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HomeMy WebLinkAboutHYLEN CREST #3 BLK 4 LT 100[i&i:11. Municipality of Anchorage`'-- . C ,'' of 4 Community Development Department Dkc'`, i On Water & Wastewater Program -Site n 1�. x904 .. 3 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (9�)', ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191457 PID Number: 050-474-24 ❑ New 0 Upgrade Name: MARIJNA AND ANTONIUS DONKER ABSORPTION FIELD ■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: 10251 STEWART DRIVE, EAGLE RIVER, AK 99577 ❑ Other Phone: No. of Bedrooms: Sail Rating: Total Depth from original grade: 726-1429 3 0.8 GPD/sq. FL SEE DWG. Ft LEGAL DESCRIPTION Depth to pipe invert from original grade: Gravel depth beneath pipe SEE DWG. Ft 6.03 Ft Subdivision: Block: Lot: Fill added above original grade: Gravel length: HYLEN CREST #3 4 10 SEE DWG. 49 Ft. Ft. Township: Range: Section: Gravel width: Beds Number of lines: Distance between lines: 4 Ft. Ft. SEPARATIONDISTANCES Total absorption area: 590+ Number of trenches: 1 Dist. between trenches: 1 To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines SD. FL Ft. Well PUBLIC PUBLIC PUBLIC 25'+ TANK ■ Septic ■ S.T.E.P. ❑Holding ❑ Other Manufacturer: . Capacity: Surface water 100'+ 100'+ 100'+ - GREER TANK 1500 G.I. Material: Number of compartments: Lot Line 5'+ 10'+ 5'+ N/A HDPE PLASTIC 2 LIFT STATION *APPROX. FOR 2ND COMPARTMENT Foundation 10'+ 10'+ 10'+ - Curtain Drain NONE KNOWN Manufacturer Capacity: GREER TANK W/ PUMP SYSTEM 500 Gal. Remarks: **PER CONTRACTOR 'Pump on" level at: **54" 'Pump off" level at: **50" High water alarm at: **58" Pump Make & Model: Electrical Inspections performed by: **GOULDS PE51 M LARRY KUNDER PIPE MATERIAL D1785/ D3034 D2665 Tank to House to tank (FOR NEW) Tank field (FOR NEW) Installer WILCO CONTRACTING Drainfield D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 81.05 Ft. Inspection Location and Description: Dates: 1st 11/8/2019 2nd 11/8/2019 3rd 11/8/2019 4th 11/11/2019 BOTTOM OF SIDING AT POINT "C" ENGINEERSEAL Community Development Department Approval *It OF qIk 0��♦ � -4 Conditional approval: Date: i 4 T �....... .............. 0 0 i ............ ............... 0 ♦ �';.' reGar ess ;'�� CE- 953' C� I� 7 I C /��J, A! t PROF Approved: Date: 02 , 4� ES S��NP.�� LICENSE #AECC884 Inspection Report _1-1-12.doc PERMIOSP 191457 T NUMBER: RECORD p RAW I N G HYLEN CREST S/D #3; BLOCK 4, LOT 11 REBUILT/NEW DRAINFIELD A B C +GEG TH#1 DBL1 33.6 10.7 11.1 DBL2 34.5 11.7 11.7 MH1 38.9 17.1 16.9 MH2 39.2 18.8 20.7 C01 62.4 72.0 86.1 MTI 65.5 75.1 89.1 CO2105.7 108.6 120.0 MT2 105.2 108.5 1120.0 EXISTING 2" SCH. 40 PVC FEED LINE PARCEL ID NUMBER: 050-474-24 1.1 40' i \\-_—�- B 3 Fp7sT%VG '' A/10 00 NEW 1500 GALLON \ INSTALLED DOUBLE _ \ GREER HDPE STEP TANK CLEANOUTS (DBL1 & DBL2) � 1W •.Qi1i+M'�-14f-+--eMr : Wr�IMT'•*V4-��"'t_�(,j NOTE: OLD STEEL STEP TANK _ T WAS DECOMMISSIONED PER UPC PER CONTRACTOR r 0� OG 15DRIVEWAY EASEMENT APPROXIMATE WATER KEY BOX LOCATION AND SERVICE LINE - PER CONTRACTOR SUPPLIED WATER LOCATES. GARNESS ENGINEERING GROUP, Ltd ENGINEERING a- SALES -CONSULTING 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 337-6179 • FAX (907) 336-3246 • WEBSITE: w .gamessengineedng.