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HomeMy WebLinkAboutSLEEPY HOLLOW #2 BLK 2 LT 12Sleepy Hollow #2 Block 2 Lot 12 #051-501-25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 204-4720 - ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME__—.��__�_..__�.—�_.._.__-_,__.. PHH`O/NSE/ 7l KNEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area / Dwelling ^ / DISTANCE /V/� —� 't �� ¢ u Y re —/ 111 _ PERMIT NO. _ G✓ w w F- z w� Manufacturer 6- ssf� Material srsf� No. of compartments z w Lic. capacity in gallons IF HOMEMADE: Inside length Width _ Liquid depth z DISTANCE TO: Well Dwelling v yr PERMIT NO. Liquid capacity in gallons TZ H Manufacturer / Material OJ Law a Well DISTANCE TO: _ N /� - No. No. of Tines Length of each line / Foundation / Nearest lot line �md' /' fie_- fj 1 Total length li / Trench PERMIT NO'92/0/5- 92 / 015" H Q / of eas mid�t�) ��14 inches Distance between II as � .-___ -'---_ Top of rile to finish grade / ± __ - - - -__ L`�_ Material beneath ti .�.. �ainches —J' Total effective ab or do rea ul Length Width Depth -' PERMI"f"f NO, (7-.- <J­ Type of crib _._ Crib diameter -_ _ Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line Class Calm0Lf_� Depth Driller Distanc'et o lot line _ DISTANCE TO: _Building foundation Sewer line Septic tank IPRMITNO. sorption area(s) OTHER -- ®— — PIPE MATERIALS Clu r .£/2o/v Ft/L, SOIL TEST RATING /' -__/�J /= INSTALLER //'��I '�/e /� �^/� / Ll W /Y C /� _r>(/ / / LL $-A) FiEMAR KS I srooQ Q�����•-- as _-F dtC •�'OOe rY y _ "Ir IN Ei 2 0 No. 1457.E T' APPROVED Zr�1-¢}•[q r,I p'WW—q � DAT. �8 Yf•32 � tl�'ty1eF�11'IV\x LE (� Vii.( �� / /moi �- i11Vr R (II.A„4C!1 t'SBil �' /y v� 2-U73 (Mev. 3/78) .� / Q , U-11_ I r -d I: A I F-- P=1 N_. I 'I'' -p ° 111 F- 9q r -d K_-: F-1 F-_ F-9 CA E--- � 3( & � DEPARTMENT L HEALTH AND ENVIRONMENTAL , ?TECT•ION 825 'LSTREET, ANCHORAGE: AK. 99501 �ca� 264-4720 _ L=• IF. E 1."-11= F.:� 1=' E F = Pi I _r 01 'X)L PERMIT NO. f: 821015 - APPLICANT HAROLD D GROSS 3443 BOBBIE CIR 344-536 r LOCATION \J LEGAL L12 B2 SLEEPY HOLLOW LOT SIZE 999999 S QUARE-rEE`1 TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SC? FT/BR)= 125 THE REQUIRED SIZE: OF THE SOIL ABSORPTION SYSTEM IS: c. E F " -r 1-9 = :ILO L ! r'd Ci T F II -- -d- II F^ F1'1•' L C -m IE F=" -1' F-1= 2=_-_ 'To THE LENGTH DIMENSION I5 THE LENGTH (IN FEETI OF THE TRENCH OR DRAINVIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE: BOTTOM OF THE EXCAVATION (IN FEET). 1- F-1 E T F E r d IC.: I-1 14 I [Da -r F-1 I : �p . 0C-012_1 F -1 - E= -r _ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE: OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION (IN FEET). F? � � 1_ � I ��� � Cti 11 F"' -[' I A� IT1- H r -d F-=_ ._'�. I � 1:� -_� �_ K� Awy 491 A:,�a 1='! L _ 1 _ A_:A r•� "=' 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. _r 1.11e_g< C14403 FAFR1s FTFEGaA_M T F- EC.:. _..._ BACKFILLING OF ANY '=SYSTEM WITHOUT FINAL INSPEC::TION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON -•SITE SEWAGE DISPOSAL SYSTEM Is 1010 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, F'EFes`M I _r E'XF-" I: F -CE'c C?Er'_'IEr"11�-�:EFP -MlL= :1 -*i.=+_^ I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR Ora -SITE `;EWERS AND WELLS AS `-:ET FORTH BY THE MUNICIPALITY OF ANCHORAGE. - : I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE.. 3: I UNDERSTAND THAT THE ON-SITE SEWER .SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED f - INCLUDE MORE THAN 3 BEDROOMS. SIGNED:_` �iF' LIC:A►•a'C H 'OI.