HomeMy WebLinkAboutHYLEN CREST #3 BLK 2 LT 13Municipality of Anchorage1
Page 1 of 3
Community Development Department -MAY 3 0
On -Site Water & Wastewater Program 2019
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number. OSP191120 PID Number. 050-474-44 ❑ New ■ Upgrade
Name: BRIAN KRAFT
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ound
Address:
10330 STEWART DRIVE, EAGLE RIVER, AK 99577
❑ Other
Phone: No. of Bedrooms:
Soil Rating:
Total Depth from origin de:
850-797-5523 4
GPD/Sq. FL
Ft
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
Grave pih beneath pipe:
F
Ft
Subdivision: Block: Lot:
Fill added above original grade:.,`
Gravel length:
HYLEN CREST S/D #3 2 13
.\�\'°
Ft
Ft
Township: _ Range: - Section: -
Gravel width: !Beds
�/ FL
Number of lines:
Distance between lines:
Ft
SEPARATIONDISTANCES
Total absorpt area:
Number of trenches:
Dist between trenches:
To
Septic
Absorption
Lift
Holding
Public/Private
From
Tank
Field
Station
Tank
Sewer Lines
SQ. Ft
Ft
Well
PUBLIC
-
25'+
TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other
Manufacturer.
INFILTRATOR
Capacity
1530
Surface water100'+
z
-
-
Gal.
Lot Line
5'+
_
N/A
Material:
Number of compartments:
IX
HDPE PLASTIC
2
LIFT STATION
Foundation
10'+
-
-
Curtain Drain
10'+
-
_
Manufacturer.
C
Gal.
Remarks: REQUEST UPDATED AS -BUILT SURVEY BE WAIVED FOR
'Pump on' level at
'Pump air level at
High water alarm at
THIS PROPERTY SINCE THE TANK IS NORTH OF THE EXISTING
Pump Make & Mode,
Electrical Inspections performed by:
DRAIN FIELD/S AND THERE ARE NO ENCROACHMENT CONCERNS.
PIPE MATERIAL
House to tank D3034) Tank to D304
dralnfield
Installer
(NEW)
WILCO EXCAVATING
Drainfield EXISTING CO/MT D3034
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
100.00 Ft
Inspection
Location and Description:
Dates: 1 St 5/3/2019 2nd -
3rd 4th -
SIDE MAN DOOR THRESHOLD
Community Development Department Approval
ENGINEER'S SEAL
lw.••
444
OF
Conditional approval: Date:
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Inspection Report _1-1-12.doc
OSPI91120 RECORD DRAWING
KEY BOX LOCATION
�- PER AWWU DRAWINGS
FCO 13.0 30.5 �-
ST1 14.4 33.9 -
ST2 15.4 41.4
DBL1 17.7 47.9
DBL2 18.5 49.0
FS 19.3 50.1
ASSUMED LOCATION
OF WATER SERVICE LINE
LOT 14, BLOCK 2;
HYLEN CREST #3
NOTE THE OLD 1000 GALLON
AND 500 GALLON SEPTIC TANKS
WERE DECOMMISSIONED PER
UPC PER THE CONTRACTOR
LOT 9, BLOCK 2; /
HYLEN CREST #3 /
N
SCALE:
1"= 30'
1984 TRENCH.
CURRENTLY
PARCEL ID NUMBER:
050-474-44
STEWART DRIVE
-INSTALLED
DOUBLE
CLEANOUTS
(DBL1 & DBL2)
EXISTING CLEANOUTS— /
INSTALLED FLOW SPLITTER (FS) /
1992 TRENCH. /
PASSED ADEQUACY /
LOT 10, BLOCK 2; TEST ON 4/16/2019 /
HYLEN CREST #3 / LOT 11, BLOCK 2;
/ HYLEN CREST #3
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GARNESS ENGINEERING GROUP, Ltd
- ---- _-- — - CIVIL & ENVIRONMENTAL ENGINEERS ---
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE: www.gamewengineedng.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
BRAIN AND GINGER KRAFT 850-797-5523 2 OF 3
PROJECT/LEGAL DESCRIPTION: - DRAWN BY: - - -
HYLEN CREST S/D #3; BLOCK 2, LOT 13 J.L.M.
TYPE OF WORK: DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE 5/28/2019
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15' TELE. & ELEC. ESMT.
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Hours
I
NEW 1530 2 -COMPARTMENT
FCS INFILTRATOR SEPTIC TANK
-INSTALLED
DOUBLE
CLEANOUTS
(DBL1 & DBL2)
EXISTING CLEANOUTS— /
INSTALLED FLOW SPLITTER (FS) /
1992 TRENCH. /
PASSED ADEQUACY /
LOT 10, BLOCK 2; TEST ON 4/16/2019 /
HYLEN CREST #3 / LOT 11, BLOCK 2;
/ HYLEN CREST #3
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GARNESS ENGINEERING GROUP, Ltd
- ---- _-- — - CIVIL & ENVIRONMENTAL ENGINEERS ---
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE: www.gamewengineedng.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
BRAIN AND GINGER KRAFT 850-797-5523 2 OF 3
PROJECT/LEGAL DESCRIPTION: - DRAWN BY: - - -
HYLEN CREST S/D #3; BLOCK 2, LOT 13 J.L.M.
