HomeMy WebLinkAboutHYLEN CREST #3 BLK 6 LT 4Hylen Crest
#3
Block 6
Lot 4
#050-474-30
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241084
Work Type: SepticTank Upgrade
Tax Code Number: 05047430000
Site Legal Address: HYLEN CREST #3 BLK 6 LT 4 G:0057
Site Mailing Address: 10315 STEWART DR, Eagle River
Owner: TYMITZ PETER A &
Design Engineer: VEI CONSULTANTS
This permit is for the construction of:
Effective Date
Expiration Date
cnt
C ,
Depa]-tuiell t
Lot Size in Sq Ft:
Total Bedrooms:
5/13/2024
5/13/2025
20764
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• Prior to installing the tank, locate the edge of the bed to ensure that the 5' separation will be met.
• The effluent pipe may not cross the property line. Reroute during construction or get an ingress/egress
easement recorded.
:i
Ree Bq: ,J C1!51 (A et^ 4, V 2�_r Date:
Issued By: Date: �73 �2 G�
3
1��/IEIUNn PAU d Y OF ANCHORAGE
-O \
Il
Development Services Department '` r ,' Phone- 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-474-30-000
Property owner(s) Peter Tymitz & Richenda Sandlin-Tymitz
Mailing address 10315 Stewart Drive, Eagle River, AK 99577
Site address Same
Day phone 505-359-1884 5o5-3Sg.-r881
Legal description (Sub'd., Block & Lot) Lot 4, Block 6, Hylen Crest #3
Legal description (Township, Range & Section) Section 8, T14N, R1 W, SM
Lot Size 20,764 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑
Initial ❑
Single Family (SF) El
Septic Tank El
Upgrade El(w/wo
ADU)
Holding Tank El
Renewal❑
(D) ElRenewal
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information
correct. I further certify that
this is in accordance with
applicable Municipal Codes. ,
(Signature
roperty ownerpyuthorized agent)
Permit/Rush Fees: #-,72!;-
Date
#- 25Date of Payment: S c 202 Y
Receipt Number:
1 1
Permit No. C SP2. y 1Q 8 �j
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241084, Deb Wockenfuss, 05/13/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241084, Deb Wockenfuss, 05/13/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241084, Deb Wockenfuss, 05/13/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241084, Deb Wockenfuss, 05/13/24
72-013 (Rev. 3/781 /
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION.1 CT HEALTH &
•--.:[:LATAE P3;iiECTIvN
�
II ENVIRONMENTAL
ENGINEERING
DIVISION
% 825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
_
IS84
`
ONSITE SEWAGE DISPOSAL
SYSTEM AND/OR
WELL INSPECTION
REPORT"
NAME
Pf} NP_ 1
`
r•fyty,t EW
PGRADE
MAILINGADDRESS.,-,O,
JIB
'
6AK�6
LEGAL DESCRIPT O
.D
LOCATION 0
NO. OF BEDROOMS
Q 1��
DISTANC 0:
Welt
Absorption area r
Dwelling
PERMIT NO
D Y
�
r
z-
17—
O .5
PZ
Manufacturer I �
Material
No. of Compartments
Wa
Nf
Liq.c758in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
6Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
DZ
2? Fa-
Manufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well(,
Foundation r
Nearest lot fine /
PERMIT NO.
W =
�
o
j W Z
No. of lines
Length of each line
Total length of lines
Trench itl hr
Distance between lines
FZW
ntcfms
H
Top of tile to finish grade
Material beneath tile/
Total effective ebsorptWn area
O
(D inches
Y !/
Length
Width
Depth
PERMIT NO.
W
U
n H
Wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areals)
OTHER
PIPE MATERIA S
TA
SOIL TEST RA`,
�G
Sd
O
INSTALLER
�
,C7
fi
REMARKS
1
¢ '
-
k w ouc
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e-
1)�,Afuk SUN.11111W
On
t,
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f
APP OV D/` - ,, arc 1. ow-:.��
DATE LEGAL
72-013 (Rev. 3/781 /
CORWIN & ASSOCIA .5, INC.
