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HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 17Onsite File #050-474-13 Municipality of Anchorage 1i U On-Site Water and Wastewater Section • (907) 343 9 4 Pa of 2 ON-SITE WASTEWATER INSPECTION RE 1'W1h Permit Number: OSP191244 PID Number: 050-474-13 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New *Upgrade Name Michael Bryan ABSORPTION FIELD ❑ Deep Trench 0_1 Wide�Trench [:]Bed ❑ Mound Site Address 10119 Raven Crest Cir. ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3(e) 4(p) 1.2 GPD/SF JTotal 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath pipe 3.5 Ft. Subdivision Block Lot Hylen Crest #1 3 17 Fill added above original grade 0.0 Ft. Gravel length 24.5 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 643.5 Fl? 1 Ft. Well TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 51+ I 10.+_ NA Plastic 2 Foundation 10,+ 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer Jr's Septic Services Drainfield 3034 CO/MT3034 inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 855.0 ft Inspectiones: 1s' 7/24/19 7/24/19 Location and description 2�d bottom trim @house point A 3rd 7/25/19 41h 10/8/19 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp :A/ Conditional Approval: Date ... ' � Steven t' e en ,r R. Ponnoia Septic System Approved Date Note: this approval does not include well permit requirements. (Rev 05/02/18) o K:-q-n0^^a --I o a icnc�0� > co n -i-i OO<0��7Or1Dp �m N -*i -+i CO c/) D p > -i N P DD rn p z c/1 m _ n Z • frrl DO>DO Ci�W m Cn �7 r*t y FTl U? Q -i n m v -� o'<prorx�m om�?gzn�oo� (Tl C I W W D v Ln O ;0 c) z D O�m.ATJ-iDNO-<Gi X o O� O / F-> 0ZZO2D Ui -I, F • mrX X Dx (n Cn _i �D �zirn0cr) N 0m -P ;u ro m o r0 o m — N — N (�0 CD CD I W D r0- -Ci C � Z z O N UTILITY EAS t�ENT 'I'0 ADO p0� �0Kw(7)�D O ul W�0o O Z m Un z D �� ()1x (,x,4w W Cn Cnrr1 O CD Uli (A O D Z o M N m � A (n �m0m O O m cn z X NO WELLS OR m Dr o z o. o U)mfrl z ,1 $ C7 —I m cn n c:m v p _ n -' \ p-iO C/) Ln 4 _ c `a'a� RAVEN CREST CIRCLN,� ,.. W / W— W �m 71 co-1_5� EASEiv1E '<\ o /f --—o —— — o / I` 1 O 1 f � 1 L < m M n m / o - > K n m �I \ m rA I £ -C / 0 --� / w . A A ` �\ OsonimN n -> ;% 0 A 0� -,i *i -n o m > m mo C -P o^o N a� n /I 0 K C) n n- N N c/) D p N oFTI a C V W W W X o O� O / Ui -I, • O D -P m -P o — N N W W N N N UTILITY EAS t�ENT W cn W ul W Un Un CD -1 m m (A co (.A cD cn cn z X NO WELLS OR SEPTICS cn cn 100' / $ 3 n -' Co � A zNz CLD.D \ � (J)Ui > c/) D \ `, oFTI a C I X o O� O / • O D — — — — — X Z � D 10' UTILITY EAS t�ENT _— -T _ z�� �z M mom z X NO WELLS OR SEPTICS o 100' / $ 3 — WITHIN r � 4 NOTES: PANNONE ENG SVC, LLC P.O. BOX 1807 PALMER, AK 99645 PHONE (907) 745-8200 FAX 907 745-8201 �.,������\� Q1=k.4 >11) °�• ''••• •••• / teLen R ' onnone•� �}• CE 8149 f��liai`�� REVISIONS DATE 10/17/2019 RECORD DRAWING REV 1: 03JAN2020 SCALE HYLEN CREST #1 B3 L17 MICHAEL BRYAN 10119 T99 R P.I.D. NO — 050-474-13 DRAWN ACP PERMIT NO. 22 4 SITE PLAN EAGLEAR VERCREST SLE SHOE 2P AK OF � (1,174"45'W) (254 70`) Tvi