HomeMy WebLinkAboutSLEEPY HOLLOW #1 BLK 1 LT 2Sleepy Hollow
#1
Block 1
Lot 2
#051-471-13
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number SW020235 PID Number. 051-471-13
Name: TIM MAUS
Wastewater System: ■ New ❑ Upgrade
Address:
20640 CHAPEL DRIVE " CHUGIAK, AK 99567
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 688-2641 4
■ Deep Trench ClShallow Trench 0 Bed 0 Mound 13Other
LEGAL DESCRIPTION
Sol Rauw.
1.2
Total Depth from orfpind grade.
8.0-9.0
GPD/so- FL
rL
Block: Lot: Subdivision:
Depth to pipe bottom from original grade.
Crawl depth beneath piper:
1 2 SLEEPY HOLLOW #1
3.93-4.93 R
4.07 FL
Township: Range: Section:
FW added above original groes:
Grovel length:
— — —
SEE DWG. Fti
50 rL
WELL: ■ New ❑ Upgrade
Gravel NON:
5
Number of lines:
1
Distance between roes:
—
Ft
FL
Claeeeieollon Private, AMC):
Total Depth:
Cooed To:
Total absorption or":
Pipe material:
D 3034/ F-810
PRIVATE
300 r1.
217 R
500 so. FL
Driller
SULLIVAN WATER WELLS
DaU DrIMd:
7 25 02
StaNa Nater Level:
177
Mohr.
OWNER INSTALL
Dote Inclosed:
8/31/2002
rL
Yield:
Pump Set At
casing Height Above Ground:
TANK
2.0 GPY
UNKNOWN FL
2+ R
SEPARATION
DISTANCES
aseptic 13Holding OS.T.E.P. 13 Other
To
Septic
Absorption
Uft
HoldingPuUIIc/Prlvob
Moala`hoem
GREER
capacity In 90110MFrom
1250
Tank
Field
Station
Tank
sewer Un«
Well
100'+
100'+
—
—
25'+
Yam. STEEL
Number of compartments
2
Surface water
100'+
100'+
—
—
—
LIFT STATION
Lot Une
5'+
1o'+
—
—
—
Sze in gallons:
Yanufoctunr
Foundation
5'+
10'+
—
—
—
'Pump on Iewl wL
mp o 9LWgh
water alarm at:
Curtain Drain
No KNOW
Pump Yaks
OecWoal NeWctlans psAormW by.
Remarks:
BENCH MARK
Location and Description:
TOP OF GARAGE SLAB
Assumed Elevation: 100.00
R,
ENGINEER'S SEAL
00600
o O
Inspections performed by: AKWWC, INC. Dates: 1st 8/31/2002
2nd_8/31/2002
4
............ ...... .
D
8/31/2002
3rd
O e Go s
Development S rvices Department Approval
00°�•. c 7953
4
Reviewed and approved by: Date:_��
ADO° Praresg�aoa`��o
(Rev. 12/Dl)
DOOOOo��Q
PARCEL ID NUMBER:
PERMTTNUMBER: AS—BUILT
SW0 - DRAWING
SW020235 051-471-13
\
I NEW
WELL \
NEW 1250 GALLON
' SEPnC TANK
I
too.
WEIC RAD(US
I
1
k4
0qltCb041
OBLI
6. DBL2 �: ':
..�..� Y''•...•�
X. HT1;ALTERNATE S(TE •,' ; ' •�• ��
I�TLfL�I�.l1 f
r-
CO2 ",�' •�
.�.••.
:•
NEW DRAINFlELD
A B .•
1.,
ST1 25.36 15,5
I -3n-6 6 18.87
UB—L1 6.00 19.
DBL2 _Y5__3_9 21.15
C01 19.63 25.37
MTt 17.93 36.51
CO2 53.12 73.57
MT2 51.59 70.88
DATE:
40
1/23/2003
0 0
�4p
DRAWN BY:
ef
J.L.M.
ALASKA WATER R WASTE
Q �,`
SCALE:
CONSULTANTS, INC.