Consulting Engineers
4321 Grape Place Suite 204
ANCHORAGE, ALASKA 99504
JOB len pe� l�li)7 f Pll Y IQl
SHEET NO.II Op
CALCULATED BY L •O. DATE
CHECKED BY DATE
�A11 hxn5�4. G,,.a„�DU�
n �
CORWIN & ASSOCIATES, INC,
CONSULTING ENGINEERS
1549 E. TUDOR RD., SUITE 204 ANCHORAGE, ALASKA 99507
(907) 561-6151
September 13, 1984
Mr. Keith Bandt
Department of Health & Environmental
Protection
825 L Street
Anchorage, Alaska 99501
Re: Hylen Crest Subdivision Lot 4, Block b
Dear Mr. Bandt:
Due to the unfavorable topographic and geologic conditions, as we
have discussed, such as extreme slopes, bedrock, etc., it was
necessary to install the drain bed five (5) feet from the lot
line as shown in the as -built. This was the best alternative for
us considering that this area is free of bedrock. The
neighboring lot is undeveloped and there is a community water
system.
We feel that there is no threat to public health or water quality
and request that, under the circumstances, a five feet waiver
from the lot line be granted.
Thank you.
CORWIN & ASSOCIATES, INC.
�u'c �Qor
Laura Ogar (J
Environmental Engineer
LO:kjh
Enclosure
�lkc�e� 9/ts/8Y .fit %
MUM I C I F='nL. I TY MF- ictPA MFiAC3F=
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �O�m
825 L STREET, ANCHORAGE, AY 99501 k
264-4720 G,
C3"—E3 I TE E3E=WEFR FaEFZM I T
PERMIT NO: 840665
DATE ISSUED: 08/06/84
APPLICANT: STEVEN L. SK,AGGS CONSTRUCTION
ADDRESS: PO BOX 670690
CHUGIAK, AK 99567
CONTACT PHONE: 688-2831
LEGAL DESCRIP: SUBDIVISION: HYLEN CREST #3 LOT: 4 BLOCK: 6
SECTION: 8 TOWNSHIP: 14N RANGE: 1W
LOT SIZE: 20764 (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.
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** 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.
Z. 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. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA 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 - J�n, , 11„ 1----c1/„ t,/-�--------- DATE:
✓J��56� 1-t1I--1F=' ----�-
APPLICANT:
ISSUED BY
DATE:-eld-r-----
13EI7
W _ DRA I FV
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
GRAVEL DEPTH (FT.)
0.5
1.5
TOTAL DEPTH (FT.)
4.5
5.5
GRAVEL WIDTH (FT.)
22.0
5.0
GRAVEL LENGTH (FT.)
42.0
97.0 +�*
GRAVEL VOLUME (CU.YDS.)'zmrl
TANK SIZE (GALS)
10000.0 **
1,000.0
SOIL RATING (SQ.FT./BR)
201
206
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** 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.
Z. 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. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA 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 - J�n, , 11„ 1----c1/„ t,/-�--------- DATE:
✓J��56� 1-t1I--1F=' ----�-
APPLICANT:
ISSUED BY
DATE:-eld-r-----
PERFORMED FOR
i f
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
LEGAL
DESCRIPTION:_
YQ 1
(.�
Af%Er- I,
f -TI,-
1
Net
10
ssa.
2
it
tpkm
Drop
12-
21314
4vsva
3-
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13-
4
4-
14-
5-
56
15
15-
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.60
7
END
END
a
b
X n
1. m - gravel Mix
• 08
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Sandy y 60me St
9
bz
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATEfl
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
1-11 , I.,
SLOPE
wS~ o�SIOG
PC PERCOLATION
TEST
DATE PERFORMED:Ion
1
81114
Reading
t
Gross
Net
Depth to
Net
10
Time
it
Water
Drop
12-
21314
4vsva
lz:
.L>n
13-
.OBo
14-
.10
15
15-
16
16-
.60
END
END
I
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bz
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19
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20
5
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PERFORMED BY:
72-008 (6/79)
WAS GROUND WATEfl
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
1-11 , I.,
SLOPE
wS~ o�SIOG
PC PERCOLATION
TEST
DATE PERFORMED:Ion
1
81114
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
+�
4vsva
lz:
.L>n
.OBo
.10
.60
I
-
sz
• 08
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Hit
I 1
bz
I �
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5
•Ob
PERCOLATION RATE ( 'S / (minutes/i'ngch)
TEST RUN BETWEEN FT AND�7F/T
Al OA I / ,-A r -t l .
