HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 4Onsite File
Hylen CAreST 1
Two wells on this lot were used for the community
make sure they were decommisioned.
Municipality of Anchorage Page of �✓
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5W 93 D/I 9 PID Number:-
Name:
Wastewater System: IX New ❑ Upgrade
Si8i3i57'JL`/
Address:
/'o o '17288 C„�r /jk �9�77
ABSORPTION FIELD
Phone:
Phone:
- 55 3y (MSC
No. of Brooms:
Deep Trench ❑Shallow Trench O Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Sol] Rating:
Total Depth from original grade: o
GPD/S .Ft
Lot: Block: Subdivision:
YLEN Ckr-ST #1
Depth to pipe bottom from orlglnal grade:
6,S Ft.
Gravel depth beneath pipe
S'•S Ft.
Township: , /
Range: /�
Section:
FIII added above original grade:
Gravel length:
8
/� /y
6 --2- Ft.
Ft.
WELL'• El New ❑Upgrade
Graveldspth"w��/�
Numberoflines:
Distance between lines:
O
/�l/A
Ft.
Ft.
Classification (Private, A,B,C): Total D
pvel-/C, Ft.
Cased To:
Fl.
Total absorption area:
%Sb SQ. Ft.
Pipe material:
3D3�t /�STi''1
Driller: Date Drilled:
Static Water Level:
Installer:(9�/ ^ A /r
C?4E�%i IY
Date Install dil 93
Ft.
Yield:
Pump Set al:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
(ySeptic D Holding D S.T.E.P.
To
Septic
Absorption
Lllt
Holding
Pnbtib/Private
Manufacturer:
Capacity In gallons:
From
Tank
Field
Station
Tank
Sewer Lines
NCy.. �
/Z_J�D
Well
IV14
A14
/(/4
/V/4
NIA
Material:_57iL
Number of Compartments:
ware;
1,114Nle}
N1.9
1,11A
1-11.4
LIFT STATION
Lot
50 7
`'/A
N/�
FO /
Size In gallons:
Manufacturer:
Line
Foundation
n
/71
yfA
I\//A
A// A
"Pump on" level at:
p leve
High water alarm at:
�/ ^
\11 ^
` �'f
r/ /A
N l A
/
/k//A
Pump Make 6 M
El9ctrlcel Inspections performed by:
Drain
Drain
/I
/
BENCH MARK
Remarks:
Location and Description:
yrs, i4y SOY,
Assumed ) vptlpn:a EL
ENGINEEQ'$ SEAL
OF
/PPE'9 s �� °aa�O Quay 6
:49 N; f�..ly5 � e• ^(� �
Inspections performed by:��(�//lECf2 Dates: is
2nd a
�a •a°a°. °a.,°a.•a
Louis '\.- butorci
'•
Department of Health and Human Services approval
U-6736
�o`�'°°,..°a.a°°°°°°"a�•����
%- 23 - V���PROFESS`�P�
Reviewed and approved by: Date:
72-013 (1/91) MOA 25
Permit. No. SW93O119
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343.4744
On -Site Wastewater Disposal System and/or Well Inspection Report
nnal nccrrintinn' Hylen Crest #1 Lot 4, Block 3 PID No.: 050-472-68
SCALE 1" 40'
/ S 80'19'30• C
200.69
o � I
n �
v
u� I
rY rr
J
I
ru I 6S
o �D—
£ O, 6, OF _ 9S D��F
340
W pZ ER PINE 9 C° 0 3
o
4`S a N M
A2 1,250 N
N I 1/SEPTIC
� I �
TANK
3Q' E D SWING TIES
F A - D = 21.2'
n I u B- D= 31.5'
m p z A- E= 18.6'
s I p B- E = 36.3'
-Z, LOT .4 Q N A -F=30,4'
? x a B - F = 41.3'
Q G _ A - G = 53.3'
B - G = 74.3'
i -Io -y H C - G = 82.9'
- — — — — — — -- — — — — A - H = 58.6'
p. B - H = 77,0'
�o �p I5' UTILITY EASEMENT. C - H = 93.5'
181.85 A - 1 = 21.1'
�.9 N 89°.59'0' W B - I = 23.1'
i I
! i
rq ENGINEER'S SEAL
ELEVATINNS & WATER KEY Bp%
(NOT TO SCALE) ASSUMED ELEV = 100.00' OF
� 11
jo'
ORIGINAL *.. 49TH
_ : * _�0
LEOVEL° 0 100.7- �� �f---a', 0
,..
