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HomeMy WebLinkAboutHYLEN CREST #3 BLK 2 LT 15Onsite File Hylen Crest #3 Block 2 Lot 15 #050-474-42 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211140 PID Number: 050-474-42 Dwelling: E Single Family (SF) F1 with ADU FI Duplex (D) El Two Single Family Project: El New nM Upgrade Name JONATHAN AND BRANDY RIEGLE A ORPTION FIELD EJ De Trench F-1 Wide Trench n Bed 171 Mound Site Address 10340 STEWART DR EAGLE RIVER Other Phone I Number of Bedrooms Soil Rating Total depth from original grade 'PSC H - lbVic- /SF, Ft. LEGAL DESCRIPTION Depth to pipe invert from original g de F Gravel Gravel depth beneath pipe .. Ft. Subdivision Block Lot HYLEN CREST #3 2 15 Fill added above original grade Ft. Gr h Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista e etweenlines Ft SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total — absorption area Number of trenches Dist . between fi�nnhes From Tank Field Tank Line Ft2 Well >100' NA NA NA NA TANK H Septic El S.T.E.P. 0 Holding 171 Other Manufacturer GREER Capacity 1500 Gal. Surface Water >100' NA NA NA Material Number of compartments Lot Line >10' NA NA NA NA PLASTIC 2 Foundation >10' NA NA NA L-TLSTATION Manufactur Capacity Remarks TANK HAS 2" INSULATION ON TOP Gal. DOWNSTREAM PIPES HAVE 2" INSUL Alarm location Elec-Mrca stalled by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer Eagle Glacier Excavating Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 8/3/2021 8/4/2021 dates: Location and description 2-d 3rd 9/4/202JI 411 BOTTOM OF SIDING NEAR PT A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date CO. - $4 .. . . . . . . . . . . . . . . . . I I G*u*rlbsl Date 7 Septic Systerrl/�J, No E 1 9e (9 ..... Approved Date v PROFESS00� Note: this approval does not include well permit requirements. rev VD/UZI 10) THIS PROPERTY AND ALL NEIGHBORING LOTS ARE SERVED BY A PUBLIC WATER SYSTEM AND THERE ' \M ARE NO WELLS WITHIN 200' WATER LINE IS \ SHOWN AS APPROXIMATE. \� M NEIGH2 FROM j'm— * S�vk%lk%jj M STD 41 M MOVE EXISTING TANK, OVIDE NEW SEPTIC TANK SA TED 5' A WAY FROM LD. PROVIDE DOUBLE _ANOUTS UPSTREAM AND WNSTREAM OF THE TANK EIGHBORING SEPTIC IS > )' FROM PROPERTY LINE SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,500 GALLON SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH MINIMUM 20" b MANWAY RISER SERVING THE FIRST COMPARTMENT. THE EXISTING DECK WAS REMOVED. THE HOMEOWNERS HAVE ELECTED NOT TO REPLACE IT. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Record Drawings Prepared for Jonathan and Brandy Riegle 10340 Stewart Dr, Eagle River Alaska 99577 HYLEN CREST #3 BLOCK 2 LOT 15 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 DATE: ffl'` lk\ SCALE: PID: 050-474-42 OSP211140 9/9/2021 CLT 1"=30' SHEET 2 OF 3 vao®atiq OF AV A F 49 T ®j ®.....::......... .............................e s 4•: CURTIS TOWNSENDf AN 0� �'sNo. E ' 1 1904® .� ®• ® 9 9 2c� Yr,.