CERTIFIED BY: DATE:
2—g ql eco-vY &q
T
CORWIN & ASSOCIATES, INC.
CONSULTING ENGINEERS
1549 E. TUDOR RD., SUITE 204 ANCHORAGE, ALASKA 99507
(907) 5616151
October 1, 1984
Mr. Keith Bandt
Department of Health & Environmental
Protection
825 L Street
Anchorage, Alaska 99501
Re: Hylen Crest Subdivision Lot 41 Block 6
Dear Mr. Bandt:
This is in response to your need for additional information on
the design and construction of the on-site sub -surface wastewater
disposal system on Lot 4, Block 6, Hylen Crest Subdivision.
The lot has slopes varying from moderate to severe. The initial
soils test on the lot was performed on May 1, 1984. Ground water
was encountered at 9.5 feet. A copy of this test is on record at
your office. A permit was issued on this soils test.
Construction of the house began in mid July. While excavating
for the house foundation, shallow bedrock was encountered. I was
called to the property to direct where to locate the second soils
test site since the house was then located over the initial test
area. In late July, I conferred with you and Robbie Robinson for
advice on how to deal with the situation. Robbie told me that if
the slope was cut into and the accepting strata was used, a bed
could be installed.
Since the area above the house was at a slope greater than 258
and fill had been brought in to extend the level for the
foundation, I felt that the area next to the house was best to
use. This area has an approximate 20% slope.
The second soils test was performed on August 6, 1984. No ground
water was encountered. The percolation test result was 185
square feet per bedroom. Once excavation began on the bed, which
ran against the slope, bedrock was encountered in the northwest
corner of the proposed use area. To be able to install the bed
in the accepting strata, remain at least 6 feet away from the
bedrock and 10 feet away from the house, the design configuration
was changed to run with the slope and 5 feet away from the lot
line.
�' I IYVIPY
Mr. Keith Bandt
Page Two
October 1, 1984
The neighboring property, Lot 5, contains 20,764 square feet with
half the lot sloping at 258 or greater. Lets assume that only
10,000 square feet of property is acceptable for any type of
development. Assume a 4 bedroom house of 2000 square feet with a
garage and driveway of 1000 square feet is constructed, thus
leaving 7000 square feet of area available for initial
installation and replacement of an on-site wastewater disposal
system, minus the 250 square feet taken by the installation of
the wastewater disposal system on Lot 4, which is 5 feet from the
lot line.
In retrospect, I do not feel that placing Lot 4's drainbed where
it is inhibits Lot 5's development capabilities, nor does it
threaten public health or water quality, and therefore request
that the variance be approved.
Sincerely,
CORWIN & ASSOCIATES, INC.
o�°t vo r
Laura Ogar
Environmental Engineer
LO:kjh j,� <4 ,//j
Municipality of Anchorage
On -Site Water &Wastewater Program
(907) 343-7904
Certificate of On.—Site Systems
(iso LfI4 30 000 Approval %
Parcel I.D.—e'F55e265 Expiration Date:
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
HYLEN CREST #3; BLOCK 6, LOT 4
10315 Stewart Drive *Eagle River 99577
Jacob & Jordan Thomson Day phone 654-3662
Heidi Clement Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community ClassWell
❑
Community On-site
❑
Public Water System
Public Sewer
❑
waiverNadarm request
Distance:
Received by:/ v(�i/' v vJ v Date:
OOSA to be releasetl b Ne engineer, unless othoWee requested by to engineer.
COSA Fee $ 521LO' 00
Waiver Fee $
Date of Payment ) i /n1 1i0
Date of Payment
120
6
Receipt Number Q �9- o 60
Receipt Number
COSA# 5,SUOKbj
Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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 GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK, 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducdrg Ws evaluation, GEGpoHtletl en ergirreervg evaluaficn of the well endrarseplic system in accordance with the
guidelines and regulations eslabeaded by Ne MuniapaldyofMohpage andinduslrypradlces. The mpodedrsinds deindbe Ne
mnditlon efthe syslen✓s m the daters ofthe evaluetvn. Separedm distances waremeasured to madthyldethfideki lealums.
