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HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 14 Municipality of Anchorage Page / of /7[ 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: ~t L%°\~'~ i~2~C~ PID Number: L~-/-,to Name; ~/~ ¢/~/ Wastewater System: ~ New ~pgrade Address: ~,,~¢~ ~¢~¢~¢.~ ~.~< ~¢~ ~ ~' Ams O R PTI O N FI E L D Total Depth from original grade: LEGAL DESCRIPTION S°ilRating: /, ~ GPD/Sq. Ft. Subdiv~i°n: ~/~ Depth to pipe bottom from 0riginal~rade: G ravel depth beneath pipe Lot: /~ Block: ~ /~ ~4~ ~ ~ Ft. Ft. Township; ~ Range: Section: Fill added above original grade: Gravel length: I WELL: ~'*~'"Q"~;~ Q Upgrade Gravelwidth: ,umber of line,: Distance between lines: ~ Ft, % // Ft. ~lassification (Private, A,B,C): Total Depth: Cased To/ Total absorption area: Pipe material: Date ~ StaticWater Level: Installer: Yield: ~at: Casing Height Above Ground: ~"~1 ~. ~,. TAN K ~~PARATION DISTANCES ~t~o u ~o~ino U S.T.~.~. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ¢~ ~' ~ ~/~ Number of Oompa~ments: SudaOewater /¢¢~ /¢¢¢// ~ ~ ~/ LIFT STATION Lot ~Y/Y ~:// ~t ~ ~ Size in gallons: Manufacturer: Line ~ "Pump on" level at: ~~evel at: High water alarm at: Foundation //~ C~n ~ ~ ~/~ ~ ~ ~ ~ ~ P~~I~ctr`~l InspectiOns ped°rmed by:~ I Remarks: BENCH MARK Loc~tion and Description:  Assumed Elevation: Inspections performed by: ~ ~' ~7 Dates: 1st ~¢/Z Department of Health and Human Se~ices approval Reviewed and approved by: ~~/~, ~Date: ~ ~" ~ 72-013 (Rev. 9/91) MOA 25 qYB8 8,~BNIONB ×~oo © © "ON (lid /,~, NOISIAI(]SnS ±S3~D NB-IXH '~' )t:)018 '!~L I0] :uo!ld!Jos~(] IO~] ~ode~ uop, oedsul Ile~ ~o/pu~ uue~s~S I~od~!Q J~,~t~e~,s~ e~,!S-uo WcD,-~'~' auoqdala/· 0§99-6L§66 o~SOl¥ 'a6o~oq~u¥ · 0§996L xo8 '0'd NOISIAIQ S::IOI^~.::JS -IV.LN=IIAINOt:IIANq SBOIAHBS NYRnH QNV H/qVBH ~0 ZN~RIMVdBO ebo.~oqouv ;o X:~!lod!olunFl · oN :!wJad 4,0' 5.0' 5.0' 7,0'± :'ON Old /~ NOISIAIOSns IS]UD N]]AH '~' ;>t00-18 '!z~ 10] :u°!~d!Jos~O i06~3 uoiloedsul Ile~ 4o/pu~ ~els~S lesods!a Jele~else~ al!S-uo auoqd¢lOl .0999 6Lg66 o~soIv 'a6oJoqouv · 09996[ xos '0'd NOISIAIQ 8~OlAM~8 ~VIN~RNO~IAN~ S~OIA~S NVRRH GNV H~3V~H ~O IN~RI~Vd~Q a6eJoqouv ~o X~lod~o~un~ ~ 8604 · oN '!!uj~ad I§ :'ON 0Id / NOISIAI(]SFIS IS3Et:) N3'I),H '~ )t00"18 '~L IO1 :uo!id?sa0 IO~q ?, uo!~,ogdsul I1~ .~o/pu~ Lu~,~,~$ I~sods!Q .~a~,~t~e~s~M el!S-uO auoqdalal .0§99-6l§66 o~solV 'aDoJoq~u¥ . 0§996L xo8 '0'd NOISI^IE] S::IOIAEI~S q~INEtlAINOEIIAN=I S~OIAB::I8 NVIAInH C]NV HI-IV:tH --t0 IN:II~IFIV,::t:IQ a6oJoqouv ~o X:~jlodjojunl,q 'ON l!w~ad MUNICIPALITY OF ANCHORAGE Deparfment of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 16, 1999 Expiration [:)ate: Jul 15, 2000 Permit Number: SW990203 Legal Description: HYLEN CREST #1 BLK 3 LT 14 Design Engineer: 0069 Douglas T. Kenley, PE Owner Name: Audie Holloway Owner Address: 10136 RAVENCREST CIR EAGLE RIVER, AK 99577-951 Parcel ID: 050-474-10 Site Address: 010136 RAVEN CREST ClR Lot Size: 20066 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April t5, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Douglas T. Kenley, P.E. 9960 E. Puffin Drive, Palmer, A~aska 99645 (907) 746-1073 July 6, 1999 Mr. Audie Holloway Lot 14, Block 3, Hylen Subdivision 10136 Ravencrest, Eagle River, Alaska PERCOLATION TEST RESULTS AND GENERAL SITE INVESTIGATION REPORT On June 25th, 1999, an adequacy test of the on-site wastewater disposal system for the above-referenced 20,073 square foot property was performed. The system, originally designed for a five-bedroom residence, was found to be in a failed condition. The water level in the 1,500 gallon septic tank was 58-inches above the bottom. The foundation, and after