6901 DEBARR ROAD. SUITE 28 • ANCHORAGE. AK 99501. • PHONE (907)337-6179 • FAX (907)339.521.6
- 40�
0""""' .. .. •'•"' """
0 Q
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
TIM HAUS 688-2641
2 OF 3
f e am s:
o0 o
LEGAL DESCRIPnON:
C 79$ e�QO
LOT 2, BLOCK 1; SLEEPY HOLOW SUBDIVISION #1
Oc
TYPE OF WORK:
AS -BUILT OF NEW WELL LOCATION AND SEPTIC SYSTEM
Pio esslo�
�DO000000
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SW020235 051-471-13
TOP OF TANK Al
INLET - 101.17
INVERT OF BUNG
AT INLET - 100.70
FINAL GRADE — 105.16 (AVG.)
S11 ST2
1 1—F TANK AT
OUTLET 101.14
NEW 1250 GALLON
SEPTIC TANK
INVERT OF BUNG AT
OUTLET - 100.43
MA
.r
ALASKA «'ATER & WASTE`NIATER
CONSULTANTS, INC.
6901 DERARR ROAD. SUITE 28 • ANCHORAGE. AK 99104 • PHONE (907)337-0179 • FAX (907)338•32L
PREPARED FOR: PHONE NUMBER:
TIM MAUS 688-2641
LEGAL DESCRIPnON:
LOT 2, BLOCK 1; SLEEPY HOLOW SUBDIVISION #1
TYPE OF WORK:
PROFILE AS -BUILT OF SEPTIC SYSTEM
DATE:
1/23/2003
DRAWN BY:
J.L.M.
SCALE:
1" = 40'
PAGE NUMBER:
3 OF 3
'. yI Or
.
I f e A. rn ss
�Qp�s E 795E
0 f•• ESS10n0\4'�
O0000�
Dr,ftUng log
by
DOC CO. dba '
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2750
OWNER OF LAND:
ADDRESS:
LEGAL DESCRIPTION:-S4G�`r Nacca �1 # 1
DATE: S� r� �+•
PERMIT NUMBER: �? a3 Date of Issue.:)—
TAX
ssuueTAX IDENTIFICATION NUMBER: O v -
Is well located at approved permit location? (yVer U No .
Method of Drilling:r rotary U cable tool
Depth of well: 3 a d
Casing Type �Wall Thickness • s� inches
/r
Diameter % inches, depth P717 feet
Liner Type: �a
Casing Stickup Above Ground: oZ • feet
Static Water Level: feet
Recover Rate: _.02.—qpm
Method of Testing: 414
Well Intake Opening Type: U open end U open hole .
Screened; '"Start—feet Stopped feet
perforations Start feet Stepped _1n feet
Grout Type: J3 r ^�T�'"r ` EF -Volume _d 40 L,$.S'
Depth: from r=7 feet, to 02 O T feet
Well Disinfected Upon Completion?4Yes O No
Method of Disinfection: C I+:[,-,4e,..1C Sy 140el-
Comments:
DEPTH
From TO
I
.7
Driller's Name
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation. ,
4
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW020235
Legal Description: SLEEPY HOLLOW #1 BLK 1 LT 2
Design Engineer: 0041 AK Water & Wastewater Consultan-
Owner Name: Tim Maus
Owner Address: 20640 Chapel Dr.
Chugiak , AK 99567 -
Date Issued: Jul 19, 2002
Expiration Date: Jul 19, 2003
Parcel ID: 051-471-13
Site Address:
Lot Size: 56244 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of.
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
S. The following special provisions.
Received By:
Issued By:
Date: %C 2 P I 0--D
Date: 3 Z� cL
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051 "' L� % 1— Permit Number
Property owner(s) TIM MAUS Day phone 688-2641
Mailing address (1) 20640 CHAPEL DRIVE + CHUGIAK. AK
Mailing address (2) Zip Code 99567
Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 1: SLEEPY HOLLOW SUBDIVISION
Legal description (Section, Township & Range) _H/A
Lot Size .o 0ggt Acres! q.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms 4
Sewer Only ❑ Well Only ❑
Sewer and Well 0 Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Permit Fees: I50f q00 % � 55D
Date of Payment:
Receipt Number: Z
Waiver Fees—
Date of Payment:
Receipt Number.