Hidden defects wenaoachments may and that were not idanlilieddunrg the evaludion.Ths otandenallAe ofeal "lls endways
systems depend an a vanalyolvadables including, but notlimded to, sed mpNons, groundestarkrels (Nat may fluctuate during
the year), quablyofwuhucb'm (materials and wwknanship), mdthe crater usage tithe lamelyuelrring the systeMs. These
conditions can vary, and are otdslde the mnbol cfGEG. Sadsladay fad mi uds do not guarantee futurepedormenco ofthte
sysiseve fishable, GEG makes no warranty (express wimplied) regarding the futureperlwmarrca bible well wseplic syslam.
GEG makes no sk resenbdm whether an ademstim well ursepdcayslem can be insfatladm the paperty in the evantadherofthe
current systems fell. The content ofthis mood is for the sole bamftofthepersWpwtywhomtained GEG. Reliance upon the
inlermdken chovided in this report by am otherp rdin ape* including but not limited to subsaguerd propertypurchasers, is riot
authorized. In shad, GEGe amm any legaldulyto anyoneother than the persWparywho paid for this report
6. DSD SIGNATURE
System #1 Approved for � bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
337-6179
Date I( I
I µ /r4,
bedrooms, with the following
Original Certificate Date:
( OFA/ttt' "f
V110 yyri
o ° �`�
R o -
PROGRA
The Municipality orAnchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for among or omissions in the professional engineers work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. ranvtz)
>C._ Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: HYLEN CREST S/D #3; BLOCK 6, LOT
A. WELL DATA
Well type
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Parcel ID: 050-474-30
PUBLIC WATER
If A, B, or C provide PWSID#
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Coliform _-� colonies/100 ml
ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate mg./L.
Well Log (Y/N)
Wires properly protected (Y/N
Casing height (ab round) in.
AT I CTION
ft.
9.p -m.
Collected by:
Date of sample:
32 YEAR OLD STEEL SEPTIC TANK IS
APPROACHING THE END OF ITS USEFUL LIFE
Tank Type/Material SEPTIC/STEEL Date installed
9/6/84
Tank size 1000 gal. Number of Compartments E 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 � - Pumper On ?- s
C. ABSORPTION.FIELD DATA BELOW EXISTING GRADE AT MONITORING TUBE
Date installed _ 9/6184 Soil rating (g.p.d./Wo '/bd 185 System type BED
Length 37 ft. Width 23 ft. Gravel below pipe 0.5 ft.
Total depth -7.4 ft. Eff. absorption area 851 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10/28/16 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 595 gal. New depth"4 in.
I
Elapsed Time:12oi�_33omin. Final fluid depth3/1_25 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN 'If yes, give date
"INITIAL 105 GALLONS INTRODUCED CAUSED A RISE OF 2 INCHES. THE NEXT 315 GALLONS CAUSED
AN ADDITIONAL RISE OF 2 INCHES. THE NEXT 175 GALLONS INTRODUCED CAUSED NO RISE IN LIQUID
LEVEL. MT EXTENDS 6 INCHES BELOW CLEANOUTS AT END OF BED.
'"'APPROXIMATLY 3.25" BELOW INVERT OF CLEANOUTS AT END OF BED.
I9)ZRf 2C -i If31L•L`I
Date installed - Size in gallons Manhole/Access (Y/N
"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 tank/lift station on lot
Absorption field on
Public sewer main
Sewer /septic service
PUBLIC WATER
On adjacent lots
On adjacent lots
Publ sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ ' : Absorption field 5'+ (ASSUMED)
Water main
10'+
Water service line 10'+ Surface water 1001+
Wells on adjacent lots 2004
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '0' Building foundation "101+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ (ASSUMED)
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
`WR080021 "PER 1984 INSPECTION REPORT NOTE: DRAINFIELD IS IMMEDIATELY ADJACENT TO A 50% SLOPE
AND IT IS UNKNOWN THE EXACT DISTANCE THE EDGE OF THE BED IS IN RELATION TO THE TOP OF THIS SLOPE. IT MAY EVEN
AS CLOSE AT V AWAY. IT IS REASONABLE TO BELIEVE THAT THIS CONDITION HAS EXISTED SINCE THE SYSTEM WAS INSTALLED
NO DAYLIGHTING OBSERVED. THE ORIGINAL INSTALLATION INSPECTION WAS PERFORMED BY49WROGUOMR LAURA OGAR.