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MARIJAN AND ANTONIUS DONKER 726-1429 2 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: HYLEN CREST S/D #3; BLOCK 4, LOT 10 J.L.M. TYPE OF WORK: DATE: %. RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 12/19/2019 1- z w 2 w cow 0 **SlL• OF ���/ •••; ........ ............ 0 0 ...�.. ... ......... ............. J fF A. Garn ss jw #�'/ ' 79 �,Z,i LICENSE I�I,OFESS�� It" #AECC884 ", PERMIT NUMBER: PARCEL ID NUMBER: OSP 191457 RECORD D RAW I N G 050-474-24 FEED LINE TO TOP OF TANK WEEP DRAINFIELD HOLE—" @ INLET = 75.57 TOP OF TANK 2" OF INSULATION @ OUTLET = 75.50 PER CONTRACTOR FLOW FROM HOUSE Inlet III I I n u ��/ y^r4"OUTLET INVERT OF BUNG V @ INLET = 74.95]-Z>Z---,,�t@OUTLET=74.72 VERT OF BUNG 50" Minimum Li uid Level -1264 GALLONS TIMER OVERRIDE FLOAT (63") - PER CONTRACTOR 3H WATER FLOAT (58") - PER CONTRACTOR NEW 1500 GALLON 'LOW LEVEL CUTOFF GREER HDPE TANK FLOAT(ON/OFF)-(52") rt - PER CONTRACTOR -1/2 HP GOULDS PE51M EFFLUENT PUMP PER CONTRACTOR —CMU BLOCKS FOR PUMP STAND .\\\\\ ' � �P�E OF is�♦♦i GARNESS ENGINEERING GROUP, Ltd *:: . ENGINEERING SALES - CONSULTING 10 3701E. TUDOR ROAD. SUITE 101 'ANCHORAGE. AK99507• PHONE (907)337-6179•FAX (907)338-3246•WEBSITEwww.gamessengineering.wm • • •• • •••••••••••••• ............ 10 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: f J rey . arne S MARIJAN AND ANTONIUS DONKER 726-1429 3 OF 4 �j#�J, CE-795-Zo '�_� PROJECT/LEGAL DESCRIPTION: DRAWN BY: �♦ Ftp• •., tZ�.��� HYLEN REST S/D #3; BLOCK 4, LOT 10J.L.M. TYPE OFWORK: DATE:♦pROFESSI�N����• LI ENS 1tllaimm RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 12/19/2019 #AECC884 i EXISTING ORENCO - NEW INTERIOR ALARM CONTROL PANEL. INSTALLED IN INTERIOR MOVED FROM (PER CONTRACTOR) GARAGE TO EXTERIOR— TOP OF MANHOLE LID (MH2) = 79.57 TOP OF MANHOLE FINAL GRADE LID (MH1) = 79.75 = 7c1 A' -7Q 17— FEED LINE TO TOP OF TANK WEEP DRAINFIELD HOLE—" @ INLET = 75.57 TOP OF TANK 2" OF INSULATION @ OUTLET = 75.50 PER CONTRACTOR FLOW FROM HOUSE Inlet III I I n u ��/ y^r4"OUTLET INVERT OF BUNG V @ INLET = 74.95]-Z>Z---,,�t@OUTLET=74.72 VERT OF BUNG 50" Minimum Li uid Level -1264 GALLONS TIMER OVERRIDE FLOAT (63") - PER CONTRACTOR 3H WATER FLOAT (58") - PER CONTRACTOR NEW 1500 GALLON 'LOW LEVEL CUTOFF GREER HDPE TANK FLOAT(ON/OFF)-(52") rt - PER CONTRACTOR -1/2 HP GOULDS PE51M EFFLUENT PUMP PER CONTRACTOR —CMU BLOCKS FOR PUMP STAND .\\\\\ ' � �P�E OF is�♦♦i GARNESS ENGINEERING GROUP, Ltd *:: . ENGINEERING SALES - CONSULTING 10 3701E. TUDOR ROAD. SUITE 101 'ANCHORAGE. AK99507• PHONE (907)337-6179•FAX (907)338-3246•WEBSITEwww.gamessengineering.wm • • •• • •••••••••••••• ............ 10 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: f J rey . arne S MARIJAN AND ANTONIUS DONKER 726-1429 3 OF 4 �j#�J, CE-795-Zo '�_� PROJECT/LEGAL DESCRIPTION: DRAWN BY: �♦ Ftp• •., tZ�.��� HYLEN REST S/D #3; BLOCK 4, LOT 10J.L.M. TYPE OFWORK: DATE:♦pROFESSI�N����• LI ENS 1tllaimm RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 12/19/2019 #AECC884 i PERMIT NUMBER: PARCEL ID NUMBER: OSP191457 RECORD DRAWING 050-474-24 `ORIGINAL GRADE NOTE: FOUND OLD ORGANICS LAYER ON WEST END TRENCH AND SHOT ELEVATION. ELEVATION FROM PREVIOUS RECORD DRAWING APPEARS TO BE ACCURATE. TIM EKLUND FROM THE MOA ONSITE DEPARTMENT WAS PRESENT DURING BOTTOM OF EXCAVATION OF TRENCH AND HAD NO OBJECTIONS TO INSTALLATION. 