c� ux *--u-- R[CUVERED)'2- R[8&R MEASURED DATA RECORD PER PLAT (83-81) WATER VAiV[, ABOVE GROUND PED[STAL, COMMUNICATIONS P[DESTAL, ELECTRIC SEPTIC VENT/CLEANOUT MANHOLE, SEWER FENCE THIS SURVEY WAS PREPARED FOR AND SHOULD ONLY BE USED FOR A SINGLE PROPERTY AC�0N. RE -US[ OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL U3[3 AT A LATER 0k7F WITHOUT EXPRESS WRITTEN CONSENT OF HANSON LAND SOLUTIONS IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS 0CCDV[R[D. THE LIABILITY OF SAID SURVEYING COMPANY SHALL BE L|W|T[0 TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT, ' | | 10` UTILITY EASEMENT __01 1. THE HEREON REPRESENTED SURVEY DOES NOT CONST | TUT E A BOUNDARY SURVEY. IT IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT B0VWQ4RY SURVEY MAY DISCLOSE. 2. INFORMATION PRESENTED HEREON Is A REPRESENTATION OF Y|5|BL[ IMPROVEMENTS AND C0NU|T/DNS PRESENT AT THE TIME THE SURVEY WAS PERFORMED ON AUGUST 38. 2019. J. DIMENSIONS OBTAINABLE FROM THIS DOCUMENT ARE LIMITED TO THOSE BEARINGS AND GROUND DISTANCES SPECIFICALLY LABELED HEREON. THE DOCUMENT 0DE5 NOT PURPORT TO PRESENT A BASIS FOR SCALING TO DIMENSIONS NOT LABELED HEREON. 4. THIS DOCUMENT IS NOT TO BE USED IN SUPPORT OF ANY NEW CONSTRUCT |ON, 5. EASEMENTS, COVENANTS AND RESTRICTIONS NOT APP[AR|HG ON THE RECORDED SUBDIVISION PLAT WAY EXIST, DETERMINATION OF THEIR EXISTENCE IS THE 8[SP0N3|8|L|TY OF THE OWNER. G. THIS SURVEY WAS COMPLETED IN SUBSTANTIAL ACCORDANCE WITH A8PLS MORTGAGE LOCATION SURVEY STANDARDS. HAM%ON LAND SOLUTIONS 30 E. FIREWEED AVE. PALMER. ALASKA 99645 (907)740-/738 / HEREBY CERTIFY THAT THIS DOCUMENT REPRESENTS A SURVEY MAD[ BY WE OR UNDER MY DIRECT SU9[RY|S|0N, OF THE FOLLOWING REAL PROPERTY: PALMER RECORDING | DISTRICT I LOCATED WITHIN SEt/ SEC. 08, T.14N. 13.1VV, SW, AK C0NT4|N|HC 0.46 ACRES MORE OR LESS `'�""`` MUNICIPALITY OF ANCHORAGE �-a On -Site Water & Wastewater Program }}} PO Box 196650 4700 Elmore Road 4i Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:/hroww.muni.orgtonsite "ctrutar.�t On -Site Wastewater Disposal System Permit Permit Number: OSP191244 Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 05047413000 Site Legal Address: HYLEN CREST -91 ELK 3 LT 17 G:0057 Site Mailing Address: 10119 RAVEN CREST CIR, Eagle River Owner: BRYAN MICHAEL R Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy g/2ql 19 p��nC L)c:p�u'hnent 7/8/2019 7/7/2020 Lot Size in Sq Ft: 20042 Total Bedrooms: 4 ❑ Private Well ❑ Water Storaae All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per ADAC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: `* The new tank is to be protected from vehicle traffic or parking. Received 8 Issued By: ,11 20 HT1 r 7/e-4/1417/e-4/141Cowl �'elA lkwveJ �We��i' Cm,klr'� a .iT / y: 7�aDate: v / Date: i� CPU:WS MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 . Development Services Division Fax: 907-343-7997 On-Site Water&Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-474-13 Property owner(s) Michael Bryan Day phone Mailing address 10119 Raven Crest