HomeMy WebLinkAboutHYLEN CREST #1 BLK 1 LT 1Hyl n Crest #1
Block 1
Lot 1
#050-472-87
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 2
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 8WSW111213 PID Number: 050-472-87
Name:
Wastewater System: ❑ New ® Upgrade
Address:
piper Lowland, Fagip River Q9577
ABSORPTION FIELD
Phone: Number of Bedrooms:
❑ Deep Trench O Shallow Trench O Bed 0 Mound ❑ Other:
LEGAL DESCRIPTION
Soil Rating:
GPDIFt'
Total Depth from original grade:
BlockLot: Subdivision:
Depth to pipe bottom from original grade:
Ft.
Gravel depth beneath pipe:
1 I Cr No.1
F
Township: Range: Section:
Fill atltletl above original grade:
Ft.
Graver Lath:
Ft.
Ft.
Well•❑New ❑Upgrade
Gravel width:
Number of lines: Distance between lines :
Classification (Private, A, B, C): Total Depth: Cased to:
Class A
Ft.
Total absorption area:
Ft.
Pipe Material:
Ft. Ft.
FF
3034
Duller. Dale Drilled: Statin Water Level:
Installer Date Installetl:
Ft.
Flintstone Const 8/16/2011
YieM: Pump Set aC Casing Height Above Ground-GPM
Ft. Ft.
TANK
SEPARATION DISTANCES
® Septic ❑ Holding I] S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ubliUlPrivate
Manufacturer:
Capacity.
From
Tank
Field
Station
Tank
Sewer Line
Anchora a Tank
1000ca1.
Well
200+
Material:
Steel
Number of Compartments:
2
Surface water
100+
LIFT STATION
Lot Line
25
Sire:
Manufacturer:
Gel.
Foundation
5
Pump on' level a :
-Pump ofP level at:
High water alarm at:
in.
in.
in.
Cuuain Drain
50+
Pump Make &Model
Electrical Inspections performed by:
Remarks:
Exist'q tank removed and disposed of per code.
BENCH MARK
connected both fields via diverter valve.
Location and Description:
Front deck
Assumed Elevation:
100.0 Ft.
Engineer's Stamp
OF
,VC
Inspections performed by: PES. LLCDates: 1`8/16/2011
49TH♦♦�
2nd08116/2011
......& ..... .... ........R.....0
Development Services Department approval
..... ,Steven R. P..a.nn..........
i
one,
♦♦�
Conditional Approval by:Date:
N CE 8149
♦4/,
Reviewed and approved by: �(JDate: - %` -
..SS ��••
UPPER LOWLAND AVENUE
15' T&E EASEMENT
DRAIN FIELD(E) MT
73LF x 5'W x 2.5' ED x 5, TD DC r', /env,
l (E)
2 � 1
T2
T1
EXISTING 100095.0
FC
COLLAPSED SEPTIC TANK
34.x.
REMOVED PER CODE
3BR
NOUS
l (E)
2 � 1
NOTES:
RECORD DRAWING
PLAN
PANNONE ENG
P.O. BOX 100217 ANCHOR)
PHONE (907) 272-8218 FAX
DRAIN FIELD (E)
27LF x 2.5'W x 7' ED x 10' TO
NEW1000g SEPTIC TANK
WITH DOUBLE CLEAN OUT
AND DIVERTER VALVE
CONNECT TO BOTH DRAIN FIELDS
i11
D/W
LLC
272-8211
HYLEN CREST #1, BLOCK 1, LOT 1
LAWRENCE & HAE IWAMOTO
21042 UPPER LOWLAND AVENUE
EAGLE RIVER, AK 99577
w
0
3
w
F-
rn
SWING TIES
CO A B
FC 7.4 28.6
T7 10.5 27.7
T2 16.5 25.3
DC 18.6 25.4
DV 20.3 25.5
EDC 21.4 28.7
MT 27.2 24.8
Ur ....�l'� 10/17/11
iy�Q'too Scale
*. 49TM '*�� P.I.D.NO
_ 50-472-87
Steven R. Pannon e" PERMIT N0.
)Imo. CE 8149 XXXxxxxxx
s r
Nl�\ �`=` ` Sh1eOF 1
�0 —�—�
0
o0
10
94.9
NEW�;94694.8 SEPT
CONNECTED TO
EXISTING
DRAIN FIELD
SECTION
NOTES:
RECORD DRAWING
PLAN
PANNONE ENG
P.O. BOX 100217 ANCHOR)
PHONE (907) 272-8218 FAX
DRAIN FIELD (E)
27LF x 2.5'W x 7' ED x 10' TO
NEW1000g SEPTIC TANK
WITH DOUBLE CLEAN OUT
AND DIVERTER VALVE
CONNECT TO BOTH DRAIN FIELDS
i11
D/W
LLC
272-8211
HYLEN CREST #1, BLOCK 1, LOT 1
LAWRENCE & HAE IWAMOTO
21042 UPPER LOWLAND AVENUE
EAGLE RIVER, AK 99577
w
0
3
w
F-
rn
SWING TIES
CO A B
FC 7.4 28.6
T7 10.5 27.7
T2 16.5 25.3
DC 18.6 25.4
DV 20.3 25.5
EDC 21.4 28.7
MT 27.2 24.8
Ur ....�l'� 10/17/11
iy�Q'too Scale
*. 49TM '*�� P.I.D.NO
_ 50-472-87
Steven R. Pannon e" PERMIT N0.
