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HYLEN CREST #1 BLK 3 LT 1
Hylen Crest #1 Block 3 Lot 1 #050-472-71 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://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241228 Work Type: Septic Upgrade Tax Code Number: 05047271000 Site Legal Address: HYLEN CREST #1 BLK 3 LT 1 G:0057 Site Mailing Address: 10211 STEWART DR, Eagle River Owner: ALBERSHARDT DAVID & HEATHER Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: r ,r Ucp�n�ttt��rnt 8/16/2024 8/16/2025 20006 Q Disposal Field 2 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 3 Received By: 1.55 %G E -G Date: _ Issued By: Date: L 2 UNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-3431-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-472-71 Property owner(s ) DAVID & HEATHER ALBERSHARDT C/O ARM SEPTIC SERVICES Day phone 907-688-9433 Mailing address 10211 STEWART DRIVE, EAGLE RIVER, AK 99577 Site address 10211 STEWART DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HYLEN CREST #1; BLOCK 3, LOT 1 Legal description (Township, Range & Section) _ Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (121 all that apply) Absorption Field FX� Initial F-1 Single Family (SF) [_X� (w/wo ADU) Septic Tank 7X Upgrade ❑ Duplex (D) ❑ Holding Tank El Renewal Fl. Multiple Dwellings 0 Privy 0 (SF and/or D) Private Well D Water Storage ❑ 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 Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: A5q_G_ Waiver Fees: Date of Payment: Date of Payment: Receipt Number: 01,aq4Sc— Receipt Number: Permit No. C)5,02ql-aZg Waiver No. GAIDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241228, Curtis Townsend, 08/16/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241228, Curtis Townsend, 08/16/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241228, Curtis Townsend, 08/16/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241228, Curtis Townsend, 08/16/24 of sE V 101 • ..'' / Isawas w"I'l s s �f 35.5' GARAGE f m NO m. LOT 1 B LO C K tl-, m 8T45��YV BLOCK LOT 7 T 00 0 0ri� LOT 1 BLOCK ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. () RECORD DATA PER FLAT 83-90 FOUND 1. 5" ALUM. CAP CENTERLINE MONUMENT EDGE OF ASPHALT FENCE PADMOUNTED TRANSFORMER C UTILITY PEDESTAL SEPTIC PIPE r DECK 000NCRETE 0' 0' 40' SCALE: 1" = 0 FEET (llflxl7") MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 82.5 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONENEW /.q^ / IJPG UPGRADE MAILINGADDRESS LEGAL DESCRIPTION LOCATION V NO, OF BEDROOMS -a DISTANCE TO: WellAbsorption P (. 4P f area Dwelling PERMIT NO. O .Y IF -z Manufacturer _ No. of compartments f Liq. capacity n gallons Cbl IF HOMEMADE: Inside length Width Liquid depth ❑ Y DISTANCE TO: Well Dwelling PERMIT NO. juz T? FQ- Manufacturer Material _ Liquid capacity in gallons ❑ DISTANCE TO: Well Foundation /—,( Nearest lot line f _. PERMIT NO. `�_ w = �.C�� r� r Q � J u.Z No. of lines / Length of eacl�l'n / Total length of lines, Trench width Distance between lines / r F, z w CC f ,. t s` ..SQ inches RI— Top of tile to finish grade �j f t Material beneath tile -z/ sl . Total effective absorption area ❑ J —'y U%rl � i P t Irw"T s ' 0 Length Width Depth PERMIT NO. Ua (7 aH a Type of crib Crib diameter Crib depth Total effective absorption area Ua W DISTANCE T0: Well Building foundation Nearest lot line Class) Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS m - SOIL TEST RATING -- _ - - — - -- - INSTALLER l' REMARKS m e s o `/ 6 j %n4- ltt�n APPR- \ 0v LEGAL ADATE/ 2 72-013 (Rev_73/78) 4_/f 11-H U P -A T, C:-:: 1* [F -t, IL 1' ._.F...IC-"o F-- F-1 PA RA V -D F�' Fo fl'_ 'q. L,'-- I) E P A RTH F -.T1 T F " HEALTH EP-P-o''I ROY-.11-1EPTITIL 0 T Ec.'r 'I o P.4 " ,,..;'-2 STREET.