HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 12Onsite File
Hylen Crest
#1
Block 3
Lot 12
#050-474-08
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221130 PID Number: 050-474-08
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade
Name
Paul Dagget ABSORPTION FIELD
Site Address p Trench ElWide Trench ElBed ElMound
10118 Raven Crest E] Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
5 PD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from origina ade Gravel depth beneath pipe
Subdivision Block Lot
Hylen Crest #1 3 12 Ft.
Fill added above original grade vel length
Township Range Section
Ft. Ft.
Gravel width Beds: Number of Lines Dis cebetween lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absor tion Holding Sewer Total absorption area Number of trenches Dist. between tenches
p p
From Tank Field Lift StationTank Line Ft2 t
Well >100' na na I na >100' TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water >100' I na na na Greer 1500 Gal.
Material Number of compartments
Lot Line >10' I na na na NA plastic 2
Foundation 8.5' I na na na STATION
Manufacturer Capacity
Remarks Gal.
Alarm location Electrics 'n led by
PIPE MATERIAL House to tank Tank to
Installer 3034 drainfield 3034
JRs Septic Drainfield Co/MT3034
Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft
Inspection 1St 5/27/2022 2�d 6/15/2022 Location and description
dates:
3'd 4th bottom of siding point A
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp
Conditional Approval:Date
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ISL. Townrand
Septic &/s tem -_ � •• , L
Date �>
Approved Date ^2� 2 ���Fcs• No.c ,1904,-:
jF'•..
Note: RFppROFE5S10�'..m�-
this approval does not include well permit requirements.
(Rev 05/02/18)
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MUNICIPALITY OF ANCHORAGE
On-Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-2904 Fax: (907) 343-7997
http://www.mu ni.org/onsite
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
cl)iil'tment
On-Site Wastewater Disposal System Permit
Permit Number: O5P221130
Work Type: SepticTank Upgrade
Tax Code Number: 05047408000
Site LegalAddress: HYLEN CREST#1 BLK 3LT 12 G:0057
Site Mailing Address: 10118 RAVEN CREST CtR, Eagle River
Owner: DAGGETT PAUL SURVIVOR'S TRUST
Design Engineer: EKLUTNA ENGINEER|NG, LLC"
This permit is for the construction of:
fl Disposal Fietd M Septic Tank E Hotding Tank fl privy D Private Well E Water Storage
All construction shall be in accordance with:
1. The attached approved design.2. State of Alaska
3. the Development
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 preventfreezing
5t20t2022
5t20t2023
20020
Received By;
MUNICIPALITY OF ANCHORAGE
Development Services Department a Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-474-08
Property owner(s) DAGGETT PAUL SURVIVOR'S TRUST
Mailing address 10118 RAVEN CREST CIR Eagle River AK
Site address 10118 RAVEN CREST CIR Eagle River AK
Legal description (Sub'd., Block & Lot) HYLEN CREST #1 BLK 3 LT 12
Legal description (Township, Range & Section)
Lot Size 20,020 Sq. Ft. Number of Bedrooms 5
Day phone
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field E] Initial ElSingle
Fam'I (SF) El
Septic Tank Upgrade Fx]
( wo A'DU
Holding Tank ❑ Renewal ❑
Duplex (D) ❑
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
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 Mpicipal Codes.
(Signature &f property owner or authorized agent)
Permit/Rush Fees:? 2 5 Waiver Fees:
Date of Payment: ,5 Y�aa�,2 Date of Payment:
Receipt Number: 4 5;2 5 S 6 Receipt Number:
Permit No. C,)SP22 I 1 -� O Waiver No.
Z
GMevelopment Services\Building Safety\On Site Water and Wastewater\Forms\C lie nt FormsTermit Application.doc
Eklutna Engineering, LLC
cu rtistownsend @gma il.com
May 12,2O22
Subject: Hylen Crest #1 Block 3 Lot 12
New Septic Tank Permit Request
osP221130
I am writing to request a septic system installation permit for the above referenced property. The
proposed system will serve a 5-bedroom single-family residence. A site plan is enclosed for your review.
The existing septic tank will be removed and one 1500-gallon septic tank will be installed. The existing
field tested adequate for 5 bedrooms in May 2022.lt will not be replaced at this time.