TYPE OF WORK: DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE 5/28/2019
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#AECC884
PERMIT'NUMBER: PARCEL ID NUMBER:
OSP191120 RECORD DRAWING 050-474-44
IN
IN
STI rFINAL GRADE = 96.24-96.51
ST2
GARNESS ENGINEERING GROUP, Ltd
---- -- -- --_=_� CIVIL & ENVIRONMENTAL ENGINEERS, --
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907)338-3246 * WEBSITE: www.gamessengineering.mm
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
BRAIN AND GINGER KRAFT 850-797-5523 3 OF 3
PROJECT/LEGAL DESCRIPTION:---------- - DRAWN BY: -
HYLEN CREST S/D #3; BLOCK 2, LOT 13 J.L.M.
TYPE OF WORK: DATE:
-._ RECORD DRAWING OF SEPTIC TANK UPGRADE 5/28/2019
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LICENSE,,"Sa, •
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5/3/I?
MUNICIPALITY OF ANCHORAGE
\ On-Site Water &Wastewater Program S.;
PO Box 196650 4700 Elmore Road .
Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997 r
http://www.muni.org/onsite
\, cpartmcnt
4 RPV
On-Site Wastewater Disposal System Permit
Permit Number: OSP191120 Effective Date: 4/25/2019
Work Type: SepticTank Upgrade Expiration Date: 4/24/2020
Tax Code Number: 05047444000
Site Legal Address: HYLEN CREST#3 BLK 2 LT 13 G:0057
Site Mailing Address: 10330 STEWART DR, Eagle River
Owner: KRAFT BRIAN CLIFTON Lot Size in Sq Ft: 20004
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field C✓( Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
41
Received By: Date: *
Issued By: = Date:
4/
6789z0
MUNICIPALITY OF ANCHORA
• a APR 2 2 2019
•, f!
:E Riln.
Community Development Department Phone: '' -343-7904 ti
Development Services Fax: 9k z; 4 -7a n�
On-Site Water & Wastewater Program 5 8 L g
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 05�s 'L/94- c/cl
Property owner(s) BRIAN AND GINGER KRAFT Day phone 850-797-5523
Mailing address 10330 STEWART DRIVE, EAGLE RIVER,AK 99577 —
Site address 10330 STEWART DRIVE, EAGLE RIVER,AK 99577 _
Legal description (Sub'd, Block& Lot) HYLEN CREST#3; BLOCK 2, LOT 13
Legal description (Township, Section & Range)
Lot Size _ Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial Single Family (SF) M
Absorption FieldU ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D)
Renewal
Holding Tank ❑ Multiple Dwellings
Privy (SF and/or D)
Private Well
Water Storage
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
NONE Distance: - —_
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: o2/ Waiver Fees:
/
Date of Payment: ` / -'/9 Date of Payment:
Receipt Number: n 6 1X2 Receipt Number:
U
Permit No. -- SP`/J71/ a° Waiver No.
(Rev.01/11)
Quanics
t j AcM,ncxi Treatment System
G�rhr,
GARNESS ENGINEERING GROUP, Ltd Dealer
ENGINEERING SALES CONSULTING
April 19, 2019
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic Upgrade for Hylen Crest S/D #3; Block 2, Lot 13
To whom it may concern:
The referenced property has a 4 bedroom residence that is served by public water and a
private septic system. The septic system consists of a 1,000-gallon septic tank, 500-
gallon septic tank, and two (2) deep trench type drainfields. The 1 ,000-gallon steel septic
tank and the original deep trench were installed in 1984; and the 500-gallon steel septic
tank and another deep trench drainfield were added to the system in 1992. We have
recently performed a septic adequacy test on the 1992 trench and found it to absorb 600+
gpd. The 1984 trench was found to be surcharged. Due to the age of the septic tank/s,
the owners would like to upgrade their septic tanks. Attached is a design drawing showing
the proposed septic tank upgrade. We are proposing that both septic tanks be excavated
and decommissioned per UPC in place or removed offsite, and a new 1530 2-
compartment Infiltrator tank or a 1250-gallon steel septic tank be installed in the same
area as the old septic tanks. The contractor shall verify if an Infiltrator tank can be
installed. The existing septic tanks have 3' to 4.6' of cover over them. The grade on the
northern portion of the new tank may need to be lowered in elevation by 8-10" in order for
a plastic tank to be installed.
We are unaware of any adverse impacts this installation would have on adjacent wells or
septic syst. s. If you have any questions, please contact us at 337-6179. Thank you
for your . : stance.
Sint erel I,
1.
J, ;7/`' G.rness, P.E., M.S.
Pre••ident
3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179`Fax: (907)338-3246*Website: www.garnessengineering.com
I ` \
KEY BOX LOCATION _
PERAWWUDRAWINGS �-�,�
\\ STEWART DRIVE
GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER
THAT PERTAINS TO THIS DESIGN.BY PROCEEDING ..,
FORWARD WITH THIS INSTALLATION,THE
ENGINEER,WELL DRILLER,CONTRACTOR AND I
PROPERTY OWNER AGREE THAT THEY HAVE •
READ THESE SPECIFICATIONS AND AGREE TO . ° .. .• —.
