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HomeMy WebLinkAboutHYLEN CREST #3 BLK 5 LT 2412 Municipality of Anchorage .� Development Services Department �:"� •o �} ti Building Safety Division s^^=. — On-Site Water & Wastewater Program, 4700 South Bragaw St. ; : , , r P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW030223 PID Number. 050-474-48 Name: JOHN & ARLENE PALUMBO Wastewater System: ❑ New ■ Upgrade Address: 10218 STEWART DRIVE * ANCHORAGE, AK 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 696-7985 3 ■ Deep Trench ElShallow Trench CIBed OMound 00ther LEGAL DESCRIPTION Sol Rating: 0.8 Total Depth from original prods: 10 MAX VD/4 rt rL Block: Lot: Subdivision: Depth to pipe bottom from original gradc Crawl depth beneath pipe: 5 2 HYLEN CREST #3 2.97 MAX n. 7.03 R Township. Range: Section: FM added above anginal grodc Grovel length: — — — SEE DWG. R 41+ Ft WELL: ❑ New ❑ Upgrade Gravel width: 2.5 Number of Ines: 1 Dlatonoe between 6ws rT. FL Cleeolloden(private, &e.c : Total Caved To: Total obeorptkn area: PIM material: 34/ 10 'NATER FL 576 so. R Dau Drilled: Drag P�BVC static water � SOUTH FORK CONST. Dau �7�28 O 0/2003 Yeld: Pump Set At: Cft" Height Above Ground: TANK DPY Ft rt SEPARATION DISTANCES ■Septic ClHolding OS.T.E.P. E3 Other To Septic Abs tion Uft Holding /Priwb Manufacturer. ANCHORAGE TANK cap" in polo"'' 1000 From Tank Field Station Tank sewer Linea Well 200'+ 200'+ — — 25'+ Matedol: STEEL Number of compartments 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Une 5'+ 10'+ — — _ Sia In go4onr Nanwocturer Foundation 5'+ 10'+ — — — tap on level at: p o at High water clam at: Curtain Drain NONE KNOW Pump Nab k Electrical swpectlurw performed by. Remarks: OLD SEPTIC TANK WAS COMPLETELY BENCH MARK Location and D..anpuan: ABANDONED. BOTTOM OF BACK DOOR THRESHOLD CONFIRMATION TEST HOLE DUG TO 16 FEET DEEP ON SOUTHEAST END OF TRENCH. Assumed Elevation; A100-00 R ENGINEER• L oa'4� X00 AKWWC INC. Inspections performed by: Dates: 1st 7/28/2003 ?'ADD .O 0 2nd 7/29/2003 3rd 7/30/2003 aif am S.: ODD�� Development Services epartment Approval '•. —7953 epi Reviewed and approved by:Date: "3I-O p°dp�ofesslo0 a\�oA"� 0 �QQ0Q�C'p6 (Rev. 12/01) PERMITNUMBER: ASBUILT DRAWING P 050 ID NUMBER SW0 - SW030223 050-474-48 / EXISTINGSO AS FORFlFUTUREELD ABANDONED USE F NEW 1000 GALLON I SEPTIC TANK I ! r DRAINFlELD •. ; \� RCO2 r. FJSS `---APPROXIMATE LOCATION �" 15 L OF KEYBOX APPROXIMATE LOCATION / OF WATER UNE / CONFlRMATION TESTHOLE DUG TO 16 FEET DEEP (NO WATER OR ;BED�RDCK) APPR0X11AATE LOCATION OFDRIVE_TELEPHONE AND ELECTRIC LINES. DATE: 7, DRAWN BY: ALASKA WATER & V4'ASTE«'ATER C.J.G. CONSULTANTS, INC. SCALE. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337.6179 • FAX (907)338.3246 1" - 30' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN & ARLENE PALUMBO (907) 696-7985 2 OF 3 HYLEN CREST SUBDIVISION #3; LOT 2. BLOCK 5, OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE mrA1 1,1 + 1 y am s: 795 �G TC ­ J% G pro A B C ST1 38.69 19.78 — ST2 43.10 18.79 — DBL1 44.88 18.60 — DBL2 46.06 17.95 — CO1 — 37.32 50.49 MT1 — 37.28 46.61 CO2 I — 152.35 25.70 MT2 I — 148.97 25.83 I ! r DRAINFlELD •. ; \� RCO2 r. FJSS `---APPROXIMATE LOCATION �" 15 L OF KEYBOX APPROXIMATE LOCATION / OF WATER UNE / CONFlRMATION TESTHOLE DUG TO 16 FEET DEEP (NO WATER OR ;BED�RDCK) APPR0X11AATE LOCATION OFDRIVE_TELEPHONE AND ELECTRIC LINES. DATE: 7, DRAWN BY: ALASKA WATER & V4'ASTE«'ATER C.J.G. CONSULTANTS, INC. SCALE. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337.6179 • FAX (907)338.3246 1" - 30' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN & ARLENE PALUMBO (907) 696-7985 2 OF 3 HYLEN CREST SUBDIVISION #3; LOT 2. BLOCK 5, OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE mrA1 1,1 + 1 y am s: 795 �G TC ­ J% G pro DBLI • i • �< B H� fOo'N .'