HomeMy WebLinkAboutHYLEN CREST #3 BLK 2 LT 17Hylen Crest
#3
Block 2
Lot 17
#050-474-40
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page I of 3
ON-SITE WASTEWATER
INSPECTION REPORT
Permit Number: OSPI 91011
Pit) Number, 050 -474 -
Dwelling: IMI Single Family (SF) FI with ADU El Duplex (D) n Two Single Family Project: F-1 New FM. Upgrade
Name
MORA MICHAEL L & JUDITH A
ABSORPTION FIELD
E] Deep Trench 0 Wide Trench [] Bed E] Mound
Site Address
10350 Stewaft Dr
0 Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
980-6232
14
GPD/SF
ITotat
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original gradeli5a�vc�_-pth
Ft.
beneath pipe
I Ft.
Subdivision Block Lot
HYLEN CREST #3 BLK 2 LT 17
Fill added above original grade
Ft.
lGravel length
Ft.
Tovmshio Range Section
Gravel width
Ft
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
TO
Septic
Absorption
Lift Statpon
Holding
Sewer
Total absorption area
Number or trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft?
I Ft.
well
100 1
na
na
'na
-1 Holding -EI Other
TANK [9 Septhc [3 S.T.E.P. L
Manufacturer lCapacity
Greer
1250 Gal.
Surface Vititer
100'+
lea
Iia
Material
Steel
Number of ompartmerits
2
,Lot Line
51+
na
na
NA
Foundation
10'+
na
na
LIFT STATION
Manufacturer
Capacity
Remarks Septic Tank Replacement
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank Tankto D3034
Installer ............... .. ..... ......
Gilbel
drainfield
DrainfieW COIWD3034
lnspector'R*0"'�i�"*j * m ff n * g I
BENCH MARK (Assumed elevation) 100 ft
Fion 1� 615!19 "6/19
Location and description
dates, 2_4
dates,
Deck
's 42'
ON-SITE WATER AND WASTEWATER SECTION
,SngW ' VO41
APPROVAL .4AV,' erW 11
AV
AT I
Conditional Approval:
Date Aff
TO
0
4�4 Steve Eng
CE -62W
Septic System
Approved
>*1 Q/ 2' v? �u
Date IOAI'zo20
Note: this approval does not include well permit
requirements.
AS -BUILT
MEASUREMENTS
A
B
DC❑1
37
36
T1
39
38
T2
46
46
DC❑2
48
48
Water \
15% Slope Q) Li`n� \
tew t
e \ \ \r Drive
w
a rp
D
o \ �
Septic ST0ankllw%DC❑'s 15' ut tv Eas
Decommissioned Md e�
Septic Tank
PER UPC 4 Bdrm S
fco
ti B
L15 SE
L1 Septic
T1 DCO
T 15% Slope
15% Slope °� C02
Dec Hi Is
1 I �Phc�
Suppports Within
5' ❑f Tank,
15% Slope
Existing
15' Slope Trench
B2 L8 Septic
l 15% Slope
Mr
Qt�.OF', , HYLERN CREST #3 1 — so
NOR THRIM ;�.