L. Soils. Previously during the month of May, a test hole was dug to a depth of 15.5' and no water
was found. GP soil was found.
Wells. This lot and the surrounding lots are served by AWWU water system. There are no wells
within L00' of the proposed septic tank.
Neighboring Wastewater systems. lmmediate neighboring septic systems are all +10' distant
from the property lines.
Surface Water: There is no surface water within 100 feet of the proposed septic tank and
existing drain field.
Topography: This property in the immediate area of the tank replacement slopes downhill
towards the southwest at a slope of < 1%.
The proposed installation will not affect the future development of this or the surrounding lots.
Sincerely,
Curtis L. Townsend, P.E.
2.
3.
4.
5.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221130, Rebecca Carroll, 05/20/22
=F=zz\a--().Ar,r+tr<'; m .r(-)u-;= i=+|=U- - !! _.r-Iao>aL- tr<3f96<rt69=-z-162.32]-0e+ 3tbZ.= 6.agHbc*Q=,',31(n -v.^-c\)zzil4= .::XrASZP=frl=rZ2TsY9 i,.!v=-XQ?PEFse>?Ei>=fr::gdg3-Pfl.'HPt"n3oo-<.,o-O- Nr')z. 4-II a)-| lDMt,="-x-Y&o_OF>o_ot!tr(n lL\(-)F>IoIJJE@L-+0[ +ot\__/\<\t<s!=.z- <T.o.=Fo=P3."Eo=--.1;tl<il;z>7 af;mo<:TaZr>St-til-*(Y (Aofi<-ZitiJ<",LJIt'rt Ilau.JY<+=a2 o'^T-Z^=:<=b..-Uznln)-lun<qJ9HzEL+_93-zn--.tI olI-UEv<P()u,=,^Y&o_OF>LOtlEAIL//lNll,l3svl AI I lt',;/l;MU'oa<)Y>OOLrmo</s\.,{.-J>>3041t-UUtLy=-a?i"?Z--trJ=i:(/)*l!At.tyUH@<<^AUF-U=-3Y -4.-oq>2.q^e)4-JazcnLl(n -)z)+zuoLdOOL!LLtLL!oIMm(')NF--rAtia6LLN\JllON-=FIf)TJJI.JJ-a@Usf--Ytoil=58Fo o a(L3NN(Laoroo)o)-gsa,(UF<Yj-cr)OY.>otoIOOO)-G+LJJ pvU)9t trJvtrOOgZ_ot4eiEJ-PO(Do)o)Go=G(Lo!a)oooo_co'a0)OO!ool.OoOaIJa^z.ftLi-lLLI^;Z?'ra)O)C) dorZ-.z4s)LLI ;)<u^ri{u) -)-s-> 5-coY).2 1'-!s--Jr (\in-CO YF.-\./-J;--Tvlrlu);\o.)-!rv Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221130, Rebecca Carroll, 05/20/22
-- .. _ .� . —1 =i �. t�� 'i • 7r1r07'-1•i 7:: J'7 4'�'i.i'G��Gi� (7
ASBUILT-NO CORNERS SET THIS DATE,
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE
SCALE'
'
FOLLOWING DESCRIBED PROPERTY Lot 12,
1" - 30'
31ock 3, Hylen Crest Subdivision, Unit No. I
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
8/11/91
YWNER TO DETERMINE THE EXISTENCE OF ANY
ORIDl
CASEMENTS, COVENANT$, OR RESTRICTIONS
NW57
NHICH DO NOT APPEAR ON THE RECORDED SUSDI-
�ISION PLAT, UNDER NO CIRCUMSTANCES SHOULD
FB+
ANY DATA HERWN BE USED FOR CONSTRUCTION
23-32
FENCE LINES, OR FOR ESTABLISHING BOUND-
iRY LINES.
DR
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Pf
& ASSOCIATES LAND
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>f•.� LS 6918 AV
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Municipality of Anchorage Page
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: ~./ ~ Ic:2)c:2c~ PID Number:
Name: ' 0 ' Wastewater System: ~New U Upgrade
Address:
~ ~ I~l~ ~ ~A~m~fl%-~ ABSORPTION FIELD
No. of Bedrooms;
~°~:34~t' 3~t~ ~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION so,,.,.,: I.~ ~,o/sq.,~. ~.5 ~T
Subdivisioni Depth to pipe botlom lrom original grade: Gravel depth beneath pipe
Lot: ~ Block: ~ H~L~ ~ST~ ~,~ Et. ~ Et.