ACCEPT THE TERMS AND CONDITIONS OUTLINED. I
•'' 15'TELE.
&ELEC.ESMT.
APPROXIMATE LOCATION f pSClis
OF WATER(SEE NOTE)
`• 1-
.
. z
w
\.. • . . • .. f
LOT 14,BLOCK 2; w
Cn
HYLEN CREST#3 • ;,
0.
• 1
• ° •
>I
EXISTING 1000 GALLON AND % R
500 GALLON SEPTIC TANKS TO
3'.
BE DECOMMISSIONED PER UPC r
Ibl
NOTE:IN ORDER TO INSTALL A iris
INFILTRATOR TANK,THE GRADE fX(Sr/N j ' °'
ON THE NORTH END OF THE 4 EEp G C
TANK WILL NEED TO BE HQV QQM a(~n
LOWERED SO THAT THERE IS SE 11 = r w
0
NOT MORE THAN 4 FEET OF PROPOSED 1530 2-COMPARTMENT U z
COVER.SOME TREES MAY ."). :; INFILTRATOR SEPTIC TANK OR w
HAVE TO BE REMOVED WITH �FOQ 1250 GALLON STEEL SEPTIC TANK I-›-
THIS Polk
INSTALLATION. j/�
`I`I`kl1, �J'•jj
N-
INSTALL DOUBLE CLEANOUTS
LOT 9,BLOCK 2; / � '
HYLEN CREST#3 /
/ o
/ 1984 TRENCH. iiii*ia4ri
/ CURRENTLY M7
/ SURCHARGED
/ EXISTING CLEANOUTS/ /
/ INSTALL FLOW SPLITTER /
/ 1992 TRENCH. /
SCALE: /
)jk
PASSED ADEQUACY /
LOT 10,BLOCK 2; TEST ON 4/16/2019 /
HYLEN CREST#3 / LOT 11,BLOCK 2;
/ HYLEN CREST#3
1"-30 //
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GARNESS ENGINEERING GROUP, Ltd '9 '`•
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CIVIL& ENVIRONMENTAL ENGINEERS immonok /........,r •• •
wwm
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337-6179•FAX(907)338-3246'WEBSITE:w .gaessengineenng.com •
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: /• A.Gam:ss �/
BRAIN AND GINGER KRAFT 850-797-5523 1 OF 1 �#J,'••� f CE- • • •J
# 9,i•
PROJECT/LEGAL DESCRIPTION: DRAWN BY: #♦ • )2- .�.•<c, .•
HYLEN CREST S/D#3; BLOCK 2, LOT 13 J.L.M. # FO••"'•p"l�JC�•�•••••(`'� , �.
TYPE OF WORK: DATE REVISED LICENSE�,I1 ;S`1:10,4\•
DESIGN OF SEPTIC SYSTEM UPGRADE 4/24/2019 #AECC884
DRIVE
THE ]NFORRAT]QX HEREON IS
FQR YHE USE OF LEND]N6 INSTITUTIONS SPEG]FIDALL7 TO SHOP 4NI
C6NF LICTS BE TYE EN E%I STIXG GF0.UCiURES AXO PLRTYED LOT LINES AND IOR EASEMENTS; AND IS
Nils SO BE UGEk FOR POSLTlONING ADDITIOXAL STRUCTURES, IRPR9V ERENYS, OR FENCELINES.
EASEMENTS OF NE [ON O, OTX ER THAN THOSE APPS ARl XG ON iNE RECORD PLAT ARE NOT SHOYR
HEREON C UNLESS INDICATED)
NOTE: FENCELINES THAT NAM APPEAR ON THIS DRAWING ARE NOT TO HE USED TO DETERfINE
PRDPERTT LINES OR POSITION ADDIiIONAI INPROVENENTS.
AXT PAVIXE SH0Wi1 HEREON RAY BE. APPR0 XEXATE DUE TO EXCESSIVE SN" ANDIOR ICE.
38
d
0
F3
2
AS -BUILT SURVEY
140 CORNERS SET TIES DATE
'4 '.0F A
A
. 49 !H*'
H
9 O
SHANE A HOLT
P
LS -6914
a44pvp ''•-�....-� rb d
�ii�n r®a mi0na
1" = 30'
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOHING DESCRI8ED PROPERTY
LOT 13, LU OCK ' t,'Y2 EN CAFSf UNIT 3
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACMIENTS
EXIST OTHER THAN NOTED.
DATED AT ANCH0RAGE,ALA5KA THIS k TN DAY O=
APRIL - _ , 3919
+"4195 M 197-:0
HOLT LAND SURVEe:N.<'
9389 GROPER DRIVE
ANCHORAGE, AIC 94597
345-5533
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~1~.~'~_ I~ PID Number: O-~)4'"'~'~
Name: "~Upg rade
~~ ~. ~~ Wastewater System: ~ New
Address:
j~~ ~~~~, ~~ ABSORPTION FIELD
LEGAL DESCRIPTION SoilRating: ~.~GPD/Sq. Ft. Total Depth from original grade;
Lot: j ~ Block: ~~Subdivision:~~ ~Depth 1° pipe b°tt°m fr°m °riginal grade~%,~ Ft. Gravel depth beneath pipe~;~¢lFt.
Township: Range: Section: Fill added above original grade~ / , Gravel length:
~t. t~/ ~t.
