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HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 5Hyl n Crest V Aff RIJ rl B lock 3 Lot 5 #050-474-01 sut"TAL SEP 14 2012 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP111160 PID Number: 050-474-01 ❑ New ❑✓ Upgrade Name: Ted and Adrienne Bachman ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 5771 Heritage Heights Drive Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 .$GPD/SF 11 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 6Ft, Subdivision Block Lot Hylen Crest No. 1 3 5 Fill added above original grade 0-1 Ft. Gravel length 63 Ft. Township Range Section Gravel width 3Ft. Beds: Number of Lines Distance between lines I SEPARATION DISTANCES Ft To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 756Ft2 One Ft. well N/A NIA N/A N/A N/A TANK ❑O Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,25OGal. SurfaceWater >100' >100' N/A N/A Material Number of compartments Lot Line >5' >10' N/A N/A Steel Two NA Foundation >5' >10' N/A NIA LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks ACG.b90 SOILS rnM Pump on level at Pump off level at High water alarm at TlN( gfcr�,It� _7_/t4 A6S;3KPT10J 77=Jce4- V6e4-djr in. in. in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank D3034 rank to drainfield D3034 Royce Martin Dralnfield HDPE CO/MT D3034 Inspector A. Harala BENCHMARK (Assumed elevation) 100.Oft Inspection sr dates: 9/15/12 2M 9/16/12 Location and description p 3" 4 t Front Porch Deck. COMMUNITY DEVELOPMENT DEPARTMENT'APPROVAL ®Ohgill�fs WaZP - m X14 Sr®®0� �. OO Conditional Approval: Date ' fr��• • 491H ... .............. 6000. ;.........060 6 .. 0 � :MICHAEL L ANF1tSOd. W CE.4381 s Approved (/ Date aaa�4 e 1 M O O r N LO 0 O a o 1110�JIO NOOK I z z a V) � U N � m� m N W 0 N O N N N N (O N N T a �— m w U U N x / 0W 2 Eo O C OjN z - / 0 00 w z� 0 7 m� 192 o Z�� �_ s U w LU > z pq oao5° ^o I Ld `00� o m N �® I U Q (� cW O `– 0 vi 0 Y aEi �wm Jv w w m e w m� i o- O O Az Q. w O r ® LLI I D2< D2< ..O n 0 N �3 � ` a u . -a W Ln N00 N I _J Q OC) LULU CL E N 22 m Z J I O O O c 0o W Em �a fIi _y C a C UN= T•- O NOU N t c O >o6 r V U- c O ~ o �T o U c N W 'V T o N y L n C - c3 LLJ H � we E2 ` I 011111 I-0Oa o w 0 I I 00'6L L 3„00,02.ZON I ��.� • `�0�� W� p .......g �.� ,a' o'•., j iz p j r•: N/ O z �1 %LL: 00, :3 D:vw% U i wiraaxr 41 m. i L5 :w OOt�/ z E a 1�'q. ♦�16 ' �' :¢ =z i R•♦ e4%11iIsk ��5�••• Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP111160 4I:X7 rM i Page 3 of 3 PID No. 050-474-01 v s U ._ 7.5..1.1..,...,. 63' (Trench Length) PR❑EILE AS No Scale C INNI 94.3 9. Municipality of Anchorage [ 10- Development Services Department t GL<Sfi 2- Building Safety Division 6e, - On -Site Water and Wastewater Program 4700 Elmore Road 4- 4- P.O. Box 196650 Anchorage, AK 99507 - www.ci.anchorace.ak.us , y 5- 5- (907) 343-7904 6- 6-7- Soils Log - Percolation Test E^ Performed For: - l {`�� �- %j{L'ri 4VeeDate Performed: Legal Description: Nu[en Crest No.1,.L5, B3Township, Range, Section: 19- SII I F1 1 CL 9. Jit) [ 10- / t GL<Sfi 2- 6e, 3- 3- 4- 4- 5- 5- 6- 6-7- E^ 7- 6 a 9. Date [ 10- / t GL<Sfi 12- 6e, 13- 3-14-15-16- 14- 15- 16- 17- 17-18- 18- cF �i7 /l'L 19- CL 20 - 49 -LH ' iAEL E. ANDERSON CE -4381 S-43 — PVOFE5510N_4'� WAS GROUND WATER ENCOUNTERED? �Y IF YES, AT WHAT DEPTH? �y__ Depth to Water After t Monitoring? Date: f I Reading Date Gross Time Net Time Depth to Water Net Drop Ik PERCOLATION RATE (minutesMch) PERC HOLE DIAMETER 7 /� TEST RUN BETWEEN 4 F �°rpFT AND - t,4, FT r .- PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.. DATE: - On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111160 Tax Code Number: 05047401000 Work Type: Septic Upgrade Permit Effective Dates: July 25, 2011 to July 24, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: HYLEN CREST #1 Site Legal Address: HYLEN CREST #1 BLK 3 LT 5 G:0057 Owner/Address: BACHMAN TED M & ADRIENNE P 21211 LOWLAND AVENUE EAGLE RIVER AK 995779584 Site Mailing Address: 21211 LOWLAND AVE, Eagle River Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: 20018 4 Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Proposed system too deep for soils information submitted. The Engineer needs to do an additional test hole prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. Received By: Issued By: Date:,. E� Date: ZS ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. VTO - q74— D Property owner(s) -ta—b -4- 4bwm-rj-,jG- 1?1Ac ,►MA,j Day phone Mailing address 217-11 totiLA" A Ayc�,3 aq CAL ic— R.I,jEfZ_ A14— 9qS?7 Site address 5 A M Legal description (Sub'd., Block & Lot) d1/u-7-j G1uS,_ ^19 % S i.VaL_ 3, I0 -r 5' Legal description (Township, Range & Section) Lot Size 'O, Ol 6 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial ❑ Absorption Field Septic Tank El Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) eerit/Rush Fees: ) ?)C yy Date of Payment: Receipt Number: Permit No. C�7D�I i 11\ yc c G:\Building\On Site\Forms\Client Forms\Permit App_01 041 1.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 1/11) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX July 13, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 5, Block 3, Hylen Crest Subdivision No. 1 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing 1,250 Gallon Septic Tank will be exposed, inspected and verified for continued use. The existing absorption trench system will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the adjacent septic system. The subdivision is served by a Class A Community Water System. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole recently placed on the lot in the area of the proposed absorption trench indicated silty gravel (GM/GP) with some sand. The percolation rate was determined to be 7 minutes per inch in the area of the new absorption system. No groundwater was found during the placement of the test hole and none has materialized in the past monitoring period. We have designed the new trench to be within the 30' radius of the test hole with an application rate of .8 gallons per date per square foot. We are proposing to place a 63' long trench with a 6' effective depth. The total depth of the system will be 10'. A flow diverter valve will be placed to tie in the old absorption trench. The old system will be allowed to dry out and regenerate for possible future use. The ground surface on the lot slopes slightly to the southeast. The absorption system Lot 5, Block 3, Hylen Crest No. 1 July 13, 2011 Page Two will be constructed parallel with the contours of the ground surface. A minimum of 100' will be maintained between all components of the septic system and any surface water in the area. It will also be constructed a minimum of 10' from the water service on the lot. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, *"..L a4--, Michael E. Anderson, P.E. Attachments oR�vE 4 Class A Well s (May be Abandoned) LOWLAND AVENUE C -D � 6\o� i i T —&—E— Easement W U U / Z 0 0 1 10 15'T & E Ease \0 1 2 TRACT A \v .*S.....', �J ��o'' • • • �'•�.•♦•� Subdivision is Served by Public Water System. AREA MAP SCALE 1' = 100' 3 1 13 12 ]M0 110 N 0 M a.. L o,o�E O C O ° N LO O O L� N O (n O C No L M IE: N N U C Q p �� CDC a Lo v O ,L � N N °- N C � / I T 0 O O O n cn Z n v ^F- p C C O C O �U I I 0 o v v) U O N �-+ Q V) O O �Uvp/ � I O N O N a °� u O - o U LAN I 6i MW � 00 7 ami J O C I v'S' L Z Z y-+ (n .0 F- C CU O ° - ° o > ZJ ALL 3� M m " 0 owa ® J- '00 I w xQ Y I w I I Q Q m U N oY O r. OJ c C)I r n o U w OI fn z I m vi w \ ` �En I La Q oc) \ �- I w -J W J U) N o W -o Ln N -i u i— co I U F— _ LO C C Z O O Z F C fn �„ p O > W UC)0 U O L (D m E p I U L N N I CL) �OZ a) p -:0, L I 0-6 LO Ivo v+.v�.'co � N x o wV)Cf o I Q) OL, �� a) C > I WUM I I I I I 0-,C: 0) 0 WU>U:m 8 0 X » I J U (n G- F'- LL z 111•• "IJ�•� LLJ /L,' ►/"/�1 ¢W N� �1 oxrrnirrxrs xosaraax► 00-- ; S w U 'J = O �..