)Imo. CE 8149 XXXxxxxxx
s r
Nl�\ �`=` ` Sh1eOF 1
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP111213
Tax Code Number:
05047287000
Work Type:
Septic Upgrade
Permit Effective Dates: August 19, 2011 to August 18, 2012
Design Engineer:
PANNONE ENGINEERING SERVICE
Subdivision:
HYLENCREST #1
Site Legal Address: HYLEN CREST #1 BLK 1 LT 1 G:0057
Owner/Address: IWAMOTO LAWRENCE A & HAE S
21042 UPPER LOWLAND AVENUE EAGLE RIVER AK 995779110
Site Mailing Address: 21042 UPPER LOWLAND AVE, Eagle River
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy
Lot Size in Sq Ft: 20004
Total Bedrooms: 3
N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the some day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
�E
k))ej
Community Development Department Phone: 907-343-7904
Development Services Division \ Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dara Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. tom" 4f7z- 4S7
Property owner(s) L- P_C-✓ 4!9 (Wh*oro Day phone
Mailing address Z4oqZ k)PFtFZ "uju 9o,1D AVC., E,91I lzUvc-�R,
Site address '2-toyz o PP62 4 a- x .gb 4U4
Legal description (Sub'd., Block & Lot) U`?GjmiJ GRIST 1#(� 5LKl , 1-671
Legal description (Township, Range & Section)
Lot Size Z6,00!V Sq. Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR: THIS APPLICATION IS AN:
(0 all that apply)
Initial ElAbsorption Field ❑
Septic Tank Upgrade
Holding Tank ❑
Renewal ❑
Privy ❑
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
Permi Rush Fees: f - Waiver Fees: _
Date of Payment: l l°t I I Date of Payment:
Receipt Number: Receipt Number:
Permit No. ('D 17 i 1\'D- 1 'J Waiver No.
GA13uilding\0n Site\Forms\Client FormsTermit App_010411.doc (Rev. 1 /11)
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve(anpaneneak.com
August 18, 2011
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
Anchorage, Alaska 99519
Subject: Hylen Crest #1, Block 1, Lot 1
Emergency Septic Tank Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this
lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is
developed. The existing septic system was designed and installed for a three-bedroom house and
is operating adequately for three bedrooms. The existing steel 1000 gallon tank is collapsed. The
damaged tank is exposing the raw sewage to the environment. The existing tank will be filled
with clean gravel or concrete and abandoned per code. The surrounding lots are served by public
water, and there are no wells within 100 feet of the proposed septic tank. This lot is served by
public water as well. PES will verify all required separation distances at time of installation.
1. Upgrade Tank Design.
a. See Sheet 1 of 1 of the plan set
2. Surface Water: There is no surface water within 100 feet of the proposed system. The
proposed systems will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: Lot 5 slopes from north to south at approximately 4% in the area of the
tank replacement. The proposed installation will be located in the central portion of the lot next
to the existing septic tank and absorption system.
Mailing: P.O. Box 100217, Anchorage, AK 99.51.0 0217
Physical: 615 Cast 8Z" Ave, Cuite B6, Anchorage, AIC 99503
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing
lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you
have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mailing: P.t), Box 1.00217, Anchorage, AK 99.510 021.7
Physical: 615 East 82i° Ave, Cuite B6, Anchorage, AK 99503
Telephone: (907) 272-8218 FAX: (907) 272-8211
3
UPPER LOWLAND AVENUE
15' T&E EASEMENT DRAIN FIELD (E)
27LFx2.5'Wx7'EDx10'TO
NEW1000g SEPTIC TANK
WITH DOUBLE CLEAN OUT
AND DIVERTER VALVE
DRAIN FIELD (E) CONNECT TO BOTH DRAIN FIELDS
73LF x 5'W x 2.5' ED x 5' TD 7.1 3
EXISTING 10009 5.0
COLLAPSED SEPTIC TANK D/W ;
ABANDONED PER CODE 36R of
>
HOUSE
(E) Q
3
w
V)
N
2 1
o�
NOTES: '.�``OF A �i Date
PANNONE ENG SVC, LLC
EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 `qt�,l+ 8716711
PHONE (907) 272-8218 FAX (907) 272-8211 irg'�Py+r Scale
�.... .. ... .... P.I.D. NO
HYLEN CREST #1, BLOCK 1, LOT 1........ .... 050-472-87
LAWRENCE & HAE IWAMOTO r tven PannonePERMIT No.
j
21042 UPPER LOWLAND AVENUE �+t CE 8149 xxxxxxxxx ,.
PLAN EAGLE RIVER, AK 99577��1 `=`�' Sh;etOF 1
Municipality of Anchorage Page of 7—
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 93 00) PID Number: OSO 4:�Z$i"
Name: Lawrence, _Tw2rv,c,4o
Wastewater System: ElNew Upgrade
Address: Z1047. (> ,,, 1..� 1�,., a �v�e. C �z
ABSORPTION FIELD
Phone:
No. of Bedrooms:
3
U+►t�E `t' stvc q
El Deep Trench [I Shallow Trench El Bed El Mound Other
LEGAL DESCRIPTION
Soil Rating:
0.8
Total Deptt, from original grade:
� 4p 9 O
GPD/Sq. Ft.
