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Home My WebLink AboutHYLEN CREST #3 BLK 5 LT 1A [ Municipality of Anchorage Page 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: /---~dqlD:?.-44 RID Number:_ ~'~"~. _ Name: Address: r -- - ~ - · ~ ~/~l~. ~. ~q'~ ABSORPTION FIELD Phone: ] No. of B~oms: ~ Deep Trench ~ShallowTre~ch ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION sog,.,~.,: ~GPD/S~.Ft. T°talDepthfr°m°riginalgrade:l Depth to pipe botlomfrom original~grade:l Gravel depth beneath Township: Range: ~ Section:~ ' ' ~ill added above~i~inal~/gra~e: Ft. Gravel length: ~1 Ft. WELL: New D Upgrade Oraveld¢:~[~ Number~lines: Ioista.cebetween~ines: Ft. . Classification~ivate, A,B,C): Total Depth: Ft. Cased To: Ft. Total absorption area:~SQ. Ft. ~ipe.'p ' : Driller: Date Drilled: Static Water Level: Installer: Date installed: ~ield: Pump Se~at: ] Casing Height ~bove Ground: TA N K GPM Ft.J Ft. SEPARATION DIS'rANCES ~s~ptic ~ Holding D S.T.E.P. From Tank Field Station Tank Sewer Lines ~ ~ ~ ~ N,m~r of Comp~,tm,nts: Surface w.t~ 10O¥ }~'~ ~ ~ ~ LIFT STATIO'N~ Lot ~ ~- Size in gallons: TManufact~er: Foundation [0'~ ~0,+ "Pump on" leye~~~p off" level at: THigh water alarm at: ~,Drain ~ ~ P P Y' Remarks: BENCH MARK Assumed Elevation: Department of Healt~d~H~ S~ices approval ~,.~'~"'.,-~, .. Reviewed and approved by: _ Date: ~~ 72-013 (1/91) MOA 25 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 72-013 A (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:SW910241 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:EAGLE RIVER VALLEY DEVELOPMENT OWNER ADDRESS:3300 ARCTIC BLVD. SUITE 202 ANCHORAGE AK 99503 DATE ISSUED: 8/16/91 EXPIRATION DATE: 8/16/92 PARCEL ID:05047449 LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK iA 5 LT LOT SIZE: 40763 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALI, 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST TWO HOURS PRIOR TO EACH INSPECTION. ~~~ RECEIVED BY: ISSUED BY: .jO¢ DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 5, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot iA; Block 5; Hylen Crest Subdivision We request you issue a permit to install a septic system to serve the referenced property. This is a large mountainside lot with a relatively shallow groundwater level. We've proposed the installation of 5' wide drainfields to be terraced down the hillside. The subdivision is served by a Class 'A' water system so no protective radii encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions or require additional information for your review, please contact us. Sincerely, RJS/ztc 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERF( LEGAL DESCRIPTION: L--~=,~" ~ ~, ~-.'~--~. ~ Township, Range, Section: SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17, 18- 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~j~ OL DEPTH? p E I Depth to Water Alter Reading Date Gross Net Depth to Net Time Time Water Drop '~ '~r '.4~ '~ $ & 5 ENGINEERING ~ ,,~/ /,~ PERFORMED BY: ~7034-Ea~e~i~veFJ.~~ ~_...~ _( ~/~.-~[,~' I/' CERTIFY 72-008 (Rev. 4/85) TRAT THIS TEST WAS PERFORMED IN 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 Lot I A; Block 5; Hyl~n Cr~st Subdivision Location (site address or directions) Stewart Drive Property owner Mailing address Lending agency Mailing address Agent Ad dress P~pp~rs Construction Day phone 694-9681 P.0.Bo'x 171064 Ea~l~ Riv~r~ Alaska 99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 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: XX 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 1~21 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 Address Engineer's signature 17034 Eagle River Loop Road No, 204 E~;!c m: .... A,--, Phone Date DHHS SIGNATURE X Approved for bedrooms. __ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ..~-'~-~ ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions 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: A. WELL DATA /~ Well type Municipality of Anchorage ~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. ADEC water system number_ ~'k/~' D, ,~' Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ IlL' Absorption field on lot ~ ~ J¢ Wires properly protected (Y/N) AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: I~1. SEPTIC/HOLDING TANK DATA Date installed ~ ~._~2'~C::~ -~:~ / Tank size Cleanouts~N) High water alarm (Y/N) Date of pumping Compartments Foundation cleanou~;.i~'N) _ y Depression /,~./~-" Alarmtested(Y/N)__ _ Pumper SEPARATION DIST~AI~CES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J~J//~ On adjacent lots ~ I'Jr' Foundation To property line lr~ [A~ Absorption field ~ !4- Water main/service line Surface water/drainage / ¢;;~t ~U 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) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ ~¢'~ Length ~¢:~ ~¢' Width Total absorption area '~:::~ Depression over field (Y/~ Results (pass/fail) Peroxide treatment (past 12 months) (Y~ Soil rating Gravel thickness '~', ~ Cleanouts present) Date of adequacy test for ~' If yes, give date ~ic¢'/'~'Z~system type ~ Total depth bedrooms SEPARATION DIS~TA/NCE FROM ABSORPTION FIELD TO: Well on lot JxJ //~ On adjacent lots ~ Iff.. To building foundation On adjacent lots Surface water Curtain drain "~¢~'~ ~ Cutbank Property line / ~ / ./_ To e/xisting or abandoned system on lot /'~//~ /~ /~ Water main/service line lc~ 5¢ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Signature · Engineer's Name Date I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & ,~ ENGINEERING i?0~4 ~t~ile River Loop Road No. ~(~;4 HAA Fee $ I~'/ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21