The URL can be used to link to this page

Home My WebLink AboutHYLEN CREST #1 BLK 3 LT 9 MUNICIPALITY OF ANCHORAGE Dr- ~TMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name / Address LEGAL DESCRIPTION TANKS ~ SEPTIC ~ HOLDING Materim~ ~'.~ / J No ol.~mpartmenls TYPE OF SYSTEM ~ 'fRENCH ~ BED ~ W, DRAIN [~ OTHER Depth to pipe bottom f¢ol]] ] otal depth from original grade Fdl added above original grade Gravel del)th benoaW p~pe ET 8~ FT ~' FT DISTANCES SEPTIC TANK ABSORPTION FIELD WELL -- WELL ¢7-~ o~ / LOT LINE '/7¢' / '~-~ ~-?~ / /zJ/A FOUNDATION / x / ._s- / /-//~. AS-BUILT DIAGRAM lShow {ocabon of welt, septic system, property hnes. Ioundatton, drlvoway, water bodies, etc.} WELLS REMARKS: ' J Scale: P, 0, BOX 773294 694-5195 .~. /¢~,' Municipal and Slale guidelines in effect on this date: ~ u ~//(~.'/~ ~- Health Depadment Approvah -- ~ - ~ Date 72-013 (3/85) g~__ P ....,~,~.,,~,'-"'" 6650 ~,/QHORAG~. ALASKA 99502-0650 (907) 264-411'i DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850696 Lot 9 Block 3 Hylen Crest Subdivision #1 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. 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 priva.te engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) 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, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit P','/1 tL..; ]1'%,.~ ][ C]: % E:='' ~1~::7;~ L... % '"'il-' % .... Dli!:F:'AR"t'MI~}:NT OF:' HEAL. TH AND ENVIRONMEN"I'AL F:'FR[)TECTI[)N 825 I... S'T'REIE'I', AN[;I-fORAI'ZJlE 264-4720 C(]N TACT L D V E [.., A C E E X C. A V A'I" I N G :1.5:1.40 CUF;~VEL. L DRIVE ANI]HORAI~:ilE, AK V':?516 ::];/.1.5- ;t 287 I...IEGAL X)h ,¢ .,l*I F' L..i]'T ~ 1 ~..1:::. ,, L..O'I I_OCA'I"I ON: HAX SUBD I V I !B I tIN: HYLI~!:I',.I CREGT :!-i: 1 SECT :1: ON: ¢.] ' 'f'[)NNSFI:[ P = :I. 4N 20198 (S[;!,, 1:::']". OR ACRIES) t....OON CIRCL.,E I_[IT: 9 Bt_OCI< I::~ANGE: . Z / I.,.i.st.c.)cl b(.:~:,lc~w E~l'.e.~ t.l'H,~..? ci[:],t:i, clr'l!ill ava:i, lal::)le to ',/c~u :i. rl [:l(~,!Bigl"lir'16j svut,?m,, t?.hc~cise:, the Ol:)t.:i. or'l tlh'at [:,e~.~'t:, fits your' -Ir-' IF:;;;, IIE:T It',, ]1 IZ::: IF,,~]t L, l~!.:.': ]1.], i[,,.,,~ .... ]E}, IJ:q',: ¢'.::'.r~ % I1",,.11 )]l!i:l::"l"H 'TO F:' I PIE :t:!I[]'T]'OM (F"t".) 4 ,, 0 4.0 Zl, ,, GRAVEl_ DEPTH (F:'T.) 5,, 5 ~ ~ 0,, U; 3,, 5 'I:'[ITAI_ DEPTH (I::"T.) ~]5]]- - 4,, GRAVEL WI D'I"t4 (1:::'"1'.) 2,, 5 22,,, () 5,, () C)RAVIF:I,. I,,..EIqG"I'H (I:::"T ,, ) 55 ,, 0 _ . 41. () 6',5 ,, 0 GRAVEl_' VOI....UME (CLI,, YDS,, ) 3(),, 6 33,, "I'ANI< S :1: ZE (GAL. S ) :t., 250. ()' .~.¢4. 1 ¢ 2.50 ,, 0 '~"~ SOIl. RA'I"]:NG (S6~,, F"r'. IBR) 150 15C) 1',.':;0 .~.~.¢~. "I'ANI< MUST HAVE!: AT I...IEAS]" 'f'WD COMI:':'AI::;:TMEN'TS :1: c: e r' 'L i ~' y t, h at.: :1.,, I am f'am:i, liar' i.,~:i.'l:.h t. he r.e)ctu:i, vemerrl'.s f'of c~n.-si'[.~:,) se~,Jer's ar",d ~e].:[s as set {'or't.h I::)y t.I]e Munic::i. pal:i, ty o{' Anchc:)r'age (IvlC)A) and the) State c){' Alaska. ;;::,, I ~:i.],l :i.n~'Lall t.l't6) f~ysFt'..(~.~)[li :i.n ac:cc)pdanc:e t.¢:i.t.h all MOA c:c)cles and vegLtlat.:i.c)r/r~~ c:trld :i. rt cc)mp].iaru::(:.:) w:i.t.l"i t. he clc,~s:i, gr'l cr':i.t[))r'ia (::){' t.h:i.s per'mit.,, ::~;,,I v..~:i, ll adher'e to ali. M[)A and' St. at.e) c:)t' Alaska r.[.:~cluir'ement.s {'(::w the set, l::) ac: l-:: dist. arH:::es t' r'c)m ~:u'/y ex :i. st :i, ng wel :l. ~, waste)wa'[,er' d :i. sposal sys'Lem of pub 1 :i.c: !S(.:et*,le?l'i¢;Uj,:J(,':'~~ !Byi;FILE~Hi~ C)I"I th:i,t~ii []f' ~l'Iy acljac:err(, c~v near'by lc:vL,, Z[, I::) E,)(:] I" (3(::)fTl~]~ ¢~i"117] ,q.,, ]i] I.