V�ti
Lot: Block: Subdivision:
I
Depth to pipe bottom or inal grade:
9
Gravel depth beneath pipe
)*-v.,' -X1-1
Ifrom
V.-mel,4 ! 6 Ft.
2.51 Ft.
Township:
Range:
Section:
Fill added above original grade:
b
Gravel length:
'73#
V l Ft.
Ft.
WELL: El New El Upgrade
Gravel width:
S
Number of lines:
Distance between lines:
—'
Ft.
Ft.
Classification (Private, A,B,C): otal De
W
Cased To:
Total absorption area: -7„
Seo
Pipe material:
fzg)<D 't>3034
Ft.
Ft.
EFF�_?2:S1Vf: SQ. Ft.
Driller: �\ Date Drilled:
Static Water Level:
Installer:
�� ��^1
Date installed:
S-11-93
�j
Ft.
Mm M
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
L
It
Hol
ing
Public/Private
Manufacturer:
A-y
Capacity in gallons:
/066
From
Tank
Field
Sta
ion
T
k
Sewer Lines
c_`\ar:2 e
��
o
-I ZAO
, "
i'�0C7
Material:
Number of Compartments:
Z,
iNot l ert
�+
Surfac
LIFT STATION
Watee
LotZ7'
,
'v
r
Size in gallons:
Manufacturer:
Line
Foundation
1 Z,
"Pump on" level at: "P evel at:
High water alarm at:
Curtain
4--,o t
* SOS
Pump Make & Model
Electrical Inspections performed by:
Drain
Remarks: a,�k r e l2ce��ev i c}io,,
BENCH MARK
1 ,, YIDS 1
Y"2Ne,a1Q,p Rqv Yi
Location and Description: L
l�c'vecai c�v��!ew Z 1 �,h�Y� v�c2 �Wv 14.
j4�
We, 5 9_J
Assumed Elevation:
100 Ft.
Aw.
I-
Inspections by: C°�`$�`'u�+'�S C`''am Dates: 1st sem- 9�
y w a
�
performed
�M4•Rs'N�lB+E£3e M1l4�wNs
�{
�) 2n S-10-93
Z- 93
w No. 1732-1
��� 1,'5►Jens 2&, 1S�ri
Department of Healtfy Huma approva
o
tNk-�
.Services
lVAL
Reviewed and approved by,�'��/ Date:
72-013 (Rev. 9/91) MOA 25
Permit No. 93-00 1
Page Z' of Z
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L-� I Bk i t�j Leh cye.T+ +1 PID No.: 0So4_t Z-82
R
o
Ar r y
22 Rot(
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w two G T*NY
low G Ar.cn rnwk. �K c '
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l a� J
.1
�I
�ir,+�51'�'FD Grtl+De
SGAI.L , t = 30 V ; T. V4 t �yC FRi2RI,.
EL2 I bs. 0 6 a
�j &L6V Id3e
FIN\SH lD G<'APt FINN 51*%V G¢Av!r, [.Ew v �_ —....
PutToR S
O�L
OA PE t Zi G 5 M+oL4 2:S 2.T
�GSl"T6 Yh 0,1K
'7R�Ncl1 ��r+°t" sew�rt. Rock
Oke 89' r
IL
- i
:�. o
C - Lw I Oil AL
Livfy �nV/ J V �.�• �•��. ��
`Lw S�6 C -Lev P.wZ �✓ "�'"
�Dd .6 _, /� Is�cu.t0. �,� '. • ••t•,•ewo�e•w�r.•p••• w
�Lr�V 9491 : MCS. 1732.6
June 22 1469 •', ,�
NTS L. A►A1.
72-013 A (2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930011 DATE ISSUED: 2/05/93
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 2/05/94
OWNER NAME:IWAMOTO LAWRENCE A & HAE S
OWNER ADDRESS:21042 UPPER LOWLAND AVE
EAGLE RIVER, AK 99577
PARCEL ID:05047287
LEGAL DESCRIPTION: HYLEN CREST #1 BLK 1 LT 1
LOT SIZE: 20020 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECOMMEND TRENCH LENGTH OF 75'. DESIGN TRENCH LENGTH IS
MARGINAL FOR THIS TYPE SOIL.