~ ,t. ~ F~.
I
Gravel d~t~ Number of lines: Distance between lines:
WELL: /~ ~ New U Upgrade ~'~ ~ Ft. ~ I ~/~ Ft.
: Pipe material:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:~ SQ. Ft. ~/~ 2~?~
~ Ft. Ft. ·
Driller: Date Drilled: Slalic Waler Level: ~installer: ~~ Date Installed:
Yield: GPM ~ Pump Set at: Fi. Casing Height Above Ground:Ft. ~/~O TAN K
SEPARATION DISTANCES ~Se.t~c ~ Holding U S.T.E.P.
To Septic Absorption Lift Holding =ubllc/Pdvate Manufacturer: ~ Capacity in gallons:
From Tank Field Stalion Tank ~....,,... AgI~A t ~
Well ~>~' '~'' '/~ ~/~ ~, Material:~e. ~ Number of Comp~enls:
SurfaCewater ~(~O' +/oo~ ~/~ ~1/~ ~/~ LIFT STATION
Lot I Size In gallona:~ Manufacturer:
I
Foundation S.~' ~.~, ~/~ ~/~ ,/~ "Pump on" level at: "Pump off" level at: High wale, alarm at:
Curtain Dra,. ~Z~ .~/~ ).{/.~ ~/~ ~ Pump Make & Model Electrical Inspeciions performed by:
Remarks: BENCH ~ARK
Location and Description:
I Assumed Elevation:
EH. GIN EEl'S SEAL
Inspections performed by: ~//~ Dates: 1st ¢~/~/~1. ~;,~~~ '~"
Department of Health~d Human Se~jces approval '-~,""~, ,~ ' .....
Reviewed and approved by: _ Date: ,~,...:.,.~.,,o;:r~;~;~o,:. ,.?
72-013 (1/91) MOA 25
PermitNo. £¢~' '~/'~/~'~' Page o~ of '~'
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
a~ ~__v,~v, ]~ [5' ELEC, & TELE,~
~. F- ~/ pRDPDSED A.C. DRIVE ~ \
>. - ._
SCALE~ 1"=40' [] - TEST HOLE
· - MONITOR TUBE
o - SEWER CLEANOUT
E__LEVATION~S . : ~'~.A~.E~ nuU
ORIGINAL
, LEVEL ~ 91'NO
NO KNOWN CURTAIN DRAINS
PROPOSED LEACHFIELB
EASEMENT
~AIER VALVE BOX
ASSUMED ELEV = t00.00'
72-013 A (2/91)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 WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910108
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:EAGLE RIVER VALLEY DEV
OWNER ADDRESS:PO BOX 141907
ANCH. AK. 99514
PARCEL ID:05047408
LEGAL DESCRIPTION: HYLEN CREST #1 BLK 3 LT 12
LOT SIZE: 20020 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (iSAAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~
Louis Butera, P.E.
Registered Civil Engineer
May 13, 1991
John Smith, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 12, Block 3, Hylen Crest gl
Dear Mr. Smith,
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The area has a community well system allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, homes are existing on each side. Soils are very
adequate, ground water is not a problem.
4. Drainage will be improved to continue drainage along existing path through lot.
Main drainage channel is road ditching.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
P.O. Box 773294 · Eagle River. Alaska 99577 · Telephone {907) 694-5195 · I'~t,x (907) 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 12, BLOCK 3, Hylen Crest #1
GENERAL
1. The septic plan is for a single family residence onlyo
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 require-
ments.
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 or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
7. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
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 9.5' at any
point.
4. The trench gravel is to be covered with approved typar or fabric
material.
5. Soil or combination of soil and extruded board insulation to a depth
of 3' or equivalent is to be placed over the leachfield. Any extra
soil is to be placed over leachfield.
6. The area over the trench is to be finish graded to prevent ponding of
surface water runoff. Drainage is to continued to South East away
from field.