•D D GRCIE,S 0 ISSUED BY ry- --�___ _lvl_Z't-_t (DATE_.___<p c'__ V4.0 CONSTI.UCTION r- TEST- LAB aERFORMED FOR: :EGAL DESCRIPTION: THIS FORM REPORTS Harold Groes Lot 12 Block - W Visual Soils Examination DEPTH SOIL =EET DESCRIPTION NOTES BOTTOM OF HOLE rYAS GROUND WATER ENCOUNTERED YES, WHAT DEPTH_ _EGEND - Perc zone b S - Sample token -- Frozen zone -- Water table No 18� W. 48TH AVE STE 'C' ANCHORAGE, ALASKA 99503 248-1333 DATE PERFORMED_1OL 0/81 Subdivision, S1eeD} Hollow O Percolation Test w a 0 J V) W U) Z LU cD GENERAL SITE SLOPE =.FADING DATE Silty Sand - SM NET TIME""'y"`-` `'"` DEPTH TO H2O 31 — Sandy Gravel - GP 6 14' BOTTOM OF HOLE rYAS GROUND WATER ENCOUNTERED YES, WHAT DEPTH_ _EGEND - Perc zone b S - Sample token -- Frozen zone -- Water table No 18� W. 48TH AVE STE 'C' ANCHORAGE, ALASKA 99503 248-1333 DATE PERFORMED_1OL 0/81 Subdivision, S1eeD} Hollow O Percolation Test w a 0 J V) W U) Z LU cD GENERAL SITE SLOPE =.FADING DATE GROSS TIME NET TIME""'y"`-` `'"` DEPTH TO H2O NET DRAINAGE 1 _ dft ' RCOLATION RATE: _ ROPOSED INSTALLATION �,Ole,IAENTS : DRAINAGE REQUIREMENTS 125 O SEEPAGE PIT O DRAIN FIELD O OTHER -EST PERFORMED BY: Kevin Braun_ DATA CERTIFIED BY: v� —� DATE: ---- Id -S-4 ,3B P r�. t ®,JA-�r eLAvc �a l � s S-3, ,5-9 4.q at 2 r Y.P53(k?i?^�w*5�'I rt�flHlFRitYFhwNs'_�'?�u� rsanY��6L.919M�1rtw;x .JP+a�" rlwrityi.Ak'z` -�ntrt-Rewe st.e e48iAaax rms�rw`w,PS'.r .evl�i�+•.Fm.?�el� T4i' xiiYhw:.� .. �. b.,+_»r. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-501-25 COSA # Q SC IQ i tgp5 Expiration Date: !�--,Z 1. GENERAL INFORMATION Complete legal description SLEEPY HOLLOW #2 BLOCK 2, LOT 12 Location (site address) 18861 MOUNTAIN ROAD, CHUGIAK, AK 99567 Current Property owner(s) WILLIAM D. GEIGER Day Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO BOX 672001, ANCHORAGE, AK 99567 Unless otherwise requested, COSA will behold by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ Day phone Day TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 05/14/2012 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`#L occupants or can ArcTerra guarantee that no unseen + t,,, encroachments, deficiencies or discrepancies exist.* ,t 5. DSD /SIGNATURE V Approved for _ �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: GUSA Gheckfist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: ' Original Certificate Date: K j (Rev. 11/05Y Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SLEEPY HOLLOW #2 BLOCK 2, LOT 12 Parcel ID: 051-501-25 A. WELL DATA Well type PUBLIC If A, B, or C provide PWSID # 213522 Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft. Date of test Static water level Well production Cased to ft. FROM WELL LOG ft. Casing height (above ground) in. AT INSPECTION WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate 2.90 mg/L Arsenic: ND mg/I Date of sample:5/4/2012 Collected by: ArcTerra B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/2/19 Tank size 1000 gal. ft. 9 - p.m - Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (YM) N Date of pumping 5L4112 Pumper JRs C. ABSORPTION FIELD DATA Date installed 10 2 982 Soil rating (g.p.d.W or ft /bdrm)125 System type Trench 