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HomeMy WebLinkAboutHYLEN CREST #3 BLK 4 LT 4Hylen Crest #3 Block 4 Lot 4 #050-474-18 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 7 �� fill 825 " L." Street, Anchorage, Alaska 99502, Telephone 264-472.0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name 1�Fi;3�1�_�f ss DISTANCES FROM TO SEPTIC TANK ABSORPTION FIELD --� WELL Address y??.O I� ��lG, �_lol — /�Y�-1-• •`� WELL ) ��U p Imo- � 1 I — T Rhone(s) Permit No. �� 32,0 8 i� oc� talo No. of B drooms �- LOT LINE _ LEGAL DESCRIPTION LotBlock Subt ivl ion 7 FOUNDATION �AS-BUILT — Township, Range. Section _ DIAGRAM (Show location of well, driveway. water bodies, etc.) septic system, property lines, foundation, TANKS _ SEPTIC ❑ HOLDING _\ Manolacur(ei Capacity in gallons Material No. of compartments TYPE OF SYSTEM — )O --TRENCH ❑ ®ED ❑ W. DRAIN ❑ OTHER 8 Depth to pipe bottom from original grade _ FT Total depth from onyalai yrede _Ld FT G Fill added above original grade U f T GravcllenglL---� fT Gravel depth beneath pipe (a FT — Gravel width �Trr---FT _ _ Total absorption area E C)JSQ FT _ _ Distance between lines 1 / —,/PS FT — — I - 4— V,.ti Number of lines Soil rating Iz-OO SQ FT msianc�%j--]�I_:)��,�O�k-Q Pipe material -- WELLS ❑ PRIVATE ;9—OTHER (Identifv) f — �j Clessi kation (A,R.c)_ l Depth FT Cased to FT Installer -- tEan,Installed: — — REMARKS: Scale: r .- Inspections Per orated by. ---i�P. Date: ENfdIMI'€)x5:5fyL ..., Off' Er t'T �� .rs•. e ••.T ('r rl p r t °ec P! n......IrIIs 1•! # �• A. apart• ` J ���•. NIX 1447 A Fv t�too*do �F9 �eerMen O•vp\r�� �fthl4C'>•'� — I _ _ S & S ENGINEERING 77 age AIvver =T]Zoad NO. 204 'yce 2— Thal this Municipal an��I�011vYnre�sAtl��bt� 19EA67aYe: T� 2 / Health Department Approval: _ �!'� �- speclion was performed according to all _Date: �1 / `�� 72-013 (3/85) MUNICIPALITY OF ANCHORAGE 'J/�� Department of Health & Hum�n Services ��ko~� 825 L Street, Anchorage� Alaska 99501 343-472O ON~GITE SEWER & SEPTIC TANK PERMIT Permit Number: 880066 Date Iss�ed: 05/31/80 Owner Name: JAMES BALES / S&S ENG. Owner Address: 5520 LAKE MIS #101 ANCH0RAGE, AK 99507 Day Phone: 562~3208 Parcel Id: 050~474-18 TRENCH Lot Leg�l: Gubdivision: HYLEN CRESTbot. : 4 Bldck: 4 Section: B TowI-11sh if) : 14N R@nge 1W Lot Size 2000'2 (sq,ft" or acre�) Max Bedrooms: This Permit: Jbtal Capacity: Gravel LeDgth (ft): ^ ,wA*, 'e7j �I���T GEWER SYGTEMS: Listed below are th' options available to you in sewer system. Choose the option that best fits your site,, designing your INSTALL PER ENGINEERS DESIGN SHOWN AgOVE" NOTIFY DHHS PRIOR TO 1S1" & 2N� INSPECTIONG. THI6 PERMIT EXPIRES 12/31/B8^ I CERTIFY THAT: 1" I am fa(IIilwith the require0ents for C)n-site sgwers �nd wells a� set forth by the Municipality oIF Anchorage: (MOA) and the State of Alaska" 2" I will install the system tn accordance with all MOA codes and rulatiori s, and in compliance ovith the design critepia of this permit" 3, I will adhere 1-_ c) all M0A and State of AlaAgka require0ent5 for the set ba�k di�tances from any existing wqll, wastc'water dispos4�11- system or public sewerage system on this or any �adjaceDt or ngarby lot" 4. I und t d th t vklid for a maximum of 3 bedroo0s" I alsocapacity of the total syst.em is 3 bedrooms and any e 1. dditional permit. Signedx DATE: m� _....... ...... ... ..... ... ..... (Owner A I�sued By: DATE: TRENCH Depth to Pipe Bottom (ft>: 4,0 Gravel Depth (ft): 6,0 Total [t): 10"0 Gravel Width (ft): 2.5 Gravel LeDgth (ft): 30,0 Gravel VolU0e (cubic INS ): 30" 1 Soil Rating Umd (sq [t/brill ): 200 LIFT STATION: If a lift station is iD$talled, a high water alarm mtjst be connected to the residence" SEPTIC TANK: Minimum total septic tank capacity: 1�000 gallons" Each septic tank Nust have at least 2 compartments" Depth to top oF septic tank(s) < 4"0 feet requires insulation over tank(s)" INSTALL PER ENGINEERS DESIGN SHOWN AgOVE" NOTIFY DHHS PRIOR TO 1S1" & 2N� INSPECTIONG. THI6 PERMIT EXPIRES 12/31/B8^ I CERTIFY THAT: 1" I am fa(IIilwith the require0ents for C)n-site sgwers �nd wells a� set forth by the Municipality oIF Anchorage: (MOA) and the State of Alaska" 2" I will install the system tn accordance with all MOA codes and rulatiori s, and in compliance ovith the design critepia of this permit" 3, I will adhere 1-_ c) all M0A and State of AlaAgka require0ent5 for the set ba�k di�tances from any existing wqll, wastc'water dispos4�11- system or public sewerage system on this or any �adjaceDt or ngarby lot" 4. I und t d th t vklid for a maximum of 3 bedroo0s" I alsocapacity of the total syst.em is 3 bedrooms and any e 1. dditional permit. Signedx DATE: m� _....... ...... ... ..... ... ..... (Owner A I�sued By: DATE: 0 Y U �X 6�� ;rev l���/ • d or dv .�� 19 Er 9 e Municlpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES p° •` "•°' °"'"""°'• 825 "L" Street, Anchorage, Alaska 99502-0650 °•� •• SOILS LOG --PERCOLATION TEST �•'"'j �' ` �•n tom. t�%� � • a�,� PERFORMED FOR: DATE PERFORMED: TJG LEGAL DESCRIPTION: L4 17)4 ./L.s,.� Cyy Township, Flange, Sectionr::C]41- KP SLOPE SITE PLAN t FPc.FT) /b -F SiC.- f——'_I—r—_I r --I- 1 ., r 2 - I 6Y; 3 4 1p O, 5 6 7 O Q� 8 p' 9 10 F 6 ' 11 ( PI 12 it/ P 13 j "6 14 51617 15- 16- 17 18 19 20 COMMENTS IAAP lki WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water e@ -xi —�/ , Monitoring? —--- Date: •5--a--ae S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop C',iia Mt�t SN` 7. `l, 0 4 `• 1 �� M tra, 95'A> 2'J ` N l PERCOLATION RATE 1(minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN Tn FT AND I FT PERFORMED -7034 Eagle River Loop Road No. 204 age River, ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN 72-008 (Rev. 4/85) CERTIFY THAT IS TEST WAS PERFORMED IN ON THIS DATE. DATE: �6 1� U) T 01 Parcel I.D. 050-474-18 0 Municipality of Anchorage On -Site Water and Wastewater_ Program (907)343-7904 sAF=+y Certificate of On -Site Systems Approval Expiration Date: C1 " 2 7- 1. GENERAL INFORMATION Complete legal description Hylen Crest #3, Block 4, Lot 4 Location (site address) 10227 Stewart Drive Eagle River, AK 99577 Current Property owner(s) Michael & Delise Casey Day phone 726-0312 Mailing address 10227 Stewart Drive Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Il Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual i1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System . Public Sewer ❑ WaiverNariance request for: to the engineer, unless otherwise requested by the engineer. COSA Fee $ y1-10' Date of Payment 1001ul13 Receipt Number O 51 11oG J COSA 8.�­q I Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE _/ System #1 Approved for i bedrooms System #2 Approved for bedrooms Disapproved 522-7773 Date 10/9/2013 Conditional approval for bedrooms, with the following 0°49Y -H -ARRDsasa� CE - 4331 ®e00000 o° OF€Si40`d`� By: �� Original Certificate Date: r Th un palityt nchorage Developme.:; Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet ; L c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Hylen Crest #3, Block 4, Lot 4 Parcel 0: 050-474-18 A. WELL DATA Well type If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel mg/L Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) - Date of pumping 8/23/13 Y C. ABSORPTION FIELD DATA Wires properly protected (Y/N) Casing height (above ground) in. I"1►&311:1aliWill Collected by: Date installed 8/24/1988 Cleanouts(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Pumper JRs Pumping Date installed 8/24/88 Soil rating (g.p.d./ftz or ftz/bdrm) 200 SF/BDRM System type Deep Trench Length 67 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 804 fiz Monitoring tube Y Depression over field N Date of adequacy test 9/27/13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 64 in. Water added 600 gal. New depth 69.5 in. Elapsed Time: 1,440 min. Final fluid depth 64 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12.mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. 