HomeMy WebLinkAboutHYLEN CREST #3 BLK 2 LT 16 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181445 PID Number: 05047441000 Dwelling: • Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Projectiiiiii htevy , Upgrade Name Palmer ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 10346 Stewart Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 980-6232 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot / Ft. Ft. Z fro Fill added above original grade Gravel length Township, /146 .N! ( eej,6tpage,..+S\ Section Ft. Ft. C / # Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft - - Ft. To' Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 _ Ft. Well na na na na na TANK i Septic l=1S.T.E.P. l=1Holding ❑ Other Manufacturer Capacity Greer 1250 Gal Surface Water I 1 001+ 100'+ na na Material Number of compartments Lot Line 10'+ 5'+ na na NA Steel 2 LIFT STATION Foundation 101+ 10'+ na na Manufacturer Capacity Remarks `T/�A ,!Z u 1 c(Z,Q.6 Gal 0-ML-k/ ! /� 'k ` ! Ir Alarm location Electrical installed by 1/ PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Stuart Gilbert Drainfield D3034 co/MT D3034 Inspector BENCH MARK (Assumed elevation) 100 ft Inspection 151 4/10/194/11/19 Location and description dates: 2" Back Deck 3`° 4/12/19 4.'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date Septic ,--- ��-. C Col w'z.�/�9Approve �— [.� Date b y r Note: this approval does not include well permit requirements. (Rev 05/02/18) • AS—BUILT MEASUREMENTS A B STI 14 23 ST2 21 28 DCO 25 31 SteWQ\ Drive 55j it I 15'\ifity Ease Q 15% Sio 15x Slope Pe 1 1 Line er I 1 L15 Septic 4 Bdrn I L17 Septic , fco ST1. New 1250 Gallon ST • Septic Tank w/DC❑'s .---- DCO Decommissioned Old Septic Tank -___,. PER UPC 15x Slope I I Existing 1Sj slope Trench I 1 B2 L8 Septic 15j Slope I 1 1 •".i* .lt." HYLERN CREST #3 1' 50 NORTHRIM 4,'•‘1-.. RECORD ENGINEERING * '4''' ' ' , BLOCK 2 LOT 16 PO Box 770724 <i�'' „.r.o,, t LAYOUT ' WASTEWATER UPGRADE . Eagle River, Alaska 99577 -ateyt, Aob: 907.694. 7028 V 'rIREPLACEZSEPTIC TANK 4/27/19 1424EETOC 3 DESIGN NOTES: Foundation Cleanout Elevation @ 97.5' / Tank Cleanouts Elevation @ 93.5' Fin ^ade Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal �' Elevation @ 93' "J r—� To Trench I\_ levation @ 93.x' 1250 Gallon E e tion @ 92.8' MOA-Approved Septic Tank lid Pipe Match Elevations To Existing FCD & Line NOR THRIM i~ ... . , t SEPTIC TANK PROFILE HYLEN CREST #3 ENGINEERING , Po Box 770724 !..:`.,, .11r. --1.05':‘'2:...; t • �, 1 BLOCK 2 LOT 16 Eagle River, Alaska 99577 11 907.694.7028 '4, 1l9 TANK REPLACEMENT °ot'5/15/19 fO1M" BY: SE $Cale` i• = 5 ' SHEET.3 of, 3 I SE yv�/ G70 G:cti .c+a alb la:27 ►i5 A.P Li'IER I • A6 M /G`( 0 4 re 4-‘,-- ~` .. 1 • 12 VA1\ /A( S.,,4A1...5.--. . , , 7-/OrGi. . �o • �1 . \ L ; /, ' : t wi 04 - l 7 ��tisr '`.: F1 ., !i[ 11;"I ��� X, `' •-7'pC4,vr k CV N - r NT r� I r v 4^ I.4 Vt ` blto O ;, p!t -' S, t kJ Rfro4,1 Ni,f 1. Z � . -a 1, ,ft h ... ►yw ` CO J 7 "7 -____ 0 cdP 1 --moo f de-1.01,"----6s. . L - 8 UW** NO JW31 WC:f-1 714W- M4 AS-&.&'T i7t usED•Ycr Cd1ef11000T101 OR IPR UtAi.RAN0 ld.A4D Tw* SJR vvTEA TAKES OKSRP,}rYnitmr.Ai_ TRAN43Ar1Ca7 CO4LY ANC #...1a11.3 /y(A1taAL UAQILIT°/ C14(.1' TSR TM' COf+ t. SAY. ' TM nit USTO OtSTANCES PPCEVAL CVER 9CAL140. RETIMUC11010( YIAY C L1'[ ERRORS 04 SCAL!- �y�,78015�_ Lor sWW1 SURV1"Y TTP -'""" S • A �' rvna�norl nrlwe' gET )aDAA ' M. + :.� 1 CC/40K T1 /Ir.l YT> ..s"�..iS o FOt7►+3 !CRAP •- 44 w1790 MICE C DEO( ►tOS -. . . . *SAW• .. •T :Li )oC y A37U1tEb E1IV. •M-'M--�E' PETAL ;INCE ot_40 P 11:•w • ITAI ' ---•-. =-., LV Ttt076 IN&ROKaA[HT•E AION£ OR UttO' '1VIUCE. Z t.t.�rC 1T :5 '?4E RES PONSerJTf CrINC 8U1lAE3t OR010471, QlADf Plt��►Ti4[ *WNW sn1UtS. wtil-R• TtiC THOR AP OZ,NAA J1*.IX _ 10 FTNI38ED C TO A)401j1"-'( r- i"°AND TC Dr �-• AM t401AN � pYtS WTI f'ROt•i 14, 2 »>4 ANDVLOCATt"•+ ?O F)tu5+•IED :RAr AY ia� CA MrtT7eS•'T1C7�.