ENGINEERING !.*..;49�i.,• •••••••*
BLOCK 2 LOT 17 RECORD
Po Box 770724 `` n„;,04 LAYOUT
..;:...�
Eagle River, Alaska 99577 . �- , 1 WASTEWATER U P G R A D E
907.694.7028 `N 1o/2si2 REPLACE SEPTIC TANK Dat 0i25i20 r2of 3
O
<
O -Ph,
V)
�^
D
F-1
O
z
OO
Z
ti
sx
e N
o
my
14 m=
00:70
C-)
cis �� Q
n
Q
lD
O
T9
V
N4
O<
O
<
O -Ph,
V)
" CSN
D
F-1
z
OO
h
Q
< `+
fl
0
�
c C+
C-)
cis �� Q
n
Q
lD
O
T9
V
.�
O<
F—
D
�
D
Z
Q
(�
7C
F -I
O
PT
�;0
z
a
tDd
H
F—
F9
S
A
O
td
I
�
I
0
r�
r
FTI
ro
(D Q
I I
an
71�
z
F- Fr1
mdr-
r <
FTI
—i
0
V)
Q
o /;
D
o
u
W
CJI H
�z
Gl(/� 3'—
<
O -Ph,
" CSN
Q
r0 `F 1
OO
h
Q
< `+
fl
0
�
c C+
cis �� Q
n
Q
lD
O
O °
.�
O<
Q r0
QQ
�
ro
m0
Q
Q
C+
LA
F-1 <
h
Q
< `+
o-
Qo
o
o ro
lD
O
O
,D
Q �
(D lD U1
�
n �
Q
O
c-�
tDd
Fri 3
N
ro
X_ Q
<+
`_+ n
(�
ro
(D Q
O
ro
F- Fr1
n
r <
M
—i
Q
:5
n
Q
o
90
O
N
n
s
Lotl
Noo°o6`|0"W 268.75 (R)
Noo°o6'14"W 268.85 (M)
Noo°o|'23"E 217.85 (M)
Noo°0|'48"W 217.90 (R1)
Uplands Subd.
TRACT A
10` Utility Easement
221.9o(wi)_,
Nloo24\dv3„EE292®]..3P(R)
-I--e . o=ez!JE-
,4,0pA"TY MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program \°Abge\ PO Box 196650 4700 Elmore Road `
,+ Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
7F r
httpa/www.muni.org/onsite 1
/ l)cpartnicnt
On-Site Wastewater Disposal System Permit
Permit Number: OSP191011 Effective Date: 1/31/2019
Work Type: SepticTank Upgrade Expiration Date: 1/31/2020
Tax Code Number: 05047440000
Site Legal Address: HYLEN CREST#3 BLK 2 LT 17 G:0057
Site Mailing Address: 10350 STEWART DR, Eagle River
Owner: MORA MICHAEL L & JUDITH A Lot Size in Sq Ft: 25330
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field El Septic Tank 0 Holding Tank 0 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
1/0
Special Provisions: The septic tank shall be located at least 5 ft from a deck or stair support, if the deck is
higher than 30". If the deck is less than 30" high, the septic tank shall not be located directly under the deck or
stair support.
Received By: Date: 2 / `
Issued By: 4 �� // •
Date: /Br
MUNICIPALITY OF ANCHORAGE
•
Community Development Department
` ��-��� 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. 0 50 - y 7y- yo
Property owner(s) ,11 O RA' Day phone 2410- 3O6'q
Mailing address ld 350 ST-et/Mier 4 R
Site address S4,11E-
Legal description (Sub'd., Block& Lot) /7 L e t?f S r 3 QZ 417
Legal description (Township, Range & Section)
Lot Size Z.5; 3 3 C Sq. Ft. Number of Bedrooms /
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field ❑ Initial ❑ Single Family(SF) `❑-
(w/wo ADU)
Septic Tank Upgrade IP- 8 s
5 6 0 . ex (D). ❑
Holding Tank ❑ Renewal
uii - Dwellings 0
Privy ❑ a ( -nd/or D)
Private Well ❑ JAN 1 1 '4u�i
Water Storage El �4.
•THIS APPLICATION INCLUDES A VARIANCE/WAIVE 0/�- :+ ��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 authorized agent)
Permit/Rush Fees: oZ A 5 Waiver Fees:
Date of Payment: ' (jig/iq Date of Payment:
Receipt Number: 03631/O Receipt Number:
Permit No. O 3P /q I01 Waiver No.
