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HomeMy WebLinkAboutHYLEN CREST #1 BLK 3 LT 18Hylen Crest Block 3 Lot 18 #050-474-14 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201141 PID Number: 050-474-14 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name CHRISTOPHER JIMENEZ ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 21419 LOWLAND AVE., EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 3 Ft. Subdivision Block Lot HYLEN CREST #1 3 18 Fill added above original grade VARIES 1.64 — 2.36 Ft. Gravel length 58 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 500 Ft' 1 -- Ft. Well 100'+ 100'+ 25'+ TANK ❑ Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line *3'+ *2'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer ORENCO Capacity 1500 Gal. Remarks Original system decommissioned per code. *Waiver Alarm location GARAGE Electrical installed by DRS ELECTRIC PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer J RS Draintield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection ectioVt 6/18/20 6/19/2020 Location and description Zia 3`d 6/19/2020 4'h GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date TH /� '. "" """':' • Curtis Huffman �� Septic System Approved - Date �'c�`-• CE 128991 •�`�% a/fs/zozo.•����,: PROFESS101"P .� Note: this approval does not include well permit requirements. (Kev Ub/U/Ia) PID: 050-474-14 1 PERMIT: OSP201141 HYLEN CREST #1 B3, L18 wrrvrVL-r'v"-r-o' Awn PREPARED FOR: ��� �F�� CHRIS JIMINEZ 21419 LOWLAND AVENUE 9 TH EAGLE RIVER, AK 99577 FIRST WATER CONSULTING DATE: 8/18/2020 rtis Huffman 13030 SUES WAY SURVEY: JLS 2020 `10N CE 127991020 2 991 'V ANCHORAGE, AK 99516 DRAWN: FWCS s/182020,G SCALE: 1" = 30'p,4b SSIOt�Ati 907-350-9566 firstwaterAK@gmail.comAV 201.57 MT N 87'10' 20" E -_- MH F KEY 69'1 v! DECK FCO C D ( 0 BOX B 62.5' 0 � gPPROX. LOC. �'- BM NEW 1500 -GAL 0 � O I WATERLINE 1, a HDPE STEP TANK G r o EXISTING w m 4BR HOUSE �' MTr1 m ::EO o I 21.0' A PAVED � 21.0' .. DEW J J 10.2' 1.7' owCol. m �! ^� LMrrI rn I V s. F S = o co LOT 18 10.0' 3.4' -' BLK 3 DECK 0 I STEEL O COVER 0 O p 4 I 0 0 15' T&E ESMT N89'59'00"W 181.48' w LOWLAND AVE A -C=34,1' B -C=11,2' PCO MH MH 10252 MT MT GRADE MT MT 101.19 FINAL GRADE !! /-FINAL 10191 99.55 A -D=35,4' ORIGINAL GRADE 13—D=15.1' 98.48 ''0� ORG/Dt. A -E=42,6' B - E = 2 4.0' 97,90 1,500 -GALLON 99 06 97.55 97,55 GM/sp C1 A - F = 6 6.9' HDPE STEP TANK 94.55 94.55 B -F=56.9' NEW FIELD 20-1 GRND. A-G=53,4' 9.5/15/2020 W/ 90.55 ELEV. B -G=54,4' SEPTIC SECTION SCALE+ NTS 12' Q� HYLEN CREST #1 B3, L18 wrrvrVL-r'v"-r-o' Awn PREPARED FOR: ��� �F�� CHRIS JIMINEZ 21419 LOWLAND AVENUE 9 TH EAGLE RIVER, AK 99577 FIRST WATER CONSULTING DATE: 8/18/2020 rtis Huffman 13030 SUES WAY SURVEY: JLS 2020 `10N CE 127991020 2 991 'V ANCHORAGE, AK 99516 DRAWN: FWCS s/182020,G SCALE: 1" = 30'p,4b SSIOt�Ati 907-350-9566 firstwaterAK@gmail.comAV 6/3/2020 Municipality ®f Anchorage cl-j P.O. Box 196650 0 4700 Elmore Road �J:J Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201023 COSA#: Permit#:OSP201141 PID#: 050-474-14 Legal Description: Helen Crest #1 Blk 3 Lt 18 Engineer: First Water Consultinq Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 2.0 feet. In addition, the proposed field may be 10 feet from the existing field. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 6/?/G� Approved by: Name of Rev' er ........................................................ ..................... **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department % Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-474-14 Property owner(s) CHRISTOPHER & JENNIFER JIMENEZ Day phone 9079806025 Mailing address 21419 LOWLAND AVENUE, EAGLE RIVER, AK 99577 Site address 21419 LOWLAND AVENUE, EAGLE RIVER, AK 9957.7 Legal description (Sub'd., Block & Lot) HYLEN CREST #1 133, L18 Legal description (Township, Range & Section) Lot Size 20,054 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F Initial ❑ Single Family (SF) El , (w/wo ADU) Septic Tank 0 Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal F]Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: FIELD TO LOT LINE & FIELD TO EXISTING FIELD Distance: 