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Municipality of Anchorage Page '~ of_~'
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 ® Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~"u,./9"z_>o I~ PID Number: (~350 ,~z~ ~
Name: ~ Vai~ ~t~ Wastewater System: ~New ~ Upgrade
Phone: No. of~edrooms: ~Deep Trench ~ Shallow Trench ~ Bed B Mound ~ Other
LEGAL DESCRIPTION so, ~atine: O, ~ OPe/Sq. ~t. To~a[ D~p,~l~ f~om~o~gi.¢ gr~d~:l~Z
Lot:8 ~lock: [%~ Subdivision: Depth Io pipe bo~om from ori~nal grade: Gravel depth beneath pipe
Towns':~ ¢~ ~n¢~ S~io~ ~Fill addedza~ve_ k°rigina*rade:~ Ft. Gravel length: ~ Ft.
WELL: U New ~ Upgrade/ Gravelwidth: Number of lines: Uistance between lines:
Classification (Private. A.B.C): ~%~Cased To: Total absorplion area: Pipe materiah
Driller: ~~ D~te Drilled: Static Water Level: h~taller: Date instal ed: '
Yield~M PumpSet at: F Ft. TANK
SEPARATION DISTANCES Cs~,~io u He,dine U S.T.~.~.
TO Septic Absorption Lift HoMing Public/Private Manufaolurer: Capacity iR gallons:
From Tank Field S,alion Tank S ..... Li .... ~~ ~
Well ~ Mslerial~ Number~ of Compartments:
Water ~°O' ~tOO' ~ LIFT STATION
Line ~t /O' i+ I~ / Size in gallons: Manufacturer:
~ ~~ ~ hwat ralarma,
Foundation ~/ II ~ "Pump on' level a ~t: H~g e :
CurtainDraiR ~.~, ~, ~ Pul~ ~ ~ctri~M Inspections perlormed by:
Location and Description:
Assumed Elevatio~
ENGINEER'S SEAL
Department of Health and Human Services approval , · ~
72 013 (Rev 9/91) MOA25
Permit No. ~'~ ~' OISZ~ Page ~' of '7_
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L.'i5
PID No.:OcJO ,~4 '7_7_.
ENGI I'S SEAL
72-013A(2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930154
DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC.
OWNER NAME:EAGLE RIVER VALLEY DEV
OWNER ADDRESS:P. O. BOX 141907
ANCHORAGE, ALASKA 99514
DATE ISSUED: 6/11/93
EXPIRATION DATE: 6/11/94
PARCEL ID:05047422
LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK
8
4 LT
LOT SIZE: 20292 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ABSORPTION SYSTEM DESIGN CALCULATIONS--STANDARD TRENCH
REDESIGN PERMIT SW93015~
SCOPE OF PROJECT: The existing permit was based upon a design which had the
field located along the lower property line. During excavtion for the house
foundtion, the builder was required to relocate the house to the southerly
portion of the lot. This required relocating the septic field. A new test
hole was dug and monitored for ground water. No water was found in the new
test hole for two weeks after it was dug; the previous hole, located lower
on the lot, still has water at the same elevation as originally submitted.
ABSORPTION ~.~EA CALCULATIONS:
Minimum Size Required: 4 Bedrooms x 150gpd/bedroom = 600 gpd capacity
Soils rating, proposed absorption design, 0.93 GPD/SF
Weighted average: 8.0' x 0.8 gpd/sf = 6.4 gpd/f
4.0' x 1.2 gpd/sf = 4.8 gpd/f
11.2 gpd/f ~ 12' = 0.93 gpd/sf
Minimum sizing: 600 gpd % 0.93 gpd/sf = 645 sf a~sorption area
Due to depth of useable soil, Use standard trench design:
2.5' wide x 12' effective depth x 27' long trench = 648 sf
IMPACT ON ADJACENT LOTS: There are no public or private wells within 150' of
this proposed absorption system. The proposed absorption system has no
adverse impact upon any adjacent lots as shown on attached site diagram.
