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HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 13Hylen Crest Block 3 Lot 13 #050-474-09 i. MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ":,ENVIRONMENTAL ENGINEERING DIVISION en L tuw - Ancho, Aloka 9960I Talsoone2"4720 :ON-SITE SEWAGj DISPOSAL SYSTEM AND/OR WELL INSPECTION NAME REPORT (,9"8 NEW "LING ADDRESS Vo A A t,%i s-74. - -MON. LtGAL DESCRI L 13' 8 5 81 -I-H-w S AA NO. OF BEDROOMS Abo�� 11in PERMIT t manvial No. of c tments �:� A I o"r I : t 5UQUIG compm,Wvyinsawo I �. 4.IF Hommiuva: I m �!DlSiAhCk Doolling PERMIT NO. Met GqWd �cpwity In colom Icrt 11m P R w 0. No.* J17 . I.- _o;ltlp 01 Itnes, v� apo , , (48 It row 1�=12. mhob=r yf. Ler" , 1 PERMIT NO�-�,, qLi depth'; - s I : &" � TO5..Tdlftvftd&, Num" lot how i Drfuw Dktowe to Iolthrom PERMIT N Boutift ftwloffuon , . 7 [��'DigiiNCE�TO, I-' teptie t.rk PEMATERIALST�. AS RL -T [A I 44 ID] AL' A I EMAR A K4 7 .......... 7 I A -.Avp,-V. Lax Jr �mw AL -7-7 7� DATE • LEGAL I . Municipa ity of Anchorage n POt,. H 6-650 ANCHORAGE. ALASKA 99502-0650 (907) 264-4111- TONY 64-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit A: 840626 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 13 Block 3 Hylen Crest Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 MUM I C I PAL I TY OF ANCHO�AGiZ ` C DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK. 99501 264-4720 ON—S I TE SEWER FP'ERM I T PERMIT NO: 840626 DATE ISSUED: 07/26/84 APPLICANT: CMEMENTS CONST. ADDRESS: P.O. BOX 1974 EAGLE RIVER, AK 99577 CONTACT PHONE: 694-4858 LEGAL DESCRIP: SUBDIVISION: HYLEN CREST LOT: 13 BLOCK: 3 SECTION: 8 TOWNSHIP: 14N RANGE: 1W LOT'SIZE: .5A (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to you in designing your septic system. Choose the option that - - - - - - - - - - - - - - best fits - - - - - - - your site. - - - - - - - - --- - - - - I TRENCH 1:3EID - - - --- W _ I3fz014 I N DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 4.0 0.5 3.5 TOTAL DEPTH (FT.) 8.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 21.0 5.0 GRAVEL LENGTH (FT.) 69.0 .40.0 60.0 GRAVEL VOLUME (CU.YDS.) 28.7 31.1 44.4 TANK. SIZE (GALS) 1;000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 183 183 183 +�* TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as.set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4• Snyndntg�@@fAe&�a&itMiFeROEFLitaAsaM@It4oARl deFAItmum of 3 bedrooms and IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MDA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED //%L� ---- DATE: r APPLICANT: C S CONST. ISSUED BY DATE: ALASKA ENVIRON ENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 ,OB-6-3-L13.�^4YLEN CA65T SUB, SHEET NO. OF �p/ CALCULATED BY J TK DATE -101-22 o n_ CHECKED BY DATE "', 2A-* 1 wl Mx.9 t6w1 llv1 n � n O SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Streat, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: +'ssO,,+' Cern.'.+ DATE PERFORMED: 7—Z'Z—S (- LEGAL DESCRIPTION: LI$ g3 Ie').N C4. -ST 5Uy SE -110- S $ n4 -N RIUJ SM ' DEPTH r)—SLOPE SITE PLAN 1 1 C�2y 2 3 VOL 4 J p5 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Z-12- vc,,•y dems�.� A( NO. M2 -E ,lune 22,1968 WASGROUND WATER A' D ENCOUNTERED? 1" IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Net Drop Vny Water f� fOlr's., ,t 13 It Ir. 3 n zo,.,, 4 n ` 3or• rr I Or. ok IT IaI I t l440 n• )C> . 'ez I7 �i l � I O s'ti'r, PERCO ATION RATE 13 ti`s" In (minutes/inch) TEST RUN BETWEEN + FT AND `!E FT _ PERFORMED: a , —CERTIFIED BY: 72008 (6179) G140 --s tkot> c Municipality of Anchorage . -• Development Services Department Building Safety Division On -Site Water and Wastewater Program , A' , r, 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' 1 Parcel I.D. oro - vyry -09 HAA# CLA t)ygb Expiration Date: 1. GENERAL INFORMATION Complete legal description _kyr 4I&A - 'r/ Ay, Location (site, address or directions) , �Ixnf .rsJR.J Cfi r- `/,' .r Current Property owner(s) T.i og Day phone 6,2.2— _ri so Mailing address .T2,1At edk AR,4-1" Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone .t6I- PL.Do 2. NUMBER OF BEDROOMS: _.57 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 Eff 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 iequired 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. 