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date IIIIL{/fto
(Rev. 11105) -
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Braaaw Street
P.O. Box 196650 `
Anchorage, AK 99519-6650
www.muni.org/onsite �?
(907)343-7904 %
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-474-30 COSA# D!JC 1012-77
1. GENERAL INFORMATION Expiration Date:
Complete legal description HYLEN CREST S/D #3; BLOCK 6, LOT 4
Location (site address) 10315 STEWART DRIVE * EAGLE RIVER, AK * 99577
Current Property owner(s) SCOTT & SHARON HAYES Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
10315 STEWART DRIVE * EAGLE RIVER, AK * 99577
Day phone
SUE BURNSTIN W/ DYNAMIC PROPERTIES Day phone 830-8387
3111 C STREET * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
0
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 a fixed hereto and as of the vaii ation datE shown behow, l'
d , l verr�y, 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. ! 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. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. 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 or 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
the sole benefit of the owner listed 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 bedrooms.
Disapproved.
� II
q`ffri(y A`Q�ss.:
�ff CE -79P3
r
prof essio��o�'
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Kt''IL ate r%U I iY VTnef
(Rev. 11105)
ON-SITE
y VtIATER AND
WASTEWATER
PROGRAM
Original Certificate Date: % `? " j
Municipality of Anchorage
• Development Services Departmentr--
V«. g
Building Safety Division ` «
On -Site Water & Wastewater Program R E T Y
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: HYLEN CREST #3; BLOCK 6, LOT 4 Parcel ID: (9> �i -!Z ZY� 3 Q
A. WELL DATA 1PUBLIC WATER
Well type If A, B, or C provide PWS1D# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height (ab round) in.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE
AT
ft.
Coliform colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 ml.
enic: ug./L. Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 9/6/1984
Tank size 1000 gala 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 7/30/2010 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA *BELOW ExiSTINGGRADE
Date installed 9/6/1984 Soil rating (g.p.ddft2o 2/bdr 185 System type BED
Length 37 ft. Width 23 ft. Gravel below pipe 0.5 ft.
Total depth *6.9 ft. Eff. absorption area 851 ftZ Monitoring tube YES Depression over field NO
Date of adequacy test 10/1/2010 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: - min. Final fluid depth 0 in. Absorption rate >= 450+ 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 (Y/N
"Pump on" level at in. "Pump ofP' level Hig;"w"
water alarm level at in.
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
On adjacent
On adjacent lots
Holding tank
PUBLIC WATER
manhole/cleanout
AAittat containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *0' Building foundation ** 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*PER EXISTING WAIVER #WR080021. **PER 1984 INSPECTION REPORT.
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date / o /1, //o
�...... .... ........
... .. ...
O y A. am ss
p049� CE -795
440��p7of esslOt
COSA Fee Waiver Fee $
Date of Payment % Date of Payment
Receipt Number ��� 7 g� Receipt Number
(Rev. 11/05)
c
S 89°5.645°E 89.5❑'
TAR T DRIVE
a
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
STRUCTURES OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATED)
NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
oA,P-c-.-'-- -•'-.-9s4p�1
49TH
............................,�.�y/.�
c SHANE A. HOLT.'
0oa LS -69 1 4 4v 1G
pF� °•, ,•° OJ�G
4 �R gyp?
d7
��0000�o
AS -BUILT SURVEY ( NO CORNERS SET THIS DATE)
V. = 30'
I HEREBY CERTIFY THAT] HAVE PERFORMED A
MORTGAGEE'S INSPECTICN OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 4, BLOCK 6, HYLEN CREST NO. 3
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE, ALASKA THIS _22 ND_
DAY OF _APRIL 2008 .
HOLT LAND SURVEYING 10733, FB 131-68
TEL. 3465513
Municipality of Anchorage
Development Services Department .