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
July 18, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed and Well Septic System Design for Lot 2, Block 1; Sleepy Hollow Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private well and septic system. The proposed
well is to be drilled in the area shown on the site plan and design drawings. A test hole was
excavated in the area of the proposed septic system. The proposed septic system will be
designed around the 30 foot radius of this test hole. We are proposing that a 1250 gallon septic
tank and a five foot wide drainfield be installed. Comments regarding the proposed design are
summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/112
should be used. The SM layer at 13 feet should inhibit the migration of effluent and will protect
the aquifer.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 500 R2
f. Total Depth: 9 feet (max.)
g. Effective Depth: 4 feet
h. Width: 5 feet
i. Reduction Factor: 0.50
j. Minimum Length: 50 feet long
k Effective absorption area = 500 ft2
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade.
4. TOPOGRAPHY: The area for the proposed septic system is mostly flat. There is a cutbank
50 feet from the primary site and 35 feet from the alternate site. We request that the alternate site
be granted a 35 feet waiver to this cutbank. Given the porosity of the soils, it is our opinion that
there is no risk with the granting of this waiver. The homeowner is going to install "Gabion"
baskets along this cutbank and if needed, a visqueen barrier could be installed.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
M.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils log, and a 7 page
construction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
TRACT A-1
SLEEPY HOLLOW S/D #1
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
PREPARED FOR
TIM MAUS
AK 99506 - PHONE
PHONE NUMBER:
688-2641
7/17/2002
AWN BY:
AM* J.L.M.
1 100'
;E NUMBER:
1 OF 2
kL DESCRIPTION:
LOT 2, BLOCK 1; SLEEPY HOLLOW SUBDIVISION
- OF WORK.
SITEPLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
LOT 1, BLOCK 2;
SLEEPY HOLLOW S/D #I
LOT 3. BLOCK 2;
SLEEPY HOLLOW S/D #1
SERVED BY PRIVATE
WELL & SEPTIC
NO ENCROACHMENT
CONCERNS
Ga ess:
7
N
q ep
f esslo &
TRACT A;
SUTE TAWN ESTATES
64
LOT 1, BLOC I•
S 0 S/D
PROPOSED
PROPL OSED 4 BEDROOM
H
WELOUSE
PROPOSED SEPTIC SYSTEM
(SEE DESIGN. PAGE 2 OF 2)
T
1:11, 13
LOT 10, BLOCK 1;
SUTE
,,TAWN ESTATES
C
epps.>
(5s
I ALTERNATE SITE
0
APPROX.
I
LocA'nON
I
zi
LOT 3, BLOCK 1:
SLEEPY HOLLOW S/D
</
61 011-1-D
of
LOT 4, BLOCK 1;
SLEEPY HOLLOW S/D
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
PREPARED FOR
TIM MAUS
AK 99506 - PHONE
PHONE NUMBER:
688-2641
7/17/2002
AWN BY:
AM* J.L.M.
1 100'
;E NUMBER:
1 OF 2
kL DESCRIPTION:
LOT 2, BLOCK 1; SLEEPY HOLLOW SUBDIVISION
- OF WORK.
SITEPLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
LOT 1, BLOCK 2;
SLEEPY HOLLOW S/D #I
LOT 3. BLOCK 2;
SLEEPY HOLLOW S/D #1
SERVED BY PRIVATE
WELL & SEPTIC
NO ENCROACHMENT
CONCERNS
Ga ess:
7
N
q ep
f esslo &
a,
\\ PROPOSED 1250 GALLON
SEPTIC TANK
1
f
7/17/2002
PROPOSED DRAINFIELD. EXCAVATE A TRENCH
IPps�
I
HAT ItS 9 FEET DEEP BY 5 A
ice•
DRAWN BY:
WIDE BY SO FEET LONG.M
ADD4 FEET OF
W
RADIUS
.••
CLEAN, WASHED SEWER DRAINROCK.
—
— 40�
I
......... .....
...........