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 verity 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 fs.,,� c P✓se E,� SY Phone Address fihy= i lirc/ Qe Ste, r ��/ Engineers Printed Dateg/21 /V.y S. DSD SIGNATURE Approved for _:5 bedrooms. Disapproved. �..o. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By Original Certificate Date: (Rw.Otg2) 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) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -/ 4'�J Qtr 3 .cam /3 Parcel ID: go --rep - 4e;r 5/ -Ofa A. WELL DATA Well type a4a"'- Date completed _ Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform mg./I. If A. B, or C provide PWSID # Sanitary seal (Y/N) Cased to ft. FROM WELL LOG g.p.m. ml. Nitrate mg./l. B. SEPTIC/HOLDING TANK DATA Tank Type/Material aTgCgzi Well Log (Y/N) Wires properly pn Casing (ab INSPECTION ground) in. ft. g.p.m. Other bacteria colonies/100 ml. Date of sample: _ Collected by: Date installed i/S //x#" Tank size /eDo gal. Number of Compartments Cleanouts(j!�YN) V.,&.v Foundation cleanou�f I) _yam Depression over tank (lfl$ a High water alarm (Yj* .4 4# Date of pumping ;•/tr! /as/ Pumper TE 1.n C. ABSORPTION FIELD DATA Date installedi!d//a+rr Soil rating (g.p.d.lflz r Ibd )1"� System type r� Length 7/ ft. Width .f. -5- ft. Gravel below pipe Si ft. Total depth P.. ft. Eff. absorption area SG fi ftr Monitoring tube _)6ft Depression over field ov-00 Date of adequacy test T'/y�e� Results(ffibFail) P^sFor .3 bedrooms Fluid depth in absorption field before test L& in. Water added #VVgal. New depth to in. Elapsed Time: Are Final fluid depth!/.fn. Absorption rate >= -6er-0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) If yes, give date 1.1� D. LIFT STATION Date installed "Pump on" level at _ in. Datum / Size in gallons j -revel at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic line Holding Hank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation G ' Property line V,0' Absorption field 9 ' Water main did' Water service line t rro' Surface water r .0o Wells on adjacent lots r ?es ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 4 f Building foundation -OR' Water main Water Service line die Surface water —,P /904:P ' Driveway, parking/vehicle storage �G Curtain drain d' *rV Wells on adjacent lots "' MtiaV Aft^Av "w 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 ��r.�%>»�rE r' .P d� /L✓n Date 61 fZ f/0 t f HAA Fee $ 1>4 • Qa Waiver Fee $ _ Date of Payment y4 a c( Date of Payment Receipt Number g�JS}� Receipt Number (Rev. 11101) UE] in. w Jan 08 01 12:03p n Butler 6 Butler,Inc. 9072761584 %1 Joo•oi'oo•e 248.3a'(4jZ) z `X•/RJ 00 Ravrsr•I �EbT . 7' P- ! i N � p cr v ,p, u� j�d'• ' U1m w $ Q T- < nto o-, 6 N R , ti r. P.2 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES V !� Division of Environmental Services',_ Onsite "Services Section P.O. Box 196650 Anchorage, Alaska 99519.6650 (907)343.4744 (. ' CERTIFICATE OF HEALTH AUTHORITY.. APPROVAL FOR A SINGLE FAMILLY DWELLING Property owner DERRIF JULSAN Day phone " (907j �5 =om _ Mailing address _s/o RLAKE OR CAROL Rln"LER' w% ' REMAX PROPERTIES Lending agency Day phone Mailing address Agent RLAKE OR CAROL RUTI_ER w/ REMAX PROP, Dayphone 257=0161/244-2485 Address 2600 CORDOVA STREET ANCHORAGE, AK 99503 Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE:." If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA 921 Computer Version Note: A/aska'Waterand Wastewater Consultants, Inc. shall be paid $1,260 