`E WAY PRS' 'CM T R2.'V L+fl$ O7}y�}tyAN NQT�U. 'NE 44 0 p:0 A ANY 'j 17" CORDrCMS E N4tiCN 00 ►:77 APP[AJt ON 'NE RECOftLUCJ 1lEDIvtiAC)N ILA S. All OIfTALeCICf A •rep•! y SURVEY `�,,,'� �# Robert E. Johns, Jr. t Assoc, P.07 MAX �,•.........•.,. Professional Land Surveyors . ,....,. ,�•y.,...,,. gyp,,••• 442 C. 1 I ANC w.M w�.n M AMwM lwwa OW OM 1 •//� .4 ,1,1A `� ems_ -+i M tip!Y WU....r N Y 111 w� J..• 4�, �1_ •.t KO ,O �•owl ="'...:'y.•.. tir. \, RasC7t. i. •� . . , . °r`& 1.045.1 94-171_ n w Nc,°"L_r. MUNICIPALITY OF ANCHORAGE ,,, »1 �\ On-Site Water&Wastewater Program N, , •, ,.. t ., PO Box 196650 4700 Elmore Road w .-- Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,., /- http://www.muni.orglonsite '- a.1's N '`" i Department 4,vc.OR 4 On-Site Wastewater Disposal System Permit Permit Number: OSP181445 Effective Date: 12/31/2018 Work Type: SepticTank Upgrade Expiration Date: 12/31/2019 Tax Code Number: 05047441000 Site Legal Address: HYLEN CREST#3 BLK 2 LT 16 G:0057 Site Mailing Address: 10346 STEWART DR, Eagle River Owner: PALMER JAMES &ARKELL SHEILA Lot Size in Sq Ft: 21059 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field El 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 (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 Special Provisions: Septic tank shall not be located under a retaining wall. Received By: < Date: !/ / , Issued By: 0 if!..A & O.. Date: (' i 8 MUNICIPALITY OF ANCHORAGE • Community Development Department " " t 4 Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water &Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. O50- '/7t,/-- L/f Property owner(s) RI/4/R3 ' 7,4,44Day phone ?(Po -(2 3 2 Mailing address /Q34l( 4 e Site address mac, Legal description (Sub'd., Block & Lot) /7/y4e/4 e Re-Sr ? z_ .z.(‘ Legal description (Township, Range & Section) Lot Size Z// as-9 Sq. Ft. Number of Bedrooms y APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial Single Family(SF) J� Q (w/wo ADU) Septic Tank [ Upgr i'"" ?1 Duplex(D) ❑ Holding Tank • CIR �Ai4 Multiple Dwellings ❑ Privy ❑ u,-..•� 7 ,0,-) (SF and/or D) w Private Well ❑ ti 4. w Water Storage ❑ c // 01681. THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner uthorized agent) Permit/Rush Fees: tag. co Waiver Fees: Date of Payment: aii]ia Date of Payment: Receipt Number. Receipt Number: Permit No. OSQI81 " S Waiver No. Permit App_9-1-12.doc NET FR IM ENGINEERING MEMO Steve Eng, PE, PH (907) 694-7028 SteveEngPE@gmail.com Date: 12/20/18 Number of Pages: To: MOA On-Site Services Subject: Hylen Crest#3 Block 2 Lot 16 Septic Tank Failure The subject property requires a new septic tank.The tank baffles are broken,but the trench appears to be working OK. Please expedite a permit so the tank can be replaced. The existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks-Steve 1\bTF- IM ENGINEERING Hylen Crest#3, Block 2 Lot 16 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom home. Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are near an acre and are served by a public water system .No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. Retaining walls are present on property. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet& outlet. • 5' minimum between the tank and bed. 10' to property lines &house. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Tank& solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) �_ . .• a•f� • /0/2071r.,"<;',..;,,.. ,'�0 X3.'3.'©► ' ''3 • DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Trench. 4. Lots Served by Public Water System. 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line— Replace If Necessary. 