2' & 10' 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: gato•25 Waiver Fees: 2;Z57//t2;Z572;Z57//t,-9.j6_%/t,•� Date of Payment: J rl/A? 1PIZI ;Lb Date of Payment: 5 I2$ Receipt Number: (d6Ivy Ll Receipt Number: Permit No. o$ p. 61141 Waiver No. Q SVaO lUa,3 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com May 26, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT W/ WAIVERS LEGAL: HYLEN CREST #1 BLOCK 3, LOT 18 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one shallow pressurized trench with a 1500-gallon STEP tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on May 8, 2020. Groundwater was observed at test hole during excavation and monitoring as noted on the attached soils log. Due to the lot layout’s limited area, we request waivers of 2’ to property line and proposed field and 10’ from existing field to proposed field. The majority of the field will be 5’+ to property line and we do not expect any adverse effect on the adjacent lot. Only a small portion of the proposed field and existing field is within 10’ of each other and potential any effluent transference between the two fields will be marginal or nonexistence. The slope is flat at the proposed upgrade location. The lot and area are served by public water with one private well to the northeast. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201141, Deb Wockenfuss, 06/03/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201141, Deb Wockenfuss, 06/03/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201141, Deb Wockenfuss, 06/03/20 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350 -9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: HYLEN CREST #1 B3, L18 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/15/2020 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 GM/sp 5 6 7 8 9 10 11 12 13 BOH 14 15 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 5/8/20 10 min 6” 5” 10 min 6” 5” 10 min 6” 4 14/16” 10 min 6” 4 13/16” 10 min 6” 4 12/16” 10 min 6” 4 13/16” PERCOLATION RATE 2 (MIN / INCH) TEST RUN BEWTWEEN 3 & 4 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 10’ DEPTH TO WATER AT MONITORING: 9’ DATE: 5/15/2020 TESTHOLE # 20-1 DATE PERFORMED: 5/8/2020 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: CHRIS JIMENEZ 5/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201141, Deb Wockenfuss, 06/03/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME '_ / / PHONE �/ ` '2:)2-717�I NEW V(i' ❑ UPGRADE MAILINdADDRES _ ^ �j v S '�. AA/C, A/. 9�S LEGAL DESCRIPTION �7C LOCATIOfy.� _J L `> !Y/ NO. OF BEDROOMS oV' Uy DISTANCE TO: Welj �-1 I �` � Absorltion�area Dwelling f PE{IT •-- S. /-J C EZ Manufacturer / Mat a - No. of corr artments p 2 N Fa- - v c. ���a Liq. �c"girilons IF HOMEMADE: Inside length Width Liquid depth O Y J(%Z DISTANCE TO: Well Dwelling PERMIT NO. = Z ti Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well i� Foundati Nearest I t e V PE�D(II��� F-J:E Z W No. of lines/ Length of�aeh�lirre 4�� Total length of inns Trench th /. inches DistancerLit ee)Aines / ,f'•j F. Top of tiro r�ish gf Mat rial bgp h Ale � �/ 2 ' L 2 .�It !� inches Total effeptiv Ebso pti area �j`> tu Length Width Depth PERMIT NO. - (7 N Type of crib Crib diamet r Crib depth Total effective absorption area wa ��- DISTANCE TO: Well Building foundation Nearest lot line J Class /'y Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: DISTANCE � Building foundation 1r 'S 0 i"Septic tank Absorption areas) `+ OTHER c PIPE MATERIALS SOILTESTRATIN (� �J /2U �l " x1 A r 1 INSTAL FC`� �5 •-I 4s ,;, REMARKS `r,._ ''= °�� Z IF A /'r'�F/�j 0/6 Gcl L9 Alo APPROVED DATE LEGAL cvia mev. otris/ _. v / �•� � MUNIClPALITY OF HNCHORHGE ( RTMENT O� HEALTH �ND � I�ONMENTHL PROTECTION DEP� ^ 825 L �TREET, ANC�UR���/ HK 99501 264 4 20 ^ ! � j / �RMIT NO� lT� �SSU�D �PLICHNT�' )DRESS� ]NTHCT PHONE �GHL DESCRIP �T SIZE� �X BEDROOMS 8401]8 . / RO � T.� [o�,HOME�� , _��° � ` °� ` � � ~ '^[� ^ �|9�4 PUST �OHD ~� HNCHORHGE, RK 99504 ` � �72~4444 ' SUBDIvISION� HYLEN CREST� SECTION8 TOWNSHIP� i4 / 20054(SQ.FT. OR RC�ES) 4 � !'