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspe tion, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal nd State codes, ordinances, and regulations in effect on the date of this inspection. Name of Finn Address Phone (907) 337-6179 Engineer's Signature" � —� Date U/. -57/`t)/ In conducting this evaluation, AWWC, Inc e e ted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and M A HRS 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 deoend on the local soils condition, ground water levels that may fluctuate during the year, and the usage of the family being served by the system. These conditions are outside the control c 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 of encroachments. AMVC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report Is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorizod, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE _1Z Approved for --bedrooms Disapproved Conditional approval for Additional Comments By: bedrooms, with the following stipulations: Datel -I$-d/ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back 610A 621 Computer Version I; i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 602 Anchorage. Alaska 99501 (907) 3434744 Health Authority Approval Checklist Legal Description: HYLEN CREST S/D N1; LOT 13, BLOCK 3. Parcel I.D.: 0 r0 - q 7 Ll — O 9 A. WELL DATA Well Type CLASS "A" If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Date completed FROM WELL LOG height (above ground) Wires property pied (Y/N) AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria S. SEPTICIHOLDING TANK DATA Data installed 7/31/1984 Tank size 1000 Number of Compartments 2 Clearwuts (Y/N) YES Foundation cleanout (Y/N) YES Depression (YM) NO High water alarm (Y/N) N/A Date of Pumping 1/15/2001 Pumper JR's PUMPING C. ABSORPTION MELD DATA •1/9/2001 — PRESOAKED DRAINFIELD WITH 1044 GALLONS Data installed 7/31/1984 _SoI1radng(g.pAJfl2oI19lbE0 185 System type TRENCH Length 71' Width 2.5' Gravel thickness below pipe 4' Total depth 9.5'+/— Effective absorption area 568 SQ.FT. Monitoring Tube present (Y/N) YES_ Depression over field (Y/N) NO Date of adequacy test *1/10/2001 Results (Pass/Fam PASSED For 3 Bedrooms Fluid depth In absorption told before test pn.r 0" Immediately after 1483 gal. water added (In.): 25.5" Fluid depth 13.5" (Ins) Minutes later. 218 Absorption rate : 450+ Perordde treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date — rtole RW.3y CWWA r VWWM D. LIFT STATION Date Installed Size In Manhole/Access (Y/N) 'Pump on• High water alarm level at' E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Sepddholding tank on lot Public sewer main 'Pump ott' level at' COMMUNITY WATER adjacent lots Public sewer manhole/deanout line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property Una 5'+ Absorption field 5'+ Water maintservice line 10'+ Surface wateHdrainege 100'+ Wells on adjacentlots 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: *SEE ATTACHED LETTER Property Una 'S'+ Building foundation 10'+ Water maln/servlce Una 10'+ Surface water 100'+ Driveway, parld"hlde storage area 50'+ Curtain drain NOTE KNOWN Wells on adjacent lots 200'+ F. ENGINEER'S CERTIFICJ I car* that I h e of Municipal with MOA gut e Signature Engineers Name rmf t/S Ol HAA Fee I 'WO . o D Inspections and review ems are In conformance Is date. Date of Payment /2— Z&-6/ Receipt Number -C) I `,l'A U K� i-1 AXW n-a2s Mwseer cwwLoer vusim Waterer Fee I 1 IIS •0 0 Date of Payment /— /& -0/ Receipt Number on, 13 Q�— W•. Y�Yr P h=8a `b$o / lVti� V k' G o a8 n �Mt..,: d�R \000 •a'f�_ if 17 Y• ry ,�j of Jot V 4 � ti • . A H tq ��V �.'V ��±•�' y �* � ;off', � 0 �p' 3 1 G8 ♦! ♦ NV , V _JZ i • O M N�\ 1 , • •�• Zwa M � w � r (W?b) 5£'IZ/ J (?f�N)�O E'$CZ B.Oo,/O.00fY _ • R b©ST9LZL06 ��i`��iz�9 9 ��i��6 dco:ET TO ©0 UQC ALASKA WATER & WASTEWATER CONSULTANTS, INC. January 15, 2001 Municipality of Anchorage Public Works On -Site Water & Wastewater P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Lot 13, Block 3, Ilylen Crest Subdivision #1 To whom it may concern: We request that your department issue a 5 foot lot line waiver from the northeast property line to the existing drainfield. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for P.E., M.S. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com MUNICIPALITY OF ANCHORAGE Department of Health & Human Services OnSke Services Waiver Review Worksheet WR#:10 0004 PID#: 05047409 HAM 010019 Permit#: Date Received: 011601 Legal Description: LOT 13 BLK. 3 HYLEN CREST SUBDIVISION #1 Engineer. ALASKA WATER & WASTEWATER 6901 De BARR ROAD SUITE 26 ANCHORAGE, ALASKA 995196650 Applicant: DEBBIE JULSAN .......... Waiver Requested: 5 FOOT SEPARATION LOT LINE TO ABSORPTION FIELD Criteria: 1. Geology Points: A. Water Table B. Sal Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other. Waiver is Granted: List Conditions or Reasons for above: Date: 1.19-0 1 Reo#: 0138 Amount: $115.0 Total: Waiver is not Granted: By:— .......... a Date Paid: 1-16-01 DZunieipality of Anchorage George 1. 117aerch,Mayor Department or Public Works Btti1di11(i Sllfety Dit-isiorl P.O. Box 1tXW)7)0 • 4700 S. Dragaw Street Anchorage, Alaska 99519.66.50 • (907) 343-&301 I, itp://nim.ct.anchnrtgc.nkms AK Water & Wastewater Consultants, Inc. ATTN: Jeffrey Gamess, PE 6901 De Barr Road, Suite 2B Anchorage, AK 99504 - January 18, 2001 Subject: Waiver Request forHYLEN CREST #1 BLK 3 LT 13 Waiver # WR010004 Lot Line Request for Parcel ID 050-474-09 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerel �eoe P ef Engineering Technician III On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C)4 -)C)- tll)-1-1[21 1. GENERAL INFORMATION HAA # VA Qq 7-1-11 AS Complete legal description Lot 13; Btock 3; Ifyten C L at SubdEvl6ion 141 Location (site address or directions) 10128 Ravencneat Property owner Debby Jutaen Day phone 694-3042- Mailing 94-3042Mailing address 10128 Ravencnea.t Eabte RiveA, AK 99577 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 y XXX Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M(Aw.1191) Fro l MOA621 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverity 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 S 3 s No. 204 Address Engineer's signature 6. DHHS SIGNATURE �� -.2L_ Approved for � ,,&(,3 bedrooms. Disapproved. Conditional approval for Additional Comments M Phone Date; —> 9— 9 3 bedrooms, with the following stipulations: Date • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. •.n Mew nl Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST rd Legal Description:�1 `—� r \� 6` K ^ALf-a Parcel I.D. C 4-�sT SD A. WELL DATA Well type _L -1i k If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM Septic/holding tank on lot Absorption field on lot Public sewer main Wires properly protected (Y/N) AT INS�P"ON ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service lirPetroleum tank WATER SAMPLE RESULTS: Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Collected by: yr ^F Ov" 14 5 AGE ,\Try;,ER'.K. +DIVISION ::A° 19 1993 g.p.m. Q�CEIVED Other bacteria Date installed '— R4 Tank size \ 0 0 0 Compartments Z Cleanouts&N)—Foundation cleanout &N)—Depression(Y& High water alarm (Y& 4.#7 Alarm tested (Y/N) Date of pumping q — '\Z ' Pumper P�} �ar lf� SOLS �C.ES SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK11 TO: Well (s)onlot Zv` %lo- On adjacent lots r�\% Foundation ZSt't" a� Water main/service line \o�} Topropertyline Absorption field Surface water/drainage \ von 72.026 (Rev. 7191) Fa+t CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical on lot _ Manufacturer Manhole/Access I "Pump on" level at E FROM LIFT STATION TO: O. ABSORPTION FIELD DATA On adjacent lots 'Pump off" level at Cycles tested ' r Surface water i Date Installed -1- 3� o 4 Soil rating I'2n�3 t'�c � $F— System type 7�k Length .