NO GWT cA^ LOUIS A. BUTERA Wd
s - CE -6736
TANK \ 94.2 X94.2 63.2
95.4 `-95.2
FIELD 1'1 pROFES51ONP� ��
72-013 A (2/011 MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930119 DATE ISSUED: 5/24/93
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 5/24/94
OWNER NAME:SIBBETT FAMILY
OWNER ADDRESS:P. 0. BOX 772884
EAGLE RIVER, ALASKA 99577
PARCEL ID:05047268
LEGAL DESCRIPTION: HYLEN CREST #1 BLK 3 LT 4
LOT SIZE: 40209 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
DATE:
ISSUED BY: C �( DATE:
Louis Butera, P.E.
Registered Civil Engineer
May 14, 1993
John Smith, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Hylen Crest #1, Lot 4 Block 3
Narrative
Dear Mr. Smith:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The area has large lots allowing sufficient room for septic sites. There are no
well setbacks.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity, and public water supply.
4. Drainage will not be effected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1993\93-019A.LTR
P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297
30'
PUBLIC WATER
LUT 3 I — _
WELL +100'
o Z — TEST HOLE
J o — MONITOR TUBE
0 — SEWER CLEANOUT
LOWLAND AVENUE -o- -- KEYBOx
PROPOSED LEACHFIELD
NO KNOWN CURTAIN DRAINS EASEMENT
SEPTOC S� TE PLAN
LEGAL: LOT 4, BLK 3 HYLEN CREST #1 OF
OWNER:
_ N/A
_CONTRACTOR: EAGLE VENTURES .49TH *,o
JOB 93-019 DATE: 05 12 93 SCALE 1" = 40' �—
# / /
..l:` ...........
0 ....4
EAGLE RIVER ENGINEERING SERVICES 00 LOUIS A. BUTERA �W®
AP.O. Box 773294 I�'sT� CE -6736
EAGLE RIVER, AK 99577
(907) 6 4-5195 FAX: (907) 694-3297 ,,,II1P'?FSSI00 •''w
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 49 BLOCK 39 HYLEN CREST #1
A. GENERAL
I. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environmental
Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 11.5' at any point with
relation to ground surface at test hole #3.
4. The sewer line is to replace the existing sewer line that leads to the existing pit.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 4' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 11.5' GRAVEL DEPTH = 4.5'
TRENCH LENGTH = 84' TRENCH WIDTH = 3'
SOIL RATING = 0.8 GPD/FT2 BEDROOM CAPACITY = 4
SEPTIC TANK SIZE = 1,250 GALLONS
Twenty-four (24) hours notice required for all inspections.
EAGLE RIVER
ENGINEERING SERVICES
P. 0. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
JOB Hylen Crest #1 Lot 4. Blk 3
SHEET NO.
CALCULATED BY
CHECKED BY —
snel a
OF—
L.B. 05/13/93
DATE
DATE _
PROM 2M-0A� In. Golm. Mm 01471.
PERFORMED FOR:
t,/e
Gross
Time
t (ENGINE ER'SSEAL)
DATE PERFORMED:
Net
Drop
Municipality Anchorage
e ea aea on o° e,;.
of
�/3��j
f DEPARTMENT OF HEALTH & HUMAN SERVICES
Louis, a 7,.