.::TED BELOW HRE THE OPTIOH HILH8LE T �STEMCHOOSE THE OPTION T0HT BEST F" j,T� YQU �PTH TO PIPE BO7TOM (FT RHVEL DEPTH (FT, ) O DEPTH (FT..) / FORTH It- 1. BY THE 111,1NICIPALIT ORHGE (MOH) HND THE ST0TE OF HLHSKH RRVEL LENGTi-r(FT. ') RHVEL V�LUME (CUYDS) HNK SIZE (GHLS) OIL RATINI-1 (SQ.FT./BR) I W�LL LOT� i8 8LOCK� � RANGE� 1W y IN DESIGNING YOUR SEPTIC / IV � 5 150 ** THNK MUST [ TTWO L T CO�PHR -\~ K`~77~ CERTIFY THHT� ` 1 I HM FAMILIAR WITH THE FOR ON~SITF__: (.-.;F_WERS HND WELLS HS SET FORTH It- 1. BY THE 111,1NICIPALIT ORHGE (MOH) HND THE ST0TE OF HLHSKH 2� I WILL INSTHLL THE SYSTEM HITH�/�LL MOH CODES HND REGULHTIONS/ AND IN GCIMPUIAdCE MYTH THE DESIGN �ERMIT ] I W�LL ADHERE TO RLL MOH HND ST8TE OF �LRSKH REQUIREMENTS FOR THE SET BHCK DISTANCES FIRC)M 8NY EXISTING WELL., UR PUBLIC SEWERF"IGE' TEI"I ON THT`�; OR' FINY OR NEHRMY T 4--�' ~,,^.`~.,,, , � ��� �MI�� � �O�� � j�f'4irJr�6` N) ,....`� ,'~=-,~-^ _`n, �.".+^'v1'' " 8NY `. ,.. . ENLARGEMENT NILL REQUIRE 8N.HD�-_,T IONHL PERMIT ' ' F A LIFT r ^�f IS IN_;THLLED IN FiN HREH COVERED B�| MGH 8U ��N� COD�S/ �` HEH (1) HN ELECTRICAL PERMIT A�D IN�PECTION MWST BE O�IH�N / (�) 8�~BU��TS �- / 1. L.1- lECTRICHL NOT BE WITHOUT fit -4 ELECTRIC L INSPECT�ON REPR T f"i WORK MUST BE DONE GY H LICENSED EL2CTRlCIHN �6NED I -- ~~ ` DH|E ^ lPPLICHHT: RO1'_:K9'l�T� LOG HOMES \1 ` SS��D B DHTE� � Xr -~~_~ '' MUNICIPHLITY OF RNCHORHGE DEPHRTMENT OF HEHLTH 825 L STREET/ PERMIT NO: DFIT E �SSUED� HPPLICNT� HDDRESS� CONTHCT PHONE LEGHL DESCRIP LOT SIZE� MHX BEDROOMS 8401]8 / 04/05/G4 ROCKY MTLOS HOMES 1924 POST ROR0 RNCHORHGE/ HK 99504 272�4444 SUBDIVISION� SECTION� S 20054 (SQ�T 4 \ PW ^ �~-,, � ~� HND ENVIRONMENTOL PROTECTION RNCHORHGE, H� 9950� 264�4720 HYLEN CREST LOCK� ] TOWNSHIP� 14 RHNGE� 1W OR HCRES) ** THNK MUST HHVE HT LEHST TWO COMP8RTMENTS IF H LIFT STHTION IS INSTHLLED IN HN HREH COVERED BY MOH BUILDING CODES, THE� (1)�N ELECTRICHL PERM�T HND INSPECTION MUST BE OBTHINED/ �ILL WOT BE APPROVE� WIT�OUT HN E�ECT�ICHL INSPECTIO� REPORT/ H� ElECT�I��L WORK M�ST BE DO�E BY H LICENSED ELECTRICIHN HPPLICHN U U ISSUED By DFl, E� �-- -- MUNICIPALITY OF ANCHORAGE Department Health and Environmenta --otection 825 L Street, Anchorage, AK. >,301. 264-4720 # HANDWRITTEN PERMIT # # # Permit _ , , ON-SITE SEWER PERMIT Applicant: N Mailing Address: Location: Phone Number: — I//eA)C9j6F.5 - Legal Description: IV/ /OV W' J 3 _4m -A -'1#a Lot Size: .2DT �3�, r7 - Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH _w LENGTH__: GRAVEL DEPTH K WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). 'There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # # REQUIRED SEPTIC(HOLDING) TANK SIZE = y� GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells ac nt to this property and the number of residences that the well will sere . # # TWO(2) IN ECTIO RE REQUIRED Backfilling of any system without final ns e tion and p .r oval by this department will be subject to prosecution.,l/ Minimum distance between a well/and aiyl�n-site se ge i.sposal system is 100 feet for a private well or 150 to 260 feet from a public 1 depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # �` I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I underst nd that the on-site sewer system may require enlargement if e resid is remodeled to include more thKt)3 bedrooms. • - • ApplicInt Date: SWP/024(1/81) 122 utoik 2priitt SR© 196X, EAGLE RIVER, ALASKA 99577 PHONE: 907/694.2979 PERFORMED FOR LEGAL DESCRIPTION: U Date Gross Time DEPTH -tFEETi`- 14 Net Drop u t P 15 i y 5 16 s 02 6 17 !� d 7 sLV �� ti- � iii , i �. 8 9 c , 10 — 11� � ) WAS GROUND WATER Lu ENCOUNTERED? 12_ IF YES, AT WHAT DEPTH? 13 Date Gross Time Net Time 14 Net Drop 15 i y y fl 16 s , 17 •.'(Nh � �� ti- � iii , i �. 18 , 19- 9 20 20 COMMENTS _ r - l; .:: PERFORMED B 4AE M.E A 72008 (6/79) E SOILS LOG DATE PERFORMED: 4 - fel G1 SLOPE S11 -E PLAN /. E Reading Date Gross Time Net Time Depth to Water Net Drop ell PERCOLATION RATE J _(minutes/inch) TEST RUN BETWEEN �..�/! FT AND -- FT CERTIFIED 13 7 -- DATE , ; /I SOILS LOG' (,(DMNIEP,IJS__._ PERFORMED BY: 72.008 (6//9) p, Gros, Peer [VILWICIPALITY01: ANCHORA(It'.. 4uh -PP PERCOLATION ON AENVIR A- 18 FEST 19 L. Street, Anchorauo, Alo:;ki 99C01 2G4 1720 Ir) .