7. Retaining Walls Are Present— Avoid Or Relocate Wall. \ SteWQ\ Du, t7 f it i 15'.......1U 5'�I U ty cos__t en t Q K 15% Slope IS% Slope Water ' ) Llne 1 L15 Septic 4 Bdrm I L17 Septic fco New 1250 Gallon M Se•tic Tank w/DCO's Decommission Old �J' Septic Tank I" 104, .. PER UPC 2 S ddl' m Slope i Zizci/B I I Existing Trench 15% Slope ' B2 L8 Septic 15% Slope ! i I %%%%% 1' = 50' r•C- �.%%% % HYLERN CREST #3 NORTHRIM *.49m *. BLOCK 2 LOT 16 DESIGN ENGINEERING LAYOUT ° Box "0724 ' Zl WASTEWATER UPGRADE Eagle RiverAlaska 99577 ' g . b .: - -_ 907.694. 7028 REPLACE SEPTIC TANK ; 12/20/16 2of 3 Foundation Cleanout Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal 1250 Gallon To Trench MOA-Approved Septic Tank •lid Pipe Match Elevations To DESIGN NOTES: Existing FCD & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. 4. Water-Tight Couplings. S. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC. 8. Check Condition Of Sewer Service Line. Replace And/Or Insulate If Necessary. 9. Avoid Retaining Walls Or Reconstruct Wall. lllllllllllllll NORTHRIM *'�49m SEPTIC TANK PROFILE HYLEN CREST #3 ENGINEERING .* • Po Box 770724 • st,,,,o,, f BLOCK 2 LOT 16 Eagb Rivrr, Alosko 99577f/ p1 907.694.7028 f Dots: *� By real.: SHEET•3 of 3 TANK REPLACEMENT 12/20/18a sE i• = 5 I I SE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephoto; 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ~IEW [~UPGRADE NAME MAILING A D(~R/SS LEGAL DESCRIPTION LOCATION DISTANCE TO: Well A ~ D/elling Manufacturer / ~//~ Material DISTANCE TO: Well (~ Nearest lot line Top of tile to finish grade ~}= /,~ Material beneath tile ~(~ inches Length Width I~pth Type of crib Crib diameter depth No, of compartments Liquid depth PERMIT NO. Liquid capacit9 in gallons PERMIT NO, ~.~ ~ /i Distance between lines Total effective absorption area PERMIT NO, Total effective absorption area Well foundation Nearest lot line DISTANCE TO: Driller DISTANCE TO: Building foundation Sewer line lot line PERMIT NO. Septic tank Absorption area(s) OTHER PiPE MATERIALS SOIL TES1 RATING IZ. INSTALLER 5~ if tn //x-£ /.'3 ¢Zc; x, REMARKS DATE MUNICIPALITY OF ANCHORAGE Department ' ~ Health and Environmental ~rotection ~ 825 ~ Street, Anchorage, AK. ~ 501 264-4720 ~ * * * HANDWRIITEN PERMIT * * * Permit ~ ~' WELL AND/OR ON-SITE SEWER PERMIT · Applicant: ~Q93~ ~-~ Mailing Address: -~ t300 Location: Phone Number: G~~ Legal Description: ~ [~ ~ ~~ C~- Lot Size: ~O Type of Soil ~sorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: DEPTH ]'0 LENGTH ~0 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 excavatio~(i~ feet). There is no set width for trenches. The gravel depth is the minim~ depth of gravel between the outf~ll pipe ~nd the bottom of the excavation(in feet). * * REQUIRED SEPTIC(,HQbB~G) TANK SIZE.= [~-~' GALLONS * ~er~it ~pplicant has the responsibility to inform this department during the ins%all~ion inspections of ~ny wells adj~cen% to this proper%y snd the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of ~ny system without final inspection and approval b~ this department will be subjest to proseoution. Minimum distance between a well and any on-site sewage disposal system is 100 feet 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 8 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) I will install the system in accordance with codes. (3) I under~s~tand that the on-site sewer system may require enlargement if th~Tt ~i~ence is remodeled to include more ~_~ ~edroom~. ~ ' Signe~: ~~~ Issued by:~.