~,Fid((.~l"!~'lL,'arlcl that th:i.s i::,er'm:i.'t', is valid ~'E)i" a l))~',,~,~,~:i, rl)LU¥'~ C::,f' E:u']y (..~.)l") ]. ~?~tP gi~))lJl(-:,~'f]t, (4 i ]. ]. 1' e'lqLI i r' (.i:.) ar'l add :J. ,IL. i cil')4':':t ], p (.:,3)P i'll :i. 'IL ,, ]:1:::' A I..iI:::T STATION IS INSTAI_I_E][) t1',1 AN ARI:.:.:A C[)VERE.i.) BY MOA BU]:!....DIIqG CODES, WILl_, N[)'f' ]BE AI:::'F'ROVIED WI'f'I,'K]UT AN IEI...ECTRI[:;AL.. INSF'EC'I"!OIq REF:'ORTI AND (3) 'FI."IIE AF:'I::'I,. I CAI',IT: t,,,ovr!i]..A[;l~:: f:. X (.,.A., (.. .I, NG PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'TEST LEGAL DESCRIPTION: 1 2. 3 4 5 6 7 8 9 ,~o"/-~' ,¢~//r .~ ~'(>,lc,., (.W.tpT°wnship, Range, Section: ~7--/ ~//'~ ~ ~-d floc SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20- WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT DEPTH? ~' ~- / O P E Deplh to Waler After ,,,v.,,. Moeiloring? Date.. Gross Net Depth to Net Reading Date Time Time Water Drop PF-RGOL~'ION RATE / ~-o (rm~utes/irrch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FTAND __ FT COMMENTS Eagle River Engineering Semites PERFORMED BY: P-0 Rn~773~4 I ~ ~'~ CERTIFY THAT THIS TEST WAS PERFORMED Eagle River, AK g9577 ~2 ~ ~_ ACCORDANCE WITH ALL STAT~i~NICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUMCWAUTY'OF0` CHORA GE a. Development Services Department j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-474-05 Expiration Date: ��.2 2-0L,j 1. GENERAL INFORMATION Complete legal description HYLEN CREST #1 BLOCK 3, LOT Location (site address) 10129 LOON CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) ALEXANDER & APRIL REYNOLDS Day phone Mailing address Real estate agent 10129 LOON CIRCLE, EAGLE RIVER. AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment q - Z'�? - 2 Receipt Number 90T Z C0 3 COSA # OS G21 1212 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907.350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/27/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to `` l these various and dynamic characteristics and are outside the control of the evaluator of theAw P •:451 well and septic system. Therefore, any estimate of how long a system will function satisfactory /��g�•.•. �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWfS - *' � TM �'* �! _ . .. � ...::- 6. DSD SIGNATURE �r • Curtis Huffman System #1 Approved for bedrooms ��F�,sr . CE 128991 F� • .4/27/z1 • •�� System #2 Approved for bedrooms I�IFO'ROFESSIOHP� Disapproved Conditional approval for bedrooms, with the following stipulations: Y OF,�ii gJ ON-SrrE VArER AND m n PROS 1 ER o B Original Certificate Date: `7 - d `z 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: HYLEN CREST #1 B3 L9 Parcel ID: 050-474-05 If more than 1 septic system on lot: COSA Checklist # --of _ Structure served by this system _ A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 12 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 4/19/2021 Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by_ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/1/2009 Adequacy test date 4/26/2021 ® ALL standpipes present per record drawing Results E Pass For 4 bedrooms Total measured depth from grade 6_5 ft (max) (SOUTH) Fluid depth prior to test 0 in (N & S MTs) Measured depth to pipe invert from grade 4_5 ft (min) (S) Water added 600 gal ❑ N/A — pressurized field New depth 3 in ® Monitor tubes go to bottom of effective. If