tank clean-outs measured 3 and 12-inches of water above the pipe invert respectively. The clean-outs at the beginning and end of the leach field measured 21 and 18.inches of water above the pipe inverts respectively The monitor tube for the 50 foot long trench with 7.5 feet effective depth measured 90-inches of water from the bottom of the pipe. On July 1, 1999, measurements were taken again to confirm the failed condition of the system with similar results. The site is located at the end of the culdesac on Ravencrest Ddve off Lowland Avenue. The front portion of the lot is almost level with an average slope of 1% to the south. The back Northeast corner slopes up 4 to 6%. The immediate area tl~at has been set aside for the replacement wastewater disposal system has an average slope of 2%. The site is moderately treed with bimh, spruce. One percolation test was taken at the site to assess the adequacy of subsurface soils to accommodate replacement on-site wastewater disposal systems. The results of this test is attached to this report. The test site 'had adequate percolation rate to support the existing five-bedroom residence. Subsurface soils were found to be gravel with some sand and trace silt overlain by 16" of surface organics. The percolation rate for the soil was found to be approximately 5 minutes per inch. On-site observation and physical survey show that there are no water wells within a 100' radius of the proposed system. The entire Hylen subdivision is served by the AVWVU water system, therefore contamination of wells is not a critical factor. The proposed system will have no measurable impact on reserve space, surface or subsurface, or on drainage to adjacent lots. Please consider this report as a request for review and approval of the attached design drawings for a replacement on-site wastewater disposal system If there should be any questions concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073 or 243-5372, Sincerely,. PE#8176 X ~oo x~ ..... N 05' 24' 5~" E ® ® N O O ,,'j Z m ?. ® ® SLOPE 03' 24' 58" E 170.81' ~ ,. MR. AUDIE HOLLOWAY LOT 14, BLOCK 3, HYLEN CREST el SUBDIVISION EAGLE RIVEFL ALAS? , IDOUGLAS T. KENLEY, P.E. Municipalily o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 %" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION; ~ /¢ zCc'z~'/' '"~' "/'>Z-Z--'/'-;' C'~'.-¢'~-~"7':~/wnship, Range, Section; SITE PLAN SLOPE 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT ~ O DEPTH? p E ~onilorinB7 Z ,,J ,~D~~ Dale: Reading Date Gross Net Depth to Net Time Time _ .,e.~W~a~e~¢%~..~ / Drop 1~ ~ ~ /y~,~/ I ~" ~,, ,., ~d ~-, PERCOLATION RATE ,~/ (minutes/inch¢lSERC HOLE DIAMETER ~"' -'~'' TEST RUN BETWEEN ~ FT AND ~.'~__ FT PERFORMED BY: ~"/~ ~'~' ~ ~'-/' /('-~/~%O1~ z~' ~'/ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEgT ON THIS DA] DATE; 'l~' ~fl 72-008 (Rev. 4/85) DE Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MUNICIPALITY OF ANCHORAGE :ITMENT OF HEALTH AND HUMAN SER' -~S 0 -~ O L/ "~ LC ,/ C~ WELL DISTANCES LEGAL DESCRIPTION Township, Rang~, Section TANKS  SEPTIC ~ HOLDING ..... ee/ g TYPEOF SYSTEM TRENCH ~ BED ~ W. DRAIN ~ OTHER orlg,~al grade Z FT /¢, ~ Total absorptio(I area Dist(~r~ce WELLS PRIVATE .~/OTHER (Identify) 7 oral %.~._FT~C a sed t° FT REMARKS: SEPTIC ABSORPTION TANK FIELD WELL ~_~..x'.~'~ ~ ~ ~ FOUNDATION /I,5' z t ~8-BUILT DI~ (Show rocanon ol Well, septic system, properly dllveway, water bodies, etc.) led by: i 17'034 EgCe_ R!¥e~_n4 ~ cedily Ihpl tiffs inspection was pedormed according Io all ~unicipal ai~ Stale guidelines in enemon inls oflie:, Health Depaflmont Approval; _ Date: 72 013 (3/85) I-:t"IC}FIIJ:~ :1i:6 9.q.'"" 2.9 '? 