- MACI-If..'Rf--oE.flk'. L A F-, P L I G A N FT) B HLIG I AK '='9` 6 7 L.00.F-0-1 ON LOT J.. Bl_OCj:,* _1 HYLEN f '.:RE,, .;'l" S./[) i.-JECiAL 1-ir-144 1,Ald SEC 8 LiDT' S!Zr--'. 2,00,D1_16 FEET TIE.,: T F' 101,4 : � - .1 C F S L. A F." k:.; Ci R 10 P. -I S ',-I S T E 1', 1 L--, ., E 1-4 C. 1-1 HL1111 Ni 11-IBEF" OF BEDRC.O1T-:' SO.lL Rl'ITINC-1 1.2' : , -, T TIAE U IF, Ef.:- �'.;.T.ZE THE FlBS(')Rf`T1Oh1 "'Y"-TE1.1 I.- 2" _51: jl -t." o_— FZ: F --H ll...P E�Ell F'�- E-_ F` -11- V-11 'I'HE L.Ei-AG311-1 TIdE LPAGTH I--E-'.ET::, OF THE TRENCF-1 CiF., DRAII'lf"IEl.l.l. -'[ I "I"HE DISI'ANCE BETWEEEN THE _':'-l_lF:F("iCE OF THE NE DEP7+1 OF:' Fj "FREhIf'"Id OP: PIT 6ROWAD Fll'Al') THE BOTTOH OF THE E;:.::Cf.Ty`A`l"lON �lkl FEET'.'.1. i[,IEI--..,E H:: h10 14I1:.'TH F.-CiR THE [.1EPTH )`'; THE PI'D-HPIUM DEPTH OF G,[',Fil-elEL. BE11.1E.P.-I TFIE F, ITT. I U.11 � Ai'Al'.1 Tl JE BOT'J"Cil'-I OF JTIE E'--l`Fl-r'IN FEET, f "T'F.i R'A U'. F.'i L_ L_ VA."S-..': PERAll'T HAE.. FHE IPAFORPI TH1,1- DEPARTHDAT TIE:.' 11, ., 1: .T F9 L. I f-TFDDl,A OF AfAY I..1EL.Ll:,3 AD-JACENT TO THT-PRClFlERP-r' ANC, THE Y..IL.lP,lBF..:'R OF:' F:ES11.lEhICE'S, THAT 'THE WELL. I.-IlLL F-_" F.. h="G! II__. I ,^°E"E i�,_o T .1 1c,11P. OF F.11,111.1 SY'EJEH 1.111TIOLIT FDAAL lNC:PL-".C.TlOI%I Fikff'll AFT,ROVAL BY THIS WILL. BE SI lB.J'EG.T TO BET[,.IEEl'-,l A WEL.L. Al'AD FlhlY OP+-l:.JTE '.�..",E14AGE D'[SPOSAL SYSTEM I1112.1 FEET FOF.-..: A PRlwA"FE IdEl L. OR AD -7-i TO 2001 FEET FFT'll-I A PUBL.T.0 1.11711, ClEPE1,1DING, L.lpohl "ITIE" T"i"I'lE OF f:`1 IBLIC I-I.P1.111LIN CI P-31"ANCE FRiDN A PRT%.lF9TE WELL Til i=j PRlVA'J"E E',IEWEP.': L.TNE 'PS 25 FEET f1hIC, TO A '.5EI,-.IER Llf-,IE (.S. T-`; FEET. ANE, COIqc.,FRLlC'TlOhl DIA13RAMS ARE 1"THEIP HA' -r' i9f'11.111. F-A.lFjlL.FjBI...E Ti"D PROPER J, n.-..= E-.- H --9 IE:.:: EE F--., L J.: T All FF11,11L.T.AR kII"Ild 1+11", FOR SEldEIRS AND WEI AC. E.E'T Ff"IF.'"J"ll BY THE M1.6ji'l D -.I PH llP*v* OF SYSTEM Thl AC C!ORD Atl C:E WITH TH E AD THAT THE: : 0 N E SE.I.,.IEF: F,, E i'-:! Ul E EhIL.AF:.G,EHE?.,l'r lf-' THE J. i.Rd, llEF,,STfW - RES 1. IS F'EMCIE)E'l ED TO r.l',.ICL_lJE:lE 1-11"DRE THFIll EEDRO1__11lc_-_.. ...... . . ..... . . ..... APPI.-TCf 0,11" F. -:'IT .... ..... . . .... ..... 'd. 0 ZF6,t 7p SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: / \ it Ca Ila ha n DATE PERFORMED: O - iN — 9 „J LEGAL DESCRIPTION: /or 1 /-/ l c1 3 Hy )e I C ISLt�,t J DEPTH j SLOPE SITE PLAN (FEET) / I I I I/ 1 .4 17 2 5 SIT ty C�rave� :[=.1 3 P©4DOy gv'0jed yPctVJ Sawj 4 6VINA n0jjc0h-tijju0ct5 6" ievo?rs V4, t;irr ,Sca�Ay 5 J Iryve I Ap'0004w' /0P� O¢ A<,q co 7 0 " Awh e 8 Date Gross Time Net Time Depth to Water WA � ®, lames L Thode ��s•.• C1 5035 9 ••" ��� ��� pp0FESSIPoOr O®N Y CrjY{ WAS GROUND WATER 11 grr�IV,I-.5CtMj ENCOUNTERED? J 12 C- P IF YES, AT WHAT 13 DEPTH? -14 15 16 17 18 -1 scy-M:+4 A Test" Pill 19 b N0 0-- — E Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) �j 7 TEST RUN BETWEEN .m FT AND ® / FT COMMENTS ©!I /CRIJ�t 2'7� %��(?r�hUt�lf1 )NOiN �7 �i '1�7T do4uti PERFORMED BY: Ja IM1')<g5 G , T17 � CERTIFIED BY: AGWA l � Q , DATE: 7-1-91-49 72-008 (6/79) • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343- 7904 s A [ = r Certificate of On -Site Systems Approval Parcel I.D. 050-472-71 Expiration Date: 1 GENERAL INFORMATION Complete legal description Hylen Crest ##1, Block 3, Lot 1 Location (site address) 10211 Stewart Drive Eagle River, AK 99577 Current Property owner(s) Robert & Suzanne Spiller Mailing address 10211 Stewart Drive E Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 382-6905 le River, AK 99577 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Il Individual Water Storage ❑ Holding Tank ❑ Community Class A Well F Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Distance: Jfor: '" 8- Received by: L Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5;26- 0 Waiver Fee $ Date of Payment �� l �y ^ �b Date of Payment Receipt Number 2 Receipt Number COSA# OZ16 /f�7%� Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineeri Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 11/11/2016 6. DSD SIGNATURE System #1 Approved for —3— bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following [i9 TH.;,� I 61 ?,^aE.fi.... ........... MICH4P� c P.IJDEDERSON• � ry CE -4381 �. <11 stipulations: By 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheet! - c If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Hylen Crest NO. 1, Block 3, Lot 1 Parcel ID: 050-472-71 A. WELL DATA - No Well on Lot. 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 Well production WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA iii g. p. m. mg/L Collected by: ft. Tank Type/Material Septic/Steel - Date installed 9/2/1983 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) _ Date of pumping 5/25/2016 Pumper One Stop Pumping N C. ABSORPTION FIELD DATA Date installed 9/2/83 Soil rating (g.p.d./ftZ or ftZ/bdrm) 125 SF/BDRM System type Deep Trench Length 26 ft. Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth 11-12 ft. Eff.'absorption area 375 ftZ Monitoring tube Y Depression over field N Date of adequacy test 11/15/16 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 492 gal. New depth 22 in. Elapsed Time: 180 min. Final fluid depth 0 - in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date The absorption trench has been idle for 6 months and was pre charged with 1,107 gallons of water prior to the adequacy test. The monitor tube extends only 4.56' into the effective depth of the trench. Date installed "Pump on" level at Datum in Size in gallons _ "Pump off"level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: - No Well on Lot Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5 Water main >10 Water service line >10, Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10' Water Service line >10 Surface water >100' Curtain drain >50 Wells on adjacent lots >200' Absorption field >5' Surface water >100' Water main >10' Driveway, parking/vehicle storage > 10, in. F. COMMENTS The septic tank and absorption trench are more than 33 years old and nearing the end of their useful life. G. ENGINEER'S CERTIFICATION 1 certify that I 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. Engineers Printed Name Michael E. Anderson, P.E. Date 11/16/2016 COSA brown sheet -1 0-1 0-12.doc ®va0a®a6�e �`�F OF At 4S 90 L..{ ......... .............. WCHAR E. ANDERSM4 �i •. CF -4381 aaaE so X00 Municipality of Anchorage ' Development Services Department E Building Safety Division On -Site Water BWastewater Program 4700 Bragaw Street IUc P.O. Box 196650„I ) Anchorage, AK 99519519-6650 www.munl.orglonsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ff11, Parcell.D. O5b-4�: �T 2COSA# fit o I(da 1. GENERAL INFORMATION Expiration Date: `✓ — 7 Complete legal description Location (she address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HYLEN CREST SUBDIVISION ill: LOT 1. BLOCK 3. 