOGS FIRE REg!LIIRED Ri'.4D i"IUST E~E RE]"URNED TO THE DEF'RF::Ti'flENT I.,.IITH]:N Z::O DRYS OF THE HELL COHPLETION. OTHER REg!UI,~:Ei'flENTL:, f'lRY FIF'F'LY. SPECtFICFFI'IONS'; RND CONSTRUC'FION [:,IFIGRFIHS ARE: RYI::K[LRBLE TO ];NSURE PROPEF.'. ;[NSTI~LLFf¥ION, I CERTIFY THRT 1: I AM FRM:[!._IR~: t4ITFI 'T'HI!:-' REQUIREMEi'4TS FOR ON--.E;ITE :SEP.IER.S FIND NE:L.L':] RS FOF.:TIq BY THE HUNICIPFILITY OF RNCIqORRGE. 2: ..I I.,.III_L//I~:~TFiLL THE .SY'.E, TEH IN RCCOF.'.DRI'4C~ l.lI]'H TIlE CODE'..5. "~'I~;'PI.i'C)Fli",IT-- LEE SUL. L.~VFIN L:;', E T NAME OF APPLICANT GF?E/ R ANCHORAGE; AREA BOY 'GH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. INSTALLATION LOCATION SEEPAGE PIT DRAIN FIELD , OT.~R COMPLETION DATE ANTICIPATED -- FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BAE:KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SiZE 'rYPE SEEPAGE AREA SIZE TYPE , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. IBIAGRAM OF SYSTEM GRAVEL ]BACKFILL TIME DRILL LOG CASING .,~ /~d/¢l ,,-~/, / ___ c_~2/, ,? ..... ,~A 99509 START COMPLETE Z~5~~ ,~1,~ '/ ~,~ ~ -- JOB LOCATION ~} ~ ~ DEPTH WELL LOG DEPTH WELL LOG COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING P~rcel I.D.# (f-'~ ~ - ~\~- ~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 26; Block 2; Sleepy Hollow Subdivision ~2 Location (address or directions) NBN Mountain Road (b) Property owner Business (c) Lending Institution Telephone Mailing Address (d)Real Estate Company and Agent _ JACK WI_{ITE COMPANY/Ba Address 10928 gaqle Rive~ Road, Eagle R~ve~, Telephone 69zJ--.55QO (e)Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Ea_cjl_e~g'ive~- r,oo? R~,4~ .~,d f:e_2~4_ · E~7~gle Rive~, Ala,~k~ Q9~77 2. TYPI-' OF RESIDENCE Single-Family [] Number of bedrooms ~r 3. WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmetion from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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 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 Telephone S & S ~NGINEERING Add ress 17~34 ~:g!~ River Loop Road No. 204 Eagle River, A,a,ka ,9577 ~/~-/¢~ Date -/ / '~' ~ Date Approved for bedrooms b Approved ~isapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DH HS 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. A. WELL DATA Well Classification ~ M~NICIPALITY OF ANCHORAGE (MOA) MUN CleN'Ii~'~:HO~iO~ealth Authority Approval (HAA) ~v~ON~Ni~Es° '~HECKL ST - FEBRUARY 1984 .JUN 5 1990 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed L- Total Depth ~ co '_ ~ased to z-JO /~_ Depth of Grouting Static Water Level I I c/ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ Yield Pump Set At [) ~ Sanitary Seal on Casing (Y/N) __ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 2 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ik) If,.q To Nearest Sewer Service Line on Lot Water Sample Collected by _ ~ '¢ ~ Water Sample Test Results Comments ; On Adjoining Lots · 2~Z~2~ ; On Adjoining Lots TO Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA/ Date Installed ~,"--/~-"~)Size/l,2.',,%-o '"~No. of Compartments _ .2_ Standpipes (Y/N) ~1 _Air-tight Caps (Y/N) _ ~ Foundation Oleanout (Y/N) Depression over Tank (Y/N) /~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,'d//,q SI=PARATION DISTANCES FROM SEPTIC/HOL?~DING TANK: To Water-Supply Well ~ ~'O ~ /- , /' To Building Foundation ~' ~ / To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~ ¢~0 hC ~O N~,O P~C/ bC~ Date Last Pumped __ 2- - /")/~ ;for A)/~ Temporary Holding Tank Permit (Y/N) 1'o Disposal Field 72-026 (Rev. 7/88} Fronl Page 1 of 2 C. ABSORPTION FIELD DATA ~ Soils Rating in Absorption Strata (;2.3- ¢//~ ~';~ Type of System Design Date Installed ~--f ~ - ~.~ ,'""~- Length of Field ~ ,~- "~J Width of Field ~ ~ Depth of Field ~ / ~ Gravel Bed Thickness Square Feet of Absortion Area .,.~ 2'o ~ ~ Statndpipes Present (Y/N) Depression over Field (Y/N) /',/ Date of Last Adequacy Test Results of Last Adequacy Test ._~ p, f, 4, ffAc.,'~¢~ ~ z. fL ~¢'.c~¢'OO/¢~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ 2_ To Property Line To Building Foundation ~ 2. ~ To Existing or, Abandoned System on Lot A)/¢q ; On Adjoining Lots "~ ~ 'h To Water Main/Service Line ~--~/'/- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~/~1 To Driveway, Parking Area, or Vehicle Storage Area % 0 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 o! this inspection. Company 17034 Eagle River Loop Roa~ No, 204 Eagle River, A. las~a ~?