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HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 8 MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street-Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer -- I Well I Absorption area DISTANCE TO: ,"2 ~.,~ I .4-- I Manufacturer ~ [Lq capacty :ga ons~ ~ ~ OO ~ IF HOMEMADE: Inside length Well bwelling NO, OFBEDROOMS Liquid depth PERMIT NO. DISTANCE TO: We,~2t~ I~ Length of each Jine No. of lines I ~ r~ Top of tile to finish grade Type of crib Crib diameter DISTANCE TO: Foundation Total le~t~ ~f lines Material beneath tile Depth Dwelling ,, W dt ~,__~ ,. Material Nearest lot line Trench w ¢1~.~1¢:~ inches (., r~.. inches PERMIT NO. No. of compartr~ts Liquid capacity in gallons DISTANCE TO: Well Building foundation P E R[~,~ T NO. Distance bet~e/~ nes Total effective ab~o/'p,t~ are.a- PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller ~" Sewer Distance to lot line PERMIT NO. Absorption area(s) Septic tank OTHER PIPE MATERIALS S(~IL TEST RATING REMARKS APPROVED ~r-013 (R~v. 3/78) i~]~, 69~2979 DATE LEGAL. / / I:::'i:::'i .. I C r"~ N T :~ Z) ii])I:;: El !ii~!ii~ :: f3 N']' {11(3 3" j:::' I" I(]~1 !",1 liil ~i E:X3~':il. Z!')IiiilSEX::~ I F::' x PERFORMED FOR: Municipality gl Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: I~-"~ - I --.C~:~5; LEGAL DESCRIPTION: L- ~ 1~'~ r/.~.~ lC.. 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: 'T'~,..J¢,,~.~ ~ ¢_.~k4~ SLOPE 'E PLAN / ~bl A/WAS GROUND WATER (. Z.~.~' ;/~¢.-/"~=.3'.~ ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Deplh to Waler Alter Monitoring? Dale: Reading Date Gross Net Depth to Net Time Time Water Drop W q'.~5 ~ L~ ,, b,l~~ PERCOLATION RATE '~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN .ETWEEN % FTAND I ~ .T COMMENTS , . /' ~/ PERFORMED BY: ,:, ,'~l¢!~ ~-'~I~,~:.[;'~,6,[A~J(¢,. "~)57~ ( / /~///~ CERTIFY TRAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STAT~ ANDMuNIOIPAL GUIDELIW I~EFFEOT ON THIS DATE. DATE: / 72-008 (Rev, 4/85) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 [] PERCOLATION TEST DATE PERFORMED: ~ ¢Vk~-~ ~'~,~ SLI~PE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop ,/ PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND FT CERTIFIED -/ DATE: O Municipality of Anchorage _= , On -Site \Nater and Wastewater Program < (907) 343-7904 5 T Y Certificate of On -Site Systems Approval Parcel I.D. 050-474-04 'I. GENERAL INFORMATION: Expiration Date: J_( - 2 0 Z e— Complete legal description HYLEN CREST #1: BLOCK 3, LOT 8 Location (site address) 10135 LOON CIRCLE EAGLE RIVER AK 99577 Current Property owner(s) FORECLOSURE Mailing address Day phone Real Estate Agent TIM KELLY Day phone 632-6205 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOPJIS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual F-1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System © Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer. unless otherwise requested by the engineer. COSA Fee $ q f2 „ �o Waiver Fee S Date of Payment7� Date of Payment Receipt Number 05.3 Receipt Number COSA # C.S-C 2012 q6 Waiver 5. STA T ENIE–EN T OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: to I ? C,//-1 o In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year). quality of construction (materials and workmanship). and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s: therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE 0 esS; 211co #AECC884 System #1 Approved for 3— bedrooms ``�l�lll V I System #2 Approved for Disapproved Conditional approval for bedrooms `\`�\G\Q�,L1T OF,q,�,���/// OWSITE � � _ bedrooms, with the followir p I MATTER AND M ` STE WATER z .