not, state depth into effective 'SEE BELOW Elapsed time 10 min ® Code -required soil cover over field Final fluid depth 0 in (N & S MTs) ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *SOUTH CO/MT SHOWED 2' ED MEASUREABLE NORTH CO/MT HAD 2.43' ED. MIS E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ❑ Yes if No *3.5 ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® 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 ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER G. ENGINEER'S CERTIFICATION l 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. low .... . TM ......... . • . . . . . . . ....... Curtis Huffman f ?'ci9 . CE 128991 w�� ROfESS10NP�'�..,�.�• ft ft ft ft ft ft ft ft rT-a n'>n-i b T O L n O O m to > r?1 U ti a `�p�=til Tnj L Z T=AOX1 tr TO �OOvbOimO v C a_ov�m„m�v�o maxm.z�.'ci�A no-a��orym °zprnz 'cc ArzD y � Arn z y m c o U S C q p a .yn a�mz npi �nm mv�0� x z y -y m m goal cn m --i a' z - o � HIS 2 HER U O A=Dtir a m nm�-c Y Ozm'y m x�ozo z os w s� Amro m n a, m it 0 LOON CIRCLE om a `=c`� O 0,m H e b �pOm� 1p 'Tim ti i z�eQm = � o� m n� z c " m i� G Z O S n rn Cl ORR I ober � n o =mo C noN � ObH y x C�C bNri o�z V � m it 0 LOON CIRCLE 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 1. GENERAL INFORMATION Complete 'legal description Location (site address or directions) /¢¢./.2'5' ,Z~,¢,,~ ~--'~.,~¢/~ Property owner 5'-~,,-~-'¢~..~ *'~--/~-'97¢.~/¢?,~,~'¢ Dayphone ~¢4/'Z~?~ Mailing address /'~/,~¢ ,4~,~,,~ 4¢~-~,~, ~<',,¢y~.~ .,'~/~'~,,-, /¢.,(¢' ~'~¢'~'~ Lending agency. Day 15hone Mailin_g address Agent -Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4. TYPE O~WAS~EWATER DISPOSAL: NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual .on-site Holding tank Community on-site Public sewer 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 furtherverify 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 ~/~x/¢, ,/~ ZT. ,/~/o/~ Phone ~- ~ ~/~ Address ¢¢~ ~ ~ ~/~'~ /~' ~~ Engineefssignature ~ ~~ Date [ [' ~% ' L~ U DHHS SIGNATURE ~ Approved for ,-'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. Municipality of Anchorage · R E C E ! V E DEPARTMENT OF HEALTH & HUMAN SERVICESN0V ]. :~ 2000 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907MU~iClPALiTy343-47440F ANCHORAGE ' Health Authority Approval Checklis~NVIRONMENTAL SEEVICES DIVISION Parcel I.D.: A. WELL DATA Well type d.//~ x~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N). Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULT~ Coliform ~ ~ Nitrate Ihat~o~ sample: Cased to Casing height (above ground) Wires properly protected (Y/N) ~ FROM WELL LOG AT INSP~ g.p.m. Collected by: Other bacteria SEPTIC/HOLDING TANK DATA Date installed /'/~,~//~b- Tank Foundation cleanout (Y/N) /~/ Date of Pumping size /o d Numberof Compartments ,~. Cleanouts(Y/N) Depression (Y/N) /~ High water alarm (Y/N) ,4/'~ Pumper ~,,~ ~ ,~-,~-~,'J/~ Co ABSORPTION FIELD DATA Date installed ?///~b-'/~..~ Soil rating (g.p.d./fFor~ ?d'-¢ System type Length .zj~ ~ Width ~. ~ / Total depth Gravel thickness below pipe ~7. ~" / Effective absorption area /-//~/,,~//' ~ Monitoring Tube present (Y/N) ? Depression over field (Y/N) /~/ Date of adequacy te~~" -/~ Results (~s~Fail) .~.~ For ~ bedrooms Fluid depth in absorption field before test (~.~- ~/~ Immediately a~~- ~. water added (in.):~- ~ ~ Fluid depth~-~Y (ins) Minutes la~'/-/~o Absorption rate = ~-d ~ g.p.d. Peroxide trealment (past 12 months) (Y/N) /)/ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* "Pump on" level at* .