�• I ! r DRAINFlELD •. ; \� RCO2 r. FJSS `---APPROXIMATE LOCATION �" 15 L OF KEYBOX APPROXIMATE LOCATION / OF WATER UNE / CONFlRMATION TESTHOLE DUG TO 16 FEET DEEP (NO WATER OR ;BED�RDCK) APPR0X11AATE LOCATION OFDRIVE_TELEPHONE AND ELECTRIC LINES. DATE: 7, DRAWN BY: ALASKA WATER & V4'ASTE«'ATER C.J.G. CONSULTANTS, INC. SCALE. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337.6179 • FAX (907)338.3246 1" - 30' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN & ARLENE PALUMBO (907) 696-7985 2 OF 3 HYLEN CREST SUBDIVISION #3; LOT 2. BLOCK 5, OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE mrA1 1,1 + 1 y am s: 795 �G TC ­ J% G pro SPERBUILT DRAWING Urr NUMBER: PARCEL ID NUMBER: SWO30223 AS - 050-474-48 1 TH#1 TOP OF TANK A INLET - 94.65 INVERT OF BUNG/ AT INLET - 94.12 FINAL GRADE - 98.73-98.84 f NEW 1000 GALLON SEPTIC TANK ORIGINAL GRADE - 77.83 0 HIGHEST POINT FINAL GRADE q Wt - 79.0+--% r TOP OF TANK AT OUTLET - 94.63 \—INVERT OF BUNG AT OUTLET m 93.82 FABRIC INVERT OF PIPE - 74.56 (AVG.) BOTTOM OF TRENCH - 57.83 (AVG.) U­QO— RELATIVE ELEVATION OF BOTTOM OF TEST HOLE 61.33 (TEST HOLE DRY) DATE: 7/30/2003 OO A� DRAWN BY. C.J.G. I, ALASKAWATER & WASTE WATER SN CONSULTANTS, INC. 6901 DFRARR ROAD, SUITE 2113 - ANCHORAGE. AK 99504 - PHONE (907)331-6179 - FAX (907)338-3246 N.T.S. ............ .... 1p, *f PREPARED FOR: PHONE NUMBER: PACE NUMBER: JOHN & ARLENE PALUMBO (907) 696-7985 3 OF 3Q pA f y A. o**r'n*e* s'*s* E-7953 4--g-% e!�;' LEGAL DESCRIPTION: HYLEN CREST SUBDIVISION #3; LOT 2, BLOCK 51 �DOpo IF as 510'D TYPE OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: MEN CREST i3 SUBDMSION; LOT 2. BLOCK 5 PERFORMED FOR: JOHN do ARLENE PALUMBO DATE: 7/30/2003 (DEPTH ZZZ= ITEST HOLE #2 1 - -- ORGANICS/FILL 7 8 9 10 11 12 13 14 15 16 17 18 GM/SM W/ SOME COBBLES AND BOULDERS DEPTH TO DATE GROUNDWATER DRY 7/30/2003 LOT 3. BLOCK 5. +4V-1 SITE PLAI 10=100' • SOIL CLASSIFICATIONS WOO •• IIIIIIIIIML � II�III!11 CL i'//_9.Gc H/NN • r SW_ IllilllllMH N %//%CH • r .�!Sc 7 8 9 10 11 12 13 14 15 16 17 18 GM/SM W/ SOME COBBLES AND BOULDERS DEPTH TO DATE GROUNDWATER DRY 7/30/2003 LOT 3. BLOCK 5. +4V-1 SITE PLAI 10=100' • 19 PERCOLATION RATE - (MIN./INCH) PERC. HOLE DIA. TEST RUN BETWEEN - FT. AND - FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: CALE13 GALL PERCOLATION TEST PERFORMED BY: COMMENTS: - (INCHES) PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WP FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: c iml— WOO 19 PERCOLATION RATE - (MIN./INCH) PERC. HOLE DIA. TEST RUN BETWEEN - FT. AND - FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: CALE13 GALL PERCOLATION TEST PERFORMED BY: COMMENTS: - (INCHES) PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WP FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: c iml— y MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030223 Legal Description:fHYLEN CREST #3 BLK'75 LT:.:2; Design Engineer: 0041 AK Water & Wastewater Consultan! Owner Name: John & Arlene Palumbo Owner Address: 10218 STEWART DRIVE EAGLE RIVER. AK 99577-9514 w6 S 33� -(o17R Date Issued: Jun 26, 2003 Expiration Date: Jun 25, 2004 Parcel ID: 050474-48 Site Address: 010218 STEWART DR Lot Size: 25856 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: 2; Date: 0.26 C)3 w Date: - - 3 Municipality of Anchorage Development Services Department Building Safety Division " !Y/Y1Y On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-474-48 Permit Number Property owner(s) JOHN & ARLENE PALUMBO Day phone 696-7985 Mailing address (1) 10218 STEWART DRIVE * EAGLE RIVER, AK Mailing address (2) Zip Code 99577 Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 5: HYLEN CREST SUBDIVISION 43 Legal description (Section, Township & Range) N/A Lot Size ?