�� ., f '•t 5� 4111 11\\\x•11•••1 LOT 5, BLOCK 3, HYLEN CREST SUBDIVISION NO. 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 7 Min./Inch Verify Existing 1,250 Gallon Septic Tank Application Rate: .8 GPD/SF 6' Drainfield Rock 4 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 750 SF Absorption Area 750 SF/16 SF/LF = 62.5 LF Trench Length THEREFORE: Construct a 63' Long x 3' Wide x 8' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be 10' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 10' Separation from Water Services in the Area. .e 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) r' NOTE: Grade Area Over Trench to Drain Away. : �z Minimum 6' Separation From Bedrock. ■:...., Minimum 4' Separation From Groundwater. Minimum 10' Separation From Water Services in the Area. Minimum 100' Separation From Surface Water or Streams.- tic 49th MICHAEL E. ANDERSON �� � � No. CE -4381 ' �= j �1N.PROFESSI������ Natural Backfill 3'6" Geotextile Fabric 611 O 4" Perforated PVC (Holes Down) .e 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) r' NOTE: Grade Area Over Trench to Drain Away. : �z Minimum 6' Separation From Bedrock. ■:...., Minimum 4' Separation From Groundwater. Minimum 10' Separation From Water Services in the Area. Minimum 100' Separation From Surface Water or Streams.- tic 49th MICHAEL E. ANDERSON �� � � No. CE -4381 ' �= j �1N.PROFESSI������ Municipality of Anchorage ' P);m . �.� fP Development Services Department �ij.• Building Safety Division 49�i t/ On -Site Water and Wastewater Program •... too* 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 • . ••• ��•�����•��•�- �' N: W www.ci.anchorage.ak.us (907) 343-7904 tom^ as � �• ( R43 8i ��?`V' V EBF•.•' l3� l �.• �� ft Soils Log - Percolation Test s ++ Performed For: Date Performed: T Legal Description: Hylen Crest No.1 a L5, 83 Township, Range, Section: -N A 7- b 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Site Plan WAS GROUND WATER ^I ENCOUNTERED? Y1 10 s IF YES, AT WHAT DEPTH?✓A `/ L S(/ Depth to Water After C P Monitoring? E Date: Reading Date Gross Time Net Time Depth to Water Net Drop 1���► �p Mt�aS il� ole .5(��, PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER ti TEST RUN BETWEENI FT AND - FT COMMENTS G(Ys 42,lj $•c PERFORMED BY: -/*IV I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REP013T NAME 119/C(e;-'I_ /''/�� // (/ IP T 1. U�J.SA%%C�'%�C %/l.�/� ONENEW :1/ :.�.��%� ❑UPGRADE MAILING DD ESS �.� Y- 6� a� �1 LEGAL DESCRIPTION LOCATIONnn NO. OF BEDROOMS fj Uy DISTANCE TO: Well /U 4? Absorption are � Dwelling PERM (�;/ �L7 � Cof I­ z w Manufacturer 2 Ma i3 / i�E� No. compartf�nts F %-'� z to Liq. capacity in gallons IF HOMEMADE: / Inside lefgt " � WidthGJ � Liquid devbf !1 X DISTANCE TO: Well Dwelling PERMIT NO. J0Z OZ z FQ- Manufacturer Material Liquid capacity in gallons w DISTANCE TO: Well �V %!} Foundation 1 Nearest lot ink l ) S � ti Z w No. of lines i Length of eac l' e / Total length of limes / Trench width-7 �� Distance l 9J a n Ines ( CS 6% .`l f) inches `" f� l.- Top of tile to finish grade, Material beneath tile f/ Total e fective� rption area- ?C'/L) 6 inches Length Width Depth PERMITNO. ul O eF Type of crib Crib dlameterl / ( 1 Crib depth Total effective absorption area ui �j DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO, W DISTANCE T0: I Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS t✓/ SOIL TEST RATI N J INSTALLER C, . " iz,C " REMARKS N. a ti I,A .e a.: APPROVED `" - "- "°' - DAT '19(11L §j ��y3i1C: 72-013 (Rev. 3/78) - - ���I o:--' I , r"-1 L- I -r I -r" iD F= ��o---- H �n r--1 F= DEPARTMENT OF HEALTH AND ENVIRONMENTAL ��OTECTIQN 825 L STREET, HNCHORHGE, HK 99501 PERMIT NO: 840289 ENGINEERED DESIGN DATE ISSUED: 05/04/84 APPLICANT: C/0 S & S EMQ'G TARGET CONSTRUCTION ADDRESS: SRB 196% EAGLE RIVER., AK 99577 CONTACT PHONE: 694-2979 LEGAL DE5CRIP: SUBDIVISION: HYLEN CREST LOT: 5 BLOCK:.3 ' SECTION: 8 TOWNSHIP: 14N