~,---~-*~'t u m Cyoles-t~t~d E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main . Sewer/~pt~rvice line On adjacent lots .~----~ublic sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /~-2' Property line ,2"7 Absorption field , ~'~ Water main/service line ~/,r~-~- Surface water/drainage ,/md ,' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ,~ ~ Building foundation ,?'- Water main/service line Sudace water /~ ~, '/',,~',,z Driveway, parking/vehicle storage area Curtain drain /'.//m--~ ¢ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal recorg~'b'~z,~l't~ in conformance with MOA ~HAA g~(idelines in effect on this date. ,~,~ ~..,~ . - .. Engineer's Name ~-~/~ /.x~,~ Date 11.(5,o IDS ar~t HAA Fee $ Date of Payment Receipt Number ~) 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE "" .... _ ' .DEPARTMENT OF HEALTH &HUMAN SERVICES '" ' ": ~ ' ' ' ~' - =" '" '":': ';:~" On-Site Services Section '"'- "~.' ' Division of Environmental Services ~;-.: ' APPROVAL FOR A SINGLE FAMILY DWELLING · .. . ~ . Parcel' . ..... ..: .................. . -.., .... .. 1. GENERAL INFORMATION ' · ~ ,. - · ~ ~ .~.., ,... ',.. ' ,, ' "~ .'.' Comple~ lega~ de~c~.p~on Lot 9; Bloc~ 3; Hyl~n.Cr~t ~ · -. '. - . .,-~.: ~_-.'~: Location (site address or directions) .. ... :'-, :~;:..~.Mailing~'~r;;s ¥-'""i01~9 'Loo~ C~ E~q~ ~v~, AK 99~77 ~ - -~:~: .... · :.-'..Lending agency "' :: ' Day phone ' '. ?';;"' :'"' ' - .~ ..... -':?;;,.f~.;.~. ....: . .. ..... . .,_.. _ .... - .... : .' .;',~L. ~'-;tW ~il~nn aHHress_ ,.,.,,, ~ ~ : ....... . .... ..,. ~.. ~: ...~...~/~...:....,-.: , . . .. ?~.~.~,.,,~..Unle~ othe~se requested, H~ ~#1 be h~ld forpickup..~ .,, ~- ,. .... ~,~., ~.~....,~,~.?,.. ~?.. ~ . ... .- ............ ~ NUMBER.OF BEDRO0 · ~ ..... ................. .. ~ . .,~,.~.~ ......... . ' '. -'; '~3.' "~=,,~. --,. ne WATER------~m=~v:'~' ' '- "' · '.' ' , -. ~-'~' ~'~r · · ~ , . . '~ ............... ". '~'~" ~. ....... ''"" '"." ' :~'~"':~O~";~ O':~ ~" · ' --_..:_.' ;:/~.:.--. ~_..~...-Ind~wdualwell: ' ' .: · . ....... . ..... Commun W well . . ... . ......... ., ~,~..~,,~...~., ,~ _ ,.~..~ ...... <, .. II i ; ~ '"r :.';;a NOTE:...' If.communi~. we!( system, provide, wri~en confirmation from Sta~e'ADEC -'. . : . .. . ~,. .... ,~.~.~.~,~ [~ .;..:~.[r r'' .' , _ · _. lng to the legali~ and status of system. :--~ r . - · 4. ~PE OF WASTEWATER DISPOSAL: - ...... ...... ¥-;~, .:. r~-~ L : .~- ,?', :;/~- ''- .: ' .... ~. ~ ~..~' .", Hold ng tank.}... ;.. :" . - '~: ; .-.' .:~..'1. ~"' ~;~ : .~ '.- ' '' ~ ; : " ' ~ -" ti ""'' ', '- ,:' . .: .. . .. :......., . .. ....... .,........ .... : .... . , ...... .... :.-: , , ~ ; Pub csewer._:~ ..... .. ,:.~ , - .... _, .,. ¥; ~)~,~-..~,~,..~....:: .......... ', : Ill .... "~;i~t~ "' ' ';NOTE:' If ~ommuni~"Wastewater s~stem;'provide wri~en ConfirmatiOh'from ~,te ~DeG -":..- -. ' a~estJng to the ;ega,~ ano status or system. ' ~,-.'-~' ·--:'.. · .... ·... - Nemeof Firm ' , - .. 17034 Eagle Riv...e~r~o/ep Re,sd No,~_04 Address ~ Eaa_le River: ' . · '.'~ .,~.' ',','.'~' r, STATEMENT OF INSPECTION BY ENGINEER ' -~.,'~ . .- :.. : · .. AS certified by my seal affiX~l hereto and as'~ t~e'valid~ti~n'date shown' bei0w, I verify that my investigation of this Health Authority Approval application shows that the'on-site water supply and/or wastewater disp0sai 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 inves.t~ation 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~his'inspection. . . ?' .... ~ ' ' ' Phone ' ~i~-'/~';"Z"~?'