•• N 78°2S' 4 W11` \ / A/- 316,004 Lot 15 BK 2 3,9 �146 3.2 rn Co Septic 'Lee C; t� a -7 12'x12' Zr Deck m Q. X3.2' Frame —25' House M 3.5' 37,1, Septic ---QS MH Septic Pipes 124, 00, I hereby certify that I have surveyed the following described property: Lot 15, Block 2, Hylen Crest Subdivision Unit No. 3, Plat No. 83-114, Anchorage Recording District, and that no encroachments exist except as indicated hereon. This As -built will only show the easements that appear on the recorded subdivision Plat No. 83-114, Anchorage Recording District; under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines. 0 15 30 SCALE IN FEET 1"=30' I Surveyed: August 24, 2021 Hylen Crest Subdivision Unit No. 3 Lot 15 Block 2 As Depicted on: Plat No. 83-114 Anchorager Recording District GRID: NW0057 1100 Water Key FD RBR/PC 4? ASBUILT SURVEY Jonathan A & Brandy M Riegle 13303 Stewart Drive Eagle River, 99577 DPWI9:RVA I CHECKM: �`���rrrrrrt�tttt *: 49TH ��,'• Anthbny P. Boneto.. LS -10393 �.' lit, trssrrwpl\� APB Land Surveying 12204 East Prince of Peace Drive Eagle River, Alaska 99577 (907)227-1361 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:llwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211140 Work Type: SepticTank Upgrade Tax Code Number: 05047442000 Site Legal Address: HYLEN CREST #3 BLK 2 LT 15 G:0057 Site Mailing Address: 10340 STEWART DR, Eagle River Owner: RIEGLE JONATHAN A& BRANDY M Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: �nle_nt s - x DehMrtment 5/1312021 5/1312022 20577 ❑ Disposal Field 21 Septic Tank ❑ Holding Tank. ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15,55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shalrbe elelfher: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received & Issued By: 9 r Date: Z l r Date: MUNICIPALITY F ANCHORAGE Development Services Department 'a s Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-474-42 Property owner(s) RIEGLE JONATHAN & BRANDY Mailing address 10340 Stewart Drive Eagle River . Day phone AK 99577 Site address 10340 Stewart Drive Eagle River AK 99577 Legal description (Sub'd., Block & Lot) HYLEN CREST #3 BLK 2 LT 15 Legal description (Township, Range & Section) Lot Size 20,577 Sq. Ft. Number of Bedrooms �{ APPLICATION IS FOR: (® all that apply) Upgrade Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0 Renewal ❑ TYPE OF DWELLING: Single Family (SF) (w/wo AD U) Duplex (D) - -Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Coes. (Signature of property owner or authorized agent) El El 1-1 - -- Permit/Rush Fees: 02 Waiver Fees: Date of Payment: J/ 1 b Cl Date of Payment: Receipt Number: Receipt Number: Permit No. OS IPa 111 Ny Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211140, Deb Wockenfuss, 05/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211140, Deb Wockenfuss, 05/13/21  MUNICIPALITY OF ANCHORAGE ? DEPARTIVIENT 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 -~AME '~" ~ '~- ~;~ ~/ ¢/~ 4'~' O ~'?~-~ ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area Dwelling / PERMIT NO. ~ ~ Manufacturer Material No. of compartments ~ ~ Liq. capacity in gallons Inside length Width Liquid depth -' J ~ ~'O IF HOMEMADE: -~ ~  DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Materia] Liquid capacity in gallons ~ ~ Well Foundation / Nearest lot line ~ PERMIT NO. each line~ Total length of lines Trench width Distance between lines ~ N°'°flines / Length°f . ~ '~' I ~4 inches ~' ~ Top of tile to finish grade / Material beneath tile Total effective absorptig~ area Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line DISTANCE TO: ~ Class~ t~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL T~T RATING ~ ~ -- REMARKS ,, // / / (~ ,.