RECEIVED BY: �Aj DATE:
2 I id
ISSUED BY: _^��-'�r��x�s�' `` DATE: _
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
�t CIVIL ENGINEERS
January 19, 1993 (907) 694-2979
A FAX 694-1211
�4CE HI V E R,
HEALTH AUTHORITY ec.c a ii. Anchona
APPROVALS Munip y a � 9
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Stteet
P.,,O.; Box 196650
SEWER &WATER
Anchorage, Atka. 99519-6650
MAIN EXTENSIONS
REFERENCE: Lot 1; Btock 1; Hyten Crust Subdivision, Unit 01
We %equest you .i3.6ue a penm.c t to upgnade the septic 6y6tem se%ving
SEWER & WATER the negenenced pnopenty.,
INSPECTION
The existing system is .in a state o6 4aitune and .i3 encn.oaching
poundwaten., 0 , p p `
t..t/J
ENGINEERING STUDIES This pnopenty iz 3e4ved by Munic spat wate%C.I There ane no wri
AND REPORTS within 200' of proposed upgnade.,
We do not anticipate any advense e66ects on ne.ighbojc i.ng pnope4tiea
by the .instaUation ob the propozed aseptic syestem.,
WELL INSPECTION
& FLOW TEST 14 you have any questions, oh nequ.ine additional .injonmatc:.on 6ok
yours nev,iew, please contact u.6.
S.incenely,
SITE PLANS �2��
ROAD DESIGN ROGER J., SHAFER, P.,E.,
RJS/tv
SOIL TEST
PERCOLATION
TEST
STRUCTURALS
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
c
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N
0
m
l" = 30' UPGRADE
SCALE —
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STEWART DRIVE
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rani �
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, 41V41
OF A
••'IENGIh&ERI
i • —r a7.ie:a r ••
Municipality of Anchorage e•oees.• .•.1is�
DEPARTMENT OF HEALTH & HUMAN SERVICES •� ••••• • "• •(
825 "L" Street, Anchorage, Alaska 99502-0650 ®cr ; ROGER J. SH)
I '• No. 8 15
SOILS LOG — PERCOLATION TEST �,,�'•.._
p� I
-W
PERFORMED FOR: �r�r•^�—� \ �\WI�TO DATE PERFORMED:_
LEGAL DESCRIPTION :�CYr 1 L, Township, Range, Section:
I}!�U�k SLOPE SITE PLAN
.'`�
2 Y, a �l P'( N
3
4 u
o . � SP ,� I Lt �t�T S „--� ►� �,
5
%ter R -A• � F L
Z.
6 s 1
7-
8-
9
89
10- WAS GROUND WATER
ENCOUNTERED?
11 �o
IF YES, AT WHAT �^ O
.t' DEPTH? 1N P
12 E
�� Depth to Water Atter l
13 Monitoring? �Z Date:
14 • -\2,,,0i-1 .
15-
16-
17
51617
18
19
20
COMMENTS
* '
Be s
Reading
Date Gross Net
Time Time
Depth to Net
Water Drop
``
d 4-•1t-A.�l. t 6
3
20-Y711►s
JILP-
ILy
�9IV
<v
? y
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER N
TEST RUN BETWEEN FT AND S FT
PERFORMED BY: S & S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loo Rol '3
ACCORDANCE WITkjoj1 �as�Ca � PL L IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
� ERU, Inc.
HYLEN CREST WATER UTILITY
P.O. Box 141907, Anchorage, Alaska 99514-1907
Phone 561-5411 or 333-7517
Febuary 2, 1992
Marie Fried
Drinking water manager
Southcentral regional office
3601 "C" St, Suite 1334
Anchorage, Ak. 99514-1907
Re: VOC water sampling
Dear Ms Fried
FEB d 4 1992
Please be advised ERU, Inc., has transferred their
utility to AWWU, and we have abandoned the wells.
Sincerely,
'4 /V-1AL
Charles Hylen, President
ERU, INC.,
FEB 6 1992
DEPARTMENT OF
EW AI CONSERVATION
0
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
November 29, 1991
Mr. Chuck Hylen
ERU, Inc.
Hylen Crest Water Utility
P.O. Box 141907
Anchorage, Alaska 99514-1907
WALTER J. HICKEL, GOVERNOR
563-6775
Subject: Well Abandonment, Hylen Crest, Class A Public Water System (PWSID
Number 213289), Eagle River, Alaska, ADEC Project Number 9221 -DW -
026
Dear Mr. Hylen:
This is in response to your submittal, received in this office on November 20, 1991. 1 have
reviewed the information that you have provided and several design references that cover
well abandonment. The method used to abandon the existing eight and six inch source
wells to conforms with the references noted in 18 AAC 80.015 (d),(3). Thus, the
abandonment of both wells is approved by this Department.
Thank you for your cooperation with this Department. If you have any questions or need
technical assistance, please do not hesitate to contact me.
Sinc
erely,
45eL44AO
Keven K. Kleweno
Environmental Engineer
KKK/cf
cc: Lynn Cochrane, SCRO/EQ/DW
RF/MEQ,
Properties, Inc.