Circle Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Hylen Crest#1 B3 L17 Legal description (Township, Range & Section) Lot Size 20,042 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field ❑X Initial ❑ Single Family(SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex(D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. \ (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: ls/a0119 Date of Payment: Receipt Number: 0(14#184 Receipt Number: Permit No. 05/9/qL r.Z,cL/ Waiver No. Permit App_:• :.,c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191244, Deb Wockenfuss, 07/08/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191244, Deb Wockenfuss, 07/08/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191244, Deb Wockenfuss, 07/08/19 app g� E9 R Ln C7 O MW H OZ 'n jag M M M M'd ^210-" epi dw > g g 6;5 . A NNrI 02 M z N 0'( s RAVEN CREST CIRCLE 2s5p� '0 S 0004'00"E 131.00' XOOAOO 'd 9916 -SQL -L06 'ON XU Wd 99N M/610UH/M MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar. e DISTANCES AddresS , TANK FIEt. D WELL Phone(s) ] Permit No. NO. of Bedroo~s WELL Lot Block.~ Subdivision Township, Range, Section AS-BUILT DIAGRAM {Show Iocabon ol wen, septic system, properly lines, foundation, 7/z4~ ~/~ '~ c'f ~ driveway, water bodies, etc.) TANKS U ~ SEPTIC D HOLDING ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Fill added a~ove original grade Gravel depth beneath pipe / ET ~, ~ FT Distance belween lines Total absorption area Number of lines ~ Sci, rating P,pe ~aterial ~ PRIVATE ~ OTHER Udentifv) ~' Tolal Depth J Cased to Classificalion (A,B,C) Installer Date Installed: REMARKS: I ~ ~~ cedily Ihat Ihis igspmion was ped0rmed according to all Municipal and State guidelines in effect 0n ~'~ -- Date: -- Health Oepadmenl Approval: / i 72-013 (3/85) EAGLE RIVER ENGINEERING SERVICES P. O, Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5i95 SHEET NO. ,// OF // CHECKED BY CATE SCALE /'on/~ ~ /7 .1'"~ ~ /~ To EAGLE RIVER ENGINEERING SERVICES P.O, Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 LETTER RECEIVE[) dAN 11 1931 D Munioipality of Anchorage Ftealti~ & Human 8erviee~ [] Please reply J~No reply necessary SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: ,~/~,c,/G~ ,- -- LEGAL DESCRIPTION: ,~¢,,~2/- ,/7 ,/'~/"'/'~ .-~ 1 2 3 4 5 9 10 11 12' 13 14 15 16 17 18 19 20- COMMENTS SLOPE SITE PLAN ~.,,..r,r. WAS GROUND WATER S ENCOUNTERED? ,/V/ L O P IF YES, AT WHAT ,/-~,,v ,','..~' E DEPTH? ~' 7d".'7 £ - Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE .~, 5~ (minutes/inch) TEST RUN BETWEEN ~ FT AND .-~ . FT PERFORMED BY: 72-008 (6/79) Eagle River Engineering Services P. O. Box 773294 Eagle River, AK 9957? 694-5195 CERTIFIED BY: ~ DATE: NO0'04'l? 131.00' x v ///¢,(///./'////~ -- X //+5,o0o ~ //Rese~e Areo~///~ ~ - ~ H0~ . - ~o~ ~U.E M ~ ~ ..... + - WE~ ~;~;~i~- PROPOSED ~ACH~IELD ~ 15' Elec, Easement NO KNOWN CURTAIN DRAINS S E PT ! C S I TE P LA N LEGAL: Hylen ~E~__~_~ Lot 17, Block 3 OWNER: S. nell Homes C~TRA~TOR: N/A EAGLE RIVER, A~ 99577 (907) 694-5195 ~AX: (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT t'7. 