7. 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 = 9.5
TRENCH LENGTH = 48
GRAVEL DEPTH = 6.5
TRENCH WIDTH = 3
Soil Rating = 1.2 GPD/FT2
Bedroom Capacity = 5
Septic Tank size = 1,500 gallons
N 88 ~V ~3~ ~ ~0~00'
[] - TEST HOLE
I $ - MONITOR TUBE
· o - SEWER CLEANOUT
/~ - WELL
mH',',:H+- PROPOSED LEAOHFIELD
NO KNOWN OURTAIN DRAINS EASEMENT
SEPTIC SITE PLAN
LEGAl_: LOT 12 BLK 5, HYLEN CREST ~1
OWNER: E, R, VALLEY DEVELOPMENT
CONTRACTOR: MIKE QUINN
EAOLE RIVER ENGINEERING SERWCES
'P.O. Bo~ 773294
EAGLE RIVER, AK. 99577 ~'~"~:
(SO7) ~4-5~5 FAX: (~07)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82§ L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
WAS
ENC
IFY
OEP
F
PEF
1
2
3
4
5
6
7
8
9
10
GROUND WATER
11 )UNTERED7
1 2 , AT WHAT
13
Gross Net Depth to Net
Reading Date Time Time Water Drop
14
15
16
17
18
19-
20 D, ~
ATION RATE (minutes/inch)
TEST RUN BETWEEN ~'-. FT AND ~ FT
COMMENTS
Eagle River Engineering Sm'vfcn~ '~;~:~'~ DATE:
PERFORMED BY: p P Ray773994 CERTIFIED BY:
Eagle River, Al< 9957=
694~5195
72-O08 (6/79)
Anchorage
POUL,,-t 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-411 '1
TONY KNOWLES.
MA YO R
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit tI: 840692
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 12 Block 3 Hylen Crest Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
rKeith E. Bandt, Supe~viso
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
PERM I T NO:
DATIE ISSLIED:
API:::'L I I]',~.~NT:
ADDRESS ,:
CONTACT PHONE~,
LEGAL. DE!BE:RIP:
LOT SIZE:
MAX BEDROOMS:
I1'¢'tl tLJI ll',.ll ][ C: :E F" ¢-h~ b. :A:.. qF' *'~F ~l F' ~¢z~ lh.,.ll E]: If-il ~[;]~ IF~',:
DEPARTMENT OF HEAL. TH AND ENVIRE}NMENTAL F'F~OTECTION /
825 I... STIREET, ANCHORAGE, Al',:: 9950
264-472~0
84 ]692
}8 / t3184
WAL. KER COI',ISTRACT lNG
F'.O. BDX 1974
EAGLE"' RIVER~, Al'::: 99577
694-4858
SUBDIVISION: HYI_F_'N CRES]'
SECTION: 8 TOWNSHIF:': 141'4
.SA (SD.FT. OR ACRES)
3
LILT." t2 :ELOCI.,..: 3
RANGE: :I.W
Listed belQw ar'e th~ {:!Ptions available .t.o yc:tu il1 de~igning ye)LIP septic
system. Ch(:.)E).~6! the opticn that best £~.ts y6~t..tl- site.
']F IF;,': Er:...-. ~'",~ rE]'..] I1-..11~3: E .'E} Ip,,ll .. ~, F;:: ~'-~ .'][ ll'",,ll
DEF"'TH 'TO PIF'E BOTTEIM (F'I".) 4.0 4.. 0 zl.. 0
GRAVEL, DEF:"I'H (FI".) .3,, 0 (),, 5 2.0
TOTAL. DEPTH (FT.) 7,,0 4,,5 6,,0
GRAVEL WID"FH (FT.) 2.5 :[7.0 5.0
GRAVEL LEI',IGTH (FT.) 63.0 ;34,, 0 53., ()
GRAVEL V[]I..UME (CLJ.YDS.) 20.4 2:L.4. 24.5
]'ANK S I ZE (GALS) 1,0()(). 0 ',~"~' 1,000.0 '~"~' ~., 000,, 0 .~.~.
SOIL RA'I"ING (SQ. F."]',, /BR) 125 :[2.5 :[25
.~..~ 'TANK IdUST HAVE AT I_IEAST TWD C[]MF'ARTMEIqTS
]: cel*t'.i, fy that:
1. I am l'amJ, liap with the r'equJ, rement?..~, for' on.'..-sit, e sewer*-s~ and we:l.:l.s as set
for'th by 'l:.he Municipa:l.i'E.y c)f' Ar'ichor'age (MOA) and the State o{' A:l. asl.::a.