-1 1 ` Width Z •s Gravel thickness q k r Total depth C61 Total absorption area Sl o� Cleanouts present�,/Y' N) Depression over field (YCW Date of adequacy test Results ss fail) for bedrooms Peroxide treatment (past 12 months) (Y ) 16A &- at' a,,5, If yes, give date to SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Ze>o��- O4kt. nadjacentlots Propertyline To building foundation To existing or abandoned system on lot6- Onadjacent lots 30 � 4- Cutbank 4 X Water main/service line ti Surface water \ t --)g> L Driveway, parking/vehicle storage area Curtain drain A> - E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect p *71Mb sbs inspection. S & S ENGINEERING �! cF" , p• f ••`S 17034 Eagle River Loop Rud No. 404 y . k Signature EeglrRiver, Me+ke 94677 ;' f• '.. M�M6 Engineer's NameA •..c •^ ti snda r f t Date 3- l 9-93 rw• t�'"E f `Q41 HAA Fee $ / 2� 00 Date of Payment %25 -19 - Receipt "/ -Receipt Number 72-026 tRM.}Ntt Suk MOA 21 Waiver Fee: $ Date of Payment Receipt Number n n 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, R R 1_ ) '2� PVL F_& CREST SUB Application Date range) ORD -1k40 Location (address or directions) 10128 RAUEN CREsr_ cls ,/ (b) Applicant Name DEBRA ei ULSFcN Telephone: Home OV -304L Business Applicant Address PC 60K 7731gp EAGLE 131dE8 o 04 995'77 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer; Other ❑ (explain); (d)' .Lending Institution, Telephone e l�. Address (e) Real Estate Company and Agent Address '4 Telephone (f) Mail the HAA to the following address: t� 3 2. TYPE OF RESIDENCE Single -Family)( Multi-Famk.R Other Number of Bedrooms 3. WATER SUPPLY �� Individual Well CommuniCK) 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 OnsiteA 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. Page 1 of 2 72-025 (11,84) 5." ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION / A As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval showsthat theon-site watersupply and/or wastewater disposal system issafe, 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 ne—irs w� Telephone .Sr,1—.470(10 — i — — Addre Date' DHEP AIrCvS Approveded for for 1ir14T:L.2�P1— bedrooms by � � t—� � ate Approved � Disapproved Conditional Terms of Conditio al Approval CAUTION DY G REID, 0 - CE -2251 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 engineers work. Page 2 of 2 72-M 01/Be) MUNICIPALITY OF ANCHO;: C;! DEPT. OF HEALTH 6 ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) OCT 2 9 QM HEALTH AUTHORITY APPROVAL (NAA) CHECKLIST - FEBRUARY 199 RECEIVED 284-4720 Legal Description: ES3 L13 HVIEN CREST T1c11V R lW SEC, A. WELL DATA Well Classification 60MMUMIT51 If A, B, C, D.E.C. Approved (Y/N) # Z 13.2 go% Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ Separation Distances from Well: To Septic/Holding Tank on Lot — To Nearest Edge of Absorption Field To Nearest Public Sewer Line Cleanout/Manhole — Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Yield _ Depth o1 Grouting Pump Set At Sanitary Seal on Casing (Y Depression Around Ihead (Y/N) n Adjoining Lots On Adjoining Lots o Nearest Public Sewer To Nearest Sewer Service Line on Lot — ; Date Date Installed Size 11004 No. of Compartments 2 Standpipes ION) Air -tight Caps ®N) Foundation Cleanout Iy1V) Depression over Tank (Y/© Date Last Pumped YM Pumping/Maintenance Contract on File (Y/N) 4ZA : for �V/A Holding Tank High -Water Alarm (Y/N) —A(IA_ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 2M,-/, To Building Foundation to To Property Line 7 IT -/- To Disposal Field 8 i To Water Main/Service Line 4/0 + To Stream, Pond, Lake, or Major Drainage Course /DO V— Comments Pagel of 2 72-026111/841 183 3 = ,S � °-L' r__3r � --433 1-13pH yLEW CKFS7' C. ABSORPTION FIELD DATA /1Z Soils Rating in Absorption Strata Type of System Design Date Installed '71�.