~/~-~Z ~^~/ ~ ~ppl'ica~t /7 Date: 4~/ ~-- ~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST LEGAL DESCRIPTION: i-t ',,, l ,~_ m //'SLO-~' ' - SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER~ J__ S ENCOUNTERED? . ~"V~) L IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS soil PERFORMED BY: ~/,~1.._~ 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department • Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 05047441000 Expiration Date: ( Z-2020 1. GENERAL INFORMATION Complete legal description Hylen Crest #3 Block 2 Lot 16 Location (site address) 10346 Stewart Drive Current property owner(s) Palmer Day phone 980-6232 Mailing address Real estate agent na Day phone 2. TYPE OF DWELLING: x Single Family (w/wo ADU) Duplex IJ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic x Water Storage n Holding Tank ❑ Community Well I I Community n Public Water System n Public Sewer Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 557) Waiver Fee $ Date of Payment L82_60/6) Date of Payment Receipt Number 0917Co0 Receipt Number COSA# 0.5619113? Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/27/19 • 6. DSD SIGNATURE —� „` System #1 Approved for bedrooms System #2 Approved for bedrooms • %'•n Of Disapproved Conditional approval for bedrooms, with the following stipulations: `���YtOF e/�q /// ON-SITE WATER AND 4VvASTEWATER PROGRAM )iii )ll)))8ER},)`�� �� 73 1 �H gy; �Y( 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 Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Hylen Crest#3 B2 L16 Parcel ID: 05047441 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA — � 4 t ❑Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes IIINo Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑Arsenic less than MRL (ND) Casing height(above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) new years ❑ Required maintenance completed Tank type/material Steel Age of lift station years _. Measured operating fluid level in septic tank new Lift station material Standpipes/foundation cleanout per record drawing Comments: ate of pumping new D. AB:ORPTION FIELD DATA "41118WP. 6 LS-het f, e/36/8 Which . stem tested (date installe• .AGI • • Adequacy test date 4/12/19 ❑■ ALL standpipes • - --- •-r record drawing Results p✓ Pass For 'T ,bedrooms Total measured depth from grade 8 ft(max) Fluid depth prior to test 30 in Measured depth to pipe invert from grade 3.5 ft(min) Water added 600 gal ❑ N/A—pressurized field • New depth 35 in ❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 60 min depth into effective • Code-required soil cover over field Final fluid depth 30 in 1= System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) n date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 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' 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' Animal Containment > 50' ❑ Yes if No ft ❑Yes if No ft 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' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' p Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' p 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' Q✓ 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' p Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' E Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION �AA"N)- O Atk�(„nl QJ -f}s, 0,,,,, 'Y ,, V., ispo:I certify that I have determined through field inspections and review ,,,1-;: ,O ,C. ,z of Municipal records that the above systems are in conformance with �'" •. C'v. ! 0 MOA COSA guidelines in effect on this date. .. -'e N ER'S "• �` �� o - Steven W. cng e' 101 <:L t',.,J /9-:\c--„,00-• Pf 65 �/ ti 1 /\.,,r •:s COSA Checklist yellow sheet v� � ' Parcel i.D. # (~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-S te Services Section .~95i9_6650 P O'. Box 196650 Anchorage,'A aska ,,, .. 343-4744 ' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATI ,ON -': Complete legal description , Property owner ... ~)A-,,,J ~ Lending agency Mailing address ~'Agent C~/~ l'Z.O ~, Address Day phone., Unless otherwise requested, HAA will be held for pickup. 2. ·NUMBER OF BEDROOMS: ~ r" . 