MODIFIED DESIGN SCOPE/CALCULATIONS
PROPOSED WASTEWATERABSORPTION SYSTEM
LOT 8 BLOCK ~ HYLEN CREST SUB, ADD #2
PREPARED FOR: MR. MIKE QUINN
PO BOX 7'74042
EAGLE RIVER, AK, 99577
DRAWN BY CAL
CONSTRUCTING ENGINEERS346-2000
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516
6-30-93
DRAWING # 93-$2-0~-2(M)
MODIFIED DESIGN DETAILS-WASTEWATER ABSORPTION SYSTEM (STANDARD TRENCH)
.... STABDARD TRENCH DESIGN DETAILS
PROPOSED WASTEWATER ABSORPTION SYSTEM
LOT 8 BLOCK & HYLEN CREST SUBDIVISION, ADD
PREPARED FOR: MR. MIKE QUINN
PO BOX 774042
EAGLE RIVER, AK, 99577
NOT TO SCALE: DRAWN BY CAL
CONSTRUCTING ENGINEERS 346-2000
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 6-30-93
DRAW~Nr, # 95-$3-06-2(M)
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
80~1.S LOG -- PERCOLATION TEST
PERFO 3MED
LEGAL DESCRIPTION:
1
2
3
4
5
6
7-
:l
10-
11-
12
13
14
15,
16
17
18
19
20'
WAS GROUND WATER
ENCOUNTERED?
D/', I'E PERFORMED:
Township, Range, Section:
SLOPE SITE PLAN,
Reading / Date
Gross
Time
1o.*,I
PERCOLATION RATE~_~ ' Z'/Z,~l,h-r~_o-~t~;-li~Ch) PERC HOLE DIAMETER
Net Depth to
Net
.
TEST RUN BETWEEN~_/,L _7$__, ~F1 ANDo_~ FT
,---. '-- - ....... ~ ~3~ ~ t~___
72-008 (Rev. 4/85)
SIT~ PL/%t~ .... WAST~WATER ~BSORPTION SYSTEM
./'
~ITE PLAN I)gT~IL~
PROPOSED WASTgW~TER ABSORPTION S¥STE~
LOY 8 BLOCK 4 H~LE~ CREST SU~DIVISION~ /%DD #2
PREPARED FOR: MR. MIKE QUINN
PO BOX 774042
EAGLE RIVER, AK,
99577
S(:ALE: I" = 100'
DRAWN BY (:AL
CONSTRUCTIN~ ENGINEERS366-2000
9601 BUDDY WEP. NER DR 69~-9098
ANCHORAGE, AK, 99516 6-5-93
DRAWING # 93-81-06-2
A~SORPTION SYSTEM D~SI~N C~LCULATIONS-~WI~ TRENCH
8COPE OF PROJECT: A new amsorpt...on field is proposed for new four (.4) bedroom
house. Lot is 'to be served by public water.
ABSORPTION A, RE~ CALCULATIONS:
Minimum Size Required: 4 Bedrooms x 150gpd/bedroom = 60() gpd capacity
Soils rating, proposed absorption design, 0.8 gpd/sf
Minimum sizing: 600 gpd -.'- 0.8 gpd/sf = 750 sf absorption area
Due to depth of useable soil, Use wide trench design:
(750 sf) + 5' W = 150 sfx Correction factor [(W+2)/(W+I+2D)]
= ].50 sfx [(5+2} {- (5+1.1-(2)(4))]
= 75' minimum trench length, 5' wi.de x 4' deep ~_~.o
IMPACT ON ~DJACENT LOTS: There are no pub].ic or priw.~te wells within ].50' of
this proposed absorption system. The proposed absorption system has no
adverse impact upon any adjacent lots as shown on attached site diagram.
