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Home My WebLink AboutHYLEN CREST #3 BLK 4 LT 9 Municipality of Anchorage Page / of 2-. 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: ,.5'~ ~(o/¢'o PID Number: O5o 41 q ~, ~ N.~.~+¢, ~ ~ Wastewater System: ~New B Upgrade Address: ABSORP'rlON FIELD . ~ ~ Deep Trench ~ ~hallowTrench D Bed D Mound D Other LEGAL DESCRIPTION Sol, Rating: Total Depth from original grade: ~ ~ GPD/Sq~ Ft. Subdiv~ion: Depth to pips bottom from original grade: Gravel depth beneath pipe / f~ / ~ O Ft. Ft~ ~ New ~ Up Gravel width: ~ ¢ Ft. / Ft~ Olassgication (Pnva Ga~o~ 1o: Total absorption ama: Pipo matodal: ~rillor: ~ ~ ~ StaticW~terLevel: Installer: Date installed: ~ GPMIPumpSetat: Ft. Casing~ TANK SEPARATION DISTANCES ~septic B Holding ~ S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Prlvate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~/~ ~ / ~ 5 Materiah Number of Compadments: Sudace Water +/OO +/~o -- -- - LIFT STATION Line Cudain ~ ~ ~ ¢~0 ~ -- Pump Mak~ectrical Inspections pedormed ~ Remarks: ~A¢~/~ Ey A W~. BENCH MARK Location and Description: ' , Assumed Elevation: Department of He~tt nd Huma~e~ices apprqva[ , ~:~. 72-013 (Rev. 9/91) MOA 25 D¢o zl/ Permit No. ,5'uJ ?/O/ ~'O Page Z. of ~ 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: ~-¢ PIDNo' ~50 5z?~,/ ~3 ~° Z/° ""5 72-O13 A (Rev. 9/91) MOA 25 ~' nRIVE~/AY E~MT EXPDSED ENn DF ~UR[ED PIPE NDTE~ NB SURFACE WATER WITHIN laD' DF SEPTIC SYSTEM AS DF 8-16-95 END []F 9URIF-J]P[PE WATER ~DES I~T £NCRDACH FRei SEPTIC SYSTEM SITE PLAN LOT 9 BLOCK 4 HYLEN CREST SUBDIVISION HENRY H. 9600 BUDDY ANCHORAGE, 346-2000 WILSON, P.E. WERNEt~ DR AK 99516 Constructin§ Ensineers Engineers, Surveyors il(J~3 i]()X 192 ~ X~',[,',H~ I)[~ July ~, 1994 Muncipality of Anchorage DHHS, On-Site Services Po Box ].96650 Anchorage, AK, 99519 re: Lot 9 Block 4 Hylen Crest sub Septic inspection report; Health authority approval checklist and certificate Gentlemen: Please substitute the attached original signed reports for the reports originally submitted and processed, and remove the file copies and send to me at the above address. Henry H. Wilson, PoE. 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 ~ 34 - Z~ HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone 6944941 Lending agency Mailing address __ Day phone °/~-o~o~ Agent Address 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- lng 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) Front MOA #21 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-~c-~%~) ¢~-~¢~.9jr,¢¢~,5 Phone Address 9~:~ ~_ L~,v~, ~, ~.,~,.ck~,-.~. e_ .__9 ~'/~ Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments [:)ate ....... By: 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 DI4 HS 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 Legal Description: /.... e~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist q I'-[vle, ~ Cl/¢~; Parcel I.D.: o o- A. WELL DATA Well type. A ~ [.aJ t.A. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) -- Date cmnpleted Tolal depth ~ Cased to ~ Sanitary seal (Y/N) FROM WELL LOG Date of test Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Static water level Well production WATER SAMPLE RESULTS: g.p.m, g.p.m. Coliform -- Date of sample: ~ B. SEPTIC/HOLDING TANK DATA Date installed '7- ~/ Foundation cleanout (Y/N) DateofPumpmg.. t.J ,4- C. ABSORPTION FIELD DATA Date' installed ? ' ~ / Length 2. 