4" CLEANOUTS (C01 & FILTER INVERT OF NEW DISTRIBUTION LINE = 96.02 - INVERT OF OLD DISTRIBUTION LINE IN OLD CO = 94.99 - EXCAVATED BELOW EXISTING GROUP, Ltd TRENCH BOTTOM ELEVATION, REMOVED 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: www.gamee engineedng.com ALL CONTAMINATED MATERIAL AND PHONE NUMBER: INSTALLED 2.0-2.39 FEET OF SAND FILTER. NEW TRENCH BOTTOM PAGE NUMBER: MARIJAN AND ANTONIUS DONKER ELEVATION (DRAINROCK) IS NOW 1.89 4 OF 4 FEET HIGHER IN ELEVATION THAN THE PREVIOUS TRENCH BOTTOM ELEVATION DRAWN BY: HYLEN CREST S/D #3; BLOCK 4, LOT 10 C�/1/li1 TYPE OF WORK: �4 FEET MONITORING TUBES (MT1 & MT2) FINAL GRADE = 99.80-100.10 NAL GRADE = 98.99 4" PERFORATED PIPE —BOTTOM OF DRAINROCK/ TOP OF SAND FILTER = 89.99 —BOTTOM OF OLD MT ELEVATION (BOTTOM OF OLD TRENCH) = 88.10 S OF EXCAVATION = 87.60-87.99 RELATIVE ELEVATION OF GROUNDWATER ON 10131/19,11/l/19. & 11/7/19 = `84.89 (BASED ON ORIGINAL GRADE - SEE NOTE) RELATIVE ELEVATION OF BOTTOM OF TEST HOLE ='80.99 (BASED UPON ORIGINAL GRADE - SEE GARNESS ENGINEERING GROUP, Ltd -- —1 ENGINEERING o SALES o CONSULTING - 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: www.gamee engineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MARIJAN AND ANTONIUS DONKER 726-1429 4 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: HYLEN CREST S/D #3; BLOCK 4, LOT 10 J.L.M. TYPE OF WORK: DATE: � RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 12/9/2019 GEG TH#1 �� .. , y A..Garn ss Q AV CE- 9 : ��AV 1� �Iti ��F,�i LICENSE ,1 A lifRO "S 1"'_�••• #AECC884 / GARNESS ENGINEERING GROUP, Ltd ENGINEERING g, SALESc CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE. AK 99507' PHONE (907) 337.6179' FAX (907) 338-3246' WEBSITE: w .g"messengino fing.wm SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: HYLEN CREST S/D #3; BLOCK 4, LOT 10 PERFORMED FOR: MARIJNA & ANTONIUS DOWER DATE: 10/29/2019 DEPTH 6" OR (feet) = TEST HOLE #1 1—NillillLOAM (SM) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 GM TO SM W/ POCKETS OF. SAND AND GRAVEL SOIL CLASSIFICATIONS DEPTH TO GROUNDWATER DATE SEEPS @ 15'-16' 10/29/2019 14.1' �11111"I 14.1' 11/1/2019 14.1' � VMS Eno •�.'�'. �. 2 III m, 30 2" 4" !y` 3 1:48 - 6" - 4 2:18 30 2 - 3/8" DEPTH TO GROUNDWATER DATE SEEPS @ 15'-16' 10/29/2019 14.1' 10/31/2019 14.1' 11/1/2019 14.1' 11/7/2019 SITE PLAN 1" =100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 11/1/2019 1 1:18 - 6" - 2 1:48 30 2" 4" 3 1:48 - 6" - 4 2:18 30 2 - 3/8" 3 - 5/8" 5 2:18 - 6" - 6 2:48 30 2 - 3/8" 3 - 5/8" 7 2:48 - 6" - 8 3:18 30 2 - 3/8" 3 - 5/8" 19 PERCOLATION RATE 8.3 (MIN./INCH) PERC. HOLE DIA. TEST RUN BETWEEN 7.5 FT. AND 8.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES 0 NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS rnMMFNTR- PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFO MED I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: L. 1 Z 6 (INCHES) i m W c Omz wD-i Oz= m Mp C 30' �y V Mc0 cow ow 0 0- m C7 r M =C - r 00 o Om �� ye'�46 00 �/ z �fi z% ® 02-0 �= n=wpb °r° z� -n O -< c IS= CA) CDD 0 W -zi (O( =nc0i cmm 0 z co m zz X - 0m K M-i0 co = n � 9 Z z v -pi y m-�j Am cn0 ax O W 0C�zzCn moz -C-Gz zo z- 00 _� �z� 00-0 �= a. CIOX 0O0 NCS wX m c-nc zz0 m -_4 o = mmz Fn cnm a-1 +n Fri <�" m m0 mm D _ mmm mB = D m tom -q0 pm w W-1 Dc -Icn ` + R: o= m0 co Co> s0 O cn n m54 m� *z o z� 0Cn z0 m snW zG Om -im M� M um z Z 0 i r a }� _ z D Z 2: z O O= -t --i m C 30' �y V z 0 v m c m 0 0- m C7 r M =C - r 00 o Om �� ye'�46 00 �/ I - �fi z% ® 02-0 �= n=wpb °r° z� JIz m / CD IS= CA) min mmm 0 G7m ®�®��`a • / (O( mz s z o m m A C/) m -m T v�y cnm00= X W G ; r y co = n � 9 Z z v -pi y osaeeeee,`i`,i N `®o a z- _� a. m vDizD_-Oa Wc zj I Om 0 < rcn . I „o=v, �' a � z <�" m mm _ mmm mB n d = m m 0 z z m m ` + R: m 0 i,'�tL1ea®es�'. i I m // o.Z. C 30' �y V z 0 v m �v° / ,r �® / �� ye'�46 00 �/ I - �fi z% rm- co 30, p ti JIz m / CD CA) C ®�®��`a • / (O( + m ®S2. co m I i a I 0 cn a z 0 v m / ,r 00 -+ 0 I - �fi rm- co 30, JIz m / M --x C) -------------- 431N3SV3J..l nun X04 08-991`dld ®31VOI(13® MON ,££ I 1 S � / CD -+ 0 I �fi rm- co 30, JIz m / CA) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Addre~ ' " Phone(st ' ' Permit'N~. ' I ' No. of B~drooms ~OI t~) I Block q Subdivision To,,n*p. ee0on /d TANKS Material ,~'T'"'~:~;~J-- No. of ~mpadments TYPE OF SYSTEM ~3 TRENCH [] BED [] W. DRAIN [] OTHER DISTANCES SEPTIC TANK WELL LOT LINE FOUNDATION ABSORPTION FIELD WELL AS-BUILT DIAGRAM (Show Iocahon of well, septic syslem, properly lines, Iounda~ion, driveway, water bodies, otc.) Depth to pipe bottom Irom original grade ~L. ! Fill added above original grade Total depth from origina~ grade FT I/ Gravel depth beneath pipe Gravel length / Total absorption area Number ol lines .i ravel width h FT SQ FT ~/~ Pipe malerial Dale Installed WELLS [] PRIVATE ~ OTHER (Identify} FT FT (A,B,C) ,~ Total Depth Cased to REMARKS: 5 & 5 ENgINEErING I 17034 LaDle Ri~er Loon Roan ~ ..... cedilY thai BIs inspection Municipal ana~ale guidfliffes m ellecl on mis eale: / . / -- Scale: fq,'T, ~, Inspections Pedormed by: was peflormed according to all 72-013 (3/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROBERT SHAFER, P.E. ROGER SHAFER August 15, 1989 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION, Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 1 '? 1989 RECEIVED REFERENCE: Lot 10; Block 4; Hylen Crest Subdivision Unit #3 Permit #890034 Permit #890034 was issued by your office for the installation of an on-site wastewater disposal system in accordance with our design dated March 22, 1989. This letter is to inform you that even though the design remains unchanged, it was necessary for us to locate the absorption trench further uphill than o~iginally shown to meet the 50 feet horizontal setback to a cut bank. As a result of the absorption trench being located further uph~, the 1000 gallon septic tank was changed and a 1250 gallon septic tank/lift station manufactured by ANCHORAGE TANK AND WELDING was installed. A new soil test performed in the area used for the absorption trench revealed soils were identical to those used for the original design. you r~ additional information, please contact us. ROAD DESIGN A. SHAFER, P.E. SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I:::' ti:i R H i1: "1' SCALE .~ ~ ~:~';~ . '~'~ '~ '3~ Municipality of Anchorage ~:, ' ..... DEPARTMFNT OF HEALTH & HUMAN SERVICES ;! ,..~. ~,~ 825 "L" Street. Anchorage. Alaska 99502-0650 //~~~' SOILS LOG -- PERCOLATION TEST 1 8 10 WAS GROUND WATER ENCOUNTERED? 11 IF YES, AT WHAT 12 DEPTH? Oep th to Water Afte~'~,/~)f/ 1 3 Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop '~ z ~ 7-0 p ~o ~,, ,'~ II .