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)
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NOTES:
PANNONE ENG SVC, LLC
P.O. BOX 1807 PALMER, AK 99645
PHONE (907) 745-8200 FAX 907 745-8201
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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
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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 ~
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'paAoJddes!c]
Jot paAoJddv
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e.mleulS!s s,Jaau!bu3
sseJppv
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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~)