10211 STEWART DRIVE * EAGLE RIVER, AK 99577 MIKE MAUGER do MIKE THURSTON Dayphone c/o AGENT c/o LYNN SWANSON w/ PRUDENTIAL VISTA Day phone LYNN SWANSON w/ PRUDENTIAL Day phone 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 242-2212 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class •A• Well 9 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-Sfte 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 samples. (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 engineers 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to moot the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole bonefit of the owner listed above. Any reliance upon or use of this repot by any other person or party Is not authorized, nor will R confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _3 bedrooms. Disapproved. Phone 337-6179 Date q/,7 Ub •.7 ............. j f y A�. .... s.r E-795 4001, �.• .•Ifl �']• tfa`cQ�G Cnnditinnal aooroval for __ bedrooms. with the filowino stipulations: a VFl111:KNM Attachments: J�OZO • .. • • • •'�S ;\\\�,\ COSA Checklist �/ Arsenic Advisory JJ ir�tN) Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Reort Nitrate Advisory Other By: Original Certificate Dale: IRwr •18,51 Municipality of Anchorage Development Services Department eukiq Safely Division OSke Water & Wastewater Program � I 4700 Bragaw street N P.O. Box 196650 Andxnage, AK 99519.6650 www.muni.orglonsite is (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HYLEN CREST SUBDIVISION #1; LOT 1, BLOCK 3. Parcel ID: 0si1 - (Y( 72 -.7 A. WELL DATA COMMUNITY WATER Well type -A' Daft completed [-?7—TII>' Static water level Well production If A, B, or C provide PWSIO# 213289 Sanitary seal Cased to ft. FROM WELL LOG R. g.p.m. WATER SAMPLE RESULTS: Coliform oolonies/100 ml. Nitrate mg./L. B. SEPTIC/HOLDING TANK DATA Well Log protected (Y/N) Casing height (above ground) in. AT INSPECTION of sample: Collected by: R. g.p.m. Tank Type/Material STEEL Date installed 9/2/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YIN) NS Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/30/2005 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA MI. Date installed 9/2/1983 Soil rating (g.p.d./ft'orjj!�o 125 System type TRENCH Length 26 ft. Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth 08.5 ft. Eft. absorption area 375 R' Monitoring tube "YES Depression over field NO Date of adequacy test 4/13/2006 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test DRY In. Water added 606 gal. New depth 8 in. Elapsed Time: 132 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — ""MONITORING TUBE ONLY EXTENDS 4.58 FEET INTO SEWER ROCK. D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot Absorption field on lot Public sewer main Sewer /septic service areas COMMUNITY WATER On adjacent lots On adjacent lots sewer manhole/cleanout Holding tank Manureianimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water service line Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain 50'+ Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION ,.� •`�'••, I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidednes in effect on this .... • .. • • •,. , • • . • •, • • • • • • date. f y A. arness. Engineer's' Printed Narge JEFFREY A. GARNESS •• CE -79 3 Date 17 ob dprolaseio^d COSA Fee s 4 W . t1b Waiver Fee $ _ Date of Payment 5/ YId 6, Date of Payment Receipt Number Lob _'ZQ Receipt Number (Rev. 1 IMS) Municipality of Anchorage Development Services Department Building Safety Division ` SA TV On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-472-71 HAA# 0 `T O � � S 1. GENERAL INFORMATION Expiration Date: co 3 " 0 Complete legal description HYLEN CREST SUBDNISION #1: LOT 1, BLOCK 3 Location (site address or directions) 10211 STEWART DRIVE * EAGLE RNER, AK 99577 Current Property owner(s) JOE WHEELER AND LANCE SPENCER Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 