702' mevsu,e�f'5�/;29/L2 Atm/✓lY. Length 52 ft. Width 5 ft. Gravel below pipe 3.5 ft. Total depth_ . Eff. absorption area 481 ft Monitoring tube Y Date of adequacy test 5/4/12 Depression over field N Results (Pass/Fall) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 470 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth o in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Nit 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 101+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 101+ Curtain drain 50+ (None Known) Wells on adjacent lots 200'+ F. COMMENTS nn q- 1.2 Neu: tfl-r insWItdjo 219's wt % 2 o�a.J 13 'l2 'Per previous COSA/HAA annotation—the monitoring tube does not extend to the total depth as indicated on field readily took the water injected with no observations of water remaining in the monitoring tube a G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are inIw g' conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name KENNETH M. DUFFUS Date 05/14/2012 COSA Fee $490.00 Date of Payment 51�s1(a Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number JOS NOTE: NO WELL WAS LOCATED AT THE TIME OF THIS SVRVEY, AMEN ■smssssissssss■MEN mmHg YC1,1190N NOT% It q N w�' r aDIRy to d.tw l,. LEGEND: SET F1Y0 , wwc °n ll ... .L...!+.• rr _., . :+no 1. w rnak V"# fp"N v,.C�, It r " 0 RANDY HAF�DMAN ' I"khja°otppWaWn #.dwedl"myahNOTU AyrkrKAy�yv with REL AX OF EAGLE RIVER I Vndw " adu wf we &n " an° dam e°rdan M fl a U"d tx " • T 7ww..ww.,a.— �•w:awcwsiwal.aww.ww�anaw iw°trvotlon or M Mfaptiq papart) iMa. ap%C-%— % Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, :AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 051-501-25 1.. GENERAL INFORMATION HAA�— Expiration Date: Z / �y3r6� Complete legal description Lot 12, Block 29 Sleepy Hollow Subd. , #2 Location. (site address or directions) 18861' Mountain Road Chugiak, Alaska 99567 Current'Property owner(s) Steve Haas Day phone (907) 441-6347 Mailing address PO Box 671051 Chugiak, Alaska 99567 Lending agency Day phone Mailing address Real Estate Agent None Day phone Mailing Address..., Unless otherwise+requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:.'-', 3 3. TYPE OF WATER -SUPPLY: ' . TYPE OF WASTEWATER DISPOSAL: Individual Well -" \ ❑ Individual On-site FXI Individual Water Storage ❑ -Individual Holding tank ❑ Community'Class ; - ;.. - Well ❑ Community On-site ❑ Public Water System ® Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage i Development Services ,Department *A11 Building Safety'Division On-Site Water & Wastewater Program - I + 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 I ,I www,ci.anchorage.ak.us (907) 343-7904 f ! HEALTH AUTHORITY. APPROVAL CHECKLIST Legal Description: Lot '12, Bk '2,iSlee y Hollow Subd. , #2 ;Parcel ID' 051-501-25 A. WELL DATA'} NA — Public ,WS i­ "If Well type _ ��` If A, B,� or C provide PWSID # r' Well Log (YIN) M ; Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth Cased to' ' ," ft. Casing height (above ground) in. FROM WELL LOG'i AT INSPECTION, Date of test i l I, I; Static water level ft. ft. Well production �: E�g.p�m m. l g.p. ! WATER SAMPLE RESULTS: € I Coliform colonies/100 ml. Ni rate mg./l. .Other bacteria :� colonies/100 ml. Dat6e'of sample: Collected 6' ', i I I B. SEPTIC/HOLDING TANK DATA I, t TakType%Material 'Septic/Steel' I{ Date n t ( 10/2/82 