Number of lines: Bistsnce between lines:
WELL: ~ New ~ Upgrade Gravel~:¢ t~, ~ / Ft. J ~ ~ Ft.
Classification~~l~ ~(Private' A,B,C):i~ Total Depth: Fi. Cased To: Ft. Total absorption area~ ~ SQ, Ft. ~ipe material:~~~J~
Driller: Date Drilled: Static Water Level: installer: Date installed: I
Yield: Pump Set at: I Casing Heighl Above Ground:
GPM Ftd ~,.~;..~ ~ TANK
SEPARATION DISTANCES ~.~ic ~ Holding u S.T.E.~.
MFnufacturer: /Capacity in gallons:
To Septic Absorption Lift Holding )ublic/Private ~ __ ~__~ __~ __
~r~m Tank Field Station Tan[ Sewer Lines .
Surface
w~t~ 1~ 1~o~+ ~- __ ~ LIFT STATI
Foundation ~ ~ / ~ ~ ~ "Pump on" level~~p off" level at: High water alarm al:
CurtainDrain ~~ ~[~~ Pump M~el ~ ~ctri~l Insp~spe~formed by:
Remarks: ~%i~t~ ~¢¢t~ ~ ~ BENCH MARK
~~<~ Location and Description:
~ ~¢¢~ ~~~ ~[~. Assumed Elevation: ~ O~~ ~,
Inspections performed by: ad, Nob~s: ls~ ~1 ~>""'m"""~"'"'¢'"' '.__/
Department of Health~ ~n Ser~s approval ,~:¢~, ~...~.~
Reviewed and approved by:
72-013 (1/91)MOA 25
Permit No. ~1,'~ ~ "~-~ h~-~ Page ~ of
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:'J~'_~/L-~----h~ K'~--~..~J~'~, '~L~~, ~ ~'"~ID No.:
72-013 A (2/91) MOA 25
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:SW920188
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:DERRER DAVID H &
OWNER ADDRESS:10330 STEWART DR
EAGLE RIVER, AK 99577
PAGE 1 OF 1
DATE ISSUED: 7/16/92
EXPIRATION DATE: 7/16/93
PARCEL ID:05047444
LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK
13
2 LT
LOT SIZE: 20004 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 1
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS UPGRADE MUST BE INSTALLED IN ACCORDANCE WITH THE
APPROVED ENGINEER'S DESIGN DATED 7/13/92.
RECEIVED BY: (] C (~7~ ~
ISSUED BY: .. · .....
/
DATE:
pality
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DI:S[GN
ROBERT SHAFER, P.E.
ROGER SHAFER. P.E.
July 13, 1992
CIVIL ENGINEERS
(907) 694~2979
FAX6941211
of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
REFERENCE: Hylen Crest #3, Block 2, Lot 13
Request you issue a permit to upgrade the existing trench
serving the referenced property to a four bedroom capacity.
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be adequate for
a three bedroom house.
A test hole was excavated and a percolation test performed in
the area of the proposed upgrade and proposed alternate site.
Attached is the proposed upgrade design with an alternate site
depicted.
The lots in this area are served by a Community Water System
and there are no wells within 200' of the septic upgrade. We
do not anticipate an adverse effect on the surrounding
properties with this septic upgrade.
If you have any questions or require additional information
for your review, please contact us.
Sincerely,
ROGER J.
RJS/LSU/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG B PERCOLATION TEST
LEGAL DESCRIPTION: L,,-/'~
-- SLOPE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
~,~ ~,cTownshJp, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~)
DEPTH? p
E
Depth to Water Alter~,=~.~
Monitoring? Date: "~ -~ ~::~ ¢
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE \-c~
TEST RUN BETWEEN z~
__ (minutes/inch) PERC HOLE DIAMETER __
__ FT AND . ~ FT
COMMENTS
PERFORMED BY: S & $ ENGINEERING ~ "~ ~--~/I/'--..) CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204 V "~.--I
ACCORDANCE WIT~t'.~,,~T~,~{~,/~$1~II~P/,~'t- GUIDELINES IN EFFECT ON THIS DATE. DATE:
1--
72-008 (Rev. 4/85)
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
MAILING ADDRESS
LEGAL DESCffilPTION
LOCATION ~ NO, OF BEDROOMS
Well ~ ~bsorption area Dwelling PERMIT NO.
2~ DISTANCE TO: ~¢~ '~ ¢~ 7~ ~ / ~
~p~ ~ Manufacturer ~ ~ Materi&l~*~/ N°' of ~partments
Liq. capacity in gallons Inside length Width Liquid depth
/~ ~ ¢ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
o~
~ ~ Manufacturer Mater'iai Liquid capacity in gallons
~ Well ~oo ~¢, Foun~ ' Nearestlotline PERMITNO.
~ ~ DISTANCE TO: ~/~ o~
~ No, of lines Length of each line / Total le~gth of / Trench width Distance between lines
~ ~ ~ Top of tile to finish grade /,~
~ _.¢~_ ~.Z(.(¢. Material beneath tile ¢ inches Total effective
Length Width Depth PERMIT NO.
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
t~ Well Building foundation Nearest lot line
~ DISTANCE TO:
j Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PI PE MATER IALS ~ ]~
INSTALLER ~
);.. .... ,, ./ , ......