Permit App_9-1-12.doc
NbTHIM
ENGINEERING MEMO
Steve Eng, PE, PH
(907) 694-7028
SteveEngPE@gmail.com
Date: 1/10/19 Number of Pages:
To: MOA On-Site Services
Subject: Hylen Crest#3 Block 2 Lot 17
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-Stev
I\ICRTFW
FE�z�INEERING Hylen Crest#3, Block 2 Lot 17
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. Decks are present on property, that must be worked around.
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)
41.41.,\ /VS
491H * i
Sttve Erg �,,
` "vz •
�4 -Y'3 0/ 19 41,
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. Decks Are Present— Avoid Or Relocate.
Water
15X Slope E LIQ- \
v/i Ste War Dr
wl t /ve
(0
47 P
= 1
0
New 1250 Gallon
'5, Utility r.
Septic Tank w/DCO's s
Decommission Old 4 Bdrrn
Septic Tank IIP) 1sz
PER UPC / fro I
/ L15
Ll Septic '
15/.
15% Slope I L17 Trench Slope
' J
I I
Remove Or
Relocate Decks
& Supports To '�
1:!lir
Avoid Septic Tank
Contruction I -....,..s.
1s% Slope
I I
Existing
15' SloPe Trench
B2 L8 Septic 15Z Slope
I I I
llllll:•'�� °F.'..r HYLERN CREST #3 1• = 50'
NORTHRIM ��P ...
ENGINEERING * :4sm .. * BLOCK 2 LOT 17 DESIGN
Po Box 770724 et LAYOUT
Eagle Rive. Alaska 99577CE-42,6 .. - WASTEWATER UPGRADE
907.694. 7028 ''"1130119 Date:
REPLACE SEPTIC TANK 1/30/19 2 of 3
Foundation Cleanout
Tank Cleanouts
Fin ^amide Opposing Cleanouts Between Septic Tank & Trench
oe.
4 Foot Cover
or Equal
r
I---
1250 Gallon To Trench
MOA-Approved
Septic Tank
.lid Pipe
Match Elevations To
DESIGN NOTES: Existing FCC' & 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.
5. 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 Decks Or Reconstruct.
NORTHRIM SEPTIC TANK PR❑FILE HYLEN CREST #3
ENGINEERING f•'�•'49m
Po Box 770724 • Stew,w 7
`F BLOCK 2 LOT 17
Eoy/s River, Alaska 99577
907.694.7028 4
' Q TANK REPLACEMENT °°t•`1/10/19 ID' By: SE real*: 5 of3
I 3 SE
1 . c•-•........„.... •
10
.•••Za,k, .... .7-,F•if --_So
&3 • , _
.--,/.....,,.. ,
i -- -- -.. //---c- ,
, .....
-...
! -...,
---
„2...,-... ,
--- --,. /
i ---.+
i 41
, \
/
,.• ip-4...k ! •
• f , 1
r
r -
I.',,
1
-Fr
c \
1
I , 2.1• a,o,.., i-I 0 v.,.., i 1
,
. .,.
1
i -.:.
t.:.:, 1 ..__,... 5.- e,-
4c' •
-1 ..,. , -. .. .
i
I .....1k.r-.1:"Ia
... ."...
.. r.;1,1/-
1 / NN 4\
I / t.,..,:t;.. .:::, .. j4 0., .1.' , 1.
1)(1
r . wd•r if.;-
.., , ...,---• • .
- ,-,. •.-- 1 -
• i... . .,..
i , ,... , •
:,•...; (.:, I 13_r—fr I 0-.•:..re ; i..).,/r,,,,d,,..-/--.,c; 3- 2,ti.•-..1.-
. . . • S.-A R E.44 b F
f
i • -111Ai-i- Pacilts.,,
. • r 1 i
1 latike. ..t,
i P1-4%-nn.:7./-:c,Tr,1.1.,k,..5, .1 -5-r•e r.5,
I
: 1
i
•
1 Cl- f•••••0-;:•.,- ,..,,,.51or 1 ;
I I / AS-BU1LT
1 1
i
! ' ! I hereby certify that I have surveyed the following described
i . ,'''
property: .i.:--r;7- ' 7 Lic....,._:...... iL. ..-L
)
'•,• , :=': ,-”' -V 1J(r eU 0,3 S.EC— 8. T/4 t‘i
i ..... ,
: Anchorage Recording Precinct,Alaska,and that the improve-
.