8LOCK 3. Itvlen Crest ~,tl GENERAL 1. The wel'l and sept:ir plan ape 'Pop ~,~ singlo '¢arnilv residence on'iv. 2. The drav¢ing and om site plan shall bo a par't of this sneai'Pication. 3. A-Il materials and s~er'kmanship shall meet bhe Anchorage E)eparttnent of Health and State Department O¢ Envfit, onmente]'l Censer'watffon requfir, e,,~ 4. Aql so'il tests ape advSsonv to the desiqn and are ko be verified or modqfied 'in the field by the en{]'ineer. Anchorage, Dopant:merit o'¢ Envir'onmenta] Conservation requirements. or easements and to locate anv adjacent rnu]t'J---famfi]y well . '7. The excavation tis to be exactly ~in the ar'ca shown on the site p'lan, any deviation requires engfineer, appr'ova]. 8. It is a'lwaMs rec:ommended that a surveyor, locate the near'est 'lot line position and the locat:1c)n o¢ 8rqv easements, [3. DRAINFI ELD ! . The drain-Pie]d 'is to 'follo~ the natural land contour, to maintain uni"form total depth o'f the trench bottom. 2. The bottom e~f the dna'in'field shall be lew~l, plus or rr, inus ! .5". 3. Tine total depth 0¢ the drain'Pield exaavation is not to exaeed 8' at any point. 4. The sebPer- 'line is te exit t:he home a~ high eneugh e"levat'{on to allow gr'av'lty 'flow at leach 'fie'Id tota'l depth. Contact engineer c]ar'~fication i¢:~ needed. 5. The dPair~'fie]d gravel is to be covered ~th typar or' fabric rnatepfial. 6. Soil or combination 0¢ soil and extr'uded board insu~Jat:ion to a depth of 4' on equivalent 'is to be placed over' the dnainfie]d. ? . The area ever the dpafinfie]d is to be 'finish graded te prevent: pending 0¢ sun¢ace ~a~en nuno~f'f. Area around leech 'field is t:o be graded to direct drainage to cash. 8. The septic ~ank and ]each'P~e'id rnus~ not be o]oseP than 100' te any existing pnivete well, 150' to any Class "C" well, or' 200 -Peet to any cornrnunitv w~e]] . IRECOMIVlENDED LEACHFIE'LD DIMENSi()NS TOTAL DEPTH ,,,: ?' GRAVEl., DEPTH = 3.5' DRAINFIELD L. ENGTH ~: 49' DRAINFIEL, D Sofil Rating .... 150 [3edroom Capacity = 3 Septfi¢,~ Tank Size = 1000 (Larger tank rnav bc,~' added i-P des'ired 'for ~urther upgrade) >~**NOTE: LIFT STATION REOUIRED IF I'OTAL DEPTH CANNOT 8E HAIlqTAINED AT GRAVITY FL,OW. DEPARTMENT OF HEALTH & HUMANSERVICES -:~'~.'.'/~;~ · Division of Environmental Services On-Site Services,Section ' · " ' .1~ ~'' 1'~ ~ ' J.[ I ' CERTIFICATE OF HEALTH ~,OTHOR TY .'. -., ,- .;. :., ..... . v '-"q-'~...,. '",' : ~,PPROVAI~ FOR A SINGLE FAMILY DWEL.LIN~ '" ...... : :: · ':" .' Parc'el I.D.~ ~/5: .:..:- - ' -, ~:-;/.~;',~ ~:"~ ~ '- , . ,-, r....,.~:~ .,-.,. ~,?:--, ~,.,.....: ........... : ...... LV' · ..""?~ .C0mPlete le~'~'l' description. "' Lo~ 17; Bloe~ '~ Htj.~e.n Cre~t Sub~v~.~on,?~l ,,%~" '- ._ ,'... ,'~d~g ag.onc~ ~ Day phone '..' _ . : '~,~>:::,~?~, NOT,lEi ,mmunity well system, provide written confirmation from:, ; ;:~: :,..,~..-:,¢,",,,.~,; ?lng to the legahty and status of system. 4. ~.~,TYPE. OF WAS~EWATER DISPOSAL ..... ~. .....,.~,. ....... ~:.~ ~ .... ~, :~ ":~'~ ':':~' }!:~/.