APPROVED DATE LEGAL / ~¥'¢'X ,
I0 6 ~'f ~3 ~/~ Q y/k/~
72-013 (Rev. 3/78)
fl""ql LJI JJ"',,.ll ][ EZ:: ][ IF:::" J¢::'a IL_. i]ii "]1'-""~ .... CD il::::::~ ~!cr~ li'",a iL'Z: ll,'ql J[Z]J It':::;i;: ~!?.::~ [I]!!!ji
glir:~f::'(~tR]'Ml}::]',J]- 01::' HIZAL.TI'"] AI',JD ENVII~;:C)NME~NT~I..
8,::..,.~ L STREE'T', ANC',HE)F:~:A[~)E, AK 99',5C~1
26/I,.-..472,()
!2} IP, dl ..,.. ',F::~; ]1:: '"ir"' IIiL~Z ~,:~!!~; IEE: b,,,ll IEZ: ll::::~:'. F:" ll, iiiii~: IF:~ii I1'""'11 ~: '-II ....
RAN(91E:x 1W
sys'Lem~ Choose the opt J. OFi l:,.J'lc:t', bes'L f its; ye, ur' s:i. te.
"qF IF~;'. II,!!Z: IP,,.II t"] ...... It....U :E3: Eiii:: ]lT) I, ,~ml :U]::]:I, ~"'":",. ,-.~J,"' ]I:: II",,ll
DEF::'TH · '1'C) F']:F::'E B(gTT(]M (F::'T.) 4,, 0 4. () 4,, 0
GRAVEL. DEF:'TH (F:'T,,) b,, () C),, 5 3,, 5
'I"C)TAL.. DEF:'TH (F'mT',,) 1(),, () 4,, 5 '7,, 5
GRAVEl.,.. N ]: DTH (F:'T.) 2,, '5 , 2(),, 0 5,, ()
GRAVI~].._ VOI...mUMI~Z (C.U. YDS ,, ) ~c?. 5 32 ,, '7 46 ,, 7
TANK S I ZE (GAL..S) J. ~ O()C~,, 0 '~"~' 1 ~ 00(),, ()
Bt::) :( I_ F;:AI" I NJ'3 (SG] ,, F:"l"~ /BR ) ~ ~ ~
-. I ':~t11.. tiU,~I I AVE. Al I...._.A,.. I I,h.J .,C.)llf AF,,IlIILI,II,..
Forth I::)y 'Lhe Mun:i. cipal:i, ty c)F An(:::hc)r~age (MOA) and the S't. at(.:~,) (::)f' Alaska.
c:J :J, ~'[..atl"lC::E~% {' r'om any ex ist :Lng va.::,)1 ]., b~ast, ev~ater' d :Lspc)sal ~systx.'.:.xn or' pub :1. :Lc
se,,,x~magfz~ system c)n th:i.s c)r' any adjac:c)rrl:., or r'i(xJarby
4,, I urJch:.~vstar~d that 'Lh:i.s permit is valid f'of a max:i, murn of' 3 I:)(~,~dr'(:x::)ms~ .am)d
WILl_ NOT BE AFq::'R[)VED WI'I"I-IOUT AN ELECTRICAL. INSF:'ECTION RE:PORTs AND (3)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGA: DESCmPT ON:
1
2
3
4
5
6
7
~0
~.
17
SOILS LOG
PERCOLATION
TEST
DATE PERFORMED:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~1-.~ IS.
O
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
CERTIFIED BY: '~5 DATE:
72-008 (6/79)
°`
Municipality of Anchorage ; o me
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997Department
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: 141135
PID#: 050-474-44
COSA#: 141196 Permit#:
Legal Description: Helen Crest #3 B-2 L-13
Engineer: PES
Applicant: Warren Dobson
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is;� feet. P�
a -o - iernC. y/z3�,Az
Zol1
a 5�
This waiver approval applies to the existing absorption field only. Any future upgrade to the on- V
site wastewater disposal system will require all separation distances be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
............................................... ■ ............................. ■ ■
Waiver is Granted: X Waiver is not Granted:
Date: _ ',2 7 — / Approved by: /v
evi er
............................................. .. .. .....................
Parcel I.D. 050-474-44
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION:
Expiration Date: C.7,d I %, o)M_o
Complete legal description HYLEN CREST #3; BLOCK 2 LOT 13
Location (site address) 10330 Stewart Drive *Eagle River
Current Property owner(s) Ginger Kraft Day phone 850-797-5523
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class_Well
Public Water System
WaiverNariance request for:
Received by:
4
Day phone
TYPE OF WASTEWATER DISPOSAL:
❑
Individual
❑
Holding Tank
❑
❑
Community
❑
®
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
nce:
COSA # 0 S C a 111 SSL 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.