• ments situated thereon are within the property lines and do
,i not overlap or encroach on the property lying adjacent there-
.
. ' to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
• ' '-. es- .3 roadways, transmission lines or other visible easements on
.. :. • • said property'except as'indicated hereon.
. , .
, ..... .
.A2,...r...1,1;:z44;?:...::".....„.„-7-:-,ff-.4....--•; ,... Dated at Eagle River, Alaska
. 7...-z.te _ ...
this IL-' day rif C'C-1-01:,'FER. 19.:::-._.2_
. _ .
ROBERT C. JOHNSON
... _ .. ,
SCALE: Registered Land Surveyor No.880-LS
1"= 30/ Box 456,Eagle River,Alaska
'-, • Phone(907)694-2543
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 LStreet - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT
NAME PHONE
LEGAL DESCRIPTION
E~UPGRADE
LOCATION NO, OF BEDROOMS
-- I Well AbsorlJtion areaI Dwell ng /*.~ J PERMIT NO,
~ IManufacturer ~ IMaterial No of compartments
/~ Liq. capacity in gallons I IF HOMEMADE Inside~en~th ' - Width ~ Liquid depth
1'~-'5-o : I ~ I
6 ~ I D~STANCETO IWw, ~1/ Io~ui"g PER~T~O.
~1~,~ ~ Manufacturer : ' ' ' 1 ~,~r'~, Liquid capacity in gallons
~ I I Well : Foundation ~ / I~earest lot line PERMIT NO. ~
~ [ Z I No. of lines . I Length of ~ch line Total len~h of li~es I Trench ~1/ Distance between I nes
P h I Top ot ti~e to f~nisn graq~ Ivlaterial beneath tile ,~ Total eff'ectJ~ absorpt
--~ I Le.¢R I Width ~epth PERMIT NO.
~~[Crlbditer~ ~ Type of crib Crib diameter .... ~rib depth I Total effective absorption area
~ [ DISTANCETO: ~ ' Bbilding foundation Nearest lot line
~ lClass~ _ _ Depth. ~ . ~riger~ ~ .. Distance to lot line PERMITNO.
~ I DISTANCE TO Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE M A T F~A~t
SOIL TEST RATING /
INSTALLER
APPROVED// /j'~ // DATE LEGAL ~ & 8 E:iGiNEE,-qiN~
'~,~k~ RIVEFI, ALASKA
.... ~' PH. 694-2979
72~ (Rev. 3/78)
Permit
Location:
Legal Description: ~l 7 ~_
Type of Soil Absorption System Is:
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environments3 Protection
825 Street, Anchorage, AK. 9501
264-4720
* * * HANDWRITTEN PERMIT * * *
~/OR ON-SITE SEWER PERMIT
Mailing Address:
Phone Number:
Trench: k/ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: c~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH f~0 LENGTH c~<f]> . GRAVEL DEPTH ~7 WIDTH
The length dimension is the length(in feet) of the trench or drainfield.
The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = I Q-~~¢D GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 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 un e~i~tand that the on-site sewer system may require enlargement if
f~/~/th~/~s~dence is remodeled to include more that 3 bedrooms.