4185 POPLAR * SALLISAW, OK 74955 Day phone DAN WOLF W/ REMAX PROPERTIES Day phone 257-0177 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 samples. (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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name ' JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ZApproved for bedrooms. Disapproved. Phone 337-6179 Date o 4-1 Conditional approval for bedrooms, with the tllowing stipulations: WASTEWATER MOGRAM 1 O•.i Attachments: •��� HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort �/11► t ol Well Flow Advisory Other �� BY: � Original Certificate Date: (Rev. 12101) 6' 3 _0 q Municipality of Anchorage • y; -Development Services Department I; Building Safety Division " k On -Site Water &I Wastewater Program c I 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 , t www.ci.anchorage.ak.us i (907) 343-7904 HEALTH, AUTHORITY -APPROVAL CHECKLIST Legal Description: HYLEN CREST. SUBDIVISION #1; LOT 1, BLOCK 3', (Parcel ID: 050-472-71 A. WELL DATA COMMUNITY WATER { i I Well type A If A, B, or C provide;PWSID# 213289 Well L i ' Date ;completed Sanita s; Wires properly protected (Y/N) isI'I a T `I ft. Cased to ft. Casing'height (above ground) in. FROM WELL LOG i AT INSPECTION I Date of test Static water level ft ft. Well production g.p.m. ! g.p.m. WATER, SAMPLE RESULTS: Coliform _ colonies/100 ml.' Nitrate l,j ri bacteria colonies/100 ml. !i q' Date sample: Collected by: n B. SEPTIC/HOLDING TANK DATA 1 "' I, l, l Tank Type/Material SEPTIC/STEEL 1 Date"instailed 9/2/1983 �� ; Tank size` 1000 gal., Number of Compartments 2 Cieanoutl!s'(Y/N) YES Foundation cleanout (Y/N) YES : Depression over tank (Y/N)' NO High water alarm (Y/N) N/A ({ 5/22/2004 Pum er' MCDONAL'DS i PUMPING Date of pumping P C. ABSORPTION FIELDDATABELOW EXISTING GRADE, Date installed 9/2/1983 Soil rating (g p d %ft`or /bdrm 125 ISyste m type DEEP TRENCH 2B 25 ; ft. Gravel below pipe 7.5 ft. Len th ft.. Width a k P P 9 Total depth *8.5 ft. Eff. absorption area 375 ftz Monitoring tube ES i! Depression over field NO r a . ' Date of adequacy test 5/25/2004 Results (Pass/Fail) PASS ' pj� For 3 bedrooms fl i I '� Fluid depth in absorption field before test 17 in. ',Water added 625'gal „ New depth **59 in. ak A I: ( i i Elapsed Time: 428 min. Final fluid depth 738 ' in Absorption rate >= 450+ g,p.d. ,' Any rejuvenation treatment (past 12 mo.) (Y/N &'type) NONE KNOWN ;If yes, give date I ' *MONITORING' TUBE ONLY EXTENDS 4.58 FEET INTO' SEWER ROCK *AT TOP. OF LATERAL D. 'LIFT STATION Date installed "Pump on" level at in. Datu E. SEPARATION DISTANCES Size in gallons :� Manhole/Ac 'Pump off' in. * High water =1armevel at in. Cycles tested Meets alarm & circuit requirements? COMMUNITY WATER SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent IoLQ Public sewer main Public sewer manhole/cleanout eptic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ _.LL Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage' 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS as � G. ENGINEER'S CERTIFICATION I certify that I have determined through t"re/d inspections and _.. ,� 4 — ;9,� do review of Municipal records that the above'systems are in """' ""' ""' "'� conformance with MOA HAA guidelines in effect on this date. O.. eff A. Garn ss: �0 Engineer's Printed Name JEFFREY A. GARNESS QO�� C —79 �Op DateoC v 04pyo f e sslon&.