_.'',2 SAcres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS INC. Permit Fees:agD�•^" Date of Payment:�^ Receipt Number: 3 !� Waiver Fees: Date of Payment: Receipt Number: ALASKA WATER & WASTEWATER CONSULTANTS, INC. June 20, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 2, Block 5; Hylen Crest Subdivision #3 To whom it may concern: The existing 3 bedroom house is served by a community water system and a private septic system that consists of a 1000 gallon septic tank and a deep trench type drainfield. The drainfield is in a state of failure and needs to be upgraded. A test hole was excavated on the property in the area of the proposed upgrade. The septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.8 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 8.6 minutes/inch b. Proposed Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 ft2 f. Total Depth: 10 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Minimum Length: 41 feet total length j. Effective absorption area = 574 fl? 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246 " Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached design drawing, the drainfield is to be installed on the toe of a 25+ percent slope. The area below the drainfield is a 10-15 percent slope running approximately northeast to southwest In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you h e any questions, please contact us at 337-6179. Thank you for your assistance. A P.F), M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, Avo soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 0 - - _ STEWART DRIVE______ D (ISTING SEPTIC SYSTEM r � I 100.STEWART 1 TRACTS2D. PROPOSED SEPTIC UPGRADE (SEE DESIGN PAGE 2 OF 2) HYLEN CREST S/D 13; LOT 1. BLOCK 3, / / / HYLEN CREST S/D 13; LOT 3, BLOCK S. 3 BEDROOM HOUSE HYLEN CREST S/D 13; LOT 4A, BLOCK S, —4---------------------- ___ STEWART DRIVE i moi-—,_--_---------------- HYLEN CREST S/D 13; LOT 1. BLOCK 4, HYLEN CREST S/D I LOT 2. BLOCK 4, MEN CREST S/D 13;I HYLEN CREST S/D 13; LOT 3, BLOCK 4, LOT 4, BLOCK 4, r ° 6/20/2003 s . DRAWN BY: ALASKA WATER & WA STLWAI LC.J.G.R C.J.G "'�� ��---- CONSULTANT9,,,INC. %� 4 SCALE: 3701 E TUDOR ROAD, SUITE 101 • ANCHORAGF. AK 99507 • PHONF (907)337-0179 • FAX (907WIA.)m 1" = 100' .......... ......... to PREPARED FOR PHONE NUMBER: JOHN PAGE NUMBER: & ARLENE PALUMBO 696-7985 OF 2 ' SGL,eff y ss. LEGAL DESCRIPTION: HYLEN CREST SUBDIVISION #3; LOT 2, BLOCK 5, y41 �/ •. 1 Vqtv 7953 e 4,> ♦ vki�1, vQ p ofeaslono�•.cQ ' TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE EXISTING DRAINFIELD TO BE USED AS A RESERVE SITE INSTALL FLOW SPUTTER NSTALL DOUBLE APPROXIMATE LOCATION CLEANOUTS OF KEYBOX EXISTING TANK IS TO BE REPLACED WITH A 1000 GALLON SEPTICNEW TANK APPROXIMATE LOCATION OF WATER UNE / 16 r . ♦ •. b J � /CLANG \ .�, • � � '; :. Try. A �- A 15 Tor, E j SMETi1 PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 10 FEET DEEP MAXIMUM BY 2.5 FEET / APPROXIMATE LOCATION OF WIDE BY 41 FEET LONG. ADD 7 FEET OF TELEPHONE AND ELECTRIC LINES pp CLEAN, WASHED SEWER DRAINROCK. INSTALL TRENCH PARALLEL TO SLOPE CONTOURS. 6/20/2003 oao O i -��DRAWN v s'T'O01 C : 1 � 1 � 1 , ALASKA `VAT.LR & NNASTr«ATLR .J.G. p �SCAB " = 30� CONSULTANTS, INC. """" """' 3701 E. TUDOR FOOD. SUITE 101 • ANCHORAGE. Art 99507 • PHONE (907)337.6179 • FAX (907)338-3266 ... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN & ARLENE PALUMBO (907) 696-7985 2 OF 2 firy ar O�0 •, E 7953 LEGAL DESCRIPTION: HYLEN CREST SUBDIVISION #3; LOT 2, BLOCK 5, Q A� dProf • • • • • • • c� � o TY PE OF WORK: SEPTIC SYSTEM UPGRADE DESIGN OF ALASKA WATER & 'WASTEWATER 0 CONSULTANTS. INC. . ... .