RANGE: I N LOT SIZE: 200:18 (SQ, FT. OR ACRES) I CERTIFY THAT: ' 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET _ FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES HND REGULATIONS.. AND IM COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. IWILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK `DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PuBLIC SE14ERHGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF ABFT STATION IS INSTALLED IN'HN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED/ (2) HS-BUILTS WILL NOT BEAPPROVED WI-THOUT AN ELECTRICAL INSPECTION REPORT.; AND (]) THE ELECTRICAL WORK MUST BE DONE BY R LICENSED ELECTRICIAN. SIGNED ��'` DATE: RPP�I����NT� C/(� �� ��� E�G/[� �HRGET CONS�R�CTIO�/ ISSUED BY DATE: ---------------------------------------- --------------- ' MUNICIPALITY OF ANCHORAGE Department < Health and Environmental --otection 825 L Street, Anchorage, AK. ')01 264-4720 Permit # # HANDWRITTEN PERMIT # # # /OR ON-SITE SEWER PERMIT Applicant: rzVd712vz1e7-1t0-41 Mailing Address: Location; 5^ �� ie� Phone Number : In T Legal Description: �G�N - C) Lot Size: 2 C� Type of Soil Absorption System Is: Trench:_ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: ,e ✓ o DEPTH .1.Z� LENGTH J . GRAVEL DEPTH (6 -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 = a 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 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 28-4 # 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 understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha bedrooms Signed: Issued by: L -J - Applicant Date. SWP/024 (1/81) psi-O"n '7 //.s /o"� SO I LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATIONTEST 825 L. Street, Anchorage, Alaska 99501 264-4720 -� SOILS LOG — PERCOLATION TEST PERFORMED FOR: I (,lAG„�•r �nyi S��'((i.n DATE PERFORMED: L a LEGAL DESCRIPTION: O'/" 64 •�7 I—la lie el 6—Xy,/4 DEPTH SLOPE SITE PLAN Qr�l� 1 �-P 2- .� SIL -.T`4 SK+NID lam) 3 4 D 5 6= 7 8 - ©' 9 10- 0 11 0 12 13 0 14 15- 16 17 18- 19 20 COMMENTS / C W EL - L- C IQ-40C-1`� &kZn\JF.L_ A sAn4b (6L0) S�r`1D1 L:��r-IT Sr�•r %Wbwt A. 3A r Mu. 1487,4 o' •P- PERCOLATION RATE_ _(minutes/inch) TEST RUN BETWEEN FT AND - FT x—r, /,/// '41)e,�//%y// /, WAS GROUND WATERS /J ENCOUNTERED? �_ L Depth to Water �Al O P E IF YES, AT WHAT DEPTH? n e0 Mr Reading Date Gross Time Net 'rime Depth to Water Net Drop /Y 9 �6 CERTIFIED 8Y PERFORMED BY: --� Cr illi, t :1, •`il,� : ��':^ ;"''�7 i.�. ,gip,, 72-008 (6/79)e 1� � �Ii/��a�FJ3`f,E•iJ 0`1 /e.Ett''ea.P DA T al le) ze- tLe Gu F, ! S3 1�s • h •_ Municipality of Anchorage •� - On-Site Water and Wastewater Program LIAM (907) 343-7904 AUG 1 sr 1 i. / F tiles' Certificate of On-Site Systems Approval \`, 5"w Parcel I.D. 050-474-01 Expiration Date: I 1S 1. GENERAL INFORMATION Complete legal description Hylen Crest #1 Block 3 Lot 5 Location (site address) 21211 Lowland Ave. Current Property owner(s) Ted & Adrienne Bachman Day phone Mailing address 21211 Lowland Ave. Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Li Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Li Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Li Public Sewer ❑ WaiverNariance request for: Distance: Received by. ,nl Date: I COSA to be released to the engineer,unless otherwise requested the engineer. COSA Fee $ 52.( Waiver Fee $ Date of Payment 8/18 /(7 Date of Payment Receipt Number 05-7-7-36, Receipt Number COSA# + 5(1413(a Co Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features, The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 8/17/2017 oF A�qs i 1 * , . 