�oo HAA Fee $ y� Waiver Fee $ Date of Payment �C, Date of Payment Receipt Number olsnw rk Receipt Number (Rev. 12/01) P": ?L :tv 0-1 :Wg "VO '-,T- Iv eaxqm tatse jUvimr. AUtdra e; 71C -VIC n. Aa�' - IN • A 00 ni 107 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M Division of Environmental Services M� On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # n41a LA`l�-`1� GENERAL INFORMATION HAA# Qt19 MIS 2n Complete legal description Lot 1, Btock 3; Hy en QLut Subd%v3tion #1 Location (site address or directions) 10211 Stewart D7cive Eanpo 21wo-jr APa�hn Property owner Tim Pa&ejc Day phone 694_2753 5403 Mailing address 10211 Stewan..t Dkive7 Eat, Riven, A2ahsa 99577 Lending agency Mailing add Day phone Agent Mike Le Lib/H0MEQU1TY #2502-3004 Day phone ( 214) 506-8808 00 , 11111�4Q,- TUaS 7509 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 [Z#VOW M089 (l6/L 'n29)9Zo-ZL 'Niom s,aaauidua leuoissa;oid ay; ul suoissiwo ao saojja ao; alglsuodsaa lou si abeaoyouv ;o Aj!Iedioiunyq ayl •panssi si a;eoi;Wao e aao;aq e;ep az (leue ao suol;oodsul ;onpuoo ;ou op SHHa }o s99AoIdw3 s;uawaainbaa a;e;s pue jeaapa; uleliaoA4si;eso;aapio ui suol;n;l;sui buipuel aiay; pue sawoy;o saaseyoand o; Asalinoo e se sly; saop SHHO ayl'eNselv;o a;e;S ay; ui paaa;si baa aaaui6ua Ieuoissa}oid ;uepuadapui ue Aq anoge 9 ydwbeaed ui UE)A16 suoi;e;uasaidaa ay; uodn Aluo paseq sa;eoi;Ilaao Jenoaddv (;uoy;nv q;IeaH sonss! (SHHa) saDWE)S uewnH pue y;leaH ;o ;uaw}jedaQ a6eaoyouv;o j!ledioiunVN ayl •uoi;oadsul sly; ;o a;ep ay; uo;oa;;a ui suoi;elnbaa pue 'saousuipao 'sapoo a;e;S pue ledlolunW Ike y;lnn eoueildwoo ui si wa;sAs lesodslp aa;enna;senn ao/pue Alddns aa;enA a;ls-uo ay; 'uoi;oodsui pue uol;ebl;sanui AW woa; pue SaIlb a6eaoyouv jo A;llediolunN ay; woa; paule;go uoi;ewao;ul ay; uo paseq;ey; A;uaAaayjjn; I •uiaaay pa;eoipul ein;ona;s;o adA; pue swooapaq;o aagwnu ay; ao; a;enbape pue leuoi;oun; 'a;es si wa;sAs lesodslp Aa;enna;Senn ao/pue Alddns aa;enn a;ls-uo ay;;ey; snnoys uoi;eoildde 1enoaddv A;iaoy;nv yUaH Siy; {o uol;eblISanui (w ;ey; A;laan I 'nnolaq unnogs a;ep uoi;epllen ay; ;o se pue o;aaay paxi;;e leas !w Aq palpliao sv a33NION3 AS N01103dSN1 d0 1N3W31d1S 'S s;uawwo0 leuoi;lppv suoi;eIndi;s 6ulnnollo; ay; y;lnn 'swooapaq Ao; Ienoadde leuoi;ipuo0 •panoaddesip swooapaq ao; pano.)ddv 1 ^ty`r1, K ElunIVNJIS SHI9a '9 fP.5) VO 'ID i l• D O O •� ��t f e n..0 C • O o. V'. J• a 00l� Y)1' e o� Ib�l_� a}ea ain;eu6lss,aaaulbu3 __ U566 a>lSely raanl� aIBe3 peoa dool JaNlb Of e3 KOLL SSaappv ONIN33NION3 SF S auoyd w.11 O awe �b N •uoi;oadsul sly; ;o a;ep ay; uo;oa;;a ui suoi;elnbaa pue 'saousuipao 'sapoo a;e;S pue ledlolunW Ike y;lnn eoueildwoo ui si wa;sAs lesodslp aa;enna;senn ao/pue Alddns aa;enA a;ls-uo ay; 'uoi;oodsui pue uol;ebl;sanui AW woa; pue SaIlb a6eaoyouv jo A;llediolunN ay; woa; paule;go uoi;ewao;ul ay; uo paseq;ey; A;uaAaayjjn; I •uiaaay pa;eoipul ein;ona;s;o adA; pue swooapaq;o aagwnu ay; ao; a;enbape pue leuoi;oun; 'a;es si wa;sAs lesodslp Aa;enna;Senn ao/pue Alddns aa;enn a;ls-uo ay;;ey; snnoys uoi;eoildde 1enoaddv A;iaoy;nv yUaH Siy; {o uol;eblISanui (w ;ey; A;laan I 'nnolaq unnogs a;ep uoi;epllen ay; ;o se pue o;aaay paxi;;e leas !w Aq palpliao sv a33NION3 AS N01103dSN1 d0 1N3W31d1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Ldr 1 !A�,l L -P-4 LR 6sr sIn`LI Parcel LD A. WELL DATA Well type A If A. B, or C, attach ADEC letter. ADEC water system number 1122 �8 Log present(Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to Driller Casing height Wires properly protected (Y/N) SEPARATION DISTANCES FROM WELL TO: G7 ® C: <m c� Septic/holding tank on lot 2 Dot* ; On adjacent lots Absorption field on lot Z -(-_>L2 ; On adjacent lots _ Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed — '� ' v 11R3 Tank size ludo C t t Cleanouts ON) ompar men s -Foundation cleanout&N) fir— Depression (Y/Q J High water alarm (Y/A 11i Alarm tested (Y/N) 'z o -1 c1 hi * 11I Date of pumping �}-A oy^rt_ Sri-�ctc.G s . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 � P Well(s) on lot Zod On adjacent lots 1 Ix To property line 1 �� } Absorption field S Surface water/drainage 10C> Foundation Water main/service line MA kk- 72-026 (Rev. 72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION R1 Date of test iC7 �' z I1'f C rti Y Static water level 0 Well flow . g.p.m. g.p.�'m- N n Q < > Pump level SEPARATION DISTANCES FROM WELL TO: G7 ® C: <m c� Septic/holding tank on lot 2 Dot* ; On adjacent lots Absorption field on lot Z -(-_>L2 ; On adjacent lots _ Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed — '� ' v 11R3 Tank size ludo C t t Cleanouts ON) ompar men s -Foundation cleanout&N) fir— Depression (Y/Q J High water alarm (Y/A 11i Alarm tested (Y/N) 'z o -1 c1 hi * 11I Date of pumping �}-A oy^rt_ Sri-�ctc.G s . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 � P Well(s) on lot Zod On adjacent lots 1 Ix To property line 1 �� } Absorption field S Surface water/drainage 10C> Foundation Water main/service line MA kk- 72-026 (Rev. 72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at "Pump off' level at Meets M=DISTANCE /N) SEPARAOM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed 01 - 7, - 63 Soil rating I1s>4 System type Length Z Lo Width �� Gravel thickness 5 Total depth Total absorption area Cleanouts present6)N) Depression over field (YQ rl Date of adequacy test Results fail) Pxss for '1AV_F,� (�3) bedrooms Peroxide treatment (past 12 months) (Y64 A�01/E XCnloklAl If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 20 0 ( On adjacent lots �1N Property line To building foundation 10 To existing or abandoned system on lot On adjacent lots __:�� `r Cutbank 'd IA- Water main/service line 10 r Surface water t oo % r Driveway, parking/vehicle storage area °)o k i Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,QnJhe-Uatp of this inspection. �y 1 Signature — (;, i,;r S & S ENGINEERING Engineer's Name 17034 Fa�4a0. Fa a euo �n Eagle River, Alaska 99577 Date g�� ���� �,, -s",y 4'Z'31 HAA Fee $ — G Waiver Fee: $ Date of Payment — �G�y �� \ Date of Payment Receipt Number /%��2� 1 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 0 IF d 1. AaA .1 WXTER J. NICKEL, GOVERNOR TEll L DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 August 9, 1991 FOR: S & S Engineering Ray PWSID #213289 14"'dLg n My review of the records on file in this office reveals that the l Crest Subdivision Class A Public Water System, is in compliance with the provisions of 18 AAC 80,060, State of Alaska Drinking Water Regulations. Sincerely, .Qe}i?ih, Keven K, Kleweno Lead Engineer $ MUNICIPALITY OF ANCHORAGE DDIISION OF ENVIRONMENTAL HEALTH DEPAR'EMENT OF HEALTH AND ENVIRONMENTAL F`f?OTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAli CERTIFICATE General I.nfor_i-otion Application Date (a) Legal Description (include lot, block, subdivision, section, tciinshi_p, range) n � LoQation (address or .directions) , (b) Applicants Naw_ -Z' lC-"u -- - - ItalepttoneC_=> Applicants Address r. (c) Applicant_ is (check t one) Lending Insti yItion Owrer/builder Buyer �C ? Other !� (explain) ;�P, %:•z �� �- _ _ T ___, (d) Lending Tn:,ti..tution / U C�; Telephone Address J (e) Real Estate C(� &Agent /-C'�/�i � :__���%?•!''�^--__ �� �✓.