~/~, " z ~ " 14 16 17 18 19 20- PERFORMED BY:~"u~lI~"~"~ ~---~-''l~-~kj~-/~'/-~~ __ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~'~T ON THIS DATE. DATE: 72-008 (Rev. 4/85) t Municipality of Anchorage,in- 0 On -Site Water and Wastewater Program Q; _ �F " ,. (907) 343-7904 S A F E T Y Certificate of On -Site Systems Approval Parcel I.D. 050-474-24Expiration Date: 1. GEN ERAL.I,NFORMATION : Complete legal description HYLEN CREST S/D #3• BLOCK LOT 10 Location (site address) 10251 STEWART DRIVE EAGLE RIVER AK 99577 Current Property owner(s) MARIJNA AND ANTONIUS DOWER' Day phone 726-1429 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ®' Single Family (w/wo ADU) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank Community Class Well ❑ Community Public Water System ® Public Sewer ❑ WaiverNariance request for. Distance: Received by: = - Date; COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 61 d Waiver Fee $ Date of Payment a11"rT a Date of Payment Receipt Number Receipt Number COSA # d�JG��1 d �O D Waiver # 0 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Z 12 LE -0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE — System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for By: bedrooms bedrooms, with the foll #AECC884 JY OF \@ A463o ON-SITE 8ng stifFaTi6RSAND d WASTL.`<, ,TER oma; J SER\A -, \NN . �J1 _1W . Original Certificate Date: ;Z- Z7 -2,D 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 Nitrate Advisory , Septic System Advisory Arsenic Advl ory ` Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: HYLEN CREST #3; BLOCK 4, LOT 10 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Parcel ID: 050-474-24 Structure served by this system 1 A. WELL DATA SERVED BY AWWU WATER u VVt-1 is filed with Onsite (or attached) Well production at time of test _ m Date drilled Water storage tank volu gallons Total depth ft Well disinfect r coliform test? ❑ Yes ❑ No Cased to ft . orm bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected enic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) in. Collecte Date of flow test for CO ^ Date of Sample Static water at beginning of test ft. ZV B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑E Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 11 '8-7"9 ❑■ ALL standpipes present per record drawing Total measured depth from grade 10.1 ft (max) Measured depth to pipe invert from grade 3.7 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑* Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑E Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: Adequacy test date NEW Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test NEW in Water added NEW gal New depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate NEW gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A N/A 1 a E. SEPARATION DISTANCES SERVED BY AW WATER From ate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Stati Lot > 100' Community Sewer Manhole le out > 100' Yes if No ft Neighboring Tank > 100' ❑ Yes if ft Absorption Field on Lot > 100' ❑ Yeses if/Nom Neighboring Absorption Fields > 88" ❑ Yes if No ft Com ewer Main > 75' ❑ Yes if No ft ❑ Yes if No P ' ewer/Septic Line > 25' ❑ Yes if No 44dding Tank ?1100' ❑ Yes if No Animal Contai t > 50' ❑ Yes if No Manure/Animal Excreta Stora _ 100' F-1 e ' 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' Q✓ Yes if No. Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' P/ Yes if No ft Private Wells > 100'✓0 Yes if No Water Main > 10' ✓0 Yes if No ft Community Wells > 200'✓0 Yes if No Water Service Line > 10' 7 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) _ ft _ft _ft ft ft ft ft ft Building Foundation > 10' EJ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ✓v Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' R✓ Yes if No ft Surface Water > 100' 0 Yes ' . if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that / 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. COSA Checklist yellow sheet 00 0 � A�wp44 j J.. f :. Ga...ess,:... Q CE 791 0 f e s sio�°Qo #AECC884 X LU cS 33' ROW DEDICATED PLAT 66-80 S 00007'20" E 266.33' 10' UTILITY EASEMENT_ Mry CY) 0 0 -17 LLJ d'!j/ 1-- WU) A �;; O�9 00 Lu od - �/ CY) Lu co '5 Q) LL p i�) L / &I — C:) cr A- c q 'o- 38.2' U) 0 LO z 0 W 'z co C) q g 0 z < w cv! 00 w L) LO U) ar w IL z 2 w(L U) co �� / cy M c). 0 A, caw ct) LU T IOLCI Q 0 00 CO I LU 0 < F- LIJ L) IJI b Z 0 < F- - n z m 001Z Z 0 Cq Lli w < fli m 0 r LLI LU F- z F- C� Lu 0 < co— U) ai p�j LL co w U) — C) Li LLJ < LU 0 z 0. F--� F- (1) Z 0S G < < Lu F- D mw (n 01- F- z F- U) < (L W Uj F W W>< a- U) cn CO cn p L) w Lli Z K LLI F- UJ X EL L) 0 0 F- 0 Z LU -J F- U- < ui LU 0 � r U) 0 a) in LU > F- — >- 0 0 ui < c/) w (L U) 0 cn Ui (L 0 z❑co F- Uj LIJ < W a 0) LLJ❑ w CL 15 Ld S; 0 o 0 -wi Uj z: CO z m -j <rcmTZU :E w 0 0 0 ZO 0 0 W W -i — T- 5; y W W m U) Lli -jF-- 0 C) X -0 =w0 0 Z=~ z Z — c LL -i < w C) < LL m z LO 0ctIi W W 0 W F- w 0 z cr- � z 0, F- - w w Lli W L4 1: Z) Z) :r OZ U) CY w <z < LLJ o F -z LO z 3: ow U) o w LLJ 0 r g M w> CO (n Z W -r- 0 CO F- Z) < r: cr- LO (L w U) z m < o 2 C6 F- 0 W < m ❑ Z: w F- W F- < w Z LU W cn co Z F- w < 0_ < 20 Z F- F- _j W Z UF-) CW/) D U_ D LL 0 WS ZM0 0 MOM cn 00 LU 0 0 -j cn � F- 000cn cn W 0 w z w F- < 0 OT- ( L F- LU Z — — z 0-0 — �- rt Z Z >- 4 b 0 clf 0 (n z Z ::) 0 0 0 �5 w < Fz W W 05 0 0 0 F- IL 0 's to z w — 0 F- W z a =) z m F - LL � z 0 00 Ov wm Po S m 0 Z W 0 :) ry0 U- W a 0 co < Z 0 2 0� 0 0 rr w fn W 0 wo z LLJ w LLI mom ODW W m Z 0 Z w 0 W F- < M =m LL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# (2 ~ 0 - L¢7/¢ 1, GENERAL INFORMATION Complete legal description Location (site address or directions) : .. Property owner ' Mailing address · _ . Lending agency Mailing address .Agent Address Day phone Lc°~L~- ~ ~,~ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBEROF 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) 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. S & $ ENGINEERING Name of Firm i7~$4 ~.ule ,~=',':r L=c~ .".-~--~ N-~- ?~x Address Eagle River, Alaska 99577 Phone 6'q~/- ~ ~/ '7 '~ Date 7 DHHS SIGNATURE '~ Approved for '~"~J~-~(~)bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 6 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 t~21 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Municipality of Anchorage ,~/~~¢,~ DEPARTMENT OF HEALTH & HUMAN SERVICESMuNici~^LrrY Environmental Services Division ~NWRONMEN~AL~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 APR 10 1997 Health. Authority Approval Checklist RECEIVED ICp ~:z~,¢.. ~ ,~ ParoelI.D.: 0~ ~"~{~Af A, B, or C, attach ADEC letter. ADEO water system number Date completed Cased to C~ ground) ¢t~s properly protected (Y/N) FROM WELL LOG ~'~ AT INSPECTION Static water level ~ Well production ~ WATER S~TS: ple:Nitrate g.p.m, g.p.m. Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed c6 "~ ~' ~l Foundation cleanou'(~N) Date of Pumping "/' ?-~7 Pumper ~"7/¢-', F~wf/',/J~7 C. ABSORPTION FIELD DATA Date installed ~ ~ ~ ~ ~ Length L.~ O' Width Tanksize I~,~'-C:) Number of Compartments ~ Cleanouts(~N)__,~ ~ Depression (Y~ ~ "~) -- High water alarm (Y/N) /. A, Soil rating (g.p.d./fF or ft2/bdrm) / ~"/-- ',,/JSf-~System type ' .'~,~'~ Gravel thickness below pipe Effective absorption area .~C-(~) ~// Monitoring Tube present~',l) / Date of adequacy test ~,-2 7 -~? ResultS/Fail) 7",4-~"J) For Fluid depth in absorption field before test (in.); ~ G ~' Immediately afterT~/¢ gal. water added (in.): Fluid depth ~7 , (ins) Minutes later: ~ Absorption rate ~_f-~ = g.p.d. Peroxide treatment (past 12 months) ("~ /Jo/J,&. K-/t~,,-) If yes, give date 7 ' Total depth // ' . Depression over field (Y~) ,~ bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Acces~N) High water alarm level at* Cycles tested .~ + E, SEPARATION DISTANCES Size in gallons "Pump on" level at* '~ *Datum o ¢.--¢- "Pump off" level at* ¢ '~" SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot Public sewer main ~~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~' \o ~'~' Property line Absorption field Water main/service line On ~ad'ac~~ Public sewer manhole/cleanout Surface wateddrainage /oc~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: \~:)\¥ Water main/service line Property line \c~ Building foundation Surface water \ o ~ Driveway, parking/vehicle storage area ~-~O Curtain drain ~. ~ ~ ~ Wells on adjacent lots ~ ~ ~ + I certi~ that I have determined thru field inspections and review of Municipal recor~.~ ~s are ,nconformancewithMO~H~uide~esineffec, onthisdate. A?%' ~"~ (/'/o/~~ ,~',%,. : z, ~,~.. Date · , '.,:.:¢ .,-. ........ HAA Fee $ /' Waiver Fee $ Date of Payment Z'/.~z'~--~ /¢ '~' Date of Payment Receipt Number ~/¢~ /~7¢.-~ / Receipt Number 72f-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION (Musl be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT I0; BLOCK 4; HYLEN CREST ¢3; Location (address or directions) STEWART DRIVE (b) (c) Property owner Mailing Address THOROUGHBRED ~MES Telephone: (home) Business iO52,0 CONStiTUTION STREET, ANCHORAGE, AK. 99515 I_ending nstitution Mailing Address 349-1541 (d) Real Estate Company and Agent Telephone Address Telephone (e) Mail the HAA to the following address: (or check here [~Xif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 E=_g!e R'.,.¥,,~-Lc,,~-p R~'-d N~. 204 Eagle River, Alaska 9952~, 2. TYPE OF RESIDENCE Single-~'amily r~X Number of bedrooms 3. WATER SUPPLY Individual Well [] Community~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE D SPOSAL ' .Qn~site'''~ 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. 72-025 Rev. 7/88) Page 1 of 2 '~Jot~ s,Jeeu!eue leUO!SSejoJd eq~ u! suo!ss!uJo Jo sJoJJe Joj slq!suodssJ ~ou s! eeeJOqOUV jo ,~),!ledp!un~ sql 'penss! s! s),eo!,t BJeo e sJojeq e),ep eZ/~leUe Jo suoBoedsu! ~onpuoo),ou op SH HQ jo ses/~oIdLU3 's),UeLUsJ!nbeJ e),e),s pue leJepe,t u!e~Jeo XJsBes o), JepJo u! 6u!pust J!eq~ pue SSLUOq ,tO sJeseqo~nd o), ,~se),~noo e se s!q), seep SHHQ eq/ 'e~Sel¥ jo e~e~S eq), u! peJe~s!eeJ Jesu!Sue leuo!ssejoJd ~uepuedepu! ue ~q e^oqe ~ qdeJee~ed u! ue^!8 suoRe),ueseJdeJ sql uodn ~lUO pessq le^oJdd¥,~),poq~n¥ q),l~SH ssnss! (SHHC]) s@o!