~.: ",' i~,i:! .nd ~idUaiOn,Ste -'~ ...... ... ....... uommun ty .... '..~".: : ',- ::Fubhcse - ..... . ~,' , :'. ~:" '.:" NOTE: i~ if community wastewater system~ provide, written confirmation?om'State AD~C 72~5 (R~, 1/91) Front MOA~21 ~ ;:~ ' 5. STATEMENT:OF INSPECTION BY ENGINEER.~ '~;~.i.'~-..:~;'=~., ~ '% '.:,i; As certified by'my seal affixed hereto and as of the validation date shown below,~J!verify that my investigation of this Health Auth ority Approval· application shows that the on-sit~.~ater supply and/or wastewater disposal system is safe, functional and adequate for the numbe'~ of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality Of ~n~ho'rage files,..,and fr0m.mY...investig.a~i~n and inspection the ohJSite water supply'and/or wastewater disposal system is in compliance with all Munici pal and State codes:,. , .. ordinances; and regu ations in effect on the date of this inspection. ',:-:.: _ ...~.. ~,-~?..-', '"- ,"~"~" ' "- '- ' , '.' S &$ENGINEERING .......... ............... ; . [e Rtver~ Al~sk'~ 99577 - - . ., , Address . - , -, ..,¢ ..... . . .... Eng~nee_r's signature . _ , Date ,a )reval ,fo~ · '. ,, ~ -III III il , ' ?;,:'[,~.he Muni~fpalitY%b'~,/~n~hora~e'Department of Health:and H'U~'fi;'S~/f(JeS~ (DHHS)'i~ues Health Auth0fi~ :, ~A~proval. Ceffifi~s. based only·upon the representat ons given in paragraph 5 above by an ndependent. 5~ ~r,.~, ¥[ ~' -," - ' , .... ~:' ': pr~lonal en~l,n~r registered in the State of Alaska. The DHHS does this as a cou~esy to purchasem of homes , and their lending institutions in order to ~t s~ ce~a n f~era and state requiremen~ Emp oyes of DHHS do not ' conduct ins~oetion~ or analyz~ data goforo a e~difieato i~ i~u~d..Tho Mgnie[pali~ of ~neh°ra~o i~ not? ro,~on~iblo for orro~ or omi~ion~ in tho profo~ional on¢~o~ work/: : Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Description: Lc~l'7 A. WELL DATA Well type VtoA- Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level tkl~t/e'^l ~,~.:4.r_d:_/ ParcelI.D.: 05-O-c[Zt-1/~13 If A, B, or C. attach ~EC letter. ADEC water system number Date completed Cased to.~ ~ Casing height (above gr~ ...... Wires properly pr~ected (Yin) FROM WELL LOG ~T INSPECTION Well prodoction WATER SAMPLE RESJ~S: Coliform / -l~te of sample: / g.p.m. Nitrate Collected by: Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed I/,r,/Y/I,o.'io Tank size /oo O Number of Compartments Z Cleanoutsl~'N) Foundation cleanout (~) 7/ Depression (Y~,.)) /,/ High water alarm (Y/N) _ ,'J/~ Date of Pumping /g~ .~.-9,r'- Pumper C. ABSORPTION FIELD DATA Length .S--O t Width Effective absorption area 6/t-2 Date of adequacy test Soil ratiug (g.p.d./fl2 or ftZ/bdrm) /'~> /X,~-System type &J, --¢- ' Gravel thickness below pipe .% ~ ' Total depth Monitoring Tobe present~jN)~ Depression over field (y/'~l~ /~- r-.