1� y*�' • 6. DSD IGNATURE ' 1' System #1 Approved for bedrooms 4 .:S even R. onn. System #2 Approved for bedrooms g�. CE-8149 Disapproved 'k `2)PROftS" `AR\�%.1� Conditional approval for bedrooms, with the following stipulations: ON—SITE 19 WATER AND m WPSTTWATER PROGRAM meg_ ,SERVIC��4. By: Original Certificate Date: 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r - ,. If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Hylen Crest #1 Block 3 Lot 5 Parcel ID: 050-474-01 A. WELL DATA Well type Public If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/16/2012 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (YIN) N/A Date of pumping 8/15/2017 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 9/16/2012 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Deep Trench Length 63 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 1 1 ft. Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/14/2017 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 30 in. Water added 610 gal. New depth 36 in. Elapsed Time: 1440 min. Final fluid depth 30 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm& circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS All cleanouts and monitor tubes present at the time of our inspection 8/14/2017. G. ENGINEER'S CERTIFICATION SOF Ac4k I certify that 1 have determined through field inspections and 'r���p� Ash-v' review of Municipal records that the above systems are in �'*; 49 Tl-I i\ *S conformance with MOA COSA guidelines in effect on this date. •• •• Engineer's Printed Name Steven Pannone " :S{even .R.,Pannone Date 9/15/2017 +�� 9,•. CE-8149 ,; 1�l%PROFES.S1.3 COSA canary sheet_2-6-15.doc LOT 6 Co ri Wire Fence Wood S82• Shed 7 27 17qE NR 13.0=- Wood Deck-N._ 172.87' �'��Wire 2.9' 5•� 2 9' 14.1' 3I O __ p,I Fence 13 13.0' _ _ ,+ 16.7'W fi.7' 9.5' a cr � 39.1' 0 0 000 0 o ao , O o a LOT 4 po n : '`? 2-Level Wood - 1.5' \ i ) •- U1:4I rt.) Frame Residence 1 .0 co — z ' 35.9' 1 18.0 --,01.6' r 15.5 {-�q 16 0' 11:::,i t,► Z Covered Wog od I Riser Pipe o 0 iri0 Entrance 3 ') `4--3,.9' (TYP•) 1 'o 'P p-1 4.0 Ashpalt a I o LOT 50 - BLOCK 3 w o 6 ' Jo, - 125' ti 0 0 15' Electric & Telephone Easement V 181.00' L=31.42' R=20.00' I N89'59'00"W Nalk`Wood Rail Fence o o r) r-) LOWLAND AVENUE N SCALE : 1" = 30' NOTES: Iliml 1. Within a 100-foot radius of the wells located on the Well Lot/Block 3 0' 15' 30' 60' there shall be no source of contamination, and all portions of sewer systems except cast iron pipe with leaded and caulked joints shall be outside of the 200-foot radius line. 2. Dimensions are measured to the wood trim. PREPARED FOR: TED & ADRIENNE BACKMAN . I hereby certify that an accurate survey of the following described _ � t� property: ��.tit �� IaF••A(�,11 HYLEN CREST SUBDIVISION, UNIT NO. 1 (83-91) AS - 3UILT ,`P•:•' •;J',F 1 LOT 5, BLOCK 3 . •'•9+� was made on September 5, 2017 and that the improvements DWN. DATE GRID N �•*: 49TH •• •• ; ►` ituated thereon are within the property lines and do not overlap or ,1Sp 9/12/2017 NW 57 x - ncroach on the property lying adjacent thereto, that no /� 'F. Lee Knrnbelnikoff: r improvements on the property lying adjacent thereto encroach on FILE NO. F.B. 2016/17 JOB NO. i the premises in question and that there are no roadways, 1713 PG. 30 1723 �j,�.�j, .No. 3143-S041 transmission lines or other visible easements on said property except r w I,tit.ii » �,- asre indicplat h eno. ppear ont thishthan those shown on the KA RAQ EL! V I KOFF N Cr •� record plat maynot a drawing. t I a/zoo Anchorage Alaska, this 12th day of September 2017. SURVEYING (907) 337-3434 N MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES 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. # 1. GENERAL INFORMATION (/ Complete legal description /07— Location oT Location (site address or directions) 'fie_ 1 D �� V l %a ;' / Property owner 6u, Day phone U Mailing address aya�� ��w�.9r�p A'j X9577 Lending agency Mailing address. Agent Address 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 Day phone Day phone 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 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 MOAN21 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm David R. Dayton P.E. Phone 04-241Y Vonalar St. Address ChyAlak, Alafka 99567 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M Date 9 �i�u eooeoeeo su........2' David R. Duyton j 7pp�i�'.o 1,10. 