'Pump offlevel at Datum Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main Public Water System Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >10 Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10 Surface water >100' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS Absorption Trench is 89% Submerged. Absorption field >5' Surface water > 100' Water main N/A Driveway, parking/vehicle storage >10, G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and �����®®��� review of Municipal records that the above systems are in �� (c conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. * 49 Date 10/12/2013 COSA brown sheet 10-10-12.doc in. Aa Z ANDERSON -,-� CF_4381 e RROFESStO�p®®® C-1-F,le. Municipality of Anchorage Development Services Department 4 11 1 Building Safety Division On -Site Water and Wastewater Program 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. 050.474.16 COSA # 68 01 Ee Expiration Date: 2 %— 0 q 1. GENERAL INFORMATION Complete legal description Hylen Crest A3 SID, Block 4, Lol4 Location (site address) 10227 Stewart Drive, Eagle River, Alaska 99502 Current Property owner(s) tan a Ahnawake Carroll Day phone 622-3497 Mailing address Lending agency Residential Mortgage Day phone Mailing address Real Estate Agent Audrey Mason Day phone 622-3344 Mailing Address 16600 Centerfield Drive, Eagle River, Alaska 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 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, 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 Douglas T. Kenley Phone (90X746-1073 Address 9806 North Star Circle, Palmer, Alaska 99645 Engineer's Printed Name Douglas T. Kerley Date S. DSD SIGNATURE Approved for bedrooms. Disapproved. %tx'••'48TM . �. y ♦r-� jlu•� 70 f. �) .` � CECf1S •� vs':I ; �f Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory V id Stfi •� • WATER m= WASTEWATER : •PROGPAM 1 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By:_ tet///Lz w, , Original Certificate Date: _5— a % — 08 (R" IIM) .+ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Hylen Crest k3 SID. Block 4. Lot 4 Parcel ID: 050474-1e A. WELL DATA Well type Public Date completed Total depth ft. Date of test Static water level Well production If A, B. or C provide PWSID # _ Well Log (Y/N) Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG ft. Niffia WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: _ mg1l Date of sample: B. SEPTIC/HOLDING TANK DATA i Tank Type/Material Septic/steel C. Tank size 1250, gal, Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping July 2007 ABSORPTION FIELD DATA Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Other bacteria colonies/100 mL Collected by: Date installed 812411989 Cleanouts(Y/N) N High water alarm (Y/N) N/A Pumper JRs Sanitary Pumpers Date installed M4n9ee Soil rating (g p.d./11:2 or ft'/bdrm) 200 Length 67 ft. Width 3 Total depth 1e ft. Eff. absorption area eo4 ft= System type ft. Gravel below pipe Trench Monitoring tube Y Depression over field N ft. Date of adequacy test 5/612006 Results (Pass/Fail) Y For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added6t1 gal. New depth 0 in. i Elapsed Time: 47 min. Final fluid denth o in Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= 600 g.p,d, If yes, give date N/A D. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at _ in. -Pump oft" 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 Manurelanimal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 6' Property line 15' Absorption field 5' Water main 10+' Water service line 10+' Surface water too+' Wells on adjacent lots 200+' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+' Building foundation 16' Water main 10+' Water Service line 10+' Surface water 100+' Driveway. parking/vehicle storage 65' Curtain drain ""'°I" Wells on adjacent lots 200+' F. COMMENTS' Although the septic system was designed for a four-bedroom house. there are only three bedrooms e=rding to the owner. G. ENGINEER'S CERTIFICATION 1 certify that I have determined through (eld inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Douglas T. Kenley Date S' 21. DS vo COSA Fee $ cola o Date of Payment f �� �4/' Receipt Number l 0S `t / O L/ (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number �49THe •p T ry.Er : J 1: Municipality of Anchorage • Development Services Department o� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Go se 5/79 - /5" GENERAL INFORMATION Complete legal description Location (site address or dire HAA # Qq ®jq Expiration Date: "3 Zdz2;rcSTEAJ/4er n2 Current Property owners) 1A4 s 5V,40 -1A Day phone is - U 7,3/ Mailing address/� XMT T�s-� v n ,u� F //� yrs i17- rq,037 Lending agency Day phone ME Mailing address Real Estate Agent Z ar //-AZ & Day phone /0T-cl - Arc.