~': ...._..~...., .: :: -.. .... . ,: ,.......,, . - ...:: - ./ ........ ,,. ,-: .... .... ~.~,'~,~'~ ~.,,~,, ,.,~! '::. . ........................... . ................................ ... . ~... .... :. .... . ........ . ...., ~..~~~,,~..~'.~, .:... .. , - , .;. , : ..-. ': .... ........... . .... . .... ~ .., ~. : . - ,. ,..~ 'K:._ . . .... ~..~,. ................ .~ ................... , ....... . .... ~-- ~,.~ ............ .:,_ .:?... :?~,~ :. r Approv~ for :,r '..'.'-m .... .' b~rooms. '" -:',",."}} Conditi6nal approval for "' -. .... :,,-,., ,.,,,. ;,: ....>~,.::. -.;.: .; ,.,. :..._. , .. . ,-:.->...: :... ~.,,,"..:" ... . .- . ::._ ::.._..',:. · :, .. -":. ", ;horage Department of Health and Human Services'(DHHS) issues Health Authority ~ased only upon the representations given in paragraph 5 above by an !ndependent dStered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes ~tions in order to satisfy certain federal and state r'equimments~ Employees of DHHS do not r~;.~'~l~ct"insr~;cti(~ns for analyze data before a .certificate is issued. The MuniciPa!ity Of An, Ch(~mge is not rPor~sible f'or ~'rr~r~"~'~';~)l'~lissi~s'iri-the prOfessional eni~ineer'~'work':. r~.~ ~1~ ...... :' --''%~'' ' 72-025 (Rev, 1/91) Bach MOA ~21 . Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L--r~m- c/ ~_~ $ A/~//..¢~/ ~-~'¢'~-"f~arcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller A. Well Data Well type Log present (Y/N) Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPE~ Date of test Static water level Well flow g.p.m, g.p.m. Pump level1 SEPARATION DISTANCES FROM WELL Septic/holding tank on lot ; On adjacent lots Absorption field on lot ~ ; On adjacent lots Public sewer main J Public sewer manhole/cleanout Sewer service line / Petroleum tank WATERSAM E/B~RESULTS: Co~ Nitrate Other bacteria Bate of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed //-/.t'~ ~ B(.¢ Tank size Idoo Compartments Cleanouts(~N) ~/ Foundation cleanout ~J'4) /"/ Depression (Ye ~-/ High water alarm (Y/~_. /'--/ Alarm tested (Y/N) Date of pumping [~,//,-b'/¢zFL Pumper ',,J ¢-¢~-~' //'¢"//~//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 'J/~/~ On adjacent lots "J//~ To property line /¢ ' Surface water/drainage /',~ 72-026 (3/93)* Front Foundation //~ Water main/service line /o ' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N)~~ SEPARAT~FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access d rTll Surface water D. ABSORPTION FIELD DATA Date installed /~ ~5" Length ~2. ' Width -.~ ' Total absorption area /-/'4.-~ '~ Cleanout present~./N) Date of adequacy test ..~ '-//~ ¢'.-¢' Result~fail) Water level in absorption field before test Z,'o" Peroxide treatment (past 12 months) (Y~ Soil rating (GPD/FF) /Jo ~,,~,~ System type Gravel thickness -.5-7..~' ' Total depth ~ Depression over field (Y/~ /¢,4-~J' for ~ Bedrooms After test ~ ~¢' /~,./~ ,-',~/'*.ld If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots -~ Surface water /ob ~ '~' Curtain drain ~//'~ On adjacent lots ~//~ Property line To existing or abandoned system on lot Cutbank '"///~ Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have ch'ecked, verified, or conformed to all MOA and HAA guidelines ineffectont, be~te of this inspection. Signature--~------ /~/ ~ , S & S ENGINEERING Engineers Narecr,.~,~ ~..~ ~; .... , __~ r,___, ....... ~~ " HAA Fee $ ~'"/~ - ~ Waiver Fee $ Date of Payment ~,,/0~,/~,=~"-~ Date of Payment ReoeiptNumbe,-~c,~/ t'~)_ .