- -s LOG PI]RCIA.A i( N I I OH: Oi\ I E T F!"FORNT --------- - ll DE p I I 7 It. J - 3 111 f( J --A- jli I r, , ,r AS(Jl-,OUND VIIAlFH �J 12 --r- MCOU M I E.�i ', F D (,(DMNIEP,IJS__._ PERFORMED BY: 72.008 (6//9) p, Gros, Peer 16 MUNI( AENVIR A- 18 19 Ir) .- (,(DMNIEP,IJS__._ PERFORMED BY: 72.008 (6//9) p, Gros, Peer MUNI( AENVIR PU K;0 I A I -ION RA -I -i I EST IMN BEI WE' Nt If ------- - - - XZ -- 13 DATE: /Z 1).2ptil t/ V"o (0, \LITY OF T. -OF -HEA IMENTAL F CEIVED (minutes/incl,) FT cl-1111-M-1 Fri MUMMPAUTY 'OF ANcHORAGE Development Services Department I Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 050-474-14 1. GENERAL INFORMATION Expiration Date: ( — I �n 2 (9Z2 Complete legal description HYLEN CREST #1 BLOCK 3 LOT 18 Location (site address) 21419 LOWLAND AVENUE, EAGLE RIVER, AK 99577 Current property owner(s) CHRISTOPHER & JENNIFER JIMENEZ Day phone Mailing address Real estate agent 21419 LOWLAND AVENUE EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 210 CoW n Date of Payment 2� �� ZO Receipt Number �o� SSU COSA # 05G2v16Z2 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 12/15/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWES 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved meg.• :9 �� *: 49TH Curtis Huffman ���Fc•. CE 128991 ••����� �6p • .12/15/2020. • ver PROFESSIONP,�?F Conditional approval for bedrooms, with the following stipulations: lull((((( �m gsTFRq �� J o OG J J 1 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 1 Legal Description: HYLEN CREST #1 BLOCK Parcel ID: 050-474-14 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA – PUBLIC WATER ❑ Weii-Iog,is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft (INTO BEDROCK) ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) NEW TANK years Tank type/material STEP / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping NA – NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 3.6+ ft (max) Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ® Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) A senic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material HDPE Comments: Adequacy test date Results ❑ Pass For _ bedrooms Fluid depth prior to test _ in Measured depth to pipe invert from grade _ft (min) Water added _ gal ® N/A – pressurized field New depth —in ® Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time _min ® Code -required soil cover over field Final fluid depth _ in ❑ System presoaked Absorption rate _ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date FWr.S Comments/Deficiencies: ,., E. SEPARATION DISTANCES Frorn-Fr vate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift S at ton-o-�Lot > 100' Community Sewer Manhole/Cleahbu` > 100' --N--Yes if No ft Neighboring Tank > 100' ® Yes if No – ft Absorption Field on Lot > 100' ® Yes if No ----ft Neighboring Absorption Fields >w1 -v0 Z Yes if No ft Community Sewer Main > 75' ® Yes if No ft ® Yes if No Pr��ato"Sewer/Septic Line > 25' ®Yes if No Hb ding_Tank > 100' ® Yes if No Animal Contain menu-, 50' ® Yes if No Manure/Animal Excreta Storage > ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ❑ Yes if No *3'+ ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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 *2+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *2020 WAIVER. G. ENGINEER'S CERTIFICATION l certify that 1 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. OF -k 1, .... .... '. Curtis Huffman �� �'�'••. CE 128991 ���%���• • 1�/15/�020���� ft ft ft ft ft ft ft G LLC man aj X ko 0) in In m Q) vi ta C12 E. ,q 0 1 -- VO Q M, :]AV (INVWO-1 4— Ouc, i CD xas IM �D M,,00,69.62N 0 7- 0 00 0, At;; :JO4 N INS3 TRI 9L z D- AIO' Oil, 0 :3� 0 L6 C� )MG LC) cl, z IWOL OD UJ AM, F " m CL LIJ 0 -LZ 0"LZ 0 LLI 0 V) ry E ui .2 go nO H .0 3s CD >- 0 ui 06 0 ONIISIX3 -:3 0 N F- 0 D CL LLJ > (n -5 9 -C, LA > S.Z9 —.2 czs to 0 N030 '0� 8020 V69 0 Z cm -0— a 0) ell 0 00 L9 toz 3! V) 0 V 04 lw-- q I AL U A 4� E 'E 8. 4 '8 4 C) P, < . -, — - &i �R 0 ce U' U L) :E ',� -,P E w c,' -. .. 0 ' 0 E!: 4. 0 0 S CU ui U C) u u -P ) 0 0 -4 z -. 