~..~, 0% ~o~ . ,h" ', . ~ ~ ,,T, APPROVED DATE LEGAL 72-013 (Rev. 3/78) F:'I}.]RM ~ ]" I',1 [): DATE ISSUIED: DEI::'ARTI¥IIEN]~ OF I"IEAI~..TH AND E x V ] RONME:'IqTAI.... I ......... I-~0 ] E(.,'"F I Olxl 825 L c ........... olk~=El , ANC]"tORAGE. Al< 99501 84071 ',5 08/~2/84 C~[]N'T'~(]T I:'HOIxlE: SANDY I:::~US SO SR ]l~(]X .1.26 EEI:~ EA[:iLJS R I VIEFi:.~ AK 694-4994 9957'7 L I.E(.(} (.t I,,. DIESC;F~ IP: LOT SI ZIE: MA X LqlEDF~C)OM,t.'!~: 'L. istecl belc~w are 'Lhe~, cq:rLions available to you n de:i!iigr'ling your,:"6. pL.LL'* .... ' '" system. Cl"lc~c)se {he Ol.')'t. ion 'Ll'~at. best f its yOL.tP S J.t:.e.l,,, '"lF' IFq: lEE: D,.tt CZ: 11,--~ :liE)', E:: :l[]l, IPql ,,. :E} ~I:::;:: ¢~z~ % lt",,.ll DEPTI-] TO I:::'IF'E DDTTCIH (I=T,,) 4.0 4,,0 4.0 GRAVEl_, DI:ZF:'TH (F'T,,) 8.0 0 ,, 5 .T:!;,, ~5 'I"OTAL.. DEF;]]-.I (F'T.) :1.2,, 0 4,, ',5 '7,, 5 GRAVliii:L,. WIDTH (FT.) 2'.,, 5 :-:~2,, 0 5.0 £".';F(f,~VE~:I.. L.,IEIxlGTIq (F:'I".) x :.]:',8 ,, 0 42? ,, 0 66.0 GF/AVEL, VCII..L.Jt%~ (CLJ. YDSi,, ) 29.9 :54,, 2 48,, 8 ']"Alql< S I ZE: (BAL,.S) 1 .. 250 ,, 0 .~,.~ 1., 250 ,, 0 a-.~. 1,250.0 '~- SOIL. RAT'ING (SQ.FT,, /Big'.) 152 152 :1,52 '~-~- TAI',II< MUST HAVE AT LEAST TWO C, DMPARml]¥IENTS I cer'L:i. Fy that: :!,,, I am fam:i, liar w.i. th the requ:Lrmments fc:H" on-site sewep's and wells as se'L for'th, by 'Lhe Iqun:i. cipality of Arldgopage (ME]A) arid the State of Alaska. 2. I wi].], install the system :i.n accopdal-~C:e with all MOA codes arid pmgu:l, ationm, ar'id in c:ompliance ~J. th 'Lhe de~:Lgn cr'iterim of Ll'l~m per'mit. 3,, I w:L1], adhere t'o all HOA arid St. ai:.e of Alaska pJ,;~qu:i, pements f(:m the ~r:~'~, back d:i. star'~ces Fpo/fi aFly ex:i. si:.ing we].~, was~Le~a'Ler di~posal syst. em of public semerage myst, em on 'LIn:Ls ar any adjacent or nearby ].o'L. 4. ~ u¢~derstand {ha'L 'Lhis p(;,)r'mit is val:Ld fop a maximum of 4 bedrooms ar'n:] any enlargement ~i].l pee:lui~m an additional perm:i,t. IF:' A L. IF:'T STATION IS II',ISTAI...I..ED I1',1 Ahl AREA COVIEIq:E':D BY MOA BUIL.DIIqG 'f'HE'I'.!(J.) AN EL. IECTF~IC:AI.... F'EIRMIT AND INSF'ECT];C)N MUST BE ODTAINED; (2) AS"~'BUILTS NZL. I... NOT BE AF'F'ROVED NZTI"IOUT AN ELEC'TR:I:C,&L ]:NSF:'ECTION REF'OR'I'; AND (3) TIqE~ EL. IECTF~ICAL NORI< MLJS]" BIE DONE BY A I...ICEt',ISED ELE::CTRIC I S :1: CONE)::) DA'TE: ........ ~ ' APPL I CAN]>~..)Y i:']:~SSO ]. ,.~cflJE,) BY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PER~©LATIO~ TES~ LEGAL DESCRIPTION: 2 / 3 4 8 I ~-~ ~/~ 9 DATE PERFORMED: ~///~ ,..~/~ ,2/' IA' 5_ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2o COMMENTS WAS GROUND WATER ~ ~ S ENCOUNTERED? L 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PF~N RATE /~'~) '¢'~'~'~ (minutes/inch) TEST RUN BETWEEN ~ FT AND // FT 72-008 (6/79) � q, o8970 • u ' a , z7 Municipality of Anchorage ti ,;Y; :, ,;"s On-Site Water and Wastewater Program < n'= i " (907) 343-7904 a ;;rY Fg *< , �� n F 3 AM A 6 ti Certificate of On-Site Systems Approval c'� hs, 050-474-42 Lj - ( 7 ,�. 