�n /1-
825 "L" Street, Anchorage, Alaska 99502-0650
a
J, c :•r,:
(%�°aa ++
SOILS LOG — PERCOLATION TEST
pp n°°co uooa
PERFORMED FOR:
t,/e
Gross
Time
i6le `irr'rJ
DATE PERFORMED:
Net
Drop
LEGAL DESCRIPTION:
�/3��j
/er✓ �i�.r7`
Township, Range, Section: �— iy�,� �/ej J'ec.8"
1
2 O
3
7
0
9
1 o d
14-
15-
16-
17
415 1617 G ,
1P
SLOPE
��" r�4 ✓/Jr Uv✓rY %�"�ett GfLvSC
WAS GROUND WATER Nb
ENCOUNTERED?
s
IF YES, AT WHAT L
O
DEPTH? p
E
Depth to Water Aller
Maniloring? d ay lb /6 Date:
SITE PLAN
e— IS -
Iz
rM
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
=
_
7r7/�.
/ - S-.7
/v
7'- V/c
r 16
20
II_ JI PERCOLATION RATE ' 7 (minules7inch) PERC HOLE DIAMETER 6 /r
TEST RUN BETWEEN FT AND -F —FT
COMMENTS e��>li �GX- / 7'r�._e� = O.£ G..... 7
PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT" ON THIS DATE. DATE. �7 �.��i
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: r
LEGAL DESCRIPTION:Z 3 Z ->oz P L
1 j
2
U
3 _
U
4 v .
6
7
8- r
9
10
G
11
_ G
12
G,p
13
14
15
16
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18-
19
Ic
iN.-vN o y
SFn�F G„GVC I
CS/h -mG)
/jYo�✓N /h ail f
^jfNGINEA'S SEAL)
tg
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R 0 1 S` O'
N
DATE PER F1
Township, Range, Section: T /i/i✓ /e/w Sa c 8
SLOPE SITE PLAN
n
N'
e
WAS GROUND WATER
ENCOUNTERED? iF J
s
L
S• i r,'w, of - e/ IF YES, AT WHAT / 0
DEPTH? P
r Cc! "ea.—Je E
Depthm Water Aller
Montt / / 3
Monitoring? ��'9 date: S �/
Reading
Date
Gross
Time
Net
Time
Depth to Net
Water Drop
IVA
N
0<r Cid
IVd
20
PERCOLATION RATE (minutes/inch) PEHC HOLE DIAMETER
TEST RUN BETWEEN — FT AND FT
COMMENTS S% i�OLF /V eT N Ti//7c.i iN �cf.J.✓
�..�. -.
PERFORMED BY: r�r/�7� S I CERT IFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,
7? 009 (R(!v A,85)
(ENGINEER'S SEAL)
Municipality of Anchorage ��i-
L DEPARTMENT OF HEALTH & HUMAN SERVICES
r
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
r {'E'.✓�hY�J
PERFORMED FOR: L4J/e
LEGAL DESCRIPTION: yz3
1
2
�o
3
4
5 ~_
f
6
G�
7 �U
v -a
a —
_ v,
G
10 G
11
12
13
14
15
16
17
18
19
i
IU�J JoI/ � Urs a.�iC
(6PJ
S6 C� <� v eel Y0P✓le
Hl "j f-
S/If/C �Gy /J rLWN
.i4N F�l. �/GYL
✓�+C e! lG�e NfP
G.ryl
DATE PERFORMED:
Township, Range, Section: T /moi✓
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?i._J
S
LffiffN
IF YES, AT WHAT
0
!J
DEPTH?
E
Depth to Water Aller /
�3
Monitoring?
Dale:
Gross
Net
Depth to
Net
Drop
Reading Date
Time
Time
Water
Sia ca
41
Ll J116
..
/
a
20
PERCOLATION RATE '� (nunutesiinch) PERC HOLE DIAMETER �.—
TEST RUN BETWEEN FT AND 3 FT
��! S yrfe eon 2 T/' /fie n/, tfc5
7
COMMENTS rr
-77 GERIIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: —
72-OOB(Rev .4185)
ERU Inc.