�'"�"i�`% Address'' -L MTelephone 2. T of Residence: Single --Family I� Multi -Family Number of Bodroortr 3 Water SUPT-A.Y Other (describe) Individual Well 1:--J Community Public Ff Note: If c m unity well system, must have written confirmation from the State Depart-wnt of Ehvironmyntal Conservation attesting to the legality and status. Is the well adequate for the number of bedrocrm specified in this HAA (YM) A/ — 4. Sewa e Disposal. Onsite Public Community Holding Tank Is the wastewater disposal system adequate for the number of b;drocam (Y/N) _Y [Page 1 of 21 2-15-84 5. rEwineering Firm ProvidingI ctions,T@sts, L�ita and Information I certify that I have checked, verified, or conformed to all MOA HAA Guideli.r:es in effect on the date of this inspection. Signed !lite"O.Date -- _ (•,/- Naim, of Firm �. T / 11 ec,i�� lac Tele hor_.e 6- Address_ / ; �"crC1l IVQV+nR- jcJl '. (N'I UQY� Ab, 7 (715-7 7 Signed by i ct t'1,1Fri Date o, DHEP A�roval Approved Approved �. (ENGINEER SEAL) be. dreoms Disapproved Terms of Conditional Approval 01 LUILAIaA �� Zhe Municipality of: Anchorage Department: of Health and Environmental Protection does not guarantee; the, continued satisfactory performance of the water supply and/or the wastewater disposal. system. This approval indicates that, as of the validation &.rite shown above, based on the data and information furnished tN an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func-- Lional for the number of bedrooms and type of structure indicated. 0 (DHEP SEAL) 7. Mail the HAA to the following address: KP2/d5/s J [Page 2 of 21 2. -•15 --II? MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION JUN 2 91984 A. WELL DATA RECEIVED, Well Classification A If & B, or, C, D.E.C. Approved(YM) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of: Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ; Date Water Sample Test Results Comments Seg- %te B. SEPTICS TANK DATA Date Installed l -2 -�_ Size GA). No. of Compartments Standpipes (Y/N) Air -tight Caps (YM) Foundation Cleanout (Y/N) Depression over Tank (Y/N) IV _ Date Last Pumped No-/- pu n SZ5.rc�cv� Pumping/Maintenance Contract on File (Y/N) for -V,Q Holding Tank High -Water Alarm (Y/N) A4ZA Temporary Holding Tank Permit (Y/N) N1,4 Separation Distances from Septic/Holding Tank: To Water -Supply Wall' (7- + To Building Foundation To Property Line C) �'� -t To Disposal Field To Water Main/Service Line J 0 To Stream, Pond, Lake, crr Major Drainage Courser Comments [ Page 1 of 2 le4r,- C4� -�- 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I ZS" - l/ 2 P Type of System Design 7` vle. Date Installed C? - i? - `g 3 Length of Field 2 6 -0- Width of Field 30 ; vs Depth of Field /0's- To ! ,S -C-T Gravel Bed Thickness ',5- FT Square Feet of Absorption Area 3 "%S� --r7-z Standpipes Present (Y/N) Y Depression over Field (Y/N) /V Date of Last Adequacy Test AIon_ e�1gly says Results of Last Adequacy 'lest /V /A Separation Distance from Absorption Field: To Water -Supply Wf:11 200 T-1-1- To Property Line 1 To Building Foundation i?(' To Existing or Abandoned System on Lot A/ /A on Adjoining Lots 3 0 r/ - To Water Main/Service Line /o -r--/- .I- To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /V /,q To Driveway, Parking Area, or Vehicle Storage Area /0 P7` -t Comwnts D. LIFT STATION Date Installed A//A Diirensions Size in Gallons "Pump on" Level at Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy 'lest. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedrooms R8tting Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA on the date of this inspection. 0 Signed� /lam ��_ Date ��� `b �' ��'Gj Compan •. 1 % MOA No. 4-4, KBl /d5/s (Page 2 of 21 in effect I 2-15-84 BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 DATE:i4 PWS I.D. .g13ZY _ To Whom It May Concern: Accord ing to records on file in this office the ` OAJ C/00 elm &hhel Water System is in compliance with the State Drinking Water Regulations. Sincerely,