8 � g5 Parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description Hylen Crest #3 Block 2 Lot 15 Location (site address) 10340 Stewart Drive Current Property owner(s) William Lorch Day phone Mailing address 10340 Stewart Drive Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 .• 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: 1 Received by: +► Date: �/id/(et+ eqedCOSA to be released to the engineer,une s by the engineer. COSA Fee $ 6 ale. Waiver Fee $ Date of Payment 51 (gi Date of Payment Receipt Number 005-5&(..,2 Receipt Number COSA# 0,42(.18 1 1 ? , 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/4/2018 ��OF A(,g kkk ire,i _cooe . ' TM -....•A"-- ••.r �A 6. DSD SIGNATURE Lr 4:1:\ /`• r 1"- System#1 Approved for 1 bedrooms .Steven R...lSonnone:to j . CE-8149 System #2 Approved for bedrooms •f .• • .r _r Disapproved ��1 `�PROFESS10�t�'�+"'' Conditional approval for bedrooms, with the following stipulations: Avoti.p -Roe cfct C-4--ei cerf-:c 4-cv.-1.(c_ is 2_c.9_...y-eciAcs o-W Y OF tiG ,�J ON-SITEcp c • WATER AND R' t•©r, WASTEWATER z- PROGRAM --7By: �,1--4 (1 Original Certificate : .. r5�'-` 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 • COSA blue sheet J '- c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Hylen Crest #3 Block 2 Lot 15 Parcel ID:05047442 A. WELL DATA Well type Community If A, B, or C provide PWSID# 213289 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/23/1984 Tank size 1250gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 4/17/2018 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 8/23/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SF/BDRM Trench System type Length 38 ft. Width 36 ft. Gravel below pipe 8 ft. Total depth 12 ft. Eff. absorption area 610 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/19/2018 Results(Pass/Fail)( PASS CO For 4 bedrooms 7 �,�(gal. 51 Fluid depth in absorption field before test 37 in. Water a de gal. „ K w pth in. Elapsed Time: 240 min. Final fluid depth 37 in. Absorption rate�� j . .d. 11 9 P N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION .°0 Afr • 1 certify that I have determined through field inspections and r''g'�P'• N.4 --..1:74a. review of Municipal records that the above systems are in 0*: 49 TH 1 " -.*V conformance with MOA COSA guidelines in effect on this date. 0•••• •- • V.', Steven Pannone •"' " Engineer's Printed Name S}everi 12.•�annone CE-8149 Date 5/4/2018 ���+gs ..*.....- 4 ice COSA canary sheet_2-6-15.doc —r - > —,.. r Al q\ d • . n Al . ti, ,�A A� e bb � 1, 0 4 411 _ a ,.. ,_.. .,0 ,,, , 1 - .6 .: \� Si ' M' ----1.9'M1 ry_ 1,� / zsy U ib zzz lo' V- t!)31 M ,fib \•• ` �j-' 9 • 1 1 • . z,<- -i�r • ,Bot �yii� --QO ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 , r.. EBY CERTIFY THAT I HAVE SURVEYED THE SCALE: ��WING DESCRIBED PROPERTY: __ tOFA ' ;/C.Plel/. . C/-1.2 "i'&3`D7/.�p,P. 2 DATE• �� . '• �HAT NO ENCROACHMENTS EXIST EXCEPT AS 9 •. �r... • '� 'tTED. IT IS THE RESPONSIBILITY OF THE ' _ ; � ' 4.J H j\ fr" \ r..... . .. ..e oo v TO DETERMINE TH�:. E.Ct5'fENCE OF ANY GRIDS �, - ¢ jENTS, COVENANTS., OR RESTRICTIONS 4iy/..57 -.y,� . ‘`�r1�,"�-!DO NOT APPEAR ON THE RECORDED SUBDI- Duen. M6rk Sewer' : •a PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: /�� S !o•. LS-e 3 .