� � � Length of Field � Width of Field r � Depth of Field Gravel Bed Thickness Square Feet of Absorption Area S6 e Standpipes Present I�N) Depression over Field (Y.� Date of Last Adequacy Test Results of Last Adequacy Test N�A Separation Distance from Absorption Field: To Water -Supply Well 21:10 / f To Property line To Building Foundation 20 To Existing or Abandoned System on Lot N/l� ; On Adjoining Lots SD � To Water Main/Service Line y� � To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ADD -, -,I- To To Driveway, Parking Area, or Vehicle Storage Area SEJ �f Comments D. LIFT STATION Date Installed Dimensions �• Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" L High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request •• Icertify that lhare cced.v rifled, rconformedtoallM A and HAA guidelines in effect on the date of this inspection. Signed Date /6 04 E 6 Company �C.5 PVC, MOA No. - 9 6 Receipt No. .2 LV O/ O D D S Date of Payment lO�Z9 a'� �.���►R\\ Amount: $& O7� s�Q'�`%ftfill OJfi At % -04 Pae 2 or z g :......• .......... #2 IlorrcE a caMk,Era� • LM C. REIDA -zssi . s�3 SITE PLAsr! 1� 72-026411,841 eIlk�okssinn� 6 Receipt No. .2 LV O/ O D D S Date of Payment lO�Z9 a'� �.���►R\\ Amount: $& O7� s�Q'�`%ftfill OJfi At % -04 Pae 2 or z g :......• .......... #2 IlorrcE a caMk,Era� • LM C. REIDA -zssi . s�3 SITE PLAsr! 1� 72-026411,841 eIlk�okssinn� ALASKA UIROfl nTAL COnTROL SCI US, IX Engineering & Enuironmentol Studies Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 Attn: Steve Morris Re: Lot 13, Block 3, Hylen Crest Subdivision Dear Steve, The subject lot was occupied for approximately 6 months by the builder. The bank has since repossesed the property. As per our phone conversation, October 23, 1986, the septic tank was pumped on October 27, 1986. Due to the small amount of time the property was occupied we agreed that an adequacy test Is unneccessary. The notice of completion is enclosed. If there are any questions, please feel free to contact me at 561-5040. Jeff Kaitchuck VPW94V6 Engineering Technician 1200 West 33rd Avenue. Suitt 6 • Anchorage. Alos6 99503 • (9071561-5040 n or RUN n SILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (90)1 Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: October 21, 1986 PWS 1.1).# 213289 To Whom it May Concern: According to records on file in this office the HYLEN CREST Water Regulations Water System is in compliance with the State Drinking Sincerely, flichael P. Lewis Environmental Engineer $Uu n �P. .PAGE 0 5 4 1 OWNERS Ene,91 NOTICE OF COMPLETIONh Q NOTICE IS HEREBY GIVEN, pursuant to A.S. 34,35.070 (d) that Clements Construction Co. Inc. of P. 0. Box 771891, Eagle River, Ak• is the 1 name address DO owner of the following described real property: owner, lessee or other Lot Thirteen (13), Block Three (3), HYLEN CREST SUBDIVISION That on the _� day of, �U, , 19 85 work was completed on the Construction of construction, improvement or particular improvement the building (or particular building) located thereon by Fred F. Clements name the original contractor. Signed: ��•,�— owne'r,"lessee or other agent Clements Construction, Co. Inc. STATE OF ALASKA By Fred F. Clements ) ss: THIRD JUDICIAL DISTRICT) Clements Construction Co. Inc. being first duly sworn, owner, lessee or other or agent upon oath, deposes and says: I have read the foregoing Notice of Completion, know the contents thereof, all and singular, and the statements contained therein are true as I verily believe. - Signed:_ X� � (owner, ltssee or other or agent Clements Construction Co. Inc. SUBSCRIBED and SWORN to before me this /y>1 day of --, 194. Note: To be recorded by owner within ten (10) days after completion of work. a. host a copy on the property b. send a copy to the point of hire w r, ,Cz�.,,o c1✓ tary Publ for Alaska My commissi n expires: � &I 0 ,• .fir .......; s 3iF�L 01, fus; L:Irrst,.te rank ^;I'Litill 73:2 0