-f- Unless otherwise requested HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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 F.4&,4,E X;vr& e.-4_—Svcs Phone Address /Oval Tlv�rr Engineer's Printed Name�'.Yr, �ro�isf e .� A�lgoo Date 00 /311 _ 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the folic Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (/eg�L„/ f�� Original Certificate Date: — cS 7 (Rev. 01102) Developer On-Sltr orage e �artment` �i Jaz 4 q igram' 3M ETv 519-6650 _l1�G�6 V prove e S ' e1�9 ares proper y eted (Y/N) _ eight (above ground) in. INSPECTION v, ST er�evel� d� ft ft M uon g.p.m. 9 p m , �. .m , .,. _. ...,_ �._ LTS: colo„nies1100 m1 Nitrate Mg./I. Other bacteria, colonies/100 m1. MO./I. Date of sample: _ Collected by Systei GravE I. m rate > ganons e7. anhole/Access(Y/N) rw $ff, at _ in. High water alarm level at tested Meets alarm & circuit requirements? rice line t 16, Si FIN in. tto, /vehicle storage ea,§" uwpccuvna dnu //// -. ystems are in VZ fect on this date CHRIST ER� �- CEIMI •.•.. SSIONA __...w. Waiver Fee Date of Payment Receipt Number 2:417W FAX N0. Aug. 13 2004 09:13PM P2 fT�N�1d�T ps/d`v . '44B9 `yS'E yp 6 'dp ASSUILT-NO CORNERS SET TH15 DATE. SEWARD t I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SC'LEt moo' FOLLOWING DESCRIBED PROPERTY, y��e-rr/c�. 3rfccgQ ari, tor,Ydb' V- • DATE+ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ���Rr INDICATED. IT 13 THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID, EMENTS COVENANTS OR RESTRICTIONS .40W r� ti k d—p �...;.......a.............. WHICH DO NOT APPEAR ON THE RECORDED SUBDI- oo.n. Mark Aw.r6 M VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB+ f�•., LS 6918 ¢+ ANY DATA HEREON BE USED FOR CONSTRUCTION S/2 rz 41,hy ., �` OFFENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN. iflw� : '* ARY LINES. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section an P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) 10227 Stewart Drive / >x. All' Eagle River, AK 99577 •p y Kurt 'ghauna Olsen 696-7557 Prp'rt �bwrYer / ` Ag Day phone Mailing eddresg'.'1{...... t wart Drive Eagle River, AK 99577 Ldnd(ng agency ,, Day phone Maiti g address' AgentM`� Va r nYa'`KoE Leld ---"�r„� - ` r; Day phone 694-4200 ReMax Address 16600 Centerfield Dive Eaa1e i= Riv,__Ax 99577 Unless otherwise requested, HAA'. will be held for pickup. 2. '"NUMBER OF BEDROOMS...4 ti - rr1 : 3. TYPE OF WELTER SUPPLYrn A c , Z .. Individual well .. r -n Community well �' A {It " Public water ;cxic �.���\ �! o NOTE: If community well system, provide written confirmation froif - tate Al E eftesPz m ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: 1= �. •' `�'' Individual on-site Holdingy. r Community.on site t < : Public sewer: NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA e21 ® Municipality of Anchorage IaL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L t s,5 Parcel I.D. A. Well Data Well type t -AD A, If A, B, 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 Pump levell Date completed Driller Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Casing height Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots On adjacent lots Public sewer manhole/cleanout m tank RECEIVED m. JUL 1 3 1995 Munic;pail;y ); Alicnorage )pt. Health & Human Services WATER SAMPL ESULTS: Colifor Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING. TANK DATA Date installed g -7,4 -9th Tank size 11-5, Compartments 7- Cleanou4�N) " J Foundation cleanout (YhN) _ Depression (Y/&) 0� High water alarm (Y49. Alarm tested (Y/N) A Date of pumping _ 13:—`ls Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Zoo 4 Foundation coll To property line 101 Ir- Absorption field'`— Water main/service line Surface water/drainage 10 1�- 72-026(3W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANeEIROM LIFT STATION TO: "Pump oft" Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed �5 _ 2 � - 9 s5 Soil rating (GPD/Ft2) 7_,o4I Pj�- System type Length L;q Width 3 Gravel thickness �_V( Total depth �c�' Total absorption area of o 4 � Cleanout presen( ) _Depression over field (YAQp_,�_ Date of adequacy test -7 Results<49iWail) fks5 for Bedrooms Water level in absorption field before test`` DAfter test O Peroxide treatment (past 12 months) (Y/� W 046- V.