9 AI::'I:::'!. ;t; I];¢']N I': CON I'ACI l:::'l'lC)t',llii;: 694-'297'9 I !i::GPd.. DIE'~iiCI.:( I I:::"11 ()lq: I_CiT :1. 4 Ed...l< :3 I-IYl..li!i]',l CI::;H~:ST tqC),, :1. SI!:!.IZZ;: 6 , T 14 N ,¢ R 1 W t. C) I SIZIZ: 1~}~100 (SQ I:::'1 OR AC;RES) S():il... RATIIqG: 15d S&i I:::"I/BI::~¢-?' S()iI. lIES] :L}E~]:::"I H~ 14,, ',5 I:::'i I"i ZI I"i,i::~!:~BZ;.I!..! I I:(1~:):) F;:IESIERYE Al:RIP,LA: 7 L')()() S(). [:'f CAi .... I:;:I'~:SEIRYIE Fq::;G~:A ¢~V¢.:1 ! I..., ~', 9700 S(.4 ,, I::: 't IJ}iJ:::l::"l!!!:(; I ]] Vii!i] L)l!}i]:':' II"1 i:JCIVIJ!]::,.' ;OEF'I II It'J I'AI .. I. lii:l"l['.~ i' I' I h! I '0 'I'H t"l i iq ,, !}!~ :1: ,/.liif: [:il:::' ~i:~tii:]:::' I I C; Tr:':]i\ii< ]: t-',~ ,, DRA I i".IF' 1 !Bl:::'liiiC I Al. CCiI\I;O .1: t' I (H".l'.:i~ C)R i his TRt..IC:'l' I CH'-.IS :: PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION).~ _.~- ./4/ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3~t< ~' /~/Y¢-~"~ ~'~£~,FT°wnship, Range, Section:'~'~/z/Aj, Z/L/~/ . <~L~.~¢ /~2 SLOPE SITE PLAN L/'-' /o~¢ S IF YES, AT WHAT ~ L DEPTH? ~-tO-~f~ , _ O'~,,.J ~ Op E Depth to Water Alter~ , Monitoring? /-) Reading ~ DSS Net Depth to Net Time Time Water Drop PERCOLATION RATE __ tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FTAND __ FT COMMENTS L,)5/~ / ~'-¢:~/~///'~ ,~ Fcw.~. ~gle R~ver Alaska 99577 72-008 (Bev. 4/g5~ ~.50 . N. OO°OI'Or'~"E 197.85 '~ ).00 127.00 I21.55 ?0 %/EN CREST CIR. 2°01 'E r~ ,, ~ 1,90.00 ~0 4'9 / ',5 ,~ "£ /?0.81 ?0 °04 '00,?£' ~:, ,' '-:- ;'~,- 565.00,.~:'..'-,' :'-' .:. ,- 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.# ~,~{'~' J,~.'-:~,.,t.,~. \(~) HAA# ~'~0~(~-~-~,~- 1. GENERAL INFORMATION Complete'legal description -'~'"~ ~'~'~'"~ ~'Y~'~ ~'~'~-~"~'~"~/~/~\ Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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 Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 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 Z:7~,¢~.¢.,¢ ,~7',/c--¢~/~/¢.¢¢y Phone ('?~/) Address ¢~ ~ ~ ~-~ ~,, ~~. ~. EngineeCs signature ~ Date DHHS SIGNATURE ["'/ Approved for ~ / ///~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 (Re~.1/91) Back MOA#21 Municipality of Anchorage JUL DEPARTMENT OF HEALTH & HUMAN SERVI~_~?^LI~¥ Environmental Services Division ~RO~ENT^LS~RV~¢ES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Health Authority Approval Checklist '~:"~"~v '?/~"~*"~ ('~'~"~'~' ~/' Parcel I.D.: A. WELL DATA Well type ,z~/.¢~., (~. Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RES~~S.' Coliform ~ oDm~o~ sample: If A, B, or C, attach ADEC letter. ADEC water system nUmber Date completed L _ ~ Cased to ____ Casing height (a~d) ~ . Wires pr~ofected (y/N) ~ FROM WELL LOG ~NSPECTION ~ g.p.m, g.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~/;~//~? Tanksize /~,~'¢~, Number of Compartments ~ Foundation cleanout (Y/N) ~ Date of Pumping Depression (Y/N) Pumper '"~/'~ C. A ~l,~x 9,.[:1~ ~ ~ N~/I~E, xL,/D,~ ~ATA Date installed Y/'~ Length .~.'~'~x,v ..-?~' Width Effective absorption area ¢ ~'~ Date of adequacy test Soil rating (g.p.d,/fF or !.F/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N). Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth '~,/,~' (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) ~, Cleanouts (Y/N) /V High water alarm (Y/N) ~u/// / ,s .¢'//,~...¢~y st e m t y pe ~ / Total depth /~, ¢/ / __ Depression ever field (Y/N) ~ For ~ bedrooms ~.~/'~ Immediately ~fter~''/-~ gal, water added (In.): ~/',~ /¢/,g Absorption rate = ,u//¢ .g.p.d. ~-//,~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Size in gallons "Pump on" level at* "~el at* On adjacent lots On adjacent ~ ~ F/"~ublic sewer manhole/cleanout Public sewer main $~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation // Property line .