Signe~: Issued by:
Date:
SWP/024 (1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
I. EGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15-
16-
17
18
19-
20-
San Jet' DATEPERFORMED:
~' SLOPE SITE PLAN
COMMENTS
PERFORMED BY:
WAS GROUND WATER ~
ENCOUNTERED? N~-~ O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
- DATE:
72-008 (6/79)
Municipality of Anchorage
-� Development Services Department 8 '<
Building Safety Division
On -Site Water and Wastewater Program s ;
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. COSA # 0 SCla.IU(A0
Expiration Date: _ e i X
1. GENERAL • INFORMATION
Complete,ldgal description Lot 17 BLK 2 Hylen Crest ?�E 3
Location'(siteaddres5) 10350 Stewart Drive, Eagle River AK 99577
Current Property owner(s) ` Euniceyrem Day phone 694-2214
Mailing address PO Box 770175, Eagle River AK 99577
Lending agency USAA First Mortgage Serv, Day phone 1-800-531- 1 449
Mailing address 10750 McDermott Freeway, San Antonio TX 78288
Real Estate Agent Barbara A. Crittenden Dayphone 242-2227
Mailing Address 16635 Centerfield Drive, Eagle River AK -99577
Unless otherwise requested, COSA will be held by DSD for pickup. e a its a�� Q r p10 -X -v p
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
❑x
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
®
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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.
NameofFirm Rodney P Kinney Associates Inc. Phone 694-2332
Address 16515 Centerfield Dr #101, Eagle River AK 99577
Engineer's Printed Name Christopher M Kinney Date 3-6-12
tit
OF Aj,
/..........�...yr!• • • ... .
• G9lttf.tlt t•t tt•
Christopher M. Kinney >�
5. DSD SIGNATURE
CE�- 1 4 • °b'
Approved for bedrooms. t,� A�f� •3f, �! •'�, n
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
u»
J <s/
Original Certificate Date:�-
(Rev. 11J05)
Municipality of Anchorage e
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: _ Lot 17 Blk 2 Hylen Crest # Parcel ID: 0 50 - y 74- 4 o
A. WELL DATA
Well type Public
Date completed NA
Total depth NA ft.
Date of test
Static water level
If A, B. or C provide PWSID # 21 3289 Well Log (Y/N) NA
Sanitary seal (Y/N) NA
Cased to NA ft.
FROM WELL LOG
NA
NA
ft.
Wires properly protected (Y/N) NA
Casing height (above ground) NA in.
AT INSPECTION
NA
NA ft.
Well production NA g.p.m. NA g,p.m,
WATER SAMPLE RESULTS:
Coliform NA colonies/100 mL Nitrate NA mg/L Collected by: NA
Arsenic: NA ug/L date of sample: NA
B. SEPTIC/MpkN{TANK DATA
Tank Type/Material Steel Date installed 8/30/83
Tank size 1 250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes (2 )
Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) NA
Date of pumping 11/2/11 Pumper Jr' s Pumping
C. ABSORPTION FIELD DATA
Date installed 8/30/83 Soil rating (g.p.d./ft2orft2/bdrm) 125 Systemtype Trench
Length 42 ft. Width 2. 5 ft. Gravel below pipe X ft.
Total depth _ ft. Eff. absorption area 50 5 fe Monitoring tube Yes Depression over field No
Date of adequacy test 3/6/12 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added600 gal. New depth 7 in.
Elapsed Time: 240 min. Final fluid depth P in. Absorption rate >= 3, 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed NA
"Pump on" level at NA in.
Datum NA
E. SEPARATION DISTANCES
Size in gallons NA Manhole/Access (YIN) NA
"Pump off" level at NA in. High water alarm level at NA in.