~ Receipt Number 72-026 (3/93)* Back 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) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name. _~' Cc ,..c-~, c'",-, ~ 7 Telephone: Home '~ ~/' ~'- ~ 7£-_~ Business Applicant Address ~ ~ I /"~ ~-~' z'~' ~ /-' /<)-"-'/~"/' °"'~3~-' "/¢/¢' (c) Applicant is (check one): Lending Institution []; Owner/builder [~],'i Buyer []; Other [] (explain); (d) Lending Institution /z"t°*~'¢ .~.~. ,.,.,.-~ Address ,,//J d: / ,,.~'~ g.~,~-'-~,~,..r~,-~, (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~r' Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual 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 Onsite..~ 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) ENGINEERING FIRM PROVIDINb 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 EAGLE RIVER ENGINEERING SERVICES ,--' ,/~ /'..~ ,¢----/,/~., ./~ ¢ EAGLE RIVER. AK 99577 Date , ,- P. 0. BOX 77-.]~94 694-5195 DHEP APPROVAL ApproveO c~<~ Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84} MUNICIPALITY OF ANCHORAGE (MO,,,., HEALTH AUTHORITY APPROVAL (HAA) A. WELLDATA,._'"' ~.,,~,.,.-,.~..,-¥:Y-,.j CHECKLIST - FEBRUARY 1984 Well Classification (~?~_r_¢ /~ 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 264-4720 Legal Description: ~/~ ;'~ ~' If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 1986 ; Date 13. SEPTIC/HOLDING TANK DATA Date Installed ////5¢,~'~ Size lO~J~..~ < / NO. of Compartments Standpipes (Y/N) 'Y' Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) ,/q'/' Date Last Pumped /.ce '-'-" Pumping/Maintenance Contract on File (Y/N) /'~/",,4 ; for Holding Tank High-Water Alarm (Y/N) /'///~/ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~'~'~¢¢~ / To Property Line '"'/'~" To Water Main/Service Line /O /' Course //~'¢ / To Building Foundation // To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / Width of Field --~ / Square Feet of Absorption Area /-/d cZ. Depression over Field (Y/N) /t/' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~.-.-.-z¢, To Building Foundation -_5'~ Lot To Water Main/Service Line //-" / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field 4/'~z_ / Depth of Field ~ / 5- Gravel Bed Thickness ~ ~"~" Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /¢ To Existing or Abandoned System on ; On Adjoining Lots ~ _7 ~" To Cutbank (if present) LIFT STATION ~,~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Signed ** 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. Date MOA No. Company ~'~/,-C Receipt NO. Date of Payment Amount: $ Page 2 of 2 72-026 (11/§4) TEC~IoN MA ¥ ~ ,9 ~986 R£CE1V£D EAGLE RIVERENGIINEERIING SER'VIlCES Lou Butera P.E. ~~~ Eagle River, Alaska 99577 ~~~ Telephone (907)69d~5~.9.5 Susan Oswalt Municipality of Anchorage Health Department 825 L Street Anchorage, Alaska 99501 2/14/86 Ref:Lot 9, Block 3, Hylen Crest Dear Susan; On behalf of my client, Mr. Steven Curry, I am applying for approval of a 5' setback distance between house foundation and septic leachfield. The level of the foundation floor is located vertically ±2' above the top of 'the leach pipe. The leachfield is "T" shaped so that the closest portion of the leach area is actually at the end of one section which would result in minimal flow in that direction. If there are any questions or concerns please call me at my office 694-5195. Sincerely, Lou Butera P.E. MUNICIPALITY OF ANCHORAO" DEPT, OF HEALTH & ENVIRONMENTAl, PROTECTION RECEIVED