6901 DESARR ROAD. SUITE 2B • ANCHORAGE. AK 99506 • PHONE (907)337-6179 • FAX (907)338-321.6
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
TIM MAUS 688-2641
2 OF 2
y�oS�
A. G rness.
7 e4.
' �.,, , ','
400 Pro
040pp000'a
THERE IS A CUTBANK
:.;
�'C
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
"••'' •• ON THE UPHILL SIDE
OF THIS DRNEWAY.
1 T•. y. •.•.. r. .' ••
•
•• r•, • • w i
•.••''1• .•�.�'
� , /
;, S'r'i' .l :.•••'•
• .'.
RUBLEUTS
ALTERNATE SITE •.
f
7/17/2002
0�
opp
-OF
v"
:7510
DRAWN BY:
-._.._._.---------------- ..__..._... -... ....
WATER & WASTEWATER
ALASKASCALE:
J.L.M.
.••
—
— 40�
••-- CONSULTANTS, INC."
......... .....
...........
6901 DESARR ROAD. SUITE 2B • ANCHORAGE. AK 99506 • PHONE (907)337-6179 • FAX (907)338-321.6
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
TIM MAUS 688-2641
2 OF 2
QQ .J f y
0
�f
A. G rness.
7 e4.
LEGAL DESCRIPTION:
LOT 2, BLOCK 1; SLEEPY HOLOW SUBDIVISION
400 Pro
040pp000'a
ess�°�°a�O
TYPE OF WORK:
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
\•
... .o pp
4p
AIL A.SKA WATER R WASTEWATER
�.— ---•— -- CONSULTANTS, INC. O*� �..
8901 , U IB • oo -Af • FAX (907)3_13-n46 Idnnc.wm
SOIL LOG - PERCOLATION TESTJ ..........
LEGAL DESCRIPTION: LOT 2, BLOCK 1: SLEEPY HOLLOW SUBOMSION f G rn ss'
Q �' 7953 epO
PERFORMED FOR: TIM MAUS DATE: 7/2/2002 Q04 J A���ler"
OQr•d rofessio�0\
DEPTH et)1po
ORGANICS TEST HOLE 1 �p0000000�
SII CLASSIFICATIONS ,
PROPOSED
2 b,, .p;: GW = - ORG i PROPOSED \ 4 HOSEM
3 ?'.•`.•:+•C GP ML WELL \
GM CL I\ PROPOSED
GC 7Trl7 OL I SYSTEM
o 0 "o 0
,poo o ° o SW MH I .."y •, ;. o e
>000` SM i OH
SC_ ",L 'tel`• :' :';inn '�.;
6— r:oo8;i
7— :°; 000 W/ POCKETS DEPTH TO DATE14
-:o ,o o OF SP/SM GROUNDWATER TH/t ���
�•
DRY
DRY 7/11/2002 i t.:...
' ,r+
o° o°
g SITE PLAN
1"=100' ALTERNATE STIE
10>b°o
4::000
11 'o-°0
,o -,'bo o
4;:poo
e; boo°
12 , ""Poo ;
:r:oo o
13 0. °°
14
SM
15
161
17
18
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 6.5 FT. AND 7.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ONO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: CALEB GALL
COMMENTS: THE SM LENSE SHOULD ACT AS A SAND FILTER
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS AS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 'T 0 Z
DATE
READING CLOCK NET TIME WATER LEVEL
TIME (MINUTES) READING
NET DROP
(INCHES)
W P��
�SOR6
Np\�
PERG
1���I2o
OZ
Municipality of Anchorage• ,
• '� Development Services Department -`
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road h
P.O. Box 196650 Anchorage, AK 99519-6650 e Y�
www.ci.anchorage.ak.us J »
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-471-13 COSA#_ S(I !2130-"
1. GENERAL INFORMATION Expiration Date: Z 0 -A,'7
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SLEEPY HOLLOW S/D #1; BLOCK 1 LOT 2
19162 MOUNTAIN ROAD * CHUGIAK AK 99567
TIM AND ANNA MAUS Day phone 907-688-2641
20640 CHAPEL DRIVE * CHUGIAK AK 99567
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
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 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 samples. (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, 1 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. 1 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
- - DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
Fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG. LTD. can therefore not provide
any warranty of future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
thesole benefit of the ownerlisted above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
�� Approved for _�t_ bedrooms.