Cycles tested NA Meets alarm & circuit requirements? NA
SEPARATION DISTANCES FROM WELL ON LOT TO: Public System
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 10 ' + Absorption field 101
Water main 101+ Water service line 10'+ Surface water None /00
-
Wells on adjacent lots _ d e C. k. y ,�7' 6 y
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 20' + Water main 10'+
{r cK, 4,y T,p
Water Service line 10 + Surface water None /V o Driveway, parking/vehicle storage 1 0 +
Curtain drain None Wells on adjacent lots *200
I`'` e d y J/�
F. COMMENTS
* PWSID #213289
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Christopher M Kinney
Date 3-6-12
COSA Fee $ c4 I o —j �Fn
Date of Payment 3 I 1 1► �. Ck���o `
Receipt Number ����
(Rev. 4/10)
Waiver Fee $
Date of Payment
Receipt Number
XkU
�'`pi • •. •. ye.Or 11
.r
*; 49*H YV� •"�
9134
MRR-5-2012 16:42 FROM:JR'S SEPTIC PUMPING 9073449821
TO:6941807 P.1
JRS Pumping
Extension Actual
Septic Sery 15K
1 $0,00
PO Box 773415
$0.00
Discount
1 $0.00
Cagle
4-645K 44577
$0.00
Service Agreement
(907) 644-ri454
(907)6
Taxabls Total Tax Total Grand Total
Estimated Charges!
Number: 034951
_
Order Date: 02 -Nov -2011
Service Date: 04 -Nov -2011
Billing Information_ ]
Technician: Mike
Eunice Vrem
Job Dosorlpaow
12608
Po Box 770175
P.O. Number:
Eagle River, AK 99577-0176
Terms:
Net 30
Tax %: 0
(907) 694-2214
Selesrep:
Dawn -Dawn
Job Type: Repeat
Map Book:
Map Grid: 102- -
{Job Site.Cfoea
Streets:
Stewart Drivenformation._.....
_.__.�
Eunice
Job comments:
_
Last Service
_._ __.._._.. ..
' 06118/2010' 12508
10350 Stewart Drive
tank normal
Eagle River, AK 99577
back flushed 2
times=clean
(907)694.2214
Additional Location Comments: Diagram:
s:lgi8oramsl174 2.btnb
Gallons Planned: 1250
Greenish home w/#'s on past
bw
4bdrm septic underneath back deck
Gal. Actual
Hose Length: 2.5
Double Tank: ❑
Pump System: WSJ
Dock
rank
Baffles Inlet: El�
rjo
Baffles Outlet: U
Service Type
Qty Price Each
Tax?
Extension Actual
Septic Sery 15K
1 $0,00
No
$0.00
Discount
1 $0.00
No
$0.00
Nonlrexabla Total
Taxabls Total Tax Total Grand Total
Estimated Charges!
Aotual Charges:
_
Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT.
$lgnatura and Title of Customer Representative Cate
11 Mi-*-�_
Accepted by JRs Pumping pato Accepted
For your added convenience we accept; Dloovor, Visa and Master Card payments over the phone.
After 30 Days account will be turned over to COLLECTIONS. $30.00 For NSF Checks Returned.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL H~EALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLIC~7I(AN ~.I)R HF~AL').~I AI~I~qORITY APPROVAL CE~]TIFICATE
(a) legal Description (in~lu[]e lo~t~ block~ s~bdivision~ section~ t~anship~ ranwe)
Location (add~ess o.~ directions)
-, .. :.-:.: :.
(c) Applicant is (check one)I.ndin. Institution E~' O'~aer/builder:~I '
(d) ~.~,.nding Institution
Address
(e) l%e. al Estate Co. & Agent
Address
Telephone
Other (¢?escribe)
30 Water
Individu. al ~,~11
Note: If ~nity ~el! system, must ha~ writt'en conf~m~tion ~ the State
~pat,~nt of ~viron~mntal Conservation attesting to t~ legality ~d status.
Is the mi1 adequate fo~ the n[u~r of ~dr~ s~eified in tills )
Is the wastewate~ dis~sal sysl~m a~quate f~ tt'~ m~m~ of ~d~ ~ N)
[Page 1 of 2]
2-15-84
( ENGINEER SEAL)
Date
6. O_H?,jL^ p2r ova 1
Date
lephone
/
Approved for z/~- bedr o~s
Approved [~ Disapt~zoved t~--]
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Depa~;tn~nt of Health and Environmental P~otection does
not wuarantee the continued satisfactory F~rformance of t)~3 water supply and/or the
wastewater disposal system. %~nis approval indicates that~ as of the validation date
sho~n above., based on the data and information furnished bf an engineer registered in
the State of Alaska~ the ~ter supply and wastewater disposal system is safe and func~
tional fo~ the numbe~ of kedrcoms and type of structu~e indicated.