Each Oth" Independenj / Owned and Operated
257.0138
2600 Cordova Street, Suite 100
Anchorage, Alaska 99503
Chuck Hylen Office: (907) 276-27
61
®� ____ Fax: (907) 276-44299
Associate Broker -J MLS Residence: 333-7517
November 18, 1991
RU, Inc.
CREST WATER UTILITY
07, Anchorage, Alaska 99514-1907
ne 561-5411 or 333-7517
i
-644
Mr. Keven Kleveno
Ak. Dept. of Natural Resources
Division of Land and Water Management
3601 "C" St. Ste #322
Anchorage, Alaska 99503
Re: ERU, INC., well abandament
Dear Mr Kleveno
The wells have been abandoned, which were located
at Lot 4, Block 3 Hylen Crest Subdivision, Stewart
Drive. The pumps were pulled and wells filled.
Enclosed is a letter from Alask Now -Well, Vern's
Drilling & Enterprises, who did the work.
Our water system was turned over to the Anchorage
Water and Wastewater Utility.
If you have any questions, please give me a call
Sincerly,
dz."� ��
Chuck Hylen, President
ERU, Inc.
NOV Z 0 1991
DEPAR MENTOF
MAID af?'.1%CONSERVATION
{ ADO
0 0
Alaska Now -Well
Vern's Drilling & Enterprises
12241 Avion Street
Anchorage, Alaska, 99516-2136
(907)345-4417
November 13, 1991
Date Work Performed: 1 1-12-91
Work Performed for:
E.R.0
P.O. Box 141907
Anchorage, AK 99514
Type of Work Performed: Bentonite Grout Sealing of 8" and 6" Water Wells
and Permanent Steel cap welded in place.
ra3�
Location:_Hylen Eie e located in Eagle River, Alaska
r Procedure: 8" Well (Total Depth: 330") was filled with clean sand to within
1 1" from Top of Casing. Sand fill was chlorinated at this time.
Bentonite Grout was mixed and pumped (from trailer mounted Portable
Grout Machine) into well to fill casing. A steel cap was welded in place at
this time to completely abandon well,
Procedure: 6" Weil (Total Depth: 308") was filled with clean sand to within
15" from Top of Casing. Sand fill was chlorinated at this time.
Bentonite Grout was mixed and pumped (from trailer mounted Portable
Grout Machine) into well to fill casing. A steel cap was welded in place at
this time to completely abandon well.
Work Performed by
0
Vernon L. Nowell, Owner
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
PHONE
CRN EW
`
Gy
l i'7S)
❑UPGRADE
MAILING ADDRESS
Bv;K eSL —7 _ '5' c —
LEGAL DESCRIPTION
j
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well
Absorption areq,
Dwelling !�
&
PERMIT NO. n
UY
��� ��`��
�
d4
a Q
Manufacturer
CJ�'F-
Material
No. of compartments
LU I..
V)
Liq. capacity In gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
pJ�Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Z
02,4
Manufacturer
Material
Liquid capacity in gallons
=
DISTANCE TO:1,
Well
Foundation f
Nearest lot line
PERMIT N0.
L)
C�
No. of lines
Length of each liv
2
Total length of lines
"%�
Trench wi th
Distance between lines �/
1—
inches
�4
I,_
Top of tile to finish grade r
Material beneath tile
Total effective absorp 'on area
C' inches
�.,,,
Length
Width
Depth
PERMIT NO.
UA
0
Qh
WCrib
p
Type of crib
Crib diameter
depth
Total effective absorption area
Lu
DISTANCE TO:
Wall
Building foundation
Nearest lot line
.jClass
Depth)Driller
Distance to lot line
PERMIT NO.
W
\ S
?2< ati
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
-" V
PIPE MATERIALS
P VC
SOIL TEST RATING
461
INSTALLER $�
REMARKS
IN
YX
e;
'Aoborl J
;<
Flo.
APPR ED DATE LEGAL
CV / (nuv. 01 /6)
MUNICIPALITY OF ANCHORAGF
Department f Health and Environments Protection
825 L Street, Anchorage, AK. 99501
264-4720 ^
�9
Permit 6;1 # # HANDWRITTEN PERMIT fWE AND/OR ON-SITE SEWER PERMITApplicant: 6/4 O ku.)- Mailing Address : T (� -e�f' .'4
Location:pp / Phone Number:
G'
Legal Description: " ! ��s, pd� Lot Size:.
Type of Soil Absorption System s:
Trench: _Z__ Drainfield: _ Seepage Bed:_ Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 12- %L
The Required Size
eeJof the Soil Absorption System Is:
/
DEPTH / LENGTH -Z / GRAVEL DEPTH_ / WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
# # REQUIRED SEPTIC(N tDtNG) TANK SIZE. COO GALLONS �" #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# # # TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) Iwill stall the system in accordance with codes.