^Je9 ueuJnH pue q~leeH jo),u@LupedaQ seeJoqouv jo,~),!led!o!unR le^oJdd¥ leUOBipuoo jo suJJeL e~eC] leUOB!puoo pe^oJddes!C] ~ pe^oJddv ~ ~/ Aq smoo~ps~jcJoj pe^o,dd¥ 'IY^OBddY SHHO '9 euoqdele& 9t41~33NIgN~ S '~ S sseJpp¥ wJ{-I ,to OLUeN 'uoBosdsu! siq), jo e3~p eq~ uo 3oe;je u! suo!),elnOeJ pue 'ssoueu!pJo 'sepoo e3elS puc I~dp!un~ Ile'q),!M soue!ldUJOO u! s! Luo~sXs leSOdS!p JS~eM@3SeM JO/pUC Xlddns Jo),eM e),!s-uo eH), 'uo!loedsu! pue uoBee!lss^u! ,~LU LUOJJ pue seliJ see~oqouv jo ,~i!led!o!unlAI aq1 LUOJJ pSUIelqo UOBeUJJOJU! eq), uo peseq ),eq),,~jpeA Jeq1Jn,t I 'u!sJsq pe),eo!pu! eJn~onJ),s,to ed,~l pue suJooJpeq jo jsquJnu eqi Joj e),enbepe pue leuo!ioun,t 'ejes s! Lue~s~s leSOds!p JeleMels~M Jo/pu~ Xlddns Je),eM si!s-uo sql ),eql SMOqS le^oJddv Xlpoq),nv qlleeH s!q~ ,to UOI),eS!iSS^U!/~LU ~eqi ~JeA I 'MOleq UMOqS olep UoBepH~A eq~ ~o se pue o~eJeq pex!j~e leSS X~ ~q pe!~RJeo sv NOI&V~BOJNI aNY ViVa 'HOBY3S 3qld 'SiSal 'SNOIIO~dSNI ONIOIAOBd ~BIJ 9NIBB3NION3 '9  MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 MUNICIPALITY OF ANCH©R/\GE F_-NVI RONMENTAL ,SERVICES DIVI,S/ON Legal Diescription: Date Completed Depth of Grouting If A, B, C, D,E,C. Approved~:(--,~;~N) y Yield A. WELL DATA Well Classification R ~ C ~ I_~' D Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ~ SEPARATION DISTANCES FROM WELL: t To Septic/Holding Tank on Lot ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 14- ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA~ Date Installed ~'~ Size [~.~'-C~ Standpipes ~'N) ~' Air-tight Capsdc,~?N) Depression over Tank (Y/~ ~ Pumping/Maintenance Contact on File (Y/N.~ / Holding Tank High-Water Alarm (Y/N) No. of Compartments "~' Foundation Cleanou~).Ii ~ Y te Last Pumped ; for Temporary Holding Tank Permit (Y/N) '7 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: '"Z,.-~;'C~l'r~ To Building Foundation ~. c:~ t'-.~L- To Disposal Field "7 To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ''~ [ '~.¢.~'O 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/~bl;:;P Results of Last Adequacy Test Type of System Design Length of Field Depth of Field ~;-;-;-~avel Bed Thickness Statndpipes Present ~N) t-~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 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 To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) ~.~;~ Comments D. LIFT STATION Date Installed Size in G~llons "Pump On" Level at High Water Alarm Level Tested for Meets MOA Electrical Codes¢/N) Comments Dimensions ~-,~"~ (~ ~ it.-- Manhole/Access 4~kl) "Pump Off" Level at Vent(-(~/N) _ kc Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Date MOA No. S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle Rtver~,/~=,~,~/~,~,' Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back n effeqL,qs~t_he dat~':~¢f this Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION/ / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 20, 1989 STEVE COWPER, GOVERNOR 563-6775 Mr. ROger J. Shafer S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, AK 99577 PWSID: #213289 According to the records on file in this office, the Hylen Crest Subdivition Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Vera E. Craig Environmental F1 ficer VEC:bas