t . s i s galled Tank'size l 000 gala ' Number of: Compartments 2 ' � Cleanouts (Y/N) y is � � Foundation cleanout (Y/N) Y Depression over tank (Y/N) ' N High water alarm (YIN) NA I Date!of pumping 1 /20%04 Pumper 'JR Pum ing I I 5 ,. . I' C. ABSORPTION FIELD DATA •• ; �I` „ f i Date installed :10 2 82 : Soil rating (g.p.d./ft2 or, ft2/bdrmj125 k;sf/bdsystem'type Mod. 5W Drainfield Length 52 ? ft ,Width : 5 ' �ft Gravel below pi 3.5 e , , t pe ft. Total 2 a depth 7. ft. Eff. abso tion are 81 l ` , , P rp a li 4 ft ; Monitonng tube , Y Depression over field N G I' Date ;of adequacy test 1 /1 3%04' " Results (Pass/Fail) Pas s For _3 bedrooms Fluid depth in absorption field befo�e;test i 0 'I in Water added 480 al. 9 New depth 0 in. Elapsed Time::90 min.;Final fluiddepth' 0 in. F Absorption rate ,>= 450 d. jg.p. Any r�ejuvenation treatment (Past 12 mo.) (Y;y/N & type) None "Known If e' s, give date i w i r PINARD ENGINEERING P.O. Box 871347 Wasilia, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 12, Block 2, Sleepy Hollow Subdivision, Unit #2 APPLICANT: Steve Haas PO Box 671051 Chuglak, Alaska 99667 SEPTIC TANK TYPESIZE: Steel/1000 gallons, per MOA Records ABSORPTION SYSTEM: Modified "5" Wide, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAL/BR = 450 gallons TEST DATA JOB NUMBER: 04-003 DATE OF TEST. 1/13104 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes XX No CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (GALs) (GALS) Liquid Level A Level Monitor Tube 1' A SAS Level Monitor Tube 2• A SAS Level 1:00 5.3 - - 4.0' - 0.0' - Start Test- Meter 123760 1:15 5.3 80 80 4.0' 0.0' 0.0' 0.0' 123840 1:30 5.3 80 160 4.0' 0.0' 0.0' 0.0' 123920 1:45 5.3 80 240 4.0' 0.0' 0.0' 0.0' 124000 2:00 5.3 80 320 4.0' 0.0' 0.0' 0.0' 124080 2:15 5.3 80 400 4.0' 0.0' 0.0' 0.0' 124160 2:30 80 480 4.0' 0.0' 0.0' 0.0' Stop Test 124240 RECOVERY Date Time ST MT1 SAS MT1 'ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: There was no measurable liquid in the SAS MT prior to or at any time during the test. However, based on Record Information on the system and our field measurements, it does Not appear that the MT extends fully to the bottom of the drainfield. Reviewed by: Paul Pinard�f Date: 1/14/04 FROM : PINARD ENGINEERING FAX NO. : 907-357-3647 Jan. 22 2004 12:39PM P1 M(> A PINARD ENGINEERING Paul F- Pined AegWored Eegine6 /AK & ID P.O. Box 871547, W"PA, AK 99887 (907) 357•ENGR (3847) llzz fol- tk-t-5 en o-.., r j, 3 Jam. a...�• -4-�. ,�.� _ - �� ..�..`. ��� a� Isar,-.., • • 9 M �,.. I��YOD D�O• h l7d�1 o p 0 0 0 0 ,• • •o goo*0000 t s O 000ao0 jOro00r oOD00�`-F-+'� , 9 -Lw* ............................... NOTE: MARK E. DAVI$ • = •� NO WELL WAS LOCATED AT % LS -7]]9 ta•� THE TIME OF THIS SURVEY. .,, '••,,, •, SOA •••: •••. '��� �roO�•�iondti�•0 ■aaaaaaaaaa�aala�a��aa�a■ zau3fOH WO fi It i, b+s.+w•.'r w�;trto d.lan+4r LEG17* SET FIND . RAN EY M•AROMAN s r.�•..... ; ts-srr�l. s:rKw+ i. •r ratrkt«r t,fr" v,Mwr ��r @. p �rl�bl� ,, AN �PIw N W ••whd w+bdM.t�w PtaL MOTs x�y kytpµ ypWyprt wlth RE[uAX OF EAGLE RIVER usw ne sru+•vune.. andar .,y roto wdan N taul tai wa a TOZK g '��-setae- eDaaQerme3neaaae Q ttsn•wetlon a M »lvbtt�r•q Mrvwty Ih.a Eva- r-- x -- ••,:..