0. m D j� E Z 0 C"3 z 0) 0 u 11) z 0 C) 00 CZ (K > 0 > 0 L"J� Q" in C) = N: U g f X 0 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-474-14 1. GENERAL INFORMATION' Complete legal description WUL,EN CREST #1, COSA # o S e to I0310 Expiration_ Date: a ` 3 X&LOT 1$ Location (site address) 21419 LOWLAND AVE. EAGLE RIVER AK 99577 Current Property owner(s) BRIAN & MARY AFFLECK Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 21419 LOWLAND AVE., EAGLE RIVER, AK 99577 Unless otherwise requested, COSA W11 be held by DSD for pickup. 2. NUMBER OF BEDROOMS:; : 4 3. TYPE OF WATER SUP.P.LX: Individual Well ❑ Individual WaterSt6rag6. , . ❑ Community Class `_ 1Nell ❑ Public Water System .. Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 code's, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING. INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD. EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date _ 02/16/2012 Engineer's Comments This investigation was completed in compliance with ADEC and MOA regulations. The aecacemunt nffhc nnnri:+:..-':, ssu.. ..,u ..��.��._x:_ �__, I_ ... •r .....: -. _ _ subject to these various and dynamic characterisfics evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD 1GNATURE Approved for 1�_ bedrooms. Disapproved, and are outside the Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory 11111111V• t. Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nit to Advisory Other By: 'ZIJ-4 (Rev. 1t 5 Original Certificate Date: a act Municipality of Anchorage • '� Development Services Department ° Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.mani.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HYLEN CREST #1, BLOCK 3, LOT 18 Parcel ID: 050-474-14 A. WELL DATA Well type PUBLIC If A, B, or C provide PWSID # Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. Well Log (Y/N) Wires properly protected (YIN) Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100ml- Nitrate mg/L Arsenic: mg/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 31984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 8/3/2011 Pumper JRs C. ABSORPTION FIELD DATA Date installed 4131984 Soil rating (g.p.d./ft2 or ft2/bdrm) 128 System type Trench Length 52 ft. Width 5 ft. Gravel below pipe 6 ft. Total depth 8-9 ft. Eff. absorption area 612 ft Monitoring tube Y Depression over field N Date of adequacy test *2/15/2012 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 630 gal. New depth 18 in. Elapsed Time: 1145 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. Pump off" level at _in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage **0' Curtain drain 50'+ (None Known) Wells on adjacent lots 200'+ F. COMMENTS *Vacant system presoaked with 2000 gallons prior to testing "Absorption trench is alone edge of driveway. G. ENGINEER'S CERTIFICATION"'' I certify that I have determined through field inspections and review of Municipal that records the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 2/16/2012 J" COSA Fee $490.00 �t Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number CtJ&T5 c Po-cr Municipality of Anchorage -. Development Services Department Building Safety Division On -Site Water and Wastewater Program . r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0!56 —q2 —_W COSA # 0I0001o3 Expiration Date: 3 — (n — 0 7 1. GENERAL INFORMATION Complete legal description f%i�L£n/ GEF5 T :9-1 GDT /P eaCK 3 Location (site address) 14 19 L_0WLA0') At/r-.- >L2^44-- q�T7-gSg.f Current Property owner(s) t j T jMC-r n)7� Day phone Sag y - 2 4A;:a Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA wit! be held by DSD for pickup. Day phone 2. NUMBER OF BEDROOMS: 4- 3. TYPE OF WATER SUPPLY: 3. TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site [� Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well❑_ Community On-site ❑ Public Water System / Lam] Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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. Name of Firm Eagle River Engineering Services Phone (! At - S195 Address Eagle River, AK 99577 Engineer's Printed Name /,ffX K7VPiff5e— r2. (,UDOD Date Z /28Mp6 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: `[/, f� Original Certificate Date: 3— 6 ` O 6 (RH.1 M) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 190050 Anchorage, AK 99519-6050 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: lliL-Ci11 CR>:ST tel. Lb -r 19 91&k 3 Parcel ID: D��' �7N"/� A. WELL DATA Well type LUM"p Miry' Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform i mgA If A. B, or C provide PWSID # _ Well Log (Y/N) Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG ft. 9.p -m. ml Nitrate mg/L B. SEPTICIHOLDING TANK DATA Wires properly protected (Y/N) Casing height (abov9.9r und) in. AT ft. Other bacteria colonies/100 mL Date of sample: _ Collected by: Tank Type/Material SIC;NPTI L 4 STEE.L Date installed li�3l8Y Tank size 4 -2So gal. Number of Compartments .2- Cleanouts49N)(_ Foundation cleanout ft Depression over tank ((YIQ _%I& High water alarm (Y(M .:44 Date of pumping Z D _ Pumper cTI\ /s C. ABSORPTION FIELD DATA Date installed y/3/Q!� Soil rating (g.p.d./fe o Podrm fes$_ ' System type Length SZ ft. Width S" ft. Gravel below pipe 6 ft. Total depth Jc__l. ft. Eff. absorption area k a. a Monitoring tube L4e4.. Depression over field dam, Date of adequacy test M Results Fail) For _LL_ bedrooms Fluid depth in absorption field before test _PZ- in. Water added_(gQpgai. New depth_(_$_ in. Elapsed Time: (YY& min. Final fluid depth Q in. Absorption rate >_ [a oo g.p.d. Any rejuvenation treatment (past 12 mo.) (Y®& type) .1-16PU ",Arn If yes, give date n4& D. LIFT STATION Date installed 'Pump on" level at _ in. Datum Size in gallons 'Pump otr level at _ In. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot _ Public sewer main Sewer /sepGsselvvice line containment areas Manhole/Access (Y/N) High water alarm level Meets alarm On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S r Property line t,10 r Absorption field f 5 - Water Water main t /D Water service line +442, Surface water -f-/00 ' Wells on adjacent lots •+260 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line * /D , Building foundation ItIn ' Water main + le) ' Water Service line -t rteSurface water 4 /no' Driveway, parking/vehicle storage 4-n Curtain drain +SO ' Wells on adjacent lots *-240' F. COMMENTS IVE OF .71 G. ENGINEER'S CERTIFICATION I certify that 1 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. R Engineer's Printed Name _ i�riS�er Le. fwd ••.• Date — Z �2�6 /06 `q••••••• COSA Fee $ y?r Date of Payment it / b Receipt Number '?Z 1 q o riti� �- (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. 6r: b L� o. z01 S7 o; 69 3 N ° • b zi • p,QI�A!✓ iS � r s•� rT�w..y, tG�/L.yf�d .fy� r ASBUILT SEWARD &ASSOCIATES LAND SURVEYING 69i 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE EAE FOLLOWING DESCRIBED PROPERTY- ~ 9d •� OF A �0 iYi�I�T�GJ�aj3�f�,(9</riiT�c(j/<oT/d e8�� ' uf� �- +1 AND THAT NO ENCRCiACHMENTS 61ST EXEEPT AS���� r,r�Q ,. S 6 INDICATED. IT IS THE RESPONSIBILITY OF THE �;'4 TH S p�4 OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS ••.• :, ....i EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- • Dusne Merk 3•wnd VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' / 15-6918 Ar ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- 5°� ARY LINES. DRAWN3 "we-skxulVIA-, 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 1norder to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate. is issued. The Municipality: of Anchorage is not r responsible for errors or omissions in the professional engineer's work. 1 72-025 (Rev.1/91) Back 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 filesand from my investigation and inspection, the on-site water supply and/or wastewater disposal'system is in compliance with all Municipal and State codes,' s ordinances, and regulations in effect on the date of this inspection. iS & 5 ENGINEERING' Name of Firm Phone ' aq e,17032; ver oop ad`No. 204 ' Eagle Rlver, Alaska 577 Address - Engineer's signature Date.u�3 o q a 04 i - - .l'. _ hoc ��,u p,i.nsa YiDaRtl oErcfii as o� r. - ��77 + y I VJ Go" hbaH A 5haia dt % No.: 1437-E a. ,�4 4 = 4 yy.a� ,M1-)iy•4t �� �S' bjC a6l4 T161'y yy;i�3 - . - .,yam S.ir.:�titln$•e - i 6i DHHS SIGNATURE Approved for bedrooms. ' Disapproved.. i Conditional approval for bedrooms, with the