~ Results (:P~ss~)Fail) f~ For ,3 bedrooms Fluid depth in absorption field before test (ill.); 0 hnmediately a£ter/a/o gal. water added (in.): Fhfid depth /(- (ins.) Minutes later: ~/2 Absorption rate z-//5~ ~ . = g.p.d. Peroxide treatment (past 12 moaths) (Y~ t-/,~ Pf~ ~,0 ~,v,~ If yes. give date /?" D. LIFT STATION Dute installed Size in gallons Mauhole/Access (Y/N) ';Pump o~~ High water alarm level u~ *Datum "Pump ofF' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTICFt-IOLDING TANK ON LOT TO: Building foundation Water main/service line Property line /o Surface water/drainage Absorption field Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Water main/service line /o / * Surface water ] o o ~ /'- Drivexvay, parking/vehicle storage area 2o Curtain druin ^[A Wells on adjucent lots ~9o ~ ~- Property line F. ENGINEER'S CERTIFICATION in conJbrmance with MO~ ~LL4 guideli~s in efJbct on this date. Engineer's Name ~ .................................................................... ........................................... ............. HAA Fee $ ~,~,) · Date of Payment /~/~//~ .~ Receipt Number /,~.Y~_~ Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-4'74-13 HAA# GENERAL INFORMATION Complete legal description H¥1en Crest #1, Lot 17 Blk 3 Location (site address or directions) 10119 Ravencrest Circle, Eagle River Property owner Mailing address Michael & Jody Columbie Box 3427, Valdez, AK 99686 Day phone 835-6117 Lending agency 1st Int'l Financial Mortgage/Rick GeoE~phone Mailing address 3333 Denali, Suite 220M, Anchoraqe, AK 99503 Agent N/A Day phone Address 229-3366 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 Public sewer NOTE: X 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 #25 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythatbasedontheinformation obtained from the Municipality of Anchorage files and from my inves~[gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineering Services Address P.O. Box 773294, Eaqle River, AK Engineer's signature /~ Phone 99577 694-5195 Date .--<-./~ .~'/'~ ~' DHHS SIGNATURE ?. Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Heatth and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1.4)1) Back MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type ,?~ &/. Log present (Y/N) Total depth Sanitary seat (Y/N) Date of test Static water level Well flow Pump level1 / SEPARATION DISTANCES FROM~LL TO: Septic/holding tank on lot / Absorption field on lot / Public sewer main / Sewer WATER,~VlPLE RESULTS: Colif~ Nitrate Date of sample: Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system numbe.r.. Date completed Drill/er'''/' Cased to ..~asing height .Wires proper y p~ed (Y/N) FROM WELL LOG /~AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Other bacteria RECEIVED MAY 2 7 1994 i~,l[~P~ffm ny oi Anchorage Dept. Health 8. Human Services Collected by: B. SEPTIC/14OEDING TANK DATA Date installed I//Ob/~D Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /ODO Compadments Foundation cleanout (Y/N) Ys-~ Depression (Y/N) /'//4 Alarm tested (Y/N) /'///4 7/73 Pumper ,~ '/' 2¢D~ S SEPARATION DISTANCES FROM SEPTIC/H~ING TANK TO: Well(s) on lot /V/~¢ On adjacent lots To property line / ~, ' Absorption field Sudacewater/drainage 'Y / ¢~2 / Foundation 3- 5 ' Water rnain/service line 7~'/L~ / 72-020 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION /'V/~ Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed // Length ,~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) _ /55 0 ~ Width .