� I "u EY COtYrr.0ft tM1im tsar Ov+ovciw o QVI'"O" � Municipality of Anchorage �• , -� Development Services Department Building Safety Division \ Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 9951M650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-501-25 1. GENERAL INFORMATION HAA # #Ir' CoV? y Expiration Date: I1/2 1/02. Complete legal description Lot 12, Block 2, Sleepy Hollow Subd. , No.2 Location (site address or directions) 18861 Mountain Road Chugiak, Alaska 99567 Current Property owner(s) Leslie Brundige Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone c/o Raney Hardman M RE/MAX 16600 Centerfield Dr.#201 Eagle River, Ak 99577 Day phone Raney Hardman — RE/MAX 16600 Centerfield Dr."#201 Unless otherwise requested, HAA will be held by DSD for pickup. Day phone (907) 694-4200 Eagle River, Ak 99577 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site IE Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System L] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph d by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approve; are required for the transfer of title (except between spouses) for properties served by a single-family or, -s 'e wastevat?r disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with vatic water samples.) Certificates are valid for one year for properties served by Class A or B we!ls or a pubiic water system. The Municipality of Anchorage is net responsible fer errors or omissions in the professional engineer's work. 4. 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 Health Authority 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 Pinard Engineering Address PO Box 871347 Wasilla, Alaska Engineer's Primed Name Paul E. Pinard Phone (907) 357-3647 99687 Date eod >0000 0 / goo „ G"o o00oaao .0006460.0 1" 0. Paul E. PMafd : - "r 5. DSD SIGNATURE ��� °ee• CE -4793 0.6,7, e _ Approved for bedrooms. °•°►tie Disapproved. Conditional approval for bedrooms, with the following stipulations: \'kkkk PL17Y Or q��'/ Additional Comments �J;' • �n • �y0 A • �4V' AND `= am PROG Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: �tc • Original Certificate Date: s/21/U2- (R., Ov02( i Municipality of Anchorage A06 sole • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program •' • "• 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 943-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 12, Block 2, Sleepy Hollow Subd f2parcel ID: 051-501-25 A. WELL DATA 8/A — Public WS Well type _ If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed _ Sanitary seal (YIN)_ Wres pmpefly protected (Y/N) Total depth ft Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level R ft Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./I. Other bacteria oolonies/100 mi. Arsenic: _ mg.A. Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA TankType/Material Septic/Steel Date installed 10/2/82 Tank site 1000 gal. �/ umber of Compartments 2 Cleanouts (Y/N) Y Foundation deanout (YIN) L-- Depression over tank (YIN) N High water alarm (Y/N) N/A Date of pumping 8/7/02 Pumper JR' s Pumping C. ABSORPTION FIELD DATA Date installed 10/2/8 Soil rating (g.p.dAe ortt21bdrm)125 of/bdSyswm type Drainfield (Mod. 5W) Length 52 It Wdth 5 it Gravel below pipe 3.5 ft Total depth 7 ft Eft. absorption area 481 ft Monitoring tube Y Depression over field a Date of adequacy test 7/24/02 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test U in. Water added 500gal. New depth 0 in. Elapsed Time: 75 min. Final fluid depth 0 in. Absorption rate >= 450 g-p.d, Any rejuvenation treatment (past 12 mo.) (YIN & type) Hone Known If yes, give date D. uFTSTATION N/A Date'Installed Size in gallons ManholefAccess (YIN) 'Pump on" level at _ in. 