following stipulations !J.; ' Additional Comments i ' f 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 1norder to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate. is issued. The Municipality: of Anchorage is not r responsible for errors or omissions in the professional engineer's work. 1 72-025 (Rev.1/91) Back MOA #21 ® Municipality of Anchorage Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loi l8, Parcel I.D. (fVZ S7' A. Well Data �/3C. C_ Well type ��L(O f�PB, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow p leveil Date completed Cased to FROM WELL SEPARATION DISTANCES FROM WELL TO: Septic/ kkRP,g-tank on lot Absorption field on lot Public sewer main Sewer service line 0?_c>0 I -/- WATER SAMPLE RESULTS: Colfform Date of Driller Wires proper-lyfrotected (Y/N) AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanou Petroleum to 7: Nitrate Collected by: B. SEPTIC/+tGUNNG-TANK DATA Date installed Zf Tank size/ 2.56_ Cleanout (Y ) Ls Foundation cleanout &) !) 0_ n o 0 V; UJ U �. W WLLJ w Other bacteria Compartments Y_� Depression (Y�iV /'-/6 High water alarm (Y6)) /ubAlarm tested (Y/N) -,U//4 Date of pumping 2� q3 Pumper At HOA46 SMVICES SEPARATION DISTANCES FROM SEPTIC#K)HTANK TO: CLa1 SS Well(s) on lot WOlf J On adjacent lots %io ` A Foundation r To property line /O �� Absorption field 2 Z Water main/service line Surface water/drainage .L /011/-- 72-026 (3193)* O11/-- 72.026(3193)• Front CONTINUED ON BACK PAGE C. LIFT STATION /UL1 11-16- /0/'ZES0' -I Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANL`E FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Manhole/Access "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed 4- 8 P<�- Soil rating (GPD/Ft2) z System type2�rvG14 Length r Width 3 Gravel thickness L Total depth O — C) Total absorption area Cleanout presen/) Depression over field( ) N Date of adequacy test �� / �� Results ass/ ail) Sf for !Jf?�'� Bedrooms Water level in absorption field before test (F3 �4 // After test 551 X22 7�_ Peroxide treatment (past 12 months) (Y/N) fM OAJ6 If yes, give date N�h SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 7-6 Well on lot 0� C�2 3(�T On adjacent lots �� CLAS Property line /o /� To building foundation 3 Y To existing or abandoned system on lot Nop�je /�'22r1�017 On adjacent lots 2 0 r� Cutbank ti L' " Lr- A�Fj&/'­Water main/service line Surface water ( 4— Driveway, parking/vehicle storage area U Curtain drain V`,Apt"Jt-� E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of inspection. Signature 3 5 ENGINEERING �- 17034 Eagle River L 9 a No. 204 Engineer's Name @ a I Date HAA Fee $ 3i)O Date of Payment� � z� i �� Receipt Number )� lJ_ l?� ' / 2^SVI 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY Ob' ANCHORAGE M E M O R A N D U M SEPTIC SYSTEM ADVISORY" HEALTH AUTHORITY APPROVAL NO. HA940223 Prior to a recent adequacy test on the septic system for this lot, 64 inches of standing water was observed in the absorption field. This indicates that approximately 89 % of the absorption area is inundated. Although , this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all cipies of the subject Health Authority Approval. Lot 18 Block 3 Hylen Crest Subdivision $1 o MUNICIPALITY Or ANCHORAGE DIVISION Or ENVIRONMENTAL HEALTH DEPARTMENT Or HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTT-ICA'i'E I. General Information Application Date /—_/ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicants Name&U5 �6 2- 7.6,5-3(b) Telen— ome Business Applicants Address 00o (c) Applicant is (check one) bending Institution ; Owner/builder ; Buyer ; Other L7 (explain); (d) Lending Institution v a.; Tele hone Address (e) Real Estate Co. & Agent Address Telephone (f) It= the HAA to the following address - 20 Tieof Residence Single—Family Multi—Family Number of Bedrooms 3. Water Supply Individual Well Community Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4e 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] 5. Engineering Firm Providing ections, Tests File Search, Data and Information As certified by my seal hereto and as of the validation date shown below, I verify that my investigatio = this health Authority Approval shows that the on®site water supply and/or wastewa disposal system is safe, functional and adequate for the number of bedrooms and r' of structure indicated herein.