� SOIL LOG - PERCOLATION TEST •„ ...... .............. LEGAL DESCRIPTION: HYLEN CREST #3 SUBDIVISION; LOT 2, BLOCK 5 of a A. rness.: QO PERFORMED FOR: JOHN & ARLENE PALUMBO DATE: 6/16/2003 YO�� '7953 `�op DEPT_ �4�Dedf'�ofessio�°& (feet __—_ ORGANICS/FILL HOLE 1 ��000000a 1 _ SPOIL CLASSIFICATIONS 2 \q ;> •iLOT 3. BLOCK 5. GW ORG 3 GPllwlu ML Wiwi GM CL 4 GC OL SW MH 5L'•'• SP CH SM OH SC 7 DEPTH TO GROUNDWATER DATE 8 DRY 6/16/2003GMSm SOME COBBLES 6/23/2003 9 AND BOULDERS SITE PLAN 1"=100' — 10 11 12 13 14 15 16 17 18 19 PERCOLATION RATE 8.6 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: CALEB GALL COMMENTS: PERFORMED BY AKWWC. INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W P FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:54 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 6/17/2003 1 2:19 - 6" - 2 2:49 30 2 1 2" 3 1/2" 3 2:49 — 6" — 4 3:19 30 2 1 2" 3 1 2" 5 3:19 — 6" — 6 3:49 30 2 1 2" 3 1 2" DEI TM 825 "L" Street, ON-SITE SEWAGE DISPOISAL -- UNICIPALITY OF ANCHORAGE NT OF HEALTH AND HUMAN SERV S Environmental Health Division nchorage, Alaska 99502, Telephone 264-4720 SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC TANK ABSORPTION FIELD WELL Address Phone(s) Permit No- No, (d-1b sOc01S I Bedrooms 3 WELL -A- Z„a«' 4- ___ LOT LINE — LEGAL DESCRIPTION Lot Block Subdi inion t,� FOUNDATION Township. Bange, sention- AS-BUILT DIAGRAM (Show location of wen, septic system. properly lines, loundalion, driveway, water bodies, etc-) - — TANKS — SEPTIC ❑ HOLDI 4G Manulactuiel Capacity in gallons Materials No. of Comparimenls TYPE OF SYSTEM TRENCH ❑ RED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade A, O FT Total depth trot, original grade ': L.,O FT t � 6{ - RII added above original grade ©.O FT Gravel length----------- 2–q.C'FT Gravel depth beneath pip 0-CFT 0fn` —r Gravel width ,OFT Total absorption area Distance between lines 03 } entifvl — - Number of Imes -- Sod rainy 1 St) SQ F Pipe matcnai f 1Slh T7 - — Installer fi Dale Installed WELLS ❑ PRIVATE ❑ OTHER (I Classihralion (A, 6.C) ----- Tolal Depth ased to FT certify that this �« Installer Dale Installed REMARKS: Scale: n r��j, Inspections Performed by. ENGINEER'S SEAL T p4{ Stil�)� �t Ft [Y�,A• - r -�2P r F" f Fri fir ; T � .•fir � T4 .l ° «I � f r - Dale: I inspection was performed according to all s� � tw " ro �7L >((-jj t D��[,, �7f Municipal and Slate gu �elif es to ell Rp _his dale: Health Department Approval: _.���. (--e.� Date: - el l..'9 e -u 10 (srnb) PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 0-11 _j 140 X Cs 3: R" w! A H... X -1 - I," U K 611111 TO 1A 1:1 RAT 02113 VE DEPARTMENT OF HEALTH AND ENVIRONMENTAL'PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264~4720 AUW~00 :E ONE TAUtop U 850675 10/15/85 CHUCK BARR S&S ENG. SRB 1960 EAGLE RIVER, AK 99577 694 2979 LEGALDESCRIP: SUBDIVISION: HYLEN CREST SECTION: 13 TOWNSHIP: 141\1 LOT SIZE20014 (SQ. FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to system" Choose the option that best Fits WVic XEIII (itW 0 DEPTH TO PIPE BOTTOM (FT.) 4"0 GRAVEL DEPTH (FT.) 8"0 TOTAL DEPTH (FT.> 12"0 GRAVEL WIDTH (FT^) 2.5 GRAVEL LENGTH (FT29^0 GRAVEL VOLUNE (CU.YDS") 22.9 TANK SIZE (GALS) 1,000"0 x* SOIL RATING (SOFT./BR) 150 ^ LOT: 2 RANGE� 1W you in designing your, site" ^ top 13 FAT 14 l: NI 4.0 3.5 7.5 5"0 4900 36.3 1,000.0 ** 150 ** TANK MUST HAVE Al LEAST TWO COMPARTMENTS your septic I certify that: 1" I am {amiliaI Ie requirements r on~sand �ells as set forth by th�,. Municipality of Anchorage (MOA) and the State of' Alaska. 