Building Safety Division „
On -Site Water 8 Wastewater Program
4700 BStreet
P.O. Baxox 19 196650650
f
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 ,�D - if 7 N- 3 o COSA# 0 Q 0
1. GENERAL INFORMATION Expiration Date: S -6--- C q
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
HYLEN CREST #3 BLOCK 6, LOT 4
10315 STEWART DRIVE "EAGLE RIVER. AK
PATRICIA OLMSTEAD Day phone 694-3238
10315 STEWART DRIVE 'EAGLE RNER, AK
Day phone
KATHI OLMSTEAD W/REMAX Day phone 244-8020
16600 CENTERFIELD DRIVE *EAGLE RIVER, AK 99577
Unless otherwise requested, COSA 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
0
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 axed 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 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 GARNESS ENGINEERING GROUP, Ltd. I Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date L 25 0B
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 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 or 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
the sole benefit of the owner listed 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 -7 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
L/
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
11
= ON-SITE
WATER AND
WASTEWATER
PROGRAM
o•
10111110
S
By: ` Original Certificate Date:
(R. II M)
Municipality of Anchorage
—�l Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: HYLEN CREST $3 BLOCK 6, LOT 4 Parcel ID: D 8_30
A. WELL DATA
PUBLIC WATER
Well type If A, B, or C provide PWSID# N/A
Date completed Sanitary seal (Y/N
Cased to ft.
FROM WELL LOG
Date of test ��Ft
Static water level
Well production Q� g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
B. SEPTIC/HOLDING TANK DATA
Well Log
NiT properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
Nitrate mg./L. Other
sample: Collected by:
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gat. Number of Compartments 2
Date installed 9/6/1984
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 10/27/07 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA BE ow EXISTING GRADE TO BOTTOM OF MT
Date installed 9/6/1984 Soil rating (g.p.d./ft'o /bd 185 System type BED
Length 37 ft. Width 23 ft. Gravel below pipe 0.5 ft.
Total depth +7.41 ft. Eff. absorption area 851 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 4/16/2008 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY In. Water added 500 gal. New depth 2 in.
Elapsed Time: 640 min. Final fluid depth DRY in. Absorption rate >= 450+ 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 (Y/N
"Pump on" level at in. "Pump off" level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
PUBLIC WATER
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line •0' Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '0' Building foundation "10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
'SEE ATTACHED WAIVER LETTER "PER 1984 INSPECTION REPORT
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 COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. CARNESS
Date Lt I ZS/O t?.
COSA Fee S 4-� '�6 • Cx.7
Date of Payment
Receipt Number. rJ�
(Rev. 11105)
Waiver Fee sU 1 % 5 . uo
Date of Payment 3 0 /J
Receipt Number
Municipality of Anchorage
Development Services Department
• re Building Safety Division
On -Site Watcr and Wastewater Program
4700 Elmore Street
P.O. Boz 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Revicw Worksheet
WR#: 08002 PID#:050-474-30 HAM 080122 Permit#:
Date Received: 4130/08
Legal Description: Helen Crest #3 Block 6 Lot 4
Engineer: Jeff Garness Garness Engineering Group, Ltd..
3701 E. Tudor Rd.. Suite 101 Anchorage Ak. 99507
Applicant: Patrica Olmstead
Waiver Requested: Zero feet separation distance absorption field to property line.
Criteria:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
was ...... ............................. ..seen.... .... ..................nesse....
Waiver is Granted:
List Conditions or Reasons for above:
Waiver is not Granted:
Date: By:
Name of Reviewer
...................................................... sessenn..e..... 0.ee06e000
Rec#: 4130108 Amount: $175.00 Date Paid: 4130/08
Municipality of Anchorage
1:21. 14ix UNWiNI-Anchoragc,.\Inskn V951I4WO. 471X1 Einmrr ltwiJ
I lllin•: (W7043.8MI • Fax: 1!MIi1:03-KCMM1 hllp://a mw.numLor4
31uyor dark Jkyich Development Services Dep.irtnient
5/5/2008
Jeff Gamess
Gamess Engineering Group, Ltd.
3701 E. Tudor Rd., Suite 101 Anchorage Ak. 99507
Subject: Waiver Request for Hylen Crest #3 Block 6 Lot 4
Waiver Request #WR080021
Parcel ID #050474-30
IIAA# 080122
Dear Engineer,
r,cnt
Ucpit runent
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. The approved separation distance
is 0.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Jeffrey W. Poet
Engineering Technician
On -Site Water & Wastewater Program
Community, Security, Prosperity
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 8 GENERAL CONTRACTORS
April 25, 2008
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Lot Line Waiver for Ilylen Crest #3 14 B6,
To whom it may concern:
We request that your department issue a 0 -foot lot line waiver from the west property line to the
existing drainfield. There is no septic system within 10 feet of the lot line on the adjacent lot. In
short there are no concerns in granting this waiver. We are unaware of any adverse impacts this
waiver would have on adjacent wells or septic systems. If you have any questions, please
contact us at 34A6179. Thank you for your assistance.