-: 1 J 9V -Original Certificate Date: % ��� The Municipality of Anchorage Development 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 errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA. blue Sheet -10-10-12 ooc COSA Checklist Legal Description: HYLEN CREST S/D #1; BLOCK 3, LOT 8 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. ELL DATA ❑ Well log d with Onsite (or attached) Date drilled Total depth f t Casedto ft ❑ Sanitary seal is functioning correctly ❑ VVires are properly protected Casing height (above ground) _ in. Date of flotni test for CO1 ", Static wrater 1P. -1 at beginning of test ft. PUBLIC WATER B. TANK DATA Age of tank(s) 17 years Tank type/material STEEL Measured operating fluid level in septic tank 43.25" ❑ Standpipes/foundatir clleanout per record drawing Date of pumping I.Sf // /�o Parcel ID: 050-474-04 Structure served by this system 1 Well production at time of test _pi -n Water storage tank VOID r gallons Well disinfect 4 ' r coliform test? El Yes ❑ No I norm bacteria is 1llegative Nitrate mg/L ❑ Nitrate less than MRL (ND) H - sic ug/L E]Arsenic less than MRL (ND) Collected b, GEG,LTD. Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station 17 years Lift station material STEEL Comments: SEE ATTACHED LIFT STATION MAINTENANCE LOG D. ABSORPTION FIELD DATA PRESSURIZED DEEP TRENCH 04 -�_2- V LV W `5 N 0''j—�DU4D Which system tested (date installed) 5/22-23103 Adequacy test date 5/1/20 * ❑ ALL standpipes present per record drawing Results R]Pass For 3 bedrooms Total measured depth from grade 9 ft (max) Fluid depth prior to test "35.5 in Measured depth to pipe invert from grade ft (min, Water added 595 gal ❑ N/A - pressurized field 37 ❑ Monitor tubes go to bottom of effective. If not, state New depth in Elapsed 169 depth into effective p time min ❑ Code -required soil cover over field Final fluid depth 15 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 2128 gallons If yes, enter date Comments/Deficiencies: 'DID NOT FIND 6" PIPE WITH BALL VALVES AND CO NEXT TO IT. BELIEVES THESE ARE UNDER WOOD WALKWAY FOR DECK. "LIQUID LEVEL AFTER 2 128 GALLON PRESOAK. TIM EKLUND APPROVED PRESOAK AND ADEQUACY TEST TO BE PERFORMED ON SAME DAY. SUMP AT THE END OF 1985 DRAINFIELD WAS FOUND TO BE DRY AND REMAINED DRY THROUGHOUT ADEQUACY TEST ON 2003 DRAINFIELD. COSA, Checklist yellow sheet E. SEPARATION DISTANCES PUBLIC WATER Frog„ - 'vate Well on Lot to: (Please enter distances if less than required or if community ,veli) Septic Tank/Liftt S iw.. Lot > 100' Community Sewer fvlan . i-leanout > 100' es if No ft Neighboring Tank > 100• ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if NO � Neighboring Absorption Fields ❑ Yes if No ft Comm''..; y Server Main > 75' ❑Yes if No ft ❑ Yes If No ft n i ate SeweriSeptic Line > 25' ❑ Yes if No ft Tank > 100' ❑ Yes if No ft Animal Containrn • 0 ❑ Yes if No ft Manure/Animal Excreta Storage > if No ❑ Yes it v _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations'_ 10' ❑ Yes if No ft Surface Water? 100' fv-� Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Absorption Field > 5 0 Yes if No it Private Wells > 100' 0 Yes if No ft b'Jater Main > '10' ❑ Yes if No ft Community kl\lells > 200' ❑✓ Yes if No ft Water Service Line > 'I U ft Yes if No ft if septic tank is under driveway comment below From Absorotion Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No fit Private Wells > 100' Q Yes if No ft Water Service Line > 10 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *MEASURED 89" FROM CENTER OF ST1 AND 94.5" FROM ST2 TO EDGE OF CONCRETE FOUNDATION. BOTH STANDPIPES ARE LEANING TOWARDS FOUNDATION. (SEE ATTACHED PHOTOS). 2016 COSA SHOWED 4'-8" (CONSESRVATIVELY) FROM EDGE OF FOUNDATION TO EDGE OF SEPTIC TANK AND WAS APPROVED, G. ENGINEER'S CERTIFICATION o I certify that t have determined through field inspections and review �j�? • ' ! ' Q of Municipal recorcls that the above systems are in conformance with ✓ .�' . � ��� MOA COSA guidelines in effect on this date. 4 ....:..4 ... .. ........ ... �.....�1 ./...:....£ ..........