ENGIN
DESIG~ SCOPE/CALCULATIONS
PROPOSED WASTEWATER ~$SORPTION SYSTEM
LOT 8 BLOCK ~ ~YLEN CREST SUB, ADD #2
PREPARED FOR: MR. MIKE QUINN
PO BOX 774042
EAGLE RIVER, AK, 99577
CONSTRUCTING ENGINE~R$3~6-2000
9601 BUDDY WEANER DR 69~-9098
ANCHORAGE, ~kK, 99516
DRAWN BY CAL
6-5 -93
DRAWING #
Municipalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-.0650
SOILS LOG .... PEHCOLATION 'rEST
PERFORIVIED FOR: ~"V~ \ \~L~~, ~':~)....., ~ ch ~ '
............................. DATE PEF~FORMED:.~-
LEGAL DESCRIPTION: L.~,~4 ~ ~' ~g~ ~(12 ~'i ~'¢''' f Township Range Section' ~¢4 %~"r ,~-.
SLOPE SITE PLAN . ........
~ I'[~1 ~
1
4
5
6
7
8
9
10
11
12
13
14
15
'16 -
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
PERCOt. ATION RA'~E __.~.~ ~.._. (m,~utes,'Hmh) PERC HOLE DIAMETER
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIF'AL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
DE$IOlq DI~.TAIL$~,.WASTf:W/%TEt~ i%I~SO}IPTIO~ S~Z~TE~! (WIDL,] TRENCH)
WIDE TRENCH DE$ION D~TAIL~
LOT 8 ~LOCK ~ H~LEN C~ST SUSDIVI~IO~, ADD #2
PREPARED FOR; MR, MIKE QUINN
PO BOX 774042
EAGLE RIVER, AK, 99577
NOT ~0 SCALE:
DRAWN 8Y
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\! MUNICIPALITY OF ANCHORAGE
WATER CONNECTION — Location Record
ACCT. N.
NAME ADDRESS
LOT BLOCK `moi ADDITION�B
SIZE CONN. nnTF MAI)F � �� �— —1� NEW CONN.
11 0
LOCATION: ALLEY El
CORP STOP
STREET
or tAwl L4 --o ;?a
Cres-1-
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REPLACEMENT GOND!.
TYPE OF MAIN ( )SHOW SKETCH ON REVERSE SIDE
11 1 THAW PLATE I PERMIT NO.
CURB ST PC TO C
CURB STOP C. TO I
CORP CONNECTOR
COUPLING C -TO 1
x BLABS BUSHING
x GALVANIZED BUSHING
PART UNION
3 PART UNION
SERVICE CLAMP X
COPPER PIPE
1 114" KAY BOX
2" KEY BOX
THAW WIRE
LOCATION ya
4 r= C7P 1l} _(A�
CONNECTION MADE BY
-058 (12/77)
A
KEA NY WIRE CONNECTOR
THE
COMMENTS: BROKEN MAI Rr EXT. CONNECTION?
CASING, DELAYSr ETC.
m
DISCONNECTS
EXCAVATOR
APPO I NTM E NT TI M E■
TIME READY:
INSPECTED B
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W.
CONN.
IISP.
PERMIT
TOTAL
EXTRA PIPE
PT.
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MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 050 -474-22
Certificate of On -Site Systems Approval
OSC251108
Expiration Date: 10/17/2025
Legal description HYLEN CREST #3 BLK 4 LT 8
Site address 10243 STEWART DR
Current property owner(s) REIFEL CHRISTOPHER SCOTT &
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By:
Original Certificate Date
4/15/2025
This C ificat(e of On -Site Systems Approval (COSA) is intended to demonstrate the subject
Sys m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Det., velopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
1. GENERAL INFORMATION
Parcel I.D. 050-474-22
Complete legal description Hylen Crest #3 Block 4 Lot 8
Location (site address) 10243 Stewart Drive
Current property owner(s) Kerry & Chris Reifel
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone (719)522-3350
3. TYPE OF WATER SUPPLY: El Private Well F1 Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units 01 Community Well or Public
F Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 01 Private Septic r_1 Private Septic serving 2 dwelling units
El Holding Tank El Community Septic or Public Sewer
5. SEPTIC TANK: Al Steel F-1 Plastic [] Concrete n Fiberglass
Age 12 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: n AWWTS E] Bed nN Deep Trench 0 Wide Trench F] Seepage Pit
Waiver request for:
Expedited review requested: F-1
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee Waiver Fee $
Date of Payment Date of Payment
COSA# 05C2_51ks Waiver #
COSA Application—June 2022
050-474-22
1
10/17/24
1993
4.3
N/A N/A
N/A
3/19/25
66
44
144
(907) 522-7773
Benjamin Schiller, P.E.