2205-1 e •'\\�Z a�tiC`,�"ROFESS\' C �I) bedrooms, with the following stipulations: Date G' ` 2 3 —?_3 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 orderto 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 (Ray. 1/91) Back MOA H21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/or 3 ��L� � Parcel I.D. l A. Well Data 4w w tc Well type Log present (Y/N) Total depth Sanitary seal (Y/N) _ Date of test Static water level Well flow Pump levell WA} -799 5 YS 79n7 _If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Driller Casing height Wires properly protected (Y/N) AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE ORALE ENVIRONMENTAL SERVICES DIVISION AU_G -:1993 g.p.m.Al IIG 1 3199993—(� •p�°1� E I v E U -X Septic/holding tank on lot On adjacent lots — Absorption field on lot Z m O vb- ; On adjacent lots Public sewer main '`J��J- Public sewer manhole/clean Sewer service line Petroleum tank WATER SAMPLE RESULTS: i✓,/1 Coliform Date of sample: H. SEPTIC/HOLDING TANK DATA Nitrate lected by: 2_Cqc5 Other bacteria Date installed 5-117 X� `f Tank size 12-5-0 Compartments Z Cleanouts (Y/N) I Foundation cleanout (Y/N) }/ Depression (Y/N) AJ High water alarm (Y/N) Alarm tested (Y/N) Date of pumping 793 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N A On adjacent lots Foundation i To property line Z7'/" Absorption field Water main/service line Gy _ Surface water/drainage /0614_ 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons— Vent (Y/N) allonsVent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed ISoil rating (GPD/Ft2) /50r-6� System type Length 5'0 Width Z/Z Gravel thickness ` Total depth �/ v Total absorption area CvUO Sf Cleanout present (Y/N) Y Depression over field (Y/N) Date of adequacy test ///oResults (pass/fail) Water level in absorption field before test S& /, for 4— Bedrooms After test C� 7" Peroxide treatment (past 12 months) (Y/N) Al o If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots "��sJ Property line To building foundation 1171 To existing or abandoned system on lot 1-5- On S On adjacent lots 2 0 -t- Cutbank Alo^icr Water main/service line s� Surface water / C, C> -t- Driveway, parking/vehicle storage area '�-,0 *- Curtain drain E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAAguidelines in effect on the_dgte,.pf this inspection. OV A a �5,°��e David R. Dayton P.E. 20210 Donalar St. Signature saa,e�5 aseaa•a•aa ,e• ee'�e/,,-nom Lhugiarc, Alaska 79567 Engineer's Nam v'nr a®940'8299®envan aava : a' David R. Dayton rj� Date /1//l/7 tJ' f a e . 2205-E a, Ids) (%s,°o 00, % 7U HAA Fee $ Waiver Fee $ Date of Payment �3 Date of Payment Receipt Number ) „ASO � 3�'J Receipt Number 72-026 (3/93)` Back D. R. DAYTDN, P.E., R.L.S. HEMOMMM Chugiak, Alaska 99567 (907) E? 20210 Donalar 696-2417 August 11, 1993 ADEQUACY TEST Legal Description: Lot 5, Block 3, Hylen Crest #1 Date of Test: August 10, 1993 Septic Tank: 1250 gallon, 2 compartment, steel tank (DHHS Records) Absorption System: 50' x 2�;' x 6' deep trench (DHHS Records) Soils Rating: 150 sq. ft. per bedroom (DHHS Records) Requirements: 4 BR - 600 gallons per day Test: Water was pumped into the absorption trench while measuring volume, time and water level rise. After the pumping was stopped, the water level drop was measured at timed intervals. The results were plotted on a graph of time and gallons absorbed and extrapolated to 24 hrs. Results: The absorption trench is currently functioning adequately for a 4 bedroom home. NOTE: There was 56" of water standing in the trench before the test. At the end of the test there was 672-" of water. The water level was down to the original 56" after 24 hrs. The water standing in the trench may indicate the absorption system is in its waning stages. as t: 4, D eoe eye `. wi`° PQM/' G'Cr+c(Y/ y77• ' J 'rc> o nucaoe n.,x o•uc •e! a '3 MUNICIPALITY OF ANCHORAGE 41VISION OF EWIIIION14ENTA-L HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AU'THORI'TY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, ? ubdivisi.on, section, township, range) Locatioq,(address or directions) � J -E t-1- /01t -so fI , (b) Applicants Name!L-l�, –Telephone –Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer Other (explain); (d) Lending Institution Address (e) Real. Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. TyE( of Residence Single–Family�4--- Multi– Family �–� Other (describe Number of Bedrooms l" 3. Water Sukply Individual Well f q� — Community E:�-j Public Telephone Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Publi54�� ' Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the: legality and status. [Page 1 of 2] 5. En ineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on7site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm,k,_ Telephone Snp 190 Address 11 LU -11 AILAISKA 'ai if Ra y �r Date (ENGI/SEAIJr 6. DHEP Approval Approved for bedrooms B�f 1� Approved ! Disapproved f Terms of Conditional Approval € 4\ Robert A. 9i1ohr a fJj Vv'° 1437-t o &M 00W Nate CAUTION Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL. CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAI, AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK, (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-•19-•84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification If Al B. or C, D.E.C. Approve (/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Y Casing Height Above Ground Sanitary Seal on Casing (1 12) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Z_ e�) /-i ; On Adjoining Lots + To Nearest Edge of Absorption Field ,on Lot �P; On Adjoining Lots_ To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole i Water Sample Collected By , Sewer Service Line on Lot Date Water Sample Test Results Cem Tents B. SEPTIC/ TANK ARTA Date Installed Size � � Q No. of Ccarpartments Standpipes/N) Air -tight Caps Foundation Cleanout0/N)�® Depression over Tank (Y & Date Last P d Pumping/Maintenance Contract on File (Y )AJ for Holding Tank High -Water Alarm (Y ) %� /1- Temporary Holding Tank Permit (YM Separation Distances from Septic/Hig Tank: To Water -Supply Wall 4- To Building Foundation To Property Line / D � � To Disposal Field To Water Main/Service Lined To Stream, Pond, Lake, or Major Drainage Course Comments [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption S ata fiL Type of System Design %,R._n/-// Date Installed Length of Field Width of Field �� Depth of Field I�', Gravel Bed Thickness � 2- �f Square Feet of Absorption Area (p Q U Y- Standpipes Present (p1) Depression over Field (YIAW Dae of Last Adequacy Test Unn _ Results of Last Adequacy Test �1A Separation Distance from Absorption Field: To Water -Supply Well 2-ov (/~F` To Property Line �Ca To Building F undaticn To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service LineyU To Cutbank(If, present) /( To Stream/Pond/Lake/or Major Drainage Course "L*/4 To Driveway, Parking Area, or Vehicle Storage Area Commnts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Di7rensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Cycles during Adequacy Test. beets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date �,pp hlS ion. ;i S B 196 4zl;z 4% .....00,,Signed (;,]•� RIV<"Fl, ALASKI� > �7i Date�. tF .•'' ••.tiS,� ! Company' -- MOAN . 0.0 •. E• 4� KB1/d5/s ..l ...:.. 4 j0 Mb•e A. the '. No. 1457 9Fp •'•••....••'P�F�"'' [Page 2 of 21 am 2-15-84 SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 2.00 ANCHORAGE, ALASKA 99501 (DATE: l l_ Lir_(.^;` ; f To Whom It May Concern: HILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274--2533 According to records on f i• I e in this office the Water- System 1 s i n comp I i ance w i th the State Dr i nk i ng Water Regulations. Sincerely, r �f