~ / Gravel thickness ..~. ~ / -'///~ ~. ¢ Cleanout present (Y/N) O G/?_..5/?z/ Results (pass/fail) System type Total depth 7 / ),/dS Depression over field (Y/N) /'V'O p~/$5' for ,-~ Bedrooms After test /O. If yes, give date /v,,//,? SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /V//~ To building foundation On adjacent lots ~,.~O / Surface water ~ /OD ' Curtain drain On adjacent lots /,//~q Property line ~//J / -/'/0 ' To existing or abandoned system on lot Cutbank /'///q Water main/service line -/'/D / Driveway, parking/vehicle storage area No~£ /~??#£ £~/-r E. ENGINEER'S '" ~'" c ,' , ,.,E,-~, h I,.,ATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec. Signature Engineer's Name Date . ~.~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 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. # _L'~) ~ ~t-~t-\- ~-~ FtAA# GENERAL INFORMATION Complete legal description Hylen Crest #1, Lot 17, Block 3 T14N, R1W, Sec. 8 Location (site address or directions) ] 0'1 19_Eave]mcresZ~_ircl~_: Eagle River Property owner 5ack _Spinelli Day phone 344-5678 Mailing address _9__2_~_0_~Van_gu_ar_d____D._~_...~S__u_!_t_e 102_,__Anchora¢le, AK 9950? Lending agency Nordstar Day phone_276-1933 Mailing address._25_50_P~_nalJ:,. Suite 615, Anchorac~, AK 99503 Agent _Kirk Mo~.~/g¢_.M_~x Day phone _257-0164 Address ___ 2600~r~v~a,_S_uite_:!_0. Q, Ap_~hQra_g~, AK 99503 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 Stale ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Flolding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to lhe legality and status of system. 72*095 (Rev. 1191) Front MOA~21 ')I.~OM s,J@au!bua leUO!SSaJoJd aLI1 U! SUO!SS!UJO JO sJo.~.~e JOt elq!suodseJ leu s! aaeJoqouv jo /q.!led!o!un!Al eq£ 'penss! s! eleo!J!lJaO e e.loleq ~,lep eZ/~leue Jo suo!loadsu! lonpuoo leu op SHHQ to saaAoldUJ3 'slueuJeJinb@J elelS pue leJepat LI!'e:P@o ,4,is!les el Jap JO u! suo!lnl!lSU! 15u!pual J !eql pue SaLUOq ,tO sJaseqo]nd Ol AsalJnoo e se S!Ltl seep SHHE] aLII '~,)lselv Jo elelS alii U! peJelsiBaJ Jeau!Bue leUO!SSatOJd :l. uepuadepu! ue Aq eAoqe g qdeJ6eJed u! ua^!6 suo!lelUas@JdaJ atll uodn XlUO paseq SeleO!l!lJeO le^oJddV XiiJoqlnV t. tlleaH sanss! (StdHQ) seo!AJe$ ueumH pue qlleeH lo lUaLUlJedeC] aBe.~oqouv 1o Aliled!o!unlAl aq± '"1~ ...... '*~ ..... ~1 .... fl,,llfl[,~,= -' · .... /o/ .../,_ .¢ alea S].ueuuLuoo leuo!].!PPV :suo!lelnd!ls Bu!MOllOt eLl1 Lll!,~ 'SLUOoJpeq JOJ leAoJdde leUO!l!puoo §6T§-~69 auoqd 'suJooJpeq ~ LLS66 'paAoJddes!c] Jot paAoJddv :.]urlI.¥N~)IS e.mleulS!s s,Jaau!bu3 sseJppv %'V 'Za^T8 aT e6¢~-'~ "F6ZELL xo~ 'O'd SaOTA.~aS bUT:[aauTbu,a .za^T8 aTbe:~ u. iJ!a ,to eLUeN 'uo!loedsu! slql ,to elep eLl1 uo loajj, a u! suo!lelnbeJ pue 'seoueu!pJo 'sepoo ele].S pue led!o!unvxl lie Ltl!,'A eoUe!ldLUO3 u! s! Lue].s,~s leSOdS!p Jele~alse,'a .