7 ' Width Nitrate Collected by: Other bacteria · · Tank size / g ~0 Number of Comparhnents ~' Cleanouts (Y/N) Depression (Y/N) A/ High water alam~ (Y/N) Pumper ~ ~ Soil rating (g.p.d./fl 3 ~'~-' Gravel thickness below pipe Effective absorption area 5"e'/'O '5,~.Monitoring Tube present(Y/N) Date of adequacy test A2 ,Ft,4J Results (Pass/Fail) Fluid depth in absorption field before test (itl.); Fhfid depth ~ (ins.) Minutes later: -- Peroxide treatment (past 12 months) (Y/N) -- System type ~FE ~,,q~/'/ /r) ' Total depth Depression over field (Y/N) For - bedrooms __ hnmediately after -. gal. water added (iii.): Absorption rate = - g.p.d. If yes, give date - D. LIlT STATION Eo Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump ou" level at* - *Datum -- "Pump off' level at* Cycles tested -- SEPARATION DISTANCES SEPARATION DISTANCES FROM WE_ELL ON LOT TO: Septic/holding tank on lot ~ Absorption field on lot -- Public sewer main -- Sewer/septic service line w ; On adjacent lots ~ : On adjaceut lots Public sewer manhole/cleanout "' Lift station ~ SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOT TO: Buildiug foundation 4-/C~ Property line -3- /o Absorption field Water maiiffservicc line q'/o Surface water/drainage 4-/o o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO; Building foundation ~- 5-0 Surface xvater Curtain draiu .A. S-O Water main/service line .-/- /o Driveway, parking/vehicle storage area Wells on adjacent lots ./.- /o O Property line F. ENGINEER'S CERTIFICATION I certiJ.'v that I have determined thru field inspections and review of Municipal records that the above ,ystems are in co~j[~rtnance with MOA H~M guidelines in effect on th(s date. 74/~ ~ ~ ~ ~/~ Date >~ Z/ f~5 . .... ................................................................................................... ~' ..... HAA Fee $ / 7~ Waiver Fee $ Date of Payment Date of Payment Receipt Number Z ~ ¢~ ~ Z7 Receipt Number Rev. 8/95 OSS: haa.wk.doc Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type '~,~¢,L.~ Log present (Y/N) Parcel I.D. O5o- 4~A- z.~__ Il A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total deptll Sanitary seal (Y/N) Cased to 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 RESULTS: Coliform Nitrate Date of B. ~ TANK DATA Date installed 7-9 [ Tank size Casing height Wires properly protected ( AT INSPECTION g.p.m. g.p.m. On adjacent lots __ · On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria I -~_¢o Compadments Cleanouts (Y/N) ~/ High water alarm (Y/N). Date of pumping Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) _1~ ~r ._ Pumper ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~J (:~ On adjacent lots To property line 't,L¥' Absorption field Sudace water/drainage Foundation I~' Water main/service line .I 5o 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT S'rATION Date installed Size in gallons __ Manufacturer Vent (Y/N) "Pump on" level at ~_'~ff Level at High water alarm level ¢~.-- Cycles tested Meets MOA electrical codes (Y/N) _.¢~-¢~-~--- __ SEPARATION DIS. S.'r.-ANCE"'~FR~"T STATION 'FO: ~¢~/ell'on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed Length Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) -~-~ I __ Soil rating (GPD/Ft2) Width ~; '/~' Gravel thickness __ ~,~01 Cleanout present (Y/N) kJ~ Results (pass/fail) l, 7. ~ pg/~'~'_._System type Io' Total depth "/ Depression over field (Y/N) ~ for After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N ~ To building foundation On adjacent lots Surface water /-/¢ Curtain drain -/'/~ On adjacent lots t- I OO' Property line To existing or abandoned system on lot Cutbank ~r~ oo' Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Signature __ Engineer's Name Date HAAFee$., . 17o~ Waiver FeeS Date of Payment 'Z'-7'~'S)'L' Date of Payment Receipt Number ~-~4~Z..~¢~.~' Receipt Number 72-026 (3f93)° Back