--¢~ / Absorption field -'~ Water' main/service line ,~-,'-,~,,2 Sudace water/drainage /~ '~'-?, Wells on adjacent lots "~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ,~,/,,r-,z Building foundation /~' / ~'/- Water main/service line Sudace water /,~ +,~;~ Driveway, parking/vehicle storage area Curtain drain /u',~,,~- .~.,o~,.~,,',J ~-~ ~'~-,:: Wells on adjacent lots / '~ ~' ENGINEER'S CERTIFICATION ,,..~,~..~.~_\\~. ~. . I certify that I have determined thru field inspections and review of Municipal rec~{~.'~ tll~'g~o~.~.ms are in conformance with MOA H,~A guider~'nes in effect on this date. ~. ?~ ~ ~A Signature ._ 0 " ~ ~/] ~~ ~=:.:.:.:.~:~:~..~ .,,.~,,,,.,. :..~ Engineer's Name '~ [P~7 ~ ;~;~;~;;~t... Date ~' ~ '~ ~'~:':'"::" ~'~::~:~ ........ ,'~ ' ~. ~SS ~ , HAA Fee $ ~,=~,"~ * pate of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVIOES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING L~\"~-L\ -- lO HAA # ~ ~'~ \ (._~c:~ GENERAL INFORMATION Complete legal description Lot 14; Bloc~ 3; Hylen Crest Subdivision; Location (site address or directions) 10136 Raven Cr~st Circle Property owner Mailing address _ Lending agency Mailing address Floyd Suchcr Day phone 696-3324 10136 Raven O_re~_e ~_i~.c~e, Eag6e R,'_:,eJ,., A~. 99577 Day phone _ Agent Kathi 01mstead Jac~ Whit~ Company Address 1fl~¢9 F,~g~ R.iu¢~ ]?nr]d; F,~g~¢ ~iver~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well Community well Y,X Public water NOTE: Day phone AK. 99577 6~4-5500 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 Public sewer NOTE: XX 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 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. Phone Name of Firm s & s 17034 Eagle River Loop Road No, Address Eagle ~iver, Aiask. ~5Z7 - Enginee¢s signature Date DHHS SIGNATURE ¢ Approved. for bedrooms. Disapproved. ConditiOnal approval for bedrooms, with the following stipulations: Additional Comments Date ~-/7 - 7/ 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 tending 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) Bsck MOA~21 A, WELL D~.T? Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ¢~q~.¢_~.1 d_.P_Cs< ~o. I Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Pump level SEPARATION DIST_.A-f~CES FROM WELL TO: Septic/~ank on lot 7--oc~ ~ Absor/Cion field--on lot ?--c,:~~ ~ / Public sewer main Date completed Driller Cased to Casing height ~ __ _ Wires prope rlyp r~~ __ FROMM WELL LOG__~AT INSPECTION  g.p.m, g.p.m. Public sewer service line WA/TER SAMPLE RESULTS: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '¢~ -~-R - ¢'~ Cleanouts (~/N) ~ High water alarm (Y~/_/~ ~ Date of pumping ~ ~.L,-°~O Acc ~r~k~ %~,4~.-~5, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Tank size \4 ~> f-~ Compartments Foundation cleanout ~)'N) "~ Depression (Y~-~ Alarm tested (Y/N) ~ Well(s) on lot 7_.c~ o ' ~- On adjacent lots .h-~/~, To property line ~c2 ~4- Absorption field ~ ~ Surface water/drainage ~)c) ~ Foundation .Water main/service line 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer ~ Manhole/Access (Y/N) Vent (Y/N) ~ "Pump off" level'at -- High water alarm level~-~~ Meets MOA electrical codes (Y/N) ~ ~ SEPAR~I F_T ST'~TIO N TO: ~ Well~:~ lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~' Width Total absorption area Depression over field (Y~ R e s u I t s/¢"ES-~'f a i I ) Peroxide treatment (past 12 months) (Y/(~) Soil rating \~'~/~¢~-. System type Gravel thickness -'-~,~ ~ Total depth Cleanouts present ~N) Date of adequacy test ,~ _ ~-_o~ for ~'~'q~-- L~i~ V-~o'~iQ. If yes, give date ~ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~"~/~ Property line ~"~ ' To existing or abandoned system on lot Cutbank ~/~- Water main/service line ~O~ '~ 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 th~this inspection. , .;-~." ',.