HYLEN CREST WATER UTILITY
P.O. Box 141907, Anchorage, Alaska 99514-1907
Phone 561-5411 or 333-7517
Febuary 2, 1992
Marie Fried
Drinking water manager
Southcentral regional office
3601 "C" St, Suite 1334
Anchorage, Ak. 99514-1907
Re: VOC water sampling
Dear Ms Fried
FEB 0 4 1992
r-'11JIgr o.lq 'ENTPAL 6ay\IStFRVATFON
vvt'fL
Please be advised ERU, Inc., has transferred their
utility to AWWU, and we have abandoned the wells.
Sincerely, /
Charles Hylen, President
ERU, INC.,
FE13 6 1992
DEPARTMENT OF
UdU16iCPs14+�rENTAI CONSERVATION
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-4.72-68 COSA *-42S ���
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Hvlen Crest #i. Blk - Lot 4
Location (site address) 21121 Lowland Ave Eagle River Ak 4gsrr
b
Current Property owner(s) Anna L & Alan P Scanlan Day phone (711)208-656i
Mailing address
Lending agency
Mailing address
Real Estate Agent
21125 Lowland Ave Eagle River. Ak 99577
Day phone
Day phone
Mailing Address
Unless otherwise requested, COSA will
be held by DSD
for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
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.
Name of Firm Pannone Engineering Services LLC Phone 272-8228
Address P.O. Box 3.00217 Anchorage AK ca4s3.o
Engineer's Printed Name Steven R. Pannone P.E. Date I (—
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features. "„11%
The operational life of all wells and septic systems depend on the local soil condition, ground water ��•� OF q,ilt�
levels that may fluctuate during the year, and the water usage of the family being served by the system.
P..•••""'••••.<..;9s��
These conditions are outside the control of the evaluator of this system. All systems eventually fail and C,,
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that A p' q m
there are no hidden defects or encroachments. PES can therefore not provide any warranty for �umre 00 .... ••••• ••• ••• ••••• •......n•••••�
performance nor give any estimate of how long the system will continue to meet the operational 0
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed R7 annone; i
above. An reliance upon or use of this report b an other person or is not authorized nor will it �1 No. CE a t a9 •e
Y P P Y Y P Party s
confer any legal right whatsoever. �.,•�
5. DSD SIGNATURE
;; p`.
LZ Approved for _ bedrooms.
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
By: r ���� �C� C Original Certificate Date:
(Rev. 11105)
Municipality of Anchorage s
' Development Services Department °
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Hylen Crest #z Blk 3 Lot 4 Parcel ID: 050.672-68
A. WELL DATA
Well type Public
Date completed
Total dep ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (YIN)
Cased to ft.
A WELL LOG
ft.
g. p. m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: _ ug/I
B. SEPTIC/HOLDING TANK DATA
Nitrate
mg/L
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Date of sample: _ Collected by:
ft.
9—
p.m-
Tank Type/Material Septic/Steel Date installed 6/22/2Qg7
Tank size 22S0 gal. Number of Compartments z Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NIA
Date of pumping 4121/2012 Pumper JRs Pumpers
C. ABSORPTION FIELD DATA
Date installed 6/3.8/ho9:t Soil rating (g.p.d./ft2 or ft2/bdrm) o.8 gpd/sf System type Deep Trench
Length 84 ft. Width 3 ft. Gravel below pipe 4.5 ft.
Total depth 3.2 ft. Eff. absorption area 7s-6ft2 Monitoring tube Y Depression over field N
Date of adequacy test ;/I;/20:L2 Results (Pass/Fail) Pass* Forlbedrooms
Fluid depth in absorption field before test 47 in.
Elapsed Time: ggo min. Final fluid depth r47 in.
Water added 6o� gal. New depth 4,8 in.
Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
"Pump on" level at _ in.