� J,fie, A_ Gartness., ,f' -O (�G COSA Checklist yellow sheet d Fr Y 1 � o o\ o 1h_ eres_,o= c� #AECC884 �� 4'1,11__' Q -,,I S, e f V S 17, J dI i A. r, 34 Lift Station/Pump Vault Maintenance Log 10 1 1- 0 Oki Cie 61, 6 Owner Street Address Septic Tank: -Z 6 -Sludge level inches -Pumping-. required yes no -Pumping completed �_no Lift station: -Pump basket cleaned Oe no -Effluent filter cleaned fts.)...n.o -Control floats cleaned (A no -Proper float settings confirmed es no -Operation satisfactory(�\/s r�io -Dedicated electrical alarm circuit #es ) no -Audible and visual alarm inside dwellingCy@�_ no -Al,qrm qvqtp.m nnprqtinn . ­.... _j -1-11, 1. satis-factorv) not satisfactor,,/ Manhole Riser -Ground water intrusion at riser to tank connection ves -Ground water intrusion around pipe penetrations ves no -Weep hole functional<�no -Manhole lid.- Functional (v -e-!5) no Insulated 9p no Properly Secured QI no Lher -All manufacturer required inspections and maintenance completed no Comments: Quaiified Maintenance Provider: Technician Date of maintenance Company Y3 e,{ e:t-J TI -g P r, Signature-,.,- Date 0 WKINTIT Parcel I.D. # 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 NO V 2 £ 199¢ i ECEIVED GENERAL INFORMATION Complete legal description Lot 8; Block 3; Hylen Crest Subdivision Location (site address or directions) 10135 Loon Circle Eagle River, AK Property owner Mailing address PHH/HOMEQUITY C/O Jack White Real Day phone Estate 11823 Old Glenn Hwy. Eagle River, AK 99577 694-5500 Lending agency Mailing address Day phone Agent Trisha Baker/ Jack White Real Estate Day phone 694-5500 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community Well system, provide written confirmation from State ADEC attest- ing to the legality and status of System. XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 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 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 & $ ENGINEERING ........ ~ ~,~ ~ Phone ¢-" ~ ~ - ~ ¢1 -7 cf Address Eagle River, Alaska gg$77 Engineer's signature .... --¢~,...~. Date DHHS SIGNATURE /~' Approved for .~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date///-- 2.4-'-/¢¢ rrhe Mu'nici~iity of Ar~chorage 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 engi&eer registered in the State of Alaska. The DH HS 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 (Re~.1/91) Back MOA#21 Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SE~,L,,.~, o,~,e ~ Environmental Services Division ' rM~NrA.~. "<flO-~ ~ 825"!.." Street, Room 502 · Anchorage, Alaska 99501· (907) 343-474~,&:'~Vl¢7{~ ~'~ ~ .o °lYl310~ Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production ~~TS.'WATER SAMPLE Date of sample: Health Authority Approval Checklist o8-0 If A, B, or C, attach ADEC letter. ADEC water system nulnber Date completed _ -- ~~ Cased to Casing beight (above grou/u~7 _ ~ g.p.m, g.p.m. Nitrate Other bacteria Collected by: B, SEPTIC/HOLDING TANK DATA Co Date inst, alled \aI~5-~?~_~ Tank size FoundaUon cleanout~) ~ DateofPumping~-'L[-~ Pumper '~ ~e/~ ABSORb,ON FIELD DATA Date installed / 0 ~ ~,ff~Soil rating (g.p.d./fl: or ft2podrm) ~ 5 System Wpe Length ~' ~' Width Gravel thickness below pipe 0 I Effective absorption area b8¢~ Monitoring Tube present) Date of adequacy test [/-~ t ~ ~& Result~fil) l'o ,~(.2 Number of Compartments ~ Cleanouts ~N)~ Depression (Y/~') ,c,') High water alarm (Y/N) ~/& Total depth Depression over field (Y~) __ For ~ bedrooms Fluid depth in absorption field before test (in.): ~) hmnediately after ~dP gal. water added (in.): ,~ ~' 0 Fluid depth 5 5' (las.) Minutes later: ~g"~) Absorption rate = q~~'-O4' g.p.d. Peroxide treatment (past 12 months) (Y,~) /Od r"~ /~AO~,~$/If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) '~Pmnp oil' le_Jg.vN~'--~ "Pump off' level at* High water alarm level at* *Datum Cyo~.tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main : On adjacent lots : On adjacent lots __~~Public sewer manhole/cleanout Lift statioa SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ ~Jc Property liue 5' '~ Absorption field ~ ~ Water maiw'service line [-o ~ 4-- ~/'~,~ Surface water/drainage 1 09 I ~Wells on adjacent lots . SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ,~ L> \)r Water nmin/service line Surface water Curtain drain '19 a Driveway, parking/vehicle storage area ~'7~ Wells Oil adjacellt lots ~/ ~ Property. lille F. ENGINEER'S CERTIFICATION in conJbrmance with MOA HAA guideh)!e¢' in effect on this date. Signature ~,/J Z ~~ 1 certij..P that I have determined thru field inspections and review ofi~&tnicipal re~ ........................................................................................................... 2>&._2;_:z:.:~.Z',~2 ............ " Waiver Fee $ Date of Payment Receipt Number ',*x CE-8801 Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. Cf CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8; Block 3; Hylen Crest; '~/ Location (address or directions) 10135 Loon Circle (b) Property owner Mailing Address (c) Lending Institution Mailing Address Freddie Mac #32-633119-0C Telephone : (home) Business 2231 Cr:~stal Drive Suite 900, Arlin.qton~VA. 22202 Telephone (d) RealEstate Company and Agent JACK WHITE CO¢4.~AN-Y ATTN: Ba~b¢~a . Address 10928 Eagle River Road Suite ¢100 Eagle River, Ak. 99577 · Telaphone 694-5500 .. ,~ (e) Mail the HAA to the following address: (or check here [~Xif hold for pick up.) [_ist co.~?tact person and day phone number below: S & S ENGINEERING ~gle River, Alaska 99577 TYPE OF RESIDENCE Number of bedrooms Single-Family,'~ WATER SUPPLY Individual Well [] Community,l~ Public E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site,k~ 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, ?~-025 (Rev. 7/~8) Page 1 of 2 ')HOM s.J@@uli~ue IBuo!sseJoJd sql u! suo!ss!uJo Jo sJOJJa Joj elq!suodse~ lou s! ebeJoqouv jo AlilBdio!un~ eq± 'penss! s! elBo!j!iJao B eJo~eq B1Bp eZ/,IBUB tO suo!1oedsu! lonpuoo ~ou op SHHC] Jo seeAOldUJ3 's~ueLueJ!nbeJ alBls pub IBJepej u!Bpao A~sRBs oi Jap Jo u! suo!1nHisu! 8u!pual J!eUll pub seLuoq JO sJesBqoJnd o~ AseiJnoo e se siql seop SHHQ eli/ 'B)tSBIV Jo e~Bl$ sql u! peJeis!BeJ J@eu!Bue IBUO!SSe~oJd luepuedapu! uB Aq eAoqB G qdBJ§eJed u! U@A!6 suop, Blu@seJdaJ eql uodn ~lUO pesBq pa1Bolj!Jeo IBAoJddv Xlpoqlnv q$lBeH senss! (SH HC]) seo!^JeS uBuJnH pub qilBeH Jo ~ueuJ~Jede(3 eBB~oqouv jo A~,!lBd!o!un~ eLt.L IBAoJdd'¢ leuoil!puoo Jo SLuJ@.L IBUO!],!puoo peAoJddes!a ~/~ peAoJddv Z¢~ __¢-_,~// eTBQ /_/~ /::~/ ...... Aq suJooJpeq ~ jot Pe^o~ddv 'IVAOHdd, ,HHO '9 elBC] auoqdela2 'UO!lOedsu! S!LI1 JO elep eH1 uC~,Jo@JJe u! suoRelnbeJ pub 's@ouBu!pJo 'sepoo eTB19 pub IBd!o!unlAI lib LI]!~ eOUB!IdLUoO g! S! Lue~sAs leSOdS!p Ja~eMel~ Jo/puB Alddns JeleM ells-uo sql 'uoRoedsu! pub UO!lBb!lse^u! ALu LUOJ~ pUB sel!~ ebeJOLIOU¥ jo Al!lBd!o!unl/N aLi1 LuoJ~ peu!Biqo UOp, BLUJOJU! sql uo pesBq 1BLI~ ~J!Je^ Jeq~Jnj I 'u!eJeLi pelBa!pu] eJn~onJls jo adA1 pub suJooJpaq jo JeqLunu sql Jo~ e]enbepB pua leUO!~ounj 'ejBs s! LUalsXS IBsods!p JelB~elsB~ Jo/pus ~lddns Ja~B~ e~!s-uo alp, 1eLI1 SMOLIS IB^OJdd¥ AI!JOLilnV LtlleeH SiLl1 jo uo!~Bb!~se^u! ALU ~BLI1/~!Je^ I '~oleq u/~oqs elBp UoRBp!IBA eq~ Jo SB pub OlaJeq pex!~lB lees XLU Aq pe!J!lJeo sV NOIIV~HO=INI ONV vIva 'HOI:IV3S M'iid 'SAS:II 'SNOI.I.O~]dSNI 9NlalAOIdd IAIHl:l 9NIH:IMNIgN:I 'g A. WELL DATA Well Classification Well Log Present (Y/N) __ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) E~o~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) IPALI'[Y O1: 6:H~C~K~IST - FEBRUARY 1984 ¢-N'rAL SERV~CnS PIViSlC~,3-4744 ",': ~ ~ l'jB9 RECEIVED_. Date Completed Depth of Grouting If A, B, C, D.E.C. Approved ~-Y'TN) _~L__ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments PL,'5 ~ [\) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed lc:,-5--E~'.; Size '~,-'.:.%~-,~'- No. of Compartments Standpipesq-'~/N) '~[ Air-tight Caps~/N)_ Depression over Tank (Y/~ Pumping/Maintenance Contact on File (Y/N! j Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well "~-~,c:, -¢o property Line '~ ~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments "i Foundation Cleanout 6C/N) Date Last Pumped (,c>-- I o .