~577 Seal ReceiptNo. ~/¢~'¢ P (c~OO-¢Zt-') Receipt Date of Payment/-) ¢~') -~)~ /F_.~-"- ~'V ~ Waiver Fee: $ Amount: $ ,/~/ Date of Payment 72-026 (Rev. 7/88) aack Page 2 of 2 CflEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 AHALYSIS REPORT BY SAMPLE for ¥1ork Orde~ # 22226 Date Report Printed: JUN 13 90 0 13:03 Client Sample ID:L26 B2 SLEEPY }{OLLO{q S/D PWSlD :UA Collected 3UN d 90 ~ IS:30 Received JUN 6 90 @ 13:20 Preserved with :AS REQUIRED Client }lame : S & S ENGR Client Acct: SNSEHGP P.O.{ HONE RECEIVED Req ~ Ordered By : R. S]{AFER Analysis Completed :JUN 11 90 Send Repozts to: Laboratory Supervise% :S~EPHEN C. EDE 1)5 & S ENGR Released By : ~~'~. Special Instruct: Chemlab Ref ~: 901703 Lab Smpl ID: I Matrix: WATER Allowable Pa~ametez Tested Result Units ~ethod Limits NITRATE-N 1.3 mg/1 EPA 353.2 fO Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY R.D,J. 1 Tests Performed See Special Instructions Above UA=Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT~G~eate~ Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL.TH 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 Jane 6, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 26; B~,ock 2; Sleepy Hollow Subdivision Location (address or directions) (b) Applicant Name Randy Flickinger Telephone: Home 688-4996 Business 694-5373 App~icantAddress P.O. Bo~ 772628, Ea~_~e River, Alaska 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder ~(; Buyer []; Other [] (explain); (d) Lending institution Alaska Mutual Bank Address Ea.qle Ri~ver~ Alaska (e) Real Estate Company and Agent Telephone Address Telephone I~.~t~e HAA to the following address: S & S Eng_ineerin_q SRB 196X River, Alaska 99577 TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of ~Bedrooms _ ~/ Other WATER SUPPLY Individual Well [] Community [] 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, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 025 (11/84) Page 1 of 2 5. EI~IGINEERING FIRM PROVIDING .,~SPECTIONS, 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 ol this Health Authority Approval shows that tile 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 inlormation 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 insI~iW~ENGiNi:EEiNG__ Name of Firm S~-~96~,~( Telephone ~::~'~ ~-~77 Address EAGLF.-EIVER~K-99577 JUN II 1986 Date Approved for ,,~"~ bedrooms by Approved ~ Disapproved Conditibnal Terms of Conditio'llal Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Proteqti/on (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. Tile DHEP does this as a courtesy to purohasers 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 (MOA) .EALT. AUT.O..TY APPROVA' <.AA> CHECKLIST- FEBRUARY 1984 986 , '/. NgF: Legal Description: Well Classification "~¢4t/cck'"¢/~- If A, B, C, D.E,C. Approved (Y/N) Well Log Present ~) Date Completed ,/-/a -~' Yield Total Depth ~ ! Cased to ~10' e Depth of Grouting Static Water Level / ~D~ / Pump Set At ~¢,4¢ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing~N~ Depression Around Wellhead (~,(~ Z_, ~c:~ t ; On Adjoining Lots /00 / /'' To Nearest Edge of Absorption Field on Lgt ~z/2' / ; On Adjoining Lots // To Nearest Public Sewer Line "~/,4- To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments To Nearest Sewer Service Line on Lot ,/~ O ~ ~ .~'~ ~-.¢,~ (~, t/x.J ¢-,~--~-~-~£ ;Date ~'~-/0 -~ ~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~'"%/'~ ~ ~ Stand pipesd~ZN)' Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ~ Comments ~ Size /~'"--%"~ No. of Compartments Air-tight Caps~)/.N)- Foundation Cleanout Date Last Pumped .~ , for Temporary Holding Tank Permit (Y/N) To Building Foundation ¢ ' To Disposal Field ~/~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata /~"~- Date Installed ~"'-~/~ Width of Field ~_o Square Feet of Absorption Area Depression over Field ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water4,Ck~-/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Par/king Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~,~- Depth of Field Gravel Bed Thickness Standpipes Presen(~CN) Date of Last Adequacy Test To Property Line ,~:~ / To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. 