2',, I wi].], insta],l the system in accopdance with a].:l. Id[]A c(:]des and
al-id ~.1"1 colilp].ial]Ee wi~..h 'l:.he design ct'itek-ia o¢ this I:)er'mit.
'3,, I will adhere t.o all IdOA and Sta'Le ~:~f Alaska r'equi~*.ements t'cm the sE~t back
distances t'r'[)m any mxis'~.~.lqg well, waslitewa'(.el* d~.SlaOS!;a], sys{em of pLd]].ic:
sewer'age system on '[.h:i.~ op any adjacent ol* near'by
4. I undepstand that {his per'mit is raj. id rcm a maximum of 3 bedr'ooms and
any enlar'gement w:i. 1]. r'equine an additional per'mit.
IF A I...IFT STATION IS INS]"ALLED IN AN AREA COVERED BY MOA BUIL. DIN[~ CODE;S,
THEN (1) AN EL, IECTRICAL PIERMIT AND II'4SF'ECTION MUS]" BE OBTAINED; (2) A'S-BUILTS
WILl.. NOT BE APF:'ROVED WITHOUT AN ELECTRICAL IIqSPIECTION REPORT; AND (3) THE
E LIECTR I ,.]AL. W~.JS"t' E,E D,.]N,.{ ~/A L I C[<NSED EI._IECTR I CiAN ..
I
GNED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
7
8
9
t0
11
12
13
14-
15-
16-
18-
19-
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
0 - t o*"090"'¢
DATE PERFORMED:
WAS GROUND WATER
ri ¢- -'- /"Z-,~,~ A~ENCOUNTERED?
DEPTH?
SLOPE
/%/o
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
I ~ o,-,, ,,. ~O..,~ ~" Z, I/~t.''
PERCOLATION RATE
TEST RUN BETWEEN . 'Cf"' FT AND --.~..L FT
.(minutes/inch)
MUHMPAUTY OF AHCHORAGE
Development Services Department �` Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 050-474-08
Certificate of On -Site Systems Approval
Expiration Date: -L -a `T -2-Z
1. GENERAL INFORMATION
Complete legal description HYLEN CREST #1 BLK 3 LT 12
Location (site address)
10118 RAVEN CREST CIR
Current property owner(s)
Mailing address
Real estate agent
DAGGETT PAUL SURVIVOR'S TRUST
Day phone
10118 RAVEN CREST CIR Eagle River
2. TYPE OF DWELLING:
Ix Single Family (w/ o ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
IX
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550 J
Date of Payment ,) 0� 2
Receipt Number 0 11 0 5 D
Date:
Waiver Fee $
Date of Payment
Receipt Number
COSA # 0 s c q')i 3 01 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE
6. DSD SIGNATURE
System #1 Approved for _.�_ bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 907.406.1058
Date v r 2- Z
�OF AL.,j kA
•AQ
TH
� ..
.... ....... rs'k, IImi sFic-,�'S :Z . v= nd
Cures T l+i7-0
s � �T��ysIF
D W gar
�C/J; • . tJo,
PR ESSION�
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: HYLEN CREST #1 BLK 3 LT 12 Parcel ID: 050-474-08
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground)
Date of flow test
Static carat
ments
B. TANK DATA
at beginning of test ft.