~ /// HAA Fee $ Date Of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72~026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 O STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: Ray S & S Engineering April 15, 1991 PWSID: #213289 (Hylen Crest--Eagle River) My review of the records on file in this office reveals that the Hylen Crest Subdivision Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, -,, Timothy A?Karnowski Environmental Engineer MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264~4720 GENERAL INFO RMATION (a) (b) (c) Application Date Legal Description (include lot. brock, subdivision, section, township, range) Location (address or directions) Applicant is (check one): Lending Institution []; Owner/buitder/~; Buyer []; Other [] (explain); (d) Lending nstitution Address (e) Real Estate Company and Agent (f) Address Telephone Telephone Mail the HAA to the following address: 17034 Eagle Ri~er Loop Road No. 204 Eagle River~ Alaska ~)Y577 TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community [] Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] 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 72-025 (11/84) ~ jo g '~JoM s,Jaauibue leUO!SSejoJd alii u! sue!ss!u JO Jo sJOJJa JOj elq!suodsaJ leu s! eeeJoqouv Io 4]!led!o!un~ eH J_ 'penssf s! @]ea!J!~Jao e eJojeq elep aZXleUe Jo suo!]oedsu! ~onpuoo ~ou op dqHC] jo sa@XoldLU:-] 's]UaLUeJ!nbeJ a]e]s pue leJepej u!eHeo XJs!les ol JepJo u! suo!ln]!]su! 8u!pual J!eq~ pue sewoq jo sJeseqoJnd ol Xsa~Jnoo e se s!ql seep d=IHQ aH/'e)lSelV ~o a]elS eH1 u! paJe]s!eeJ Jeauieue leUO!SSejoJd ~uapuadepu! ue Xq a^oqe g qdeJeeJed u! ua^!8 suo!le]uasaJdaJ aq] uodn ,~lalOS peseq saleo!j!lJeo le^oJdd¥ X1Hoq]n¥ qlleaH sanss! 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NOI/¥1N~JOJNI tiNY ¥.LV'C] 'HOIJ¥eS =1"114 '$J.S~]/'$NOI/OedSNI 9NIOIAOEId INEII=I 9NItJ~ieNIeN3 WELL DATA MUNICIPALITY OF ANCHORAGE (MOL/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments , '/~"f.,/. ~"-~ /' ,4~ ,Z~. Date Completed Yield/ Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ,/4/'/~,~.zf/,~.,,'7 Size /,~-"~:~ ~) No. of Compartments Standpipes ((~N) Air-tight Caps ) Foundation Cleanou ) Depression over Tank (Y/~ Date Last Pumped · ~O//,-'~. ; for Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticS§ Tank: To Water-Supply Well ~__.~z::, ~' ;,Z-.. TO Property Line ~ To Water Main/Service Line //0 ~"'1/-'- Course Temporary Holding Tank Permit (Y/N) / To Building Foundation //, To Disposal Field ,/ '~' / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~___~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~ ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present(~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,/,j Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) Pump Off" Level at //'/'~ Vent (Y/N) / (/ Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all M dA an~/~AA guidelines in effect on the date of this inspection. Signed& $ ENGINEERING Date L~'~/2, / ~¢' '~ 17034 E~gle River Loop Ro~d Ne. 204 Corr~ River, Aie.k. -2;52'2 MOA No. Date of Payment ~/4/~¢ Amount: $ /O (~ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIROI~M[~NT,AL CO~SERV, AT~ON / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 SHEFFIELD, GOVERNOR Telephone: (,.o07) Address: 274-2533 To Whom it May Concern: According to records on file in t hi.s office the ~~ ~~ ~.~~ater System is in compliance with the State Drinking Water Regulations