M.S.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259
Ph: (907) 337-6179 0 Fax: (907) 338-3246 • Website: www.gamcssengincering.com
#00�,
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIROtZMNTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE I /
1. General Information Application Date
(a) Legal Description (include lot, blocl, subdivision, section, township, range)
n (address or directions)
(b) Applicants
Applicants Addres
ne -
(c) Applicant is (check one) Lending Institution ; Ener/builder ;
Buyer ; Other M (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. b Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family Q
Multi -Family M
Number of Bedrooms 3
3. Water Supply
Individual Well Coumunity
Other (describe)
Public =
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and stAtus.
4. Sewage Disposal
Onsite Public Community Holding Tank
jlote: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 21
5. Engineering Firm Providing Inspections, Testa, File Search Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of
Firm
4"t�_ Y (656o
k6 ----.---'Telephone 57'44'k5l
Address
�-
ZQ •� j
Date 10
MY
'.
------------
(ENGINEER SEAL)
6. DHEP Approval
Approved
for
bedroomsBy
_, Date
Approved
�/
Disapproved
/` Condition a `
Terms of
Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO%ZiENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEN"L-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RRS/ej/D18
[Page 2 of 21 . 7-19-84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal
Well Classification If A(; B
Well Log Present (Y/N) Date CCITT!
Total Depth - Cased to
Static Water Level
Casing Height Above Ground
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH & .
ENVIRONIVIZNTAL PROTECTION
SEP1�'184
RECEIVED
Pump Set At
Depth of Grouting
Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wbllhead (Y/N)
Separation Distances from Wbll:
To Septic/Holding Tank on Lot 4',?001 On Adjoining Lots t200�
To Nearest Edge of Absorption Field on Lot +2001 ; On Adjoining Lots +ZOO
To Nearest Public Sewer Line N�R To Nearest Public Sewer
Cleancut/Manhole To Nearest Sewer Service Line on Lot d1A
Water Sample Collected By — Date
Water Sample Test Results
Camlents
B. SEPTIC/HOLDING TANK DATA
Date installed 10A0 p4. R1 *Size 0 No. of Compartments 7 -
Standpipes (Y/N) Air -tight Caps (Y Foundation Cleanout (Y/N) res —
Depression over Ta c (Y/N) Alm Date Last Punpe a /a
Pumpirg/Maintenanee Contract on File (Y/N) — for
Holding Tank High -Water Alarm (Y/N) — Temporary Holding Tank Permit (Y/N) -
Separation Distances from Septic/Holding Tank:
To Water -Supply Well +ZC)C)' To Building Foundation / 2
To Property Line 201 To Disposal Field /p
To Water Main/Service Lire 40, To Stream, Pond, lake, or Major Drainage
Course r/00
Comments
�-/Lr-yy
9Of, .-Y-Z
(Page 1 of 21
2-15-89
C. ABSORPTION FIELD DATA f
Soils Rating in Absorption Strata Type of System Design hod
Date Installed Length of Field 37 '
Width of Field ' Depth of Field Y
Gravel Bed Thickness (o lr('IE_S
Square Feet of Absorption Area t7 s� Standpipes Present (YM) S.
Depression over Field (YA 6 Late of Last Adequacy Test
Results of Last Adequacy Test _
Separation Distance from Absorption Field:
To Water -Supply Fie11 'f' ?00' To Property Line
To Building Foundation W To Existing or Abandoned System on
Lot 4 I_: On Adjoining Lots _ d16:
To Water Main/Service Line AIL)' To Cutbank(if present) NA
To Stream/Pond/Lake/cr Major Drainage Course +/00
To Driveway, Parking Area, or Vehicle Storage Area
Ccmmnts
D. LIFT STATION IA
Date nsta
Size in
"^ —_ ()n"
High Water
Tested for
Electrical
1 at
Level at
Manhole/ s (Y/N)
"Puny Off" Le 1 at
Vent /N)
Cycles curing Ade4uicy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this irspecticn.
Signed .ti�p Date 10 1�eI `"+'
Conpany 4 MOA No.
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