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 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S &S ENGINEERING Date JUN I I !g86 SRB 196X Company i~L~Ri~OA NO. ¢~'¢<~'--'¢::~::~ ~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11184) t¥iUNiCIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PRDTECTION DIVISION OF ENVIfION~IENTAL HEAL"I'H CEBIIFICATE OF INSPECTION FOR HEALTH AU FHORITY AP?ReVAL OF ON-SiTE SEWEF~ AND WATER FACII_ITY 264-4720 GENERAL INFORE/IATION (a) Legal Description (include lot, block, subdivision, section, township, range) / Location (address or directions) (b) Pi ..... _~- i( I ......................... Applicant Address (c) Applicant is (check one): Leading Institution (d) (e) Lendin,q Institetion .... ~'~.P,, ~.~ ~-_~,.. Address Rea~ Estate Company and Agent Address ............. Te]e, phone (f) '~2t-8_dhe HAA to the following address: 8 & ~', ~ '~91~EqlNf:L TYPE OF RESIDENCE Single-Family ~-¢'~ Multi-Family ['3 Other ._ ........... Number el Bedrooms .... WATER StJPPLY Individual Well~[~ Community E] Public [] Note: If community well system, must have written confirmation from the State DepaCtment o¢ Environmental Oonservation attesting to the legality and status. 4. SEWAGE DISPOSAl. Onsit6~L~.. Public [] Community [~J Holding Tank [] Note: If community well system, must have written confirmation from the State Department o~ Environmental attesting to the legality and states. Page 1 of 2 ~.~.2~ ~ *..~ ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE ,>EARCrl, DA'FA AND II1FORIVIATIOI',I AS certified by my seal affixed hereto and as of the validation date sl~own belov,'. I v(.r,fy t, Authority Approval shows that the oe¢site water supply and/o~ w~stow~tor dlsposaJ syste ~ for the numbor of bodrooms and type of structuro indicated herein. I further verdy that b~se~ from the Manicipality of Anchorage files and from my investigation and ~nspecbon, wastewater disposal system is in compliance with all Municipal and State codes, oral,nonces the date of this r spection Name of Firm .... S~113 '~u,,~~ ,, :.. l elephone Address I>It~ Date .... ~ ~5~- Approved for~..,~,*~.2_~drooms by Terms of Conditional Approval ........ CAUTION Tho Muncipality of Anchorage Department of Health and Environmental Protection IO!¢EP~ ~.~ues Approval certificates based solely upon the representations given in paragraph 5 above b~,. a~', independent engineer registered in the State of Alaska. The DNEP does this as a courtesy to purchasers of homes and institutions in order to satisfy certain federal and state requirements. Employees of DNEP do not conduct analyze data before a certificate is issued. The Municipality ct Anchorage is not responsible for errors or professional engineer's work, Page 2 of 2 72-025 (11/84) A. 'WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ~vtUNICIPALtrY OF ANCHORAGE DEPT. OF HEALI'~ & ENVIRONMENTAL pRO~ECTION 264-4720 Legal Description: Well Classification ~'-"~f"4 ~.v~,,"~'~_ If A. B. C. D.E,C, Approved (Y/N) Well Log Present~/~ Date Compl~te~ I'l~ Yield Total Depth _ ~' Cased to I~ ~' ~` ~th of Grouting Static Water Lovel [O~t Pump Set At _ I Z) l ~ Sanitary Seal on Casing ~) Depression Around Wellhead~/~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot ~-'"~ ~ On Adjoining Lots To Nearest Edge of Absorption Field on Lot ;~, ~,.r~-~,, ¢¢-- : Oi1 Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole _ I'~ \/¥. To Nearest Sewer Service Line on Lot Water Sample Collected by _-~.~ ~----¢'~ ~ i~.~-~.i~¢,¢t,1.'~ · Date __ Water Sample Test Results _ ~.~'~"'/'¢',...% ~¢"~¢:~ ~-"~'-O ~.-~ ~' Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes t~/,N') Depression over Tank (~.~) Pumping, Maintenance Contract on File Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holdinc~ Tank To Water-Supply Well ~-- '~ ~ i To Property Line ~.~ ) 4- To Water Main/Service Line ~,~ I,~ Size [~*%"' '~' ~ No. of Compartments Air-tight Caps ~,N~ Foundation Date Last Pumped for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposa Field Course To Stream. Pond. LaKe. or Major Drainage Page 1 of 2 72-026¢1/84) C, ABSORPTION FIELD DATA Soils Rating in Date,nstalled~~ Width of Field Square Feet of Absorption Area Depression over Field ~ 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 ~.~, y~ -r-~¢~, W Type of System Design Length of Field (..¢,~- t Depth of Field ~:~ Gravel Bed Thickness '~;'~ Standpipes Present ,-,~N) Date~f Last Adequacy Test ~o/~'~/*~- ~'-~ To Property Line ~ ~ To Existing or Abandoned System on ; On Adjoining Lots ~5" ~ +' To Cutbank (if present) hf~ / 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 M/~,A and HAA guidelines in effect on the date of this inspection. Signed Com.p¢~LE !~.VER, A.~,S,¢2; ~ST~ MOA No. ~ 0 ~ Amount:$ ~. ~ Page 2 of 2 72-026 (11/841