Datum
E. ' SEPARATION DISTANCES
Size in gallons
"Pump
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tan on on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Manhole/Access (Y/N) _
Hich water alarm level at
Meets alarm & circuit
On adjacent lots
On adjacent lots
Holding tank
manhole/cleanout
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation c+ Property line —5+ Absorption field c+
Water main io+ Water service line io+ Surface water ioo+
Wells on adjacent lots 2.00+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line io+ Building foundation io+ Water main io+
Water Service line io+ Surface water ioo+ Driveway, parking/vehicle storage io+
Curtain drain So+ Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
.��O��.U- A�.
k9
I certify that 1 have determined through field inspections and ;
review of Municipal records that the above systems are in T"
.... . .... ... u. i...
conformance with MOA COSA guidelines in effect on this date.0.....h
......................................nn
Engineer's Printed Name Steven R. Pannone. P.E. s�i Steven R. Pannone."
Ls.. *CE 8149`,•�
Date S�I `2� l "L �D'.... '.•S.�•
COSA Fee $_
Date of Payment
Receipt Number
(Rev. 11/05)
0
Waiver Fee $
Date of Payment
Receipt Number,
in.
.. -e
Municipality of Anchorage
• --. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1. D. 050.472-69
1. GENERAL INFORMATION
Complete legal description Hylen Crest SID#1, Block 3, Lot 4
Location (site address) 21125 Lowland Avenue. Eagle River, Alaska
COSA# 0 0 H 6-3
Expiration Date: / a - 3 O — / O
Current Property owner(s) Aldrich, Roder 1: Judy Day phone 22243622
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Audry MasonlReMax of Eagle River Day phone 622.3344
Mailing Address 11525 Old Glen Hwy.. Eagle river, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
Q
TYPE OF WASTEWATER DISPOSAL:
Individual On-site❑
Individual Holding Tank
❑
Community On-site
❑
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 Stale 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.
Name of Firm
Douglas T. Kenley, P.E. Phone (907) 746/1073
Address 9608 E. Nonhslar Drive, Palmer. Alaska 99645
Engineer's Printed Name Douglas T. Kenley P.E. Date Ill-Ti°%°I
F. .
9 ii H�
i`
5. DSD SIG ATURE err S T 1� M
l�Approved for bedrooms. ��v •• CEI '
Disapproved.
'fit FjPv �t _
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_
By: a, Original Certificate Date: I' 3 0_0 1
(Rev IiM)
Municipality of Anchorage
Development Services Department
Building Safety Division t�l
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Hylen Crest Subdivision k1. Block 3. Lot 4 Parcel ID: 050-472-68
A. WELL DATA
Well type Public If A. B, or C provide PWSID N _ Well Log (Y/N)
Date completed _ Sanitary seal (YIN)_ Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height (ab round) in.
FROM WELL LOG AT IN TION
Dale of test
Static water level ft, iL
Well production g.p.m. g.p.m.
WATER SAMPLE RES
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
A enic: mg/l Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 06121193
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y' Depression over lank (YIN) N High water alarm (YIN) WA
Date of pumping 6/1012009 Pumper JRs Pumpers
C. ABSORPTION FIELD DATA
Date installed 06/21/93 Soil rating (g p.dJf? or ft'/bdrm)0.6 0pmm 1250 System type Trench
Length 42.42 ft. Width 3 ft. Gravel below pipe 4.5 ft.
Total depth 11 ft. Eft. absorption area756 fe Monitoring tube Y Depression over field N
Date of adequacy test 12/26/09 1 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 16/10.314 in. Water added 1463 gal. New depth 53-3/4/41.3/4 in.
Elapsed Time: 1456 min. Final fluid depth 30.1/2/18-7/8 In. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 me.) (YIN & type) N If yes, give date —
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
'Pump on' level at _ in.
`Pump off" level at _
in. High water alarm level at in.
Datum
Cycles tested
Meets alarm & circuit vements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent tots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /se ervice line
Holding tank
A mal containment areas
Manure/animal excrete storage areas "
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 17 ft.
Property line18 ft.
Absorption field
Water main 25+ ft.