(3) I un er that the on-site sewer system may require enlargement if
th re i remodeled to include more that boom
Signed: Issued by: ✓(\
licant
Date
r
SWP/024(1/81)
// i
i -. .] �� y �) X SOILS LOG
MUNICIPALITY OF ANCHORAGE
I • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: c�t'7 t-C?'-[�� C`•`,�Z_��. �0 f , DATE PERFORMED:-(()
LEGAL DESCRIPTION: Z-017 rAlL ala k��
qE T SLOPE SITE PLAN
(F � k.fk I cue- e� 011,) to
,r
2
3
4
5
6
7 /
8
9
10
11
12 `
13
14 i�j� r'i e✓ •—z
16;
Z + +
17 r r
r;
Si
i'
19 ''
20
�t
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER S
ENCOUNTERED? f a L
O
P
IF YES, AT WHAT E
DEPTH?
tq
L
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
�(minutes/inch)
—//FSAND e FT
DATE:
r
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
o5a 4,4 zo+ HAA# 0 Lt`1
1. GENERAL INFORMATION
Complete legal description L I iS( AAc�14-(
Location (site address or directions) Z )o47- C eelly LowtDn')Ave.
Property owner L'zwvrr,C-0 -T\,Va O a Day phone
Mailing address C)ue L -o
Lending agency Day phone
Mailing address
Agent _
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 \t
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
r
72-025 (Rev. 1/91) Front MOA 921
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U33NION3 AS NOLLOUSNl d0 LN3W31'
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L 1 r31 14�-1 le -n cmi4 fl-( Parcel I.D. Oso 4 -1 Z��
A. WELL DATA
Well type
Log present(Y/N)_
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
I I
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller _
Cased to Casing height
Wires properly protected (Y/N)
`�Ni
�M'UjRp C;{°Ai��Y
E7' q
� � q(SFRI/ CSU,GF
1 V416vy
.. R ;n-
FROM WELL LOG
g.p.m.
�/
Pump eve L,/
SEPARATION DISTANCES FROM WELL TO: j)!
IIQ
AT INSPEOTION
Septic/holding tank on lot ; On adjacent lots _
Absorption field on lot ; On adjacent lots —
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank
WATER SAMPLE RESUL
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
Collected by:
Other bacteria
Date installed M 1993 Tank size ovo Compartments Z
Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N)
High water alarm (Y/N) rte' Alarm tested (Y/N) t
Date of pumping new Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ry A On adjacent lots
To property line Z } Absorption field 6
s
Surface water/drainage 4 Z-00
Foundation --
Water main/service line
s'
N
72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTA
Well on lot
D. ABSORPTION FIELD DATA
— Manufacturer
Manhole/Access (Y/N)
mp off' level at
Cycles tested
LIFT STATION TO:
On adjacent lots
Surface water
Date installed 19 93 Soil rating O.8 System type w ��`TYe Bch
Length Width S Gravel thickness Z Total depth
Total absorption area (:fFe<TwV S-70 S Cleanouts present (Y/N) Y
Depression over field (Y/N) Date of adequacy test N S ter
Results (pass/fail) for — bedrooms
Peroxide treatment (past 12 months) (Y/N) I If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot av 3 On adjacent lots 4-,?,,� Property line
To building foundation 2 To existing or abandoned system on lot
On adjacent lots—4 Z5 Cutbank + ) oo Water main/service line
Surface water _r ° Driveway, parking/vehicle storage area
FZS'
Curtain drain 4- S01
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection
I ri J' S
Signature C70�s `��
Engineer's NameBwddu WQ-Y2 u }b.c}\rnznfc
Date S /✓'–%7° h� ta.rr32-€: 4�r-r
HAA Fee $ 7U Waiver Fee: $
Date of Payment �� fl(� 1��/ Date of Payment
Receipt Number °� T�9� ( %yzS Receipt Number
72-026 (Rev. 3/91) Back MOA 21
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services Mfr
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # HAA # A 11--\S9
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal pescription (include lot, block, subdivision, section, township, range)
T i a r--)
Location (address or directions) 11
(b) Property owner -�� a� Telephone: (home) � 9�% �3A�usiness
Mailing Address
(c) Lending Institution C 17W /�_ (�!_ Telephone
Mailing Address
(d) Real Estate Company and Agent '-
Address i� �3 i SOS ycJ �9 S6
Telephone �� 60—
(e) Mail the HAA to the following address: (or check here Or if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17094 Eagle
Eagle River, Alaska 49577
2, TYPE OF RESIDENCE
Single -Family P<
3. WATER SUPPLY
Number of bedrooms 3
Individual Well ❑ Community Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
Z ;o 3 abed MOUS (981L A98) M -U
•�aoM s,aaauibua leuolssa;oid aql ui
suoissiwo jo saoaaa aol alglsuodsaa lou si abeaogouy jo Alpdioiunw aql •panssi si aleoilpoo a aao;aq 101ep GZAIvue ao
suoiloodsui lonpuoolou op SHH4 to saaAoldw3 •sluawaainbei alels pue lejapal uieliaoApiles olaapio ui suoilnlllsui
6ulpual aiayl pue sawoq }o saase14oind of Asalinoo a se s114l saop SHHa 9141 Te SVly ;o OWIS 9141 ul paaalslbaa
aaauibuo leuolssapid luapuadapui ue Aq anoge 9 gdej6eaed ul uaAib suoileluasaidai a14l uodn Aluo paseq poleoi;iaao
lenoaddV Aj!aoylny 14lleaH sanssi (SHHa) saolAaaS uewnH pue 1411eaH to luawlaedar] abeaogouy to L(lllediolunn a41