2, I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o[ this permit" 3, I will adhere to all MOA and State of A1aska requirements for the set back disstances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby I.C.A. 4. I �nderstand that this permit is valid For a maximum of 3 bedrooNs and any will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECT I RMIT AND INSPECTION MUST OBTAINED; (2) AS-8UILTS WILL NOT BE AP WI OUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORQMUST BE/DONE BY A,LICENSED ELECTRICIAN" SIGNED APPLICANT:/[��C 1/BARR ISSUED BY �� ` ��r-... ��-..__._.~..__�.��^,�.���*�' ' DATE: �,..~~77~~~~�~�� DATE u Municipality of Anchorage 'u DEPARTMENT OF HEALTH & HUMAN SERVICES �ttv '7 .) 825 "L" Street, Anchorage, Alaska 99502-0650 ren. te57 4 ` SOILS LOG — PERCOLATION TESTry'u'. PERFORMED FOR:2- FQ. DATE PERFORMED: l0 /L LEGAL DESCRIPTION:/— Z I✓ S / /�N "r�iy Township, Range, Section,:Sp c(. A-/ j` Vt A) SLOPE SITE PLAN FR:41 1 S f%i'J 2 V �D 3 � 4-r _ v `r 5 a 6- 7 - 8 - G 9 U� 10- �G 11 ` U 12 13 G 14 u t1 0 15 i 16 _ 17 18- 19- 20— COMMENTS 81920COMMENTS PERFORMEO,BY,')J- ACCORDANCE WITH 72-008 (Rev. 4/85) 46U61" 7,511- T ��S-D ��e WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L 0 DEPTH? P E Depth to Water After Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE G-tte�s/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AfJC� - FT 7 CERTIFY THAT THIS TES WAS PERFORMED IN CIPAL GUIDE/- N EFFECT ON THIS DATE. DATE: �� / :-�p� N 0 Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE G-tte�s/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AfJC� - FT 7 CERTIFY THAT THIS TES WAS PERFORMED IN CIPAL GUIDE/- N EFFECT ON THIS DATE. DATE: �� / :-�p� Municipality of Anchorage ' Development Services Department Building Safety Division ,. �.. Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ou CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI,D. 050-474-48 HAA# 03021 1. GENERAL INFORMATION Expiration Date: %^.3J — 0 4L Complete legal description HYLEN CREST SUBDIVISION #3: LOT 2, BLOCK 5, Community Class Well ❑ Public Water System Location (site address or directions) 10218 STEWART DRIVE * EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN do ARLENE PALUMBO Day phone 696-7985 10218 STEWART DRIVE * EAGLE RIVER, AK 99577 Day phone LES BAILEY w/ PRUDENTIAL VISTA Day phone 16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 689-6451 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 samples. (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. Note: Alaska Water and Wastewater Consultants, inc. shall be paid $ at, or prior to closing for the engineering services provided. 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SURE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation. AKWWC, inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE 337-6179 Date d t7 Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: �<<<t( 1S Y IOF era�!ii� 0 ON-SITE WATERAnrn , m :• WASTEWATER PRnea� �, Attachments: Jai `�0 • •0S`,` HAA Checklist _�� Manitenance Agreements �ViJ 9ht�' 0 '%N1 Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: Original Certificate Date: (Re l=i) Municipality of Anchorage Development Services Department Building Safety Division On.Slte Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.a.anchorage.akus (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HYLEN CREST S/D 1113 LOT 2. BLOCK 5. Parcel ID: 050-474-48 A. WELL DATA Well type Date completed PUBLIC WATER If A. B, or C provide PWSID€A Sanitary seal Cased to ft. , . FROM WELL LOG Date of test Static water level ft. Well production 90.