3. TYPE OFWATER SUPPLY: Individual well ::" ..... commu~iity'welI' ×X Y,~ - ' Public water NOTE: /f community well sYStem, provide written confirmation from State ~D Ec attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: ndividual on-site -:'.Holding tank Community on-site 72425 (Rev, I/91) Front MOA ~1 · Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ~.;-.,. - ,,.?:'.~c! ',i :': ~ ,,.?::_,: ,~:-- Se 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 ~hat the On-site water supply i".". and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms' :':-*i/ and type of structure indicated herein. I further vedfy 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. - "... DHHS SIGNATURE ' Approved for bedroc ms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 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 conduc{~inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors c r omissions in the professional engineer's work., ~- '" 72.025 (Rev. 1/~l) Back MOA~I Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /--u'r" /~,, /~/.,o Ur.._ Z-.,~ ,./~)/c~t~j Parcel I.D. A. Well Data _T:::U1~LIC L,~ Well type /"-/'/~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /'g//~ Date completed Driller Total depth Sanitary seal (Y/N) 5',/ Cased to Casing Ileight Wires properly protected (Y/N) ~FROM WELL LOG AT INSPECTION Date of test ~ Static water level Well flow Pump level1 ~ SEPARATION DISTANCES FROM WELL TO: 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 WATER SAMPLE RESULTS: Petroleum tank Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Cleanouts (Y/N) "~ Foundation cleanout (Y/N) 'Y~ High water alarm (Y/N) /'~/A Alarm tested (Y/N) Date of pumping ~/.~ 0 / ~ 5L Pumper ~", ~ .' SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO: Compartments Depression (Y/N) Well(s) on lot ,~/~ On adjacent lots /',/'/A: Foundation To property line ~ g Z_. t Absorption field ~ i Water main/service line Surface water/drainage ,/~ o ~ ~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed c~ 0 ~ ~ Soil rating (GPD/Ft2) /'Z-~' ~ D/~.~.System type Length Width Total absorption area ~'00 ~ z... Cleanout present (Y/N) 'Y Depression over field (Y/N) ,/~ Date of adequacy test ,:~>/Z~'"/~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Results (pass/fail) for After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: /. Well on lot To building foundation On adjacent lots Z. Surface water Curtain drain /',Jo on adjacent lots /~//~ Property line To existing or abandoned system on lot Cutbank ~ O ~J (=' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I ce¢'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the.date of this inspection. Signature Engineer's Name /1~ C.~-/AL.o'/,.. E' ,/~,¢J~ L-'~0~ Date ~/.~ O/q'¢ HAA Fee $ Date of Payment Receipt Number ~ ?r~ ~j~,.~.~ Waiver Fee $ Date of Payment Receipt Number 72-026 (3~93)* Back SEPTIC SYSTEM ADVISORY Prior to a recent adequacy test on the septic system for this lot, ~"~ inches of standiung water was observed in the absorption field. This indicates that approximately _~ ~ % of the absorption area is inundated. However, this system did meet the minimum absorption requirements for a ~ bedroom residence. This advisory must be attached to all copies of the subject Health Authority Approval. SHEET NO. CALCULATED BY CHECKED BY OF DATE SCALE %1 ~.~1 ~./ SENT BY:FORTUNE ; 8-28-04 ;12:18P~ ; FORTUNE PROPERTIES~ ~07 044 2130;# 2/ 8 09/09/94 15:1~ ~ 90? 