Water service line
10+ ft. Surface water too+ ft.
Wells on adjacent lots 100+ It.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 18 ft.
Building foundation
20 ft. Water main 25+ ft.
Water Service line 10+ ft.
Surface water 1100+ ft. Driveway, parking/vehicle storage 5+ ft.
Curtain drain N/A
Wells on adjacent lots
100+ ft.
F. COMMENTS: • F.C.O. is located Rush in the asphalt.
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 guidelines in effect on this date.
Engineers Printed Name Douglas T. Kenley
Date It I 1 ° 1
COSA Fee $ �� O
Date of Payment
Receipt Number Y,/ 3 Z3 nq G
(Rev 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number
�.:f. vim. •�; e��'
T MUM
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES 4cl
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 050-472- (A HAA #1a Fla q 2)
1. GENERAL INFORMATION
Complete legal description
Hvlen Crest #1 Lot 4 Block 3
Location (site address or directions)
10115 Stewart Drive, Eagle River
Property owner Sibb .tt Family Day phone N/A
Mailing address P.O. Box 772884, Eagle River, AK 99577
Lending agency N/A Day phone
Mailing address
Agent NSA Day phone
A.4,4� r.r,
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water X
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 X
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) Frani MOA 021
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Eagle River Engineering Services Phone 694-5195
Address
P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Dated 53
bedrooms, with the following stipulations:
Date 7 2 3 - 93
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this`as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA M21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: #y1_4N C/eif,5T #1 Parcel I.D. pSp.. y72 Llai
l r � 3c oe,jr s
A. WELL DATA
Well type 100136/C If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N).
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Date completed
Cased to
FROM WELL LOG
SEPARATION DISTANCES FROMWELL
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SA LE RESULTS:
Colifor Nitrate
D e of sample:
B. SEPTIC/+feL-0414G TANK DATA
Driller
Casing heigW/—
XproperlytecteSdIONg.p.m.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Other bacteria
Collected by:
Date installed — 0 04 /1/ 93 Tank size / z 50 Compartments 2–
Cleanouts (Y/N) yc,5 Foundation cleanout (Y/N) li� Depression (Y/N) /V0
High water alarm (Y/N) IV11,4 Alarm tested (Y/N)
Date of pumping /V/4 " wcw Pumper N�l
SEPARATION DISTANCES FROM SEPTIC/Htf BFWG TANK TO:
Well(s) on lot A On adjacent lots /� ��� Foundation
To property line 5'Z-- Absorption field Water main/service line r d
Surface water/drainage
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N
Manufacturer
Manhole/Acces
SEPARATION DIST/ANC`E FROM LIFT STATION TO:
Well on
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water
Date installed D(o /2/ Aq Z Soil rating 0, q 6-d- - System type dCLI) file E"NC/Y
Length $4 Width 3 Gravel thickness 4, 5 � Total depth
Total absorption area %s6 %� Cleanouts present (Y/N) YGS
Depression over field (Y/N) N / Date of adequacy test
Results (pass/fail) PAS S for '7` bedrocims
Peroxide treatment (Past 12 months) (Y/N) If yes, give date At
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N�� On adjacent lots Al l q Property line
/
To building foundation �� To existing or abandoned system on lot N��1
On adjacent lots -/30 Cutbank Water main/service line > /o
Surface water /A Driveway, y, parking/vehicle storage area 2_0
Curtain draini�IM
E. ENGINEER'S CERTIFICATION
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effqptV�11 inspection.
neo
e 0.
tr£
Signatureu
/ �y e
Engineer's Name A, 4f .C3h 7� ✓G ;� ..., :, ,... ......... ,...
Lowi A. l;ui3ra
, R
Date
I�4�AR;o Q,a QN
HAA Fee $ (/� ` Uv Waiver Fee: $
Date of Payment 7` 3 Date of Payment
Receipt Number 1c�0 I �g g� 1 Receipt Number
72-026 (Rev. 3/91) Back MOA 21