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:rf'3`'I =i
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 11��
2_ System #1 Approved for -1 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
,,,
4 1
r f ffrd
A. GyP/ness ••.
79 ;3 Z`G
... J. °o
#AECC884
tOF
ON-SITE
with the followinulm
R AND
r
S'LLopt)--+-, =4 WAST`=V..!ATER 3
etc 4-D be qo; ng --`f' rau�1\('y 1�e 2 �� v � ,(� PROGRAM
\hese 1S V\n rel-1-LIL eA RQnarcMaY1 4-44\,P, J///i.�Lh�. GCJO���`
Y_ !4/ j))�KNi�
o
By: _ _ �i,C�('� �C� �X 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 X Nitrate Advisory
Septic System Advisory X Arsenic Advisory
Well Flow Advisory Other
Z4 1 `l/`
COSA Checklist
Legal Description: HYLEN CREST #3; BLOCK 2, LOT 13
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ 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) 2 years
Tank type/material SEPiIGHOPE
Parcel ID: 050-47444
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes X 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
AWWU WATER
Measured operating fluid level in septic tank 46.25°
❑ Standpipes/foundation cleanout per rec rd drawing
Date of pumping `6f4f2$=/ ` '7-V
D. ABSORPTION FIELD DATA TRENCH
Which system tested (date installed) 7/22/92
A-1 ALL standpipes present per record drawing
Total measured depth from grade 9.5 ft (max)
Measured depth to pipe invert from grade *2.08 ft (min)
❑ N/A — pressurized field
❑■ Monitor tubes go to bottom of effective. If not, state
depth into effective
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Adequacy test date 4/13/21
Results QPass For 4 bedrooms
Fluid depth prior to test 42 in
Water added 758 gal
New depth $1 in
Elapsed time 125 min
❑ Code -required soil cover over field Final fluid depth 53 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE
date of test) N/A
Gallons introduced N/A gallons If yes, enter date
Comments/Deficiencies: '1992 TRENCH IS INSULATED PER INSPECTION DRAWING -SEE ATTACHED EMAIL ABOUT FREEZING.1984 TRENCH WAS FULL UPON ARRIVAL
COSA Checklist yellow sheet
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 ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ❑ Yes
if No ft
❑ 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
❑ Yes
if No 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'
❑✓ Yes if No ft
Property Line > 5'
0 Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓ Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No ft
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 ft
Surface Water > 100'✓0 Yes if No ft
F. ENGINEER'S COMMENTS
*1984 TRENCH IS UNDER DECK (SEE PHOTOS - ADDRESSED ON
2019 DESIGN DRAWING). **WR#141135 STATES THAT TRENCH IS 5' FROM LOT LINE, BUT AS -BUILT
SHOWS THE MEASUREMENT CLOSER TO 3'. AN MOA DRAINFIELD ADVISORY NOTICE IS RECOMENDED.
oo6�O �
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with p 9 y �O
MOA COSA guidelines in effect on this date. * 00
0
J fGarr
Qpr A. ;ess: � 9 C — c�op�
el
COSA Checklist yellow sheet �a pr o f e s sloe,
0
#AECC884
Septic System Absorption Field Advisory
Certificate of On -Site Systems Approval 1# OSC211189
Subdivision: Hylen Crest #3, Block: 2, Lot: 13
During the absorption field adequacy test, the observed level of standing water in
the absorption field indicates approximately 86% of the absorption area is
inundated. Although this system passed the adequacy test, the remaining life
expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Maden Address P .O Box 196650 * Anchora a Alaska 99519 6650 *www mum org
g. __ n m
Erik Widger
From: Ginger Kraft <kraftfamilyl @yahoo.com>
Sent: Friday, April 16, 2021 4:08 PM
To: Erik Widger
Subject: Septic info
We have no knowledge or experience of our septic having any problems with freezing. It has and continues to
work efficiently.
Ginger Kraft
10330 Stewart Dr
Eagle River, AK 99577
Sent from Yahoo Mail for iPhone
__--- DRIVE --
N,376"
3!500
L , 5g68
Fe�P DECK
r7 i
DECK oti
WOOD CRIS
TO LOWE DECK
LEAN - TO
DECK V
O 26.3 � •
o DECK c DISTANCE TO HOUSE
v 14.6
PORCH
UPPER DECK
OCKPATIO V�82-5'47„ °D
NOTE l4iIS400
55' TO UPPER DECK
68' TO LOWER DECK
DOCKDIMENSIONSARE FOR LOWER DECK NO TE. L0WERDECK ISAT30"ORLESS ABOVEGRA DE
N 89 56'45" W 14.38
rrrrr»•rnscrrrr•�irer.���i�y
�P0
,CO.. 49 TH
*'
o
N SHANE A. HOLT ,e�G
LS -6914
Q4a a o
s Sio nab foo
AS -BUILT SURVEY 1"
= 30'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 13, BLOCK2, HWLENCREST UNITS
THE INFORMATION HEREON IS
FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
ANCHORAGE RECORDING DISTRICT, ALASKA,
AND THAT THE
CONFLICTS BETWEEN EXISTING
STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
VISIBLE IMPROVEMENTS SITUATED THEREON
ARE WITHIN
NOT TO BE USED FOR POSITIONING
ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF RECORD, OTHER
THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
EXIST OTHER THAN NOTED.
HEREON ( UNLESS INDICATED)
DATED AT ANCHORAGE,ALASKA THIS 26TH
DAY OF
NOTE: FENCELINES THAT MAY
PROPERTY LINES OR POSITION
APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
ADDITIONAL IMPROVEMENTS.