344 21~0 ROCKFORD CORP 02 ADEQUACY I NSPI-'~TOR ~ ~' . TYPE OF DWELLING: '~/'~', NO. OF BEDROOMS1 ~ PEAK LOAD CALCULATION=, ~, TEST REPORT PROJECT # SEPTIC TANK S TYPE OF $,A,$ TEST RESULTS: REVIEWED BY;__ DATE: MUNICIP'ALITY OF ANCHORAGE Department of Health & Human Services 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. # ~-~(~-Ct~'Lt- L~\\ NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 16; Block 2; Hylen Crest Subdivision ~r~ Location (address or directions) Mile 3.5 Eagle River Road (b) Property owner Larry Thomas ~' Mailing Address P.O.Bn~ (c) .Lehding Institution Mail'ing Address Telephone: (home) ~ct4-~870 Rdu¢,,~: Ab. 99~77 Telephone Business · '(d)' Rea'l Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here [~,xif hold for pick up.) List contact person and day phone number below: $ & 5 ENGINEERING 17034 Eagle Ri,vet Loop Road Eagle River, Alaska 9~577 2. TYPE OF RESIDENCE Single-Family ~x Number of bedrooms __ 3. WATER SUPPLY 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-siteY~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of.structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspect[on. Name of Firm S & S ENGINEERING Address ,-__~ m~_r Lool~ Road No. 2u~ Eagle River, Alaska 99577 Date Telephone 6. DHHS APPROVAL Approved for ~1~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval ~'IA,'~ ( T/-~ Date Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issuesHealthAuthorityApproval cerificated 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 DHHSdonotconductinspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72-025 (Rev. 7/88) Back Page 2 of 2 A, WELL DATA Well Classification Well Log Present (Y/N) Date Completed 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 ~ ~O To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ ~kJ _<-, .%_ ~ MUNICIPALITY OF ANCHORAGE (MOA) Healt.hj~.uthorily Approval (HAA) O~ A~4~_.,,,~'~T - FEBRUARY 1984 s~v~~" 343-4744 Legal Description: ~o~ / ~ ', Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) 4- Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots Z¢~:2 'f- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ¢-5o-'S~ Size_; Standpipes (Y/N) t./ Air-tight Caps (YIN) Depression over Tank (Y/N) _ tO Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments U Foundation Cleanout (Y/N) Date Last Pumped /.)/¢1 ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line ! O ~ f- To Water Main/Service Line / O To Stream, Pond, Lake or Major Drainage Course Comments ~ ~_~O '¢-'l'C~ ~0~¢¢_~ SFPARATION DISTANCES FROM SEPTIC/HOLDING 'I"ANK: 2¢oo fi- To Building Foundation To Disposal Field ( O /-/- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - 30-~ ~ Width of Field ~0" *' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well Z / ~--oo ~ /d ! Z1 ~ '¢,/&:~ Type of System Design Length of Field ~--O IO Depth of Field Gravel Bed Thickness 6¢ o Statndpipes Present (Y/N) Date of Last Adequacy Test - H To Property Line To Building Foundation To Water Main/Service Line / O '~ To Stream, Pond, Lake, or Major Drainage Course ,~-)/~ To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots ~ o "/- To Cutback (if present) ~J/db GLo i Comments D. LIFT STATION Date Installed ~ Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at /k,/~% A Tested for Meets MOA Electrical Codes (Y/N) ~ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidel,ines in effe inspection. Signed Company Date MOA No. S & S ENGINEERING 17034 ~=g!e RJ',-'~' Loop Road No, 204 Eagle River, Alaska 99577 Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back /90 Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 AUgUSt 13,"1990 STEVE COWPER, GOVERNOR 563-6775 FOR: S & S Engineering Attn: Rodney PWSID: #2.13289 According to the records on file in this office, the Hylen Crest subdivision Water System is in compliance with the State of Alaska Drinking'Water Regulations. Sincerely, v~.~ ~.. c~i~ ( 1 Environmental S~e~ialist VEC:pf MUNICIPALITY OF ANCHORAGE DIIr[SION OF ~VIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRC~NMENTAL PROTECTION APPL:~CATIfIN FOR HEALTH AUTHORITY AI°PROVAL CERTIFICATE 1. C~neral Information Application Date ~.?