Age of tank(s) `1 years
Tank type/material septic plastic
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping installed May 2022
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1991
❑ ALL standpipes present per record drawing
Total measured depth from grade 12.5 ft (max)
Measured depth to pipe invert from grade 6 ft (min)
❑ N/A — pressurized field
NO Monitor tubes go to bottom of effective. If not, state
depth into effective
Well production at time of test
Water storage tank volume gallons
Well disinfected f orm test? E] Yes ❑ No
❑ C if m�a is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance co
Age of lift station y
Lift station matefial"_-
Adequacy test date 5"512022
Results ED Pass For 5 bedrooms
Fluid depth prior to test 17/0 in
Water added 829 gal
New depth 35/32 in
Elapsed time 1440 min
❑ Code -required soil cover over field Final fluid depth 17/0 in
❑ System presoaked Absorption rate '750 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: MT11MT2
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
[D Yes if No ft M Yis...—ifii'
Neighboring Tank > 100' Yes if No ft
Absorption Field on Lot > 100' Yes if No ft
Neighboring Absorption Fields > 100
Yes if No ft
Main > 75' E] Yes if No ft
ft
Zo
ivate S�eptie-�> 25' F-7 Yes if No ft
ing Tank > 100' Yes if No ft
Animal Containment > 50' Q Yes if No ft
Manure/Animal Excreta Storage > 100'
M Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No 8.5 ft Surface Water > 100' P Yes if No ft
Property Line > 5'
L✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
[✓
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Main > 10'✓Q
✓V
Yes
if No
ft
Community Wells > 200' Yes if No ft
Water Service Line > 10'
M✓
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
[]
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓V
Yes
if No
ft
Private Wells > 100' [✓ Yes if No
Water Service Line > 10'
M✓
Yes
if No
ft
Community Wells > 200' U Yes if No
Surface Water > 100'[]✓
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that / 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. --%Ml.
COSA Checklist yellow sheet
i NGINEEWS
M
ft
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
Parcel I.D. #
050 474 08
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #
GENERAL INFORMATION
Complete legal description
Hylen Crest ~1, Lot 12, Block 3
T14N R1W Sec.8
Location (site address or directions) 10118 Ravencrest C~_~cle, Eaqle River
Property owner
Mailing address
Michael Quinn Construction Day phone 694-4955
19321 Cherni C~rcle, Eagle River, AK 99577
Lending agency
Mailing address
N/A Day phone
Agent N./A
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
×
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
NOTE:
x
Public sewer
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 #21
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 Eagle River Enqineerinq Services Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
DHHS SIGNATURE
Approved for ,~./?J~ ~_/~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: . Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
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. 1t91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ./-/YL,~/V CJ&ES'F~J,
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Parcel I.D.
If A, B, or C, attach ADEC letter.
Date completed
Cased to
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
ADEC water system number ¢.2./.7..~-~' ?
Driller
Casing
Wires properly protected
INSPrCT'-.Ni~INICIPALiTY OF ANCHORAGE
'- I~¢IR~iNMENTAL SERVICES DIVISION
": t o ].99[
g.p.m.
SEPARATION DISTANCES FI:
Septic/holding tank on
; On adjacent lots
Absorption field on I~t
Public sewer m ',¢f~
Public s/~ervice line
WA~R SAMPLE RESULTS:
Z or,
Nitrate
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
B, SEPTIC/HOLDING TANK DATA
Date installed 0(¢/¢)z/,/<2 ) Tank size //:~¢(~
Cleanouts (Y/N) Y~5 Foundation cleanout (Y/N) ~/~5
High water alarm (Y/N)
Date of pumping
Compartments
Depression (Y/N) ,'~/O
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot A///~ On adjacent lots
To property line ~ ' Absorption field
Surface water/drainage /~///~
Foundation /~. ~ ¢
Water main/service line ,~/ ~
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LI~
Date installed"'---.. Manufacturer
Size in gallons ~ Manhole/Access (Y/N)
Vent (Y/N) "Pump ~.,.......,,,,,.....~. "Pump off" level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N) ~ .-l.,/
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Soil rating /.~ ~P~,//'7"~ System type_~C-~CP
Gravel thickness ~" ~-' / Total depth
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
Date installed
Length ,2.~ ~ Width
Total absorption area
Depression over field (Y/N)
Results(pass/fail) ~/~¢;.<~ //
Peroxide treatment (past 12 months) (Y/N)
J
Property line ~-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,,~///~ On adjacent lots ¢' ,~)(~
!
bedrooms
To building foundation
On adjacent lots
Surface water
Curtain drain /'//'~
To existing or abandoned system on lot
Cutbank "¢/,4 Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
HAA Fee $ /~ .~)
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONS]ERVATION
WALTER J. HICKEL, GOVERNOR
ANCHORAGE DISTRICT OFFICE
3601 "C" STREET, SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
September 10, 1991
FOR: Eagle River Engineering
PWSID 213289
My review of the records on file in this office reviews that the Hylen Crest Subdivision
Class "A" Public Water System, is in compliance with the routine coliform bacteria samples
requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC
80.200.
'~~Sincerely' ~
Keven K. Kleweno
Lead Engineer
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