(DHEP SEAL)
7o Mail the HAA to the following addcess:
Kn2/d5/s
[Page 2 of 2]
2-].5-84
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification
Well Log P~esent (Y/N)
Total Depth Cased to __
Static Water Level
Casing Height Above Grcund
Electrical Wiring in.Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank cn Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewe~ Line
C leanout/Manhole
Water Sample Collected By
Wate~ Sample Test Pesults
C~t~tents
MUNICIPALITY OF ANCHORAOE
DEPT. OF HEALTH
ENViRONMENI'AL PROT[~C[ION
Date ~leted Yield
Pump Set At
Depth of Grouting
Sanitatty Seal on Casing (Y/N)
Depression A~ound Wellhead (Y/N)
; On Adjoining Lots
; On AdjoiningLots
To Nearest Public Sewer
To Nearest Sewe~ Service Line on Lot
; Date
B. SEPTIC/~ TANK 5~TA
Date Installed ~-~O'-~3 Size /~_--,5~-d)~_No. of Co~v~nts ~
Standpims ~) Ai~-tight Caps ~1) Foundation Cleanout ~)//
~p~ession o~ Ta~ (~ Date ~st ~
P~ing~intenan~ ~n~a~ on File (Y~)~ fo~ ~
Holding Ta~ High-Wate~ ~a~ (Y~) ~/~ Ternary Holding Tank ~rmit (Y~)~
Sep~ation Distan~s ~ ~ptic~~ Tank:
To Water-Supply Well
To P~ope~ty Line
TOcou~seWater Mai~//$e~vice Line
To Building Foundation.. //? ~
To Disposal Field. ~,//2 /
To Stream, Pond, Lake, c~ MajoroD~ainage
[Page 1, of 2]
2-15-84
C · ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'-3 ~3 o-~
Width of Field 3'Q //
Square Feet of Absorption Amea
Depression over Field (Y~
Results of Last Adequacy Test
'~,~--V///~-~Type of System Design 7~v,c~/J
Length of Field ~ /
~p~ of Field ~ /
Grail ~d Thick,ss ~ /'
~ Stan~i~s ~esent ~)
~te of ~st A~a~ Test ~
Separation Distance frcm Absorption Field:
To Water-Supply Well P~/~Z~;6L To P~operty Line /~'%
'~-CD /-(~ To Existing or Abandoned Sy~stem cn
To Building .F~dation
Lot ~/~ ; On Adjoining Lots 3~3 /~
To Water Main/Service Line ~ To Cutbank(.if present)
To Stream/Pond/Lake/or Majo~ D~ainage Course
To Driveway, Parking A~ea, o~ Vehicle Storage Area ~ /
Co~,~,ents ,~L ~c3/~_//2_~ /)%/ /c~/%/g-j ~. ~7_~ ¢
7,4/
Do LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Din~nsions
Manhole/Access (Y/N)
"Pump/Off~ Level at
A/ / Vent (Y/N)
Pumping Cy lng Adequacy Test.
/ --
Meets MOA
**
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA GuLd~lines in effect
on the date of this inspection. . / ' ~=. r~ ~.. %%
· ;,,~,~?.....,.. :,~,,,",,,
[Page 2 of 2] -~,,~.~-,,~.:-
2-15-84
DEPT. OF ENIVIRONMENTAL CONS~¥/kTHON
SOUTHCENTRAI_ REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
PWS t.D. ,~ Z/f_V~9
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom It May Concern:
According to Cecords on fi~le in this office the
Water Regulations.
_ Water System is in compliance with the State Drinking
Sincerely,