Disapproved.
Phone 337-6179
Date
Qoo
T ....
QQ.P ey A. Garn ess
pp CE -7953 m�
��d Pro f es sio�°dd
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
V
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
/>p
(Rev. 11105)
ON-SITE
WATER AND
WASTEWATER
Original Certificate Date: 7- Z) 7 ~ 12,
Municipality of Anchorage
• '� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SLEEPY HOLLOW S/D #1; BLOCK 1; LOT 2 ParcellD: 051-471-13
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 7/25/02 Sanitary seal (Y/N) YES
Total depth 300 ft. Cased to 217 ft.
FROM WELL LOG
Date of test 7/25/2002
Static water level 177 ft.
Well production 2.0 g.p.m.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/15/2012
176 ft.
5.2
WATER SAMPLE RESULTS:
Coliform d colonies/100 ml. Nitrate3 3 - mg./L. Collected by: GEG, Ltd.
Arsenic: /U10 ug./L. Date of sample: 7/15/2012 't�18 11 y
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 8/31/2002
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 9/19/2011 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 8/31/2002 Soil rating 4H/ft50r ft2/bdrm) 1_2 System type 5—WIDE
Length 50 ft. Width 5 ft. Gravel below pipe 4.07 ft.
Total depth *8.8-9 ft. Eff. absorption area 500+ ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 7/15/2012 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test o in. Water added 675 gal. New depth E in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g,p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YM
"Pump on" level at in. "Pump off" level _ . High water alarm level
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout N/A
Holding tank
Manure/animal excrete storage areas 100•+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION o Ur H�
1 certify that I have determined through field inspections and * : 4 T y
review of Municipal records that the above systems are in ........... • • "" "".... • •
conformance with MOA COSH guidelines in effect on this
date. .J rey . arness:
Engineers Printed Name JEFFREY A. GARNESS ao s ` CE— 53
�0� o44
Date 0
4%,ZP'o f essioP��o
COSA Fee S `t Qo
Date of Payment
Receipt Number f
(Rev. 11/05)
Waiver Fee $
Date of
Receipt Number
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Municipality of Anchorage
• Development Services Department ; X'.
Building Safety Division
On -Site Water & 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
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-471-13 HAA#_j�(r TJ 3CC5'C-
1. GENERAL INFORMATION Expiration Date: ("-6107
Complete legal description LOT 2, BLOCK 1; SLEEPY HOLLOW SUBDIVISION #1
Location (site address or directions) MOUNTAIN ROAD * CHUGIAK, AK
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TIM MAUS
Day phone 688-2641
20640 CHAPEL DRIVE * CHUGIAK, AK 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
IN
Individual Holding tank
❑
Community On-site
❑
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 samples. (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 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 riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
bedrooms. ,tt(t(ttffff�r�
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date 0 3
Engineer's Comments:
• •
. • • . •!��+����
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
,`������?�`
��5'J•• �• '4� =
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported described the the
ol QF
" ' K•
results performance of
system under the conditions encountered the time the fest,
0v" ��! %` •S�0
0
at of and separation
distances measured to readily identifiable features. The operational life wells
/
of all and
septic systems depend on the local soils condition, groundwater levels that may
........ .. .. .. ........:....I
fluctuate during the year, and the water usage of the family being served by the system.
„•.
These conditions are outside the control of the evaluator of the system. Satisfactory test
O,a • • • • `�2 \��
results do not guarantee future performance of the system, nor do they guarantee that
!? ff a A. Come s: G
there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provideQO
o 79 3 o p
any warranty or future estimate of how long the system will continue to meet the
V Manitenance Agreements
operational requirements of the ADEC or MOA DSD. The content of this report is for
4�� Pro
the sole benefit of the owner listed above. An reliance upon or use of this report b an
Y P P Y Y
f essto°o 0
On�..��c�ao
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Ll
Approved for
bedrooms. ,tt(t(ttffff�r�
Y OF4
Disapproved.