'Pump ofr level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm b circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: NIA Septic tankllift station on lot On adjacent lots Absorption field on'lot On adjacent lots Public sewer main Public sewer manholetcleanout Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property line 651* Absorption field 5' Water main 101+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots IR/A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water Service One 101+ Surface water 1001+ Driveway, parkingNehide storage 101+ Curtain drain NIA Wells on adjacent ktis H A F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard Date 8/14/02 HAA Fee $ Date of Payment Receipt Number (Rev. ??(0t) Waiver Fee $ Date of Payment Receipt Number �y~�'•• ••s* '9J�a fee so /..� .•....•..�. t£. Pinard • d CE -4793 ' f •. .r PINARD ENGINEERING P.O. Box 871347 Wasilta, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 12, Block 2, Sleepy Hollow Subdivision, Unit 92 APPLICANT: Leslie Brundige 16861 Mountain Road Chugiak, Alaska 99567 SEPTIC TANK TYPESIZE: Stee111000 gallons, per MOA Records ABSORPTION SYSTEM: Modred "5" Wide, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAI BR - 450 gallons TEST DATA Time Flow Volume Cumulative Septic Tank Septic 0.0' Rate 0.0' Volume 0.0' Tank pAl (GPM) (GALs) (GALs) Liquid Level' ALevel 3:40 6.7 - - 4.0' - 3:55 6.7 100 100 4.0' 0.0' 4:10 6.7 100 200 4.0' 0.0' 4:25 6.7 100 300 4.0' 0.0' 4:40 6.7 100 400 4.0' 0.0' 4:55 100 500 4.0' 0.0' RECOVERY Date Time ST MT SAS MT 1�1 JOB NUMBER: 02463 DATE OF TEST: 7/24/02 FIELD STAFF: PJ. Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Soil Absorption System Monitor ASAS Monitor ASAS Tube 1' Level Tube 2' Level 0.0' - 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED Comments Start Test -Meter 120360 120460 120560 120660 120760 Stop Test- 120860 CONINIENfS: There was no measurable liquid in the SAS NIT prior to or at any time during the test. However, based on Record Information on the system and our field measurements, It does not appear that the MT extents fully to the bottom of the drainfield. Reviewed by: Paul Pinard Date: 7/28/02 Bent By: RE/MAX OF EAGLE RIVER, INC.; 9078980214; Rug 09 02 11140a Rent A Can Tellot Co Inc MU Pemplai PO Box 773511 Eagle Rivet. AK 99577 (907) 694-6454, — Rswai 2W.CoMon ata.100 Aft Cdbn Rew Abetape. AK WW Oct) a"mi arddr JaeWA bfb f rami - . . Rarw I/l$i LlouWh Rd too AMr, AK WT7 MM A944 OD ample 8aniot Lh w 71K 1 AOAWW Leoalon Canmwda: Hmm is vwrK h On wKM. NO f aq. Pt" b w Ne We **A:1 be NmEM Aug•12.02 1:41PM; Page 2/3 907-684-6432 P.1 Job D"Wom: 10000 P.O. Number. Toms: NK So $ensR mwmift wo Bode CIM aseen. Job Cesanwb: hm off 10 64 of ba*o ►corp W* erw Of 4 1 7aa ►wow t D _ Aiw tech A 2 atm Tm W= No No Dltowrc Service Agroement ow DWK 05-iwp zoos $Orvko Data: OYAJW.