Nounv0
leuolllpuoO
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lenoaddy leuoll!puoO;o swaal
panoiddesla panoaddy
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ssaippy
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aubgdalal
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pue ledlolunW Ile 14l!M eouelldwoo ui sl walsAs lesodslp aalumalsem ao/pue Alddns aal10M al!s-uo a14l 'uolloadsul
pue uo1l10b1lsanul Aw woil pue salg abeaogouy ;o A1!lediolunlry 9141 wool poulelgo uollewiolui a141 uo paseq
110141 ApJOA a914lan; ! •uiejeq paleolpul ainlonjls }o adAl pue swoojpoq to aagwnu aqj jo; alenbape puu leuollounl
'ales sI walsAs lesodslp aaleMalseM ao/pue Alddns jaleM ails-uo 9141 110141 sMOgS IeAoaddy Aluoglny 141POH
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NOIIVWIdOdNI ONV VIVO `HOHV3S Slid `S.M.L `SNOLLOUSNl ONIdIAMId WHIR ONI833NION3 '9
MUNICIPALITY OF ANCHORAGE (MOA) a
Health Authority Approval (HAA))NICIRALrry&edk&W�FEBRUARY 1984
IRONMENTAL SERVICES DIN"744
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
RECEIVE D
Date Completed
Electrical Wiring in Conduit (Y/N)
Legal De cription: �
-i
Depth of Grouting
SEPARATION DISTANCES FROM WELL:
If A, B, C, D.E.C. ApprovedaN) /
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot I -t%?' I,4' ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot �14'. ; On Adjoining Lots
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
To Nearest Public Sewer Cleanout/Manhole
Water Sample Test Results
Comments I?t .�S 117 'LI�Z£3y
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed 7 Size etc" No. of Compartments
Standpipesd N) `- —Air -tight Caps:TZN) ��Foundation Cleanout(�DN) Y
Depression over Tank (Y(W 7AXI
o Last Pumped g " -7
Pumping/Maintenance Contact on File (Y/N) rA ; for
Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) P
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 112� 1'� To Building Foundation
I
To Property Line- Ta -t-- To Disposal Field —
To Water Main/Service L,i,no�
��
To Stream, Pond, Lake or
Comments
or Drainage Course
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 22� t"A& • Type of System Design
Date Installed — ` �� Length of Field 2a 1
Width of Field
Depth of Field
Gravel Bed Thickness f
Square Feet of Absortion Area �1 a� Statndpipes Present!5?N)
Depression over Field (YJ§P Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well t To Property Line l `y
To Building Foundation . "2-:;, To Existing or Abandoned System on
Lot
To Water Main/Service Line
— ; On Adjoining Lots 30
1
1 a To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course - 1 aC.--> 1
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date In led
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
L
Dimensions
Manhole/Access (Y/N)
"'Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at -
Pumpin les during Adequacy Test.
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 & 5 ENGINEERING
17034 Eagle River Luvp mood No. 204
CompanyEaUlz 7
Date /1O
MOA No. C
Receipt No. �l L1,90 /6f?
Date of Payment 10.2 V—
Amount: $ 1�e /a7
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
STEVE COWPER, GOVERNOR
3 a BF a s a
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
October 20, 1989
Mr. Roger J. Shafer
S & S Engineering
17034 Eagle River Loop, Suite 204
Eagle River, AK 99577
PWSID: #213289
563-6775
According to the records on file in this office, the Hylen Crest
Subdivition Water System is in compliance with the State of Alaska
Drinking Water Regulations.
Sincerely,
Vera E. Craig
Environmental Field fficer
VEC:bas
b
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION�� (-J- Z
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL Ng' . Qa��
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date —MaY 15, 1987
1. GENERAL INFORMATION
(a) Legal Description (include lot, b&qk, subdivision, section, township, range)
Location (address or directions)
2.1007 UPPER LOWLAND AVENUE. EAGLE RIVER
(b) Applicant Name _Audrey Mason Telephone: Home n/a Business 694-4200
Applicant Address P.O. Box 772849, Eagle River, Ak 99577
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other KK (explain);
![) - • • • • :III:F.'1[H�iI•llF�`•1►[•!'J1�►/!V [•j'J�K• : • - - • • • •
Addresslie
(e) Real Estate Company and Agent RFMAX OP RAGTR RTVRR A71W- AUDRRY MASOM
• :.•. i • P.ArTT.T?. IRTIM.R, AK99577
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-FamilyZ Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well ❑ CommunNM 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
OnsiteM 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)
W/l0 930-ZL
Z 10 Z abed
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all ui suo!ss!wo ao sjoaaa Aol a!q!suodsaa lou si a6eaolouy to Apedioiunn all 'panss! si oleo!jpoo a aaolaq ejep azA!eue
Ao suo!joadsui jonpuoo lou op d3H4 to saaAo!dw3 •sluawaa!nbaa ejels pue !eaapal u!elaao Appus 01 aapao u! suo!ln1pu!