� owu If yes, give date � 4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot w (A On adjacent lots 7-<� C::� X4- Property line 1-0 k4 To building foundation To xisting or abandoned system on lot ~ n On adjacent lots 39 t k Cutbank r�A- Water main/service line I r' Surface water I o L> 0, Driveway, parking/vehicle storage area 436 F Curtain drain A,0, E. ENGINEER'S CERTIFICATION I cerBfy that / have checked, verified, or conformed to all MOA and HAA guidelines in Engineer's Name Date of Payment Date of Payment Receipt Number/6�/ ��� % Receipt Number 72.026 (3/93)' Back this inspection. 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 1. D. # - �(`iLt- 1� HAA # 1. GENERAL INFORMATION Complete legal description Lot 4, BPock 4, Hu.2e.n C)Lut Su`Od-(yi.5ion #3 Location (site address or directions) 10227 S.te.wan-t Dive Property owner Teal 9 Johanna BcV-u Day phone 279-141 1 Mailing address 10227 S,te.wa,%t DK. Eagle. Rive:`L, ADZ. 99577 696-4401 Lending agency Day phone Mailing address Agent Vikg,inia Koht4ietd RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centek, .etd Dkive. Eagle Rive7L, A2a/ska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 'N 3. TYPE OF WATER SUPPLY: Individual well Community well — XX Public water -- NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 a M STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s s, r Phone 17034 Eagle River Loop Road NO. 204 Address gagle River, Alaska 995" Engineer's signature Date �2—q 9 r° J JIG IG DHHS SIGNATURE��'� Approved for �� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ItITIC Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Ak Legal Description: L &.A4- q &LA" ��%arcel I.D.�r� �J- � 2!GI -A9 A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number 2_1�5289 Log present(Y/N)_ Total depth Sanitary seal(Y/N) Date of test Static water level Well flow Pump level Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lots `~ Driller Casing height Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots Absorption field on lot 2�0 `" _ ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Z UJ O V O a. r—.1 d x LU �o W Date installed 6 -?-"1 —bF2 Tank size 015D Compartments I, Cleanout&y N) Foundation cleanout &N) _ Depression (Yc% High water alarm (Y& _ h� Alarm tested (Y/N) �/,4 ''II Date of pumping 9- 2 — `� / Pumper A+ 4oms 5f¢,u t r_ : s SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: x t, Well on lot Zoti On adjacent lots '4 Foundation LP To property line 112 Absorption field S Water main/service line_ 1.0 ` Surface water/drainage 1 t;:> -c> � -- 72-026 (Rev. 7/91) Front 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) Meets MOA electrical codes SEPARATIO TANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots -� "Pump off' level at Cycles tested Surface water _ Date installed o'ZA "rd2) Soil rating �a�/$�- System type I, Length Width 3 Gravel thickness Total depth Total absorption area rRCA0 Cleanouts present &N) Depression over field (Y& >J Date of adequacy test -28-4t I Results fail) Pof,S for Foy 2 (-4) bedrooms Peroxide treatment (past t2 months) (YO hlonLF_ r /VP (/JeA If yes, give date n�J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -2-o C� ' ~ On adjacent lots 'Aa Property line 101 -1 To building foundation 1 � To existing or abandoned system on lot ''/� On adjacent lots �� +x Cutbank ljIA Water main/service line I I ~ Surface water IOo) Driveway, parking/vehicle storage area 86 + Curtain drain rJ 1,4, E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect op,,th& ate of this inspection. , aei T � 4 Signature 5 & S ENGINEERING Ii034 Eagle River Loop Road No. 204 Engineer's Nameiagle River, Alaska 99577 ae ° �•��,'' Y I �p �'Ct o Ii0(; -j J. L'i,^.r°i:.'iP.B. ° lil Fy Date a HAA Fee $ 1 �7 © - (�2 Date of Payment -.3 Receipt Number �2 a 3`s_ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee:-$ Date of Payment Receipt Number ( � WALTER J. HICKEL, GOVERNOR I.l LI DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 August 9, 1991 FOR: S & S Engineering Ray PWSID #213289 My review of the records on file in this office reveals that the d 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, i'a� Keven K. Kleweno Lead Engineer p�_© ¢7¢ /8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES �f CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL /`rUo8—oz-, OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date. O—'2- � 88 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) ISO !!I- eq— Location Location (address or directions) (b);, Property Owner � Telephone: Home Business Mailing Address tiS2o L%,'Y� 0 (c) Lending Institution Telephone Mailing Address. (d) ,,.Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or: Check here El, if hold for pick up. List contact person and day phone number below. g &. g ENGIN 1N6 17034 Eagle River Loop Road No. 204 Eagle River, A as a 99577 2. TYPE OF RESIDENCE Single-Familyfg Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community ❑ Public V�qL6_ e/� Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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. 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(w leyl Al!J9A 1 ,mo!aq umo14s alep uo!lep!!en 0141 to se pue 019,1014 pixy;e leas (w (q pa!;!1,100 sy NOIIVWUOdNI ONV VJ.Va `H011V3S 3lld `S1931'SN01103dSNl UNIOIA01jd Wlilj ONI833NION3 9 MUNICIPALITY OF ANCHORAGE & 0,G�o� I S\oN HEALTH AUTHORITY APPROVAL(MOA) HAA CHECKLIST - FEBRUARY 1984 ) G�t��c�� 264-4744 Legal Descri ion: A. WELL DATA Well Classification _ If A, B, C, D.I=.C. Approved& -A) Well Log Present (Y/N) _ Date Completed Total Depth Static Water Level Cased to Depth of Grouting Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ) On Adjoining Lots To Nearest Edge of Absorption Field on Lot! ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Water Sample Test Results Comments B. SEPTIC/"OtBlING TANK DATA Date Installedr'v-'%1F —ge Size O No. of Compartments StandpipesO/N) �L_ Air -tight Caps (9N) V Foundation Cleanout(VN) Depression over Tank (YQ _ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for I Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit Separation Distances from SepticPtioldiug�Tank: To Water -Supply Well �Z� )'( To Building Foundation To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026 (Rev 8186) Front To Disposal Field la � To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �� / F� Type of System Design Date Installed �-7-4l—Ibg Length of Field (,-7 r � Width of Field o-7121 Depth of Field t-� Gravel Bed Thickness LO Square Feet of Absorption Area Standpipes Present Wim/ I) Depression over Field (Y i Date of Last Adequacy Test p Results of Last Adequacy Test Separation Distance from Absorption Field: \ To Water -Supply Well Zpo k To Property Line To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION / Dat nstalled I Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments tel+ To Existing or Abandoned System on On Adjoining Lots � To Cutbank (if present) \ t A - Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping les during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MO/A and AA guidelines in effect on the date of this inspection. Signed _ Date � 2 ` �� Company 17034 Eagle River Loop Road Ri0OX"0. -� O�3 Eagle River, Al�k�9:5y7l 4 Receipt No. Date of Payment 1J Amount: $ C/ Page 2 of 2 72-026 (Rev 8/86) Back s it-, Ec�- or [rAU/jl-AlsN[fAl DIEPT. OF EMVAAAONIBAE�NTAIL cWfIDNSERVAULTON ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 I DATE: July'7 , 1988 PWSID: 213289 To Whom It May Concern: STEVE- CO WPE-R, 563-6775 z Ifi si S r YA SWE.: Pkk S' SWE.: Pkk