= +toD.m Twtww: Don aorutz Jab roe: Aapst: Na0 Odd 46 • . *-7 a:ttmwmisn AcaW $14.00 Cailonm Named: 0 — GaWls Achar Mose LKVM; DDA4 Tonk: D Amp &Ai m: ❑ $shoe WDL ❑ s Bann Oww [3 L_. _ MonTaetdo TOW TetabY TOW telmtemd GttorOem: Swoo $0.00 Adaar Chrpr: Cu.mm« ovsa a w hrm. r.d eonalKr pksK m w btot. Tna u A etNoiNa AORIaMWT. ebntede woTwo or GLMorwr R.mwwftwo Dow AooytlM 7At ti+P`W Dam AdampYd Pow yav tided cwftw ww.. romm am Wn *soli ewd pgmwsm oar r.. pbww. . Tw ToW brand Tsai 30.00 $M•00 i NOTE: NO WELL WAS LOCATED AT THE TIME of THIS SURVEY. A0 v+ .r1. i!. :....................... O MARK E. DANS +� LS -7376 t� .. ....I _."6 ■ ONE eeaaMMEEMM REMmemeu• xn.usow WO]p u r Use ow*,' r .arty to o6tamirm LEGEND: SET FND =...e.--_ �y ._....�..., ..:r. en i, a ratnensnr l" r,M"Wp .n• NO 0 R AN EY H A R D M AN I Which 1e het .Cour iw the . i" wddhiefon sJoL NOTL• y,m• k cKQ yp,yygT with RE[MAX OF EAGLE RIVER 1 undr " ereuTetaner Wn m any data Wean M used tar „A w TA= d -me,aee-Mepeae Naeesease ee seeetrvetlon or W °etarNor9 WWaty thew rpa- —■-- x - .., I wmtY aamurna; LutTM4 1191 4WQW jW 0 otwu"o- 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT 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 —_ZZZI =_S 1. GENERAL INFORMATION (a) Legal De cription (include lot, block, subdivision, section, township, range) _ Location (address or directions) (b) Applicant Name�,�_ Applicant Address U? (c) Applicant is (check one): e_nz`—Q11y_ Telephone: Home 6/ �a Business ing Institution ❑ ; Owner/builder 11; Buyer ❑ ; Olhorfvl (explain); (d) Lending Institution �['r �Wc�— °'r`-s—e Telephone Address (e) Real Estat Address Telephonf (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family X Multi -Family ❑ Other Number of Bedrooms—_ - 3. WATER SUPPLY Individual Well ❑ CommunityA Public[:] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. C 4. SEWAGE DISPOSAL d cOnsite [ Public ❑ Community ❑ Holding Tank ❑ t Note: If community well system, must have written confirmation from the Stale Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,04) Mi 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 any 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. e` - ki %t Name of Firm _ Address Date 6. DHEP APPROVAL Telephone Approved for l! — bedrooms by 61T 7�AA�4 Approved— Disapproved —__ Conditional — Terms of Conditional Approval CAUTION o� °nTS..o •. � e. o. o re =• r, IC�*crt A. .PihaSof l'do, l4i/•C The Muncipality of Anchorage Department of Health and Environmental Protection (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. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or 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 (111II4) 1 1 1 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264.4720 MUNICIPALITY Or ANCHORAGE DEPT. OF HEALTH .& ENVIRONMENTAL PROTECTION API', 26 1985 Legal Description: L�z_�rX � "� ��� A. WELL DATA Well Classification A ---If A, E3, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth — Cased to — Depth of Grouting — Static Water Level — Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ Depression Around Wellhead (Y/N) _ Separation Distances from Well: To Septic/Holding Tank on Lot Gia AOn Adjoining Lots ZOO 0` To Nearest Edge of Absorption Field on Lot l —; On Adjoining Lots —ail �. Yield Sanitary Seal on Casing (Y/N) To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HQWD+" TANK DATA — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date Installed /nZ- - 82-- Size 00 : No. of Compartments StandpipesCY)N) _ — Air -tight Caps ON) Foundation Cleanout (YQ_ Depression over Tank (Y/_v _-- Date Last Pumped �L - 2,2, -9r Pumping/Maintenance Contract on File (Y/N) —_ ; for fVZ^_ Holding Tank High -Water Alarm (Y/N)_ Temporary Holding Tank Permit (Y/N) _ a Separation Distances from Septic/HefdimzyTank: To Water -Supply Well _ 2�� t+ To Building Foundation To Property Line _ iDS To Disposal Field To Water Main/Service Line — 695- L Course _1 Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 0//w—, Type of System Design pk^(Q ru6xx) Date Installed -1 " e,7— Length of Field SZ / Width of Field &D(r Depth of Field 7 .Vz. / Gravel Bed Thickness ¢z q Square Feet of Absorption Area 4310 Standpipes PresentP;1) Depression over Field (Ye Date of Last Adequacy Test Z3 - 86- Results SResults of Last Adequacy Test 57_15/=11. c /y2V Separation Distance from Absorption Field: / To Water -Supply Well 2�u �% To Property Line S To Building Foundation Lot N / To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area •i�7r1107ii- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Existing or Abandoned System on On Adjoining Lots .3V / F � To Cutbank (if present) 4 J s-3 , �- Dimensions Manhole/Access(Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MO land H A guidelines in effect on the date of this inspection. Signed ti ENG11CU11M GRB '196) Date 2 S r:f, SaIUEF?, ALASK4 �9S7T Company MOA No. 1% 604 2 79 If Receipt No. 2:) 4 e°°•• °°•°�S� Date of Payment `� ��` i ] °� r� •~e�z'$bs1 Amount: $ Kober) A. Shofar A°ee No. 1457.E T� e Page 2 of 2 72-026 (11/84) S�SSC� DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: -,/- PWS PWS I .0 .#-2 13 sz —.?- To To Whom it May Concern: DILL SHEFFIELD, GOVERNOR Telephone: (907) Address - 274 -2533 According to records on file in this office the _ Sly c_ r/0Water System is in compliance with the State Drinking Water Regulations v Sincerely, F - APPLI( 'IVT FILLS OUT UPPER HAI ONLY Time Properly Owner /yi I le L'.1_ /._) G." A, Q Time Phone Mailing Address „y Lf �� �� x��J���' ( //�' Zip Code Buyer n q - CA, 9� Date Date Address Date Zip Code Lending Institution /� / /I La / f Jr`) ^✓ f� �? !` i- C.+ �'? /9 ,�: /•' C -z- Address (�� '�% Zip Code )Phone yl?(,-I)-2C>c.J Realty Co. & Agent --- 7 _- i / ' ---/----- O / /� 7:' U -; Phone Address 1 / f4—_ZipCode Inspector Field Notes: Legal Descriptlon ,� J Y j L 7( 2 / C' / 3' It/ e) Street Location Al Q (/ !Ll TA //L/ _ %11 C�/l DEPT. OF FIFALTf l .. Type of Residence ENVIRONMENTAL PROTECTION Single Family AUG g i 19£;3 ❑ Multiple Family No. of Bedrooms__-? RECEIVED (�) APPROVED BEDROOMS ❑ Other OF APPROVAL ( ) DISAPPROVED Water Supply -! ( ) CONDITION APP ❑ Individual '! ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ,[y7 Community rn -��� For wells drilled prior to that dale, give well depth (attach log If available(. ❑ Public Utility BY: Sewer Disposal ,2 Individual - _—-----�—_ —- t- ! Year Individual Installed: — El Public Utility Well To Absorption Area When Connected to Public Utility:.____ Well Log Received ❑ Holding Tank Well to Tank Septic Tank Size NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -v fid) c\ .. ? P u Time Tinnie Time Time n q - CA, 9� Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF FIFALTf l .. ENVIRONMENTAL PROTECTION AUG g i 19£;3 RECEIVED (�) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITION APP pV-AL' DATE 0 BY: Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72 023(31a2)