-�.ATA HEREON BE USED FOR CONSTRUCTION / ,�2,,.�; s'/ S`'�.rNCE LINES, OR FOR ESTABLISHING BOUND- — ' 'h >�' ixV.:.:.-::' t+INES. DRAWN: � vow-.4, Mu.,c,P^UTY or ANCHO.^GE DIVISION OF ENVIRONMENTAL HEALTH ~ [ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 0~he~ 1~; ~R~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Sznd~ "Russo" Telephone: Home Business 69q-8200 Applicant Address 2~5 Stewart D~e ~aD]¢ Ri~ A1~2 ~77 (c) Applicant is (check one): Lending Institution D; Owner/builder ~; Buyer ~; Other D (explain); (d) Lending Institution Centrust Mortgage Telephone 561-4930 Address 4000 01d Seward Hw,y., Suite 103 Anchorage, Alaska (e) Real Estate Company and Agent N/A Address N/A (f) 99503 Telephone N/A Mail the HAA'to the following address: plckup b,y en~,lneer 2. TYPE OF RESIDENCE Number of/~dro~.// WATER SUPPLY /,~'~ Individual Well [] Commun' y~ .,..~ublic E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 (1~/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny 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 E/;CLE RI',~R ~NChNEER~q(~SERV!CE." Date/2~/g--'~' .F/',CLF' ~"rrR. ,, AK99577 P. 0, BOX 773294 694-5195 Seal Approved for ,Z~-'~l~'¢''~' bedrooms by Approved /. Disapproved~' ' ' Conditional~'~ 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) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAG.~ DEPT. OF HEALTH & ENVIRON/VENfAL PROTECTION RECEIVED Well Classification ~ ~ )~ ,¢'~ ~' "~"'" ~'? ~r. If A, 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 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 B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ To Property Line t-/~ / To Water Main/Service Line '"-/¢' / Size /,=,,.)-,5-¢ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped Oc~- ; for Temporary Holding Tank Permit (Y/N) Course /'~'¢¢ ¢ · / 5-7 To Building Foundation To Disposal Field /~/ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~""J"z' -?/~/~z' Width of Field '-~¢ '/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / To Building Foundation ~/--') Lot To Water Main/Service Line '/-/¢ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area '¢~J'"'~,"'~ Type of System Design Length of Field ~q' / Depth of Field /-~- / Gravel Bed Thickness '¢~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~-/~2 * To Existing or Abandoned System on ; On Adjoining Lots Y'-~ ~ ~ To Cutbank (if present) /~'/~ .h/o / Comments LIFT STATION /1,,",/~ 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 ** Check Permitted Bedroom Rating Against HAA Request** I certify that I h~ff..~hecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Y~--"-'-~ Date /~'//~'~ ~'~ MOA No. Company .~-~,z~, z~. Receipt No. 2d;) ~' / Date of Payment Amount: $ ~',..~'"- Page 2 of 2 72-026 (11/84) Eagle River Engineering Services P. 0. Box 773294 Eagle River, AK 99577 694-5195 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT DFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-~533 DATE: October 14, 1986 PWS I.D.# 213289 To Whom it May Concern: According to records on file in this office the HYLEN CREST Water System is in compliance with the State Drinking Water Regulations Sincerely, mes c. Allen, RS gional Sanitarian Supervisor