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate r mg L. Date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Tank sits1000, gal. Number of Compartments ..,,,? Well Log (YM) properly protected (YM) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Collected by: Date installed 7/28-3012003 Cleanouts (Y/N) YES Foundation cleanout (YM) —YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping NEW Pumper – C. ABSORPTION FIELD DATA Date installed 7/28-30/2003 Soil ratingp.d. r ftlbdrn) 0_8 System type DEEP TRENCH ml. Length 4.,. 41+ �it. Width 2.5 ft. Gravel below pipe 7.03 ft. Total depth 011-2+/7 ft. Eff. absorption area 576 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) – For 3 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth – in. Elapsed Tlme:. F min. Final fluid depth – in. Absorption rate >= – g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) – if yes, give date D. LIFT STATION Date installed "Pump on' level at in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main line PUBLIC WATER On adjacent lots On Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+/200'+ Pvr• A+6. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkinglvehicle storage 10'+ Curtain drain NONE KNOWNWells on adjacent lots 100'+ 200'+ pr-_ Fv6 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed ame JEFFREY A. GARNESS Date HAA Fee $ Date of Payment 3 3 Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ..... ........ ...... .. P e Go ss; ° e � —79� Q�°.._ ` .... X04 Date of Payment Receipt Number 0 1 1 1 _ .EAST /B9JZa -4- _. ,.. f 1 i z e ¢Z I51 I •.'�� J, r DJ �I SEPT/G 'BENTS411 • • , • • �' rde. !cnt 15 �p5p0� 3 �r0 Q I— 5CALE I of= 30, AS -BUILT NO CORNERS SET THIS DATE I hereby certify that t have performed a Mortgagee's inspection -.6 4, =" Lv of the following described property: 1-0 TL0 7- z .GV•. l- Ja 1't 8 L o c K 51 HYI—EIt/ CREST S u bjP- j �v•�u,'� •cy�..tq UAJ IT- NP. 3 Anchorage Recording Precinct, Alaska, and that the ' improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent ; Ftid Wm4 a ;? thereto. that no improvements on property lying adjacent thereto Ts�',rl • I NO. 32d .7t �l',� v� encroach on the premises in question and that there are no P''�'••e�..p1�e�.4 '. roadways, transmission lines or other visible easements on said !� 4V&S"W property except as indicated hereon. ►}.���� �,:a3`~ i Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 30 dA ' day of T141 -y' 20 03 BE THOSE TS O ON THE RECORDED I FRED WAIATKA & ASSOCIATES PLAT ARE NOT SHOWN HER 248 1666 Engineers Surveyors ears an u t' n �r0 Q I— 5CALE I of= 30, AS -BUILT NO CORNERS SET THIS DATE I hereby certify that t have performed a Mortgagee's inspection -.6 4, =" Lv of the following described property: 1-0 TL0 7- z .GV•. l- Ja 1't 8 L o c K 51 HYI—EIt/ CREST S u bjP- j �v•�u,'� •cy�..tq UAJ IT- NP. 3 Anchorage Recording Precinct, Alaska, and that the ' improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent ; Ftid Wm4 a ;? thereto. that no improvements on property lying adjacent thereto Ts�',rl • I NO. 32d .7t �l',� v� encroach on the premises in question and that there are no P''�'••e�..p1�e�.4 '. roadways, transmission lines or other visible easements on said !� 4V&S"W property except as indicated hereon. ►}.���� �,:a3`~ i Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 30 dA ' day of T141 -y' 20 03 BE THOSE TS O ON THE RECORDED I FRED WAIATKA & ASSOCIATES PLAT ARE NOT SHOWN HER 248 1666 Engineers Surveyors ears an u J�,�1/ MUNICIPALITY OF ANCHORAGE • l DEPARTMENT OF HEALTH & HUMAN SERVICES, M} 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. # 05D— L � t-(— Lf e) HAA # �J�( & 9 4' 0 1. GENERAL INFORMATION Complete legal description L(2 4"-/ LE N Lam_ si- tfNIT 43 Location (site address or directions) E a --A aT R Property owner Mailing address Lending agency 10'x_/ s'i e CrLv 1 r�✓ Day phone (12 9 V ^ ;Uo O Z Day phone Mailing address Agentyi ��,'�a �� �i �LoP Day phone (v Yy - yzv Address r x Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 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. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site V/ 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 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 furtherverify 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 I °�he�l �� u," � Phone Address (203 �� 1-51-L "'5203 Engineer's signature 6. DHHS SIGNATURE x Approved for Disapproved. By: 3 bedrooms. Conditional approval for Additional Comments Date bra r a � J bedrooms, with the following stipulations: Date 8 - 30 - y� 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 MOAN21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo V > Parcel LD. O L-1 7' A. Well Data Well type If A B r C tt ch ADEC I tt r ADEC t t b Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell o a a e e . wa er sys em num er Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG 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 sample: 13. SEPTIC/HOLDING TANK DATA AT INSPECTION ; On adjacent lots _ On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed 111-7/00 �s Tank size / 0 -co D Compartments �- Cleanouts (Y/N) __Foundation cleanout (Y/N) � Depression (Y/N) High water alarm (Y/N) �'� Alarm tested (Y/N) Date of pumping_ o / / / 9 y Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot_On adjacent lots � Foundation To property line ,Absorption field Water main/service line Surface water/drainage ' 't tl V -P— U iD 72-026(3/93)•Front CONTINUED ON BACK PAGE Y� oZ n Z r g•p• �o �z c� VJJ o o0 N n 9 m Other bacteria Date installed 111-7/00 �s Tank size / 0 -co D Compartments �- Cleanouts (Y/N) __Foundation cleanout (Y/N) � Depression (Y/N) High water alarm (Y/N) �'� Alarm tested (Y/N) Date of pumping_ o / / / 9 y Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot_On adjacent lots � Foundation To property line ,Absorption field Water main/service line Surface water/drainage ' 't tl V -P— U iD 72-026(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION 7/ Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed I I /' I I t3., Soil rating (GPD/Ft2) Length C - Width Imo Gravel thickness Total absorption area Cleanout present (Y/N) Date of adequacy test �(// o l `i `( Results (pass/fail) Water level in absorption field before test 5 R Peroxide treatment (past 12 months) (Y/N) IN Surface water System type I P. 1�- N O J - Total depth 10.!S _Depression over field (Y/N) N for �s Bedrooms After test 7 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I '/ /A On adjacent lots h//A_ Property line l To building foundation AL) To existing or abandoned system on lot 1//--k On adjacent lots �i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date / A 7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, sec/t�ion, townsh�ip7, range) Location (address or directions) (b) Applicant Name--4`4d1jTelephone: Home 121__ 6 Business�xy Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ; 6uyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f)the HAA to the following address: S & S ENGINEERING _117o34TagtuRhvrL**p Road No. 204 Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community ❑ Public)4 Telephone 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. Page 1 of 2 72-025 (11,84) (b9110 9Z0-ZL Z to Z abed -�aom saaauibuo leuo!ssaloid a43 u! suo!ssiwo ao saoaaa Aol alq!suodsaa lou s, a6eaogouy to Al!led!o!unlnl a41 -panss! sl aleo!lpao e aaolaq elop azAleue ao suoiloodsu! ionpuoo lou OP d3H0 to sa@Aoldw3 -sluawaa!nbei @leis pue leaapal u!elAeo Als!les of aapio ui suo!inl!isui bu!pua, a!a4l pue sawo4 to saasegoand of Asalinoo e se s!4l saop d3H0 441 'eMsuIV to @ISIS a43 ul paaals!6aa aaau!6ue !euo!ssaloid ivapuadepu! ue Aq anoge 9 ydea6eaed u1 uaA16 suo!Ieluasaidaa a4l uodn Alalos paseq soleo!l!uao lenoiddV l!jo43nV 431eaH sanss! (d3H0) uo!Ioaload leiu8wu0a1Au3 pue 4IIe91-1 to ivawlieda(] a6eao4ouy to /l!led!ounn a41 NOunvo !enoaddy leuog!puo(] to swaal leuo!l!puo(] panoiddes!