APRIL , 2921
ANY PAVING SHOWN HEREON MAY
BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
74195, FB 197-40
345-5513
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # L"'3~("') - L-['"~L/- L\L/
1. GENERAL INFORMATION
Complete legal description
Lot 13; Block 2; Hylen Crest
Location (site address or directions)
Property owner
Mailing address
10330 Stewart Drive
Eagle River~
Scott & Lisa Thurner
AK
Day phone 694-6449
Lending agency
Mailing address
Agent Carol Bennett / FORTUNE PROPERTIES
Address 2525 "C" Street Suite 100 Anchorage,
Day phone
Day phone 265-9113
AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public Sewer
NOTE:
XXX
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
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and re~.g~a~,~.~t on the date of this inspection.
Name of Firm 17034 Eagle E!ve.r Lo_o_p..E~oa~'~ Phone .~,4Z'_ ~-~ '~ ~'
EagJe River, AlaSK
Address ~
Engineer's signature ~
Approved for ~'?-t~'~%.// bedrooms.
Disapproved.
DHHS SIGNATURE
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ~,.-~ ~-~t.~-,..~' 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 engineeCs work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage /~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL OHEOKLIST
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
A. Well Data
Log present (Y/N)
Cased to Casing height
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot "~
Absorption field on lot
Public sewer main
Sewer service line
Wires properly protected (Y/N)
g.p.m.
AT INSPECTION
; On adjacent lots
g.p.m.
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
B, SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (~/N)
High water alarm (Y/N)
Date of pumping
Tank size
Foundation cleanout (~N)
-~6 D~,~.--- Compartments '~5'~o'~d-
Depression (Y/~ /-~(
Alarm tested (Y/N) ~
Pumper ~;-~J¢ ~voW~__~ %P~I ,C~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ \ ~ On adjacent lots
To property line \ ,~\ j¢ Absorption field
Surface water/drainage \ ~ o
Foundation
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
~.__..---~-'
Size in gallons Manhole/Access (Y/N) ....~-~
Vent (Y/N) "Pump on" level at "P~vel at
High water alarm level .~t~s tested
Meets MOA electrical codes (Y/N) ~
SE~STATION TO:
We'll on Ici On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
Length ¢,?~,c~ ~/,~ ~ I Width
Total absorption area ~::~'~'~
Date of adequacy test ~"(1 -'~'7~/1~ P~;~ Result~fail)~,,~'~ ~,~¢~ --',~. ?~¢-o¢c,¢.¢1~
Water level in absorption field before test After test
Peroxide treatment (Pest 12 months) (Y~ ~ If yes, give date
Soil rating (GPD/FF) % ~, c'~'~'/F-~ System type
Gravelthickness ,~t /7,S..~ Totaldepth
/
Cleanout present ,~JN) ',// , Depression over field, (~
, ,,d¢~ . -r~edrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots '~ \ .:,u. Property line
¢-~ ¢% VSg~ To existing or abandoned system on lot
Cutbank ~ lA-- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have che~nformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature /7 /
Engineer s Nam~,~ F .~1. River Loop Ro~8 1~', 204 .
Date Eagle ~ver, Alaska 99'¢77 ,, , ~ d~ ' ' : '
HAA Fee $
Date of Payment
Receipt Number
Waiver
Date of Payment
Receipt Number
72-026 (3/93)* Back
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
1. GENERAL INFORMATION
Complete legal description
Lot 13; Block 2; Hylen Crest Subdivision Addition 113
Location (site address or directions) 1O.:L:~0 S~wa~ D~x'u¢.; Eagle. Riv~; Alaska
Property owner
Mailing address
Dave and sue Derrer Day phone 696-3084
10330 Stewart Drive, Eagle River, Alaska 99577
Lending agency
Mailing address
Day phone
Agent Margaret Goche/FORTUNE PROPERTIES
Address 3000 A Street, Anchorage, Alaska 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WAI'ER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone 562-7653
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72-025 (Rev. 1/91) Front MOA ~t21
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.
17034 Eagle Rivet' Loop Roa~ Ne, 204
Eagle River, Alaska 99577
Phone
Name of Firm
Address
Engineer's signature
bedrooms.
DHHS SIGNATURE
Approved for
Disapproved.
conditional approval for
Date
bedrooms, with the following stipulations:
Additional Comments
By:
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.
72q325 (Rev. 1/91) Back MOACI21
Legal Description: /~.¢-'~%-\'2~ ~(.-'?.-- ~¢'~ Pj._arcel I.D.
A, WELL DATA .
Well type ~/'~' ~' ¢~ If A, B, or C, attach ADEC letter.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Date completed
Cased to
ADEC water system number
Driller.