~~_~ (a) Legal ~e. sc~.iptiop(include lot, block, ,subOivisipn, section, tq~4nship, range) LocatiQn (addL~ess or directions) (b) Applicants Nam~ Applicants AOdress~q (e) Applicant is (che~ o~) ~nding Institution (d) Lending Institution 2% le phone Ad~:ess (e) Ileal E~tate Co. & Agent Add~ess Telepho[~ 2. ~t[~ qf~ l~sidenoe Numbe~ of Bed~co~s 3. ~ate~ _Suppl_ji Individual ~11 ~ Community ~ Publi~_~ Note: If conmunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status~ Is the ~11 adequate fo~ the nu.~mber of bedrccras specified in this [{~A (Y/N) 4. ~seWaJge Disp%%_a~l_~ Onsite~'- Public ~. Community t'-~ -~-' Holding TapJ~ Is the wastewater disposal system adequate fc~ the number of b~drooms ~.N) [Page 1 of 2] 2-15-84 5. En~qineer_in_~. Firm Providing Inspections, Tests, D~ta and Information Si~f~~ Date Address (ENGINEER SEAL) 6. DHEP ~Ap_p_r ova 1 Approved for z/~ Approved ~ Disapproved ~ Conditional Terms of Conditional Approval .The Municipality of Anchorage Department of Health and Envirorm~ntalProtection d~s not ~arantee the contim~ed satisfactory perfom~ance of the wate~ supply and/or the wastewater disposal system. This approval indicates that~ as of the validation date shown above~ ~sed on the data and information furnished by an engineer registered ir~ the State of Alaska, the water supply and wastewater disposal si;stem is safe and func- tional fo~ the nombe~ of bedrcoms and type of structure indicated. ( D~EP SEAL) 7. Mail the H~% to the following address: KB2/dS/s [Page 2 of 2] 2~15-84 A® MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification A Well Log Present (Y/N) Total Depth Cased to Static Water Level Pump Set At Casing He ight 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 Cle ancut/Manho le Water Sample Collected By ; Date Water Sample Test Results MUNICIPALII¥ OF ANCI-IO~AO5 DEFI'. OF HEALTH & ENVIRONMENTAL PROTECTIOIX[ L Date Completed Yield Depth of Grouting 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 C~i~nts B. SEPTIC/H~&~=NG TANK DATA Date Installed ~.-.-fl~) --- 83 Size / ~.~--Oe~/{~, No. of Compartments, 7_-. Standpipes ~.f~N) Air-tight Caps ~) Foundation Cleanout ~) ~pression o~ Ta~ (Y~ ~te ~st ~d ~ k/ P~ing~intenan~ Con~a~ ~ File (Y~)/~ ; for -~ Holding Ta~ High-Water ~a~ (Y~) ~/~ ~ra~y Holdi~ Tank Petit (Y/N). ~pt l~..~u~g Tank: Separation Distan~s ~ ' "'--~=:- To Water-Supply ~11 ~a~/C To ~ilding Foundation To omrt To Dis sa To Water Main/~rvi~ Li~ .~' To S~e~, Pond, ~e, ~ Major ~aina~ Course [Page 1 of 2] 2.~:L5-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Stmata Date Installed ~" ~- ~3 Width of Field ~O ~r _~ Square Feet of Absorption Area Depression over Field (Y_~ Results of Last Adequacy Test 1 ~ ~- ~.~Type of System Design Length of Field ~--O / Depth of Field /~? / Gravel Bed Thickness ' ~(~3 5--~ Standpipes P~esent ~/N) Date of Last Adequacy Test ~/~ Separation Distance f~om Absorption Field: To Water-Supply Well (~iQL;~/.-.~iC TO P~operty Line TO Building Foundation ~ /4- To Existing or Abandoned System cn Lot /%///4 ; On Adjoining Lots To Wate~ Main/Service Line .'~ To Cutbank( if present) /~/~. To Strew/Pond/Lake/or Sajo~ Drainage Ccurse To Driveway, Parking Area, or Vehicle Storage Area ~ / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) C~nts Dimensions Manhole/Access (Y/N) "Pump Off" Level at / Vent (Y/N) du~ing Adequacy Test. Meets MOA ** ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Date [Page 2 of 2] 2-15-84 DEPT. O~ E~VIRONMENT/~L SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (.,o07) Address: 274-2533 To Whom It May Concern: According to ¢ecords on fi, le in this office the J~.(~t~kl ~),UcJ~'l\Jl~;i~] _ Water system is in compliance with the State Drinking Water Regulations. Sincerely,