(] panojddV @ISO Aq swooapaq 7" J JO) panoaddy ;- p (' IVAOUddV d3H(3 '9 ���.�DCIDAA \G�CP�R NnRA Vy$ 01 p.N.• :�cuny'f ... f ale(] LL966 G)1111V'aln111 911513 ssaaPPV Z _ auo4dalal wJ!d to aweN 9NIb33NIJfolagsu! 1!43 3o alep a43 uo loalle ui suo!leln6ei pue'saoueu!plo'sapoo alelS pue led!o!unW Ile 4I!m aoue!ldwoo ui si wals(s lesods!p AalemolseM Ao/pue (lddns AaleM al!s-uo a43 'uo!loadsul pue u01le611sanu! Aw woal pue sal!i abeaogouV to Al!led!o!unw a4I woal pau!elgo uo!lewiolu! a4l uo paseq le43 Al!a@A aaqunl I ,u!aaa4 poleo!put ainlonals load (i pue swooapaq to aagwnu a4l aol alenbape pue leuo!lounl'ales si walsAs lesods!p aaleMaiserA ao/pue (lddns aaieM ails-uo aM le4l sMo4s !enoaddy tl!ao4lnV 411e@H sNI to u0!le61is9nu1 AW JUL]] Al!aaA I 'Molaq umogs alep uo!iep!leA @14110 se pue olanq pax!lle leas Lbw Aq pa!i!Iiao sy NO11"HOJNf (INV VIVO `HOdV3S 3-11d `S1S31 `SNOUOUSNl ONMIAO Lid WHId JNI833NI!DNg '9 MUNICIPALITY OF ANCHORAGE (MOw) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 2 19$ Legal Description: LCiT L_ Al- J� A. WELL DATA RECEIVED Well Classification — If A, B, C, D.E.C. Approved N) G S Well Log Present (Y/N) _ Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground _ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot Zaa < ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot — Water Sample Collected by _ Date Water Sample Test Result Comments B. SEPTIC/HOLDING TANK DATA Date Installed -5s` Size / oc7r] No. of Compartments — Standpipes &N) _ _ Air -tight Caps &N) _ Foundation Cleanout ON) Depression over Tank (Y/) Date Last Pumped — —Z 9- Pumping/Maintenance Contract on File (Y/N) N1 _ ; for YM Holding Tank High -Water Alarm (Y/N) W -Temporary Holding Tank Permit (Y/N) - N/i4 Separation Distances from Septic/Holding Tank: �i To Water -Supply Well _ Z Dy -,<- To Building Foundation To Property /O P Y Line 4 To Disposal Field To Water Main/Service Line /o 4- To Stream, Pond, Lake, or Major Drainage Course NSA Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Ib �4L15e__ Type of System Design Date Installed �` �� Length of Field Width of Field 3� Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y& Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot rJ Standpipes Present 6�N) Date of Last Adequacy Test ISL a 1v S y<?Z - Lass T�a1g>✓ ves Ou? i 74 To Property Line_ 15 -Z' To Water Main/Service Line /o /-/ To Existing or Abandoned System on On Adjoining Lots 3(>l4 To/Cutbank (if present) t�/o4 To Stream/Pond/Lake/or Major Drainage Course Iv To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOAand HAA guidelines in effect on the date of this inspection. Signgdk S-EN6{P6EERINa Date Road No,. 204 �(� �p �2 �®"' Com{�A�4 Eagle Rives Loop MO No. a ..>° *fig Y. R <<.te River, A as u ,Cq *64 QFI p Receipt No. Date of Payment Amount: $ - U U Page 2 of 2 72-026 (11/84) T Mr Lys%.,,I.,.f ,4.. rN,�!'�.F���`'�a. y.P•%� 4)9 I [I P� [, BILL SHEFHH.D, GOVERNOR (, I (DEPT. OF ENVIRONMENTAL CONSERVA'T'ION 7elephono: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE:, PWSI.D.# 12? To Whom it May Concern: According to records on file in this &4! -"Water System is Water Regulations office the '00" &12 in compliance with the State Drinking Sincerely,