~o/pue Xlddns Je].e,v, el!s-uo eLl1 'uo!loadsu! pue uop, eb!lse^u! ALU uJO.U pue LUOJJ peu!elqo uo!leLUJOtU! eLI]. UO peseq leLt]. ,~J!Je^ .~eqlJ n~. I 'u!aJeLl peleo!pu! eJnlonJ].s jo adA1 pue stuooJpeq jo JequJnu eLI]. JOJ elenbape pue leUO!1.ount 'ales s! LUa].S/,S leSOds!p Je].e~else,,A Jo/puc Alddns Jele~ el!s-uo eql 1eLl1 s~oLls UO!leO!ldde le^oJddv A~!JoLl].nv qlleeH s!Lll jo UO!lelS!l. sa^u! XLU ieql ~J!.~aA I ','Aolaq U~Aoqs elep UO!lep!leA eql lo se pue ola.taq pax!lie leas ALu Aq pa!J!iJea sv '9 Ui]:INIgN:I tel NOIIO~dSNI JO /N:II/~iiI/¥.i.S 'iii Legal Description: A. WELL DATA Well type "~4 Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage M~ ................ Department of Health & Human Services mvmuh~sE~wc~s~ oIVlSiON HEALTH AUTHORITY APPROVAL CHECKLIST~vu-~ ,-~I~9 1991 //Y£~'N ¢/~'5'? ~/ L0¢/~ /~/'¢¢~'~ Parcel I.D. RECEIVED If A. B. or C, attach ADEC letter. ADEC water system number .~/~-~¢ Date completed Driller Cased to Casing he ght Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level g.p.m, g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hot~ing tank on lot Absorption field on lot Public sewer main Public sewer service line ,/~'//¢ ; On adjacent lots _ ; On adjacent lots Public sewer manhole/cleanout /v'//~ Petroleum tank WATER SAMPLE RESULTS: Coliform ,c/CF Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/I'I~kBiN~ TANK DATA Date installed ///.~.-?¢/~/¢0 Tanksize /~0¢~ (~.,¢/,~,5/,/5' Compartments Cleanouts (Y/N) ')/ Foundation cleanout (Y/N) _ ,~ Depression (Y/N) High water alarm (Y~) ~'74 Alarm tested (Y/N) Date of pumping ,4,,¢,,, SEPARATION DISTANCES FROM SEPTIC/ICr~LDiNG TANK TO: Well(s) on lot /'//~ To property line /~- / Surface water/drainage On adjacent lots Absorption field Foundation ,'~ Water main/service line_ .,,./¢ / 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ///5' - ///~/~ ~ Length ~'(~ / Width Total absorption area 4~- Depression over field (Y/N) 'Results (pass/fail) '~ Peroxide treatment (past 12 months) (Y/N) Soil rating ,/5O / System type ~/. /~//k/ Gravel thickness '~' ~' / Total depth ¢ / Cleanouts present (Y/N) ~' Date of adequacy test /¢/4 ,¢~ ¢*~¢~'~. for ,7 bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots :~ Surface water Curtain drain On adjacent lots ,,, ?,e Property line To existing or abandoned system on lot Cutbank ,~"~'~ Water main/service line Driveway, parking/vehicle storage area ¢"/¢ E. ENGINEER'S CERTIFICATION I have checked, verified, or conformed to all MOA and HAA auidelines in,:.e'(fec_'t'on ;the date of this inspection. I certify that Signature ¢~ Engineer's Name ~'> ~o ~ Date ~/~ ~/¢/ HAA Fee $ [ ~-~-~ ~ Date of Payment '~/~ / C( ~. Receipt Number ,~_ '~'~7~' ~2 ,~-(~::~'} % Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 May 23, 1991 WALTER J. HIOKEL, GOVERNOR 563-6775 FOR: E/R Engineering Loria PWSID #213289 My review of the records on file in this office reveals that the Hyland 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, Keven K. Kleweno Lead Engineer ~ pd~[ed on recycled pape~ b y C,,i~)