• •
. • • . •!��+����
,`������?�`
��5'J•• �• '4� =
Conditional approval for
bedrooms, with the fllowing stipulatlersg.:
ON-SITE
• WATER AND "
I• m
iC v VA I`' h
PROGRA,;;i c
„•.
O,a • • • • `�2 \��
Attachments:
HAA Checklist
V Manitenance Agreements
Septic System Advisory
Supplemental Engineer's Reort
Well Flow Advisory
Other
By: APJA Original Certificate Date: Ado?
U(Rev. 17/01) \
Municipality of Anchorage
Development Services Department
Building Safety Division
O"Je Water& Wastewater Program
4700 South Sragaw St
P.O: Sox T966.50Anchorage, AK 9951"650
www.d.snchorage.akus
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legalpescriptiom LOT 2. BLOCK, SLEEPY HOLLOW SUBDIVISION #1 Parcel ID: 051-471-13
A. WELL DATA
Well type PRIMAIE PRIMif A.'B, or C'provtde PWSID# N/A
Date completed 7/25/02 Sanitary seal,(Y/N) YES
Total depth _Z0.0% Cased to217 fL
FROM WELL LOG
Date of test 7/25/2002
Static water level 177 ft.
wen production 2.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100,m]. Nitrate 1.65 mgJL.
Well Log (YM) YES
Wires properly protected (YIN) YES
Casing height (above ground) 24+ in.
AT INSPECTION
Other bacteria 1 colonies/100 ml.
Arsenic: N/A mglL. Date of sample: 1/22/03 Collected by: AKWWC, INC.
B. SEPTICIHOLDiNG TANK DATA
Tank Type/Material STEEL Date installed 8/31/2002
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping NEW. Pumper —
C. ABSORPTION FIELD DATA
Date instaned a/s1/2002 Son rating; .p:d rftW4rm) 1.2 System type 5—WIDE
Length 50 ft. Wltith 5 ft Gravel below pipe 4.07 ft.
Total depth '8•4�iL Eff. absorption ariea 500 ft' Monftoring tube YES Depression over field NO
Date of adequacy test NEWr, Results (Pass/Fall) — For 4bedrooms
Fluid depth In absorption fleld:before1est in. Water added � gal. New depth =in.
Elapsed Time: l min. Final flulddepth ! in. Absorption rate >= — g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 6 type) — If yes, give date —
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
1002+
Absorption field on lot
1000+
Public sewer main
N/A
Sewer /septic service line
25'+
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 1000+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank _ N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 109+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION 'Je�, P f --!9
I certify that I have determined through field inspections and C9:-*
review of Municipal records that the above systems are in . • • .. • • " ' • ' . "" ' •' • • • •
conformance with MOA HAA guidelines in effect on this date.
f QY A. amess..
Engineer's Printed Nara JEFFREY A GARNESS FE -7953 e�
4h
e„e .......• ��4
Date 7 4�O��p�ofessloo��
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
n
BASIS 177.80' (R)
_ N 00°00'55"E 177.66' (M) _
10' UTILITY EASEMENT
------------------------- ------------------------------
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10'DR41NAGE EASEME-
N 8'04'NT
50"E 84.9f' (R)
4
I
G gUROSYiNG
8221 DEL STREET
s' ANCHORAGE, ALASKA 99502
PHONE 243-4890
2/3/03 AS BUILT 57-72
7/8/02 PLOT PLAN 55-51
DATE FLD. BK.
'o -0000
0
•0
- 4
NOTES: Easements not appearing on record subdivision
plat ore not shown unless description of easement is
provided by'client. It is the responsibility of the owner
or builder, prior to construction, to verify proposed
building grade relative to finish grade and utilities
connections, and to determine the existence of any
easements, covenants, or restrictions which do not
appear on the recorded subdivision plat.
Elevations based on assumed datum unless otherwise
indicated, and bearings and distances are record data.
CLIENT:
TIM MADS
LEGAL DESCRIPTION
LOT 2, BLOCK I,
SLEEPY HOLLOW SUBDIVISION
PLAT NO. SCALE GRID
73-84 1"=40 NW 1160