- I further verify that, based on the information obO�,"ed from the Mani.cipality of Anchorage files and from my investigation and inspectio s=he onsite water supply and/or wastewater disposal system is in compliance Sr1C =1 a 1 Municipal and State codes, ordinances, and regul- tions in effect on the datc`d this inspection. Name of Firm a t+s 3 Hf 6�t=c�ll FJ "vn. Address 3J Fl;%l Date G. DHEP Approval Approved for. 4— bedrooi` Approved_ Di s ; _: owed 7 Terms of Conditional (ENGINEER^ a By Telephone �9 a ocecr i -Cy �U Reharr A, °!i r Conditional. Approv, , CAUTION THE MUNICIPALITY OF ANCHORWE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHOOUY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT ATIONS GIVEN IN PARAGRAPH z\BOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. TO, DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS :N ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS< EMPLOYEES OF DHEP ,'0 NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. Zar; MUNICIPALITY OF ANCHORAGE. IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESfiWNAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 'JAN 161985 A. WELL DATA Legal Description: Well Classification zIf A, B, or C, D.E.C. Approved(Y/N) Well tog Present (Y/N) Date Completed Yield Total Depth Cased to Depth Static Water Level Pump Set At _ Casing Height Above Ground Sanitary Seal on Casing (XA) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) _ Separation Distances from Well: To Septic/Holding Tank on 2 U (j On AdjQ#ing Lots To Nearest Edge of Abs tion Field on Lot Za�) � On Adjoi 'ng Lots__ To Nearest Public wer Line To Nearest Public wer Cleanout/Ma le To Nearest Sewer Service Line on Water S Collected By ; Date Water ample Test Results _ C nts w/9 7/-i2 ,Sc,zEI-C neo OA/ B. SEPTIC/HOLDING TANK DATA Date Installed _ O Size 12-5() No. of Compartments 2 Standpipes (Y d) Air -tight Cap ( ) Foundation Cleanout (�) Depression over Tank (Y Date Last Pumped /y e Pumping/Maintenance Contract on File (Y/Nfor Holding Tank High -Water Alarm (Y )41-IA Temporary Holding Tank Permit (Y/Nelp Separation DistanCes from Sept icng-Tank: To Water -Supply Well Z-ov To Building Foundation _ To Property Line lb To Disposal Field _ 22 To Water Main/Service Line /D To Stream, Pond, Lake, or Major Drainage Coursed w Comments Receipt # vZcZ j Date Paid:`_ Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /2 �La Type of System Design Z'l^eoc_ Date Installed _ f3 �4 Length of Field - Width of Field ellDepth of Field Gravel Bed Thickness 2 Square Feet of Absorption Area 6, /2 Standpipes Present (/w Depression over Field (X Date of Last Adequacy Test_17— ti w Results of Last Adequacy Tb:st i✓� /� { Separation Distance from Absorption Field: To Water -Supply Wall 2-0-0 To Property Line LO To Building Foundation 12 To Existing or Abandoned System cn Lot w w F_ ; On Adjoining Lots 30 To Water Main/Service Line C0 -/ To Cutbank(if present) '-� To Stream/Pond/Lake/or Major Drainage Course 1�f -0 `' )=' To Driveway, Parking Area, or Vehicle Storage Area "'0 ' Comments ti QD r__J r D. LIFT STATION Date Installed Diirens ions Size in Gallons Manhole/Access (YM) "Pump On" Level at Off" Level at High Water Alarm Level at Vent (YIN) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) Comments ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed a A v _; niwm_-Ui�rra -- Date r Company.,;, 1V R tAS A"n-miz MOA No. • ti F_+379 KB1/d5/s (Page 2 of 21 hq ENG' Y �••li O n n a9.,.i+. �., 91.1 ae� Re F crt An Shchir � d.5n,"q No. 14 -E .'s' es 2-15-84 7 r_x BILL SFIEFFIELD, GOVERNOR _ 7 DEPT. QI9F ENVIitONM1LlNTAII. C®ANSIVO3WAVION i Telephone: (907) F- Address: k ANCHORAGE/WESTERN DISTRICT OFFICE 437 "Ell STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 I . DATE: _ Z1,L hu_.2tL 1. PWS Is1)o#aI32 )_f To Whom it May Concern: According to records on file in this office the 1&l_b��)t� _ Water System is in compliance -with the State Drinking Water Regulations u Sincerely,