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NOIIVWdOdNI ONV V1VO `HOHV3S 3-1Id `S1S31 `SN0003dSNl ONIOIAOad Wald ONIa33NION3 '9
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF 264-4720
> NVIRONMENTAL SERV CES O VIS L `e"
�al Description:
MAY �
A. WELL DATA 51987
RSec /�fitia»�ti��
Well Classification �''" " E� IQA B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed Yield
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
B. SEPTIC/HOLDING TANK DATA
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
Date
Date Installed Zy7 3 Size Ayo S 1-1E, No. of Compartments -3-
Standpipes (Y/N) i Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) u ��
Depression over Tank (Y/N) All Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) i�gE ; for ✓✓/G
Holding Tank High -Water Alarm (Y/N) _��15 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well
To Property Line
To Water Main/Service Line 7"/" �
To Building Foundation
i
To Disposal Field
Course '%4
Comments __ W/V If
Page 1 of 2
72-026(11/84)
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata �5 0��� Type of System Design Tri
Date Installed fy� 3 Length of Field 65
Width of Field S / Depth of Field %
Gravel Bed Thickness /
z i y /<g,
Square Feet of Absorption Area f,�' � Standpipes Present (Y/N)
Depression over Field (Y/N) Date of Last Adequacy Test ✓C�/`/�7
Results of Last Adequacy Testr�k
Separation Distance from Absorption Field:
To Water -Supply Well a "
To Building Foundation
Lot
'261,
To Water Main/Service Line "/o "
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments6�-7'h>j?
(w)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) —
Comments
To Property Line S r.�� /� s6 0* 6�4�—J
To Existing or Abandoned System on
On Adjoining Lots f �a
To Cutbank (if present) —
ce. s2g.✓ �Ae--
r
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
** Check Permitted Bedroom Rating Against HAA Request **
def
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all_ MOA and HAA guidelines in effect on the date of this inspection.
Signed � �� - Date S/,l
Company �S MOA No.
/ (]
Receipt No. V ' 0 2
`
Date of Payment
Amount: $ / ip �s
Louis A. Butera a �w�
CE -6736020
��
Page 2 of 2 Eagle River Engineering Services �1Fa��®
0°° a
.ao=°
P. 0. Box 773294 �V4 ROFESS1��g�'
Eagle River, AK 99577
72-026 (11/84) 694.5195
� r-) F / STEVE COWPER, GOVERNOR
L S N
EDIIJ7f. OF II'.1'�VAHON NZ1JNTA L CONME!,Rf+'ATI ON Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
DATE: 1Iay 13, 1987
PWS I.O.# 213289
To Whom it May Concern:
According to records on file in this office the Hylen Crest
Water Regulations
Water System is in compliance with the State Drinking
Sincerely/,
Cory Ti11lis, R.S.
ADPL[ ',Ni FILLS OUT UPPER SIA 'ONLY
Time
Property,Owner 1 �QClt/Ii J-',./l.�7-YL;/_" CU/','�%/•v. rY��✓Sr,f /Cf/C,/(/Phone
Mailing Address Zip Code ``c%s
Buyer/.' Cr_%!k/-ot?
Date
Address Zip Code
Date
Lending Institution
Phone
Address Zip Code
Realty Co. & Agent [>AQ i•�1GACu'ti'/'iA._7<,r JAr r Y� z/C_
Phone
Address %i✓!a�'/: N ]'tom (�1,.�r/=fes' Zip Code 94 S" 7 7
6 9Y-
Legal Description U bC./: /i H Y/ r=Ay r5 5r- SU
(�
Street Location
Type of Residence
_G\am' -T�
Occ"
x"Single Family
MUNICIPALITY OF Af,I
PEP T. OF
❑ Multiple Family No. of Bedrooms_
❑ Other
Water Supply
❑ Individual �C pj6+ 0
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
>K Community •kJ
For wells drilled prior to that date, give well depth (attach log
if available).
Public Utility
( ) DISAPPROVED
Sewer Disposal
Individual Year Individual Installed:
CIPublic Utility When Connected to Public Utility: L1
f0 -:2((-S-3
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
(�
Field Notes:
_G\am' -T�
Occ"
MUNICIPALITY OF Af,I
PEP T. OF
0/�
HP,LTFI�
\LT[ j
ENVIRO\',,ILNTAL PROTECTIO(q
e3n,�
kECEIVED
( APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
f0 -:2((-S-3
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received of /f,
Septic Tank Size o
{ Z Z
t
Well to Tank