STE��RT OR/
N 89 59'W 123. 00
0000�OO�O
.. 49 TH
D
SAft
0
0ooi°NSHANE A. HOLT
el �DO
Qn LS -6914
�ofessionax
��DOOoo��
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
MTA HAS ISSUDED ANON OBJECTION EASEMENT ENCROACHMENT
REGARDING THESTAIRWAYENCROACHING INTO THE 10' UTILITYEASEMENT.
DA TED APRIL 92014
WOOD OR BLOCK RET. WALL
SEWER SYSTEM PIPE
THE SURVEY DATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE
OWNER OF RECORD AS OF THE DA TE OF THIS SURVEY.
ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
AS-BU/L T SURVEY 1" =20'
NO CORNERS SET THIS DATE
/ HEREBY CERTIFY THA T / HA VE PERFORMED A SURVEY
OF THE FOL LOWING DESCRIBED PROPERTY
LOT8 BLOCK 4 HYLEN CREST UNIT3
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THA T THE
VISIBLE IMPROVEMENTS SI TUA TED THEREON ARE WI THIN
THE PROPER TYLINESAND NO VISIBL E ENCROA CHMEN TS
EXIST OTHER THAN NOTED.
DATED ATANCHORAGE,ALASKA THIS 7TH DAYOF
MARCH , 2025
16218 240-51
HOL T LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
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
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Fronl MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Phone ~-~r- ~o~,9
Address A~c~r:~lb-- ,A,~; 99~\G ~z_ P~,~-~ }~K ~95'~
EngineeCs signature ~ ~//~/~ t,4.,,.~ Date ~'-//- ¢%
DHHS SIGNATURE
Approved for '~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date ~-/~
Ill ~'-'PJJ/£fl~
The Muni¢ipslity of Anchorage Department of Heslth and Human Services (DHHS) issues Health Authority
Approvsl Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and 8tare requirements. Employees of DHH$ do not
oonduct inspections or anslyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissio, ,s in Lhe professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A, Well Data
Parcel I,D,
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing hei!
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE ~:
Coliform Nitrate
Date of sampl .'~
B. SEPTIC/HOLDING TANK DATA
AT INSPECTI
g.p.m. ~.~ r,~
acent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Z
Collected by:
Other bacteria
Date installed 3-u t_y L%,%T,
Cleanouts (Y/N) 'V
High water alarm (Y/N)
Date of pumping ',~ [~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Tank size ~ ~Sc::) Compartments
Foundation cleanout (Y/N) 'Y Depression (Y/N)
i~¢, Alarm tested (Y/N) --
5~ Pumper
Well(s) on lot ~ G
To property line z'l~ '
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
t-
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION~ LIFT STATION TO:
Well ~ On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length 7_ <~
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Width
Manufacturer
Manhole/Access
~es tested
Soil rating (GPD/Ft
Gravel thickness
.Cleanout present (Y/N)
Results (pass/fail)
Sudace water
System type ~.~--~jc t4
Total depth )¢o'
Depression over field (Y/N) kJ
for ~ Bedrooms
After test
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1'4 ,q On adjacent lots
To building foundation
On adjacent lots '~S~ Cutbank
Sudace water
Curtain drain
-4-5'-0
Driveway, parking/vehicle storage area -v 5o
Property line
To existing or abandoned system on lot
+1 oo' Water main/service line
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect/on.
Signature
Engineer's Name
Date ~-/[ ~ ¢' %-
HAA Fee $ /' ~) ' ~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back