- ~'"~ ; for ,~ i Temporary Holding Tank Permit (Y/N) /"~"/ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ - Width of Field '3 Square Feet of Absortion Area Depression over Field (YLb82 Results of Last Adequacy Test Type of System Design Length of Field :~ 7 Depth of Field '~ / Gravel Bed Thickness ~ ~'- ~/~ ~ Statndpipes Present (Y/N) /'~ Date of Last Adequacy Test (~,'- f¢ --9? SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation ~---c,/.----w~ Lot To Water Main/Service Line / ¢ To Stream, Pond, Lake, or Major Drainage Course / 42 To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots .-~.~ ~.4- To Cutback (if present) Comments / D. LIFT STATION ~,- Date In_stalled Size in "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~mping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conforme, d to all MOA and HAA guidelines in effect on the date of this inspection. Signed 5 ~ $ m~,, ......... Company 17034 Eagle RiYer Loop Roa~ No. 204 Date Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE~ ALASKA 99503 563"'6775 DATE: August 28, 1989 PWSID: 213289 Requested By: S&S EngineerinE According to the records on file in this off~.ce~ the Crest Water System is in complianc~ with the State of Alaska Drinking Water Regulations. Sincerely, Cindy Thomas Environmental Engineer 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 GENERAL INFORMATION (a) Legal Description /include lot, block, s. ubdi¥ision,~.section,,township, range) Location (address or directions) (b) Applicant Name ~ ~'~'/~ Telephone: Home Xr¢'x~s~ Business Applicant Address (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address (f) ~Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY hldividual Well [] Community [] Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsit,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address Approved for bedrooms u/,y.~ ' Approved ~ Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depadment of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/~4) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /-~ ~:~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level 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 on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved f~/R) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots 7-'('~c> ['~' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~,N'~' Air-tight Caps Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~'/¢~,-~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~ O ~ '~- To Water Main/Serv~ Line Size /Oo,..c> No. of Compartments Foundation Cleanout ~,.~ate Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Course Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata .Date Installed I E)*' ~ -~ Width of Field '~(¢¢ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~.~, t 4-- To Building Foundation Lot To Water Main/~-Scr;'!ce:Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~'-r'- Depth of Field Gravel Bed Thickness Standpipes Present (~ Date of Last Adequacy Test To Property Line I o ~ To Existing or Abandoned System on ; On Adjoining Lots ,.~O ~ ~ To Cutbank (if present) / Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions iManhole/Access (Y/N) [/ "Pump Off" Level at ~"'"~ ~.~_ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA/and~HAA guidelines in effect on the date of this inspection. Signed S & S E'r~l|neering Date ~--- .../~ I _ Company ~,4~ o:,.~ ~..t.. ~"~ MOA No. ~'~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) D~Ii~T. OIF ENVIROnMenTaL ~ONSERV/~T~ION / / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" SI'REET, SUITE 303 ANCHORAGE, ALASKA 09501 BII. L ~JEFFIELD, GOVERNOR Telephone: {907) Address: 274-_533 To Whom it May Concern: ~ ~,/~Water System is 'in compliance with the State Drinking Water Regulations Sincerely,