Casing height
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well flow
Pump level
g.p.m,
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot "~,~J
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots _
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
SEPTIC/HOLDING TANK D_A~A
Date installed
Cleanouts~l)~/
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping ~::~l'~¢t~- ~1 / -'~-"-¢:~. (--~ ~',.~"~::~J
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
72-028 (Rev. 3/91) Front MOA 21
Tank size ~
~,,~!..-,
Foundation cleanou~) y
On adjacent lots
Absorption field
Compartments
Depression (Y<~-~
Foundation '¢~
Water main/se~ice line \ ~ -A~
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
S u rface water
D. ABSORPTION FIELD DATA
Date installed ~/ ?-~ ~1~ Soil rating ~¢ ~ Systemtype~/~
Length ~ /Width ~ Gravel thickness
¢ I
Total absorption area ~ ~ ~
Cleanouts presen~N)
Depression over field (Y~ ~ Date of adequacy test
Results ~fail)~ ~ ~ ~ ~~ for
Peroxide treatment (past 12 months} (~ ~ If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ On adjace_nt lots. ~:~:~ ~ ~ Property line
To building foundation ~ ~Y-5~'F, /¢/E~' To,existing or abandoned system on lot
On adjacent lots
Cutbank Water main/se~ice line
Su~ace water ~ ~ I~ Driveway, parking/vehicle storage area
Cu~ain drain ~oA~ ~~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o.<~t%~.~ data of this inspection.
~. . 17034 ~agle River Loop Road No, 2~ ~¢q',"' ~,t~J~;~ o,~ ~,
HAA Fee $ / '7
Date of Payment
Receipt Number
72-020 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONbfENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1o General Informat:[on Application Date ~-¢
(a) Legal Description (include lot, block, su~bdivision, section, township, range)
Location (address or directions)
. . o,
(b) Applicants Name ,/DC~?2~: :]C-::'-:p' Telephone- Home Business
Applicants Address ~.~?~; (~-v 3~f - ~:~%'.~ ,+.5~
(c) Applicant is (check one) Lending Institution
Buyer ~ ; Other :~ (explain);
(d) Lending Institution .~,'
(e) Real Estate Co, & Agent ~'--~-.~>.-z~
(f)
~--~ ; Owner/builder~ ;
Telephone
Telephone
Mail the HAA to the following address:
Multi-Family ~ Other (describe)
2o T~..e of Residence
Single~FamiJ
Number of Bedrooms
3o Water.~.$~.~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status,
4o Sewage Disposal
Onslt'~: Public ~.]: Community ~I Holding Tank :~[
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
Engineering Firm Providing Inspections~ Tests~ File Search~_ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein° I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site w~ter supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection°
Name of Firm ~'/¢ /~,/er /~-/~'~,~,~,~¢
Address ~ .~ P ~_ ~ ~
(ENGI~ER S~L)
onm~ approva~ ~'~
Approved for //!'~W_ bedrooms By
Approved ~ Disapproved~ ~Oition~l
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF [~ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEILAL AND STATE REQUIRE-
MENT$o EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY O~ ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19--84
Well Classification ~'~,/~,r.~' .~
Well Log P~esent (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wining in Conduit (Y/N)
Separation Distances frcm Well:
To Septic/Holding Tank on Lot
To Neanest Edge of Absorption Field on Lot
To Nearest Public Se~r Line
C leanoat/Manhole
Water Sample Collected By
Watch Sample Test Results
C~,Ler~ts
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH ALrl~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
If A, B, o~ C, D.E.C. Approved(Y/N)y
Date C~,~)leted 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
TQ Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TAN~ DATA
Date Installed /O/~o/F~/ Size /~.30~' d~//¢, NO. of C~,t~a~tm~nts ~
Standpi~s (Y~) ./z ai~-tignt Caps (~) ./ Foundation Cleanout (Y~) /
~pression o~ Ta~ (Y~) ~ ~te ~st P~d ~
P~ing~inte~n~ Con~act ~ File (Y~)~ ; fo~ ~f
Holding Ta~ High-Wate~ Ala~ (Y~) ~ ~=a~y Holdi~ Tank ~it (Y~) ~
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply Well ~-~-¢~ /-
To imfoperty Line /¢ '~
To Wate= Main/Service Line /D /-
Course /~ ~; ~f-
To Building Foundation
To Disposal Field ~- /
To Stream, Pond, Lake, c~ Major D~ainage
Co~nents
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /
Width of Field
De
Square Feet of Absorption A~ea
Depression over Field (Y/N) /~
Date of Last Adequacy Test
Type of System Dasign ~7-re~cA
Length of Field ~ /
Depth of Field / ~ / (~' ~J~e~{ ~,~e~ )
Grail ~d ~ick~ss ~ /
~ Stan~i~s ~esent (.Y~) ./
Results of Last Adequacy Test /9/;F~V Co /~/P?re~c T~"
Separation Distance frcm Absorption Field:
To Water-Supply Well .~OD ~
TO Ih~operty Line
/
TO Building Foundation ~- /
LOt ~ a
To Water Main/~=vi~ Line
To Stre~ond~ke/~ ~jo~ ~aina~ C~
To ~i~way, Pa=ki~ ~ea,
LIFT STATION /~
Date Installed
Size in Gallons
"Pump On" Level at
High Wate~ Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Map]aole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles ~]ring Adequacy Test.
Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
MOA No. ?CT ~5-- ~2.63-
HAA Guidelines in effect
Date
~..' ~
~ % % Louis A. Butera
2-15-84
SOUTHCENTRAL REGIONAL OFF ICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
RILl. SHEFFIELD, GOVERNOR
Tel~,pho~,~:: (~907)
Addros$;
274-2533
' ?:i 57. (,F~ --
PWS I.D, #
To Whom It May Concern:
According to Pecords on fi, le in this office the
Water Regulations,
Water System is in compliance with the State Drinking
Sincerely,